Inspection on 10/02/10 for Fairfield Manor

This inspection was carried out on 10th February 2010.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfield Manor 16/02/09

Fairfield Manor 25/09/07

Fairfield Manor 20/02/07

Fairfield Manor 20/01/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JU     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: Julie Sumner     Date: 1 0 0 2 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 30 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 30 Information about the care home Name of care home: Address: Fairfield Manor Fairfield Road Broadstairs Kent CT10 2JU 01843860715 01843868516 fairfieldmanor@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited care home 36 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36. The registered person may provide the following category/ies of service only: Care home only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Fairfield Manor is an old manor house set in gardens next to Woodlands Care Home, both of which are owned by the same company. Ashbourne (Eton) Ltd is the registered company, which is a subsidiary of Southern Cross Healthcare. The building is not ideal for meeting nursing needs, as many corridors are narrow for wheelchair users. However, some adaptations have been made, and include a passenger lift, which provides access to all floors. Ramps are in place to facilitate wheelchair users. Accommodation for residents is provided on three floors and comprises rooms for single use only. Thirty rooms have en-suite facilities. The lower Care Homes for Older People Page 4 of 30 Over 65 0 0 Brief description of the care home ground floor is used only for staff, and includes the kitchens. The building includes a five bedroom flat which is let to staff. These facilities are entirely separate, so that they do not encroach on residents facilities. There is ample car parking at the front of the building and garden areas where service users can sit out in good weather. Fees ranges can be obtained from the service. These vary depending on the need for residential or nursing care, and taking into account residents dependency levels. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out a key unannounced inspection on 16th February 2009 and an annual service review on 12th January 2010. In this report we refer to the people living in the home as residents. We visited the home without telling anyone we were coming so that we could see what they do on a usual day. We were in the home from 9.30 in the morning to around 5.30 in the afternoon. An expert by experience also visited the home to assist us with the inspection visit and they were in the home at the same time and left at about 12 oclock. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Care Homes for Older People Page 6 of 30 The expert by experience spent time talking to the residents who were in the lounges and talked to the relatives who visited during the morning. She also observed what was happening in the home and talked a little to the staff. We talked to the deputy manager and nurse and 3 care staff. We had a look around the home and chatted to some of the residents. We had lunch with the residents in the dining room. We had a look around in the house and outside. We looked at plans and records for supporting the people living in the home. We looked at staff records including training records. We looked at some of the policies and procedures and the fire risk assessment. The manager was on annual leave so was not present during the inspection visit but we were able to talk to the area manager who visited the home and gave him feedback at the end. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also looked at information we have about concerns and complaints and how these have been managed. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. Since the last inspection we have received 2 complaints about the home and one of the complaints made was looked at by the local social services safe guarding adults team. The manager and area manager have responded to both these complaints which have been upheld. After the visit we looked at all the evidence we had gathered to say what kind of service is being provided to the residents. The overall outcome for the service was poor. And we found that the requirements made at the last inspection were still not met, despite being told by the previous manager, on 25 June 2009, that they had. For this reason we met with the area manager on 19th February 2010 and served a code B notice. This tells the person in charge of the home that we feel that an offence under the Care Standards Act 2000 may have been committed, and the notice tells the person in charge their rights. The registered provider needs to make sure that improvements are made to the service and that all requirements are fully met or we may take enforcement action. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The manager needs to make sure that all the personal care needs of the residents are met. We saw the care staff rushing around the home and not being able to finish some of the personal care properly. Records of drinks were being kept for residents whos fluids need to be monitored but they were being written in at a later time and we could not see whether they were accurate. We saw residents sitting around with nothing to do. Residents need to be offered some meaningful activity to occupy them. There is an activities coordinator but she did not have any training and said she was not sure what to do. The dining room looked well maintained and comfortable but there was not enough space for the residents in wheelchairs to move in and out without bumping into the dining room chairs. Care Homes for Older People Page 8 of 30 The residents are not able to have a bath because none of the bathrooms are useable. Residents are offered a shower once a week and sometimes less than this. The kitchen needs a good clean and the meals need to be improved. The residents cannot be confident that they will have a hot dinner or that they will be a to eat in a timely and comfortable way. There need to be enough staff working in the home so that they can provide person centred care and give residents the opportunity to say how they want to be supported. The staff team need to be managed so that their time is used effectively and the team is organised. The staff shift times have changed but this has not benefited the residents as their mealtimes and refreshment breaks are not evenly spaced through the day and the resident do not have as much choice about what they do and when they do it. The care plans are not referred to for information and records are completed when staff have a moment in between care tasks and this can be some time after. The current quality monitoring is ineffective as it has not really highlighted the shortfalls and there is no action plan to address any of these. The home does not have a development plan so we could not see what the manager was planning to do to make improvements to the service. We talked about all these shortfalls with the area manager who had only recently joined the company. He said that he was aware of the problems and had started to work on the solutions. He said he would provide us with a development plan that would include everything with timescales. 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. Evidence: The home has produced a statement of purpose and each resident is given a service user guide that is kept in their bedroom. We looked at 2 assessments for 2 residents, who had recently moved in, in detail and talked to the deputy manager about them. The deputy manager said that a preassessment is completed before a person moves in to make sure they can meet their needs. When a person moves in the assessment is carried out in the first week and then is adjusted as they get to know them better. We saw that they include assessments for skin care, nutritional needs, moving and handling and equipment needed. We spoke to a resident who had recently moved in who said she was quite happy. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care is not always timely and is not person centred. Peoples dignity is not always respected. The medication administration practice in the home is safe. Evidence: The personal care and nursing care each person needs is assessed and a care plan is written based on this. The care plans are kept in individual folders and each part is colour coded to make it easier to find the information. The folders are kept in a central place for staff to access. We looked at 6 care plans with the deputy manager. We looked at two in detail and specific parts in others. We saw that each persons needs have been identified from the assessments. One of the moving and handling assessments said that the resident needed the assistance of one care staff and a hoist but the staff said that two care staff were always needed when using the hoist. Some of the records of care given in the care Care Homes for Older People Page 12 of 30 Evidence: plan were inaccurate as different records said different things. One of the residents has developed a pressure sore. The deputy manager explained the circumstances around this and we looked at her care plan. She has been given a pressure relieving mattress and bed but there was a delay in this being available to her. In situations like these the nurses need to be more proactive. The manager said in the AQAA that they are continuing to develop the care plans to make them more person centred. At present there is good assessment information in the care plan but the guidelines for staff are brief. Also when talking to the care staff and from what we saw the care plans were not being used as reference. Staff pass information to each other verbally. Some of the care staff said they know the residents very well and know what they prefer so do not need to refer to them. We saw care staff filling in the records in the care plans but sometimes there were long gaps between when care was given and when the care plan was completed. We also saw that the care staff completed records of what some residents had had to drink during the day. Again these records were completed from memory rather than straight away so we were not able to see how accurate they were. Staff said that most of the residents like to come down and have their breakfast up and dressed. But they are unable to do this in a timely way so some residents have to have their breakfast in their rooms otherwise their breakfast time gets too close to lunch time. The deputy manager explained that there are problems with the bathroom and washing facilities and this restricts what they are able to offer the residents. They try to shower 4 people each day there is a list for this. We looked at the list and from that and the records we looked at in the care plans, residents are able to have a shower once a week and sometimes the time between is longer than that. The staff said that they do offer bed baths in between and if the resident does not want a shower as some do not like them very much but tolerate it. The expert by experience said in her report There is an obvious lack of bath and showering facilities at the home and apparently they are still waiting for a Parker bath to be installed. Visitors told me that they ask for their relative to be showered, which is done. Others say they are not showed regularly. All the residents need assistance with getting washed and dressed and some need help drinking and eating. We saw that staff were kind and polite to the residents but the personal care given to the residents was not personalised. We saw staff help Care Homes for Older People Page 13 of 30 Evidence: residents to eat and then before they had finished they left the person and moved to help someone else and then another staff would see that they needed help and continue. Staff were very rushed and moving from one task to another and the work did not look very organised. The expert by experience told us in her report that Some residents were not wearing socks or tights and some not dressed with care. Drinks were not placed close at hand for those less able to reach them. It was noted that a member of staff started to feed a resident porridge and then disappeared and did not return to finish. The expert by experience also said that there did seem to be a breach of confidentially in that the Activities co-ordinator told me something about a residents medical condition in her presence. We reported this to the area manager. The manager said that residents have the choice to keep their GP and we saw a list of different GPs for each resident in the office. People have access to community health specialists. We saw a hearing specialist visiting one of the residents to assess their needs during the visit. The nurse gave out the medication at breakfast time and lunch time using the trolley going from room to room and in the lounge and dining room depending where the residents were. The medication is administered using the trolley and a Boots Monitored dosage system, so most of the tablets are in blister packs. The home has a good sized clinical room. We looked at the medication storage and administration records. We looked at both the storage and records for the controlled medication with the deputy. The deputy explained that assessments are carried out for each person to see if they are able to take their own medication. All the residents are currently given their medication by the nurses. We saw that the clinical room was clean and well organised and that all the medication records were completed accurately. The manager audits the medication at least once a month using the company quality and safety monitoring sheet. This outcome area has been judged as poor because the manager and staff team are not supporting the residents health and personal care needs sufficiently so that they are all kept well and comfortable. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have little opportunity for activities and the routines in the home are organised around personal care tasks due to the lack of staff. The mealtimes are disorganised and residents do not get a hot or appetising dinner. Evidence: The expert by experience spent the morning talking to the residents, visiting relatives and the hairdresser. She said in her report: There was an Activities Co-ordinator on duty but although she was sitting with a resident in the lounge, she was doing the colouring and not encouraging the resident to do so. There was no evidence of any other activities apart from an occasional outing for some of the more able bodied residents. This was confirmed by a visitor who said they are trying to get a fund raising group started and have also suggested that they try and recruit volunteers to come in and chat with residents. A lot of the residents appeared to be quite withdrawn, sitting in the lounges with the television on. No one was watching and on questioning the residents said there was nothing interesting to watch. We were told that a new co-ordinator is also going to be employed to provide more activities and the current activities co-ordinator said that she had found it hard on her own and had had no training for this role. Care Homes for Older People Page 15 of 30 Evidence: We had lunch with the residents in the dining room to see what it was like and talk to the residents about their lifestyle. The lunch time was very chaotic. The dining room tables were laid out nicely and everyone sat waiting for their lunch. The food was given to each resident ready served on a plate from a hot trolley. Most of the residents needed their food cut up so they could eat it and three residents in the dining room needed to be fed. The staff were polite and kind but they were not able to sit and help one resident at a time. Different staff came in and out throughout the meal and it is unlikely that anyone got a hot dinner because it was not very hot to start with and it all took so long. The dinner was not very tasty and some of the residents said they did not like it very much and left it. The drinks that everyone had been given were left unfinished. We saw that it was difficult for the care staff to push the wheelchairs out of the dining room as there was not enough room between the chairs and tables. The routines in the home were not very flexible because the care staff were just trying to make sure all the residents had the personal care that they needed. And this was on a task basis moving from one to another to try to fit everything in the best they could. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints from individuals are not always fully recorded. The records are incomplete, with timescales, outcomes and actions not being properly logged. Evidence: There have been two complaints to the home recently. One about personal care and the other about the lack of bathrooms. The complaint about personal care has been acted on and action taken to prevent it happening again. The situation about the bathrooms is ongoing and the area manager talked about the Parker bath being moved so that it can be used. He said the bathroom should be in use in the next 2 weeks. The manager keeps a complaints log. We looked at this with the deputy manager and talked about the recent complaints. There were some records relating to these and to a complaint a few months ago. The records show that when complaints have been received there is little information about what has been done or the outcome. This is consistent with other information we have received and indicates that the manager needs to show that there are plans in place to prevent a situation happening again as a result of a complaint. We discussed this with the area manager who explained that when a complaint is received the manager deals with it but the records go to the central office and the final letters go from there and a copy is put into the home file. He is going to follow Care Homes for Older People Page 17 of 30 Evidence: this up to see if this is why the records in the home are incomplete. Meetings are held each month for the relatives and residents. The relatives use this forum if they have concerns and complaints that they want to talk through informally. We looked at the minutes of the last 2 meetings. We talked to the deputy manager about residents confidentially because of the information discussed and recorded in the minutes. She said she would discuss this with the manager. We also talked to the area manager about this and he said he would look into this and resolve any confidentiality breaches. We saw in the training records that all staff have been given training in safeguarding and abuse. When we talked to the care staff they seemed aware and sensitive to the residents needs. The manager told us in the AQAA and our previous information tells us that all the staff have safety checks before being employed to work in the home. The area manager said that the home do not act as appointee for residents finances. Residents either have their own representative or social services are their representative. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical environment does not always meet the assessed and specialist needs of the residents. Essential maintenance has been outstanding for some time and there was no maintenance plan in the home to address this. Evidence: Fairfield Manor is an old building that needs a lot of ongoing maintenance. Parts of the home have been decorated and there is a seating area in the entrance lobby. There is a notice board to give visitors information. Previously to this visit, the dining room was in the basement floor but as there is no safe exit without using the lift, for fire safety reasons the basement is not used for the residents at all. The current dining room is on the ground floor and is decorated and carpeted to make a pleasant place for the residents to dine in, although there is not enough space for the wheelchairs. When the care staff were taking residents out of the dining room after lunch they had difficulty getting the wheelchairs out between the chairs. The area manager said they are looking at reorganising the ground floor to give resident more space. Residents now have the use of two lounges a large one and a smaller one as the office has been moved to another room. The residents looked comfortable sitting in the small lounge and said they liked it. It is well decorated and carpeted. The larger Care Homes for Older People Page 19 of 30 Evidence: lounge needs to be redecorated but residents do now have enough communal relaxing space. We looked at the kitchen. It is not big enough for the size of the home. It was very cluttered and did not look clean. The environmental health officer has visited each year requesting various works to be done and it looks like only minimum improvements have been made in response to this. The area manager said that it is intended that the kitchen be refurbished and preferably moved. In the meantime the kitchen needs to be made as clean and well organised as possible. The area manager said he would include this in the action plan. The issues with the bathrooms are still ongoing. The staff explained that they cannot use the 2nd or 1st floor bathrooms safely. There is not enough room to get around the Parker bath on the 2nd floor. The ordinary domestic bath on the 1st floor is against the wall and it is not possible to use any of the hoists or the bath chair because of the position. A ceiling hoist has been fitted in that bathroom but the staff said they cannot use it to assist residents into the bath safely because of the position of the bath. At present all the residents are having a shower in the ground floor wet room. This means that residents are not able to have a bath at all and are only able to have a shower once a week at the most. The problem with there not being enough bathrooms for residents to use has been ongoing for at least three years and is unacceptable. We were told by the previous manager that this requirement had been met. The requirement made at the last inspection has not been met and has been carried over. A code B notice has been given to the home as it is an offence not to meet a requirement made. The area manager said that he had asked for plans to be made to refurbish and reorganise the bathrooms and would keep us informed of their progress. We found the home very hot and the staff and residents complained about the heat. (And it was snowing outside.) The residents are not able to regulate the radiators in their bedrooms. This has been an ongoing issue as the deputy manager explained that they cannot regulate the heating and if they turn it off it gets really cold. We talked to the area manager about this. He was aware of it and said that it would be resolved as part of the planned refurbishment but this will take some time. The home has made improvements to the infection control procedures. The staff said they now sort the laundry using a trolley with three bags. We saw the sluice room and the staff explained their procedures for this. Infection control training is on the staff training programme. We saw that there was a good supply of wipes, gloves and aprons for the staff to use. The home did look reasonably clean and the home has dedicated cleaning staff for this. We looked at the laundry and at the time of the visit Care Homes for Older People Page 20 of 30 Evidence: all the appliances were working and the laundry was well organised. This outcome area has been judged as poor because of the heating, the kitchen facilities and because the issue of not having sufficient bathing facilities is unresolved and has been outstanding for so long. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels may not meet the needs of the people using the service, with their health and welfare being adversely affected. The service does not recognise the importance of individualised person centred support and sees personal care needs as the limit of support provided. Evidence: From the AQAA and reading the last inspection report there is a good recruitment process. The manager requests a Criminal records bureau (CRB) check and protection of vulnerable adults list (POVA/ISA) check to make sure they have not done anything in the past that will indicate that they are unsuitable or cannot be trusted. Staff work for a trial period of time in the home while everyone gets to know each other. One of the staff told us that they had had these checks before working in the home. Staff usually have induction training which is in line with the Skills for Care standards but the newest staff we spoke to had not had an induction. This is not good practice, despite the care staff having previous experience, and was because they were short of staff. She did have three days shadowing the staff to see what to do. We looked at the duty rota and talked to the deputy manager and staff about the shifts and how many staff were in the home during the day and night. When we visited the home there were 26 people living there. The manager and deputy manager are nurses and they work together or with another nurse during the day. During the Care Homes for Older People Page 22 of 30 Evidence: day there are usually 4 care staff in the morning and 3 or 4 in the afternoon. There is one nurse working at night with 2 care staff. Two of the staff are leaving in the next 2 weeks. We saw that there are a mixture of long days and short shifts. The staff work long hours and do not always have 2 days off each week because they are covering shifts. There are a lot of changes to the rota. Annual leave is cancelled or rearranged, shifts are changed, people come in on their day off, most of the shifts seem to be long days and care staff cover the kitchen duties. The staff said they were ok but they did not think the new shift times of starting later were as good for the residents, because it took so much longer for everyone to get downstairs in the morning. The expert by experience said in her report: The Staff appeared to be quite caring but very rushed and they said there is no time to stop and chat. The Home is difficult in that it is on three floors, the bedrooms being on the first and second floors and so time is taken up with transporting people down in the morning. Another visitor said there are not enough staff here and people have to wait a long time for their bells to be answered. Some staff are blinkered in that they do not see a need which is obvious The expert also noted that due to the time it had taken the staff to get all the residents up it was 11:45 by the time they had their morning coffee and lunch was being served at 12:30. A requirement was made at the last report to make sure that staff have the competency to undertake the task they have been asked to do. We looked at the training matrix and talked to the staff about their training. The training provided has much improved. The deputy manager is in charge of this and has made sure that all the staff have received the training they need both mandatory training like health and safety and specialist training to meet the needs of the residents like dementia awareness. The home has an NVQ programme for care staff. The records stated that 3 staff had an NVQ qualification and one of the staff registered and had her first meeting with the NVQ assessor during morning of the visit. However there are not enough staff to make sure that the residents are supported in the way they wish and in a timely manner. So even if the staff know what to do they do not have the time for good practice and things are being missed meaning that the residents needs are not being met. Care Homes for Older People Page 23 of 30 Evidence: The requirement made at the last inspection has not been met and a Code B notice has been issued to the home as it is an offence not to meet a requirement. There was also a recommendation to keep the staffing level under review. The staffing level is less stable than the last key unannounced inspection. The requirement has been made at this inspection to make sure there are sufficient staff with the competency to undertake the tasks they have been asked to do. This outcome area has been judged as poor because residents cannot be sure that their needs will be met. Their personal care has been left unfinished, they have to wait unreasonable amounts of time for assistance and staff are so rushed the quality of their care and support is diminished. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents do not live in a home that is well managed and run in their best interests. The company have failed to support the manager to promote the organisational principles and priorities. Evidence: There has been a change of manager since the last key unannounced inspection. The current manager previously worked in the home as a nurse and was also the deputy manager for a time. She has been the manager of the home for around 4 months. The manager said in the AQAA that she is going to study for her registered managers award (RMA) but there have been problems with the training provider which has caused a delay in her starting. The area manager said that the manager has sent in her application for registration with the CQC. The expert by experience said in her report: The Manager is fairly new (apparently the 4th one in 3 years). Visitors said We are hopeful that things will get better. Care Homes for Older People Page 25 of 30 Evidence: From what we saw and the discussions that we had it does not look like the manager has had very much support from the higher management in the company. There have been very recent changes in the company and there is now a new area manager and two quality managers. The new area manager talked about the plans for the home that will improve the service currently being provided. The company does have a quality auditing tool but it has not been used very effectively in the home up to now. We had a look at the folder where the audits and feedback is kept. Residents and their relatives are asked their views and questionnaires are given out. We could not find an action plan for areas in the home that needed improvement. We talked to the area manager who said that the two quality monitoring managers who have recently been employed will carry out monitoring visits and write a report with actions needed. One of the quality monitoring managers came to the home with the area manager during our visit. The area manager said he is going to write a development plan for the home and it will incorporate all the areas that need improvement that have been identified. The AQAA stated that all servicing and maintenance checks are carried out to make sure the building is maintained safely. The company employs a maintenance man who carries out some of the checks and repairs to the home. We looked at the fire risk assessment and the fire log which were completed accurately and up to date. We could see that fire drills occur regularly and that all the staff have had fire training. Hot water temperatures are regulated and the staff always check the temperature before giving residents a shower. We saw the temperature records for this. The mandatory training is ongoing and was mostly up to date. The deputy manager said that they do not take staff away when they are on duty but they attend training on their day off. Due to the current staffing levels and the number of hours staff are working this may not be sustainable at the present time. This outcome area has been judged as poor because there is not visible plan to improve the service provided despite there being serious shortfalls that have been outstanding for some time. And because the requirements from the previous inspection have not been met. A code B notice has been served because of the unmet requirements. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 The service needs to make sure all personal care needs of the residents are monitored and met. To ensure that the home provides sufficent numbers of bathing and shower facilities for the numbers of residents in the home. 31/03/2009 2 21 23 (2) (j) 30/04/2009 3 30 18 (1) (a) The service needs to make 30/04/2009 sure that staff have the competency to undertake the task they have been asked to do. Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 25 23 The service must make sure that the home is kept at a comfortable temperature. Action plan to be sent by timescale. The temperature in the home needs to be able to be regulated. 17/03/2010 2 26 23 The service must make sure that the kitchen is kept clean and well organised. To keep good standards of hygiene and protect the residents from infection. And to provide good quality meals. 17/03/2010 3 27 18 The service needs to make 10/03/2010 sure there are sufficient staff to undertake the tasks they have been asked to do. This is so that residents health and personal care needs can be met with Care Homes for Older People Page 28 of 30 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 dignity and can be personalised. 4 32 24 The service must provide a development plan following a quality audit of the home and service provided. To address all the shortfalls identified in this report and any identified as a result of the audit. So that there is a plan for improvement to the service provided to the residents. 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 17/03/2010 Care Homes for Older People Page 29 of 30 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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