Inspection on 16/03/10 for Dearnlea Park Care Home

This inspection was carried out on 16th 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dearnlea Park Care Home 28/09/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Dearnlea Park Care Home Park Road Thurnscoe Rotherham S Yorkshire S63 0TG     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: Janis Robinson     Date: 1 6 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 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: Dearnlea Park Care Home Park Road Thurnscoe Rotherham S Yorkshire S63 0TG 01709893094 01709893094 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Elder Homes South Yorkshire Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 67 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 numbers of users who can be accommodated is 67 places. 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 catergories Old age not falling within any other catergory OP Dementia - Code DE Date of last inspection Brief description of the care home Dearnlea Park is a care home providing personal care and accommodation for up to sixty seven older people. Twenty three places are registered for older people with dementia and they are cared for in a separate unit with a dedicated staff group. Care Homes for Older People Page 4 of 33 Over 65 0 44 23 0 2 8 0 9 2 0 0 9 Brief description of the care home Accommodation is provided over two floors. A range of communal areas are provided. A commercial type kitchen and laundry serve the home. A passenger lift provides access to the upper floor. Sufficient bathing facilities are provided. The home stands in its own grounds and has an accessible garden area. There are car-parking facilities. The home is situated off Park Road, Thurnscoe, Barnsley. It is adjacent to a park and is close to local amenities. Main bus routes are close by. At the time of this inspection fees ranged from 356.77 to 386.20 pounds per week. Written information about the home in the form of a Service User Guide is available and can be obtained from the home. 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: The quality rating for this service is zero star. This means that people who use this service experience poor quality outcomes. This was an unannounced inspection carried out by Janis Robinson, regulation inspector and Jo Bell, local area manager. A visit to the home took place between 9am and 5pm on the 16th of March 2010. At the time of this inspection there was no registered manager in post. An acting manager, Josie Beswick and the homes area manager Barbara Duffield, were present during this inspection. This inspection was carried out under a Code B notice. This means that we evidenced serious breaches concerns. Code B gives us the power under the Police and Criminal Evidence Act to take away written records to assist in our inspection. Care Homes for Older People Page 6 of 33 On the day of the inspection staff were observed interacting with people that live at the home. A partial inspection of the environment was undertaken and records relating to care and the running of the home were inspected. Some people living at the home, and relatives, were spoken with about their experiences of the care provided. Some staff were interviewed about their roles and experiences of working at the home. The acting manager and area manager were spoken with about the running of the home. We distributed questionnaires about the home to staff and people living at the home. Three staff and one person living at the home returned completed surveys to us. Comments from these have been included in the relevant sections of this report. 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: Serious issues that posed a risk to peoples safety and well being were identified during this inspection. Care plans and risk assessments had not been completed in full so that staff had access to important information and risks were identified. Health care issues had not been identified and acted upon to keep people well and maintain their health. Some staff were administering medication without being provided with adequate training. Medication records had not been fully completed to uphold peoples safety. Staff showed a lack of understanding and awareness of the issues related to Dementia. This meant that peoples lives and choices were restricted. Staff had not been provided with safeguarding and health and safety training which Care Homes for Older People Page 8 of 33 posed a risk to peoples safety and did not protect them. Staff were unclear of the procedures to follow if they saw abusive practice or an allegation was made. This did not protect people. People had not been provided with written information about how to complain so that their rights were upheld. Staff recruitment practices did not uphold peoples safety. Essential information had not been obtained to ensure full and safe procedures were adhered to. There was no quality assurance system in place so that peoples views could be obtained and acted upon. Staff were bot provided with supervision , for support and appraisal. There was no permanent manager in place. Systems within the home had not been audited or monitored to make sure the home was well managed and people were 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 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 were not provided with information about the home, which limited their rights and choices. Assessments had been carried out prior to admission to make sure the home could meet identified needs. Evidence: The acting manager and area manager were unable to find the statement of purpose or service user guide for the home. None were seen on display in the home, and peoples rooms did not contain a copy of the service user guide. Staff said they were not aware of a new service user guide being available. This meant that people were not provided with information about the home, which did not uphold their rights and choices. A recommendation was made at the last inspection to update the statement of purpose so that it contained up to date details. A further recommendation was made at the last inspection to develop a service user guide so that people were provided with important information. These recommendations have been carried forward. Care Homes for Older People Page 11 of 33 Evidence: A voluntary stop on admissions had been in place for some months, which meant that people had not been admitted to the home. However, in their questionnaire, when asked Did you receive enough information to help you decide if this home was the right place for you, before you moved in?, the respondent said Yes. In addition, one relative spoken with said that they were involved in an assessment that took place prior to their relatives admission. The care plans checked contained evidence that an assessment had been undertaken before the person moved in. This ensured that peoples needs were identified and could be met. Care Homes for Older People Page 12 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. Peoples health and personal care needs were not being fully met due to inadequate systems, procedures and records. Evidence: Two peoples care plans were checked in detail. They contained very basic information and did not give a clear picture of the person, or detail their needs so that these could be met in a way the person preferred. Whilst the plans contained sections on personal hygiene, mobility, diet, health and interests, the information recorded on these sheets did not reflect individual needs. For example, one persons Activities for Daily Living record only stated No problem against most sections. In addition, it stated Uses a frame around the home. The person was observed using a wheelchair and when spoken with said, I used to be able to manage with just a frame, but for some time now I have used a wheelchair because I cant manage a frame. Staff help me move around in the chair. This person was also observed sitting in a wheelchair during the mid day meal. This Care Homes for Older People Page 13 of 33 Evidence: change had not been reflected in the care plan. Most sections of the care plans had not been dated, and there was limited evidence to verify that they had been reviewed on a monthly basis to keep them up to date. One plan contained a monthly review sheet with one entry No changes dated 11/03/09. Some sections of care plans were blank. One persons plan had no entry against Culture and Religious needs, and No problem against the Self Esteem section. This person was spoken with. They took great pleasure in saying that they had recently won an award for positive thinking. They said, I always look on the bright side of things. It doesnt do any good to dwell on bad things. Everyone that knows me knows I am always happy. This important information was not recorded to help provide a picture of the person. Each section of the care plans contained Key Worker Notes. All of those seen were blank. Care plans contained brief detail about peoples personal care needs, for example, Assist with all care, and One person to assist, was recorded in the care plans checked. This meant that there was insufficient information about the actions required of staff to make sure people were supported in the way they preferred. Whist a chart was kept regarding personal hygiene, those seen had not been consistently recorded to say what support the person had been given. Whilst staff undertook daily records, those checked contained very brief detail, such as No problems, and Assisted with care. This meant that there was no clear record about the persons well being and how they had spent their day. The care plans contained some written risk assessments. However, most seen were not dated and there was no evidence to verify that they had been reviewed to keep them up to date. One persons plan contained a moving and handling risk assessment that was inaccurate, as it stated that the person used a frame, when a wheelchair was used. The risk assessments relating to nutrition, falls and pressure sores had not been completed. In their questionnaires, when asked Are you given up to date information about the needs of the people you care for?. Two staff said Always and one staff said Sometimes. The acting manager was aware that care plans required updating. However, the week of the inspection was her first full week at the home. She stated that two of the thirty four care plans had been updated. Care Homes for Older People Page 14 of 33 Evidence: People spoken with said that they could see their GP when they needed, and a chiropodist and district nurses visited the home. However, lack of information recorded in care plans created the potential for risk. One persons daily records stated District Nurse visit to give injection. The plan made no reference to this and it was unclear what the injection was for. In the GP visit sheet, it was recorded that the nurse had visited to give an iron injection. However, the dates recorded on the visit sheet did not correspond with the dates detailed in daily records. One person told us that they had a sore foot. This was seen to be bruised and appeared sore. Staff confirmed that they were aware that the person had been complaining about their foot, but no action had been taken to act upon this and make sure that any treatment was provided. An immediate requirement was issued during this inspection to ensure that action was taken to rectify this. It was confirmed the day after this inspection that the person had been seen by a GP and no treatment was required. One persons file held loose letters from hospital referring to appointments and treatments. No other information about these health issues were recorded in their plan. Requirements to fully complete and update care plans and risk assessments were made at the last inspection. It was evident from the records checked during this inspection that these had not been acted upon. The lack of information in care plans, risk assessments and health records, and the lack of response or action by staff to health issues poses a serious risk to peoples well being. A warning letter regarding care plans and risk assessments was sent to the provider the day after this inspection to ensure these issues were acted upon as a matter of urgency. A policy on medication was in place. Senior staff administered medication and part of a medication round was observed. Medication was administered safely and the records were signed after the senior staff had made sure medication was taken. Some medication administration records (MAR) were checked. These had not been consistently completed and several gaps were apparent on some records which meant it was unclear if medication had been administered or refused. This did not uphold peoples safety. Some stocks of medicines were checked, and these corresponded with the records. Medication was securely stored. However, two senior carers spoken with said that they had not been provided with medication training. They said that another senior had talked to them about medication administration, and they had been observed handing out medication. When records were checked, it was apparent that Care Homes for Older People Page 15 of 33 Evidence: one of the seniors had had medication training from Boots, but had forgotten. Staff showed a lack of understanding of the risks posed to vulnerable people regarding medication. At the last inspection gaps in medication training and MAR were identified. Requirements were issued to ensure staff were provided with training, and MAR were fully completed. It was evident from the records checked during this inspection that these had not been acted upon. This poses a serious risk to people. An immediate requirement was issued regarding the training of staff in safe medication administration. We were informed the day after this inspection took place that further training had been organised for the 23rd of March 2010. It was confirmed that the untrained member of staff would not administer medication until they had been provided with this training. All of the people spoken with said that staff respected their privacy. Staff were observed knocking on doors before entering peoples rooms. People said that they were well cared for. Comments included, Its smashing here, the staff are kind. I cant grumble. It could be a lot worse. The girls (staff) are lovely. They (staff) give me the help I need. Its all fine. Ive no worries. In their survey, when asked what the home does well, one person said, Cares for all my needs. Staff said, Meets the standard of care of service users. Treats everyone with respect. Listens to residents, families and staff. No problems with carers or standard of care. The problems all stem from management. Elder Homes give no support or guidance to staff, only criticism. One relative spoken with said, Care Homes for Older People Page 16 of 33 Evidence: The home is nice and clean, they have enough staff. My (relative) always looks clean. They do a reasonable job. The interactions observed between staff and people living at the home appeared caring and respectful. Staff included people in conversations and took time to talk to them. This made sure that people felt respected. Care Homes for Older People Page 17 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. Peoples daily life ans social activities were restricted due to lack of choice. Evidence: An activities worker was employed for part of each week so that people were provided with some choice about how they spent their time. Posters and pictures were on display that showed a variety of activities were provided, such as arts and crafts, quizzes and baking. People spoken to said that they enjoyed the activities provided. Comments included, I like to join in, it helps pass the time. I enjoy the quizzes. However, most of the activities took place on the ground floor residential unit. People with Dementia were accommodated on the first floor, and they were provided with very limited activities, which restricted their choice. One staff said that activities were not routinely offered, just Sometimes we will get colouring books out, and They are not interested. Staff said that people Had not been outside for months. One person was known to like outdoors, and often tried to exit the unit, yet time spent outside Care Homes for Older People Page 18 of 33 Evidence: was not provided. This seriously limits peoples choices and does not respect their preferences. People spoken with said that their friends and relatives could visit them at any reasonable time, and they could choose to spend time with them in the privacy of their rooms if they wished. People said that they could get up and go to bed when they chose, and how to spend their time. This showed that some of peoples preferences were respected. A varied menu was provided. People said that they enjoyed the food and could always have something different if they chose. Comments included, The food is okay. I like the food. Recently I lost my appetite a bit and couldnt face big meals. I had sandwiches and salads instead. It was a lot better and now my appetite is back. The cook on duty was aware of peoples preferences, and said that people who needed a soft diet had their food liquidised separately so that it looked more appealing. Fresh fruit and vegetables were available in the food stocks seen to ensure people had a healthy diet. Part of the lunch time meal was observed. Staff were seen sitting with people to offer assistance with eating if they needed this support. However, people with Dementia were not routinely offered choices at mealtimes. Staff said that they just provided what was on the menu as people would not know what they wanted. This evidences a lack of understanding and seriously limits peoples choices. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Unclear and disorganised complaints procedures did not ensure people were listened to and kept safe. Gaps in staff training and knowledge about safeguarding placed people at risk. Evidence: Whilst a complaints policy was in place, no information had been provided to people about how to make a complaint. This information would be contained in a service user guide. However the home had no guide in place at the time of this inspection. One complaints leaflet was found that contained inaccurate and outdated information. This lack of information did not uphold peoples rights. It is acknowledged that since his inspection, a service user guide has been produced and will be given to people so that they have access to information. A complaints file was kept. This was disorganised and there was no clear trail of complaints. The file contained letters and a copy of old safeguarding meeting minutes. There was no record of what documents related to, the action taken in response to complaints and the outcome of complaints. This issue was identified at the last inspection and a recommendation was made to update the complaints systems and provide people with information about how to make a complaint. As no progress had been made this recommendation has been carried forward. It is concerning that peoples concerns and complaints could be lost within this disorganised system. People spoken with said that they could talk to staff if they had any worries, comments included, Care Homes for Older People Page 20 of 33 Evidence: The staff listen to me. I can talk to staff about any worries and they would help me. Ive no worries at all. A policy on safeguarding adults was in place. The training matrix checked showed that only fifteen of the forty eight staff had been provided with safeguarding training. This issue was identified at the last inspection. A requirement was made to ensure that staff were provided with safeguarding training. No improvements had been made. In addition, some staff spoken with were unclear about safeguarding procedures, and the action to take if they observed abusive practice or an allegation was made. Staff were unaware of all of the different types of abuse. One staff on the Dementia unit said, You cant say mental abuse because these people dont remember, so dont know. One staff spoken with said that if they overheard verbal abuse, eg staff swearing at a person, they would Leave it that time if there was a good enough reason. In their surveys, when asked Do you know what to do if someone has concerns about the home? Two staff said Yes, and one staff said No. Lack of understanding of the issues related to safeguarding poses a serious threat to peoples well being and safety. An immediate requirement was issued to ensure that staff were provided with training in safeguarding. Information to confirm this training had taken place on 18th and 19th of March was received by us. 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. On the whole, people were provided with a pleasant, clean and well maintained home. Evidence: Parts of the environment were checked. Communal lounges were well decorated and appeared comfortable. Pictures and ornaments created a homely atmosphere. Suitable bathrooms and toilets were provided. Specialist equipment was available to assist people and equipment had been serviced to make sure it was safe. Peoples bedrooms contained personal items and reflected individuals interests. People spoken with were happy with the accommodation provided. Some parts of the home required attention so that good accommodation was maintained. In some bedrooms, the pillows were old and lumpy. This did not respect people or make sure they were comfortable. One toilet was used to store equipment and furniture, which could be hazardous. Recommendations were made in relation to these issues at the last inspection. No improvement had been made. It is acknowledged that on the day of this inspection new pillows and duvets were ordered over the telephone so that people could be more comfortable. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples well being and safety was not promoted due to insufficient recruitment practices and gaps in staff training. Evidence: The acting manager stated that good levels of staff were being maintained. Staff spoken with said that they were a good team and worked well together. People living at the home said that enough staff were provided. Three staff recruitment files were checked. None of the files contained full information to evidence that thorough procedures had been adhered to. Two records showed gaps in employment history that had not been explained. One record did not detail the dates of previous employment so that these could be checked. One file did not contain copies of references or evidence that a Criminal Records Bureau (CRB) check had been undertaken. This member of staff confirmed verbally that they had their CRB check. One CRB check seen detailed a previous offence. There was no evidence to show this had been explored or risk assessed so that peoples safety was upheld. In their surveys, when asked Did your employer carry out checks, such as your CRB ans references, before you started work?, two staff said Yes, one staff said No. Requirements were made at the last inspection in relation to these issues. No Care Homes for Older People Page 23 of 33 Evidence: improvement had been made. An immediate requirement was issued to ensure peoples well being and safety was maintained by thorough and effective staff recruitment systems. Since this inspection we have received written confirmation that all staff files were being audited, and to ensure full checks were being undertaken where gaps had been identified. The staff training matrix was examined. This showed that staff had not been provided with training at regular intervals to improve and maintain their skills and knowledge. Whilst the training matrix showed that training in Dementia Awareness was part of the training programme, only five of the forty eight staff had been provided with this training in November 2008. The staff spoken with displayed a lack of understanding of the issues regarding Dementia, and how to care for people with this condition. Further comments regarding this have been reported on under the relevant sections of this report. It is acknowledged that since this inspection we have received written confirmation that a training session on Dementia Awareness had been organised for the 22nd of March 2010 for all staff working on the Dementia unit. A further staff training event had been organised for later in the month so that all staff had relevant skills and knowledge to care for people. Care Homes for Older People Page 24 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. The home was not well managed due to lack of effective management, monitoring and gaps in training. Evidence: Since the last inspection the registered manager had left the home. An acting manager was covering the vacancy until a permanent manager was recruited. Josie worked for the Elder Care Homes group and was an experienced manager. The week of this inspection was Josies first full week at the home. Issues reported on in the relevant sections of this report evidence that systems within the home were not being efficiently monitored or audited. This has resulted in serious breaches of the regulations and put people at risk. Whilst there was a quality assurance system in place to obtain and act upon peoples views, there was no evidence to show that this had been implemented. A recommendation was made at the last inspection to implement a quality assurance system so that the home was run in peoples best interests. No improvements had Care Homes for Older People Page 25 of 33 Evidence: been made and the recommendation has been carried forward. Some monies were kept for some people. These were securely stored. Records of monies were maintained and the amounts kept corresponded with the records. However, there was no evidence that receipts head been obtained so that safe procedures were adhered to. The staff files checked showed that staff had not been provided with supervisions for appraisal and support. A recommendation was made at the last inspection to ensure staff were provided with supervision. No improvement had been made and the recommendation has been carried forward. A programme of staff training was in place. The training matrix checked showed that health and safety, food hygiene, infection control, first aid and moving and handling were part of the programme. However, the matrix showed that there were serious gaps in the provision of training, which did not promote peoples safety. For example, of the forty eight staff, fifteen had been provided with moving and handling training, nine with basic food hygiene and nineteen with infection control. Twenty staff had been provided with first aid training so that they knew how to respond in an emergency. However, on the day of this inspection there were no staff trained in first aid on duty in the Dementia unit. A requirement was made at the last inspection to ensure that staff were provided with refresher training to maintain their skills. No improvements had been made and the requirement has been carried forward. These gaps in training do not promote or uphold peoples safety. On the whole, systems were checked and serviced to make sure they were safe. Fire extinguishers had been serviced within the last year to make sure they were in working order. A fire risk assessment had been completed to identify and minimise any risks. Whilst staff confirmed that regular drills and weekly alarm checks took place, the fire book to evidence this could not be found. It is important that this information is kept to evidence that full and safe procedures are adhered to. Care Homes for Older People Page 26 of 33 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 7 13 Risk assessments must be undertaken. To uphold peoples safety. (Previous timescale of 18/12/2009 not met). 30/04/2010 2 7 15 Care plans must be undertaken, fully completed and regularly reviewed. This will mean that full information is available. (Previous timescale of 04/01/2010 not met). 30/04/2010 3 10 13 All staff who administer 18/03/2010 medication must be provided with medication training at relevant intervals. To maintain their knowledge and keep people safe. (Previous timescale of 18/12/2009 not met). 4 10 13 Medication administration records must be fully and accurately completed. To keep people safe. (Previous timescale of 18/12/2009 not met). 18/03/2010 Care Homes for Older People Page 27 of 33 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 5 18 13 All staff must be provided with training on adult safeguarding. To keep people safe. (Previous timescale of 04/01/2010 not met). 18/03/2010 6 29 19 Thorough recruitment 18/03/2010 procedures must be adhered to. A complete application form, full employment history, proof of identity, and two written references must be obtained. All gaps in employment must be explored. To ensure full and safe procedures are adhered to. (Previous timescale of 29/01/2010 not met). 7 29 19 Evidence that CRB checks have been undertaken must be available. To ensure full and safe procedures are adhered to. (Previous timescale of 04/01/2010 not met). 30/04/2010 8 38 18 All staff must be provided with refresher training. This will ensure staff skills are maintained. (Previous timescale of 04/01/2010 not met). 30/04/2010 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 1 8 12 The named individuals foot care needs must be reassessed and professional advice must be sought from health care professionals. This will ensure that appropriate action has been taken to meet health care needs. 17/03/2010 2 9 13 Effective systems for 18/03/2010 handling medication must be put in place. This will ensure that peoples well being and safety is upheld. 3 18 18 People must only be cared for by staff who are alert to the signs of abuse and fully aware of the action to take. This will ensure people are safe. 18/03/2010 4 29 18 Effective and thorough staff 18/03/2010 recruitment systems and full checks on prospective and current employees must be undertaken. This will ensure peoples well being and safety is maintained. 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 1 12 12 People with Dementia must 21/05/2010 be offered choices. A range of activities and time outside the home must be provided. This will ensure that peoples daily life is not limited. 2 15 12 People with Dementia must be provided with choice at meal times. systems must be put into place that assist people to make choices. This will ensure that peoples preferences are respected. 21/05/2010 3 16 12 A system to ensure all complaints are recorded, responded to and audited must be put into place. This will ensure peoples safety is promoted. 21/05/2010 4 30 18 All staff must be provided with training in Dementia Awareness. This will ensure they have the skills and knowledge to promote peoples well being. 21/05/2010 5 33 24 Effective quality monitoring systems must be put in place This will ensure the home is well managed 21/05/2010 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 6 38 18 Sufficient staff must be trained in first aid to ensure there is a qualified person on duty at all times. This will ensure peoples safety is promoted. 21/05/2010 7 38 18 All staff must be provided 21/05/2010 with all aspects of mandatory health and safety training. This will ensure people are kept safe. 8 38 23 Records of fire drills and checks on fire equipment must be maintained. This will provide evidence that appropriate checks have been undertaken and full procedures have been adhered to. 21/05/2010 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 1 A statement of purpose should be made available tp people so that they have access to full information about the home. A service user guide should be provided and made available to people so that they have full information about the home. People should be provided with written information about the complaints procedure so that they have access to this Page 31 of 33 2 1 3 16 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 information. 4 5 6 21 24 33 Toilets should not be used to store equipment to maintain peoples safety. All worn and lumpy pillows should be discarded and replaced so that they are suitable for peoples comfort. A quality assurance system that actively seeks peoples views should be developed so that the home is run in peoples best interests. Receipts should be obtained and kept for all purchases so that people are protected. All staff should be provided with supervision at relevant intervals to make sure they are supported and appraised. 7 8 35 36 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. 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. 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