Inspection on 30/09/09 for Derwent House

This inspection was carried out on 30th September 2009.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Derwent House 17/09/08

Derwent House 10/10/07

Derwent House 01/09/06

Derwent House 06/12/05

Derwent House 16/05/05

Derwent House 05/10/04

Derwent House 21/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Derwent House Ulverston Road Newbold Chesterfield Derbyshire S41 8EW     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: Rose Moffatt     Date: 0 5 1 0 2 0 0 9 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) 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. 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: Derwent House Ulverston Road Newbold Chesterfield Derbyshire S41 8EW 01629537515 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.derbyshire.gov.uk Derbyshire County Council care home 40 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: 40 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Derwent House is located on the north-west outskirts of Chesterfield in a busy residential area, close to local shops and amenities and on a direct bus route to Chesterfield town centre. The home provides personal care and support for up to forty older people, having all single room accommodation, provided over three floors. Wheelchair access is provided throughout the building, which is suitably adapted to assist those people who may have mobility problems, including a passenger lift and emergency call system throughout. There is a range of communal lounge and dining rooms, including quiet areas and a smoking area. Assisted bathroom and toilet Care Homes for Older People Page 4 of 33 Over 65 40 0 1 7 0 9 2 0 0 8 Brief description of the care home facilities are located on each floor. Grounds and gardens are well maintained and include an internal courtyard/garden area with seating for people. People are provided with care and support from a team of care and hotel services staff led by a registered manager, who also has deputy and external management support via Derbyshire County Council. The home provides both short-term respite and long term care provision. The fees for a permanent placement in the home are currently £404.06 per week. This information was provided by the manager on 06/10/2009. Information about the home, inlcuding inspection reports, is available at 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 0 star. This means the people who use the service experience poor quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we Care Homes for Older People Page 6 of 33 have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place on 30th September and 5th October 2009, over a total of 10 hours. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 15 surveys to people living in the home and received 11 completed responses. We sent out 10 surveys to staff employed at the home and received 6 completed responses. We also received 2 completed surveys from social / health care professionals involved with the care and support of people in the home. There were 37 people accommodated in the home on the day of the inspection visit, plus 1 person attending for day care. People who live in the home, visitors and staff were spoken with during the visit. The manager was not available on the first day due to annual leave, but was available and helpful on the second day. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 4 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. 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: Include in admission procedures information about whether the person has made an advance decision on receiving medical treatment, and if they have a Lasting Power of Attorney, Independent Mental Capacity Advocate, or Relevant Persons Representative. Also, consideration of the persons capacity to make decisions about their daily lives, care and treatment. This will ensure that people are safeguarded and their rights are promoted. Ensure that there are person-centred care plans in place for each person, reviewed and updated regularly, and produced in consultation with the person, or their representative. This will ensure that peoples needs are met in the way they need, prefer and expect. Provide sufficient staff at all times to ensure that peoples needs can be fully met. Ensure that all the required documents and information are in place before new staff commence employment at the home. This will help to protect people living in the home by having fully robust recruitment procedures. Notify CQC of all events as required to protect people living in the home. Care Homes for Older People Page 8 of 33 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. There was sufficient information available for people to make a choice about living in the home. There were satisfactory assessments of individual needs, though staffing levels were not always sufficient to ensure peoples needs were fully met. Evidence: We looked at the care records of 4 people in the home and found assessments in place of their individual needs. The assessments were completed prior to the admission of the person to the home. People came for a day visit to the home, and often for a period of short term care, before deciding to live there permanently. Most people told us they had sufficient information about the home, and that they usually had the care and support they needed. Most people told us there were usually staff available when needed, but they always seem to be short-staffed. Although the individual dependency level of each person was assessed, it was not clear how staffing levels were determined in relation to this. Care Homes for Older People Page 11 of 33 Evidence: Staff told us they did not always have up to date information about the needs of people in the home, and that staffing levels were not sufficient to meet those needs. The admission procedures did not include asking if the person has made an advance decision on receiving medical treatment, and recording if the person has a Lasting Power of Attorney (LPA), Independent Mental Capacity Advocate (IMCA), or Relevant Persons Representative (RPR). The Statement of Purpose and Service User Guide had both been updated in May 2009 and included all the required information. The contact details for CQC needed updating in both documents. The AQAA included the statistical information we asked for about admissions to the home and the needs of people admitted. Standard 6 did not apply as there were no people receiving intermediate care in the home. 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. People living in the home were supported by staff working in a generally person centred way. However, care records did not reflect this as there were gaps in information, incorrect information, and a lack of detail about the persons needs, abilities and preferences. People, or their representatives, were not always involved in care planning. Evidence: We looked at the care records of 4 people in the home. All had Personal Service Plans completed by staff at the home. As found at the last inspection, there were gaps in the plans and insufficient detail about the persons abilities and preferences, and of the action required by staff to meet their needs. 1 of the plans had been signed by the person to indicate their involvement and agreement, the other 3 were not signed by the person or their representative. At our last inspection we found that personal service plans were not reviewed and amended to reflect changes in the persons needs and we made a requirement about this. At this inspection we found that this requirement had not been met as the Care Homes for Older People Page 13 of 33 Evidence: personal service plans seen had not been updated with changes in the persons condition and needs. For one person, we found the plan had not been amended since March 2008 even though there were significant changes in the persons physical and mental health. For another person, although the plan had been updated in April 2009, there were further changes in the persons needs that had not been added to the plan. We found that monthly reports about each person by staff were not carried out every month. As noted at the last inspection and above, changes in the persons condition noted in the monthly reports were not used to review the personal service plans so the information in the plans was not up to date. 3 of the 4 care records included a completed assessment of the persons dependency level. However, this assessment did not indicate the overall dependency level and the assessments had not been reviewed. There were risk assessments in place for falls, tissue viability and nutritional risks. However, these were not fully completed and not regularly reviewed. For 3 people the tissue viability risk assessment indicated that a monthly review was required, but this had not been done. There were personal handling assessments and plans in place with sufficient information about the persons needs and the action required by staff to meet those needs. There were assessments of the oral health of each person in place, but again these were not fully completed or regularly reviewed. We saw records of the visits of healthcare professionals, such as GP and District Nurse, with details of any diagnosis and treatment. People told us they could see their GP when they needed to and we saw that people were supported to attend healthcare appointments. Many of the documents seen in care records were not fully completed and were not dated or signed by staff. Staff told us that they did not always have time to carry out monthly reviews and to ensure documentation was up to date. Most people told us they always had the care and support they needed, including medical support. People told us that staff usually listened to them and acted on what they said. People said the staff were very helpful, welcoming and friendly, and there was always someone there to help. We observed that staff had a good rapport with people in the home and treated them with respect. Care Homes for Older People Page 14 of 33 Evidence: We found there were generally satisfactory practices for the safe-handling and administration of medicines. Staff administering medication had received appropriate training, apart from care staff who were administering prescribed topical preparations. The administration of these topical preparations was not properly recorded. For medication prescribed as required there was no information in the personal service plan about why or when this medication should be given, or any alternatives to offer. The AQAA included details of relevant policies and procedures and information about the range of needs of people in the home. The AQAA said that further work was needed to improve care records using the computer system. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities and meals provided met the needs, wishes and expectations of people living in the home. Evidence: There were 3 staff employed at the home to coordinate and help with activities, working a total of 52 hours between them. However, some of these hours were used to help with personal care, taking people to appointments, serving teas and coffees, setting tables, and assisting at meal times. We saw records that showed that most people in the home were offered the opportunity to take part in activities every week. The records showed a range of activities, such as crafts, games, gentle exercise, and trips out. There was a regular religious service in the home. Most people told us they were satisfied with the activities provided in the home. One person said they would like to go out more often. People told us they could get up and go to bed when they wanted to. We observed people moving freely around the home and using different areas. There were regular meetings for people in the home where they could give their views on the service provided and make suggestions for improvements. Care Homes for Older People Page 16 of 33 Evidence: Visitors told us they were always made welcome and could visit at any reasonable time. An area had recently been made available for people in the home and visitors to make a hot drink if they wished to. Most people told they always enjoyed the meals at the home. They said meals are good and I am satisfied with the food. There was a varied menu with choices at each mealtime. The lunch served on the day of the inspection visit appeared appetising. We observed staff giving appropriate assistance during the meal in a sensitive manner. The AQAA said that meal times, menus and activities had been revised as a result of listening to peoples views. The AQAA said they planned to improve by encouraging more involvement of relatives, and by encouraging people in the home to be more flexible in the use of lounges. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory procedures so that people were protected and their concerns taken seriously. Evidence: People told us they would speak to staff informally if they were not happy about anything. Most people said they knew how to make formal complaint, though several people told us they did not know how to do this. We saw that the complaints procedure was displayed in the main entrance area of the home and was also in the Service User Guide provided to each person in the home. People were able to raise any concerns at the regular meetings or directly with the manager. We saw that the records of complaints included details of the action taken and the outcome, and included minor, less formal, complaints. Staff training records showed that all staff had received training about safeguarding vulnerable adults. Staff were aware of the correct procedures to follow if abuse was alleged or suspected. We found that an incident with possible safeguarding issues had not been referred for further investigation and had not been notified to us as required. We had not received any complaints about the home and there had been no safeguarding vulnerable adults referrals since the last inspection. Care Homes for Older People Page 18 of 33 Evidence: The AQAA showed that there were appropriate policies and procedures in place that had been reviewed in the last 12 months. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, well maintained and suitably equipped to meet peoples needs and preferences. Evidence: The home had a choice of lounge areas for people to use, including a room for people who wanted to smoke. 3 of the lounges had dining areas. The lounges were comfortably furnished. The home was suitably equipped with manual handling equipment, specialist baths, ramps and handrails. There was an enclosed courtyard garden with seating for people to use. People told us they enjoyed sitting outside when the weather allowed. Several areas of the home had been decorated, including areas noted at the last inspection as in need of redecoration. Most people told us the home was always fresh and clean. One visitor commented that the lounges sometimes had a smell of old food. We found that the home was mainly free from offensive odours on the day of the inspection visit, except for a smell of urine in the passenger lift. The home appeared clean in all the areas seen. We found that some staff had received training about infection control. Staff were generally aware of good practice regarding infection control.The AQAA said that the Care Homes for Older People Page 20 of 33 Evidence: home had achieved a 4 star very good rating from the Environmental Health department. The AQAA said that toilets had been changed from unisex to designated male and female facilities at the request of people living in the home. Information in the AQAA showed that maintenance of equipment and systems was up to date. Care Homes for Older People Page 21 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. There were not always sufficient staff available to ensure the needs of people in the home were fully met. Evidence: During this inspection there were 37 people living in the home, plus 1 person coming to the home for day care. The staff rotas showed that there were 4 care assistants for the morning shift - although at weekends 1 of these worked a shorter shift until 11 am. There were 4 care assistants working the afternoon shift, 1 of these working a shorter shift from 5 - 9pm every day. In addition, there was a deputy manager working each shift, and the manager working 5 days per week. The care staff were supported by an administrative assistant, domestic and laundry assistants, a cook and a kitchen assistant. As noted earlier in this report, there were 3 staff employed for activities working a total of 52 hours between them. Not all of these hours were used for activities as the activities staff usually helped out with care of people in the home. The staff rotas showed there were 2 care assistants working each night. The manager said that there was sometimes a third member of staff on one night per week, but this was not included on the rotas seen. Staff told us they were concerned about the safety and welfare of people in the home during the night as they felt that their needs could not be safely and properly met with only 2 staff on duty. The home is on 3 floors with bedrooms on each floor. We found that there were several people who were Care Homes for Older People Page 22 of 33 Evidence: wakeful and walking around during the night. As there were people who needed 2 staff to provide care, this meant that there were times when both staff were occupied and unable to supervise people who were walking around. The night reports showed that there were times when the night staff were both occupied with people for around 30 minutes. The manager was not clear about how the needs of people in the home were used to determine the staffing levels. The dependency level of each person had been assessed using a chart to determine the persons needs in activities of daily living, such as mobility and eating and drinking. The assessments seen did not give the overall dependency level of the person. It was not clear if or when the dependency assessments were reviewed - 1 chart was dated October 2007 with no reviews evident. The manager had carried out an assessment of all dependency levels in the home in August 2008 and this had been updated in October 2008, but not since then. From discussion with the manager and staff, we found there were 8 people who needed 2 staff for all their manual handling needs, 19 people with communication and comprehension difficulties which meant that providing care often took longer, and all the people in the home needed help with bathing. People told us there were usually staff available when needed, though one person said the home was understaffed and another person said I cant understand why they are always short staffed. People said staff were always busy. One person said they sometimes had to wait for staff attention when moving from the first floor to the ground floor for breakfast. Another person said they would like to have more than one bath per week, but knew staff would not have the time to do this. One person said they had hoped to do more in the homes garden, but had been told that staff did not have time to spend on this and consequently the home was unable to enter the annual garden competition for local authority care homes. Staff told us that the staffing levels were not sufficient to meet the needs of people in the home. Staff said Derwent House is always under staffed for the needs of the residents and as residents are high dependency we have failed to fulfill our job properly. Staff said that there had been some improvement recently as a laundry assistant had been appointed and this took away some of their workload. Also, an administrative assistant had been appointed and this helped with the workload of the deputy managers and the manager. New relief staff had started work and this had helped with covering shifts for staff sickness and holidays. We found that nearly all care shifts had been covered since the beginning of August this year. During the inspection visit we observed that staff appeared busy and call buzzers were Care Homes for Older People Page 23 of 33 Evidence: sounding frequently. At lunchtime, 2 staff were occupied with a person who was unwell and so the lunch was delayed. Some people waited 30 minutes at the dining tables for their lunch to be served. The deputy manager on duty was occupied for over an hour with the morning medication round. We were told that the planned activities for the morning had not been carried out as the activities staff were needed to support the care staff. We found that people were not offered baths at weekends due to the lower staffing levels in the mornings. At our last inspection we found similar issues with staffing and made a requirement that there must be suficient staff provided at all times, taking into account the dependency levels of people living in the home. This requirement had not been met. Staff personal records were not kept at the home as they are held centrally by the local authority who own the home. We requested the application forms, references, and confirmation that satisfactory Criminal Record Bureau (CRB) disclosures had been obtained for 3 members of staff. We saw the application forms and references, but did not receive any information about the CRB disclosures. One member of staff did not have a full employment history on their application form. For one member of staff the dates of previous employment given on the application form did not match the dates given in the reference from that employer and there was no explanation of this. Two members of staff had 1 written reference instead of 2 as required. The manager said that she had seen the second reference for 1 person, and for the other person there had been difficulty obtaining the reference as the employer had gone out of business. She did not know if an alternative reference had been sought. One person had previously been employed in another care home and there was no written explanation of why they had stopped working there. Staff had completed an induction programme that met Skills For Care Standards. Staff were up to date with all the required training. Staff told us that there was a good training programme, although some staff said they did not always have training to help them to understand and meet the needs of people in the home. Most of the care staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. People told us there were good caring staff, and that staff were welcoming and friendly and very helpful. The AQAA said that the home had well qualified and experienced staff who are trained to meet the needs of our residents and the establishment staffing ratio is consistently maintained. The home had improved by better recording of staff training Care Homes for Older People Page 24 of 33 Evidence: and an increase in the hours allocated to the home. There was no information about what the home could do better in this area. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of action on requirements on requirements made at the last inspection and poor record keeping meant that the home was not operated in the best interests of people living there. Evidence: The manager was suitably qualified and experienced to run the home. She was supported by a team of deputy managers and an administrative assistant. She and the deputy managers said the appointment of the administrative assistant had really helped with their workload. We observed that the manager was available to speak to people in the home and visitors. People told us they liked the manager and had missed her when she had been away on holiday. Staff said they found the manager approachable and said she listened to their concerns, but they felt that appropriate action was not always taken. They said that this was sometimes because issues needing tackling by more senior management. Some staff said they did not have enough support from management. Care Homes for Older People Page 26 of 33 Evidence: Most staff spoken with or who responded to surveys said that communication did not always work well at the home. For example, when appointments for people in the home were made or canceled, when staff shifts were covered, and when there were changes in the needs of people in the home. Staff told us that morale among staff was low at the home due to the demanding workload and the perceived lack of response from management to concerns raised about staffing levels. The quality assurance systems included surveys of the views of people in the home, and/or their representatives. An annual report was produced with the analysis of quality assurance measures and details of action taken. The report was available to people in the home and their representatives. There were regular meetings for people in the home. The service manager carried out monthly visits and produced detailed reports that highlighted the issues raised by staff regarding workload, morale and staffing levels. We saw records of the personal money of people in the home. Receipts were produced for all transactions but we found that many of these had not been signed by staff or by the person in the home. We found the same issue at our last inspection. We sampled health and safety records - accident records, fire safety checks, and gas safety checks - and found these all to be satisfactory and up to date. Staff had received relevant training, such as manual handling and first aid. The AQAA showed that there were relevant policies and procedures in place, although some of these had not been reviewed for several years. We found that 2 incidents had not been notified to us under Regulation 37 as required. The AQAA was completed by the manager. The self assessment section gave a reasonable picture of the current situation within the home, though a few sections about how the home could improve were left blank. There were other areas where more information about how the service planned to improve would have been useful. The data section was fully completed. Care Homes for Older People Page 27 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 15 Service user plans of care 31/12/2009 and risk assessments must be reviewed and amended to reflect any changes to the persons needs. This is so that staff have up to date information to assist them to provide a good standard of care. The previous timescale of 18/10/2008 has not been met. A time extension has been given. If the extended timescale to meet this requirement is not met, enforcement action will be taken. 2 27 18 At all times staff must be provided in sufficient numbers as appropriate for the health and welfare of people living in the home, taking into account peoples individual needs and dependency levels. This will ensure that people living at the home have their needs met at all times. 31/12/2009 The previous timescales of 31/12/2007 and 17/10/2008 have not been met. A time Care Homes for Older People Page 28 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 extension has been given. If the extended timescale to meet this requirement is not met, enforcement action will be taken. Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Each person in the home 04/12/2009 must have a care plan with full details of how their assessed needs in respect of their health and welfare are to be met. This will ensure that peoples needs and preferences are properly documented and fully met. 2 9 13 All staff who administer medication, including prescribed topical preparations, must have relevant training. This will ensure that people receive the correct medication from competent staff. 31/12/2009 3 27 17 There must be an accurate record kept of the duty rota actually worked by staff at the home, and in what capacity. 13/11/2009 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 This will help to ensure that peoples needs are met by appropriate numbers of staff with relevant skills. 4 29 19 The required documents and 30/11/2009 information must be obtained for all people employed at the home. This will help to ensure a robust recruitment system that protects people living in the home. 5 38 37 Notification of all events specified in this regulation must be made without delay. This will help to protect people in the home. 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 31/10/2009 1 1 The Statement of Purpose and Service User Guide should include correct contact details for CQC to ensure people have up to date information. The admission processes should include: - recording whether the person has made an advance decision on receiving medical treatment, and if they have a Lasting Power of Attorney, Independent Mental Capacity Advocate, or Relevant Persons Representative. - consideration of the persons capacity to make decisions about their daily lives, care and treatment. This will ensure that people are safeguarded and their Page 31 of 33 2 3 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 rights are promoted. 3 7 Care plans should be reviewed and updated at least monthly so that information about individual needs is current and correct to ensure those needs are met. Care plans should have a person centred approach and should be signed by the person, or their representative, to indicate their agreement and involvement. This will ensure that peoples needs are met in the way they prefer and expect. For medication prescribed as required, the persons care plan should include details of when and why the medication should be given, and of any alternatives to offer first. This will ensure that people have their medication as prescribed. All parts of the home should be kept free from offensive odours to ensure that people live in comfortable environment. All staff should have training about infection control to ensure that risks to people in the home are minimised. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. There should be 2 signatures for each transactions of the personal money of people living in the home. The person or their representative should sign whenever possible as well as a member of staff. This will help to ensure a more robust system that protects people living in the home. 4 7 5 9 6 26 7 8 26 33 9 35 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. 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