Inspection on 25/01/10 for Faithfull House

This inspection was carried out on 25th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Faithfull House 29/01/07

Faithfull House 13/03/06

Faithfull House 22/09/05

Faithfull House 03/03/05

Faithfull House 19/10/04

Faithfull House 17/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Faithfull House Suffolk Square Cheltenham Glos GL50 2DT     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: Lynne Bennett     Date: 2 6 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 42 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 42 Information about the care home Name of care home: Address: Faithfull House Suffolk Square Cheltenham Glos GL50 2DT 01242514319 01242578392 suzanne.booker@lilianfaithfull.co.uk www.lilianfaithfull.co.uk Lilian Faithfull Homes care home 72 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: Date of last inspection Brief description of the care home Faithfull House is a substantial attractive property, originally three Regency Houses, which have been converted to provide accommodation for 72 older people who require personal care. The home is owned and managed by Lilian Faithfull Homes and is one of three homes that the charity owns and operates in Cheltenham. It is situated in the Montpellier area of Cheltenham, within easy access of shops and local amenities. Accommodation is provided on five floors of the home. All of which are served by two shaft lifts. In addition, a variety of aids and adaptations have been provided throughout the property to assist people. All but one of the bedrooms have been equipped with en-suite facilities and assisted baths and toilets have been installed throughout the home. The communal areas on the ground floor consist of several lounges, a dining room and a conservatory. There is also a library located on the lower ground floor. People have the benefit of well-maintained enclosed gardens at the rear of the property. The fees range from 600 to 650 pounds per week. Copies of the Statement of Purpose are available from the home. Care Homes for Older People Page 4 of 42 Over 65 72 0 Brief description of the care home Care Homes for Older People Page 5 of 42 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: This inspection took place in January 2010 by two inspectors over two days. One of the inspectors was a Pharmacist and his role was to look at the arrangements the home has in place for the management of peoples medications. The registered manager was on annual leave during our visits. She had completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We (the Care Quality Commission - CQC) had received this before the requested deadline. The assistant manager was present throughout and the Chief Executive spoke with us on both days. We talked to 5 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also observed the care provided to other people living in the home, walked around the environment and visited people in their rooms. We Care Homes for Older People Page 6 of 42 examined a range of records including staff files, health and safety and quality assurance systems. We received surveys from 4 people living in the home, 7 relatives and 9 staff. We joined people during lunch on two days and were invited to visit some people in their rooms. We observed several activities. We joined staff during their handover and spoke with a small group of staff. Care Homes for Older People Page 7 of 42 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 42 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 42 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 42 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory admission arrangements are in place that includes an assessment of peoples needs. Ongoing re-assessment of people will ensure that the service is continuing to meet their changing needs. Evidence: The copies of the Statement of Purpose and Service User Guide in the home were last reviewed in April 2008 and contained some out of date information. We were forwarded a copy of the Statement of Purpose which had been reviewed in January 2010. Copies of this should be available in the home. The AQAA indicated that 20 people living in the home were presently diagnosed as having Dementia. The Statement of Purpose made no reference that the home would continue to support people who may develop dementia. One of the people we casetracked had a diagnosis of dementia upon admission. The home presently has no category of registration to admit people with dementia and they must bear this in mind when assessing people to move into the home. Care Homes for Older People Page 11 of 42 Evidence: We looked at admission information for two people who had recently moved into the home. The home had completed a full assessment of need prior to admission and encouraged people to visit with their relatives or carers which could include an overnight or respite stay at the home. People we spoke to who had recently moved in said they had settled in well and had been made to feel welcome. Staff explained how they orientate people to the home encouraging them to join others for meals at an allocated table in the dining room. The AQAA stated new people have one to one support of a member of staff during this period. They are then allocated a key worker. There was evidence that the changing needs of people were being monitored and that where the home felt they could no longer meet a persons needs they were being moved into nursing care. People living in the home do not receive intermediate care. Care Homes for Older People Page 12 of 42 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. A person centred approach to care planning will make sure that peoples individual wishes and aspirations are identified and respected. Improving the quality of monitoring records will ensure that peoples health care needs are being responded to appropriately and in a timely fashion. Major shortfalls in the administration of medication were identified which could potentially put people at risk of harm. The arrangements for managing medicines had particular weaknesses that needed attention so that people living in the home are not put at unnecessary risks to their health and wellbeing. Evidence: We case tracked the care for 5 people living in the home including one person with Dementia, one person with a visual impairment and a person with a physical disability. The AQAA stated,the residents care plan is developed from the aspect of person centred care. Surveys completed by staff also said, person centred care is in place, treating people as individuals and understanding their needs. Whilst we found the Care Homes for Older People Page 13 of 42 Evidence: latter to be the case, observing staff supporting people to make individual choices about their daily lives, we found care plans to be less person centred. Each person had a copy of their care plan based on activities of daily living and associated risk assessments. They had a file in their rooms containing general information but current records were kept in the main office. An assessment was in place based on peoples physical, cultural, spiritual, psychological and social needs and preferences. However in places these were vague - assist with - does not provide the reader with what support the person actually needs - for instance whether they need verbal prompts or physical prompts. There was no indication of whether people had any preferences about the gender of staff providing their personal care. There were copies of generic care plans in each file which had been pre-populated such as medication, eating and drinking, safe environment and personal hygiene. Most of these were blank and the assistant manager explained that these would be completed where there was an assessed need. People living in the home had been asked to sign a document stating they had read and understood their assessment of need and care plan. They had also signed other documents in their files. Audit forms indicated there was a monthly review of peoples assessed need. Robust records were being kept confirming peoples access to and appointments with a range of health care professionals. Daily records indicated when people had seen their Doctor, Optician, Dentist, District Nurse and Chiropodist. During our visit the Chiropodist was present providing treatment to people in the privacy of their rooms. The current information file for each floor also contained evidence of appointments with health care professionals. People were also being supported with outpatient appointments and referred promptly for treatment with specialists. Monitoring forms were in place for fluid and food intake, body mapping and weight. For one person the outcome of a Doctors visit stated that fluids are to be pushed. The entry did not state how much but that a nutritional drink had been prescribed. Fluid charts were inconsistent in both the recording of how much fluid had been drunk and the provision of the nutritional supplement. Records indicated that two different supplements were being provided. One person was being supported by District Nurses for a pressure sore. The assistant manager said that the District Nurses keep their own records. Records on the persons file included a tissue viability assessment but other monitoring records were either not being completed or completed inconsistently. Daily records indicated that cream was to be applied every 2 hours and that they were to be moved and toileted at 2 hourly intervals. Again records were inconsistent with some long gaps each morning and evening. The treatment and outcome of any tissue viability concerns must be recorded by the home. The assistant manager confirmed that the appropriate pressure relieving equipment had been provided. Care Homes for Older People Page 14 of 42 Evidence: We observed staff interacting with people and they supported them with dignity and respect. People were addressed by their full name although some staff were overheard using endearments such as sweety and darling. Staff were observed supporting one person who was distressed and did this calmly and with sensitivity. Those staff spoken with had a good understanding of peoples needs and discussed with us how they would support someone with Dementia. Staff said that communication within the home was excellent and we observed a handover between staff discussing the support they had provided to people. Surveys stated, staff treat ... with kindness and respectfully, and are treated with respect and good humour even when being difficult. The AQAA confirmed that all staff are trained in giving choice, respecting their privacy and always caring in a dignified way. People spoken with during our visits spoke positively about staff, their attitude and demeanour. People living in the home have the use of telephones and will soon have internet access in the library to keep in touch with relatives and friends. Relatives and friends were observed visiting people during our visits and being entertained either in the privacy of their room or in communal areas. Pharmacist inspectors report about arrangements for the handling of medicines. As a part of this key inspection one of our (the Care Quality Commission) pharmacist inspectors specifically examined some of the arrangements for the handling of medicines. We looked at some stocks and storage arrangements for medicines and various records about medicines. We spoke to the deputy manager and four senior carers on duty who were responsible for medicines. We visited some bedrooms and spoke to two people. At lunchtime we saw the senior carers giving some medicines to people who lived in the home. The inspection took place during a seven and half hour period on a Monday. There were arrangements in place for managing medicines but there were areas of particular weaknesses. Because of the number of concerns about medicine arrangements we found at this inspection we sent a letter for urgent action to the registered manager and provider about the issues they need to attend to urgently in order to comply with the law and safeguard the people who are living in this home. We asked for a response by 8th February 2010. On 28th January and 5th February 2010 we received information from the deputy manager telling us about the actions taken and arrangements put in place to address the issues in our urgent action letter. We will be checking that these arrangements are effective at a future inspection. Staff supported a number of people to look after and administer their medicines to varying extents. Some records for people who self administered their medicines Care Homes for Older People Page 15 of 42 Evidence: needed improvement. We saw some residents agreements about this but these did not give information about what plans were in place and what this meant for that person. We also did not see any risk assessments carried out to inform the way staff could support people to safely handle their medicines. Records to demonstrate accountability for some of these medicines were not in place. Senior carers who had undertaken training for the safe handling of medicines were responsible for administering medicines. Staff must make sure that additional information provided about when to administer medicines is followed. One person was given a tablet to take whilst in the dining room eating lunch. The direction on the medicine label and medicine chart was to give before food but had not been followed. We pointed out that antibiotic doses for another person could be better spaced throughout the day so as to gain the best effect from the treatment. All doses were given within a nine hour period. We looked at some of the arrangements for recording medicines. Accurate, clear and complete records about medicines are very important in a care home so that people are not at risk from mistakes with their medicines because of poor records and so that there is a full account of the medicines the home is responsible for on behalf of the people living here. We found some weaknesses and concerns with some of these records and that these were not always accurate and complete. The pharmacy provided printed medicine charts each month on which to keep records of the medicines prescribed and administered. The space provided to record allergies on the medicine charts was generally blank. Although allergy information was included on a cover sheet for each person in front of their medicine chart it is good practice to make an entry in this box even if this is none known as an indication that this important issue has been considered. It is very important for the pharmacy to be made aware of allergy information as one action to reduce the risk of providing a medicine to which the person is allergic. We found some gaps on the current medicine administration charts (that generally had only been in use since 21st January 2010) for five people with no explanation so we could not tell if people had taken their medicines as prescribed or had missed doses for whatever reason. We saw the code M used on a number of medicine charts but there was no definition for this printed on the chart. Staff said this meant make available which actually seemed to be out of stock. Staff need to use properly defined codes when making records on the medicine charts so that there is an accurate, clear and complete record of medicines given or reasons if not. Care Homes for Older People Page 16 of 42 Evidence: There were not consistent records on the medicine charts for administration of prescribed creams, ointments, lotions applied to the skin or for prescribed food supplements. There needs to be a defined way in which you make sure that these prescribed treatments are used correctly, that staff have clear information about this and that records clearly demonstrate what treatment has been provided. We have published information about this on our website (www.cqc.org.uk Pharmacy tip 9 Administration and recording of creams and nutritional supplements). The arrangements for recording the treatment with warfarin tablets for another person needed improvement so as to follow national guidance published by the National Patient Safety Agency Alert 18 (www.npsa.nhs.uk). This is to make sure that there is a clear record of what dose should be given and what dose has been given. Staff did not seem to be aware of this alert. The medicine record was not clear as there were 1mg, 3mg, 0.5mg tablets all included with direction as directed. There was a post it note on the chart about the dose but this was not very clear. The poor records put this person at risk of receiving the wrong dose. The standard yellow oral anticoagulant therapy record book was not used. Warfarin doses must be confirmed in writing and clearly indicated on the medicine administration chart. Some charts were handwritten or with handwritten additions. As these are critical records good practice is for these to be signed and dated by the person writing these with a second signature by another authorised person as a check that this was correctly written. Handwritten medicine charts also need to include full date information (day, month and year) with a starting date. We found examples of inaccurate and incomplete information about medicines or dates on some handwritten charts. We found for various people living in the home a number of medicines (for example pain relief, laxative, inhalers or hypnotics) were prescribed to use when required or with a variable dose. Sometimes the medicine charts had extra information but generally there was no written guidance for staff about how to make a decision about when a dose was needed, or what dose, or if the person was able to say when they needed the medicine. The provisions of the Mental Capacity Act 2005 must be taken into account particularly where people may lack capacity to understand or consent to their medicines. Staff we spoke to did tell us about how they did this. So that there is some consistency and agreed actions this type of record is needed. Records showed that a pain relieving patch for one person had not been changed for 14 days instead of at seven days as prescribed. Records indicated that none were available on 18.01.10 when a dose should have been applied yet some records Care Homes for Older People Page 17 of 42 Evidence: indicated the medicine was in the home all the time. It is also likely that poor recording had contributed to this error. This was a risk to the health and well being of this person. We spoke to this person who said (s)he was not uncomfortable but said his/her legs were painful. Two medicines for one person were not being given as prescribed and staff had not taken appropriate action when doses could not be given. The senior carer phoned the doctor for advice during the inspection and said a doctor was coming to visit. It was not clear to us if staff would have taken this action if we had not been there to prompt them. Two different types of tablets for another person were not available to administer as prescribed. Staff said they had phoned the doctor who was to visit and review this. The inspection identified that there were some medicine errors. Not administering a medicine as prescribed for what ever reason is still an error with medicines and an incident that should be recorded, reported and investigated as an event which adversely affects the well-being or safety of any person living in the home. There was very poor recording and accountability for controlled drugs with many discrepancies pointed out to staff. Records for controlled drugs were poor with inaccurate and incomplete entries. The controlled drugs actually in stock did not agree with the recorded balances in the record books so this appeared that some were missing. Some controlled drugs were in stock but not entered into the controlled drug record books. These must all be investigated immediately. Our published guidance (www.cqc.org.uk) is for care homes to keep records in the controlled drug record book of a particular liquid medicine we pointed out to staff during the inspection. There was a proper controlled drug (CD) cupboard but the space within here was not sufficient to keep all these medicines. Controlled drugs waiting return to the pharmacy were not correctly stored. All controlled drugs within the home must always be stored legally in accordance with the Misuse of Drug (Safe Custody) Regulations 1973. These were noted in the returns medicine record book signed by two staff members but no entry was made within the controlled drug record book indicating what had happened to the stock balance that was showing. This could be the explanation for a number of the stock balance discrepancies. There were no regular recorded stock checks of controlled drugs in the record books Care Homes for Older People Page 18 of 42 Evidence: as is contained in published good practice guidance. This is poor practice and needs to be introduced so that issues such as we found at this inspection can be quickly identified and resolved. It was a concern that the medicine audit chart in the office was initialled for January 2010 including the section for the controlled drug book. Locked cupboards and a medicine trolley were provided to keep medicines safely. Most bedrooms had an individual lockable medicine cupboard in which medicines for the month were kept. Where staff were responsible for handling the medicines they administered directly from these cupboards when people were in their bedrooms in the morning and at bedtime. We were concerned in two rooms we went to the cupboards were in the bathroom area. One was directly above a warm radiator and another was directly above the toilet. Issues such as temperature, humidity and hygiene must be taken into account when locating medicine cupboards so some of these need moving. We were concerned at lunch time that because some tablets were only stored in the bedroom cupboard staff did not follow safe medicine administration practice. A better procedure is needed to prevent staff having to walk around the home with tablets in a small pot as this can lead to mistakes. The main central medicine storage area felt very warm. A thermometer needs to be in place in medicine storage areas and the temperature checked daily so that action can be taken if recorded temperatures are consistently above 25 degrees Celsius. The medicine fridge was not locked yet was in an open office on the ground floor. All medicines must always be kept securely locked up. In the morning we saw that the fridge temperature record chart had not been completed for a number of days. After lunch we saw that the record chart was up to date. There was a bottle of eye drops in the fridge with no date of opening so there was no way to tell when to replace the bottle after 28 days in use as the manufacturer directs to reduce risks from using contaminated eye drops. Another bottle of eye drops did have an opening date and staff told us they did replace stock routinely every four weeks. During the inspection the deputy manager gave us a copy of the medicines policy which she said was kept in the policy file for staff. This indicated that it was reviewed in September 2008 but needed updating as it does not reflect the specific circumstances in Faithfull House that we found at this inspection. For example it refers to nurses and old references are used rather than up to date good practice guidance. Storage and administration arrangements need to describe the current systems. Staff need to be provided with clear procedures as to how the company expect them to manage medicines. Care Homes for Older People Page 19 of 42 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in appropriate activities inside and outside of the home, have links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. People are offered a varied and balanced diet appropriate to their needs, promoting their health and wellbeing. Evidence: Two activity co-ordinators support people to access a wide range of social, leisure, spiritual and educational opportunities both within the home and outside of the home. They have built up a picture of each persons hobbies and interests before they moved into the home and endeavour to support them to continue with these if they wish. One person described how they look after the grounds and involve others in the growing of their favourite flowers. They were going on a trip to a local garden centre to look for spring plants whilst others took advantage of the cafe and shop. Another person said they enjoy going for walks into Cheltenham and others liked to use the facilities at the local bowls club. People were independently accessing local facilities nearby but if they needed staff support they said this could be provided. An activities board advertised trips out inviting people to register their interest. People said there were two trips out each week and staff indicated that they would monitor participation in these encouraging people who were not signing up to join them. Each day a note describing Care Homes for Older People Page 20 of 42 Evidence: the afternoon and evening activities was placed on each dining table as well as being displayed on a white board in the entrance hall. People were observed participating in a bingo session, enjoying using mobile sensory equipment and listening to music. Surveys from relatives commented, there are trips and activities provided, and plenty of activities for residents. A survey from a person living in the home stated, I am not told to do anything, have complete freedom on either staying in my room or going downstairs or going out. Staff surveys said, activities are person centred, and a large range of activities .. people have choice in all areas. Records were being kept confirming who had participated in which activity and daily records also mentioned how people had spent their day. People were having access to local churches or could go to the service held in one of the lounges. Peoples spirituality and beliefs were noted in their care plans. An inventory of peoples personal belongings was in place and those rooms we visited were fitted out with peoples personal fixtures and fittings. Financial risk assessments were in place for each person indicating whether they needed support to manage their finances. There was information in the home about access to advocacy. An external catering company provides meals and snacks for people. In response to feedback from people living in the home about the quality of meals this company was changed and people said they were extremely happy with the new provider. A menu was being produced each day and displayed in the dining room providing information about the choice of meals for breakfast, dinner, tea and supper. One person said they had requested a copy of the menu and had been provided with a four week rolling menu plan. This had been produced in small text and on white paper. They had struggled to read this. We discussed with management the possibility of producing menus in a more accessible format and they said this would be done. Staff were observed taking breakfast to people in their rooms and some also had their other meals taken to them. Some people said they had access to a fridge or kettle in their room (risk assessments for the use of these were in place). Each person was supplied with fresh water each day. We joined people for two lunches and sampled a starter and desert. These were tasty and tastefully presented. Most people said they really enjoyed the food and that it had recently improved since the change of caterer. Some commented that the meal provided did not always meet up to their expectations but on the whole they were satisfied. This was verified by comments in surveys from people living in the home and staff. Catering staff waited on people and responded quickly and respectfully to peoples requests. They appeared to have a good knowledge of peoples dietary needs, reminding one person of an allergy preventing them from choosing a particular desert or providing additional gravy or no gravy with meals. We were shown an aide memoir in the servery which used photographs of Care Homes for Older People Page 21 of 42 Evidence: people alongside their dietary needs such as a soft diet or allergies. Catering staff confirmed that soft diets were displayed in an appetising way. Freshly produced cakes and biscuits were observed being baked in the kitchen and people said they really enjoyed the diversity of produce available. Care Homes for Older People Page 22 of 42 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. Systems are in place that enable complaints and concerns to be raised by people living in the home or on their behalf. Improvements need to be made to the management of challenging behaviour and recruitment and selection processes to make sure people are safeguarded from possible harm. Evidence: The AQAA stated the home has a clear and accessible policy for complaints, illustrating how complaints are dealt with and time scales. All residents and relatives are kept informed regarding making a complaint. We saw copies of the complaints procedure displayed around the home. Some versions used large text. People spoken with said they would talk to staff or the management if they had concerns and were confident these would be dealt with quickly. The DataSet indicated that 2 complaints had been received in the past twelve months. We examined the complaints and compliments file which evidenced how complaints had been responded to and copies of letters to the complainants from the Chief Executive. He said the Quality Care Committee monitor complaints and their outcome. Several compliments from relatives were read. The AQAA indicated that all staff had received training in the protection of vulnerable adults and the Mental Capacity Act. Staff spoken with had confidence that the management would challenge poor practice and take the necessary action. Staff had access to information about local procedures and the organisations whistle blowing Care Homes for Older People Page 23 of 42 Evidence: policy and procedure. Staff said they had completed training in the management of challenging behaviour. Daily records for one person indicated that on several occasions in December 2009 and January 2010 staff had used restraint to prevent the person harming staff. Staff had completed incident and accident records about these incidents. We examined the homes Restraint policy which clearly stated that staff were not to use physical intervention unless this was clearly agreed in the persons care plan and only if they had been trained in de-escalation techniques. Staff had not received the appropriate training and the persons care plan did not provide any guidance about the use of physical intervention. The persons initial assessment indicated that the person was not to be woken up because this frightened them and later records stated that staff were not to provide personal care if refused and to leave the room. Records evidenced that the home had sought further advice from the Community Psychiatric Nurse and their General Practitioner. More comprehensive guidance needs to be in place for staff detailing how to support this person when anxious or unsettled, the triggers to look for and the techniques they can use to de-escalate or divert a person. As a last resort if physical intervention is to be used this must be discussed with other health care professionals and evidence provided that it is in their best interests and in line with the Mental Capacity Act. We examined recruitment and selection files for new staff appointed since our last visits. There were some shortfalls identified that could place people at risk. See Standard 29. Some of these shortfalls were noted at our last inspection. Care Homes for Older People Page 24 of 42 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Evidence: Faithfull House provides well maintained, warm and clean accommodation over 5 floors. The on-site maintenance team deal with all decorating, building, electrical and maintenance work. Rooms were being redecorated during our visits. All maintenance issues were recorded in the maintenance book on a daily basis and these were addressed each day by the team and signed off when they were completed to ensure an audit trail. Surveys stated, there are high standards of cleanliness, ambience is very good as if in a 5 star hotel, and everywhere is spotlessly clean, facilities are remarkable. People spoken with particularly liked that the large dining room was split into separate dining areas. Surveys commented, happy atmosphere in the dining room. This was certainly our experience too. Gardens to the side of the home were safe, accessible, attractive and well maintained. People living in the home were encouraged to help care for the gardens. People have the benefit of a summerhouse and arbour. The AQAA stated that since our last visit new furniture had been purchased in Care Homes for Older People Page 25 of 42 Evidence: communal areas creating a more homely feel. Patterned carpets in the lounge were replaced with plain carpets in response to the increasing number of people living in the home with dementia. The Chief Executive described other plans to create an environment which would create a home which would reflect the needs of people with dementia. These included changing crockery, toilet seats and lighting. All bathrooms and cloak rooms have had temperature valves fitted. Wet rooms and toilets on each floor had washable floors and ceilings. Assisted baths were provided, some with a jacuzzi facility. We examined the Legionella test confirming this was completed last year. Water temperatures throughout the home were being monitored. There was a domestic team that kept the home clean and odour free. The laundry in the basement was clean and tidy during our visits providing satisfactory facilities which appeared to promote good infection control measures. Clinical waste was being disposed of appropriately. Surveys said, laundry care and clothes are well managed. People said they were appreciative of the additional support of a seamstress also located in the basement. All communal hand washing and hand drying facilities had liquid soap and paper towels. Personal protective equipment was supplied for staff use. Staff were being instructed in the Control Of Substances Hazardous to Health (COSHH) during their induction. Care Homes for Older People Page 26 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Improvements need to be made to recruitment and selection processes to make sure people are safeguarded from possible harm. Evidence: The AQAA stated, we have a low turn over of staff and this is due to respecting the staff giving them support as often as is needed. Surveys commented, well trained staff, in good numbers and there are always staff around, turnover of staff seems very low. Staff confirmed that staffing levels were maintained even during sickness. The off duty rota indicated that levels varied from a minimum of 7 up to a maximum of 10, with 5 staff on duty during the night. Where one to one support was needed for people this was observed being provided. A domestic team was employed to maintain the high standards of cleanliness and a catering company ensured that the quality of meals was being maintained. Staff confirmed that excellent systems were in place starting with an induction which was equivalent to the Skills for Care Induction Programme followed by shadowing staff until the training officer had signed off their induction. Once they had successfully completed their 6 week, 6 and 12 month follow ups they could then progress onto Care Homes for Older People Page 27 of 42 Evidence: their National Vocational Qualification Awards (NVQ) in Health and Social Care. The DataSet indicated that nearly 80 per cent of staff have their NVQ Awards. This exceeds the National Minimum Standard expectation of 50 per cent of staff having this award. We looked at the recruitment and selection files for 5 new members of staff. There were inconsistencies in the information obtained prior to employment. Each applicant had provided an application form with information about their previous employment. There were gaps in employment history on each application form. We could not find evidence that these had been questioned with the applicant. Applicants had been asked to provide two referees. Some references had not been received prior to appointment, one applicant had one reference and another had copies of pre-written references. This is not good practice. New staff must only be appointed after two satisfactory references have been obtained. Evidence was provided for one applicant that a second reference request was sent out but this was a considerable time after they had been appointed. All applicants had been appointed prior to receipt of a satisfactory Criminal Records Bureau (CRB) check. One applicant had a copy of an email stating that an ISA Adult First (Independent Safeguarding Authority) had been requested but not the outcome. The other applicants did not have any evidence that a Povafirst (which has been replaced by the ISA Adult First check) had been completed. There was no evidence of risk assessments detailing staff responsibilities whilst working without a CRB check. CRB checks for these staff were examined and can now be destroyed. Evidence of identity and a current photograph were in place. Copies of birth certificates can be noted as seen, but should not be kept in line with the Data Protection Act. Our last inspection report in 2007 noted concerns about the quality of recruitment and selection records in particular obtaining references prior to appointment and incomplete work histories. Staff surveys stated, all staff are presently studying for their Aset certificate in Dementia Care, we are offered a number of training sessions and opportunities for further qualifications. Relatives said, well trained staff, and whichever member of staff I speak to I find that they are able to give up to date information about my mothers health. We were provided with a copy of the current training matrix which indicated that staff had access to a robust training programme for mandatory training and any additional training relevant to peoples needs such as Dementia Care, Action on Elder Abuse, Palliative Care and Parkinsons Disease. Staff said that if they identified a learning need the training department did their best to enable them to access open learning, courses or taught learning. Copies of certificates confirming completion of training were kept on individual staff files. Care Homes for Older People Page 28 of 42 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Major shortfalls in the administration of medication and recruitment and selection need to be addressed to safeguard people from possible harm. Quality assurance systems are in place involving people living in the home but these need to be more robust to make sure that they closely monitor practice promoting safe working practices. Evidence: The registered manager was not present at this inspection and during the past year had been providing additional management support to another home in the group. She is a qualified nurse and has completed the Leadership in Management in Care Services. The assistant manager was present throughout and worked with us when identifying shortfalls, particularly in relation to medication to address these issues immediately. The registered manager completed an AQAA as part of the inspection, providing considerable information about the service and plans for further improvement. This was sent to us before the deadline. Surveys said,the management team have created a great team atmosphere, managers are always helpful, and Care Homes for Older People Page 29 of 42 Evidence: management are friendly and approachable. During this inspection we have identified serious concerns about the administration of medication. We sent the home an urgent action letter to ask them to address issues within a stated timescale. We also have concerns about the recruitment and selection of staff and shortfalls when obtaining information before new staff begin working in the home. People living at the home could be put at risk of harm or possible abuse, by both of these shortfalls. The homes quality assurance systems had not identified these issues. We also have concerns that the home has been admitting people with dementia. They are not registered to admit people diagnosed with dementia and our findings indicated that staff were struggling to support one person when anxious and distressed. The Lilian Faithful Homes have Quality Assurance systems in place and the home has accreditation for Investors in People and ISO 9001. A further review in September 2009 confirmed the organisation continues to meet with their standards. A number of auditing tools were in place including health and safety, care, activities, finance and buildings. These were done throughout the year to examine quality and effectiveness of systems in the home. Surveys of people living in the home and a customer service survey for relatives were completed in November 2009. The Chief Executive confirmed that the quality improvement plan was being put together. We were able to inspect the previous years improvement plan. People were also being involved in house meetings every 3 months providing another forum for them to express their views. The Trustees had also held a meeting at the home enabling them to talk with people. The Chief Executive was completing monthly visits (Regulation 26) to the home involving people living there and staff. The records of these were kept in the home confirming that any actions identified were being monitored. We discussed with the Chief Executive our concerns about shortfalls in the administration of medication and why the quality assurance processes had not identified these. He acknowledged that these issues had not been picked up during Regulation 26 visits and that this would be addressed in future. Staff and management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Assessments had been completed for people in December 2009. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Each person had a financial risk assessment in place indicating whether they needed support managing their money or whether they had a power of attorney in place. Staff were observed helping people who needed support. Records were not examined at this Care Homes for Older People Page 30 of 42 Evidence: inspection. Secure facilities had been provided in peoples rooms should they wish to use them. Copies of inventories of peoples personal possessions and furniture were on their individual files. Staff training records indicated that they had access to refresher training in first aid, moving and handling, fire, food hygiene and infection control. Moving and handling risk assessments were in place where needed and specialist equipment and adaptations had been provided such as sliding sheets, hoists and bath chairs. Records confirmed that testing of water temperatures, fire systems and portable appliance testing were being conducted. The kitchen had recently been inspected by Environmental Health and received 4 stars. An inspection by an independent Fire Assessor had not highlighted any concerns. The AQAA stated that an external health and safety company was conducting regular audits of the home and took part in health and safety committee meetings. Environmental and fire risk assessments were in place. We discussed the need for an individual fire risk assessment for people who could not independently leave the building. Care Homes for Older People Page 31 of 42 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 32 of 42 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 The registered person must 12/03/2010 make sure that the Statement of Purpose clearly reflects the category of people for whom they provide a service. This is so that people are able to make an informed decision about whether their needs can be met by the home. 2 3 14 The registered person must make sure that a comprehensive assessment of peoples needs is completed - this is in relation to admitting people outside of their category of registration such as those with Dementia. This is to make sure that peoples needs can be met. 12/03/2010 Care Homes for Older People Page 33 of 42 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 3 8 17 The registered person must 12/03/2010 maintain records for the treatment and outcome of any tissue viability concerns. This is to promote the health and wellbeing of the individual. 4 9 13 Arrange to review the 25/02/2010 assessment and records used when people who live in the home self administer their medicines so that there is always a full written risk assessment and plan specific for that person that is regularly reviewed to make sure the arrangements are safe for everyone in the home. Records must be made when medicines are received and subsequently given to people to look after as well as any regular checks carried out to see that the correct amounts of medicines are taken. (Included in letter for urgent action.) This is so that the home can be fully accountable for all medicines handled on behalf of people living there. 5 9 13 Arrange to review medicine records and care plans for people living in the home to 25/02/2010 Care Homes for Older People Page 34 of 42 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 make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. (Included in letter for urgent action). This will help to make sure people living in the home receive the correct amounts of their medicines in a consistent way in line with planned actions. 6 9 13 Make arrangements so that the provisions of the Misuse of Drugs (Safe Custody) Regulations 1973 are complied with for all controlled drugs kept in the home. (Included in letter for urgent action.) This is to make sure of safe storage of these medicines and to comply with the law. 7 9 13 Review the arrangements 25/02/2010 for managing treatment with oral anticoagulant medicines so that guidance detailed in 25/02/2010 Care Homes for Older People Page 35 of 42 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 Patient Safety Alert 18 from the National Patient Safety Agency is understood and followed by all staff handling medicines. (Included in letter for urgent action.) This is to help make sure that the health and wellbeing of people living in the home is not put at risk by not having their correct prescribed medicines or because of poor recording arrangements. 8 9 13 Make arrangements so that 08/02/2010 the fridge in which the medicines are kept is always locked and secure. (Included in letter for urgent action.) This is to prevent access by unauthorised people. 9 9 13 Put in place arrangements to 08/02/2010 make sure that staff do not administer medicines that that are beyond the manufacturers shelf life. (Included in letter for urgent action.) This will help to make sure that people are not put at risk from medicines that are not of the correct potency or quality. Care Homes for Older People Page 36 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 10 9 13 Always keep accurate and 08/02/2010 complete records in the controlled drug record book and be able always to fully account for all controlled drugs received into the home. Investigate all the discrepancies identified at this inspection and take appropriate action to resolve these and notify the Care Quality Commission about the outcome. (Included in letter for urgent action.) This is to help make sure that all these medicines are properly accounted for and people have received the correct doses. 11 9 13 Review and make sure that 08/02/2010 there are robust arrangements in place that make certain that people living in this home always receive their prescribed medicines in accordance with the directions of the doctor and that this is supported by accurate, clear and complete medicine administration records that provide full accountability for all prescribed medicines including those products applied topically to the skin and prescribed food Care Homes for Older People Page 37 of 42 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 supplements. (Included in letter for urgent action.) This is to help make sure that the health and wellbeing of people living in the home is not put at risk by not having their correct prescribed medicines or because of poor recording arrangements. 12 18 18 The registered person must make sure that staff who may need to use physical intervention have access to the skills, knowledge and training. This is to safeguard people from possible harm. 13 18 13 The registered person must 12/03/2010 make sure that where physical intervention is used its use has been agreed in the best interests of the individual to safeguard them from harm. This is to protect people from possible abuse. 14 29 19 The registered person must 12/03/2010 make sure that new staff do not commence work before an ISA Adult First check is in place - this is to be only in exceptional circumstances. 12/03/2010 Care Homes for Older People Page 38 of 42 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 This is to safeguard people from possible harm or abuse. 15 29 19 The registered manager must make sure that new staff start work only after the necessary documentation is in place such as two satisfactory references, full employment history and a satisfactory CRB check. This is to safeguard people from possible harm or abuse. 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 12/03/2010 1 2 3 4 5 1 7 7 8 9 Up to date copies of the Statement of Purpose should be accessible in the home. Care plans should include reference to peoples preferences for the gender of staff providing their personal care. Care plans should be person centred. Monitoring charts should be completed consistently. Review and update the medicine policy and procedures to make sure that all aspects about the management and handling of medicines are up to date, reflect the specific arrangements in this home and staff have access to good information about the way in which they are expected to handle medicines. Review arrangements for when medicines are administered to people living in the home so that staff are always able to Page 39 of 42 6 9 Care Homes for Older People 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 follow practices that are safe and in accordance with best practice guidance. This particularly refers to some arrangements when medicines are not stored on the trolley. 7 9 Review all locations where medicines are stored to make sure these are suitable with regard to heat, humidity and hygiene. Keep records of the particular liquid medicine identified at the inspection in the controlled drug record book and store in the controlled drug cupboard. Introduce regular audits of medicine arrangements with appropriate actions taken following each audit to improve on any shortfalls and risks found. Make sure that handwritten entries on medicine charts are signed and dated by the staff member writing this with a second staff member checking and signing as correct. Introduce regular recorded checks of the controlled drugs record book and stocks. This is to make sure that these medicines can always be accounted for and any discrepancies are quickly identified and dealt with. Staff should refrain from using endearments such as sweety. Menus and other information should be produced on yellow paper and in large black text for people with visual disabilities. Care plans and risk assessments should provide clear guidance for staff about how to support people when anxious or distressed. A risk assessment should be put in place for staff working without a CRB check describing their roles and responsibilities until a satisfactory CRB is received. Copies of birth certificates should not be kept. Quality assurance processes should be put in place to monitor medication administration systems and recruitment and selection of staff to make sure they comply with our guidance. Individual fire risk assessments should be in place for people who are unable to leave the building without staff Page 40 of 42 8 9 9 9 10 9 11 9 12 13 10 15 14 18 15 29 16 17 29 33 18 38 Care Homes for Older People 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 support. Care Homes for Older People Page 41 of 42 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 42 of 42 - 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. 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