Inspection on 06/08/09 for Edgelea Care Home Ltd

This inspection was carried out on 6th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Edgelea Care Home Ltd 16/11/09

Edgelea Care Home Ltd 14/10/09

Edgelea Care Home Ltd 03/03/09

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Edgelea Care Home Ltd 14-16 Half Edge Lane Eccles Manchester M30 9GJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Jennings     Date: 1 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 43 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 43 Information about the care home Name of care home: Address: Edgelea Care Home Ltd 14-16 Half Edge Lane Eccles Manchester M30 9GJ 01617890430 01617896000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Edgelea Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people 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 Physical disability - Code PD The maximum number of people who can be accommodated is: 37 Date of last inspection Brief description of the care home Edgelea Nursing Home provides nursing and residential care for 37 older people or people with physical diabilities. Accommodation within the home is situated on the ground, first and second floors in single and double rooms. There is car parking space available at the front and the side of the home but this space is unsuitable for people to sit out in. Roof space has been converted to a roof garden. There is a Statement of Care Homes for Older People Page 4 of 43 Over 65 37 0 0 37 0 3 0 3 2 0 0 9 Brief description of the care home Purpose/Service User Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are, and what people can expect if they decide to live at the home. Information provided during this visit showed that the fees for the home are three hundred and seventy three pounds and eighty pence to four hundred and seventy six pounds and eighty pence per week with added expenses for hairdressing, chiropody, toiletries, newspapers and outings. Care Homes for Older People Page 5 of 43 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: The quality rating for this service is 0. This means the people who use this service experience poor quality outcomes. This report is based on information gathered by the Care Quality Commission (CQC)Commission since the last inspection on 03 March 2009 and any other information received prior to this visit. People living at the home and staff were asked to complete survey forms. We have received two completed forms from people living at the home. This unannounced visit forms part of the overall inspection process and took place on Thursday the 6th and Monday the 17th August 2009. This inspection was carried out by two inspectors and was in response to a number of serious concerns received by us regarding poor infection control at the home. Care Homes for Older People Page 6 of 43 As part of the visit time was spent examining relevant documents and files, talking with the homes relief manager, a nurse, several people living at the home, two visitors and five members of staff. The manager was absent from work during our visit. A relief manager had been appointed to oversee the running of the homeduring the managers absence. We spoke at length to the relief manager about concerns that had been raised before and during our visit. Care Homes for Older People Page 7 of 43 What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose displayed in the hallway was outdated and did not give enough information for people to make a decision on whether the home was right for them. Care plans were outdated and did not fully identify peoples changing needs or the action required to meet needs. This means that staff may not be able to monitor peoples health and wellbeing. Care plans for health, social and emotional needs were not in place for everybody living at the home. This means that people were at risk of not having their needs met. The health, wellbeing and dignity of people living at the home was not always promoted. We saw that although specialist nurses had visited and given advice on the care of people living at the home this advice was not always followed. We saw some people sat for long periods in arm chairs with their feet unsupported and dangling. This could lead to major health problems for individuals. We saw that staff did not engage people in conversation. This means that all contact between staff and people living at the home was task based. We saw that some peoples clothing was stained, hair uncombed, men unshaven and some people were not wearing shoes or slippers. This shows that there was little importance placed on respect and dignity. The home does not have a dining room. This means that people are not given a choice of where to eat and have to eat their meals sat in their armchair. The large conservatory was being used as a lounge. The room was very hot this means that people were sat for long periods in high temeratures. We did not see jugs of water or fruit juice to make sure people were getting enough fluids. There were no planned activities and few opportunities for people to be involved in community activities. This means that people are just sat in the lounges all day with no stimulation. The outside space available for people living at the home was a roof garden. We did not see any garden furniture or sun shades in this area. This shows us that this area was not used. This means that people living at the home have nowhere they can sit out in the nice weather. Care Homes for Older People Page 8 of 43 We were concerned about the level of cleanliness in the home. For example, some armchairs were dirty and in need of cleaning and several areas areas around the home were dusty and unclean. This means that the cleaning routines were not thorough enough and leaves people at risk of cross infection. We saw that the recruitment procedures were in need of improvement. For example one persons file did not have any evidence that Criminal Records Bureau (CRB) or Protection of Vulnerable Adults (POVA) checks had been undertaken. In other records two written references were not obtained. This means that they were not carrying out thorough checks to make sure that anyone employed in the home is safe to work with vulnerable people. All staff must complete an application form and provide details of two referees. The home must make sure they obtain two written references for staff in line with the homes recruitment policy and procedures. There was no evidence that the owner was completing a monthly quality monitoring report as required by Regulation 26 of the Care Homes Regulations 2001. This is a requirement from the previous inspection that has not been met. The requirements of the local fire officers report in March 2009 had not all been addressed. We were concerned that these requirements had not been met and may place people living at the home at risk of harm. Not all staff were receiving regular formal supervision in line with the homes policy. This means that care practices and training needs were not being formally discussed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 43 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 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were not assessed and they were not given enough information about the home for them to make an informed decision about moving in. Evidence: We saw that a statement of purpose was displayed in the hallway. The statement of purpose is an information booklet that tells people about the service and the type of support they can expect to receive. We saw that the statement of purpose still had the name of the previous owner/manager even though the new owner bought the home a year ago. The statement of purpose did not have any record of the fees charged, room sizes, no information about staffing numbers or qualifications or what facilities/activities the home offered to people. This document was not available in large print or other languages and formats such as audio cassette or pictures. Care Homes for Older People Page 11 of 43 Evidence: The document stated that people had to pay per hour for any activities and staff support outside the home. We looked at a sample of peoples contracts. This information was not written into any of the contracts we were shown. We saw a sample of the new providers terms and conditions for people coming to live at the home. We saw that they were not signed or dated. One person had signed a loose leaf sheet in their file but this was not attached to any contract. We saw a sample of peoples care plans. Pre-admission assessments were not seen on every care plan. The pre-admission assessment identifies peoples care needs and is used by the home to make sure they can meet peoples care needs. The information in the pre-admission assessments is then used to help write a care plan. Care Homes for Older People Page 12 of 43 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and care practices did not make proper provision for the health and wellbeing of people living at the home. Evidence: We looked at a sample of five care plans. We saw that some were dated 2006. This means that they gave out of date information about the support people needed. We saw that some care plans gave limited information about how to provide the support needed to keep people healthy. We saw the care plan of one person who had Parkinsons disease. This condition is progressive and there will have been some changes in the persons care needs in the 3 years since the plan was written. However, the care plan had not been amended in this period and the review sheets record no change. This person is at risk of not having their needs met. Care plans had not been fully reviewed following our last visit. This means that staff do not have the most up to date information about how to meet peoples care needs. We saw that where risks had been identified such as moving and handling a person Care Homes for Older People Page 13 of 43 Evidence: who becomes immobile there were poor records regarding how to support them. Using the wrong moving and handling techniques has the potential to put people at risk of harm. We saw that several of the care plans did not address care needs. It was difficult to assess how staff were meeting peoples health and care needs. This included monitoring of unstable diabetes and the care of pain. We were concerned that although a nurse who specialises in wound care had visited the home and advised staff on how to care for wounds. The records failed to show that staff had followed this advice. This means that there was no method for staff to use to monitor if peoples wounds were healing. The records written on a daily basis by staff did not provide any information on the care given to people. For example entries such as care as plan were being made. We saw poor records of fluid balances. This means that we could not see that people were having enough fluids to drink. We saw that there were no clear plans in place with regard to managing unstable diabetes. There were no clinical updates of managing peg feeds or weight loss. This means that they have no clear systems in place to accurately monitor the health and wellbeing of people living at the home. There were no detailed dementia care plans in place. We did not see any care plans relating to meeting peoples continence needs or use of a catheter. We also saw that there were no systems in place to review the management of peoples pain, pain relief and communication needs. This means that staff had no clear guidance on how to identify if people with no verbal communication were in pain. We saw there was limited information about how the service identifies and meets peoples needs when there are changes to their condition. This means that staff are not being updated on peoples changing needs posing a potential risk that peoples care needs are not being met. We found various points of concern through the care plans that we looked at. They showed that staff had not safely or appropriately managed peoples needs to help improve their condition. This means that peoples care needs were not being met. We saw some care plans showed that some people had been losing weight over the last 12 months. We saw that nursing staff had not updated the care plans to tell staff what care and support people needed to help improve their condition. The lack of appropriate reviews and clinical input raises concerns about the knowledge and skills Care Homes for Older People Page 14 of 43 Evidence: of the staff. This has the potential put people at risk. We saw that some risk assessments in peoples care plans were out of date. Although we saw falls risk assessments, the care plans gave staff no information on how to minimise the risk of falls. We saw that one person had sustained a wound to their ankle in an accident. There was very little information for staff to show them how to support this person. This means there are no adequate systems in place to reduce the risks of injury. We saw one persons wheelchair was in a poor state of repair. The seat was loose and missing a bolt. This means that the person was at risk of hurting themselves each time they got into their wheelchair. The wheelchair was very dirty with a build up of grime and stale food. We had concerns that care plans were not detailing the care people were receiving. We saw there was an urgent need for each persons care needs and care plan to be reviewed by staff with the appropriate experience, skills and knowledge. We walked around the building and spoke to people living at the home. We went into the lounges during different periods in the day and evening. We noticed a lot of poor standards of care and support. For example people sitting for long periods of time in unsuitable chairs with their feet hanging. This means they may be at risk of drop foot and pressure areas. We saw that although staff had assisted people to dress some were unshaven and others were wearing stained clothes and dirty glasses and a number of the ladies had facial hair. All of these things demonstrated a lack of attention to residents basic care needs. We looked at the management of medication. As part of this we looked at a sample of medication administration records (MAR). We saw some issues relating to medication practices. We saw one persons MAR sheet listed paracetamol. The qualified nurse on duty told us that this was discontinued but it had not been crossed off the MAR sheets. We also saw that some MAR sheets did not record the quantity of medication received. We also saw that this medication had not been signed into the home as received. This means it is difficult to audit the medication systems and determine whether people were receiving their medication as prescribed. We saw that some MAR sheets were handwritten. Where MAR sheets are handwritten they should record the amount of medication and the date it was received. This had Care Homes for Older People Page 15 of 43 Evidence: not been signed by two people to make sure that the correct dose and frequency have been copied from the medication container to the MAR sheet. We looked at the medication stocks. We saw that some dressing packs and needles had out of date expiry dates and should not have continued to be used or stored. A person who was no longer at the home still had very strong medication stored and staff had not arranged for its disposal. Staff did not record medications and stores sent back for disposal. At our previous visit we found that staff were sending disused medications to a local chemist rather than to a licensed contractor who is legally obliged to safely dispose of medications from nursing homes. This practise still remains and staff have not changed this practice. We saw that one persons care plan stated that medication should be left on their table for them to take at their leisure. We did not see any risk assessments on the care plan to show that risks to the person or to other people living at the home had been considered. Care Homes for Older People Page 16 of 43 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were not provided with enough activities to keep them stimulated or active and choice was not provided. Evidence: During our visit we did not see any activities or social support to meet peoples needs. Staff told us that there had been no trips out despite people telling us they would love to go outside the building. We saw that there was a roof terrace for the use of people living at the home. We saw that this area did not have any furniture for people to use. People living at the home told us that they had not been able to sit outside during the nice weather. We saw some garden furniture outside the conservatory. People told us that this was for staff use and that they were not allowed to use it. This raised serious concerns that the needs of the staff are being put before the needs of people living in the home. We saw that staff have sole use of this limited outside space. People told us they were bored and that there wasnt anything to do and that they would love to get involved in anything on offer. Some people chatted to each other and told us they would love to go to places like the Imperial War Museum, Southport, Care Homes for Older People Page 17 of 43 Evidence: Blackpool and others told us just would just like to sit outside. The service had no space or facility specifically for younger adults. Younger adults currently living at the home share the same space as other people and they have no quiet area, games, computer or music room. There have been no developments to adapt the service to meet the needs of younger adults. The relief manager advised us that she had already identified the lack of social support and she planned to arrange a meeting with people living at the home and their representatives to discuss their plans for the future. She also explained that she was going to start a weekly surgery to be displayed in reception so that people are informed that she is available to speak to about anything. We saw a sample of care plans. We saw that peoples preferred activities or hobbies had not been recorded. This meant that the staff did not have enough information to meet the social needs of people living at the home. We spoke to a number of people living at the home. People told us how they spend their days. Some people told us they were looking forward to their tea. Most people said they really enjoyed their meals and looked forward to meal times. We saw there were no dining tables. This means that people ate their meals sat in their armchairs. We saw that people were sat for long periods throughout the day in their armchairs. This means that people did not have the opportunity to eat their meals in pleasant surrounds and socialise with each other. We saw that one person was given a lap tray for their meal while sat at their armchair however we noticed it was stained and dirty yet staff had still chosen to use it without cleaning it first. We saw one person sitting eating their lunch at a small table that had been positioned in a corridor opposite the lift to eat their meals. This was the persons choice however it raised concerns about the risk of blocking an exit in the event of an emergency. We saw there was a large conservatory where approximately eight people were sat. It was a sunny day and it felt very warm in this area. There were ceiling fans but these were not in use. They had a small mobile air conditioning unit that was directed at one person. The conservatory did not have a wall thermometer so that staff could monitor and check whether the room temperature was appropriate for people to sit in for long periods of time. As stated previously we noticed that a lot of people were sat in their armchairs all day. Care Homes for Older People Page 18 of 43 Evidence: Some people were not even facing the television and could not see the television. We noticed that some people were still sat in their chairs after eight pm including people in the conservatory. This was considered a long time to be sat in such a warm area with no way of checking on the room temperatures. We did not see any jugs of water of fruit juice in the room for people to have a cool drink. The menus were displayed on a notice board in the hallway it was quite high and some people using a wheelchair may not e able to see them. We saw that most staff had limited interaction with people during our visit. One carer was seen helping a person with their meal but did not speak or try to engage the person in conversation. Staff seemed to have limited skills in how to effectively communicate with people. However, the relief manager communicated quite well with different people with different needs. This was evident during our visit in how various people chose to come to her to speak openly and told her they appreciated what she was doing for them. We saw that some people used self propelled wheelchairs. We did not see any specialised openers on the doors that would help people move more easily around the home. Care Homes for Older People Page 19 of 43 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living at the home did not know how to make a complaint so their concerns may not be listened to or addressed. Evidence: We saw the complaint records. We saw that just one complaint had been recorded. There was no evidence of any investigation or action taken by the previous manager regarding the concerns raised. These records showed that people had not been encouraged to express their concerns or complaints. We saw that there was one complaint recorded. This was made by a relative and related to hygiene, nurse call system, door open, social stimulation, nails and hoists. The relief manager told us that they were meeting with the persons relative to discuss the issues and evaluate the care plan. They told us that there has been one other issue raised about poor practice and they think it could be linked to two members of staff. This was not recorded. There were no other records relating to concerns or complaints. This raised concerns that peoples comments or complaints were not taken seriously enough to investigate. We spoke to people living at the home. One person told us I am not really sure how to make a complaint, I suppose I would speak to one of the girls. Care Homes for Older People Page 20 of 43 Evidence: The relief manager told us that they have started a relatives surgery on a Wednesday at 2pm. This was so that visitors could discuss any concerns they may have about the care. The relief manager told us that they would prefer to deal with concerns as and when they arose rather than waiting until they became major complaints. We spoke to a number of people living at the home and some visitors. We were told that there were concerns about how some staff spoke to one person who is had difficulty communicating. We were told that some staff had been seen mimicking the persons attempts to verbalise their needs. They told us that other staff were present at the time. We were told that the person had been very distressed about this incident. We had serious concerns that potential witnesses had not referred the incident using the local adult safeguarding procedures. Any suspected abuse of a vulnerable person must be referred using the safeguarding procedures. We looked at the safeguarding policy and procedure. The policy gave information about the different types of abuse but did not mention the local multi-agency safeguarding procedures. We looked at a sample of staff training records and when we spoke to staff we found that several members of staff had not received safeguarding training or updates to previous training. All staff must have the necessary training that is up to date in safeguarding and complaints so they have the right skills and knowledge to always be able to protect and safeguard the people they support. Care Homes for Older People Page 21 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home did not provide people with a clean, hygienic and pleasant environment in which to live. Evidence: We saw that there was a major refurbishment underway. We saw that the renovation works had been poorly managed. Rather than the refurbishment being done in stages the whole building was affected. This means that the safety of people at the home could be compromised. A relief manager had been appointed the week before our visit. They told us they plan to renovate each persons room to completion and then move on to the next room. This is to cause the least disruption to people. The relief manager told us they plan to fully refurbish 2 rooms a week which will take them up to November for the work to be completed. The relief manager also told us that they were going to ask people what colour schemes and soft furnishings they would prefer. This would give people living at the home some control over their environment. The relief manager was being thanked for already organising new bedroom furniture for one person who was delighted with the news. The relief manager had already identified a review needed for one person to be assessed for an electric wheelchair to help them mobilise around the home more Care Homes for Older People Page 22 of 43 Evidence: easily. Again they were delighted with the relief managers support and help in trying to achieve improvements for them. The owner told us that a full electrical re-wire had been carried out and the boiler replaced because they had no hot water. They told us that this had delayed the renovation work. As stated previously we noticed the home did not have a dining room or any clearly defined dining space. We saw that people were sat in the same place all day and they ate their meals sat in their armchairs. This did not address peoples social needs it did not give people an opportunity to sit and chat or enjoy their meal in pleasant surroundings. We saw there was a large conservatory where approximately eight people were sat. It was a sunny day and it felt very warm in this area. There were ceiling fans but these were not in use. They had a small mobile air conditioning unit that was directed at one person. The conservatory did not have a wall thermometer so that staff could monitor and check whether the room temperature was appropriate for people to sit in for long periods of time. We saw that there were a number of younger people who used a wheelchair to move around the building. The lounges looked crowded and there was not much room for people to move around. They should consider if the environment is adequate to meet the social, emotional and physical needs of the younger people living at the home. We saw various armchairs that people were sat in were worn and stained and peoples wheelchairs were dirty and unkempt. We saw that one persons wheelchair was damaged and posed a potential risk of injury to the person. Equipment used by people living at the home must be kept in good repair to minimise the risks of harm. We saw staff giving a dirty lap table to a person to use for their meal. This did not respect the persons dignity showed a lack of care and is poor infection control practice. We noticed a strong and unpleasant smell on entering the home. This did not provide a pleasant and comfortable living environment for people. The relief manager was confident that the renovation works, new carpets, decoration and review of cleaning schedules would improve the living areas and provide a better place to live. The relief manager told us that she had already carried out various actions to review Care Homes for Older People Page 23 of 43 Evidence: the management of peoples incontinence and the cleaning schedules to help improve the cleanliness and unpleasant smells within the home. They told us that carpets were going to be replaced. In the meantime consideration should be given about how they can improve the environment. The relief manager had been in post for a short period of time. We noted that in this short space of time she had identified a number of important actions that needed to be taken to improve the service. The relief manager was honest about the present standards of decoration and the list of jobs that still needed to be done. The manager showed us a copy of a detailed infection control audit carried out by the community infection control team in March 2009. This gave a list of a number of concerns regarding infection control and recommendations needed to improve upon them. The relief manager said that since she arrived almost all of the actions and recommendations needed to improve the infection control procedures and cleanliness of the building had been addressed. They told us that they were working closely with the infection control nurses to improve the practices in the home. However, we were concerned about the level of cleanliness in the home and the risks of cross infection. We walked around the building it was evident that a lot of work is needed to the improve the cleanliness of the building. We saw a number of carpets that were worn and stained both in bedrooms and communal areas. We saw window sills and radiators were sticky to touch and had build up of dust on them. We acknowledged the extent of work that had already been carried out to improve the safety of the building. We saw they had invested in buying equipment for people living at the service such as electric beds and airflow mattresses to help improve peoples care and comfort. We saw that there was no outside space for people to sit and enjoy the nice weather apart from a large roof terrace. This was not being used at the time of our visit even though it was a nice day. A risk assessment should be carried out before people use the roof terrace. On our second visit to the home we saw that the door to the roof fire escape was open. We saw there was a digital door lock attached to this door. The door opens onto Care Homes for Older People Page 24 of 43 Evidence: a metal staircase and posed a risk to any vulnerable people who may be able to access the area. Care Homes for Older People Page 25 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedures do not fully protect people and staff had not being provided with the right training and skills to help them do their job in the best interests of the people living at the home. Evidence: We saw that some staff files did not have an application form or two written references. One did not have a Criminal Records Bureau CRB check or a check against the Protection of Vulnerable Adults (POVA) list. This means that the recruitment and selection of staff was not robust enough to protect people. Three people told us that staff were usually available when needed but that they sometimes had to wait a long time. We saw that people were not receiving individual support. This means that peoples social and emotional needs were not being identified or met. We spoke to people living at the home. One person told us I feel that night staff carers are not trained enough. There had been a safeguarding issue raised about staff attitude. The relief manager told us her plans for the laundry and cleaning staff hours so they have improvements to the environment and the cleaning schedules. We chatted to people during our visit who were happy with the day staff but felt they didnt see enough of them as they were always busy. One person said they are OK Care Homes for Older People Page 26 of 43 Evidence: they are kind girls and work very hard. One person told us there is nothing to do but sit here all day and all evening, I am not ready for this yet I hate it they dont arrange anything for us to do. We saw that staff were wearing gloves and aprons when serving the meals. We spoke to one member of staff. We asked why they were changing their gloves and apron during meals and why they were used. They told us they were unsure and were doing it because others were wearing gloves even for giving out meals. We walked around the home. We saw very little interaction between people living at the home and the staff. Any contact with people was task based. We saw staff placing cutlery onto the lap tables without explaining that it was tea time and the meal would be served soon. We saw two members of staff helping people to eat their meal. They stood over the person and did not speak to the person at all throughout the meal. This means that care practices are task based and mealtimes did not appear to be enjoyable for people. This is poor practice and does not show respect for the person or help to maintain their dignity. One person asked us for some face cream the lounges were open plan and staff could hear people talking to us and making requests. The response was they had to wait a week until the persons family visited. We did not see staff respond positively to any of the requests or issues people raised. We saw that the qualified nurse was sat at a small table in the lounge writing reports then doing medications. During this time they did not interact with people. We spoke to two members of care staff on the first floor. They told us that the trained nurse had resigned the previous week and that there was only one trained nurse on duty. We spoke to the manager who asked the nurse to arrange cover. By late afternoon nothing had been done regarding the staffing shortfall. We spoke to staff about the changes in the home. The staff we spoke to seemed more concerned that they now have to take individual breaks which can sometimes leave one person on the floor to do all the work. They told us they had done some training including Protection Of Vulnerable Adults (POVA) when she did her NVQ level 2 but that this was 3 years ago. One member of staff told us that they had recently had infection control and fire Marshall training. They also told us that had not had any training in dementia care, diabetes or dignity Care Homes for Older People Page 27 of 43 Evidence: and choice. Some staff told us that they had not had any moving and handling, nutrition, health and safety or food hygiene training. To make sure people are kept safe from harm staff must receive training in all aspects of health and safety and safe working practices. We saw a sample of staff files. We did not see any evidence that staff had a formal induction period and only some of the files contained any record that staff had received training in safe working practices. We spoke to staff on duty. They told us that they have four people who need to be fed through a tube (PEG). They told us that the nurses dealt with the PEG feeds. This raised concerns about who would take responsibility for this with the shortfall in staff identified earlier in the report. We saw people living at the home wore stained clothing and furniture was dirty with dried on food. Staffing levels should be reviewed to make allow for developing and providing activities and for the ongoing laundry of clothes and linen and cleanliness of the building. The relief manager told us her plans for the laundry and cleaning staff hours so they have improvements to the environment and the cleaning schedules. Care Homes for Older People Page 28 of 43 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management structure was not sufficient to make sure the home is run in the best interests of the people who live there. Evidence: The manager of the home was absent and a relief manager had been appointed. As detailed throughout this report the evidence during our visit showed their were ongoing concerns about the service. We had concerns about the way the service had been managed. We were concerned that requirements had not been addressed by the previous manager following our last visit. We spoke to the owner and the relief manager during our visit. They were honest about the previous shortfalls at the service. They told us they felt positive that they could work together to improve the quality of the service within the next few months. Due to the concerns raised before and during our visit we have arranged a senior management review. As a result we decided to bring this key inspection forward. The relief manager had a number of years experience in running a care service. They Care Homes for Older People Page 29 of 43 Evidence: showed a good understanding of the areas of weakness and identified where the service needed to improve. The relief manager was faced with the task of raising standards and introducing new systems within the home. The owner must make sure that there is enough support for the relief manager to carry out the improvements to the service. The owner told us that they were considering one of the managers from another home in the group working alongside the relief manager. This would enable the relief manager to put the systems and procedures in place needed to improve the service. We did not see any evidence of a formal quality monitoring process or that people were asked their opinions about the home. The relief manager discussed their plans to meet with people and their relatives. This was to get peoples opinions about the home and to help keep them up to date with developments. We asked the manager for the monthly monitoring reports written since the last inspection. The manager provided us with a file that contained one report that had three separate dates on it. Subsequent to the inspection the provider has told us that the reports were available in a different file. The manager should be aware of the contents of these reports and a copy should be made accessible to them. The relief manager had made some improvements to the homes management systems since her appointment, but much more work was needed to make sure that care staff receive the leadership and support they need. We saw that a detailed infection control audit was carried out by the Infection Control nurses in March 2009. We saw that even the most basic requirements of the audit had not been addressed until the week before our visit in August 2009. This was when the relief manager started work. We spoke to the owner of the home. They told us that they were not made fully aware of the infection control issues until recently. We saw that regular auditing of records and practices were not being done. Audits make sure that the home offers the right standards and facilities to people. The policy file showed that staff did not have access to all necessary updated policies and procedures. These are needed to help them do their job in the right way. The staff must have access to a full list of updated policies and procedures to help them provide the right support. The training, development and supervision of staff has been inconsistent and staff have been lacking leadership. We did not see any records to show that formal staff Care Homes for Older People Page 30 of 43 Evidence: supervision was taking place. We spoke to staff. They told us that they did not have regular formal supervision. This means that they are not getting any structured support or guidance from the manager. We received an Annual Quality Assurance Assessment (AQAA). This had been completed by the previous owner and did not contain enough information. We did not see any evidence to back up the statements made in the AQAA. We spoke to a number of people who expressed concerns about the attitude of some night staff. The manager needs to address these issues. There was no evidence of any type of quality assurance audit and checks of medications. Regular audits of medication procedures would help to identify concerns listed above and would help to reduce the risk of mistakes occurring and provide a clear audit trail to check people receive their medication correctly and would ensure that medications are safely managed. We did not see any environmental risk assessments in place. We saw that building tools and equipment were left unattended. We saw that carpets had been lifted in the hallway leaving loose wires close to the doorway posing a potential trip hazard. It was good to see that the relief manager had carried out a risk assessment and made safe the loose wires by the end of our visit. Prior to this people were exposed to the risk of harm. We saw that some fire doors were being held open with fire extinguishers. This posed a potential risk to people as the fire doors are designed to provide some protection in the event of a fire in the home. On our second visit to the home we saw that the door to the roof fire escape was open. We saw there was a digital door lock attached to this door. The door opens onto a metal staircase and posed a risk to any vulnerable people who may be able to access the area. We saw one person sitting eating their lunch at a small table that had been positioned in a corridor opposite the lift to eat their meals. This raised concerns about the risk of blocking an exit in the event of an emergency. We looked at the way they manage peoples finances. They told us that any monies held on behalf of people living in the home were deposited into a charitable non interest bearing account. Care Homes for Older People Page 31 of 43 Evidence: The administrator told us that relatives generally supported people to manage their finances. We looked at how home managed the finances of some people and they kept a computerised record of any transactions made on peoples behalf. We looked at one persons financial record that showed a balance and monies paid in and out. However, because they used a collective bank account it was difficult to check individual balances and this must be addressed. Care Homes for Older People Page 32 of 43 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Care records need to have detailed, up to date information about residents health and personal care needs in place and any restriction of rights agreed and recorded. So that staff know how to meet residents needs effectively 18/04/2009 Care Homes for Older People Page 33 of 43 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Unless it is impracticle to 30/09/2009 carry out such consultation the registered person shall after consultation with the service user or a representative of his prepare a written plan the service user plan as to how the service users needs in respect to his health and welfare are to be met. The regiastered person shall make the service users plan available to the service user keep the service users plan under review where appropriate and unless it is impractical to do so carry out such consultation with the servicew user or a representative of his revise the service users plan and notify the service user of any such revision. Each person living at the Care Homes for Older People Page 34 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action home must have a care plan that clearly identifies their care needs any identified risks and the action required to meet them. 2 7 15 Unless it is impractical to 30/09/2009 carry out such consultation the registered person shall after consultation with the service user or a representative of his prepare a written plan as to how the persons needs in respect of health and welfare are to be met. The plan must be kept under review, where appropriate and unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his revise the service users plan and notify the service user of any such revision. Care plans must contain sufficient detail on all aspects of a persons care needs to enable staff to offer appropriate support. 3 7 13 All parts of the home to which service users have access are so far as possible free from hazards to their safety. Unecessary risks must be 30/09/2009 Care Homes for Older People Page 35 of 43 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 identified with the use of risk assessments and actions taken to eliminate those risks to people living in the home. 4 8 12 The registered person shall 30/09/2009 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users to make proper provision for the care and where appropriate treatment education and supervision of service users. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users They must make sure that the peoples health and social care needs are fully met. Care Homes for Older People Page 36 of 43 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 5 9 13 The registered person must 30/09/2009 make sure that medication is managed in a safe and appropriate manner to make sure prople are kept safe. In order to make sure that people receive their medication as prescribed they must make sure that medication records are kept up to date and accurate. 6 16 22 The registered person must ensure that any complaint made is fully investigated. All complaints must be recorded to show that they have been dealt with in line with the homes policies and procedures. 17/09/2009 7 19 13 unecessary risks to the health and safety of service users are identified and so far as possible eliminated. Equipment used by people living at the home must be kept in good repair to minimise the risks of harm. 28/09/2009 8 19 23 There must be adequate sitting, recreational and dining space provided seperately from the service users private accommodation. 21/09/2009 Care Homes for Older People Page 37 of 43 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 Advice must be taken from the local fire officer with regard to having a dining table placed in the corridor outside the lift to make sure people living in the home have a safe environment. 9 26 13 The registered person shall 30/09/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. There must be suitable risk assessments and actions taken to prevent infection and toxic conditions at the service. Actions must be taken regarding improving the cleaning schedules at the service. All areas that are unclean must be improved to reduce risks and improve the environment so that people are not put at risk. 10 27 18 The owner must make sure that there are enough staff to meet peoples needs. Staffing levels must be reviewed regarding the necessary resources and hours needed for developing and providing activities and for the ongoing cleaning of 05/10/2009 Care Homes for Older People Page 38 of 43 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 the service. They must assess the dependencies of the people at the service and how they measure the ongoing staffing levels to meet the needs of the people living there. 11 29 19 The registered person shall not employ people to work in the home unless he has obtained the information and documents specified in paragraphs 1-7 of schedule 2. To ensure the safety of people living at the home a robust recruitment procedure must be adhered to at all times. There must be evidence that thorough safety checks have been undertaken before anybody is offered work. 12 30 18 The registered person shall make sure that staff have the appropriate training for the work they are to perform. Staffing levels must be reviewed to make sure that there are enough staff available at all times to meet the health and social care needs of people living in the home and to ensure that the cleanliness of the 05/10/2009 21/09/2009 Care Homes for Older People Page 39 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action home is maintained. 13 35 20 The registered person shall 28/09/2009 not pay money belonging to service users into a bank account unless the account is in the name of the service user to which the money belongs and the account is not used by the registered person in connection with carrying on the management of the care home. There must be clear financial care plans and up to date policies relating to the management of the monies held on behalf of the people who live at the service. People should be supported with various options that meet their individual needs or advised as to how they can support them with their financial needs. 14 36 18 The registered person shall 30/09/2009 ensure that people working in the home are apprpriately supervised. In line with the homes policy and procedure staff must recive supervision. This must include night staff Care Homes for Older People Page 40 of 43 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 to make sure that good care practices are used. 15 38 23 The registered person after consulting with the fire authority shall make adequate precautions against the risk of fire including the provision of suitable fire equipment. Staff practices at the home must not compromise peoples health and safety. 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 28/09/2009 1 1 An up to date accurate statement of purpose should be provided and where possible in other fonts, languages and formats so that it is accessible to all people who may be considering moving into the home. Each person living at the home should be provided with a contract so that they know what service they will be receiving and how much it will cost. Daily records are detailed and reflect the care given. Daily records should also give details about how the person has spent their day. This is so that staff can monitor peoples health and wellbeing. Action should be taken to enhance the outdoor area for the people who use want to use it so they have a facility to go to when they want to. The owner should consider how they can meet the social care needs of the younger people living at the home to make sure their needs are met. Staff should be encouraged to communicate with people 2 2 3 7 4 12 5 13 6 15 Care Homes for Older People Page 41 of 43 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 when carrying out tasks such as assisting people with meals and personal care to make sure peoples dignity is maintained. 7 15 Action should be taken to review areas that could be used to offer further day space including appropriate dining facilities for those people who would enjoy and benefit from socialising with meals. The safeguarding policy and procedure should give clear direction to staff of the action to be taken in the event of an alegation of abuse. To reduce the disruption to people living at the home they should produce a plan of maintenence and refurbishment. This should include an environmental risk assessment. A complete audit of the training needs of staff needs to be identified and a clear and accurate training plan developed so the manager can plan and identify the right training for people and put this in place within appropriate timescales. The manager should be aware of the contents of the regulation 26 reports and a copy should be made accessible to them. The provider should review staffs opinions regarding the service so that they can look at what actions can be taken to improve the moral of the current work force to ensure a stable staff team continues to work at the service. There should be a lot of development and consultation with the people who live at the service and their relatives around important issues affecting Edgelea. A development plan should be produced and shared with people, staff and relatives to show what plans are taking place regarding their home and regarding feedback to any of their requests and suggestions. 8 18 9 19 10 30 11 31 12 33 13 33 Care Homes for Older People Page 42 of 43 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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