Inspection on 01/04/10 for Diamond House Care Home

This inspection was carried out on 1st April 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Diamond House Care Home 10/06/10

Diamond House Care Home 09/07/09

Diamond House Care Home 19/01/09

Diamond House Care Home 26/02/08

Diamond House Care Home 18/04/07

Diamond House Care Home 22/05/06

Diamond House Care Home 13/12/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Key inspection report Care homes for older people Name: Address: Diamond House Care Home Bennett Street Downham Market Norfolk PE38 9EJ     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: Ruth Hannent     Date: 0 1 0 4 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 31 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 31 Information about the care home Name of care home: Address: Diamond House Care Home Bennett Street Downham Market Norfolk PE38 9EJ 01366385100 01366385600 diamondhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Diamond House is a care home providing residential care for up to 42 older people including service users with dementia. It is situated on the edge of the town of Downham Market and is within easy reach of local facilities including shops, pubs and other community facilities. Diamond House is purpose built with accommodation provided on two floors. Stairs and passenger shaft lift service floors. There are 38 single rooms and 2 shared rooms. There are patio and garden areas that are visible from a number of service users bedrooms. Diamond House is one of several homes in Norfolk owned by the proprietors. The range of weekly fees at the home is £275 to £550. Care Homes for Older People Page 4 of 31 Over 65 42 42 0 0 0 9 0 7 2 0 0 9 Brief description of the care home Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report was completed after an unannounced visit to the home that lasted six and a half hours. During this visit care plans were looked at in detail, health and safety records were inspected and residents and staff were observed throughout the day and spoken to about the service offered. We took into account the information AQAA (Annual Quality Assurance Assessment) we received prior to the inspection that had been completed by the Deputy Manager. We also took in to consideration information from other professionals who have informed us of events and incidents that have occurred in the home since the last inspection. Residents, staff and relatives surveys received prior to this visit have also been taken into account with comments quoted in the text of this report. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to improve the use and recording practices in residents care plans to ensure all needs are monitored, reviewed, actioned and improved. The information sometimes identifies a problem but no action is taken. The care plans all need to be fully reviewed so that gaps in information can be addressed. The mealtime experience for those residents who live upstairs needs to be improved to have staff who are available to sit and encourage residents with their meal, ensure the person has a choice of what they would like to eat, that the food is served hot, be able to monitor and record what is eaten and follow up any concerns. The home needs to employ more staff and ensure that there are no gaps on the rotas that also include domestic and catering staff. The kind of needs many of the residents have at Diamond House show a high level of staffing is required to offer the full support to the individuals. The environment, especially upstairs is small and with everyone trying to sit in the one lounge that has to accommodate hoists and wheelchairs the area is cramped and lacking in homeliness. More space is required to make this comfortable. The residents do not have access to an outside garden and are walking the corridors. Consideration Care Homes for Older People Page 7 of 31 should be given to how people with dementia can have access to the garden. The home needs to ensure that fire door closures are on all doors to be certain those doors will close in the event of the fire alarm being triggered. The home needs to recruit a suitably qualified and experienced Manager who can bring leadership back to this service and take it forward through quality monitoring, reviewing and improving. 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 8 of 31 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 9 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does offer information about the service. Visits are encouraged and a preassessment of needs is carried out to ensure the service at Diamond House can meet the potential residents needs. Evidence: In total the Commission was sent 9 completed surveys that were from the residents who live at Diamond House. 6 of them tell us that they were offered the information about the home prior to admission so they could make an informed choice as to the suitability of this home. 2 surveys tell us that their families made the decision for them and 1 survey told us that they did not have the information. The home does have a service users guide and home brochure that was seen at the previous inspection and the AQAA does inform us that the home is in the process of completing a new homes brochure. Residents are assessed prior to admission by a Senior staff member. Copies of Care Homes for Older People Page 10 of 31 Evidence: completed assessments were noted within new residents care plans and appeared to hold some information that would enable a decision to be made as to the suitability of the service to meet the individual persons needs. Relatives and potential residents are encouraged to visit the home and according to comments written by relatives they are made welcome. Care Homes for Older People Page 11 of 31 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. The home does have care plans that are basic and give staff a picture of the needs but they are not focused, detailed, followed through when problems arise or reviewed on a regular basis. Health care needs are supported by the professionals and medication procedures are carried out correctly however, dignity at all times is not always maintained. Medication administration is carried out correctly but record files need to be stored safely. Evidence: During this visit a number of care plans were looked through, with 2 looked at in detail. The formats for the care plans are all in place and a number of care plans also have a risk assessment attached to the care plan. Unfortunately these are in place but not observed in detail by the staff. For example a resident was noted in the care plan and daily records to have little or no appetite which had changed over the past few months. Weighing was spasmodic and there was no reference to advice or support being obtained from a dietician. This particular resident was observed during the meal time. It was noted that staff were aware of the difficulty in encouraging this person to Care Homes for Older People Page 12 of 31 Evidence: eat and soup was sent for, after an attempt to eat the meal was made, but still no further action was taken to refer on to experts regarding suitable diets. The weight loss is obvious with clothes being very loose and baggy which was pointed out to staff during this visit and who agreed the person had lost weight. A recent visit by the Quality Officer from Norfolk County Council and the Safeguarding Social Worker have also identified that concerns within care plans are not followed up and the details that have been found by them have been shared with us. Another example was of a resident who is having numerous falls and yet no follow up has occurred regarding looking at the pattern of falls or the support of the falls co ordinator. It was also noted on the care plan that the auditor from Southern Cross had looked at care plans on 05/03/10 and stated risk assessments need to be in place for behaviour and hallucinations. Also advice from a dietician was required. These were not yet noted as actioned in the care plan even though the audit was a month ago, nor was there any reference to the need for further help in the daily records, even though the lack of appetite and loss of weight is mentioned regularly. Residents in the upstairs of the home appear a little unkempt with the gentlemen seen, all looking in need of a hair cut. On discussing with staff some people may refuse a hair cut. This was noted in the hairdressing folder but it was only the ladies who refused with no record of the men being asked. In the care plans there is no information to tell the staff how often they would have seen a hairdresser prior to admission with no information about how they like to style their hair. Although basic information is in the care plans they are not detailed to show they are for the individual nor do they follow through the concerns to improve the outcomes for the person. The care plans have been reviewed in the last month but it was noted that the gaps between reviews are long and not regular with some that have gone as long as 6 months or more without a review. The home does receive support from the GP practices within the area and all residents are registered with a practice. District Nurses visit when requested and work with the staff with the health care needs of residents. There was detailed information about the continence needs of one resident but when a problem was identified the information did not tells us what action is/was taken to rectify the problem such as how to encourage someone to change a pad. The medication needs of residents was not looked at in detail at this visit as a recent inspection by the Primary Care Trust had been carried out in the home the week prior to this visit. The Senior on duty gave us a picture of the inspection carried out and reported to us that no major concerns had been raised. It was noted on this visit that Care Homes for Older People Page 13 of 31 Evidence: the folders containing the MAR sheets were old and loose with paper records not securely in place. There were also some photographs missing of residents with others not looking anything like the person they belonged to due to the photograph being a number of years old. The recording temperature of the medication storage room and fridge were fully up to date and appeared correct with no gaps seen from day to day. During the day it was noted how courteous and respectful the staff were with each resident, especially upstairs where it was noted a number of residents were presenting a challenge to the staff. Due to the time of the visit and the lack of staff available a GP came to see a resident and continued to carry out his examination in the dining room with 9 other residents in the room listening and seeing what was happening. The staff member did not offer to take the person to their room nor did the GP offer to wait until the meal was finished. Dignity, privacy and respect was not taken into consideration for this person who was examined at the meal table. Care Homes for Older People Page 14 of 31 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. Activities have improved in the home and people are offered more stimulation with a wide variety of activities for three days a week with more hours planned to include weekends. Friends and families can visit and are welcomed at any time. Meals have improved but the mealtime process is in need of improvement. Evidence: On the day of this visit there were no activities taking part. Residents were just sitting with the television on. The home has recruited, since the last inspection, an Activities Organiser who has made a big difference to the home but is only in the service three days a week. A full programme of events that are varied and stimulating are displayed in the entrance and photographs of trips out show happy smiling faces. The comments on the surveys such as, there is so much more to do with activities now, also tell us of the improved activities and how good this designated person is with motivating and encouraging residents to be involved. We are told that more hours have been found for an activities person that will include some weekend hours that will improve the activities even further. It is unfortunate that when that designated person is not on duty very little happens as mentioned by some residents. In the upstairs area many residents were walking up and down the corridors looking in and out of rooms and Care Homes for Older People Page 15 of 31 Evidence: some were distressed. One particular person required a lot of time and support due to the distress, which was given by a carer, but only in short spells. This did not help the rest of the residents who had limited staff support while the attention was given to this one person. Although the staff were very patient and tried to occupy residents there was very little time to do this. Families come and go as they wish with all the relatives surveys received telling us they are welcomed and always updated by staff. Some of the rooms at Diamond House are shared rooms and it is not clear where visitors would go if they wished to have some privacy with the resident, especially upstairs where the lounge is too small and the other small room is used as an office. The residents who were spoken to downstairs tell us that the meals have improved over the past few weeks with comments fed back to the kitchen being listened to and that more home cooked pies and meat are now on the menu. The meal in the downstairs dining room appeared to go well with choice and food served from the hot trolley that was commented on as being delicious. There are less sausages now was one comment and at last we have good meat such as steak pie and chicken in a nice sauce. Upstairs the situation was different. The meal was sent in the lift on an ordinary trolley (not heated) with covers over the food. No choice was offered at the time and the meal was taken in 2 sittings as the room is not big enough for all 25 residents. The people who need assistance have all the staff in the dining room to help with the meal. Two residents were noted not to be eating and by the time staff noticed, the meal had been without a lid for a number of minutes and appeared cold . The GP arrived in the middle of the meal which then took the attention of one staff member. Another staff member had come up from downstairs to help with the meal process but due to the number of people who need encouraging and supporting to eat their meal it was disturbed and food was exposed to the air for at least 5 minutes. Clear observation and encouragement of residents who are poor eaters was limited due to the staff being busy elsewhere and the main lounge, where a number of residents were seated waiting for their meal, were left unsupervised. Care Homes for Older People Page 16 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does have a complaints procedure and residents and families will make a complaint if necessary. The residents are protected from abuse as staff do now know how to report on any concerns regarding potential abuse. Evidence: The home has a procedure that is on display and in the homes literature on how to complain. From all the surveys from relatives and residents (15 in total) 3 said they do not know how to complain, 2 said they would ask and the other all said they knew how to complain. The complaints record held in the Managers office was looked at. A complaint that was made in December and has been carried on into this year has not been upheld. The concern was the lack of management support in the building due to the Manager being absent and then leaving. A letter was written in reply to say the home would be covered by a Manager but this still did not happen and again a letter was sent by the complainant with concerns of lack of management. The home still has no permanent Manager with the Deputy covering both her post and the Managers while the problem is resolved. The home staff team are trained in the protection of vulnerable adults which is recorded on the training matrix and certificates are held in the staff members folders. On talking to staff they tell us how they understand how to refer on any concerns that Care Homes for Older People Page 17 of 31 Evidence: may be safeguarding issues. The team from safeguarding have visited the home a number of times to talk to the staff about concerns and to inform the team of their duty to refer any concerns. Some recent concerns that had not been forwarded to the correct safeguarding team have recently been referred on and action has now been taken. Care Homes for Older People Page 18 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment, especially upstairs, does not meet the needs of the residents who are now using the service. The equipment to ensure correct and safe methods are used should be available for all users. All bedroom doors should have fire closures attached for safety. The home should ensure they have enough staff in the building who can keep the home clean and hygienic. Evidence: The home is a purpose built establishment with limited grounds for wandering and viewing. The residents with high needs and who may challenge the service have no outdoor space due to living in the upstairs secure area. The 25 residents who live upstairs all share one small lounge that is cramped with furniture and where people who need equipment or wheelchairs find it difficult to get in. The quiet lounge is now used as an office and although this room was planned as a sensory/activities style room it is not used for that purpose at this time. The dining room is small and can only seat a maximum of 20 people at a time and so the home has 2 sittings. With no outside space, a smaller lounge area than downstairs, yet more residents who need Care Homes for Older People Page 19 of 31 Evidence: space to wander and a number of people who challenge the staff the whole area appears cramped and as stated by one distressed resident too noisy. We found this person sitting in the furthest bedroom to get away from the noise and be quiet. A number of upstairs bedrooms also are missing fire door closures and no risk assessment has been put in place. The residents are constantly opening the doors and leaving them open. This was pointed out to the management and orders are to placed immediately for all doors to have self closures and a risk assessment clearly available for all staff to read while awaiting delivery. Family members have told us that the home is clean in communal areas, but bedrooms are often forgotten. Another told us that old furniture and mattresses are left outside the property for long periods and make the place look shabby. Although this survey was completed a few weeks prior to this inspection visit it was noted by us that the old mattresses and furniture were still at the front of the property. The bedrooms appear large enough with some rooms used as shared rooms that house appropriate furniture. The rooms are basic and some have an en suite facility. The corridors have been made tactile with items to touch and feel. This helps occupy the residents who spend much of their waking time walking the corridors. Some areas such as bathrooms have been painted inappropriately with pictures that are not age appropriate. The upstairs area has at least 6 people at present who require moving and handling equipment. The home has equipment but it is recognised that there are not enough items such as sliding sheets to meet the needs fully and safely and more sheets are to be purchased by the home. There is suitable bathroom lifting equipment and enough space to assist with bathing. The home uses one bathroom to store all the hoists in as there is no storage facilities in the home leaving 2 bathrooms only for the 25 people upstairs. On the day of this visit the home did not have the correct number of domestic staff on duty which left many upstairs rooms not cleaned. No odours were detected but toilets and en suites appeared to be in need of cleaning. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does have a core of very good and suitable staff but does not have enough staff on duty to ensure the needs of the residents in this home have their needs met fully. The recruitment of staff is carried out correctly and no one commences employment without all the correct paperwork being in place to ensure all residents are cared for by safe hands. Training and induction is carried out correctly. Evidence: On the morning of this visit there were 3 carers and 1 agency staff member upstairs for 25 residents. Downstairs there were 2 carers to 17 residents with a Senior staff member floating between the two floors dealing with medication and senior tasks. There was not a deputy manager, manager, activities co ordinator or 2 domestic staff, all of which should have been in the building. With this lack of personnel the home was not functioning to meet the needs of the residents. At a strategy meeting held the week before this inspection we were told that at all times agency would cover the short fall in staff while recruitment was taking place. This was not evident on this day and the home, who have already had a complaint about the lack of management and which has also been reflected in the staff surveys, were not able to meet the needs Care Homes for Older People Page 21 of 31 Evidence: fully of all the residents. We need good, consistent management and staff are so good but we need management to give us support and guidance are just some comments received. Residents families tell us how good the staff are and the surveys reflect this with comments such as, the staff are always busy but have time to talk to us about any concerns. The family member spoken to on the day told us that the staff are great and although often working with less staff, are always kind and considerate. A number of residents were observed in the upstairs group where time and attention was needed for the people who were showing signs of distress (weeping and anxious in voice) or requiring attention/assistance with their day to day activities. This was also obvious at the meal time where assistance was fully required by staff sitting and encouraging them with their meal but which was not possible due to the lack of staff available. The bedrooms were also noted to have not been cleaned as there were no domestic staff upstairs. The home should have three on duty with one of those working in the laundry. On this day there was only 1 domestic who was being shadowed by a new staff member as part of their induction. The Administrator went through the personnel files with us and three were chosen at random. All the correct paperwork was found and the person named had a training file and a folder full of training certificates. The training matrix was shared with us that showed a good system to train and update staff. On talking to the newly recruited carer she told us that she is enjoying the job and that her induction in the home was thorough and that she has already carried out the moving and handling training before she could transfer anyone. the full Skills For Care is yet to be started. Care Homes for Older People Page 22 of 31 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 does not have appropriate management cover for this home to ensure the tasks for a Manager can be carried out fully and competently. A full quality monitoring system to ensure aims and objectives that meet the needs of residents are achieved needs to be in place. Residents finances are well managed. Health and safety in the home is being carried out safely at present. Evidence: The home has struggled with management cover for a number of months. The previous Manager who had only been in post about a year had a number of weeks off sick and has now left. The home has not had a Manager in permanently for some time. The Deputy Manager is trying hard to cover both her own role and that of the Manager but staff and residents families have commented in a number of surveys that Care Homes for Older People Page 23 of 31 Evidence: the home is in great need of leadership. A letter of complaint has also been received at the home regarding the lack of management with a reply returned to the complainant saying management cover would be in place which was seen in the complaints folder. This has not happened to date and although Southern Cross are interviewing for suitable candidates no one is fully managing the home. There was no manager in the home during this inspection and therefore the Regional Manager was called in and was available for answering questions but with no Manager it was difficult to find out about the ethos of the home. Two staff told us that they have struggled with the lack of leadership and although the Deputy is very hard working and supportive she is trying to do too much. Although there is no documented evidence within the home of an annual quality audit the surveys received by us are positive. They tell us the care staff are good, even when the home is short staffed, that visitors are always made welcome, that they visited the home prior to making a decision to move in. We are told that the concerns about the meal were listened to and that the meals have improved. Activities and outings have improved with the introduction of a designated staff member. Once the home has a competent Manager a quality monitoring system needs to be introduced fully. The Administrator has been in post just over a year and has support and regular checks from the Administration Manager for Southern Cross. All monies handled on behalf of the residents are thoroughly checked and recorded. Although this was not inspected on this occasion it has been recognised through procedures seen throughout the Southern Cross homes that this area of the service is carried out fully and thoroughly. The home has a designated Maintenance Officer who showed us the books held that have fully recorded details of the servicing of equipment plus weekly, monthly, 6 monthly checks for health and safety such as fire, water temperature and safety equipment. Staff are trained and nearly all up to date in the statutory training as shown on the staff training matrix and of which the Administrator keeps a check on to ensure staff who are due a training are placed on the next available course. The home has not been sending through to the Commission the Regulation 37 notifications that informs the Inspector of any deaths, injuries or major events that may adversely affect the well being of a resident. This has been discussed after a visiting Manager discovered the concern and should now be rectified. Care Homes for Older People Page 24 of 31 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 33 24 The home does need to introduce a robust quality monitoring system and include all stakeholders. To ensure the monitoring, improving and development of the home is suitable for the residents of the home. 01/10/2009 Care Homes for Older People Page 25 of 31 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 Care plans need to reflect the changing needs of residents with the correct action recorded as needs change. To ensure that any concerns or changing needs are dealt with and outcomes for residents are improved. 01/06/2010 2 7 15 All care plans must be reviewed monthly. To ensure that all residents are having their needs met correctly. 01/06/2010 3 7 15 The individual care plans 01/06/2010 must be detailed and person centred to reflect the individual support required. To ensure that people are cared for in the manner expected, by all staff who can read the information clearly. Care Homes for Older People Page 26 of 31 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 4 10 18 Staff must be aware that dignity at all times is paramount. To ensure that at all times residents are treated with respect and their right to privacy is upheld. 01/06/2010 5 12 16 The home needs to provide stimulation and occupation to all residents that is suitable for them as an individual. To ensure that all efforts are made to occupy at all times residents who may challenge the service. 01/06/2010 6 15 16 The way meals are presented and the way people are supported to eat the meal needs to be improved. Meals need to be served with choice, at a suitable temperature and that residents are helped in a manner that is relaxed supportive and observed to ensure a good diet is eaten. 01/06/2010 7 16 22 The home must carry out 01/06/2010 the action stated in the reply letter when a complaint is made. Care Homes for Older People Page 27 of 31 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 Facts stated in the replys must be carried out to ensure the outcome is as stated. 8 19 23 Bedroom doors must be fitted with fire door closures To ensure that all residents are as safe as possible in the event of a fire. 9 19 13 A risk assessment must be in place for the missing fire door closures To ensure all areas of potential risk while waiting the fire door closures are recorded and actioned if required. 10 19 23 The home does need to look 01/08/2010 at the number of people who live upstairs and ensure the facilities are suitable for that number and that the needs of people with dementia can have those needs met in that environment. The lounge and dining rooms need to offer a comfortable and suitable setting for all residents 11 27 18 The home must ensure that at all times qualified, competent and experienced staff are working in the 01/06/2010 01/05/2010 01/06/2010 Care Homes for Older People Page 28 of 31 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 home in such numbers as are appropriate. To ensure the health and welfare of residents is upheld. 12 31 8 The home must appoint a suitable Manager. To ensure suitable leadership and skills are in place to offer stability and management skills to this home. 13 33 24 A quality reviewing system must be carried out. To ensure that the service reviews and improves the care service offered. 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 01/06/2010 01/09/2010 1 9 The medicines folders containing the MAR sheets need to be replaced with up to date photographs and record sheets that are not going to fall out. The home needs to ensure that procedures regarding any concerns are passed to the safeguarding team who will make the decision as to what is safeguarding or not The home needs to consider the need for people who now live upstairs to have the availability of outside space. All equipment including sliding sheets need to be in sufficient supply to meet all needs. 2 18 3 4 19 22 Care Homes for Older People Page 29 of 31 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 5 6 7 26 26 31 Old furniture and mattresses should be disposed of and not stored at the front of the building. All areas of the home should be kept clean and hygienic. The home should have a suitable person in post to manage the service and not expect the Deputy to cover her own and the Managers post in such a large home. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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