Key inspection report
Care homes for older people
Name: Address: Dorrington House 73 Norwich Road Watton Thetford Norfolk IP25 6DH 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: Dragan Cvejic
Date: 1 1 0 5 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 30 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 30 Information about the care home
Name of care home: Address: Dorrington House 73 Norwich Road Watton Thetford Norfolk IP25 6DH 01953883882 01953889035 dhwatton@btinternet.com www.dorrington-house.co.uk Mr Steven Dorrington,Mrs Lorraine Dorrington care home 52 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Any new admissions to the home must be in the category of Dementia (over 65 years of age). Eight (8) Older People who are named in the Commission`s records may be accommodated. Maximum number accommodated not to exceed fifty two (52). One service user under the age of 65 years, with a diagnosis of dementia, may be accommodated. Date of last inspection Brief description of the care home Dorrington House is a purpose built care home providing residential care for up to 52 older people including care for older people with dementia. It is situated close to the centre of the town of Watton and within easy reach of its amenities. The home comprises accommodation on two floors serviced by a shaft lift, stair lift and stairs, with 20 bedrooms on the ground and 32 on the first floor. All rooms have en-suite Care Homes for Older People
Page 4 of 30 Over 65 52 0 1 6 1 0 2 0 0 8 Brief description of the care home toilet and hand basins in addition to the homes communal showers and bathrooms. There are other communal areas including hairdressing saloon, lounges and dining rooms that accommodate most service users at meal times. The home is one of three homes in Norfolk owned by the proprietors. The range of weekly fees is £380 - £459 Care Homes for Older People Page 5 of 30 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: After the home went through a difficult period last year,but made progress since May and in particular since March this year they managed to significantly improve their service, although there were many issues identified at this inspection that still needed to be addressed. Three complaints issues were investigated internally and externally and the measures resulting from these investigations helped the home to make adjustments and further improve protection of people that used the service; residents, as they called themselves. We asked the service to send us their self assessment, AQAA. We collected quality assurance survey questionnaires and analysed them for this inspection. We made an unannounced visit to the service on 11/05/09. We observed breakfast time in one dining room and conducted an observation in the other dining room using a specialised tool, SOFI, developed by Bradford University, for short observation of people who have difficulty in verbally explaining their experience. Care Homes for Older People
Page 6 of 30 We spoke to several residents during our site visit, to staff members, to the deputy manager and to the consultant who helped the home set directions and principles of care, to improve outcomes for people living there. We checked 4 residents files and 4 staff files. We collected a newsletter and the brochures that provide information about the home to potential new residents and their families. we discussed and checked previous requirements with the management of the home. We combined our findings, analysed collected evidence against National Minimum Standards and reached judgements for each group of standards. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Generally, the home has significantly improved services and provisions and is moving in the right direction. It is only a matter of time before the home will move from a poor to adequate or even a good service rating, as there was a confidence in the management since the improvements started. A new admission checklist introduced in September helped the home assess new referrals better. A new approach to care plans, both the new format and better recording, improved care in general, but there was still a need to co-ordinate and update all entries to ensure that residents receive the care they expected and that their needs were met appropriately and in a timely fashion. A new process, introduced in January, The resident of the day helped all staff focus on each individual and ensured that reviews were carried out regularly for all residents. Medication procedure was significantly improved and ensured much better protection for residents. All medication related requirements were met at this inspection. Even a visitor, the relative of a resident, who had visited daily in the last 5 years, noticed improvements and spoke in a positive way about the home: I have no complaints, the devotion of staff is exceptional, although sometimes more staff are needed. Since April, the ethos and the atmoshpere in the home was much better, staff were more settled, communication had improved and team working principles were implemented. Quality assurance was introduced, surveys collected and, currently, as reported by the consultant after the site visit, the process of analysing comments and creating an action plan was on-going. The home also acted on previous requirements by addressing them in their Improvement Plan. A staff supervision plan was drawn up since the new deputy joined the team and the first sessions had already been held. However the outcomes in terms of frequency of supervision sessions for staff are still to be seen. Safe working practices were addressed and brought the home to a safe level of Care Homes for Older People
Page 8 of 30 operation. What they could do better: The homes brochure should contain some explanation of how to complain or how the complaint procedure works within the home. Despite significant improvements of the services and provisions, the carers still were not able to meet some residents needs at certain times, for example at meal times, due to staffing number and residents high needs. As one carer rang off sick on the day of the inspection and a replacement was found later that day, the morning staff did not meet the residents needs despite their hard work. The lack of a manager for a prolonged period was another issue that affected the management and organisation of the home, despite the improvements achieved since the capable deputy manager had been appointed. The home had a manager from September last year until March, when she was dismissed, as she had not carried out her duties as expected. Although nutritional care was much better addressed, a user stayed without breakfast, partially because she decided to have an alternative and asked for it repeatedly and partially because staff present in the dining room at the time simply could not serve all present residents and respond to their, sometimes confusing, but sometimes clear messages. Healthcare of the residents was relatively good, but the lack of action in relation to a chiropody service for residents resulted in one example of a recorded refusal and another in a complaint resulting from another residents refusal to accept chiropody service. Staff did show respect for residents privacy and dignity in difficult circumstances where conditions such as dementia and depression affected residents engagement in daily life. However, as the SOFI showed, there was a need to address respect in an appropriate way to achieve a satisfactory level and positive outcomes for all residents. Social engagement of residents still varied depending on their abilities. Those with dementia did not seem to be involved in sufficient stimulating activities, while these with predominantly physical needs still needed to patiently wait for staff while they were engaged helping residents with dementia. Both groups suffered in one way or another. The home would need to consider the best options to address the area of activities. Maybe to consider the needs, structures, content and formats of activities seperately depending on residents conditions. Reorganising meal times was definitely one of the major challenges the home would need to face. Passive engagement, long waiting, respect of residents wishes and choices made at meal times, ensuring that all residents eat and enjoy their food, that enough staff were present at meal times to ensure both dignity and meet all residents needs were the issues that needed to be addressed and improved. Apart from staffing complement, the home must improve checks on overseas staff that they employ through an agency, to ensure they comply by law, and arrange for work permits to be a part of staff files. This finding was addressed immediately after the inspection and the missing yellow cards were added to the staff files in the home. The home still needs to meet a long lasting requirement and employ a permanent manager. The previous attempt was not successful as the person appointed was not the best for the job and the home re-started the procedure again, but in view of outcomes for residents, this issue was still open at the time of the site visit. The outstanding requirements were repeated in this report without enforcement actions, as the home made significant progress and seemed to only need more time to achieve positive outcomes in all areas and improve overall rating. Care Homes for Older People Page 9 of 30 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 10 of 30 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 11 of 30 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite significant improvements in admission process and re-organisation of the staff engagement, the home still did not manage to meet the needs of all residents at all times. Evidence: At the entrance to the home through the automatic door, there was a small table with a visitors book, newsletter,comments from visitors record, complaints procedure and certificate of registration. A welcome pack, later collected from the homes administrator, also provided information about the home. This booklet explained the homes aims and objectives and principles of care and provided other relevant information supported by inserted photos. The booklet, however, did not mention the complaints procedure. The deputy manager explained and the files checked confirmed that the procedure was a part of the pack held in the residents bedrooms. The files checked demonstrated that the new format for the initial assessment, now
Care Homes for Older People Page 12 of 30 Evidence: arranged in sections, addressed the needs that would need to be responded upon admission. The forms in three checked files were appropriately filled in. Although the AQAA, a self assessment filled in by the home and the deputy manager, stated that they were able to meet the residents needs, our observation of breakfast time and SOFI, a tool that is used to assess residents state of being, engagement and interactions, all showed that during peak time, some residents needs were not met. We observed a resident suffering from dementia being left without breakfast, as there were not enough staff in the room to ensure that her comments and requests were responded to. Another resident was left for 20 minutes asleep in her wheelchair after breakfast in a dining room. The other two residents created a little conflict and it took staff some time to act and ensure the protection of the resident. Two of four residents observed using the SOFI tool showed a high level of negative or passive state of being, and their interactions were generally poor. However, one or at the time two staff members in the dining room physically were unable to locate more time to these two, because they had to support others present in the room and were engaged in helping some individuals to eat. This collected evidence demonstrated that the home did not meet the needs of all residents at all times. Care Homes for Older People Page 13 of 30 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. Improved care plans helped both staff and residents ensure that their care has been better responded to. However, the lack of staff at peak times meant the respect for dignity of residents fell under an acceptable level and diminished other good work by staff to achieve positive outcomes for residents. Evidence: Three residents files were checked. The new care plan format improved recording and addressed the needs and how to meet them in more detail. There was a short summary created from the main care plan that provided a quick outlook of needs and helped staff get basic information quickly. However, there were discrepancies in these two documents when the change in condition of a resident was recorded in one document but not the other, following regular monthly reviews. The acting manager was aware and undertook action to rectify these small discrepancies in the following review. This was seen in the case where a doctor was contacted and appropriately addressed healthcare needs (pressure sores) and provided advice. This was recorded in the main care plan, while the summary did not mention pressure sores. The home generally addressed the healthcare needs of service users well. Their
Care Homes for Older People Page 14 of 30 Evidence: comments included: Yes they call a doctor for me if I am not well. Surveys carried out through the homes quality assurance review also confirmed that the health care was well organised and conducted. One of the files contained evidence of how the home arranged for a resident to be seen by a chiropodist. The need was identified and recorded, and the chiropodists visit to the home was recorded. The daily notes stated refused treatment. The case was reviewed 7 days later and after a number of attempts, the resident finally accepted treatment which was documented as toe nails cut 52 days after the initial refusal. One of the files did not have anything recorded under life history, but the staff explained that they were collecting full information before adding the story to the file. One of the files contained recorded weight loss of a resident and suggested now monitor weight weekly. The weight chart did not have weekly, only monthly, records. All these records were relatively new for staff and these little lapses did not significantly affect the safety of residents. Both the deputy manager and the consultant were aware that staff needed some more time to learn to record all these issues correctly. The home made significant progress in the area of medication. Their action plan to meet 5 previous medication requirements worked well and ensured all requirements were met and the safety of residents improved. Procedure was checked, administration of medication was observed, a full audit of one residents medication was carried out and evidenced all these improvements. Respect for dignity was seen in staff working with residents patiently and skillfully, calming them down if they were distressed. However, the presence of only one staff member with occasional support from kitchen staff during breakfast, serving 12 residents, seriously undermined respect for dignity. One stayed with no breakfast, as her specific request was not responded to. Another was left alone for 20 minutes resulting in her falling asleep in a wheelchair. A stronger resident dominated a conflict, managing to pinch another user several times before staff could intervene. Two residents scoring highly negative scores compared with other two who scored more positive outcomes during SOFI observation, was another example where dignity was not properly respected and determined the final judgement of poor respect for dignity. This was caused by inadequate staff number in a particular area in the home at peak times. Care Homes for Older People Page 15 of 30 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 were much improved, but not all residents could simultaneously enjoy the improvements and be appropriately stimulated to enjoy the organised activities, thus either going into a very passive state or having to wait beyond a reasonable time. Evidence: The home used various ways to find out what residents wanted in terms of activities. The AQAA reported: Organised events which have taken place are: Halloween Party, Karaoke (twice), Carol singers, Xmas Party, Valentine Party, Rock and Jive,st Patricks Day Party, St Georges Party and a visit by an Easter Bunny. Planned are Flower arranging classes, Clothing Shop, Extend, Coronation Day Party, Queens Birthday party. They also explained: The new care plans also recorded peoples history, hobbies and interests so work is commencing on ensuring that holistic care is offered to the residents. We have a tuck shop and friends of the home up and running. All these activities were relatively new and demonstrated that the home had started addressing these provisions. The deputy manager explained that the home was planning to expand on these to ensure that residents with different needs have appropriate activities organised for each group according to their conditions and abilities so the outcomes were still to be seen. The activities scored the least in the survey carried out by the home in their Quality
Care Homes for Older People Page 16 of 30 Evidence: assurance review. Nutrition had improved since the last inspection. The MUST, a tool to monitor nutrition, was introduced and had already given some results seen in the files checked. In addition comments on food in questionnaires were positive and praised the home for improvements. However, observation and SOFI observation showed that not all residents benefited from the new programme. At least 4 residents did not enjoy meal times, two observed by the SOFI tool did not positively engage at all, another one stayed without food for breakfast and one was pinched at the time when residents needed to experience appropriate care and support. Some residents were encouraged to express and develop their autonomy, but some suffered opposite effects, as stated above, and their dignity was seriously undermined by the events described in our observation comments. Care Homes for Older People Page 17 of 30 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of sufficient staff at peak periods left vulnerable residents prone to abuse by others who, due to their conditions, did not have full control of their behaviour. The extra hazard was created by not checking staff work permits and exposing residents to a potential risk, but was addressed immediately after the inspection. Evidence: A complaint procedure was displayed in the entrance hall. However, the homes brochure did not mention complaints, as stated earlier in this report. The new deputy manager was not aware of any complaints or protection issues, as the consultant was dealing with these. When the consultant arrived, she explained about two complaints and POVA (Protection of Vulnerable Adults) procedure that affected the home prior to current improvements. She kept records of these procedures and complaints. Two residents and two visitors confirmed that they knew how to complain. All staff attended POVA training. Protection of persons was not appropriately implemented. A conflict observed in the dining room showed that not all residents were protected at all times. A resident was brought into the dining room in a wheelchair. Staff respected her choice to park her where she wanted. She wanted to sit next to a resident who in a confused state was wiping the table. As soon as staff left the resident in the wheelchair, she stared pinching the resident next to her: Stop it! Stop it, she shouted several times and pinched the arm of the resident next to her. A senior staff member present in the room was giving medication to another resident and could not
Care Homes for Older People Page 18 of 30 Evidence: leave what she was doing, as that would create another hazard. So the pinching continued until the staff managed to close medication trolley doors, to intervene and stop the conflict. However, both residents were still left in the same proximity, leaving one particularly vulnerable to another attack. The described witnessed incident showed that residents challenging conditions created a higher risk of abuse. As staff tried to respect their wishes (to sit where they wanted) another hazard was created and developed into a conflict. Despite staff being present, this type of unintetional abuse could not be stopped straight away, or prevented by reviewing the seating arrangements and acting immediately after the incident. Some staff were employed directly from the agency that was bringing overseas carers to this country. Some of these staff, as seen in checked files, did not have application forms, but the main issue was the lack of documents of proof to work: Work Permits. Passports were used to confirm identity and copied passports showed the stamp that clearly stated that the holders needed to have a Work Permit before engaging in work. The home did not have the evidence to show these and consequently created a potential hazard to residents. The proprietors have arranged immediately after the site visit for the missing records to be brought from the Head office and stored in staff files. Care Homes for Older People Page 19 of 30 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. Although the layout of the home required different staff deployment, the residents still could enjoy a homely environment. Evidence: The tour of the home showed the conditions and provisions available to residents. The layout of the home and the managements intention to accommodate free movement of all residents resulted in residents with different conditions mixing in and sharing communal spaces. As much as this arrangement minimised restrictions and allowed residents to express their independence and autonomy, it created a potential risk when staff were engaged in helping individuals and could not fully control what was happening in the communal areas. There was a need to either organise staff differently or to ensure a higher staff presence in the areas used by residents to ensure their safety and protection, in most cases from one to another. This was addressed under other standard groups in this report. The home was well maintained and some bedrooms seen contained residents personal items. The records of valuables contained recorded personal possessions brought into the home to make it more private for residents. The home was investing into maintenance and improvements to the environment. The laundry room was appropriate for the home. A relative spoken to stated: There are no issues for laundry. They do not mix residents clothing. Infection control measures were in place. The entry hall did have a bit of an offensive
Care Homes for Older People Page 20 of 30 Evidence: smell on our arrival, but at the end of the site visit this was eliminated. Care Homes for Older People Page 21 of 30 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 staffing complement at peak times diminished the positive outcomes of otherwise devoted and commited staff in appropriately caring for and protecting residents. Evidence: Staffing number in particular communal areas at particular times was insufficient to meet the residents needs and to ensure their protection. This was observed in the dining room at breakfast time. Lunch time in another lounge was covered by 1 to 3 staff, although the majority of time there were two staff in who helped 7 residents to eat. This was recorded as a part of a SOFI observation. The deputy manager reported both in the AQAA and verbally during the site visit that the home exceeded the minimum expected percentage of NVQ qualified staff. They reported that 17 out of 30 care staff hold or are currently undertaking training for the NVQ qualification. 4 Staff files were checked to determine the appropriacy of the recruitment procedure. One staff member did not have references, but the deputy explained that the references for longer serving staff were held at the head office. The other checked files contained at least 2 references for each worker. Some staff employed from the agency for supply of overseas workers did not have their application forms. Two of the checked files did not have application forms. Two files contained passport copies as proof of workers identity and they were stamped by the request for these people to obtain Work Permits before engaging in employment.
Care Homes for Older People Page 22 of 30 Evidence: The home could not produce any proof of work permits. The deputy stated that there was a possibility that the agency held these required documents, but that he was not sure about this. The proprietors reported straight after the site visit that the missing applications for the yellow cards were brought to the home from the head office, to prove staff had permission to work in this country. Training was significantly improved since the last inspection and staff received not only manadatory training, but also training related to residents conditions. This helped staff better serve individual residents and helped them cope better with their conditions. Visitors spoken to also noticed improvement as a result of staff training and commented positively on the progress made. Care Homes for Older People Page 23 of 30 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. A great improvement in this area and the right track for the future was reduced only by the lack of a permanent manager and determined the adequate rating. Evidence: The home did not have a manager and was managed by the deputy manager who had been in post for 3 weeks at the time of the site visit. The home had employed a manager since the last inspection and requirement, but that person was dismissed as not suitable for the post, leaving the home again without consistent and appropriate leadership. Although the new deputy started working in a clear and positive direction, the uncertainity of the future managers style created another uncomfortable situation for staff and residents. The staff team worked well, as they were supportive to each other, they were devoted to residents and tried their best to look after residents when their number on shifts allowed. The consultant led the quality assurance review, and sent out and collected returned questionnaires. Although the final action plan has not been drawn at the time of the
Care Homes for Older People Page 24 of 30 Evidence: site visit, the consultant explained that quality assessement of the received comments would determine this action plan. The comments of residents and their relatives were shared with us at the site visit and some were used in this report to illustrate the current state of the home and triangulate our own findings. The home had a policy of not dealing with residents money. Instead, they were engaging social services, social workers advocates and family members to help residents that needed help in this area. The consultant and the deputy were aware of the need to respect the Mental Capacity Act 2005 to ensure that these issues were appropriately handled. Staff supervision was addressed in previous requirements and there was now a plan for regular and supportive action to address this supportive and monitoring tool. The deputy manager stated that the process has already started, but at the time of the site visit, it was too early to see the positive outcomes regarding the frequency of these meetings. Safe working practices were determined by the observations presented earlier in this report that did not show the safety of residents was ensured at all times. Despite good practices, such as ensuring safe water temperatures, appropriate moving and handling procedures, good food hygiene measures, good maintenance of the equipment and environmental risk assessments, the final outcome was still not appropriately safe and was rated as adequate. Care Homes for Older People Page 25 of 30 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 18 13.6 People who live in the home must be safeguarded from harm so they are protected. 31/07/2008 2 27 18.1(a) People who live in the home 31/07/2008 must have their needs met by adequate numbers of competent staff so that their health and well-being is promoted. This requirement made at the inspection 02/08/07 and 23/05/08 remains unmet. People who live in the home 30/09/2008 must be assured that the home is managed by a person who is competent and assessed as fit to do so. So that their health and welfare is safeguarded. This requirement made at the inspection 02/08/07 and 23/05/08 remain unmet. 3 31 8.1, 9.1 Care Homes for Older People Page 26 of 30 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 4 12 The home must arrange appropriately planned and organised staff action to meet the needs of service users at all times, including peak periods This would ensure that the needs of all service users are met. 15/07/2009 2 10 12 The home must rearrange 30/07/2009 staff engagement, especially at peak periods, to ensure that residents needs were met and that they were properly supervised and supported with full respect for each individuals dignity This would ensure that all residents dignity is respected 3 15 12 Staff must ensure that 30/07/2009 residents are given appropriate support discreetly and sensitively, so that everyone present in the
Page 27 of 30 Care Homes for Older People 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 dining room can enjoy meal times and food prepared. Residents wishes and choices, even when expressed at meal times, must be respected as much as possible. This would ensure that residents experience the respect for dignity at meal times. 4 18 13 Residents must be protected 15/07/2009 from abuse, including at peak times, such as meal times,by having sufficient staff members present to ensure their protection. This would minimise potential abuse of residents. 5 27 18 Staffing number must be 30/07/2009 appropriate to ensure that residents needs can be met. This is a repeated requirement addressed before on 02/08/07 and 23/05/08 that has not been met to ensure residents needs are met and ensuring their protection 6 31 8 The home must employ a stable, competent and permanent manager to ensure that the home is managed in a consistent 30/07/2009 Care Homes for Older People Page 28 of 30 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 way and safety of residents is ensured at all times. This is a repeated requirement, as the previous requirement related to the managers post was not satisfactorily met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 1 The homes brochure should contain basic details about the complaints procedure to give the opportunity to potential residents and referrals to learn how the home would deal with potential complaints. The home should aim to organise specific activities for each group of residents determined by their conditions and abilities in order to ensure that all residents do have an opportunity to engage in stimulating and interesting activities. 2 12 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
