Inspection on 04/02/10 for Cranwell Court

This inspection was carried out on 4th February 2010.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for older people Name: Address: Cranwell Court Cranwell Court Cambridge Road Grimsby North East Lincolnshire DN345EP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Theresa Bryson     Date: 0 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Cranwell Court Cranwell Court Cambridge Road Grimsby North East Lincolnshire DN345EP Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Longhurst and Havlok Homes Ltd Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is: 55 The registered person may provide the following category of service only: Care Home only-Code PC, to service users of the following gender; Either, whose primary care needs on admission to the home are within the following categories: Dementia DE; Old Age, not falling within any other category- Code OP Date of last inspection Brief description of the care home Cranwell Court is a purpose built care home providing care for those with symptoms of old age and dementia. Each person has their own bedroom space which comprises of a bedroom section, sitting area, ensuite shower,toilet and washbasin and a fully equipped small kitchen. Electrical appliances in this area can be disabled for those with memory loss. Care Homes for Older People Page 4 of 33 Over 65 55 55 0 0 Brief description of the care home There are ample communal areas and extra toilets and bathrooms. In the grounds are a couple of enclosed garden areas and ample car parking facilities. This home is on a direct bus route to other areas of the main town of Grimsby, with the seaside area of Cleethorpes near by. It is set in a residential area of the town, with in walking distance of local shops and a larger supermarket. The Statement of Purpose and Service Users Guide informs people of the services the home can offer are on display in the main reception area. Fees are set on an individual basis and are renewed annually. Cranwell Court is owned by the Longhurst/Havlok Group and has other care homes in the area. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We brought this key inspection forward as we had been given information which caused concern about the safety and welfare of people living at Cranwell Court. We had already sent out surveys to people using the service, health and social care professionals, relatives and staff, as the home was due an Annual Service Review. We received a number of these back.We also looked at the service history we keep on the home to see what they and others had told us about how the service has been running since the last key inspection. The Company had also sent us their Annual Quality Assurance Assessment (AQAA) which gave us information about how the service was planning for the future and what they feel they have achieved. Plus other statistical and numerical data. During the site visit we looked at a number of records and documents, toured the home. observed staff at work and spoke to a number of people living there, some relatives, visitors and staff. We have reviewed our practice when making requirements, to improve national Care Homes for Older People Page 6 of 33 consistency. some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People must be adequately assessed to ensure the service can meet their needs and staff trained to look after them. Evidence: Since the last key inspection the Company had submitted an application to the Registration Team of CQC to have a change of Company name and a new category of registration, that of dementia, added. This had been granted in late 2009. Prior to the Registration the company had made changes to the environment, policy changes and were training staff in the basics of looking after people with dementia. During the course of our site visit we had concerns that the management of those showing signs and symptoms of dementia were not being monitored. People were wandering around the building and continually asking staff and visitors where they were, there was no diversion therapy taking place. People who could make informed decision to speak to us raised concerns about how some others were being monitored. Telling us I dont go into the lounge any more, you cannot watch the TV as these Care Homes for Older People Page 11 of 33 Evidence: others shout or turn the TV off and another person told us how people enter their bedroom area any time of the day and night, I just raise my fist and shout. Another person told us meal times are spoiled as she (a person sitting opposite) jabbers all day and I dont want to appear rude but dont know how to reply, staff told me to ignore her. Another told us that life was not the same any more. We had been assured at the time of the newest Registration that measures would be taken to ensure those with symptoms of dementia were adequately monitored through a 24-hour period. This was not happening and could put people at risk of harm if an altercation occurred. We had been informed in the Annual Quality Assurance Assessment (AQAA) the Company had completed prior to our visit, that the pre-assessment tool was being revamped to include sections such as assessment under the Mental Capacity Act and skin/pressure sore assessments. In the latest admissions care plan we saw this had not yet been put in place. Also in this care plan the initial assessment had not been signed. The Company also likes there to be a chemical risk assessment to be in place for the kitchen area of each persons personal room and a general risk assessment. This was not in place and staff had not followed the Company policy in this matter. To enable a fuller care plan to be in place all details must be correct and other staff able to identify who completed the initial assessment in case they need to ask any questions. When interviewing staff on the day of our visit and in the survey forms they returned they detailed some of the recent specific training they had received to enable them to do their jobs. This needs expanding upon as some staff were not aware of how to look after those with more challenging behaviour and we observed situations during our visit where some people living in the home were uncomfortable with those exhibiting challenging behaviour due to their memory loss. For example not knowing what to say to some one who only talked in riddles and eat food with their fingers, which would normally be eaten with a knife and fork. Staff also did not handle situations well for ever ones comfort. For example when walking in a corridor a person was walking in circles and asking to go home. Staff who passed this person completely ignored this person and told us she does this all day. We also had to stop a person leaving the building as another person, who lives in the home, was allowing them to leave and when we read the persons care plan they cannot go outside unescorted. Staff told us this is a continual problem but seemed at a loss as to the best way to eliminate this risk. We asked to see the new Statement of Purpose and Service Users Guide, this was not available,in its new format, as we were informed a new print run was required. In the meantime the older version was in use which gave broad details about the services the home could provide. As a temporary measure inserts had been placed in the old version to enable prospective service users to make informed decisions about using Care Homes for Older People Page 12 of 33 Evidence: the home. The home does not give intermediate care and therefore Standard 6 is not applicable. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Accurate records must be maintained to ensure peoples current needs are being met and they receive their prescribed medication. Evidence: Prior to this key inspection we had sent out a number of survey forms. Of this eight were returned by people living in the home, eleven by staff and two from health professionals. We also were able to speak to a number of health and social care professionals before our visit, either in person or on the telephone. We also spoke to seven people living in the home during the site visit, a relative and another visitor. Concerns had been raised, as detailed in Section 1, Choice of Home, in this report that people were unhappy about the way staff were managing those suffering from symptoms of dementia and we observed some inadequate practices in place. Health and social work professionals told us they had observed some people wandering meaninglessly around the home. Some had observed them rattling door handles and the gates at the bottom of stairs. All practices we also observed during our site visit. Staff seemed occupied in the practical tasks of ensuring people had been washed, dressed and were up and walking or sitting about.There appeared to be no strcuture Care Homes for Older People Page 14 of 33 Evidence: to each persons day. Those people with memory loss were not being encouraged to take part in meaningful daily tasks such as helping with the laundry or setting tables ready for a meal time. Some people sat in corridors, some in lounges and a few in their rooms. One lounge area was disruptive for those who wished to watch the television or have a conversation with a family member due to the shouting and very loud talking of a couple of people seated there with memory loss. We did not observe any staff sitting in lounge areas at all throughout the day. Situations could possibly have been defused if this had happened. Staff spoke kindly to people and some people living there told us how kind staff are, even when their work is busy for them Other people who returned surveys and who we spoke to talked of how friendly staff were and will go the extra mile if I ask them. Health and social care professionals told us that they follow instructions about looking after people, but this usually was at the instigation of those professionals and not as a result, generally, of staffs own initiative. We tracked five care plans and found that sections had not been signed when they had put core care plans in place. There was only intermittent examples that people had been told about their care plans and the content, as most sheets remained unsigned or had been signed just be a member of staff. The Company provides a comprehensive range of documentation to help staff record the needs of people living in the home, with instructions on how this should be completed. When reading the five care plans we found that in only one had evaluations of a persons needs and expectations been recorded more regularly. For example where a person required intermittent oxygen therapy, the core care plan had been written in conjunction with instructions from the hospital team monitoring this persons health. There was a large sign on their bedroom door saying oxygen present. A risk assessment was in place to instruct staff how to store the equipment and oxygen and details made in the evaluations and daily records of when it was used. This ensures this person is receiving assistance when required when they have problems breathing due to underlying other medical conditions. In one care plan of someone who is suffering from symptoms of dementia a community assessment was in place which had been supplied by the placing and funding local authority. This detailed this persons cognitive impairment. The Mental Capacity Act and Financial assessment sections of the care plan supplied by the home, had not been completed and neither had the core care plan. There was no way we could ascertain on the day of our visit if this person was receiving adequate care which was meeting their needs. In another care plan a core plan was in place for someone with diabetes. A nutritional and fluids assessment had been commenced. This referred to the persons poor eating regime and stated they should be weighed monthly. There were no recordings of Care Homes for Older People Page 15 of 33 Evidence: monthly weights.We could not measure whether this person was consuming an adequate diet to ensure they remained healthy. The recording in the daily report sheets about diet intake was only spasmodically recorded. Another care plan we looked at stated that all risk assessments of an individual should be reviewed every three months. There were no such recorded entries. A failure to ensure that care plan records are up to date could result in peoples current needs not being met and they being put at risk of harm. The mix of people with memory loss and those more able to make informed decisions and move around the home unaided needs to be managed better by staff to ensure volatile situations do not occur. We looked at a selection of drug administration sheets.There were a few gaps in the signature boxes so we we could not ascertain whether people had received their prescribed medication. Details of peoples personal needs were inconsistently recorded. For example where one person required medication to be given in a covert manner, a letter was in place from a medical practitioner who had reviewed this request and made a clinical decision to allow this practice. Instructions on how to give various types of medication for this person were recorded. On three other administration sheets we saw that these people could allegedly self medicate some of their prescribed medication. The administration sheets were not signed to say this was occurring and when we looked at the care plans for this topic in each of their notes only one persons had been evaluated recently. Of the two others one had last been reviewed in 2007 and another in August 2009. We were unable to ensure that these people could still perform this task and when we asked staff the reply was we think so. This could put these people at risk if they were not receiving their prescribed medication. The storage area was cramped and staff found it difficult to find documentation when asked as so much was stored in this room. We looked at the drug fridge temperature records and saw that the recording was very high and did not follow the Royal Pharmaceutical Society Guidance. The room temperature was not being recorded. A failure to record accurate temperatures could result in medication being stored incorrectly. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More thought must be given to the needs of each client group within the home and meaningful activities placed on offer so each person, regardless of their condition can lead a full life. Evidence: On our site visit to the home we checked a selection of service users rooms. Each one had been personlised to their individual tastes and needs. Where a person was suffering from symptoms of dementia all electrical appliances had been disabled so they could not harm themselves. People told us they had found it comforting to be able to bring in some of their own belongings and this had helped them settle in. Two people had their own computers installed to enable them to keep in touch with family and friends. There was also another computer in one of the lounge areas for general use of people living there. Those who were able to make informed decision to speak to us told us that there are a variety of events taking place within the home. Such as exercise to music, bingo, crafts and games afternoons. A bingo session took place on the afternoon we visited. The activities records and social needs assessments in each persons care plan showed what they liked doing and a little piece about their previous lives in the community. The records were a balance of group events, such as described above and one to one Care Homes for Older People Page 17 of 33 Evidence: sessions such as shopping trips and reading. There were some links with the local community such as visits to and from the Salvation Army, local Churches and schools at festival times of the year such as Christmas. No one, we were told attended any local clubs, at the time of our visit, but people were encoruaed to keep links in place which had been identifed at their inital assessment. The staff told us they had not had the time to explore possible outside interests for people living there apart from planned outings to, for example the seaside or a garden centre. Links with local organisations and clubs should be sought so people do not become isolated and can lead a full life style. Since our last visit the home has ceased producing a newsletter as the person compiling it has left the home. This is not being reintroduced at the moment. Staff told us it is difficult to know what to do with those suffering from dementia and they can be disruptive to group events. Staff also told us there arent always enough staff on to do one to one with the dementia sufferers. Some staff told us they were unsure whether people suffering from dementia would be allowed out in the garden. There was little understanding of how to occupy this client group and most were seen wandering around the inside of the building or just sitting in one sitting room all day. The training records of staff showed they had received training in looking after this client group but their knowledge base had not been tested as the supervision records were not up to date and the comments made to us and our own observations during the inspection visit showed they were not applying this knowledge to day to day events. Health and social care professionals who visit the home also told us of their concerns about the lack of stimulation for this client group.The home does receive visits from an outside organisation who provide sessions for reminiscence therapy occasionally. Day to day occupation for this client group and more meaningful social activities need to be explored to ensure this group of people can lead as full a life as their illnesses allow. We briefly toured the kitchen area of the home. The local Environmental Health Officer had visited in January 2009 and awarded the kitchen their highest score of 5-stars for excellent hygiene standards. On our visit day food was being prepared in a clean and safe environment and all safety checks on the records we saw had been completed. A senior member of the kitchen staff told us there had been no change to suppliers in the last eight months and the cooks were happy with the quality of food provided. Kitchen staff set each meal placements at the dining tables and food is served through a hatch. The days menu was on display and the cycle of menus was on offer for people to see. Staff were seen to assist some people with their lunch time meal and were calm and encouraging to ensure each person received a balanced diet. Some people living in the home told us they did not like the mix of people on their table. For example one Care Homes for Older People Page 18 of 33 Evidence: person was distressed to see another person eating food with their fingers, when the items would normally be eaten with a knife and fork. Others told us I dont like them wandering about at meal times, I like a quiet time. Most people living there did tell us how much they enjoyed the food. Telling us we get good portions and we still get a choice. A couple of people thought there was too much mince beef these days and attributed this to the change in category of clients. Thought should be given by staff to ensure the mix of clients is correct at all meal times to ensure this is a relaxing time of day for everyone living in the home. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff must ensure that they know when to refer significant events to the correct agencies so decisions can be made if people need protecting from harm. Evidence: This key inspection had been brought forward due to concerns which had been raised through three current safe guarding investigations, which are in progress and concerns raised directly to us by social care professionals. Since the last key inspection there have been two other safe guarding investigations, which are now concluded. One of which resulted in action being taken with a staff member and the second being inconclusive. One of the current investigations was notified to us on a Regulation 37 report. Staff appeared unsure of when to report events using this system and were directed on the day of our site visit to the CQC website so they had up to date information about what and how to refer significant events. This will ensure we can see if staff have taken appropriate action when an event has occurred. The policy manual appeared to be up to date and was detailed for staff to follow, but their practical application of processes should be challenged to ensure they are not putting people at risk. The Company had told us on their Annual Quality Assurance Assessment (AQAA) that they had dealt with four complaints in the last year but records of only three could be found by us. No one on the day had any knowledge of the fourth one. Staff must ensure that accurate records are kept in case there is a challenge to a decision. Staffing training in safe guarding vulnerable adults is up to date but may need to be Care Homes for Older People Page 20 of 33 Evidence: challenged through supervision of staff to ensure they know how to refer when necessary and do not place people in a harmful situation. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should be able to live in a safe and comfortable environment suited to their needs. Evidence: We toured the home during our inspection visit and saw all bathroom and toilet areas and communal areas. We also saw a selection of peoples bedrooms and the garden and grounds. The bedroom areas had been personlised to peoples needs and individual tastes and there were ample examples of how they had been able to bring in their own pieces of furniture and belongings. People living in the home told us it was as near to home as I can make it and I didnt realise I would have so much space. Since the last inspection the home has added the category of dementia to its Registration certificate. To ensure people do not harm themselves by falling down stairs the Company has installed stair gates at the bottom of stairs which have been approved by the fire brigade. Digital locks have also been installed on doors, which require a number or fob to open them. For those without fobs or who are incapable of remembering numbers this will restrict them in any given area. Some people wandering in the building appeared distressed by this and staff only made passing comments to them and did not divert them to more meaningful activities. People living there told us they were often disturbed by people wandering in and out of our rooms and feel I can no longer come out off my room, only for meals, as they Care Homes for Older People Page 22 of 33 Evidence: pull at the curtains and stand in front of the television in the lounge. All areas of the home were clean and people told us they were happy with the standard of cleanliness.There were ample supplies of linen, in locked cupboards. We checked the safety certificates for equipment in use and all were valid. Records were also seen which showed that regular fire checks are completed and day to day maintenance checks in the home. Such as water temperatures, bed rail safety and hoist safety. No maintenance plan could be found and the general business plan for the Company was not specific to this service. Some areas of the home had been redecorated, but some areas were looking tired. An action plan must be produced with time scales. Alterations had been made to the garden area and more secure areas created so those with memory loss could enjoy some fresh air and could enjoy the outside if they could not leave the main premises unescorted, in case they could not find their way back. All areas are accessible for wheelchair users. There is ample car parking space with in the grounds and on the streets surrounding the home. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There must be sufficient staff on duty at all times to ensure the current needs of people living in the home can be met. Evidence: Of the surveys returned to us and in speaking to staff and health and social care professionals visiting the home concerns were raised that insufficient staff could be on duty to always meet the needs of people in the home. Some staff told us its better at times now we have an extra pair of hands in the day. People living there told us staff are lovely and very caring but at times take a long time to answer call bells. Someone else told us I dont ring my bell at night if someone enters the room, I just shout at them, as staff take too long to come. We looked at the rota for all staff but there was no matrix available to tell us how they had arrived at the numbers through each 24-hour period. There were only three staff on duty at night in a large building with many corridors and staircases, an issue which had been identifed by a new acting manager. 52 people were resident at the time of our site visit and some of those were suffering from symptoms of dementia.Staff could not tell us how they make adequate checks on people through the night time period to ensure each person is safe and free from harm. We did not interview night staff but senior staff on duty could not idenitfy for us how checks were made and there was insufficient written evidence to support hoe this was carreid out. The current management team were in the middle of verifying all staffing levels at the time of this Care Homes for Older People Page 24 of 33 Evidence: inspection. This included addiditonal administration staff support. The Company had created a Business Manager role last year whose job role is to partly oversee the functioning of the Care homes for the Company. When speaking to other staff, the laundry area work was suffering at times due to the volume of soiled linen and clothes which now goes through the laundry. All other departments told us they felt their volume of work was acceptable. There must be sufficient numbers of staff on duty through a 24-hour period to ensure the needs of all individuals can be met and no one is put at risk of harm. We looked at six personal records of staff and found sufficient evidence to support that adequate safety checks had been made prior to their commencement of employment. There was also written evidence to support that where a positive Criminal Records Bureau check had been received a risk profile was in place to ensure a decision was recorded as to whether that person was safe to work with vulnerable people. On two peoples files we saw where the staff members had been disciplined for poor practices after an investigation and what action plan had been put into place to ensure they were now safe practitioners. We looked at the training records of staff and found that all mandatory training had taken place and some service specific topics such as dementia, Mental Capacity Act and pressure area care. The supervision records were poor and there was no way for us to judge how this training had been tested for practical application of the tasks. Staff told us how much they like the training sessions, which are a combination of speakers, videos and outside courses. They told us it had helped them understand their work. A new training matrix has now been developed on the computer so staff can keep track of when staff require up dates to training and when specific topics have been accessed. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate checks must be made to ensure that the home is being run for the benefit of the people living there and their views are sought. Safe practices must be in place to ensure people have the capacity to manager their own affairs. Staff must be supervised to ensure they can do their job and people are being looked after safely. Evidence: At the time of this site visit there was an Acting Manager in place and we were informed an advertisement was being placed to recruit a permanent member of staff. Details were given to us of the interim arrangements until this takes place. On the inspection day no Regulation 26 reports could be found on site and staff were unaware if they had been completed. These are required to be open and available for inspection so we can see whether the Responsible Individual or their delegated Company representative is monitoring the home to ensure people are free from harm and live in a safe environment. The Company operates a quarterly auditing system, sending out questionnaires to people who live there and other interested parties. Only a few of these could be found Care Homes for Older People Page 26 of 33 Evidence: at the time of our visit, but people living there told us they are asked by staff how they feel and whether they are happy. Staff also told us of meetings which take place on a regular basis and they can express their view point. We checked a number of files of peoples personal allowance records. All entries could be allocated to receipts and entries showed money was being used for their own personal needs. There is currently a safe guarding investigation in place concerning one persons ability to manage their own money. This investigation was instigated by family members and the Solicitor of the said person. During the course of this investigation it has been brought to the notice of the local care management teams, by senior management at Cranwell Court that some other people may need best interest meetings due to their possible lack of capacity to understand how to manage their personal finances. Even though staff have received training in the Mental Capacity Act and dementia awareness, health and social care professionals have raised concerns that staff do no know how to practically apply this knowledge. Extra training has been offered by members of the North East Lincs Care Trust Plus and each case is being looked at individually and as a matter of urgency by the care management team, family members and staff jointly. The home operates a Residents fund which is accessed on a need to know basis only by some staff. This is currently under review due to some staff members having left the homes employment. Safe guarding checks are being made to ensure there is no fraudulent use of funds. We looked at the written records for staff supervision. These were very poor and did not meet the minimum level in any of the six folders we tracked. Insufficient numbers of sessions had taken place with some staff only having one recorded session in a year.Few recorded outcomes for people or action required even when inadequate practice had been noted. Staff told us that sessions were spasmodic and usually consisted of talking to their line manager. Some staff told us there was little time to take on this task. This could result in staff not doing their job sufficiently well and putting people at risk. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 People must be adequately assessed prior to admission. To ensure the service can meet their needs within the services categories of Registration. 30/04/2010 2 4 18 Staff must have received training in service specific topics such as managing challenging behaviour and aggression management. To ensure people are not put at risk of harm. 30/04/2010 3 7 15 People must have their needs reguarly reviewed, in accorordance with their individual needs. To ensure their current needs are being met and they are not at risk of harm. 30/04/2010 4 9 13 All medication records must be signed. 30/04/2010 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure each person is receiving their prescribed medication. 5 9 13 People who can self administer medication must have their ability reviewed. This is to ensure they can still receive their prescribed medication. 6 16 37 CQC must be notified of any 30/04/2010 death, illness and other significant events with in the home. This is to ensure we can judge whether the service has made correct decisions to protect people using the service. 7 19 23 A maintenance plan must be 30/04/2010 produced, with action dates and when implemented. To ensure people live in a comfortable and safe environment. 8 27 18 There must be sufficient staff on duty at all times, to meet service users identifed needs. To ensure the current needs of people can be met. 30/04/2010 30/04/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 9 31 26 A monthly site report must be available and open for inspection. To ensure a Company representative knows how the home is run and whether people living there are free from harm. 30/04/2010 10 35 12 Assessment must take place to ensure people have the capacity to manage their own money. This is to ensure there is on fraudulent use of funds. 30/04/2010 11 36 18 Supervision records must be 30/07/2010 in place for all staff. To ensure they can safely do their jobs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 An up to date and legible Statement of Purpose and Service Users Guide should be in place to ensure people can make informed decisions about using the home. The pre-assessment tool used by staff prior to admission of a prospect service user should be holistic and encompass changes to any recent legislation which may affect that persons welfare. Staff should be trained to recognize volatile situations so people are not at risk of harm. The medication storage area should be arranged so staff Page 31 of 33 2 3 3 4 7 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations can access information easily and that the room temperature and drug fridge temperatures are recorded to ensure every item is stored correctly and safely. 5 12 Staff should ensure that they know how to make a persons life more meaningful when they are suffering from symptoms of dementia. Links with the local community should be explored more to ensure peoples social, religious and cultural expectations and needs are being met. Thought should be given at meal times in the main dining room to ensure this is a relaxing time for people and each person can eat their meal peacefully. Staff should keep accurate records of all complaints in case these need to be referred to at a later date. Staff should be tested to ensure they know when to make referrals to safe guard individuals living in the home. There should be sufficient staff on duty in ancillary departments of the home such as the laundry to ensure the work can be completed and there are no risks of infection which could occur. Staff receive a variety of training throughout the year which should be tested to ensure they can practically apply their knowledge. Quality assurance audits should continue to ensure the home is being run for the benefit of people living there and it is a safe place to live and work. 6 13 7 15 8 9 10 16 18 27 11 30 12 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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