Inspection on 20/01/10 for Erith House

This inspection was carried out on 20th January 2010.

CQC found this care home to be providing an Adequate 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Erith House 09/07/09

Erith House 21/01/09

Erith House 30/01/08

Erith House 21/03/07

Erith House 07/02/06

Erith House 23/08/05

Erith House 07/01/05

Erith House 15/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Erith House Lower Erith Road Torquay Devon TQ1 2PX     The quality rating for this care home is:   one star adequate 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: Ian Wright     Date: 2 2 0 1 2 0 1 0 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 37 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 37 Information about the care home Name of care home: Address: Erith House Lower Erith Road Torquay Devon TQ1 2PX 01803293736 01803211311 janehannaby@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Erith House Management Committee care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Erith House provides residential care for up to twenty older people, who may also have physical disabilities. The house was purpose built in Victorian times, and was solidly built, with gothic archways and fine windows. The home is situated in a quiet residential area in Wellswood, between Torquay and Babbacombe. The home has a very pleasant garden which is available for the use of people who use the service. There is car parking at the front of the home. There is level access throughout, with a shaft lift, and wide doors and corridors. Flagstones have been laid along the garden paths to make walking easier. There are raised toilet seats and two specialised baths to support residents with mobility Care Homes for Older People Page 4 of 37 Over 65 20 20 0 0 0 9 0 7 2 0 0 9 Brief description of the care home difficulties or frailty. As well as a large lounge and dining room there is a library and a kitchenette for the use of people who use the service. All bedrooms are single, with en-suite facilities. Several are large with lovely views over the town of Torquay and gardens. The registered provider is Key Change Charity which is a Christian charity which owns a number of care homes for elderly people. The home provides care for people of all religions or for those who do not have any religious faith. The fees at the time of the key inspection in January 2010 were £490 per person. Copies of this and previous inspection reports are available from the registered persons, or free from CQC via our website or as a hard copy (via our national call centre). Care Homes for Older People Page 5 of 37 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place in fifteen and a half hours over two days. All the key standards were inspected. The methodology used for this inspection was: (1)To case track four people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussion with staff about their experiences working in the home. (3) Discussion with other people using the service, and their representatives. (4) Observing care practices. (5) Discussing care practices with management. (6) Inspecting records and the care environment. (7) Completing a postal survey of a group of people who use the service, staff members and professionals that work with the service. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgement made in the report. Care Homes for Older People Page 6 of 37 A random (short targeted) inspection was also completed in July 2009. This was to monitor compliance with the previous requirements made at the key inspection in January 2009. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided to people who use the service (e.g. regarding services offered) is to a satisfactory standard. For example all people who use the service receive a statement of terms and conditions of residency or contract when they move to the home. This ensures people are aware of their rights and responsibilities. Pre assessment procedures are satisfactory. This helps to evidence that pre admission procedures are appropriate, and should assist the registered persons to be clear that they can meet the persons needs before admission is arranged. This information should always be signed and dated. A Statement of Purpose must be developed, and all documentation needs to be updated with details of the new registered provider and details of the Care Quality Commission. Evidence: The registered persons have a satisfactory service user guide. There is also colour brochure available about the home. A copy of the service user guide is given to the person / their representatives when admission is arranged. We would advise a copy is Care Homes for Older People Page 10 of 37 Evidence: also kept in the foyer of the home. Some updating of this documentation is however required for example regarding details of the new registered provider and how to contact CQC. A Statement of Purpose was not presented to us for inspection. (This document outlines the homes organisation, services, operational policy etc.) This is required by law and must be developed as soon as possible. The home has an admission and discharge policy. The registered manager said she will always go and visit prospective clients before admission is arranged. A pre admission assessment will be completed either at the persons home, or at a hospital etc. if they are unwell. We inspected files for four people, some of whom had moved to the home since the last key inspection. A pre admission assessment was present on some of these files. The information was generally satisfactory, but such information should always be signed and dated. We were able to inspect contracts /terms and conditions of residency for people admitted to the service. These seem to be to a generally satisfactory standard, although again this documentation should always be signed and dated. We were told a copy of this information is provided to the person using the service and / or their representative. Care Homes for Older People Page 11 of 37 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 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 very happy with their support and care, and care appears to be delivered to a good standard. However improvement is required to care planning, notifying the commission regarding certain events and incidents, and to medication procedures. Improvement in these areas will give people living in the home, and their representatives, more assurance their personal and health care needs are being met. Evidence: People using the service, and staff working at the home, all said care delivered was to a good standard. We received completed surveys from people using the service, staff and professionals working with the service. All respondents said care is delivered to a good standard. We spent the first day of the inspection speaking to people using the service and they were very complimentary about the care they received. People said they felt their privacy and dignity was respected by staff. People said they were always referred to by their preferred name. People all looked clean, healthy and well cared for by staff. Staff on duty on both days of the inspection were attentive to peoples needs and seemed caring. Care Homes for Older People Page 12 of 37 Evidence: All people, who we case tracked had a care plan, and most care plans seemed reviewed. However care planning could be simplified, as there appears to be two systems in operation and unnecessary duplication of information. For example there is a cardex type care planning system, and also separate pre printed care plans. Documentation in both systems is not fully completed so at times it was difficult finding all the required information. There is also a danger that information in both systems could contradict the other. We would therefore strongly recommend the system is streamlined. We noted one case where a review of a care plan seemed comprehensive. However the review failed to acknowledge the significant number of falls (including one which resulted in a hospital admission) that the person was having, or what action was taking place to subsequently minimise the risk. For example the risk assessment deemed the person as being of low risk of fall, but did not appear to outline any action following the significant number of falls in the accident book or when one accident resulted in a hospital admission. Care plan reviews subsequently need to be more rigorous. It is essential that in each file there is: (1) An up to date care plan containing satisfactory information for staff to deliver care and outlining the persons physical, emotional, social and educational needs. (2) Care plans are fully reviewed-preferably monthly. (3) Risk assessments e.g. regarding moving and handling which are accurate, and reflect the persons current needs. We also looked at records of health care support. Records of GP support are generally satisfactory, although in respect of some people using the service we could only satisfactorily track support from daily care records. Records of support received from district nurses, community psychiatric nurses (where appropriate), dentists, opticians and chiropodists were harder to track. Staff told us that people get domiciliary support from opticians and chiropodists (where wanted and required). However, the sections at the front of the care plans regarding the name and phone number of the professionals involved was left blank in many cases, and records of these interventions limited or non existent. It needs to be clear in care plans when this support is required and who is providing it. It needs to be possible to ascertain at a glance when people last saw the relevant health care professional. Should the person not require this support, or not wish for it, this needs to be clearly recorded in the care plan. This information will ensure staff clearly know the people concerned are getting this support regularly as required. Care Homes for Older People Page 13 of 37 Evidence: We have raised concerns with the registered manager that we have not been notified either verbally or in writing regarding some events, which the home is required to inform us about by law. This includes deaths, and accidents which occur in the home and result in hospital admissions. Full details of events and incidents which we require verbal and/or written notification are outlined in the Care Homes Regulations 2001 under regulation 37. It is essential that the registered persons re-reads the regulation, and ensures we are notified appropriately. The registered persons have a medication policy. We inspected the homes medication system. Medication is stored in a purpose built trolley and also a locked cupboard. There is a separate cabinet for controlled drugs. Medication is administered via a Monitored Dosage System (MDS). (i.e pre packed in bubble packs by the pharmacist). The system needs the following improvements: (1) Some doses of medication were not signed for. Staff need to check that when they administer medication they always sign for it or outline the reason, on the rear of the medication sheet, why medication is not administered. (2) In a minority of cases it was not clear whether some doses of medication were given, and if not, why this was the case. For example some medication remained in the monitored dosage system although it was signed for as administered. In other cases it was not in the bubble pack and was not signed for. The registered manager said in some cases medication was being administered from boxes of prescribed medication even though this medication had also been received in the bubble packs. It is essential that records of medication administered always correlate with the correct dosage in the MDS system. There should not be duplicate stock being used outside the MDS system. Failure to administer medication correctly and in a methodical manner could result in medication being administered twice by different staff. (3) There were significant amounts of excess stock in the medication cupboard. Although most of this was not passed the used by date, some of this stock was (a) far in excess of the individuals requirements (b) Prescribed and dispensed some time ago e.g. 28/11/2007, 13/8/2008 etc. It is essential that the system is thoroughly audited by senior staff, and where not required, excess stock is returned to the pharmacist without delay. (4) A stock taking system is introduced to minimise the receipt of excess stock, and ensure the timely disposal of stock which is no longer required. For example stock Care Homes for Older People Page 14 of 37 Evidence: received should be recorded when received, and staff should be vigilant to ensure stock is not reordered when it is not required. Storage and recording of general and controlled drugs is generally satisfactory, although one persons medication was not double signed (as is required) on two separate occasions. Staff, who administer medication appear to have received formal training regarding medication, although this may need to be up dated in some cases to ensure people manage the system more effectively. Care Homes for Older People Page 15 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines, food and opportunities meet the needs of the people living in the home. Support in these areas is delivered to a high standard. Evidence: People using the service, who we spoke to, said they could get up and go to bed when they wished. Routines in the home appear calm and relaxed, and on both days of the inspection, people got up in a leisurely manner. There was a friendly atmosphere in the home on the day of the inspection. People also said they could spend their time as they wished during the day and go to bed when they wanted to. There are some structured activities available for example Exercise to Music and reminiscence sessions with external facilitators. There are also tea parties, talks, external entertainers, bingo sessions, and a monthly holy communion (Church of England). The library visits the home so people can have a selection of books to read each month. People can have a daily newspaper. Activities for the day are recorded on the white board in the hallway. It may be helpful to people using the service if there was a timetable, for the month ahead, displayed on the notice board so people know well in advance what activities will be available. A minority of people did tell us there should be more activities available to occupy people. Care Homes for Older People Page 16 of 37 Evidence: People are very positive about the food provided. Although there is no choice of main meal at lunch time, the registered manager said staff know peoples likes and dislikes and an alternative is always prepared if people do not like the main meal on offer. A minority of people did tell us there should be more choice of main meal available. A choice of evening tea /supper is provided. Staff ask people using the service in advance what they would like for supper. Tea / Coffee/ other drinks are available throughout the day. Biscuits are provided with morning coffee and home made cakes are provided with afternoon tea. The inspector shared a meal with people using the service on both days of the inspection. Lunch on both days was to an excellent standard. Food was well prepared, nourishing and appetizing. Coffee or tea was offered after the meal with a chocolate mint. The people the inspector spoke to all enjoyed their meal. The support provided to the people using the service was to a good standard, and the meal was unrushed. People who the inspector spoke to said specialist foods were provided e.g. for people with diabetes etc. Suitable records are kept of meals provided. Care Homes for Older People Page 17 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider has a complaints policy and an adult safeguarding procedure. However these need to be developed to contain information regarding appropriate contacts should staff or people using the service have a concern or a complaint. Improvement of the homes procedures will ensure people involved with the service have more information regarding how any concerns or complaints will be managed and resolved .One concern was expressed to the commission, prior to the inspection, which was referred to the local authority under their safeguarding procedure. This is currently under investigation. Evidence: The registered provider has a complaints policy. This is generally satisfactory; although it now needs updating to give details of how to contact the new registered provider and the Care Quality Commission. A summary of this information needs to be included in the service user guide. We also suggest the complaints procedure issued to people who use the service (e.g. as part of the service user guide) contains details of relevant social service department complaints procedures. If people receive funding via the local authority (or health authority) they have a statutory right to use these procedures. The registered persons maintain a complaints record, and according to this, and the discussion we had with the registered manager, there have been no complaints since the last key inspection in January 2009. The commission received two concerns about Care Homes for Older People Page 18 of 37 Evidence: the home since the last key inspection-one which was noted as the person concerned did not wish to make a formal complaint. The second matter regarding the conduct of a member of staff was referred to the registered persons, and appears to have been resolved appropriately. Details of action taken should however have been recorded in the persons personnel file. The registered persons have a adult protection (safeguarding) policy. There is also a file containing the local authority safeguarding policy and procedure. The homes policy needs to be amended to state that if there are any safeguarding concerns these will be referred to the local authority for investigation. The policy should contain relevant telephone numbers for example of the adult social care department so staff can contact the department if they have a concern. A summary of this information needs to be included in the service user guide. The commission should be informed of any safeguarding concerns via our notifications procedure (i.e. under regulation 37 of the Care Homes Regulations 2001). The commission was informed of a safeguarding concern prior to the inspection. This was referred, by the commission, to the local authority. An investigation has been instigated by them. The registered persons were not informed of this concern at the time of the site visit as the matter was deemed confidential. We inspected several staff files, and all had evidence that these staff had received adult safeguarding training in either 2008 or 2009. Some staff had received training regarding the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. It is strongly recommended that all staff receive this training. We saw evidence that staff files we assessed had received a Criminal Records Bureau check (to ascertain staff do not have any criminal convictions etc. which would deem them unsuitable to work with vulnerable people). Care Homes for Older People Page 19 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Erith House provides a comfortable and homely environment for those who live there. Evidence: The building was inspected. There is suitable shared space, for example, a large lounge, a library area which can be partitioned off from the lounge, and a dining room. There are suitable communal toilet and bathroom facilities. Two of the bathrooms have assisted bathing facilities i.e. a bath lift for one of the baths and an assisted Parker type bath in another bath room. There is also a walk in type shower although the shower tray does have a small lip which may prevent wheel chair access. We were informed that hot water on bathing facilities is thermostatically controlled to prevent scalding. Hot water temperatures are recorded and maintained in each bathroom. A thermometer was kept in each bathroom for this purpose. Soap and paper towels were present by the wash hand basins in each toilet and bathroom. There is a lift connecting the ground floor to the first floor. Bedrooms are decorated and furnished according to individual tastes. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. Bedroom doors are lockable from the inside. There is an en suite toilet in each bedroom. One of the bedrooms was noted as having a stained carpet (where bleach had been used). Another bedroom had an odour, which the registered manager said staff were aware of and were trying to address. Any carpets Care Homes for Older People Page 20 of 37 Evidence: which are stained or soiled should be replaced as soon as possible. Lino or other specialist floor coverings may be used if there are no other suitable solutions to erase incontinence problems. The building is maintained to a good standard. Carpets in the hallway, and stair cases are becoming worn, but these are due to be replaced. All rooms are well decorated, and furnished to a high standard. The home is very attractive both inside and outside. The home was very clean, comfortable and homely. The home was warm on both days of the inspection. None of the people using the service, or the staff we spoke to expressed any concerns about the environment. Everybody said it was a pleasant place to live /work in. Laundry facilities are satisfactory. The registered manager said these would be improved with new washing machines being purchased shortly, and better storage for clean laundry. Some people using the service said laundry did occasionally go missing but the new storage system should prevent this occurring. There is a very pleasant garden at the rear of the home, with suitable space for people to sit. There are rails alongside pathways to help those who are frail to walk on their own. There are two sun houses where people can sit. Many of the people using the service said to us they enjoy sitting in the garden during the summer months. There is some parking available at the front of the building. Care Homes for Older People Page 21 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear satisfactory to meet the needs of people currently accommodated at the home and staff are viewed as caring and supportive. Improvement is required to recruitment and training procedures, their implementation and delivery. Evidence: On the day of the inspection the following staffing was arranged: * 08:00 to 14:00 4 care staff * 14:00 to 20:00 4 care staff * 20:00 to 08:00 One member of staff on a waking night duty and one member of staff sleeping in. Ancillary staff such as a maintenance person, cleaners and catering staff are also employed. The registered manager was on duty from 09:00 to 16:00. Staff hours are recorded on the homes rota, and also on the white board in the hallway. All of the people using the service, who we spoke to, and who answered our postal survey were positive about the support they received from staff members. Staff are viewed as kind and caring, and people said staff do what they can to meet their needs. We also spoke to some of the relatives of people using the service, and also to external professionals. All these people were very positive about staff attitudes and approaches to caring for people using the service. One person answering our survey Care Homes for Older People Page 22 of 37 Evidence: said there should always be four staff on duty during the mornings. According to the rotas we inspected this is usually the case, although we do note that there are only three staff on duty on some days according to the rotas we were provided with. Personnel records were inspected for seven staff (i.e. staff on duty during the 24 hour period on the day of the inspection plus some additional members of staff). Two files were not available due to a disciplinary investigation. The registered managers file was also not available, and this should be available for inspection at the home. There are some gaps in records which are required in personnel records, as required by the regulations. For example: * Application forms for two members of staff (who commenced in employment in 2007 and 2009 respectively) were not on their files and subsequently there was no record available to us of their employment history. * Two written references were not available for the majority of files assessed. However, two written references on each file were available for two staff who commenced from September 2008. However, for one of these people, references were addressed to whom it may concern. It is advised such references are not deemed acceptable as it is important references are provided for the specific job applied for, and checks should take place that references provided are bone fide. References for one person, who was employed since the last inspection, were not obtained although an attempt was made. If such references cannot be obtained it is important that either a decision is made not to employ the person, or alternative referees are sought for the person-of which one should be from the previous employer. *No information has been obtained to ascertain staff are medically fit (i.e. via a self declaration of fitness contained in the application form). * Only one person had a copy of information to verify their identity (Although this information would have been obtained when a Criminal Records Bureau check was applied for.) A photocopy of a persons driving license, birth certificate etc. should be maintained on their file to show this check has been performed, as is outlined in the regulations. * We were shown a schedule outlining the Criminal Record Bureau (CRB) disclosure numbers for staff employed. A copy of the disclosure should be maintained for inspection, and then shredded after the inspector has seen it. The new registered provider has improved procedures regarding Criminal Records Bureau checks (CRB) and Protection of Vulnerable Adults First check (POVA First) / Care Homes for Older People Page 23 of 37 Evidence: Independent Safeguarding Authority First checks (ISA First). We were told that a CRB was previously not obtained until a person had passed their probationary period. It is essential that an ISA First check is always obtained as soon as a person is employed, and the person does not commence working in the home until it has been received. The person must then be supervised until a full CRB disclosure is obtained. CRB checks are now deemed as transferable, if they have recently been obtained by a previous employer, although the registered persons must satisfy themselves that the check was performed recently, the check is bona fide, and they have no concerns regarding the persons fitness. This matter should always be risk assessed. In respect of the two staff currently subject to disciplinary action, the commission needs to be informed of the outcome of action taken as required by regulation 37 of the Care Homes Regulations 2001. We looked at whether staff had a National Vocational Qualification in care. According to the records assessed, two people had a copy of an NVQ certificate in care on file. The homes Annual Quality Assurance Assessment (AQAA) states 12 of the 15 care staff have an NVQ in care. A copy of the persons certificate should be maintained on their individual files to verify this. We checked records of training staff have received. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level) (3) All staff must have manual handling training and regular updates of this (e.g. annually) (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. In regard to the records assessed: (1) Staff had a record of fire training. (2) Four of the seven staff had a valid first aid certificate.On the day of the inspection there was satisfactory first aid cover during the day. However, at night the waking Care Homes for Older People Page 24 of 37 Evidence: night member of staff did not have a first aid certificate. The person due to sleep in was scheduled to be an agency member of staff. It was not clear whether this person would have a first aid certificate. It is therefore essential there is always satisfactory first aid cover at all times. (3) Four of the seven staff had evidence of receiving manual handling training. Three people had no evidence of receiving this training, including the person on the waking night duty. (4) Six of the seven staff had a record of receiving infection control training. (5) Five of the seven staff had a record of food hygiene training. Staff need to receive this training as necessary (i.e. if they handle food). (6) There was evidence two of the seven staff had a record of formal induction since they commenced employment. It is essential staff induction is recorded, and this should comply with Skills for Care standards. A Skills for Care induction checklist can be downloaded from their website. Care Homes for Older People Page 25 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We have some concerns regarding the organisation of the management at the home. We require assurance, via the registered providers monthly management reports, that the situation improves so senior staff are clearer about management expectations, their roles and responsibilities. Some improvement is required to quality assurance systems. The management of the monies of people who use the service is satisfactory. Some improvement is required to health and safety procedures. Improvement in these areas will assure people who use the service that management of the home is effective in order to provide a safe service for the people who live there. Evidence: The registered provider was previously a voluntary management committee. This was taken over in the last few months by the Key Change Charity which is a Christian organisation providing care for the elderly and homeless. The organisation owns several other care homes for the elderly. The committee no longer exists and Key Change has a paid, professional management structure. Care Homes for Older People Page 26 of 37 Evidence: The registered manager is Mrs Jane Hannaby who has managed the home for several years. The registered manager has suitable knowledge and experience to manage the home. We raised concerns about the management structure of the home, and post holders understanding of what their roles and responsibilities should entail. From observation it is clear care delivery is generally very good. People seem generally well cared for, and happy with the service they receive. Food is good, there is a suitable range of activities and day to day life in the home, as experienced by the people who use the service, is positive. It is clear the management and staff team put considerable effort into these areas and subsequently there are very positive outcomes for the people who use the service. However, the inspection has resulted in a number of requirements requiring improvement to care planning and recording, medication procedures, policy documentation and its implementation, and staff recruitment and training. Although the registered provider and manager were both viewed positively by both staff and people using the service, staff we spoke to raised concerns regarding support and communication from some individuals in the management structure. It also was not clear whether there is a clear understanding regarding who is responsible and accountable for some supervisory and management tasks. This must be clearer within the home to improve the functioning of the service, where it is currently below standard. Failure to address the issues of concern could put people using the service at risk for example if medication is not managed properly. The new registered provider is aware of some of the issues of concern and is taking action to address them. This has included taking disciplinary action where this has been judged necessary, and introducing new policies and procedures. However the registered manager will require ongoing support over the next few months to oversee the changes that are required if the service is to perform effectively. We are subsequently requesting that monthly reports of visits, by the registered provider (as required by law), are forwarded to the commission. This needs to be done each month so we can monitor progress in the changes which are taking place. In regard to quality assurance procedures, a survey of the views of people who use the service and their representatives, was completed in 2008. The registered manager said there are residents meetings which are regularly conducted. The registered Care Homes for Older People Page 27 of 37 Evidence: persons however need to develop a Quality Management Policy to outline their approach to monitoring, maintaining and improving service quality. We received the Annual Quality Assurance Assessment (AQAA). This document is a self assessment, completed by the registered persons of the home. It outlines to us how the service is run and any plans there are for its development. It also provides us with a data set confirming policies in place, health and safety checks completed and information about people living and working in the home. The return was completed on time and to a satisfactory standard. We discussed the management of the finances of people who use the service. The registered manager said that staff at the home do not look after money or valuables on behalf of the majority of people using the service. However, the registered manager said she acts as appointee for one person who does not have any representatives.Records are kept for this person. If items are purchased, on behalf of people using the service, the persons representatives or the person themselves are invoiced for the cost of the items, and they subsequently reimburse the registered provider. Records are kept of these transactions. The registered provider has a health and safety policy. There is also a fire risk assessment. Testing, by external professionals, of the fire extinguishers and the fire system appears to have been completed appropriately. In regard to fire precautions emergency call points are tested weekly by staff. Suitable checks have been completed on fire doors and fire drills have been completed appropriately by staff. Testing of emergency fire lighting is regularly completed by staff. Records of fire training of staff is satisfactory. Portable electrical appliances were last tested in February 2009. The electrical hardwire circuit was tested in June 2009, and was deemed satisfactory by the contractor. Satisfactory health and safety risk assessments have been completed although a risk assessment needs to be completed regarding the prevention of Legionnaires Disease. Subsequently suitable precautions need to be put in place regarding this matter if deemed necessary. The Health and Safety Executive publish a useful leaflet regarding the risk of Legionnaires Disease in care homes. This is available free on the Health and Safety Executive website. Moving and handling equipment has been tested and is satisfactory. The bath hoist and Parker bath (assisted bath) have also been tested and are deemed as safe. However gas safety appliances were last tested in December 2008, so these items need to be retested and a new gas safety certificate obtained. Some improvement is required to training relating to health and safety issues as outlined in the staffing section of the report. Care Homes for Older People Page 28 of 37 Evidence: The registered manager said she did not know when the Environmental Health Department last visited the home in regard to general health and safety, and food safety, and it appeared there had not been appropriate visits for some time. The insurance certificate currently displayed ran out on 5/12/2009. The registered manager assured us this had been renewed. A current certificate needs to always be displayed as required by law. Care Homes for Older People Page 29 of 37 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 29 19 The registered person shall 15/02/2008 not employ a person to work at the care home unless - he has obtained in respect of that person the information and documents specified. (References, Criminal records bureau or POVA first checks Supervision, proof of identity, evidence of fitness and evidence of qualifications must be obtained before a member of staff commences employment at the home.) Care Homes for Older People Page 30 of 37 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 1 4 The registered persons must 01/04/2010 develop a Statement of Purpose outlining the information outlined in the National Minimum Standard and associated regulations. This will ensure there is clear information outlining the services the home provides. 2 7 15 Care plans must contain suitable detail to inform and direct staff to provide care for people using the service. Care plans need to be reviewed at least monthly. Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 01/06/2010 3 8 12 Record keeping regarding when people last saw a medical professional (e.g. dentist, chiropodist, 01/06/2010 Care Homes for Older People Page 31 of 37 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 optician) needs improvement. It should be possible to track when someone last had an appointment with each professional. This should help give people more assurance their medical needs are being monitored, and they will receive frequent appointments from these services as required. 4 9 13 The registered provider must ensure there is a suitable system in place to manage the storage, administration, recording and disposal of medication. This will help to ensure medication is managed safely 5 10 37 Any incidents and matters outlined in regulation 37 of the Care Homes Regulations 2001 must be reported to the commission without delay. This will ensure the commission is notified of all matters required under this regulation, and should help to give assurance that, where necessary, that appropriate safeguards are 14/02/2010 01/03/2010 Care Homes for Older People Page 32 of 37 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 put in place. 6 18 12 The adult safeguarding (protection) policy must be updated to reflect guidance issued in the Department of Health No Secrets guidance, and relevant local authority guidance. For example any allegation of abuse must be reported to the local authority. As outlined in the local authority guidance, they will act as the lead agency to coordinate appropriate action. This will help to ensure any safeguarding issues are appropriately reported and coordinated by the local authority. This will help to ensure people using the service are protected from abuse, and suitable procedures are followed should suspected abuse occur. 7 29 19 The registered provider must ensure satisfactory recruitment checks are performed regarding any member of staff employed to work in the home. For example all staff must have an employment record, two 01/03/2010 01/04/2010 Care Homes for Older People Page 33 of 37 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 written references and other preemployment checks, written documentation to verify their identity and a self declaration regarding medical fitness. (Previous timescale not met. Second Notification) These measures will help to ensure that staff employ are considered suitable to work with vulnerable adults. 8 30 18 Staff must receive training 01/07/2010 which is required by law. For example staff must receive training as outlined in the body of the report (i.e. fire training, food hygiene, first aid, manual handling and infection control). This will help to ensure people who use the service are supported by suitably trained and skilled staff 9 31 26 Provide the commission with 14/02/2010 reports of monthly registered provider visits for the next 6 months. This will assure the commission that appropriate improvements are being made to benefit the people who use the service. Care Homes for Older People Page 34 of 37 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 10 33 24 Develop a quality assurance 01/03/2010 system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, health and safety etc. Measures taken should be included in the quality assurance policy. This will help improve service quality and help minimise risks to staff and people who use the service The registered persons must 14/02/2010 check the home is insured. An up to date insurance certificate must be displayed. A copy of the insurance certificate, to evidence satisfactory levels of insurance cover, must be forwarded to the commission within the timescale set. This will assure the commission satisfactory insurance cover is in place. People using the service, visitors and staff, can then be more assured cover is in place should there be an accident, theft, fire etc. 11 34 25 12 38 12 The registered persons must 01/06/2010 ensure a risk assessment is Care Homes for Older People Page 35 of 37 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 developed regarding how the risk of legionnaires disease will be minimised. Appropriate remedial action must be completed as necessary This will help ensure the risk of legionnaires disease is minimised to the people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 16 Ensure information regarding social service department / health department complaint procedures are included in individualised service user guides. This will help to ensure people, funded by these authorities, are aware of their statutory rights to use these procedures if they have a concern or complaint. Care staff and management receive training regarding the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. 2 18 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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