Inspection on 02/02/10 for Falcon House Care Home

This inspection was carried out on 2nd February 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 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Falcon House Care Home 21/04/10

Falcon House Care Home 14/11/08

Falcon House Care Home 13/11/07

Falcon House Care Home 22/05/06

Falcon House Care Home 12/12/05

Falcon House Care Home 23/09/05

Falcon House Care Home 05/01/05

Falcon House Care Home 29/07/04

Falcon House Care Home 05/02/04

Falcon House Care Home 12/11/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Falcon House Care Home 2 Middle Street Beeston Nottingham NG9 1FX     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: Mary OLoughlin     Date: 0 3 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Falcon House Care Home 2 Middle Street Beeston Nottingham NG9 1FX 01159228151 01159223759 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Minster Care Management Limited care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 46 The registered person may provide the following category of service only:- Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories:- Old age, not falling within any other category- Code OP Dementia - Code DE Date of last inspection Brief description of the care home Falcon house is a purpose-built modern home providing accommodation for up to 46 people. The care home provides personal care for people who have needs due to older age and or dementia. There are bedrooms, bathrooms, lounges and dining rooms on ground and first floor levels. The first floor can be accessed via a shaft lift or stairs. The home is in the centre of Beeston near to local shops and amenities. There is a car park to the rear of the home. Bus routes operate along the road outside the home. 46 0 Over 65 0 46 Care Homes for Older People Page 4 of 38 Brief description of the care home The range of fees are from £366.00.00 to £475.00 per week. The last inspection report is made available within the reception area of the home. Care Homes for Older People Page 5 of 38 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 focus of inspections undertaken by the Care Quality Commission(CQC) is upon outcomes for the people using the service and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of the service that need further development. We looked at what the previous manager had told us in the Annual Quality Assurance document(AQAA) and the responses we received from our Have Your Say surveys which we sent to residents at the home and received them back in September 2009. The main method of inspection used was called case tracking, which involves looking at the quality of care received by a number of people living at the home.We use evidence from our observations, from speaking to people about their experience of Care Homes for Older People Page 6 of 38 living at the home, talk to staff about their understanding of peoples needs and the training they receive to support them in their role. Nottinghamshire County Council sent us their Quality Audit report following their visit to the home on 21/07/09 and we used this information to inform our inspection. Information from complaints and safeguarding adults investigations was also used to inform our inspection. The provider supplied us with the homes own quality audit reports for November and December 2009 and we include a summary of the report findings within each outcome group. All of the information we have received about the home has informed a multi agency strategy meeting as part of our Safeguarding of Vulnerable Adults policy. Police ,Social Services, Local Authority Commissioners of services, Environmental Health Department and Primary Care teams are all working with the provider to investigate concerns raised about the service over the previous 5 months and ensure the health and safety of the residents. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The registered provider must ensure that the home meets the National Minimum Standards. There must be improvements in the way managers are supervised and any action plans should have continuous monitoring to ensure the plans are properly implemented and objectives met. From the start of the admission process people must be assured that they will have their needs assessed and be consulted on their wishes and expectations. The staff team must be trained and supervised to ensure they practice person centred care and uphold peoples dignity. There must be improvements in the management of peoples personal and health care to ensure that they are regularly monitored and any changes in their condition are recognised and addressed quickly. People must receive their medicines as prescribed to ensure their health and welfare. There must be suitable opportunities for social activities with specific regard for people who have Dementia type illness. There must be improved recording of diets and hydration to ensure people receive Care Homes for Older People Page 8 of 38 suitable nutrition. Identified risks must have suitable up to date care plans in place that will explain in detail how the risks are to be managed. People must be safeguarded from abuse and neglect and staff must recognise and respond appropriately to any suspicion or allegation of abuse. People must be consulted about their care regularly and where they have no capacity to consent appropriate records should identify how decisions are made in accordance with the Mental Capacity Act. Staff recruitment must be robust to ensure people are not employed until all the required checks have been made and confirmation is received that they are suitable to work with vulnerable people. The provider must ensure accountability and ownership of the issues within the home through appropriate management and supervision of that management. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 38 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 38 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. Admissions to the home are made without proper consultation with people and their representatives and information they are provided with about the home is not up to date. Intermediate care is not provided at the home. Evidence: The AQAA told us that We invite prospective service users and their familys to view our home and spend the day to see if the home is right for them we do a pre assessment to ensure that we can meet individual needs before they move into our home and any service user that is in our home for a period of respite care is helped to maximise their independence and return home we also always seek their and their families views. 5 service user surveys we received in September 2009 told us that all 5 had received Care Homes for Older People Page 11 of 38 Evidence: enough information before they agreed to admission and had been given information about the terms and conditions of their stay. At this inspection we spoke to two visiting relatives who told us they had visited the home before deciding if it was the right place but had not been consulted on a care plan for their relatives at any time since admission. One relative commented, I went to see the manager some time after my mother was admitted and had to ask her if she had details of how to contact the family, nobody had asked anything about my mother and I have not been involved in her care plan. We saw that information had been gathered from social workers involved prior to admission which formed the basis for a care plan, however 2 of 3 care plans did not demonstrate that either the person or their representative had been consulted about their needs and expectations. We saw evidence from the homes own quality assurance audit undertaken in November and December 2009. This told us that the information provided to prospective residents was not in a suitable format and the information within the documents was not reflecting the current services and fees at the home, we did not see any evidence that any action had been taken to improve on the information available. Care Homes for Older People Page 12 of 38 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. Staff do not adequately record health care issues within individuals care plans and regular health monitoring does not take place. The management of medicines does not ensure people receive medicines as prescribed. Evidence: The information provided to us within the revised AQAA in December 2009 told us that the staff involved residents and their representatives in creating a care plan from the point of admission and that they prided themselves in their efforts to involve families. They told us that the home was harmonious and they had very few complaints. We received 5 responses to our surveys in September 2009 from residents at the home, these told us people generally felt they were receiving the medical care their needed. Complaints received by CQC and Social Services have highlighted incidents where people have not not had their needs met and this has led to safeguarding adults investigations which are ongoing. Care Homes for Older People Page 13 of 38 Evidence: We looked at 3 care plans and these reflected that health needs were not being monitored and responded to in a timely way and people were not given suitable aids to support their needs. Where peoples health needs had deteriorated there was no evidence that staff initiated an appropriate review with external professionals to ensure a full assessment was made to determine the level of support required. Care plan one described how the person had a normal diet. A corresponding complaint was found in a separate complaint folder indicating that the relatives had expressed concerns that the person was not receiving the special diet they needed and was not given prescribed medication as directed. We saw how kitchen staff had a full diet sheet for this person but there were no records of the actual diet provided to the resident. The acting manager agreed to record the persons diet and hydration to ensure they received the correct diet and fluids each day. We saw from the persons medicine administration records that on many occasions they went without their medicines when leaving the home early in the morning to attend hospital appointments. We saw the daily records which showed staff recorded some medicines being refused but we could not see any evidence that staff had considered the effects of these omissions or requested a review from the persons Doctor. Care plan two had no care plan to address the persons wounds which were extensive. There were no records of how the wounds were sustained. The District Nurse was attending regularly to change the dressings and assess the wounds.The person was seen to be cared for without an appropriate pressure relieving mattress or seat cushion as requested by the district nurse. We saw from their medication records that staff had not administered two courses of antibiotics prescribed to them in January 2010. Care staff responsible for administering these medicines told us that the person refused these medicines but they had not considered the Doctors instructions to administer these covertly. The acting manager agreed to initiate appropriate pressure relief equipment and ensure a daily audit of medicines was undertaken to make sure prescribed medicines were given. We observed how one resident had a skin condition and her relatives told us that they regularly applied prescribed cream themselves as staff had not done this for her. When we looked at the persons care plan it did not detail how staff were to manage her skin condition. When we looked at her medicine records it showed that prescribed creams had not always been recorded as applied. We saw from care plans we looked at that residents had originally signed a care plan in some cases 2 years previously, and that care plan was recorded as reviewed on a Care Homes for Older People Page 14 of 38 Evidence: monthly basis, however the plans did not reflect the current health needs of the residents and the information within monthly risk assessments for pressure sore risk and nutritional risk was not used to ensure the appropriate support and management of the risks was recorded into a care plan to ensure that staff knew how to support them safely. Relatives we spoke with told us they had no confidence in the staff team to manage health care, some comments we received were, I have never been consulted on a care plan My mum has been left in bed by staff who have forgotten about her, she has been left without medicines on two occasions when the staff failed to obtain appropriate stocks and they do not supervise her diet and fluids, as a result she has had frequent urine infections I have to tell the staff when my mum is not well, they dont seem to know her at all. There has been more staff over the last 2 weeks which helps but some residents tell me that they dont recognise the staff and they feel vulnerable when they enter their rooms. A carer called my mum a naughty girl which was very upsetting. We observed staff without uniforms or identity badges, and we were told by the management that there has been excessive absences from the staff team resulting in agency staff and newly recruited staff working many hours in the home. We spoke with a temporary staff member who has recently been allocated the responsibility for reviewing medicine management in the home and she was able to tell us that she had initiated appropriate recording of medicines into the home and was now auditing the medicines regularly to ensure correct supplies were obtained and administration accurate. The homes own audit of care plans was seen and this reflected that in December 2009 the overall standard of care records examined was poor, they were neither comprehensive nor easily defined and failed to identify specific care needs and interventions required. Life stories were, when completed bereft of any meaningful information. One care plan contained a reference to a persons behaviour as unacceptable, being rude to staff and residents, none contained any reference to peoples capacity to consent but several files suggested that people with dementia had signed their care plans. The acting manager told us they are now providing care plan training 08/02/10 to care staff and involving them in their compilation. The acting manager tells us that they are introducing a key worker system to promote ownership and accountability. Care Homes for Older People Page 15 of 38 Evidence: Social Services staff have informed us that they are reviewing each resident in the home to ensure that their needs are being fully met. Care Homes for Older People Page 16 of 38 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. There are limited opportunities available for social and leisure activities and no person centred approaches are in place. The organisation of mealtimes and delivery of hydration and nutrition does not ensure people receive suitable nutrition. Evidence: Information provided to us in the AQAA told us We encourage the involvement of family members socially and residents are consulted on activities and provided with a regular choice and variety of activities. The Nottingham County Council audit undertaken in August 2009 told us that There was no evidence that social activities were an important part of the care of the residents. During the audit, there were no social activities taking place. We have received information from relatives as part of complaints and safeguarding information which tells us that activity days are listed on the notice board. They told us that two events in December were cancelled without notice and residents had not been informed. Care Homes for Older People Page 17 of 38 Evidence: The providers own quality assurance audit in December 2009 told us that they undertook a modified dementia care mapping of the home which demonstrated the quality of dementia care services at the home was poor. Institutional practice was evident, staff did not interact with residents and were insensitive and oblivious to people as human beings. The acting manager told us during this inspection that they have now appointed an experienced activities worker who will commence work once her recruitment process is completed. During our inspection we found that the routines of daily living were not flexible, were told by staff that there are up to 16 residents that are helped to get up very early by the night staff, the records we looked at did not reflect that people were consulted about times of getting up or going to bed. A relative also told us that staff had contacted them in the early evening about 7.00 pm because their mother had refused to go to bed, they asked the daughter to tell her to go to bed. Two of the three care plans we looked at did not record appropriate guidance to staff on the nutritional needs of those residents.The acting manager told us that where indicated diet and fluid intake was monitored, however for the two people we case tracked with nutritional problems there were no records in place for staff to monitor their intake and ensure appropriate nutrition and hydration was being acheived to maintain their wellbeing. Information we have received from relatives within complaints and safeguarding investigations tells us that they feel people are not properly supervised during mealtimes and they are not provided with adequate hydration, and they feel that this results in people having repeated urine infections. The homes own quality audit report from December 2009 states that, People were seen having to wait long periods at the table. The management and organisation of meals was very poor and insensitive. It described little social engagement taking place between staff and residents and staff. As a result of this report the quality manager has drafted the required urgent actions for improvement to the provider. Care Homes for Older People Page 18 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service say that they do not always feel safe or listened to by staff, and that their concerns are not taken seriously. Evidence: The AQAA told us; The management approach in the home is transparent and open; by an approach of managing all concerns, we have minimal complaints, service users and relatives benefit from this approach and talk openly if they are worried or have a concern. Our staff team are well trained and observant they ensure any concern whatsoever is brought to the managers attention. The Nottingham County Council audit report in August 2009 told us; The home had a standard complaints procedure displayed in the entrance to the home, which included some lines of reporting, and appropriate timescales. The home had good abuse and whistle blowing policies in place. During our inspection we saw that a revised complaint policy is in place and that the staff team have been provided with training in how to safeguard vulnerable adults from abuse, however when we spoke to one member of staff about it he could not demonstrate to us that he understood there were policies and procedures to follow in the event of any suspicion or allegation of abuse which would not ensure that the appropriate actions would be undertaken to protect people. Care Homes for Older People Page 19 of 38 Evidence: We looked at the records of complaints in the home and found evidence that concerns raised by one relative had not been properly addressed and the issues affected the health and wellbeing of the resident. The acting manager was advised to take appropriate action which she agreed to do. Relatives and residents told us that they are not listened to and taken seriously. Residents tell us they feel very vulnerable when staff enter their rooms without any identification, they have no uniform and no name badges. We saw only two staff on duty with name badges during our inspection and most staff had on casual clothing that did not help residents identify them. The acting manager was asked for records of recent safeguarding investigations and outcome reports but she was unable to provide these, she said there were none in the home. The lack of suitable recording and monitoring of safeguarding investigations does not ensure that any necessary actions would be taken or lessons would be learned to improve the protection of residents in the home. There have been 7 recent safeguarding adults investigations. Five outcomes to the investigations have been received all identifying poor care practices and medication management. Following these investigations appropriate actions have been taken by Social Services to safeguard those individuals involved, however the present acting manager did not have details of these safeguarding alerts and could not identify to us any action taken to address the emerging themes. We identified from the homes quality audits that the staff do not respond appropriately to difficult behaviours and our inspection found that staff have not received any training in this area to ensure appropriate management of aggression and safety of the residents is maintained. We discussed the shortfalls with the acting manager who evidenced that additional training will be provided in February and March 2010 in an attempt to address the issue. A visitor stated I feel the care staff are demoralised and dont seem to care. No I have no confidence in the staff or the manager, I cannot trust them at all. I have highlighted a concern to the manager but she just laughed at me. External professionals have told us that the present acting manager demonstrates a negative approach when dealing with peoples concerns, addressing people who express concerns as problematic rather than seeing them as a positive contribution to improve care practices and improving peoples experience of the care they receive. Care Homes for Older People Page 20 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally clean and tidy and planned improvements are being undertaken to make the environment more suitable and safe for people with Dementia. Evidence: During our inspection the home was clean and warm. The acting manager told us that recent problems with the central heating are now addressed after essential maintenance and servicing of the boiler. We have received complaints from relatives that tell us they feel the home is not hygienic. During the inspection we observed main lounges and sampled bedrooms which were found to be clean and organised. We saw that one person had a duvet on their bed which was ready for renewal as frequent washing had made it lumpy and bare in parts. The acting manager reported that some new furniture has been obtained to replace old soiled seating. The staff were seen to use appropriate protective equipment to control infection. Care Homes for Older People Page 21 of 38 Evidence: A recent outbreak of a winter virus was reported to the infection control team by the acting manager. We have been informed that an audit of the home has been undertaken by the Primary Care Teams Infection Control Nurses following our inspection which found no serious issues with the control of infection at the home. The Infection control staff considered the acting manager had taken appropriate action to control infection. We saw that service users prescribed creams and lotions were not securely stored in their rooms and the cleaners room containing chemicals was seen unlocked which may present an ingestion hazard if accessed by residents with impaired judgment. Care Homes for Older People Page 22 of 38 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. People are not fully protected due to shortfalls in the recruitment practices and care staff are not effectively supervised. Service users are supported by trained staff and identified deficits in the provision of staff training is being addressed. Evidence: On the day of the visit 39 service users were in residency at the home, being supported by seven care staff, the acting manager, two catering personnel, two domestic staff and a maintenance man throughout the day and three care staff throughout the night. The Have your say pre inspection questionnaire asked Are staff available when you need them respondents stated always . We asked a relative who regularly visits the home if she felt the staffing levels were sufficient to meet the needs of the service users and if she felt the staff were competent in meeting service users needs. The visitor stated I dont think the staff really know my mother, I have to tell them when she is unwell and ask them to get the Doctor My mum has gone weeks without being bathed. The provider has informed us that due to excessive staff absences they have relied Care Homes for Older People Page 23 of 38 Evidence: heavily on agency staff but they are presently recruiting more permanent staff to ensure improved continuity of care. A common theme within complaints that both the CQC and Social Services have received tell us that residents are not helped to rise in accordance with their wishes, delays are then incurred with meals and medication. We saw from duty records that staffing levels are not increased at peak times of activity such as early mornings and mealtimes which would provide improved resources at those times. The acting manager said they have deployed a member of staff from another care home within the group to assist in the required medication improvements at the home. The staff files, examined on the day of the inspection were disorganised and did not demonstrate that recruitment practices were effective in promoting service users safety. As part of the inspection process we examined two staff files. The first file examined, for a member of staff who had been in employment since July 2009, did not evidence a contract of employment or two written references. The staff file did not contain a Criminal Record Bureau Check (CRB) although the CRB was located later in the day. Furthermore the files did not show that the member of staff had received an induction process, this was confirmed by the member of staff. The second staff file did not contain a Criminal Record Disclosure (CRB), although the member of staff had been in employment since 27th July 2009. The acting manager stated that the member of staff had taken the CRB document to her home and a copy had not been retained at the care home. We requested the acting manager to obtain a copy of the CRB and this was provided after the inspection, however the Protection of vulnerable adults barred list was not obtained until 11th August 2009 which breaches the Regulations and does not protect people from staff that may be unsuitable to work with vulnerable adults. We asked the acting manager to establish if all the staff in employment at the home had a contract of employment, which is a legal requirement. The acting manager, after examining all the staff files stated that a further four members of staff did not have a contract of employment. Records showed and staff confirmed that an induction process, which is based on the Skills for Care common induction standards, is provided when staff commence employment to ensure that staff have the basic skills to address the needs of service users. Care Homes for Older People Page 24 of 38 Evidence: The homes staff training matrix showed, and staff confirmed that some accredited training has been provided, a member staff stated The training programme is good. On examination of the staff training matrix it was evident that there were shortfalls in relation to training in Dementia Care, Nutrition and Diet, The Mental Capacity Act, Managing Challenging Behavior, Continence Management and First Aid. We discussed the shortfalls with the acting manager who evidenced that additional training will be provided in February and March 2010 in an attempt to address the issue. Care Homes for Older People Page 25 of 38 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. There have been no effective quality assurance and quality monitoring systems in place to measure success in meeting the homes aims,and objectives and outcomes to service users. The home does not comply with the National Minimum Standards. Evidence: The AQAA we received in December 2009 gave brief information about the service and our inspection found little evidence to support the claims made within it. The inspection found that training, development and supervision of staff, including the manager has been inconsistent and the recruitment practices do not safeguard residents from unsuitable staff. We saw no evidence that the care provided was person centred and monitoring of peoples health and personal care failed to accurately identify peoples needs. Concerns and complaints had not been fully addressed and they were not used to improve the care being provided. Care Homes for Older People Page 26 of 38 Evidence: The home is presently being managed (since January 4th 2010) by an operations manager for Minster Care.The registered provider tells us they are now looking to recruit a new permanant manager. The provider employs an independent quality assurance manager who told us that he frequently visits the home and we saw that he is preparing action plans to address the non compliance with the National Minimum Standards. The operations manager/acting home manager previously monitored the home on a monthly basis preparing hand written reports, she told us that the home manager had not been supervised and there had been a deterioration in the standard of care. Relatives we have spoken with and external professionals tell us that they do not have confidence in the present management arrangements, they feel they are not taken seriously. The registered provider was notified of our inspection and he attended the home during our inspection.He spoke with us about his willingness to work with us and improve the service. He told us he had not received a copy of the Councils audit report in August 2009 and was not aware of the improvements required. The Nottingham County and City Councils have told us they are working with the provider on an improvement plan to address the identified non compliance with National Minimum Standards and will be meeting with the provider in March to assess improvements. Admissions to the home have been suspended by the councils and the provider has given CQC his assurance that he will not admit people who may be self funding until the required improvements have taken place. We have seen evidence that the home has improved numbers of staff and training plans are now in place for the staff team. The Quality report recorded that the home does not manage peoples finances and when we asked the the acting manager about this she confirmed that they do not manage any personal finances for residents. We saw that gas appliances, lifts and hoists had all been serviced appropriately. Care Homes for Older People Page 27 of 38 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 28 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 You must review the 10/04/2010 statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home. To make sure people have accurate information to help them decide if the home is suitable for them. 2 3 14 You must consult with the 30/03/2010 prospective service user or their representative regarding pre-admission assessments and confirm to them in writing that following the assessment the home is suitable for the purpose of meeting their needs. To ensure that prospective service users are clear about what is being provided and that they agree to the plan Care Homes for Older People Page 29 of 38 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 of care and support being offered. 3 7 15 You must ensure that care plans set out in detail the actions to be taken by care staff to support service users health and personal care and ensure the service user or their representative is consulted on the plans. To ensure that all aspects of the persons health, personal and social care needs are met and that these actions are agreed with the person or their representative. 4 8 17 You must keep a record of food provided to service users that is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory and that special diets are prepared for individual service users. To ensure the health and wellbeing of service users is suitably monitored. 5 8 17 You must complete a record of any accident, incident, injury or illness which is detrimental to the service user. 28/02/2010 28/02/2010 31/03/2010 Care Homes for Older People Page 30 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that appropriate action is taken in any event that effects the health and wellbeing of service users. 6 8 13 You must ensure that 28/02/2010 following risk assessment equipment necessary for the promotion of tissue viability and prevention and treatment of pressure sores is provided. To ensure that unecessary risks to service users health is identified and so far as possible eliminated. 7 8 12 You must ensure that service users health is properly monitored and access to medical, nursing and community health services is supported. To ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the service users. 8 9 13 You must ensure that there 28/02/2010 is a policy and staff adhere to procedures, for the receipt, recording, storage, handling, administration and disposal of medicines, and service users are able to take responsibility for their 28/02/2010 Care Homes for Older People Page 31 of 38 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 own medication if they wish, within a risk management framework. To ensure that service users receive their medicines as prescribed. 9 10 12 You must make suitable arrangements to ensure the care home is conducted in a manner which respects the privacy and dignity of service users. To ensure the service users privacy and dignity are respected at all times. 31/03/2010 10 12 16 You must provide 30/04/2010 opportunities for stimulation through leisure and recreational activities in and outside the home which suit service user needs, preferences and capacities, particular consideration is given to people with dementia and other cognitive impairments, those with visual, hearing or dual sensory impairments To enable people to be engaged in social activities which are person centred having regard for the individual needs of service users. Care Homes for Older People Page 32 of 38 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 11 14 12 You must ensure that if a 28/02/2010 service user has always got up very early and wishes to continue to do so then this is acceptable practice and the agreement should be recorded. To maximise service users capacity to exercise personal autonomy and choice. 12 15 16 Hot and cold drinks and 28/02/2010 snacks must be available at all times and offered regularly. A snack meal should be offered in the evening and the interval between this and breakfast the following morning should be no more than 12 hours. For the health and wellbeing of service users. 13 15 16 You must ensure that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 31/03/2010 Care Homes for Older People Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that people receive adequate quantities of food and hydration. 14 16 22 You must ensure that complaints are dealt with promptly and effectively. To ensure that concerns are addressed and resolved to improve the quality of the service. 15 18 22 Records must be held of all safeguarding investigations and the outcomes. To ensure that issues are suitably addressed and the management are taking their responsibilities seriously in the protection of vulnerable adults. 16 19 13 You must ensure that all prescription creams and chemicals are locked away appropriately. For the health and safety of the service users. 17 19 23 You must ensure that a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. 28/04/2010 26/02/2010 28/02/2010 31/03/2010 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the environment is suitably maintained and safe. 18 28 18 You must ensure that the home has a minimum ratio of 50 of care staff trained to level 2 National Vocational Qualification. To ensure staff are trained in the needs of people in the home. 19 29 19 You must not employ a 26/02/2010 person to work at the home unless it can be demonstrated that he has obtained for that person the information and documents specified in Paragraphs 1 to 9 of Schedule 2 of the care home regulations 2001. To ensure the recruitment process promotes the health and wellbeing of service users. You must ensure that the planned staff training programme is completed. To ensure that staff at the home receive training appropriate to meet the needs of people at the home. 30/06/2010 30/11/2010 20 30 18 Care Homes for Older People Page 35 of 38 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 21 33 24 Evidence from complaint records, accidents and incidents must be used to inform a full review of each persons care plan in consultation wth them and their representatives. To ensure the views of residents are considered and concerns about the services they receive are suitably addressed. 31/03/2010 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 The manager should audit the daily records regularly to ensure the appropriate care is being given in accordance with the care plan, and provides a consistent approach and good quality care for residents. If a resident lacks capacity as defined by the Mental Capacity Act Code of Practice then care plans should record how decisions are reached. All wounds should have a care plan that describes how these are managed. Records of personal care such as bathing should be held within the care files. Hand written medicines should be signed and witnessed. You should store all external medicines safely and record the application of creams and ointments. Ensure staff have clear identity badges. Provide service users with information in a suitable format about the available activities and support available in the 2 7 3 4 5 6 7 8 8 8 9 9 10 14 Care Homes for Older People Page 36 of 38 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 home with particular regard for those who suffer from Dementia, describing the specific activities that will support their individual needs. 9 14 If a number of people are awake and asking to rise early then it may be worth considering whether there is sufficient provision of meaningful activity and stimulation during the day. Hot and cold drinks and snacks should be available at all times and offered regularly. A snack meal should be offered in the evening and the interval between this and breakfast the following morning should be no more than 12 hours. Assess staff competency in dealing with allegations or suspicions of abuse. Have revised care plans in place for service users that have developed infections to ensure that the staff team know what they have to do to support the needs safely. Replace worn duvets. Consider staffing levels at peak times of activity to ensure people are supported in accordance with their wishes. The present acting manager should also receive monthly supervision and assessment which is recorded, to show that the home is being managed effectively to meet its aims and objectives within the improvement plans. Care staff should receive formal supervision at least 6 times a year 10 15 11 12 18 26 13 14 15 26 27 31 16 36 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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