Inspection on 18/03/10 for Crown Meadow Care Centre

This inspection was carried out on 18th March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Crown Meadow Care Centre 08/06/10

Crown Meadow Care Centre 09/04/09

Crown Meadow Care Centre 24/05/07

Crown Meadow Care Centre 25/09/06

Crown Meadow Care Centre 27/02/06

Crown Meadow Care Centre 29/07/05

Crown Meadow Care Centre 16/11/04

Crown Meadow Care Centre 26/05/04

Crown Meadow Care Centre 11/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 0HB     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: Mandy Beck     Date: 1 8 0 3 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 37 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 37 Information about the care home Name of care home: Address: Crown Meadow Care Centre Bayleys Bridge Tipton West Midlands DY4 0HB 01215200700 01215578279 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.schealthcare.co.uk Southern Cross Care Centres Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 35 Date of last inspection Brief description of the care home Crown Meadow Nursing Home provides nursing care for up to 35 people who are over 65 years of age. The home is situated on a main road close to Great Bridge, Tipton and other local shops and amenities. The property is a purpose built three-storey building with parking to the front and garden at the rear of the property with patio and seating that can be used when the weather permits. The home consists of 31 bedrooms, there Care Homes for Older People Page 4 of 37 Over 65 35 0 0 9 0 4 2 0 0 9 Brief description of the care home are some shared bedrooms as well as single occupancy and all have en-suite facilities. There is a large lounge/dining room on the ground floor fronted by a conservatory, which forms the entrance of the home plus a small quiet lounge on the first floor. Bedrooms are located on all floors and there is a hairdressing salon and staff room on the second floor. There are two passenger lifts giving access to all areas of the home and there is one assisted bathroom that is suitable for people with mobility problems on each floor; showers are also available in most bedroom en-suites. Information in the form of a welcome pack and service user guide were available in the reception area, so people had access to information about the services and facilities availaable in the home. The notice advised people to ask for a copy of our latest inspection report if they wished to see it. The information available did not include the range of fees and people will need to discuss this with the manager at the time of making enquiries. Care Homes for Older People Page 5 of 37 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: This was an unannounced inspection of the home, they were given no prior notice that we were going. The inspection was completed by two inspectors over a period of two days, 18 March 2010 and 23 April 2010. We looked at all the information that we have received, or asked for, since the home was last inspection in April 2009. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self assessment that focuses on how well outcomes are being met for people who live in the home. It also gave us some numerical information. Information we have about how the home has managed any complaints and safeguarding investigations. Care Homes for Older People Page 6 of 37 What the home has told us about things that have happened there, these are called notifications and are a legal requirement. We spent time talking to the people living in the home and to the staff who support them. People have also provided us with information from surveys we sent to them. We have also included information we have been given from other health care professionals. We looked at the care of four people in depth. This is part of our case tracking process and helps us make judgements about the homes ability to meet peoples needs. At the time of this inspection the home has its contract with the local authority suspended. This means they are unable to take admissions until significant improvements have been made. Readers of this report should contact the home directly for information on how they intend to do this. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The home must make sure that before people move in their needs are assessed in full and this information is used a the basis to plan peoples care. The home needs to make sure that information relating to peoples specific healthcare needs is not overlooked. The record keeping systems in the home are poor. This means that peoples care plans and risk assessments do not contain all of the information necessary to give staff clear guidance to meet peoples needs. Medication systems in this home are poor. We have serious concerns about the homes ability to make sure people have their medication as the doctor prescribed it. We have given the home an immediate requirement for them to take action. The home was required to tell us what improvements they were taking within 48 hours of the immediate requirement being issued. The home has supplied us with an action plan for improvement. The home needs to improve the way in which is manages people who are at risk of malnutrition, dehydration and pressure damage. Systems should be in place to ensure all staff have a knowledge and understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguards commensurate with their position to ensure they are aware of how to support people who lack capacity. The home must be more proactive in recognising abuse and reporting of incidents to Care Homes for Older People Page 8 of 37 the safeguarding team. As a result of this inspection we have made three safeguarding referrals. Staffing levels and staff competence must be addressed if peoples needs are to be met in a timely manner. The home must audit its staff files to make sure they have all of the required information contained within them. The home must also be able to demonstrate that it has taken action to reduce risks to people living in the home when they allow staff to start work without all of the required checks in place. The homes own quality assurance systems have already identified a number of areas for improvement. The current management of the home needs to improve if people are to be protected. 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. 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 37 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 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does supply information for people in order to help them make a choice about living in the home. There are significant improvements needed by the home to make sure peoples needs are assessed in full and staff understand what is required of them. Evidence: We looked at all the information the home provides for people choosing to live there. We found there was an up to date copy of the home Statement of Purpose and Service User Guide in the reception area of the home. People living there also had their own copies of these documents in their bedrooms. In general most of the information required has been included in the service user guide, we have made one recommendation. The home should include the correct details of the Care Quality Commission so that people will have the means to contact us should they choose to do so. Care Homes for Older People Page 11 of 37 Evidence: We looked at the way the home arranges peoples admission to the home. We looked at the admission and assessment information of three recently admitted people. We found there is room for improvement. The home does make every effort to visit people in their own homes or in hospital prior to admission to discuss their needs. However when we looked at the records the home keeps of these needs assessments we saw information vital to peoples health and well being had not been included. For example one person needed an injection every three months to treat a blood disorder. This information had not been included in the assessment and had not been transferred into the care plan. Another person was admitted to the home needing pain relief on a regular basis, the reason for this had not been included in the assessment and when we asked staff what the cause of the persons pain was they did not know. We have also been informed by the local authority of their decision to suspend placements in the home until there has been significant improvement. This means the home is unable to accept any new admissions at this time. We are concerned about the homes ability to meet the needs of the people living here at this time. Staff did not demonstrate a good understanding of peoples needs during this inspection and we were concerned about the competence of some of the current staff group. Care Homes for Older People Page 12 of 37 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. People living in this home cannot feel confident their healthcare needs will be met. There must be improvements with medication systems in order to make sure that people have their medication as it has been prescribed. Evidence: We looked at the care records of four people living in the home. We saw that each person has a collection of risk assessments and care plans in their file. These documents should clearly show the care people require and the risks associated with delivering that care. This is not what we found. The completion of care plans and risk assessments was poor and it was difficult to determine exactly what care people needed. The following is a sample of some of the evidence we have found during this inspection. We looked at how the home manages peoples need for adequate nutrition and fluids. The home completes a nutritional screening tool that identifies those people Care Homes for Older People Page 13 of 37 Evidence: considered to be nutritionally at risk. When a risk is identified we would expect to see a care plan that details exactly how the home is going to manage and reduce the risk to the person. We found inconsistent information in all care plans. One persons care plan evaluation stated if weight drops below 65kg then a referral to the dietitian is needed. The persons weight was last recorded as 55kg and when we asked staff they confirmed that no referral had been made. Another persons care plan said that supplements should be given. When we checked we found that staff were not doing this. We looked at fluid balance charts, they were not being completed on a daily basis and over a ten day period one persons recorded fluid intake only reached 1000mls on one day. We also noted that no fluids were recorded after 5pm until 8am the following morning. We asked staff about this and were told they do get drinks but the records dont get filled in. Without consistent and accurate recording of a persons fluid intake the home cannot reasonably demonstrate that people are being given the fluids they need to prevent them from becoming dehydrated. We were also very concerned when we observed one member of staff attempt to feed a person whilst they were still lying on their back in bed. We asked the carer if this was how the person needed to be assisted and they said no. They then called for assistance to sit the person up so that they could eat their meal. When we raised this issued with the person in charge, she added thats not good that person is a choking risk. The home must address these shortfalls in practice if people are to be protected from harm. We looked at how the home manages pressure area care for the people living there. We spoke to staff about how they support people in reducing the risk of pressure damage occurring. We found inconsistencies in staff knowledge. The nursing staff had a difference of opinion in the actual numbers of people in the home with pressure sores. One member of staff told us about one persons care, she is very sore, sometimes her pad does not get changed all day and this is why, it wouldnt surprise me if she had broken down. We looked at this persons care records and saw that other written entries had been made by staff, for example very sore and left buttock about to break, nurse advised sudocrem and bed rest. We looked at the Medication Administration Record (MAR) and saw this person was not prescribed sudocrem. Care staff told us it had not been given. We could not evidence what care had been given to this person in relation to the pressure damage on their buttocks. We checked some of the pressure relieving equipment in use. We found that people did not always the equipment they needed. Some pressure relieving cushions we thinned out and in need of replacement. We saw one person had been assessed as a high risk of pressure sore development. We noted that they did not have any pressure Care Homes for Older People Page 14 of 37 Evidence: relief on the chair they were sitting on and the mattress on their bed was not suitable for this level of risk. We have recommended the home completes an audit of all pressure relieving equipment to make sure it is appropriate and fit for use in the home. There was evidence to show the home does call for medical assistance and other specialist advice from healthcare professionals. What we did not see was how the specialist advice from these professionals was being put into practice. For example, one person had specific mental healthcare needs that were regularly being monitored by the community mental health nurse (CMHN). The home had not recorded in the care plan the outcome of these visits and/or any changes in the persons treatment they needed to take since October 2009. Staff told us the person was visited on a fortnightly basis by the CMHN. We looked at the way in which the home manages peoples medication. We found serious shortfalls in practice that meant that people were not being given their medication as it had been prescribed. We gave the home an immediate requirement to address this. An immediate requirement, in this instance, means we have serious concerns about the homes ability to meet peoples needs in relation to medication. The home must take urgent action to address our concerns. When we checked the Medication Administration Record (MAR) charts we found omissions, duplications and incorrect balances of medication. We looked at how the home manages controlled drugs. We identified one person had not been given their pain relief as it had been prescribed. It had been omitted on two occasions. Staff told us this was because it was not needed. This medication had not been prescribed on an as required basis and should not have been omitted. We asked the nursing staff why this person needed pain relief, they could not tell us. We looked at the care records and found their was no pain chart, no care plan and no details about why this person needed this pain relief. We consider this to be a breach of previous requirements made by the commission and we are now consulting with our enforcement team about taking further legal action. We have other concerns raised in relation to medication for example, one person was prescribed antibiotics, the dose was recorded, the name of the medication was recorded but the length of treatment was not. We asked staff again how long the antibiotics should be administered for and again they were unable to tell us. The same person had been prescribed medication for oral thrush. This medication was found in the fridge and had not been opened. This person had been discharged from hospital with specific instructions to administer this medication for 7 days. This had not been Care Homes for Older People Page 15 of 37 Evidence: done. We asked the nurse in charge why this had not been given. We were told she was on it before she went into hospital, her mouth is clear. We visited the person in their bedroom, we found them to be distressed and the condition of their mouth was very poor. It was evident that the oral thrush was still apparent. We noted there was no mouth care tray in the bedroom and there was no evidence that any mouth care had been given to this person. Another person had been prescribed an injection for treatment of a blood disorder. This information had not been included onto the MAR chart, it was not written into the care plan and when staff were questioned about it they told us Im not aware of that. We asked the person in charge to address this and make sure the person has their treatment as it has been prescribed. We have also completed a follow up visit to the home 23 April 2010. We did this to assess the improvements the home has made in relation to the medication systems. We looked at two peoples medication, we found that things were still not right and these people were not having the medication as it had been prescribed. For example, the person who needed an injection to treat a blood disorder had still not received this. The person who required regular pain relief had not received one dose as it had been prescribed. We acknowledge, that the doses of this mediation are now being given regularly with no extended gaps in administration. The home has also told us, it have begun to audit all of the MAR sheets weekly and spot checking some on a random basis. The person in charge also told us that training has taken place for staff but competency tests are still be done. We have also been notified of one medication error the home has picked up by completing these audits. We are consulting with our enforcement team about whether further legal should be taken at this stage to bring about improvements. We have asked our pharmacist inspector to visit the home given the nature of our concerns. When staff were aware that we were observing them people were treated with respect and dignity. We have also seen that people are not treated with respect and dignity on occasions. We saw one person left in distress for over five minutes after we had pressed the emergency call button. The call button had been placed out of reach of the person and they were unable to summon assistance as a result. We saw another person calling for help, asking for their teeth to be put in so they could eat their meal. Staff did attend to the person but failed to put the teeth in and proceeded to try and feed the person whilst they were lying down in bed. We spoke to another person who Care Homes for Older People Page 16 of 37 Evidence: told us about their distress when they had waited so long for staff to attend to them they had soiled themselves. The home does have a dignity champion as part of the organisations dignity challenge. It is clear that more work is needed in this home before people can be confident they will be treated with respect and dignity. Care Homes for Older People Page 17 of 37 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. People are supported by the home in leading active lives. People are given choices at meal times and the home does provide a well balanced diet. Evidence: There is an activity coordinator employed by the home who arranges outings, events and other activities for people to take part in. Staff also spend time completing a list of peoples preferences for keeping active and staying in touch with family and friends. We looked at peoples records as part of our case tracking process. We saw that staff had recorded one person wanted a daily newspaper. We asked the person if this was happening and we were told no I dont get one. We asked other people about choice in the home, they told us when the staff say its time to go or get up we do it, another person said yes you do get a choice within reason. People who answered our surveys told us they felt there were enough activities in the home for people to take part in and they felt the home did offer them choice. They said the activities for residents are good and they provide lots of outside entertainment, we even get a resident and family meeting every month. On the day of this inspection we saw keep fit had been planned and the person did turn up to deliver this class however this was not altogether possible because of the Care Homes for Older People Page 18 of 37 Evidence: carpet fitting. People were in their bedrooms and could not participate. We spent some time talking to visitors during this inspection. They told us the home does allow them to visit when they want. There is an open visiting policy at the home and people are supported to maintain contact with their families and friends. Each person is encouraged to make their room their own by decorating to their own taste. We saw people had taken advantage of this and rooms were very nicely decorated and had been personalised with belongings from home such as photographs, ornaments and furniture. We did have the opportunity to observe meal times during this inspection. On this particular day the home was disorganised due to the re fitting of the carpet in the lounge. People were in their bedrooms and staff did their best to get meals to people in their rooms. People do have a choice of menu each day and we were told that if this was not to their taste an alternate dish is available for them. We spoke to staff who told us at times there are not enough crocks, such as plates, cups and dishes. The person in charge at the time of this inspection told us these have been ordered. Every person who answered our survey told us the meals were good and they enjoyed them. They said if a resident mentions a favourite food the chef provides it. We have already mentioned our concerns about staff assisting people with meals and understanding their dietary needs in the previous section of this report. After recent consultation with people living in the home the dining room on the ground floor has been moved to the front of the building. One person said its better because we can sit in the lounge now and look out into the garden. Care Homes for Older People Page 19 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does have systems in place to be able to listen and act upon peoples concerns. There are however improvements needed if people living in this home are to be protected from harm and neglect. Evidence: The home has a complaints policy that is available to all people. A copy of the complaints policy is in the service user guide and in each persons bedroom. Since the last inspection in April 2009 there have been five complaints recorded. We looked at the way in which the home manages and investigates complaints. People we spoke to during this inspection told us yes I know who to talk to if I am unhappy, the nurses are ok. All of the people who answered our surveys told us they knew who to speak to if they were unhappy about anything and wanted to make a complaint. Following a recent visit to the home by the local authoritys contracts and monitoring team, serious concerns were raised about the homes ability to meet and manage peoples needs safely. As a result of a subsequent strategy meeting where the local authority, the home and other interested parties attended, it was agreed that a suspension of placements would need to happen in order to give the home time to make improvements and to reduce the risk of harm to the people currently living in the home. The home will need to make improvements in its care delivery, record Care Homes for Older People Page 20 of 37 Evidence: keeping, medication systems and staff competence so that people can be confident their needs will be met. The home has policies in place for dealing with allegations of abuse and keeping people safe from harm. We call this safeguarding vulnerable adults. We spoke to staff about this. All of the staff we spoke to were able to tell us what different types of abuse there were and how they would recognise the signs of abuse. Generally most of the staff knew who to refer to if an allegation was made to them or they had witnessed an act of abuse. Staff also told us they knew about the whistleblowing policy and said they would use it if they felt they had witnessed poor practice. Despite staff being able to discuss these issues with us, we were not confident that appropriate referrals would be made to the safeguarding team. We have made three additional safeguarding referrals as a result of this inspection. We were not satisified that peoples needs were being met. The safeguarding team is investigating these referrals at this time. We also talked to staff about their knowledge of the Mental Capacity Act 2005 and the deprivation of liberty safeguards. We did this because we wanted to know if staff were aware of what the implications for practice this legislation has. Staff need to be able to understand what a deprivation of liberty is so that they can take action to prevent it from happening or to take steps to protect the people in their care. Staff told us they had not had any training in this and were not aware of what it meant. The home will need to arrange for this training to take place. The home does use bed rails for some people in order to keep them safe whilst in bed. We looked at the risk assessment for their use and found them to be up to date and reviewed regularly by the staff. This means that people would not be restrained inappropriately. We looked at recruitment practises and found the home is taking steps to prevent unsuitable people from working with vulnerable adults. This includes required checks against the Independent Safeguarding Authority (ISA) and a Criminal Records Bureau disclosure (CRB). We found the home could make improvements. We did not see any risk assessments in place for staff that had been allowed to start work with only a ISA adultfirst check in place. We did ask for this information during the inspection but it could not be supplied by the organisation. The home must be able to demonstrate that it is taking all precautions to prevent unsuitable people from working with vulnerable adults. Care Homes for Older People Page 21 of 37 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 live in a well maintained home, that is free from offensive odours. It is homely and offers a comfortable place for people to live. Evidence: The home is pleasantly decorated and the majority of it is free from offensive odour. There are two communal lounges one on the ground floor and another lounge upstairs for people to enjoy. There is ample seating through out the building. The dining facilities are satisfactory and do offer a pleasant place for people to sit and eat their meals. After consultation with people living in the home the dining room has now been relocated to the front of the home leaving the lounge at the back. One person told us we can see the garden better like this. On the day of this inspection the home was having new flooring put down in the lounge on the ground floor. The home did not appear to manage this situation well. People were asked to spend the day in their rooms or sit in the smaller lounge upstairs. The smaller lounge has a capacity for eight people so the majority of people spent the day in their bedrooms. Their bedroom doors were closed. Some of the people living in the home are very frail and cannot summon assistance when they need it. We entered one persons bedroom to find the call bell had been disconnected, they had no way of calling for help if they needed it. We also noted in this persons Care Homes for Older People Page 22 of 37 Evidence: bedroom their were no pillows on the bed. The person told us I dont know where they went but I hope they come back. We looked at the equipment in use for those people who needed bed rails, hoists and pressure relief. We saw that some peoples bed rails were soiled and needed a deep clean. Staff have told us one of the hoists was not working properly because it did not hold its charge and people were at risk of being suspended in the air if the battery was flat. We spoke to the person in charge about this at the time of the inspection, we were told the home has already ordered a replacement hoist and delivery was expected shortly. We looked at pressure relieving equipment, people who need this type of equipment had the correct mattresses on their beds however we did not see that people had the appropriate pressure relief when sitting out of bed on their chairs. We asked the person in charge about this. We were told that air cushions had not been considered. Staff have had training in infection control and throughout the home each toilet and bathroom had hand washing facilities with liquid soap and paper towels. Staff also said they had access to plastic aprons and gloves when they needed to assist people with personal care. There is alcohol hand rub throughout the home for people to use. All of these measures will help reduce the risk of cross infection to the people living here. We have not been notified of any outbreaks if infection in the home since our last inspection. We did look at the laundry facilities and found them to be satisfactory but there was no evidence of cleaning schedule. We have made good practice recommendations for improvement and we will expect the home to address them. Care Homes for Older People Page 23 of 37 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. Staffing levels and staff training are in need of improvement so that people living in the home are cared for appopriately. Evidence: We have been made aware of concerns about the number of staff on duty to meet peoples needs. We found the duty rota supplied by the home was not an accurate reflection of the staffing levels and we saw staff arriving at different times that were not clearly recorded on the rota. Staff told us there are usually five staff on duty during the morning shift, plus a trained nurse. There are four staff plus a trained nurse during the afternoon and at night there is one nurse and two care staff. We asked staff if they felt there was enough of them to meet peoples needs. They told us yes mostly but it would be nice to have time to talk a bit more with people, I think that because there are alot of people that need hoisting we could do with more staff. We spent time talking to people during this inspection about how the staff in the home supported them. They told us The staff are lovely but you do have to wait for them to answer the buzzer or go to the toilet, one person became upset when we spoke to them stating I had to wait so long for them once I soiled myself, I was very upset by this. We went into another persons bedroom and found them to be distressed. We pressed the call bell for assistance, we waited with the person for over five minutes until the staff arrived to assist. Care Homes for Older People Page 24 of 37 Evidence: People who answered our surveys responded positively and said that staff were always available to help them. Two people said that staff were usually available to help them, one of them added they could be better by making carers aware of each persons health needs when handling them and improve the carers attitudes, I suggest there are more night staff. The home was made aware of these comments during our inspection. We were told the organisation is aware of some of the staffing difficulties and they have already begun to put an action plan together to address these issues. We were told by staff we spoke to and from the homes completed AQAA that over 80 of the current care staff have acheived their National Vocational Qualification (NVQ) level 2. The home has said they aim to register all of their care staff in the near future to complete this training. Other staff training is provided by the home but there are gaps and this will need to be addressed by the home. The home should also consider the effectiveness of its own training. For example, we were told all of the staff have completed training in care planning, yet we have found significant shortfalls in this area that should not happen if staff have been trained. We have also identified shortfalls in the way the home manages peoples pressure area care and their nutirtional needs. The home has told us that staff have also received training in both of these areas but peoples needs are still not being met. We looked at the recruitment procedures in place. We did this so we could see what steps the home takes in order to prevent unsuitable people from working with vulnerable adults. We looked at the staff files of three new starters. We found that most of the required information had been obtained prior to staff starting work in the home. Staff had completed an application form, the home had obtained two written references. There were also checks against the Independent Safeguarding Authority (ISA) Adult first. We did see evidence the home has applied for the Criminal Records Bureau (CRB) Disclosures but we did not see any risk assessment in place when staff had started work before the return of a satisfactory CRB. We did ask for this information but it could not be supplied during this inspection. Care Homes for Older People Page 25 of 37 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. The management of the home needs to be improved so that peoples needs are met. The home is not being run in the best interests of the people living there. Evidence: The home management has not changed since our last inspection April 2009. We have found during this inspection a decline in the standards of service people are receiving. There are shortfalls in almost all areas of the home management that must be addressed if peoples needs are to be met. We have discussed our concerns with the organisations Regional Manager who is fully aware of the current problems within the home. In order to bring about improvements the organisation has already conducted its own internal inspection of the service. They have already identified that people are experiencing poor outcomes in some areas and are in the process of producing an action plan for improvement. Despite the home doing this they still failed to indentify some of the issues we have during this inspection. Care Homes for Older People Page 26 of 37 Evidence: The local authority has, as we have already said, imposed a suspension of placements on this home until satisfactory improvements have been made. The home has supplied us with the AQAA, we found that some information contained within the AQAA was not correct at the time of our visit. For example, the home told us We have a well trained and informed team of staff who are able to identify service users needs and interest which enables them to deliver high standards of care. We have found that staff knowledge of peoples needs is not comprehensive and is placing some people at risk. We have already said we made referrals to the safeguarding team as a result of this inspection. We have identified within the complaints and protection section of this report that staff were not aware of the Mental Capacity Act and the Deprivation of Liberty safeguards or their responsibilities under this legislation. We have said that all staff should have training so that they are aware of their responsibilities under the legislation. The manager has told us the organisation has already recognised this as an area for improvement and they will be providing training for their staff in the near future. Secure facilities are available for the safe keeping of peoples personal money and valuables. Records are available for all transactions which detail the reason for the withdrawal, receipts are available as proof of purchases. All money is kept within a bank system and we were able to see that interest is added monthly to any balances. The home has computerised records of all training statistics which show that most of the staff have received all statutory health and safety training and when needed training is booked to address any gaps. The home also has trained trainers to deliver training, we have already commented on this in the staffing section of the report. We spoke to staff who told us the training is very good I am a trainer and feel very supported. Despite this training being available to staff we have still seen there are shortfalls in practice. We have seen poor feeding techniques, poor recording of accidents and poor pressure area care. The home must develop a system that allows them to support their staff to put newly acquired knowledge into practice and thereby reducing the risks to the people living in the home. The AQAA confirms that maintenance contracts for the building are up to date. We found the home is in a good state of repair and most of the equipment is in working order. We identified problems with the dishwasher the home needs address. All of the staff we spoke to confirmed they had had fire training, and a recent fire drill. We did Care Homes for Older People Page 27 of 37 Evidence: look at the provision of hoists and slings in the home for the safe moving and handling of people. One hoist is losing its charge and is not really suitable for the task, the home has ordered a replacement hoist, we saw confirmation of this order during the inspection. The home continues to notify us of changes in peoples conditions and other adverse events under Regulation 37 of Care Home Regulations 2001. However there is no accident book in the home. This means that when people have an accident there is no formal record this has happened. The home is required to have an accident book and must take steps to purchase one. Care Homes for Older People Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 There must be a robust 09/05/2009 medication systems in place to include the accurate administration and recording of all medication given to people. To ensure people receive the medication prescribed for them. 2 9 13 All handwritten medication must be countersigned by two members of staff. To ensure safe practices within the home. 09/05/2009 3 28 18 A review of staffing levels 09/05/2009 must be undertaken and action taken to ensure there are sufficient staff on duty at all times. To ensure peoples needs are met in a timely manner. Care Homes for Older People Page 29 of 37 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 1 9 13 The home must have 23/03/2010 effective systems in place for the management of peoples medication. The home must be able to demonstrate that people are not being placed at risk by poor medicines management 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 13 The home must have in place safe systems for the ordering, safekeeping, safe administration and disposal of peoples medication. This is to protect the people living in the home and to make sure they have their medication as it has been prescribed 31/05/2010 2 3 14 The home must make sure that peoples assessments are kept up to date and are reflection of peoples needs. They should do this so that peoples needs are recognised by the home and 30/04/2010 Care Homes for Older People Page 30 of 37 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 so people can feel confident their needs will be met. 3 8 17 The home must make sure that peoples food diaries and fluid balance charts are diligently completed. They must do this so that can demonstrate that people who are at risk are having the food and fluid they need. 4 8 12 The home must be able to demonstrate the actions they have taken to reduce the risk of malnutrition for people living in the home. This will reduce the risk to the people living in the home. 5 8 15 The home must make sure that peoples care plans contain the correct and comprehensive information about peoples needs and how they are to be met. This will give staff clear guidance about peoples care needs and give people reassurance that staff know what they need to do. 6 8 12 The home must review each persons pressure sore risk score. They must also make sure that people have the 31/05/2010 31/05/2010 31/05/2010 31/05/2010 Care Homes for Older People Page 31 of 37 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 correct pressure relieving equipment for their needs. This will reduce the risk of pressure damage to people who are at risk. 7 8 15 The home must make sure that short term health problems such as chest infections have an appropriate care plan for staff to follow. This will make sure that staff now what care should be given in order to treat the condition. 8 9 13 A quality assurance system must be installed to assess staff competence in their handling of medicines This will enable the home to take action with staff who do not administer medication as prescribed. 9 9 12 medicines must not be administered unless the name of medication, the dose, the frequency and route of administration are clearly recorded. Where short term medicines are prescribed such as antibiotics the length of treatment should also be included. 31/05/2010 31/05/2010 31/05/2010 Care Homes for Older People Page 32 of 37 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 This will make sure people have the correct medication. 10 9 12 All prescribed medicines must be available for administration by staff. This is to ensure that people receive all their medication as the doctor intended. 11 18 17 The home must make sure 30/04/2010 that staff allowed to work in the home without a satisfactory CRB and only an ISA adult first check have a written risk assessment completed and that a copy of the risk assessment is kept in the staff members file. This will demonstrate how the home intends to protect the people living in the home when staff start work without all of the required safety checks in place. 12 18 13 The home must make sure that staff have training in relation to the Mental Capacity Act 2005 and the deprivation of liberty safeguards. This will help staff understand their role in supporting those people who 30/07/2010 31/05/2010 Care Homes for Older People Page 33 of 37 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 do not have the capacity to make decisions for themselves. 13 18 13 The home must make sure they make timely referrals to the safeguarding team. This will reduce the risks to the people living in the home. 14 27 12 The home must be able to demonstrate that peoples healthcare needs are being met. They must do this by providing staff in appropriate numbers to meet peoples needs 15 27 17 The home must make sure that the staff rota is an accurate reflection of the dates and times staff are working. They must do this to provide documentary evidence that people are being supported by the appropriate number of staff at all times. 16 28 24 The home must develop a quality assurance system that addresses staff competency. 31/05/2010 31/05/2010 31/05/2010 31/05/2010 Care Homes for Older People Page 34 of 37 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 This will help reduce the risk to the people living in the home. 17 33 24A The home must submit an improvement plan that clearly details the action the home will take to address the shortfalls indentified in the report. This will show the action the home will be taking in order to improve the service for people living there. 18 38 17 The home must have an 31/03/2010 accident book for use on the premises. This will make sure all accidents are appropriately recorded. 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 06/05/2010 1 1 The home needs to make sure that the details of the Care Quality Commission are correct. They should do this so people have the correct information to be able to contact the Commission if they choose to do so. The home should source further training for staff in specialised areas such as nutrition, pressure area care and pain management. The home should complete an audit of all pressure relieving equipment in the home and take action to replace or repair 2 8 3 8 Care Homes for Older People Page 35 of 37 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 equipment where needed. 4 5 9 9 The home should record the variable dose of medication where this is prescribed. All nurses working in the home should familiarise themselves with the Nursing and Midwifery Council (NMC) Standards of Medicine Management to promote and protect the health and well being of people living in the home. Trained staff working at the home should re-familiarise themselves with the Nursing and Midwifery Council (NMC) Record Keeping document to promote and protect the health and well being of people living in the home. When mops are not in use the home should store all mops inverted (upside down), this reduces the risk of cross contamination. The home should have a detailed cleaning schedule for the laundry, this should include the daily laundering of all mop heads. The home should keep a copy of the induction records for new staff. They should do this so they can demonstrate new staff have been supported through the process and have received a suitable induction to social care work. 6 9 7 26 8 26 9 30 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!