Inspection on 11/12/08 for Fairlawn

This inspection was carried out on 11th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairlawn 30/04/08

Fairlawn 22/09/05

Fairlawn 09/04/05

Fairlawn 24/01/05

Fairlawn 07/05/04

Fairlawn 09/12/03

Fairlawn 01/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fairlawn St Marys Road Ferndown Dorset BH22 9HB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Johnson     Date: 1 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Fairlawn St Marys Road Ferndown Dorset BH22 9HB 01202877277 Telephone number: Fax number: Email address: Provider web address: fairlawn@care-south.co.uk;kim.harding@caresouth.co.uk Name of registered provider(s): Type of registration: Number of places registered: Care South care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One named person (as known to CSCI) under the age of 65 may be accommodated within the category DE (Dementia). This condition will not apply after the person`s 65th birthday. Date of last inspection Brief description of the care home Fairlawn is a residential care home registered with the Commission for Social Care Inspection to accommodate a maximum of 60 older people including up to 20 with dementia. The premises are operated by Care South, a not for profit organisation. The home is purpose built and was opened on the 9th June 2003. Service users are accommodated on the ground, first and second floors. The second floor provides specialist care for up to 20 people with dementia. All bedrooms are for single occupancy and have en suite facilities. Communal areas are provided on all the floors and include kitchen areas where snacks and drinks can be made. On the ground floor is a large area including a conservatory which is used for large group activities. There are three staircases and two passenger lifts. Outside the grounds are landscaped and Care Homes for Older People Page 4 of 33 Over 65 20 40 0 0 Brief description of the care home one area provides a safe garden with varieties of sensory plants and other features. Fairlawn is located in the centre of Ferndown with shops and amenities available within a short walk. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience Poor quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the Care Homes for Older People Page 6 of 33 home, information shared from other agencies and the general public and a number of case files. This key inspection was brought forward following adult protection concerns made to the local authority. This inspection visit was unannounced (we did not let the home know that we were coming) and took place on 11th December between 9.30 am and 4.00 pm and on 12th December between 9.30 am and 12.50 pm. The acting manager was present throughout the inspection. The organisations operations manager was present on the latter part of the first day and for the second day. The inspection involved: observations of and talking with people who live at the home, relatives, the staff and agency staff on duty and the management team. Four people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. What the care home does well: What has improved since the last inspection? What they could do better: Since the last inspection, there has been deterioration in the quality of the service provided by the home and on the outcomes and the safety and well being of the people who live there. Accurate full assessments must be completed for people. This is to make sure that peoples needs are identified and staff know how to care for them. The ongoing assessment process for people must identify when the home is not able to continue to safely meet their needs. This is so people whose needs have increased or changed move to a more appropriate care setting. Peoples care plans must be reviewed, kept up to date, and include all the individuals needs identified in their assessments. This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. Any areas of risk identified for an individual must assessed and these assessments must include nutrition, pressure areas, behaviour and falls. This is so that any risks are minimised and staff know what action to take to keep people safe and well. Accurate care records must be maintained for people. This must include weight, fluid and nutritional monitoring records. This is to demonstrate that people are being provided with the care and support they have been assessed as needing. Care Homes for Older People Page 8 of 33 People must be provided with suitable stimulation and have the opportunity to be occupied. This is to ensure that people have a good quality of life and well being. Additional staffing must be provided to meet the needs of the people currently at the home. This is to ensure the safety of people and to ensure that their personal and social care needs are met. Staffing levels provided at the home must be based upon the individual needs of the people who live there, and not based upon the number of people in residence. This is to make sure that there is sufficient staff to meet the personal, physical, social and psychological care and support needs of the people at the home. Two references must be obtained before staff start work at the home. This must include their last care sector employment. This is to ensure that staff are suitable to work with vulnerable people. The overall management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are moving into and living at the home cannot be sure that all of their needs are assessed and planned for. This means that they cannot be confident that the home can meet all of their needs. Evidence: The assessments for four people were looked at. This included the most recent admission to the home and one person who was readmitted from hospital. The manager told us that the physical dependency and frailty of people living at the home is high. We observed and confirmed this throughout the inspection. Some of the increased dependency is due to people becoming frailer and a general increase in their needs as they age. However, there has not been any planned way of balancing the increasing dependency with the dependency of new people being admitted or returning into the home. Care Homes for Older People Page 11 of 33 Evidence: The two pre admission assessments seen were of a suitable quality and as an initial assessment prior to admission were acceptable. However, the information gained during the assessment process was not used to develop a care plan or assess any risks identified during the assessments. Both of the people have high needs including total assistance with washing, dressing, support to eat and drink. They also need full assistance from two staff with all transfers and hoisting. One of the people was admitted from a nursing home. The full assessments for two people who live at the home with complex needs had been recently reviewed. They were of a suitable quality and included basic aspects of individuals cultural and social needs. It is not clear based on the assessments seen, observations and discussion with the manager and staff whether the home can be sure that they can meet peoples needs before they are admitted to the home. This is because there has been little consideration for the staffing levels at the home and the current needs of the people already living at the home. There are also people living at the home whose dependency has increased to such a level that they may need nursing care rather than residential care. Care Homes for Older People Page 12 of 33 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. Care plans and risk assessments do not identify and or consistently describe the actions necessary to meet the identified needs of people living in the home, which puts them at risk of not having their needs met. The poor record keeping means that the home cannot demonstrate whether they are meeting peoples needs. The shortfalls in medication management potentially put people at risk of harm from nonadministration or misadministration of medication. Evidence: Four peoples care records were looked at. The care records are kept in the ground floor office. This means that they are not accessible to staff. It is particularly important for staff to see the assessments and care plan whilst there are new people moving into the home, peoples needs are changing and there is continued high use of agency staff. This is so all staff including agency staff are aware of peoples needs. The organisation has a standard assessment, care planning, risk assessment and daily record system. The information gained from the initial assessments should identify Care Homes for Older People Page 13 of 33 Evidence: needs that must be risk assessed and planned for. The shortfalls identified mean that elements of peoples lives are not risk assessed or planned for. For example: One person who was identified as nutritionally at risk, had a high risk of urine infections and pressure areas did not have risk assessments or care plans in place that were accessible to staff. Their weight on readmission was recorded on the initial assessment but not transferred on to the weight record or on any nutritional risk assessment so it was not clear that the individual had lost 2 kilos since their readmission. One person did not have any risk assessments completed for falls or moving and handling. Even though they had fallen on their first day at the home. In addition to this, the lack of any care plan for someone admitted into the home on 25th November 2008 means that people are at high risks of their needs not being met as staff do not have the information to be able to care for them. For one person records of fluid and nutritional intake were not available from the date of their readmission until two days prior to the inspection. These records were infrequently completed and no urine output was recorded over a 24 hour period. This is particularly concerning as the individual has a catheter in situ. Another two people who have been identified as nutritionally at risk had fluid and nutrition charts in place. However, again these were erratically completed and did not give any clear indication whether people had been offered or given any drinks or food or passed any urine. This means that there is no way of demonstrating whether these individuals have received adequate fluids and nutrition. The personal profile section in the care plans seen had very little or no information about the individuals. Two of the people have dementia and one of them has very complex behaviours, the staff spoken knew very little about them as individuals and about their lives. The manager showed us that she has recently written to peoples relatives requesting more information about the life histories. The operations manager for the organisation and the acting manager agreed to ensure that all of the people with high needs had a care plan summary and records in their bedroom as a matter of priority. This was being actioned on the second day of inspection so that staff had access to information about how to care for people. Care Homes for Older People Page 14 of 33 Evidence: A section on the care planning document relates to DNR (Do Not Resuscitate) directives. In one of the plans seen, this section had been completed with the consent of peoples next of kin. Any decisions as to end of life care and directives should be agreed by a multidisciplinary team including the individuals doctor. Peoples next of kin must not make these decisions alone if the individual does not have the capacity to do so. This is to make sure that peoples best interests are taken into account. One person had refused to take their medication for seven days. The Care Team Manager told us that this had been raised with the GP. However, the care records did not reflect that this had been raised. It showed that the GP was spoken with on a number of occasions but not that the medication refusal was discussed. It is is vital that records accurately reflect any discussion with health professional to demonstrate that suitable health care is being sought. The medication and the records for the four people being case tracked were seen and a number of shortfalls were identified. For example: One person had Thick and Easy in their bedroom that had been prescribed to another person. This had not been prescribed for this individual nor was there any plan in place for its use. One persons morning medication had been signed for but not administered and another persons eye drops had not been dated when they were opened. There is new medication system in use at the home which is now in the third month of use. Staff told us that there have been a number of problems with the new system and trolleys but that these have now been resolved. The manager told us that there are monthly medication audits that identify any shortfalls in administration. Any shortfalls identified are addressed with the individual staff. Only the Care Team Managers or Senior carers administer medication. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people who live at the home are able to participate in social activities and are given choices including choice of meals provided to maintain their quality of life. People with dementia who live at the home have very little opportunity to participate in daily living or stimulating activities. This means that there are long periods of time when people are unoccupied and become unsettled and or upset. Evidence: People spoken with said that their visitors were made to feel welcome whenever they visited. Two relatives spoken with told us that they were welcome and kept informed about the well being of their relative. The is a full time activities co-ordinator who is responsible for arranging individual or group activities for the people who live at home. An activities schedule is in place, which shows that there is an activity being provided each weekday. On the afternoon of the first day of inspection there was a Christmas party on the ground floor. People from the dementia care unit on the 2nd floor did not benefit from attending this or any organised activity. On the second day of inspection people from Care Homes for Older People Page 16 of 33 Evidence: the dementia care unit came down to join in the activities on the ground floor. We observed that staff did not have time to socialise with people who live at the home. They spent all of their time providing personal care and support to people. There were significant periods of time when people, particularly on the dementia care unit when they were left unsupervised. The television was left on in the lounge which no-one was watching and people became agitated with each other. For example, we needed to intervene between two of the people as they were becoming very agitated and shouting at each other. One person who is cared for in their bedroom due to their complex behaviours had no stimulation. There was not any sensory environment or tactile things for stimulation. The manager told us that they had purchased a sensory wall covering for when the person is in bed and that there was a bag with tactile things in their bedroom. Staff must ensure that this person has a sensory stimulating environment so that they are less reliant on self stimulation and at times self injury. Menus showed that the people who live there have a choice of meals through the day. The menu was varied and meals appeared nutritious. The manager told us that people on the dementia care unit are now given visual choices of meals. People who live on the first floor told us that they choose their meals the evening before. At lunchtime on the first day of inspection, we observed lunch being served in the dementia unit. There are two dining areas on this living unit. In one area seven people who need support to eat and drink were supported by one member of staff. The member of staff was observed to stand up and feed people, this is poor practice and does not encourage a relaxed atmosphere in which to eat and drink. An new agency member of staff was asked to go and assist one person who has complex nutritional and behavioural needs. They had not worked at the home before and did not know the individual. On the first day of inspection, there were insufficient staff on duty to ensure that people were supported to eat and drink in a safe and relaxed atmosphere. Care Homes for Older People Page 17 of 33 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. People living in the home and relatives are confident that their concerns will be listened to. The shortfalls in identifying that people are at risk and planning how to minimise these risks means that people have not been protected from risk of harm or injury. Evidence: The home has a formal complaints policy which is accessible to people and their families. People are encouraged to raise their concerns with the manager. People who live at the home and relatives spoken with know how to make a complaint. Staff spoken with told us that they know what to do if a person living at the home or relative or friend has concerns about the home. The acting manager told us that there has been one formal complaint made to the home since the last inspection. This subsequently resulted in a number safeguarding referrals resulting in this key inspection. The acting manager took immediate action on receipt of the initial complaint and introduced additional monitoring systems for the Care Team Managers to undertake. We have identified through out this report that there are further shortfalls that Care Homes for Older People Page 18 of 33 Evidence: potentially place people at risk of harm or neglect. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidences of abuse. Staff employed by the home have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. Staff spoken with had an understanding of how to recognise and report any allegations of abuse. Care Homes for Older People Page 19 of 33 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. The home is maintained and furnished so that people live in a clean and comfortable environment. Evidence: The home was purpose built and the accommodation is over three floors. There are 18 bedrooms on the ground floor, 22 on the first floor and 20 on the second floor dementia care unit. There are two lounge and dining areas on each of the living units and a large conservatory on the ground floor. We looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. The rooms were personalised with their own belongings. As identified in the Daily life and social activities section of the report. One of the people case tracked would benefit from a more sensory stimulating environment in their bedroom. More stimulating and tactile environments should be developed both in peoples bedrooms and in the communal areas in the dementia care living unit. Equipment is available to assist people and staff in the delivery of personal care, which includes assisted baths, profiling beds, accessible showers and moving and handling equipment including hoists. Care Homes for Older People Page 20 of 33 Evidence: The laundry room was clean, tidy and well organised. All of the washing machines were in working order. Hand washing facilities and protective clothing was available. Systems are in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub were available and were used by staff when handling soiled linen and when supporting people with personal care. Care Homes for Older People Page 21 of 33 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. There are insufficient staff on duty to fully meet the needs of the people living there. Staff present as competent and caring. However, due to the high dependency levels of some people who live there, people are not receiving the best possible care. Evidence: During the inspection visits, there were 53 people at the home. Staff rotas were seen for a one month period. The acting manager told us that the staffing at the home is as follows: During the day and evening nine care staff, one senior carer and one care team manager. During the night there are four waking care staff. There are three care staff on the ground floor, three care staff on the first floor and three care staff plus a senior carer on the dementia care unit on the second floor. There has been historically a high use of agency staff at the home due to local recruitment difficulties. The acting manager has successfully recruited staff since being confirmed in post at the beginning of December. However, there are still approximately 400 hours of agency staff used each week and although the acting manager tries to ensure that only regular agency staff are used there have been times Care Homes for Older People Page 22 of 33 Evidence: when their are more agency staff on duty that the homes staff. From talking to people at the home, staff, acting manager and by observation, there are at least four people living on each of the three living units that need two people to assist with moving and handling and one person to assist them with eating and drinking. The needs of the people on the dementia care unit are significantly higher with seven people needing the support of two people for all transfers. In addition to this a majority of people at the home need full assistance with washing and dressing. On the dementia care unit the senior carer is responsible for the administration of medication. This means that at key times such as mealtimes the number of carers effectively reduces to three. This combined with the high numbers of people who need two (or more) staff to meet their personal care needs and the high use of agency staff means that there are insufficient staff to safely meet the needs of the people currently living at the home. Observations, discussion with staff, people living at the home and relatives told us that there are insufficient staff to meet the needs of people at the home. Two people living at the home told us home is understaffed and shortage of staff more recently, we have to wait for staff to come. Two relatives told us There are not always enough staff around but they do an excellent job. During the first day of inspection, we told the acting manager that we were concerned about the immediate safety of the people in the home due to a combination of their very high needs and the staffing levels, including the high use of agency . The acting manager took immediate action and ensured that one additional member of staff was on duty through out the day and night. Staffing levels provided at the home must be based upon the individual needs of the people who live there, and not based upon ratios of staff to people. The last four recruited staff members files were looked at. Three of them included CRB (Criminal Records Bureau) and PoVA (Protection of Vulnerable Adults) checks. One file only included one reference from a colleague form their previous care sector employment. There was a PoVA check and the home was awaiting the CRB check. Two references must be obtained before staff start work at the home and should be from their manager and not from colleagues. This is to make sure that staff are suitable to work with vulnerable people. Staff training records demonstrate that staff complete an induction programme. The training matrix demonstrates that staff attend a range of training programs. Care Homes for Older People Page 23 of 33 Care Homes for Older People Page 24 of 33 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. People who live at the home do not benefit from or live in a home that is consistently managed or that has effective monitoring systems. Evidence: The home has gone through a number of management changes since the key inspection in April 2008. The longstanding manager and deputy manager have left and there was another manager in post before the current manager was appointed. She was originally appointed as the deputy manager and has acted as manager following the transfer of the previous manager to another of the organisations homes. There are a number of serious shortfalls in the assessment of risks and care plans for new people who have been admitted or readmitted in to the home. The care plans and monitoring of the care provided to people already living at the home, poor record keeping and the staffing levels and reliance on agency staff are all having an impact on the quality of care that people at the home receive. Care Homes for Older People Page 25 of 33 Evidence: There has not been any way of determining whether the current staffing levels could safely meet the changing and increased needs of the people at the home. The impact of then admitting people with high needs has meant that there has been insufficient staff to meet the needs of people. The home does monitor incidents and accidents on a monthly basis. However, there has been no specific analysis of the falls that people have. This must be completed to make sure that any patterns are identified and the risks minimised where possible. The acting manager has notified us of any deaths and a majority of hospital admissions. However, there have been a number of incidents and accidents that have not been reported to us. Following discussion with the acting manager, she has agreed to notify us of all events that effect the well being of people living at the home. The monitoring and quality assurance systems of the organisation and the acting manager have not identified all of the shortfalls we have reported and these must be improved. We acknowledge that the manager and operations manager took action to address shortfalls once we had identified them. Information sent to us in the AQAA (Annual Quality Assurance Assessment) in July 2008 tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence of this was seen at the Key inspection in April 2008. No specific checks were made at this inspection. There are organisational systems in place for the routine servicing of equipment and fire, heating and electrical systems. Equipment seen during the inspection was in good order. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 12 Additional staffing must be 08/01/2009 provided to meet the needs of the people currently at the home. This is to ensure the safety of people and to ensure that their personal and social care needs are met. 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 2 12 Accurate full assessments must be completed for people. This is to make sure that peoples needs are identified and staff know how to care for them. 06/02/2009 2 2 14 The ongoing assessment process for people must identify when the home is not able to continue to safely meet their needs. This is so people whose needs have increased or changed move to a more appropriate care setting. 06/03/2009 Care Homes for Older People Page 28 of 33 3 7 17 Accurate care records must be maintained for people. This must include weight, fluid and nutritional monitoring records. This is to demonstrate that people are being provided with the care and support they have been assessed as needing. 20/02/2009 4 7 12 Peoples care plans must be reviewed, kept up to date, and include all the individuals needs identified in their assessments. This is so staff know what care and support people require to make sure that all their needs are met and they are well cared for. 06/02/2009 5 7 13 Any areas of risk identified for an individual must assessed and these assessments must include nutrition, pressure areas, behaviour and falls. This is so that any risks are minimised and staff know what action to take to keep people safe. 06/02/2009 6 8 17 Accurate health records must be maintained and include records of discussions with all health professionals. This is to demonstrate that professional health advice is being sought for people living at the home. 30/01/2009 Care Homes for Older People Page 29 of 33 7 9 13 Only medication that is prescribed to an individual must be administered. This is so that people only receive medications that have been prescribed by a health practitioner. 09/01/2009 8 9 13 The right medicine must be administered to the right person at the right time and at the right dose as prescribed and medication records must be completed This is to ensure that people receive medication as precribed. 09/01/2009 9 9 13 Eye drops must be dated when they are opened. This is to ensure that they are disposed of 28 days after opening 09/01/2009 10 12 12 People must be provided 20/03/2009 with suitable stimulation and have the opportunity to be occupied. This is to ensure that people have a good quality of life and well being. 11 27 12 Staffing levels provided at the home must be based upon the individual needs of the people who live there, and not based upon the number of people in residence. This is to make sure that there is sufficient staff to meet the personal, physical, 06/02/2009 Care Homes for Older People Page 30 of 33 social and psychological care and support needs of the people at the home. 12 29 19 Two references must be 27/02/2009 obtained before staff start work at the home. This must include their last care sector employment. This is to ensure that staff are suitable to work with vulnerable people. 13 33 24 The overall management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. 14 37 37 Regulation 37 notifications must be made for all events that effect the well being of people living at the home. This is to ensure that the home is effectively monitoring and reporting incidents in the home. 09/01/2009 27/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Personal profiles in care plans and or Life History books should be developed that include details and photographs of their history such as family, friends, where they have lived, pets, work etc. These profiles or life history books will assist staff to have a greater understanding of them as an individual. Page 31 of 33 Care Homes for Older People 2 7 All documentation relating to individuals should include their name and be signed and dated by the person completing it. This is so that accurate records are maintained and it is possible to see who completed them. Peoples assessments and care plans should be accessible to staff. This is so they are aware of peoples needs. More stimulating and tactile environments should be developed both in peoples bedrooms and in the communal areas in the dementia care living unit. References should be from employers or managers and not from colleagues and be verified. This is to make sure that references are from a person who has managed the staff member. The formal monitoring of falls should be part of the quality assurance system. Falls should be reviewed on a monthly basis to establish the times, causes and frequency, and whether they relate to staffing or health factors. 3 4 7 19 5 29 6 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!