Inspection on 03/03/09 for Drummuir Nursing and Residential Home

This inspection was carried out on 3rd March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Drummuir Nursing and Residential... 29/03/10

Drummuir Nursing and Residential... 03/03/10

Drummuir Nursing and Residential... 02/02/10

Drummuir Nursing and Residential... 02/09/09

Drummuir Nursing and Residential... 11/04/08

Drummuir Nursing and Residential... 11/12/07

Drummuir Nursing and Residential... 05/03/07

Drummuir Nursing and Residential... 26/06/06

Drummuir Nursing and Residential... 10/01/06

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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: Drummuir Nursing and Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ     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: Gail Richardson     Date: 0 3 0 3 2 0 0 9 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. 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. 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Drummuir Nursing and Residential Home 9-11 Northfield Bridgwater Somerset TA6 7EZ 01278422144 01278420397 drummuir@ashbourne.co.uk 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) : Ashbourne (Eton) Limited care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Additional conditions: 0 Elderly persons of either sex, not less than 60 years, who require general nursing care Up to eight places for personal care Up to two persons of either sex, between the ages of 50-60 years who require general nursing care Date of last inspection Brief description of the care home Drummuir Nursing Home is situated in a quiet residential area close to the town centre of Bridgwater. The home is not purpose built. Drummuir is registered with the Commission for Social Care Inspection to provide general nursing care for up to 38 older people, although the home can only accommodate a maximum of 31 people. This includes up to 8 people who require personal care. There is a registered general nurse on duty at all times. The home has has a new manager in place who is not yet registered with the Commission. The fee range is between 421.00 pounds and 600.00 pounds. This does not include hairdressing, newspapers, toiletries, optician and some activities. Care Homes for Older People Page 4 of 31 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 was an unannounced inspection, which took place over 7.5 hours on the 3rd March 2009 by Regulation Inspector Gail Richardson and CSCI Regional Lead Pharmacist Brian Brown. Whilst there were two inspectors throughout this report the term we will be used when referring to the Commission. As part of the Inspecting for better Lives program we use Experts by Experience who provide the inspection process with insight into what it is like to live at the home. An Expert by Experience attended this inspection and looked at what it is like to spend time in the lounge and lunchtime and their comments are included in the body of this report. Care Homes for Older People Page 6 of 31 Drummuir Nursing and Residential Home currently has 26 people using the service with one of those people receiving personal care only. Since the last key inspection on 11th April 2008 a concern was raised and as a result a random inspection was undertaken on 29th August 2008. Following that inspection we met with the providers and management of the home. The home has provided CSCI with a completed AQAA (Annual Quality Assurance Audit), which was completed by the manager and gives details of all aspects of the home. As part of this inspection we surveyed the opinions of a random selection of people using the service and Care Workers . The responses from these surveys are contained within the body of the report. We also spoke with 5 staff, 3 people using the service and one regular independant visitor to the home and their comments are included in this report. Records relating to care including 4 care plans, 2 staff files and health and safety records were examined. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are, excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? What they could do better: The manager designate is required to ensure that a full assessment is completed prior to any new admission to the home.This is required to ensure that the home can establish that it can meet the persons needs. The registered person is required to ensure that each person has been risk assessed and has a suitably detailed supporting care plan is in place to ensure all identified needs are met. This is required to ensure that staff can provide the care needed and the person using the service is not placed at risk. Also, the manager designate is recommended to review the care plans of any people who require end of life care to ensure that there is a clear plan of care in place to support any specific end of life care needs. The service need to review the systems in place for obtaining medicines to ensure that out of stock situations are avoided and that people receive their medicines Care Homes for Older People Page 8 of 31 as prescribed. They also need to look at how the medicines are stored and ensure that this complies with current regulations and also with manufacturer guidance. The manager designate is recommended to review the selection of activities provided as it appeared limited in choice and did not appear to reflect the input, choices and preferences of people using the service The complaints log is recommended to be updated to ensure that all responses and outcomes are recorded, furthermore the manager designate is recommended to ensure that all staff identified on the homes training matrix receive abuse awareness training. The registered person is required to ensure that he ground floor bathroom is repaired/ refurbished to meet an acceptable standard of hygiene. All areas of the home must remain clear to ensure there is no risk of falls or fire risk in the home. The registered person is required to ensure that there are sufficient staff available on all shifts to ensure the needs of the people using the service are consistently met. The recruitment procedures of the home are not complete and the registered person must ensure that all recruitment procedures are in place prior to people being employed at the home to ensure the safety of people using the service. The responsible individual is required to ensure that a manager is registered with the Commission to promote the stability of the service provided. All health and safety checks must be undertaken and recorded to promote the safety of people using the service. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes Service User Guide, Statement of Purpose and contract of residency have been updated to ensure that prospective people can make an informed decision about the home. Pre admission assessments are undertaken by the home but are not consistently completed to ensure that all needs are assessed prior to admission. Evidence: The home has in place a Service User Guide and Statement of Purpose to enable prospective people using the service and their relatives/representatives to make a decision about the home. Each person has a contract of residency with the home. This contains details of the fees charged and the terms and conditions of residency to ensure that people are clear Care Homes for Older People Page 11 of 31 Evidence: about the service they are paying for. The homes AQAA (Annual Quality Assurance audit) states that, Prospective users of the service are invited to visit the home at a time convenient to them, so that they are able to make an informed choice. On admission to the home all residents receive a contract which states our terms and conditions. They also have a service user guide which is placed in every service users bedroom. We examined two recent pre admission assessments. One was fully completed , however one was not fully completed to include all areas of assessment and has not signed or dated when completed. The manager designate is required to ensure that a full assessment is completed prior to any new admission to the home to ensure that the home can meet the persons needs. Staff training records indicate that staff training is updated regularly and staff rotas confirm that a qualified nurse is on duty 24 hours each day.People told us that they felt staff were capable and caring and could meet their care needs. Care Homes for Older People Page 12 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. Most care plans provide a clear guide for staff about the needs of people using the service and how those needs are to be met. The timescale for the writing of care plans after admission is required to be addressed as a matter of urgency to ensure there is no risk to people using the service. People cannot be confident that medicines will be stored appropriately or that they will always receive medicines as prescribed. Staff were observed to treat people with dignity and respect at all times and people feel well cared for. Evidence: We looked closely at four care plans, two of which were for people who had recently been admitted to the home. We found that those care plans of people who had been at the home for a longer period of time contained clear information for staff to follow to ensure that peoples identified needs could be met. Risk assessments had been completed and a plan of care implemented to support those risks whilst promoting independence. However two care plans of recent admissions had not been completed Care Homes for Older People Page 13 of 31 Evidence: in an appropriate timescale. One person who had identified health risks and needed specific nursing care had been cared for in the home for 12 days before a care plan was completed. The staff had provided the care without a clear plan of care and this may have placed the person at risk. The other care plan identified very basic details of the care needed in one and two word descriptions but there were no completed risk assessments or associated care plan to inform staff of the risks and care needed. The person has specific nursing needs and is at high risk of changes in condition, this person had been in the home 5 days and so staff had not been able to access clear information and guidance to care for that person for that period of time. Equipment is provided where there is an assessed need, however staff told us that the service could do better by More equipment for moving and handling and Better laundry equipment and facilities. A clear daily record is maintained for each person and the care plans had been signed by the person or their representative in most instances. There was a clear record of all visiting health care professionals visits and the outcome. One visiting healthprofessional commented The staff were very good at linking with the GP and informing relatives of changing needs. Another told us that the home were very positive and supportive in their management and had promoted independance . Updated reviews were available and in most cases include the input of the person or their representative. We observed that clear records were maintained in each persons rooms related to pressure relief plans, fluid intake and wound care with detailed body mapping, which is updated regularly. This is noted to be an improvement since the last inspection and provides staff with a clear audit trail of changes in condition. The manager designate is recommended to review the care plans of any people who require end of life care to ensure that there is a clear plan of care in place to support any specific end of life care needs. We spent time observing the care being given and noted that the members of staff treated people using the service with dignity and respect at all times. People using the service appeared relaxed in the company of the staff and the atmosphere was happy and calm. The home employ both male and female staff to support any gender preferences for care. The homes AQAA states that, We have conducted an annual review of our Policy on equality and diversity to ensure that it continues to be pertinent to needs of present and prospective service users. One person using the service told us staff are my little angels- they have been marvelous, showed me how to dress and undress, wash and shower, have showed me over and over again until i got it. Confidence has to be re taught and they taught me that here. A staff member told us The home is a friendly, relaxed, caring environment for residents and families which provides high levels of support. Care Homes for Older People Page 14 of 31 Evidence: The Expert by Experience spoke with a relative who stated the standard had been up and down, but is better now. A visiting health professional told us, A service user who is very independant was fully supported to carry on managing his own medication on respite they were happy that the staff had supported them to do this. We found that whilst lockable storage is provided to keep medicines secure that not all of it complies with the current regulations and also that during the administration round that all medicines are not kept secure when the trolley is not attended. This means that there is an increased risk of medicines not being available for administration when needed. We found for some people that the systems in place for stock control do not ensure that they receive their medicines as prescribed. We found for one person prescribed a medicine to be administered weekly that they did not receive one weeks medicines at all, another person was without their prescribed medicine for a period of 8 days and other person had an antibiotic prescribed on 27th February that had not been received into the home by the time of our inspection on 3rd March. This means that people are having their health compromised by poor systems of stock control in the home. We found that the supplying pharmacy offer annual advice visits and that the most recent of these had taken place on 27th February. At this visit they had highlighted 2 issues, one of temperature control of the medicines fridge and the second of provision of homely remedies in the home. We found that the medicines fridge had temperature records indicating a minumim of 2C and a maximum of 9C on the day of inspection meaning that the medicines within the fridge were not being stored in accordance with the manufacturers directions and this may compromise the stability and effectiveness of the medicines. Also the medicines room teperature was recorded daily and from 29/01/2009 there were 40 occassions where the temperature had been recorded as greater then 25C. This is not in accordance with the directions stated on many of the medicines in the room, which had a statement to store below 25C written on them, this may compromise their efficacy and stability. We did see that for a medicine applied in the form of a patch that the site of application each day was indicated on a body map so meaning that the site of application could be rotated effectively. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides some activities and people have the choice of participation.Contact with the community and is maintained and visitors to the home are welcome. The meals provided are enjoyed by the people using the service and a choice is available, more staff or changes in routine are needed to ensure that all people enjoy the dining experience as much as possible. Evidence: The home employs activity staff and has a monthly plan of activities. The manager designate is recommended to review the selection of activities provided as it appeared limited in choice. The home surveyed the responses of 6 people using the service and 6 relatives in August 2008. Comments noted included More activities should be organized and people using the service survey comments also notes not enough activities. Since the last inspection the manager designate has ensured that there is always a member of staff available in the lounge area to support people and remain as an observer and point of contact. This system appear to work very well and the person was seen to interact with people using the service in a casual and friendly manner and was seen to be discussing previous interests with them. Care Homes for Older People Page 16 of 31 Evidence: The homes AQAA states, We encourage and support residents to maintain their independence and encourage them to make their own choices. The home has an open door policy where residents are able to receive guests at any time. We have also improved our documentation to contain an in depth social profile of all service users. The Expert by Experience observed, A new carpet has been fitted in the sitting area of the combined lounge dining room. When I arrived there were eight people in the lounge, and the television was on but no one seemed to be watching it. Instead of being placed in rows an attempt has been made to make a more friendly atmosphere by putting chairs in groups, but this is a long, narrow room and it is difficult to make it feel cosy. On the last visit I noticed that the large alcove at one end of the room was very cluttered with scattered books, videos etc and while an attempt has been made to tidy it up and to screen it from the rest of the room by placing chairs across the entrance it does not really improve the look of the sitting area. The usual list of activities was displayed in the hall and lounge, together with two books of satisfaction surveys, one each from residents and family. These were all undated, but it was noticeable that the overall rating was in the middle range, fairly good. Visitors were seen at the home throughout the inspection. The local Vicar visited the home and confirmed that he visits regularly and also provides a church service. The home has a cat who was seen to move about the home and people using the service were seen to interact comfortably with the cat. People told us that within reason they could get up and retire whenever they wanted and that staff were kind and supportive of their choices and preferences. Many people at the home have varying levels of disability and staff are supportive of all levels of disability and were respectful when undertaking moving and handling procedures in public areas. The Expert by Experience observed The downstairs bedrooms which look directly onto the road have been fitted with net curtains for added privacy. Also The residents to whom I spoke seemed generally satisfied with their care. The staff were described as cheerful and kind. One lady said that having been confined indoors for many years the staff had given her the confidence to walk again so she was very well pleased. Another lady said she enjoyed the activities but finds it difficult to hold a conversation with other residents. The people using the service confirmed that they enjoyed the meals and that a choice is available. Breakfast is served in the persons bedroom or the dining room, lunch is the main meal of the day and a lighter evening meal is served around 5pm. Care Homes for Older People Page 17 of 31 Evidence: The menu is planned by the cook with input of choices from people using the service . People using the service are asked on the day what their choice of main meal will be and staff show people what the choice is. Breakfast and lunch are served in peoples rooms or the dining room. The evening meal is prepared by the cook who leaved everything ready for care staff to serve at 5pm. Supper is available around 8pm. Lunch was observed and was seen to be a very busy time. The dependency level for help with eating and drinking is currently high. There was a high demand for staff to assist with eating and drinking which meant that people had to wait for periods of time. The manager designate is recommended to review the mealtime organization to ensure that all people using the service enjoy the dining experience. The Expert by Experience observed I spent a lot of time during my visit observing what went on at lunchtime. There were three tables, each to seat four. The first resident was brought in, in a wheelchair, at 12.35 and then had to sit for nearly an hour until the persons food arrived. Six people were seated at the tables, another seven remained in their chairs in the lounge area. The staff had to serve food from the heated trolley, carry meals to residents eating in their rooms and help those who could not eat unaided, so far as I could see only three residents were able to do this. The result was that plates of food were left untouched for some time while the staff tried to get round to everyone. This presented an almost impossible situation for the staff who did their best to look after everyone. One had eventually to resort to trying to assist two people at the same time. A lot of food was wasted and I wondered why they were not simply offered smaller portions which might have made the meal more attractive. Also, one person who had shown no interest in the food offered, was later given a sandwich which was seemed to be enjoyed.One person had been sitting in their chair in the lounge before I arrived in the morning and was still in the same position when I left. A visiting health professional told us, All reports regarding food quality have been good and also positive reports about how friendly and helpful the staff are. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that they are listened to and their requests acted upon. Staff demonstrated good knowledge and understanding of their role to ensure that people using the service are protected from abuse. Evidence: The home has updated the complaints policy to include the correct contact details and is displayed in the home to enable access to all. It is also available in the homes Statement of Purpose/ Service user Guide provided in each persons bedroom. Both people using the service and staff told us that if they had any concerns they would raise them with he manager designate and would be confident that appropriate action would be taken. The homes AQAA states, All complaints whether verbal or written are recorded in the complaints log. A holding letter is sent within 24 hours of the complaint being received and is dealt with within 28 days and signed off by the Manager when resolved. The home has received two complaints which have been appropriately investigated and responded to.The complaints log is recommended to be updated to ensure that all responses and outcomes are recorded. All people using the service are registered to vote in any forthcoming elections and an Care Homes for Older People Page 19 of 31 Evidence: independent advocacy service is accessed for people who require this service. The home displays prominently its policy on abuse awareness and most staff have received abuse awareness training. The home has copies of the Safeguarding Vulnerable Adults Policy for Somerset (September 2008) and has company policies for staff on whistle blowing and abuse awareness. Staff spoken with were clear of the actions to take should an allegation or suspicion of abuse be raised. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people with a homely place to live, it is comfortable and suited to the needs of the people who live there. Equipment is provided where there is an assessed need. The standard of hygiene must be reviewed to ensure that an appopriate standard is achieved in all areas of the home. Evidence: The home is a large older building, which has been converted and extended. There is a communal lounge, smaller lounge and dining area, these areas are adequately furnished and decorated. Personal accommodation is located on each of the 3 floors of the home and is accessible to people with all levels of mobility. Lift access is available to each floor. All bedrooms seen varied in size and were comfortably furnished and had been personalized to reflect the tastes of the individual person. People are able to bring personal effects and small items of furniture with them when they move to the home, which gives rooms an individual homely feel. Various aids and adaptations have been put in place to assist people to maintain their Care Homes for Older People Page 21 of 31 Evidence: independence. Specialist pressure relieving cushions and mattresses were seen were there was an assessed need. Profile beds have been provided for people with nursing needs. The Expert by Experience noted There is a lack of storage space around the Home; a small lounge on the ground floor would have been much nicer had not a large supply of incontinence pads been stored along one wall. The homes AQAA states that, We are planning to redesign our lounge and dining areas in order to make them more user friendly. Redecoration of the large lounge has made the space brighter and a pleasant space. Repairs to the heating have been completed and hot water is accessible to all areas of the home. Some areas of the home were noted to have a malodour of urine and the ground floor bathroom and toilets are in need of repair/refurbishment to ensure they have a good standard of appearance and hygiene. The home is currently advertising for a cleaner and on the day of inspection only one cleaner was working. Some areas of the home were observed to be cluttered with equipment and incontinence aids. These areas must remain clear to ensure there is no risk of falls or fire risk in the home. The home has developed a wet room which is now in use for people using the service to have a shower. Care Homes for Older People Page 22 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 employs enough staff to meet the needs of the people using the service and to ensure the safety, comfort and maintenance of the premises. However, staffing levels are not consistent over the rotas seen. Recruitment procedures are mostly robust in protecting people using the service. People benefit from having experienced staff who have a good understanding of their needs. Evidence: On the day of inspection there were the Nurse in Charge, 5 care staff, 1 cook, 1 cleaner and a handy person on duty. The administrator was also available throughout the day. The manager designate was not available in person but was available by telephone. The company provided a manager from another home in the company to support the nurse in charge during the inspection. The staff on duty told us that there were enough staff but we were made aware of the homes difficulties when staff were off sick. Agency staff are used but mostly the staff cover extra duties at the home. Staff rotas for a two week period were observed, these showed that staffing levels at the home were not consistent. There is a registered nurse on duty 24 hours per day and there varies between 4 and 5 carers each morning and 3 and 4 care staff each afternoon. It was noted that on 2 occasion only 2 care Care Homes for Older People Page 23 of 31 Evidence: staff were available on an afternoon shift. Staff surveys told us , We are staffed at the lowest possible legal ratios and this is not sufficient to support our service users needs, occasionally putting both staff and service users at risk. It is also extreemly difficult to get agency cover from the company when needed. The registered person must ensure that staff are available in sufficient numbers to meet the dependency level of people using the service. This was a requirment made at the previous key inspection and has not been met. The home provided a staff training matrix which identifies when people need updates in the mandatory training program. Most staff have received mandatory training , however some people are required to attend updates to ensure that they are fully trained to meet the needs of people using the service. The home has staff who have achieved an National Vocational Qualification in care and also staff working towards this qualification. Staff told us that they had undertaken an induction process which was in line with the Skills for Care Common Induction Standards. Staff felt the induction provided them with the information they needed to start work at the home. Staff records and staff comments confirmed that they receive regular one to one supervision to discuss further training needs and any ongoing concerns in the home. This takes place no less than 6 times each year and is in place to support and devlop good practice in the home. 2 recruitment files of the most recently recruited staff were examined. The recruitment procedures were mostly complete. One recruitment file only had one reference when two are required. This was also a requirment made at the last key inspection and has not been met.The manager designate is recommended to ensure that all gaps in employment histories of prospective staff should be explored and the reasons documented. This is recommended to protected the people using the service from the risk of abuse. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes residents involvement in the life of the home and promotes by health and safety monitoring prevention from the risk of harm. Financial systems for people using the service personal monies are managed in an auditable manner and the storage of records is secure and in line with the Data Protection Act. Evidence: The manager designate has been in post since the last inspection but has not yet registered with the Commission, therefore standards 31 and 32 cannot be fully assessed. Staff who spoke with us told us that they find the manager designate approachable and that morale at the home has improved. They told us that the home has a more settled staff team and that they have confidence in the managers abilities. A visiting health professional told us, I have always found the manager to be very helpful. A staff member told us The home manager is always available for support but we need to go to her, she rarely comes to us. The home implemented a quality Care Homes for Older People Page 25 of 31 Evidence: assurance audit in August 2008 and the results have been made available in the front hallway of the home. These include comments about the provision of activities. The management of the home also undertakes audits of the home to improve service delivery. The home has been delays in forwarding Regulation 37 notifications to the Commission and is reminded to ensure that all notifications are forwarded promptly for our information. Records stored at the home are stored securely and in line with the Data Protection Act. Staff are aware of the need for security of confidential documentation and all records are maintained individually. There are established systems in place for dealing with people using the service personal finances. We evidenced that each persons personal monies were recorded and receipts checked. All accounts are held by the companys accounts and a float of accessible cash maintained for people using the service to access should they need any money. An invoice of cash flow by each person was sent with the fee request each month. Accident records are maintained and a regular audit of accidents is undertaken to promote accident prevention. Records were examined with reference to safe working practices. Most records were well maintained and documented. Maintenance certificates were up to date. Some routine checks had been ticked as undertaken but not signed and dated, these included, the fire alarm checks and emergency lighting checks. All health and safety checks must be undertaken and recorded to promote the safety of people using the service. Care Homes for Older People Page 26 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 18 12(1)(a) The Registered person must 01/10/2008 ensure that all staff receive 2 suitable references, one of which must be the previous employer prior to commencing employment Any gaps in employment history must be investigated and the reasons documented. This requirement was not assessed at this inspection 29/08/08 previous timescale 01/05/08 2 26 16(2)(j)(k) The registered provider is required to ensure that all areas of the home have a satisfactory standard of hygiene and ensuring that there is no malodour. The registered person is required to ensure that staffing levels are calculated by the dependency levels of the Service users. Previous timescale not met 01/01/08, 01/05/08 01/10/2008 3 27 18(1)(a) 01/10/2008 Care Homes for Older People Page 27 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 1 9 13 Arrangements must be made 05/03/2009 to obtain and fit a Controlled drugs cupboard meeting the current regulations This is to keep medicines safely and reduce the risk of any diversion occurring 2 9 13 Arrangements must be made 04/03/2009 to review the arrangements for monitoring stock of medicines and ensuring a continuity of supply, This is to ensure that people can be confident that they will receive their medicines as prescribed. 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 3 14 The manager designate is 08/05/2009 required to ensure that a full assessment is completed prior to any new admission to the home. This is required to ensure that the home can meet the persons needs. 2 7 12 The responsible individual is 08/05/2009 required to ensure that each Care Homes for Older People Page 28 of 31 person has been risk assessed and has a suitably detailed supporting care plan in place to ensure all identified needs are met. This is required to ensure that staff can provide the care needed and the person using the service is not placed at risk. 3 9 13 Arrangements must be made to ensure that medicines are stored within the temperature range as specified by the manufacturers. This is to ensure that efficay and stability of the medicines used is maintained so that people receive medicines that will work in the way intended 4 21 16 The registered person is 08/05/2009 required to ensure that he ground floor bathroom is repaired/ refurbished to meet an acceptable standard of hygiene. This is required to ensure that there is no risk of cross infection from equipment in this room. 5 31 8 The responsible individual is required to ensure that a manager is registered with the Commission. This is required to promote the stable management of the service. 08/04/2009 08/05/2009 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 1 7 The manager designate is recommended to review the care plans of any people who require end of life care to ensure that there is a clear plan of care in place to support any specific end of life care needs. The manager designate is recommended to review the selection of activities provided as it appeared limited in choice. The manager designate is recommended to review the mealtime organization to ensure that all people using the service enjoy the dining experience. The complaints log is recommended to be updated to ensure that all responses and outcomes are recorded. The manager is recommended to ensure that all staff identified on the homes training matrix receive abuse awareness training. All areas of the home must remain clear to ensure there is no risk of falls or fire risk in the home. All health and safety checks must be undertaken and recorded to promote the safety of people using the service. 2 12 3 15 4 5 16 18 6 7 24 37 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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