Inspection on 16/10/08 for Dorrington House

This inspection was carried out on 16th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dorrington House 07/08/09

Dorrington House 11/05/09

Dorrington House 23/05/08

Dorrington House 02/08/07

Dorrington House 16/03/07

Dorrington House 16/11/05

Dorrington House 23/06/05

Dorrington House 06/01/05

Dorrington House 10/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives 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, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Patience     Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Steven Dorrington,Mrs Lorraine Dorrington Type of registration: Number of places registered: care home 52 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, Care Homes for Older People Page 4 of 30 0 Over 65 52 Brief description of the care home with 20 bedrooms on the ground and 32 on the first floor. All rooms have en-suite toilet and hand basins in addition to the homes communal shower and bathrooms. There are other communal areas including 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 £367 - £442 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: This inspection report contains information gathered since the last inspection in May 2008 and measures improvement in respect of meeting the requirements made at that inspection. This inspection includes a site visit to the home which was conducted without the service knowing that we were going to visit. The site visit took approximately 8 hours to complete and involved speaking with residents, staff, and visitors to the home. We also looked at records relating to residents, staff and the running of the service. Observations of daily life and interaction between staff and residents were also made. The site visit included an inspection of medication arrangements, which was conducted by the Commissions pharmacist inspector. The findings of the inspection are Care Homes for Older People Page 6 of 30 incorporated in this report. We sent surveys to residents, relatives and staff working at the home. At the time of writing the report the returned surveys were not available and therefore any comments have not been incorporated in this report. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home will ensure their needs can be met prior to moving into the home and that information is provided so that people can decide if they want to live there and the home offers a service that will meet their needs. Evidence: There has been no change to the way the service conducts the admission process. One file relating to a person admitted to the home in August 2008 was inspected. There were no issues with the way in which the assessment was conducted or the way in which the person was admitted. We were unable to verify if the person had been given an opportunity to visit the home prior to making a decision to live there. However, the service says it offers people information about the accommodation, facilities and what care they can expect to receive. The manager confirmed that people are provided with a brochure which contains the relevant information. Care Homes for Older People Page 10 of 30 Care Homes for Older People Page 11 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. People living in the home still cannot be assured their health and care needs needs will be fully assessed and met and there are still concerns in relation to the unsafe management of medicines. Evidence: We looked at the care records relating to 6 people living in the home. We also made some observations of those people during the site visit to assess if their needs were being met in accordance with what was written in the records. Since the last inspection, some work has been completed on care plans and some new care plan summaries have been introduced along with risk assessments. There are further plans to introduce new care plans for all residents and the manager is in the process of completing care plan reviews with relatives to ensure the information is as full and detailed as possible. However, this work had not been completed at the time of the site visit and we still found shortfalls in care planning and associated records that resulted in peoples needs not being met. For instance, for one resident a pressure care risk assessment had been completed on the 13/05/08 and stated that the person Care Homes for Older People Page 12 of 30 Evidence: was low risk of developing sores. However, the person was observed to be hoisted into a chair in the lounge where they stayed for the whole day. Other records written more recently also indicated that mobility had deteriorated and the person could not weight bear. This suggests there would be an increased risk of pressure sores and the pressure care assessment was not up to date. For another person, the records showed that they were diabetic. A risk assessment stated that blood sugars should be checked weekly but in the records we examined the last entry for blood sugar results was recorded on the 07/09/08. In addition, there was no clear guidance as to what the normal results should be and what action should be taken if the results were outside of the normal range. There was no risk assessment written to provide staff with guidance about what to do if the person experienced a diabetic coma. Similar concerns were found in another persons records and this person had experienced several falls. When we asked the deputy manager what training had been given to staff in relation to taking blood sugar levels and assessing the results she stated that no training had been provided. This was also confirmed with a care assistant who said she had been responsible for checking blood sugar levels. When looking at other records we found that although risks had been identified there were no assessments for nutritional needs and the home has not yet introduced nutritional screening tools. In one case, the person had a care plan stating they needed a soft diet and food needed to be fortified. Advice had been given by a dietician but there was no detail for staff as to how his diet should be increased. The records stated that the person was losing weight and should be weighed monthly but the last recorded weight was 2/08/08. in addition there was no nutritional screening tool. We found similar omissions in other records. In relation to falls we found that falls assessments had not been written for all people. One person had fallen three times in one month and had possibly sustained a serious injury due to one fall. However, there was no falls assessment in the persons records and no guidance for staff as to how the person should be protected from further harm. We also noted that during the visit one person was observed as aggitated and a care assistant was trying to establish what was wrong. The person had difficulty with verbal communication and was displaying behaviours that indicated there was something wrong. At one point they said they were in pain and the care assistant tried to find out more but gave up when not successful. The home does not appear to have any way of assessing pain in people with cognitive impairments. Care plans did contain some person centred information and this is an improvement on what was seen however, social care plans still need to be developed to make them more meaningful. For instance the care plan for one person stated find new and stimulating activities there were no links to the persons previous experiences, interests or hobbies. Other records looked at stated interests such as listening to music. Staff spoken with said they found it difficult to engage with people and to entertain them. Care Homes for Older People Page 13 of 30 Evidence: This home has not yet introduced mental capacity assessments in accordance with the Mental Capacity Act. The inspection of the medication standard was conducted by the Commissions pharmacist inspector Mark Andrews. Following the previous inspection Mr Andrews wrote to the provider seeking his investigation into comments recorded in minutes of a medication meeting conducted on 16th November 2007. The following is a direct quote taken from the minutes of the meeting; medication must be given - some medications have to be given ie. Diabetic, it is not acceptable to put refused, at the end of a round staff must report to a deputy to see why it wasnt given and decide what decision is to be made. If someone is asleep they could die as happened recently at Watton for 5 days it was recorded, asleep, asleep, asleep. To date we have still not received the providers report on this matter. During this inspection we observed some medicines administered to people in Bluebell unit and saw that staff were following satisfactory procedures. However throughout the inspection we found that peoples prescribed external medicines were not being stored safely and securely in their rooms placing their health and welfare at risk. The home has obtained a proper cabinet for the storage of controlled drugs. The home has put some safeguards in place to assist in ensuring staff handling and administering medicines can do so safely. This includes information alongside records used to administer medicines and a system in place to ensure medicines are not used after their expiry times. However we conducted sample audits of medicines to account for medicines and again found there to be discrepancies where we could not account for them. For example for a person prescribed anti-coagulant warfarin tablets there was a deficit of 3 x1mg tablets from current records. Previous records indicated that 3mg tablets were not available for a period of time so more of 1mg tablets were administered but the period of time in which this occurred was not clear. We noted that recorded information about the prescribed dose of warfarin located in the medicine trolley was inaccurate and this could lead to confusion when this medicine is being given. For another person with dementia recently prescribed painkiller codydramol tablets we could not account for some tablets when it was later stopped by the GP. We found there were accurate records of the GPs instruction but we found there to be no pain assessment in place enabling staff to know when the painkiller should be given to the person. We again looked at the use of psychotropic (and potentially sedative) medicines at the home. There were a total of 15 people prescribed medicines that could lead to sedation during the day. This is an improvement when compared to the previous inspection. We Care Homes for Older People Page 14 of 30 Evidence: found evidence that the use of some such medicines had recently been reviewed and stopped by prescribers however the manager agreed that further reviews were needed for people prescribed these medicines. We noted that for night time sedatives prescribed for occasional use there was no written guidance available for staff to determine when the medicines were needed. Many were supplied in the monitored dosage system as if for regular use and were being recorded as given routinely without recorded justification for this. Whilst some people have care plans referring to difficulties sleeping we saw none that referred to the use of such medicines or the dose to be used when this was prescribed flexibly. For one resident a night time sedative is being crushed to enable it to be administered whereas it was evident this is not necessary for the persons other medicines. Care records indicated that the crushing had been authorised by the GP on 05th August 2008. There was no further written information relating to the reasons for this and no evidence that this persons mental capacity had been assessed if they were refusing administration of the medicine and it was being given without their consent. We looked at training records and found that all staff had been provided medicine management training. The manager said training was planned for senior carers the week after the inspection. She also said that from 27th October 2008 a senior carer will be on duty 24 hours daily and available to administer medicines. The competence of approximately half of staff handling and administering medicines has so far been assessed. The manager agreed to continue this on a rotational basis. We also discussed the need to update the staff specimen signature list. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst some improvements have been made to the provision of activities and the mealtime experience it is not significant enough in order to ensure peoples health and well being is being promoted. Evidence: Some improvements have been made to provide people with more activities. An activities coordinator has been undertaking some family tree work with people and engaging in one to one sessions. Group activities were advertised around the home, such as quiz games, reminiscence, knitting and bingo. Some good work has been done to introduce items of interest and activity around the home, such as old peices of furniture, a stand with hats and coats on it, items that are familiar to older people and promote memory and recall. However, further work is needed to ensure that people are provided with activities that are meaningful to them. Care plans do not fully reflect peoples hobbies and interests or expectations in respect of daily life. The overall approach to activities is structured and needs to be seen as an integral part of peoples daily life in the home. However, observations during the inspection showed that some peoples interests had been incorporated into daily life. For instance, we saw people reading books and news papers and one person has moved a piano into the home so Care Homes for Older People Page 16 of 30 Evidence: they can maintain their interest and skills in playing it. The residents records we looked at contained little evidence of activity that was linked to their previous interests. It was also noted that again several people were seen asleep during the morning and afternoon. We observed the mealtime experience. We also spoke with residents, the chef and other staff. The meal of the day was written on a sheet of paper displayed on the wall of the main dining room. We did not see menus on the tables or any other visual display that would aid memory, recall and stimulate appetite. tables were prepared for lunch at approximately 12 oclock and people were being assisted to the tables from 12:10. Some people had been seated at the tables since breakfast and it was not clear whether it was their choice to stay there. People were provided with tabards to protect their clothing and again it was not clear whether a choice was given in this respect. One gentleman was given a tabard and told by the care assistant that he had to wear it as it would protect his clothes. She placed the tabard around his neck and it was clear he did not want it and took it off. The meal was served by care assistants at 12.30 and the food looked appetising. One resident said the food was very good and the chef was good. One meal option was offered to people and no one had chosen an alternative. We spoke with the chef who said care assistants had informed people what was for lunch and no one had asked for anything different. However, more choice is given at teatime and people often select different options. The chef showed the inspector a list of peoples dietary needs and any likes and dislikes. However, a record of peoples daily dietary intake could not be provided as the chef said this is written into peoples individual care records. When we looked at the care records we found some records relating to dietary intake but these were not maintained in sufficient detail to assess if the diet was good. We observed one person having their meal, which was beef casserole. When we looked at the persons records, they clearly stated the person was a vegetarian and did not eat red meat. We also checked the list about peoples dietary requirements held by the chef and it also stated that the person did not eat red meat. When asked why the cook had provided this meal he said he needed to get the meals out and it was a mistake. However, the records relating to this person showed that they had been given meat on other occasions previously. In the records relating to another person we found that it stated meals should be fortified but there was no evidence that this was being done, the records stated the person was losing weight. One other person reported in their records to be a diabetic was given a pudding the same as the other residents. This is concerning as it was not clear from the records we examined that the home are monitoring blood sugar levels as frequently as set out in the care plans. However, it was noted that care assistants were aware of the dietary needs of some people and were observed to return a pudding to the kitchen and ask for a low sugar alternative due to the person being a diabetic. Care Homes for Older People Page 17 of 30 Evidence: We observed two care assistants assisting people to dine and this was completed sensitively and discretely. The care assistant sat by their side and described the food that was being given. The softened food was presented in separate portions so the person could experience the various tastes and textures. The atmosphere in both dining rooms was better than seen at the last inspection. It was much calmer and people appeared to be provided with better support than before. The staffing levels have been increased and staff in Bluebell said it has made a difference as they have more time to spend with people now. There were some issues about the way in which some staff addressed people in a way that did not necessarily promote dignity and choice. For instance, one care assistant was talking over a resident saying we leave her here in the chair as she gets distressed when sitting at the table with others the resident responded no, Im trying to be quiet in a distressed tone. Another care assistant was heard saying to a resident come on, we dont get down from the table until weve all finished. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People making complaints or raising safeguarding concerns can be assured the home has systems in place to ensure they are handled correctly. However, not all staff are trained in safeguarding matters. Evidence: The home has a policy and procedure in relation to complaints and how people can make complaints. It has recently been updated and now shows accurate information about the other agencies people can contact if not happy with the way in which the home has handled the complaint. Staff spoken with were aware of how to support people to make complaints and how to report concerns on their behalf. The Commission has not been made aware of any complaints since the last inspection. Two members of staff were interviewed and both had some knowledge of safeguarding issues and what to do if they observed abuse in the home. However, one member of staff was not entirely clear about what constitutes abuse. Both members of staff said they could not recall having received any training about safeguarding. The Commission has not been made aware of any safeguarding matters since the last inspection. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements have been made to the environment to make it more suitable for the needs of people with cognitive impairments. However, people cannot be assured they will be provided with a safe, clean environment that promotes their dignity and choices. Evidence: We completed a tour of the premises and looked at some of the residents private accommodation. We found that some improvements have been made to the physical environment since the last inspection. For instance, the seating in the main lounge has been re-arranged to provide smaller seating areas and a member of staff has done some good work on placing items of interest around the home. It was noted that the signage has been improved and there is more directional signage to support people to orientate around the home independently. However, signage still needs to be improved and some bedroom doors remain unnamed and not easy for people who live there to recognise. No odours were detected on entering the home. However, when entering the Bluebell wood area of the home some unpleasent odours could be detected and these became stronger as the day progressed. It was observed that some of the chairs in both lounge/dining areas were soiled and stained. In one small upstairs lounge the seat Care Homes for Older People Page 20 of 30 Evidence: cushions had been removed from 3 chairs and the seat underneath was soiled. A care assistant said that the cushions had been removed in order to have them cleaned as one resident had been entering the room and soiling on a regular basis. One of the communal bathrooms was untidy and the toilet seat was soiled with what appeared to be faeces. In another bathroom the lid of the bin appeared to be soiled with faeces also. When the communal facilities were inspected unnamed toiletries were found. In one of the bathrooms there was an unlocked cupboard full of unnamed toiletries, razors, denture cleaning tablets, prescribed creams and some hairbrushes. this was raised with the homes consultant who arranged for the cupboard to be cleared during the inspection. We also observed a trolley in the corridor with unnamed hairbrushes on it. As found at the last inspection there were still clocks in both lounge areas that did not show the correct time and so would not help people to know what time of day it is. The conservatory door in Bluebell wood was locked at the time we tried to access the garden and it appeared people did not have the freedom to access to the garden when they wished. The fence that was broken at the last inspection has now been repaired and some additional pots and garden ornaments are in place, but little else has been done with the garden to make it more suitable for people with physical, cognitive or sensory impairments such as more suitable seating. 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. People can now be assured that there will be sufficient numbers of staff avaliable to adequately meet peoples needs. However, they may not yet have the skills and knowledge necessary to do this effectively. Evidence: Since the last inspection, we were informed by staff that staffing levels have been increased and staff now report there are always three care assistants working in the Bluebell wood area of the home. Staff spoken with said it was much better and they had more time to spend with residents. During the inspection there was no evidence to suggest that peoples needs were not being met due to staffing levels being inadequate. However, we did observe areas of practice that could be improved, such as promoting dignity and meeting peoples holistic needs effectively. Two members of staff were interviewed and confirmed that they had been provided with training in a variety of subjects such as, moving and handling techniques, supporting people with behavioural disturbances, food hygiene and care planning. The homes consultant said that a significant amount of training had been provided in order to educate staff about person centred care, care planning and caring for people with dementia. the manager also stated that further training was planned in medication practices and dementia. Staff interviewed said that they had not received training in Care Homes for Older People Page 22 of 30 Evidence: safeguarding and at least one new member of staff had not been provided with training in fire safety. Another member of staff confirmed that she was involved with testing peoples blood sugar levels but had not received training. Training records showed that recently training has been provided in dementia awareness, first aid, moving and handling and medication. However, not all staff have been trained in dementia awareness at the time of writing this report and the training list did not contain training in areas such as safeguarding and fire safety. 20 of the 42 staff employed have started or have completed an NVQ 2. We looked at the files relating to new staff and whilst the files appeared to contain all the relevant information and identification we were unable to cross check the dates when references were received and when criminal records checks were carried out as the start dates were not clear in the files. 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. Improvements have been made in the overall management of the home. However, further improvements needs to be made before it can be said the service promotes the best interests of the people who live in the home. Evidence: Since the last inspection the provider has appointed a new manager. However, the Commission has not been formally notified of the new appointment. The new manager said she has previously provided community nursing services to people living in the home, therefore already has some knowledge of residents and the running of the home. Following the last inspection and the home being given a poor quality rating the provider appointed a consultant. The consultant prepared an improvement plan and has been supporting the implementation process. New systems for care planning and risk assessments have been introduced and staff are being trained in order to ensure Care Homes for Older People Page 24 of 30 Evidence: they understand how the new records should be completed. The consultant has also organised and provided training in key areas to promote better outcomes for people living in the home. However, the improvement plan is still in the early stages of implementation and some systems such as care planning have not yet been fully completed. The Commission has not yet been provided with copies of the regulation 26 reports to demonstrate they are carried out. We asked the provider to send us a copy of the improvement plan within 28 days of the last inspection report being published and we have not received one. However, during the inspection the homes consultant provided us with a copy and said it had been completed within the timescales. The home does have some quality monitoring systems in place such as accident audits and medication audits but further work is needed to ensure that there is a total quality management system in place and that any shortfalls in service provision are identified and action is taken to make the necessary improvements. We did not fully assess the quality assurance system on this occassion and did not look at how the home consults with people. During the inspection we highlighted some continuing concerns in relation to health and safety such as products that could be hazardous to people if used incorrectly and issues around hygiene and infection control. We also observed some equipment being used inappropriately, which could place people at risk of harm. The home has fire safety procedures in place but at least one member of staff said they had not received any training on the subject. 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 7 13.4 (c) People who live in the home 31/07/2008 must have risks associated with their daily living assessed and written into plans so that action can be taken to minimise or eliminate risks to their health and safety. People who live in the home 31/07/2008 must have their needs fully assessed and written into care plans so that staff know how needs should be met. People who live in the home must have their nutritional needs assessed and written into a plan of care so that staff know how to meet peoples nutritional needs. People who live in the home must have their medicines administered safely so that their health and welfare is safeguarded. This requirement made at the inspection 02/08/07 and 23/05/08 remains unmet. People who live in the home must have their social and emotional needs assessed 31/07/2008 2 7 15.1, 15.2 (a)(b) 3 8 12.1(b) 17.1(a) 4 9 13(2) 20/06/2008 5 12 16.2(m)(n) 31/07/2008 Care Homes for Older People Page 26 of 30 and written into an individualised plan so that staff know how their needs should be met. 6 15 16.2(i) People who live in the home 31/07/2008 must be provided with meals in a way that promotes a positive experience of dining so that it encourages good nutritional intake and wellbeing. People who live in the home 31/07/2008 must have their daily dietary intake recorded so that their daily diet can be monitored and action taken in response to needs. People who live in the home must be safeguarded from harm so they are protected. 31/07/2008 7 15 17.2 8 18 13.6 9 20 23.2(o) People who live in the home 31/07/2008 must have safe access to the outdoors with appropriate seating to meet their needs so that their health and wellbeing is promoted. People who live in the home 31/07/2008 must have an environment that promotes independence so that their health and wellbeing is enhanced. People who live in the home must have an environment that is free from hazards to their safety so that they are protected from harm. People who live in the home must have an environment 31/07/2008 10 22 23.2(n) 11 25 13.4(a)(b) 12 26 16.2(j) 31/07/2008 Care Homes for Older People Page 27 of 30 that is hygienic so that their health and welfare is safeguarded. 13 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. People who live in the home 31/07/2008 must be assured that there are systems in place to selfmonitor the quality of the service so that their health and well-being is safeguarded. This requirement made at the inspection 02/08/07 remains unmet. People must be assured that 31/07/2008 they live in a safe environment and that risks to their safety are eliminated so they are protected. 14 31 8.1, 9.1 15 33 26 16 38 13.4 Care Homes for Older People Page 28 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 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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