Inspection on 22/09/09 for East Riding

This inspection was carried out on 22nd September 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

East Riding 05/12/08

East Riding 05/12/07

East Riding 30/10/06

East Riding 11/05/06

East Riding 24/11/05

East Riding 23/05/05

East Riding 05/11/04

East Riding 06/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE East Riding Whoral Bank Ashington Road Morpeth Northumberland NE61 3AA Lead Inspector Janet Thompson Key Unannounced Inspection 22nd September 2009 10:00 DS0000000506.V377746.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. East Riding DS0000000506.V377746.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address East Riding DS0000000506.V377746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service East Riding Address Whoral Bank Ashington Road Morpeth Northumberland NE61 3AA 01670 - 505444 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) East.Riding@fshc.co.uk Four Seasons Health Care (England) Ltd Manager post vacant Care Home 67 Category(ies) of Dementia (67), Old age, not falling within any registration, with number other category (35) of places East Riding DS0000000506.V377746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 35 2. Dementia - Code DE, maximum number of places 67 The maximum number of service users who can be accommodated is: 67 5th December 2008 Date of last inspection Brief Description of the Service: The home is a two-storey purpose built facility situated on the outskirts of Morpeth. There are no local shops nearby. The approach to the home is via a steep driveway, unsuitable for people with a physical disability. There is a good sized car park at the front of the building from which there is level access into the home. The home comprises two units. Millview Unit is situated on the ground floor and caters for older persons with nursing care needs and residents who require social and personal care only. The Wansbeck Unit is situated on the first floor and has beds for people with dementia who require nursing care. Bedroom facilities are mainly single en-suite with a total of six double rooms throughout the home. Each unit has lounges and dining rooms and there are specialist bathrooms and shower rooms located on each floor. The kitchen and laundry are located on the ground floor. Stairs and a passenger lift provide access to the first floor. Information about the home’s services and facilities are displayed in the entrance area. Fees for the home vary and information about fees is available at the home. East Riding DS0000000506.V377746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last key unannounced visit on 5th December 2008. • How the service dealt with any complaints & concerns since that visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals, where this information was available. The Visit: An unannounced visit was made on 22nd September. Three inspectors carried out the visit and it took a combined total of 19 hours. During the visit we: • • • • • • Talked with people who use the service, staff, and visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, including medication, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable. Checked what improvements had been made since the last visit. The manager for the service was not available. A Regional Operations Manager from another area attended the home for the inspection. Feedback was given to her throughout the day and summarised at the end of the inspection. East Riding DS0000000506.V377746.R01.S.doc Version 5.2 Page 6 What the service does well: Residents’ needs were assessed prior to their admission to the home. This enables an initial plan of care to be carried out as soon as residents enter the home. Residents spoken to said the staff were caring and treated them well. Residents’ monies were properly accounted for. The handling of all finances undergoes a lot of checks and monitoring to ensure that money is held safely. The administration of medicines is generally well managed. The provision of social activities achieves the minimum standard expected of a care home. The food was well received by residents. We tasted a meal and found that it was well cooked and tasty. What has improved since the last inspection? What they could do better: Not all of the residents looked well cared for. Many of the female residents did not wear stockings, some people’s hair looked unkempt and residents’ clothes were crumpled and faded. Some people had dirty fingernails and we could not find records indicating nail care had taken place. East Riding DS0000000506.V377746.R01.S.doc Version 5.2 Page 7 We did not find evidence that people were given enough fluid throughout the day. Those that had their fluid intake recorded did not appear to be offered drinks other than at mealtimes. Records showed a very poor fluid intake for the two people on a fluid balance chart. Fluid output was not recorded. Residents in lounges or bedrooms were left alone for long periods throughout the morning. Care plans were not good enough, they did not give up to date information about people’s needs or were not up to date. One resident admitted two months ago had not had any assessments carried out. Medicines storage, security and record keeping could be improved. Audit of the medication system should include checking stocks of medication against administration records to help confirm that medicines are being given as prescribed. Bed tables and chairs were dirty and stained. Specialist chairs that people were sitting in were unhygienic. Some residents were sat on sheets on their chairs which could increase their risk of pressure damage. Beds were made up with faded sheets that were very creased. There were odours in some areas of the home and some residents’ bedrooms. One of the toilets was out of order and another needed some repair work to the toilet surrounds to make it safe. Several of the bathrooms and toilets require redecoration. Some curtains in bathrooms were stained with mould and the rails were rusted. Light pull cords were not clean. The mechanical ventilation units were not clean and could not function properly. Little attention had been paid to making the first floor lounge look attractive. Cushions were missing or without their covers and the décor was bland and uninteresting. Staff were very busy in the morning. They did not interact with residents whilst carrying out their tasks. This improved in the afternoon. One staff member was working her second shift in the home as part of a three day induction. She had not received any formal induction training and was working as a full member of the team despite the fact that any past training she had was very out of date. The manager audits a lot of the systems in the home, but this has been done ineffectively as most of the issues identified at this inspection could have been prevented. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 8 The five year electrical test certificate was not available. Residents, relatives and staff had been consulted through meetings but records showed that some months have elapsed without a meeting. A relative told us that she has raised serious concerns in the home and not received a satisfactory outcome or explanation. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs are fully assessed before they enter the home. EVIDENCE: There has been no change to the admission procedure since the last inspection. Care records showed that residents’ care needs are assessed before admission. This information was sufficient for staff to judge if they could meet the needs of each resident. Most of the residents spoken to could not remember the admissions process, but one resident remembers someone visiting him in hospital to check how he was cared for there. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 11 East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal care that is not well planned or reviewed. This means their health care needs are not fully met. EVIDENCE: Four care plans were examined and all were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. One care plan did match the individual it was written for. Care needs were clearly identified and it was up to date. The second care plan contained a plan of care for mobility. This had been written in May 2008 and stated that the resident was ambulant and wandered into the rooms of others. This did not match the current status of the resident. We observed that this resident needed to be transported in a East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 13 wheelchair and records in the daily notes confirmed that the resident could only walk very short distances with two staff to assist. Another plan of care was for a resident with substantial dressings on her legs. The resident had leg ulcers which had tested positive for MRSA. The resident had care plans written in July which had not been re-evaluated. There were no assessments in place at all. Forms were there for assessments relating to nutrition, consent, capacity, pain, continence, falls, depression, wounds and use of bedrails. All of these documents were blank. A body map was in place detailing some bruising in August but there was no name filled in on the form. Care plans relating to care of the resident’s leg ulcers showed that the Tissue Viability Nurse had visited in July, the prescription was for dressings to be changed every two days. Evaluations showed regular periods of 3-5 days between dressing changes. The Tissue Viability Nurse was also due to revisit after ten days but it was difficult to see if this had happened. Her visits were not recorded in the record of professionals’ visits. There was no evidence that the MRSA status had been reviewed. The fourth care plan contained documents for Do Not Resuscitate orders and Consent to Treatment forms. These had been completed with the resident’s name and date of birth but no other information. It was not clear whether these were actually in use. We noted that this resident was sat alone in a bedroom for long periods without access to fluids. There was a strong odour of urine in the room which we asked staff to investigate. Records showed that, in August, this person had been admitted to hospital with dehydration and a urine infection. We would expect that extra fluids would be encouraged but fluid records were not being kept for this resident. Only two residents in the home were having their fluid intake and output recorded. We thought more of the residents should be monitored as they were physically dependant or confused and unlikely to be able to help themselves to fluids. We also noted that none of the rooms had jugs of juice or water in them. We examined the fluid records of the two residents who were monitored. We found that some days they had not been completed at all. All of the days when they had been completed showed intakes of between 700880mls daily, and on one occasion 1200ml. This is not good enough. None of the fluid charts showed records of out put. None of them had been totalled by a nurse. Not all residents looked clean and well cared for. Six residents sleeping in a ground floor lounge were wearing clothes that were crumpled, faded and ill fitting. Two female residents in skirts wore socks or knitted boots. Other residents throughout the home were similarly dressed. These residents were not attended by staff for long periods throughout the morning. There was also very loud pop music playing until a nurse turned it off. Some residents had dirty fingernails and we could not find records to indicate when nail care had taken place. A carer told us this would happen when the resident was bathed. We spoke to a resident who said she had a shower the night before, however East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 14 her nails were not clean. This resident told us she preferred a bath but had a shower because it was quicker for staff. Medicines storage within the home is poor and the treatment room is also used as an office. Medication documents are not stored efficiently and duplicate record books for medicines receipt and disposal were in use at the time of the inspection making it difficult to audit medicines within the home. Although most medicines were stored securely medicine fridges were not locked and some ointments and creams were stored in unlocked cupboards. Temperature records for one medicine fridge indicated that medicines were not being stored within the temperature range recommended by the manufacturer. Lunchtime medicine administration was observed on the first floor and was well managed and followed good practice guidance. Staff were not disturbed by colleagues during the process and people taking medicines were offered support and encouragement. Medicine administration record (MAR) charts were looked at on each floor. There were a few gaps in the records but the quantity of medication recorded as received on many of the MAR charts did not always include any medication carried over from the previous month. This makes it difficult to maintain a complete record of medication in the home and to check if medicines are being given as prescribed. Handwritten medication entries on MAR charts were nearly all countersigned by a second person to confirm their accuracy but some entries recording discontinued treatment were not signed or dated. A number of medicines within the medicines trolley did not have dispensing labels attached and it was not possible to confirm that doses of calcium supplements had been administered from the personal supply of the named resident. One box of Calfovit contained more sachets of the medicine than the original quantity dispensed and were of mixed batch numbers suggesting staff had transferred medication from one container to another. A plastic box inside the trolley containing one service user’s medication contained a strip of tablets which were not readily identifiable because the strip had been removed from the labelled dispensed box. The controlled drug cupboard appears to meet safe custody regulations and all entries in controlled drug registers were complete and fully signed. However, stocks of four controlled drugs had not been transferred over to the current registers in use and because regular controlled drug stock checks are not being carried out this had not been identified. In addition, none of these controlled drugs had been in use for three months or more and should have been disposed of. The old registers were not stored securely and could not be readily located at the time of the inspection. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 15 The receipt and disposal of medicines is documented but more than one record book was in use at the same time on the first floor. This makes it difficult to maintain and check the medicines audit trail. The date of opening of medicines with limited use once opened is not always recorded. This means that there is a risk that the medication may be used beyond the date recommended by the manufacturer and may not be safe to administer. Regular audit of the medication system is undertaken but a recent audit had failed to identify the majority of medication issues identified during this inspection. There was no evidence of any medication counts being completed to help confirm that people are receiving their medicines as prescribed. Some people were prescribed medicines to be taken as required for treatment of agitation but written guidance was not always available with the MAR chart or in the care plan to fully inform staff exactly how to use the medication. Residents and relatives did tell us that staff were kind to them when carrying out care tasks. A relative said staff always responded well to requests and on the whole they were happy with the staff attitude. A relative said she was happy with the care and attention given in the home though she felt standards could be improved. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 provided with a regular activities programme should they choose to take part. Their visitors are made welcome. A range of healthy meals are provided. EVIDENCE: Although staff appeared to have little time to spend with individual residents during busy periods in the morning, this situation improved in the afternoon and staff were observed later spending time with people and ensuring their individual needs were met. The activities coordinator who has worked in the home for many years has recently reduced her hours but has support from a part time worker meaning the actual hours provided has increased. The new activities person is being inducted and is working through a good practice guide produced by specialists in dementia care. In the morning people were seen being supported by the East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 17 activities coordinators to visit a nearby garden centre and they were also seen returning shortly after lunchtime to the home. In the afternoon a game of bingo was being held in the dining room. This was well attended. The activities coordinator spoke about a social activities committee in the home and minutes were seen recording the last meeting in July attended by seven people. Ideas put forward to improve the home included; photo boards, new social activities and a new theme for the activities lounge. Some of these ideas are being put in place. There are also house meetings that are attended by residents and their relatives. Any requested changes to activities are recorded. The activities programme is recorded on a wall board and evidence was seen in care plans that peoples preferences related to activities are assessed. However the records for one person known to choose not to be involved in activities had no information to record this fact or that staff have tried to identify any preferences they may have. Several residents spoken to were not interested in activities. Some said they enjoy bingo and others would take part in most of the planned activities. The activities coordinators were seen advising each resident of activities about to take place, also throughout the later part of the inspection staff were seen with residents talking and enjoying each others company. There is a weekly religious service for all to attend. An organist leads the singing. Everyone spoken to said they choose what to do and where to go. Residents were seen at lunchtime on the first floor. Tables were pleasantly set with linen cloths and napkins. Staff were seen providing appropriate support when needed and lunchtime appeared to be a very pleasant experience. The inspector had lunch with residents in the ground floor dining room. The menu choices were displayed outside of the dining room and the meal was well presented, hot and tasty. Everyone spoken to had enjoyed their meal and those residents needing support were provided with it. We observed that a resident eating in his own room was served lunch by a carer who handed over a plate and spoon. There was no tray, drink, salt or pepper. The regional manager addressed this immediately as this does not meet the standard expected by the provider. The cook maintains a record of those people who choose to have large or small meals and also those people requiring meals to be prepared differently such as soft diets. Some people have food brought in for them by their families and a fridge in the kitchen is maintained for this purpose. Some people identified East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 18 specific changes or additions to the menu they would like the home to consider. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the 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 who use the service are not fully protected from harm through thorough complaints procedures and recording. EVIDENCE: We received some complaints prior to this inspection about deteriorating standards of care. We are also aware of some safeguarding issues surrounding the administration of medication. On the day of the inspection we received a complaint about the lack of ventilation and excess heating in the home. This has been passed back to the Provider to respond to. In both cases, complainants stated that they had raised issues with the home manager, some action had been taken but standards had not been improved for long and complaints not resolved. A relative told us of a safeguarding issue she had raised. She did not feel that anyone had given her an adequate explanation of the outcome and did not feel reassured by this. This safeguarding issue was recorded in that resident’s case file but not in the complaints log. The deputy manager was able to give an account of what had happened. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 20 We asked the residents if they knew how to complain. Two said they would tell a staff member, one would speak to a nurse and three said they did not know. Two said they had raised concerns in the past and felt able to do so again. Staff have received training in adult protection and did appear to recognise and understand the issues surrounding potential abuse. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26. People using the 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 do not live in a home that is well maintained, comfortable or clean enough. EVIDENCE: The home consists of two Units. The Millview Unit on the ground floor and The Wansbeck Unit situated on the first floor. There is easy level access into and around the building with a passenger lift between floors. Bedrooms are mainly single en-suite with a total of six double rooms throughout the home. Each unit has lounges and dining rooms and there are specialist bathrooms and shower rooms located on each floor. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 22 Areas of the home have been improved with new non slip hard flooring in corridors and some redecoration. A ground floor lounge was very pleasantly decorated with wallpaper and border. The room also contained new seating, a chiming wall clock, television and music system. A small lounge was also comfortably arranged with settees and lounge chairs, a dresser, cabinet and plates and pictures on the walls. Many areas of the home however required some maintenance. The walls of a lounge on the first floor had several holes that were not repaired. The decoration was plain with no pictures. The curtains were not fixed adequately to the pole. A seat base cushion was missing and a scatter cushion had no cover. One toilet had flaking paint on the walls and a boxed in area had dangerous corners that required further repair. Another toilet was out of order. Several air extractors throughout the home were dirty or where they have been replaced a repair and redecoration of the ceiling was needed. Most of the pull cords around the home were not easy clean to promote good infection control and other areas of poor decoration also made this task more difficult. Some showers and bathrooms contained curtains with mould growing on them that were hung on rusted curtain poles. A visitors’ toilet was pleasantly decorated and in good working order demonstrating that management are aware of the standards generally expected. During the day some staff and residents complained that the temperature in the home was uncomfortable. A relative has raised complaints about the heating and ventilation system within the home. Many of the bedrooms viewed were personalised with residents’ belongings. Bed linen was crumpled and did not appear to have been pressed. A room converted for use by the activities person was pleasantly decorated and furnished. The laundry contains a good standard of equipment. The floor was clean and storage space was good. Domestic workers spoken to state there is sufficient equipment to enable them to do their jobs but on the day of inspection only two cleaners were in the home and one was being assessed for NVQ standards. This meant many areas of the home were not cleaned and some malodour was noted. This was commented on by one visitor. The lack of working air extraction will add to this problem. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 23 Chairs and bed tables used by residents were found to be sticky and dirty. Some of the legs of tables were stained with what appeared to be old food. This means residents were eating and sitting in areas that were unhygienic. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the 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 using the service are not supported or protected through adequate staff numbers, training or thorough recruitment procedures. EVIDENCE: The staffing requirement is currently: Three First Level Nurses through the day. Eight carers in the morning. Five carers in the evening. Two nurses and four carers at night. When we arrived at the home the manager was off sick and one of the nurses had been sent home sick. A bank nurse, who was supposed to be the third nurse on duty, was in charge on the ground floor. She confirmed that she had worked many shifts at the home and did appear to know the residents well. The nurses were very busy in the morning with medication administration. This took most of the morning to accomplish. The administrator asked the deputy East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 25 manager to attend the home and he arrived late morning. A Regional Operations Manager from another area also attended. The nurses reported to us that the home had been short staffed for some time and staff were under a lot of pressure. They confirmed that they regularly worked with two nurses instead of three. We noted that staff appeared to be rushed, especially in the morning and we did not think there were adequate amounts of staff on duty. Staff training records indicated that most of the statutory training was up to date. Staff had also received training in challenging behaviour, infection control and equality and diversity. One staff member had just commenced employment. We checked her recruitment file which showed she was an experienced care assistant. There was a recent gap of five months in her employment history which had not been explored at interview. The interview record stated that she had been trained in statutory areas but would need refresher training. The carer confirmed that she was working a three day induction period. She stated that her last moving and handling training had been in 2004, she had not received any induction instructions regarding Fire procedures or health and safety issues. She was also working as a full member of the team instead of being extra to the staff numbers. We requested that she was given immediate fire training which the regional manager organised before we left the home. Three more staff recruitment files were checked. They contained two references and good background checks. We noticed that staff carried out their role at busy times in a task orientated way. They had little interaction with residents during this period and some practices restricted residents choice. For example when bringing a resident into a lounge two staff members sat him down without asking where he wanted to sit and without acknowledging any residents already in the room. Staff attending to one resident who stayed in his room left him in a chair in the middle of the floor without drink, call bell or any reading/listening material. During the afternoon this improved, staff did talk to residents and give more attention to their emotional and social needs. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. People using the 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 using this service are not protected through reflective management that takes account of the diverse needs of the service. EVIDENCE: The home does have a manager. Despite being in post for almost one year the manager has not been registered with CQC. The manager was absent on the day of inspection. There is an experienced deputy manager in post and residents commented that he was approachable and well liked. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 27 There was no evidence of management planning within the home and the atmosphere was confused, busy and disorganised. Staff could not find records that they should use every day and should be familiar with. Staff, residents and relatives had been consulted through meetings but the last staff meeting was in April, for relatives it was May and for residents June. Prior to this not many meetings had been held. Evidence given in other sections of this report would confirm that the home is not run in the best interests of residents and the management has not been strong, clear or direct enough. Issues raised in every section of this report have an impact on residents’ lives, welfare and safety. There was evidence of self monitoring and audit, which, had they been carried out correctly, should have prevented most of the issues raised in this report. The health and safety checks carried out were mostly up to date. The electrical installation certificate, which is valid for five years, could not be found. The Regional Manager later confirmed that this had expired. This compromises the safety of the building and all in it. The Regional Manager has taken action to address this. Residents’ monies are held in a central account. Electronic records are kept, with paper receipts and records to show all transactions. Money is checked by the administrator and manager weekly. A regional administrator also audits accounts and carries out spot checks. As the money is held centrally we were unable to count individual amounts. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X 3 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 3 X X 2 East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) 15(2)(b) (c) Requirement Ensure all residents have a written care plan detailing all care needs. Ensure care plans and assessments are kept under regular review and revision. 2. OP8 12(1)(a) (b) Ensure residents receive good personal care. Including adequate intake of fluids. Ensure that accurate records of personal care are kept. 3. OP9 13(2) Medicines must be stored safely and securely and within the temperature range recommended by the manufacturer and the treatment room should be used exclusively for the storage of medicines and related healthcare products. Medicines must only be administered to a person from the original labelled container supplied by the pharmacist for DS0000000506.V377746.R01.S.doc Timescale for action 22/11/09 22/11/09 22/12/09 4. OP9 13(2) 22/11/09 East Riding Version 5.3 Page 30 that individual. Best practice guidance and the provider’s medicines policy must be followed when recording all medicines, including controlled drugs. 5. OP10 12(4)(a) Residents must be dressed in 22/11/09 well laundered, age appropriate clothing that takes account of their wishes and preferences. All complaints must be fully 22/11/09 investigated and the complainant informed of any action taken as a result of the complaint. All complaints should be fully recorded. All allegations of abuse must be reported to the safeguarding agency and full records kept of actions taken. Ensure that all parts of the home are kept clean. Redecorate and repair walls in the first floor lounge. Ensure chairs in the first floor lounge are provided with seat cushions and covers. Ensure that all toilets are in working order. Repair surrounding woodwork to the toilet identified to ensure that it is safe. Redecorate and repair walls of identified bathrooms and toilets. Remove moulded curtains and all rusted hanging rails from the bathrooms. Ensure all mechanical ventilation 01/12/09 systems are kept clean and in good working order. DS0000000506.V377746.R01.S.doc Version 5.3 Page 31 6. OP16 22(3)(4) (8) 7. OP18 13(6) 22/11/09 8. OP19 23(2)(b) (d) 01/12/09 9. OP21 23(2)(b) (j) 01/12/09 10. OP25 23(2)(p) East Riding 11. OP26 23(2)(d) 13(3) Repair the heating system to ensure that temperatures within the home are maintained at levels comfortable for service users. Ensure that all bed tables, chairs 22/11/09 and equipment used by residents are kept clean. Clean or replace light pull cords. Clean or replace carpets identified as causing odours. Ensure that sufficient numbers of 22/11/09 staff are on duty to meet the needs of residents. Ensure that all staff receive induction training suitable to their role. Demonstrate how the quality of care in the home will be improved. Ensure that the electrical wiring system is tested every five years. 22/11/09 22/11/09 22/11/09 12. OP27 18(1)(a) 13. 14. 15. OP30 OP33 OP38 18(1)(c) 24 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP9 Good Practice Recommendations Train staff in person centred care. A system should be in place to record all medication kept in the home including any medication carried over from the previous month. The date of opening of medicines with a limited use once East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 32 opened should be recorded to make sure that they are not used beyond the date recommended by the manufacturer. The medicines fridge on the ground floor should be checked and replaced if necessary to ensure that medicines requiring refrigeration are stored within the correct temperature range. Medicines fridges should be locked when not in use and the key kept with the person in charge of the floor. Staff should sign and date any entries they make on MAR charts. Additional guidance on how to administer “as required” medication should be kept with the service user’s MAR chart. Medication audit should be sufficiently detailed and thorough to identify any medication issues promptly and to help confirm that staff are closely following the medicines policy. Regular stock checks of controlled drugs should be carried out and recorded. Controlled drugs no longer required should be disposed of promptly. Security bars should be fitted to the external window of the ground floor treatment room. 3. 4. 5. OP29 OP31 OP32 Use the interview record to demonstrate that all gaps in employment have been explored with staff during the recruitment process. Provide a registered manager for the home. Specify the measures taken to ensure the home is managed with clear direction. East Riding DS0000000506.V377746.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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