Inspection on 09/06/09 for Farmhouse Rest Home

This inspection was carried out on 9th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Farmhouse Rest Home 12/01/10

Farmhouse Rest Home 02/11/09

Farmhouse Rest Home 12/10/09

Farmhouse Rest Home 28/09/09

Farmhouse Rest Home 19/08/09

Farmhouse Rest Home 17/08/09

Farmhouse Rest Home 17/06/08

Farmhouse Rest Home 02/08/06

Farmhouse Rest Home 23/01/06

Farmhouse Rest Home 15/08/05

Farmhouse Rest Home 10/11/04

Farmhouse Rest Home 10/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ 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: Sue Kinch Date: 0 9 0 6 2 0 0 9 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. things that people have said are important to them: 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: They reflect the Care Homes for Older People Page 2 of 31 This box describes the information we used to come to our judgement 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 Page 3 of 31 Care Homes for Older People acknowledged as CQC copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Care Homes for Older People Page 4 of 31 Information about the care home Name of care home: Address: Farmhouse Rest Home 87 Water Lane Totton Southampton Hampshire SO40 3DJ 02380868895 02380868865 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Richard E Kitchen,Mrs Elizabeth Kitchen Name of registered manager (if applicable): Type of registration: Number of places registered: care home 20 Conditions of registration Category(ies): dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Old age, not falling within any other category (OP) Number of places (if applicable): Under 65 20 0 Over 65 0 20 Date of last inspection: Care Homes for Older People D D M M Y Y Y Y Page 5 of 31 Brief description of the care home: Farmhouse is a registered care home providing personal support and accommodation for up to twenty older people who may have dementia. The home comprises of ten single and five shared bedrooms, eleven of which have en-suite facilities. Communal space includes two lounges and a dining room. Car parking and a small, enclosed patio can be found at the front of the property. The home is privately owned by Mr and Mrs Kitchen and Mrs Jean Hunt is the registered manager. Farmhouse is situated in a residential area on a main road close to the centre of Totton. The homes fees range from 504-520 pounds aweek. Care Homes for Older People Page 6 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: zero star poor service Our judgement for each outcome: How we did our inspection: This was first Key unannounced inspection of the home since 17th June 2008. For this inspection we have reviewed the information received about the service since that visit and this included an Annual Quality Assurance Assessment (AQAA) which the registered manager is required to submit. We also received eight surveys from people living in the home and relatives and one health professional. None were returned from staff. The inspection included an eight hour visit to the home where we talked with three staff, the manager and four people living there. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The registered persons must make sure that the assessment is completed to ensure that service is able to meet all peoples general and specific needs and people assured that they can be met. A requirement about care plans, daily records and risk assessments has been repeated stating that they must be up to date with clear guidance for staff such as for when working with aggressive behaviour, or meeting all short and long term needs. Staff competence in medication procedures has not been assessed and mistakes are being made meaning that people are at risk of not receiving the correct medication. The manager must, assess staff as competent before they are involved in administration of medication, and provide any additional training assessed as needed. The manager must ensure that proper arrangements are made for the storing and administration of medication with accurate records held. Arrangements must be improved to ensure that staff are assessed as competent before they are involved in the administration of medication, and provide any additional Care Homes for Older People Page 8 of 31 training assessed as needed. The manager must have evidence of a POVA first check or a fully completed CRB check before people start working in the home. There must also be full evidence of employment checks available in the home including written references, employment gaps, and testimonials, where needed, about why people left previous care employment. There must be clear evidence to demonstrate that staff are trained in relevant skills infection control, adult protection and specific needs such as mental health and alcohol dependence. It must be demonstrated that audits of the home and consultation informs a development plan shared with people living in the home. 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 31 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 31 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. Although changes have been made to the pre-admission process, gaps still exist which puts people at risk of not having their specific needs met when they move into the home. Evidence: In the report of the at inspection on 17/6/08 we made a requirement that full assessments must be made, including information from relevant others and the people to receive the service, before an admission is made, so that at all times, people coming to the home know that their needs will be met. The manager told us that she was going to improve the assessment by including mental capacity assessments and a personal profile. In the AQAA the manager told us that the system had improved and that full assessments were in place including obtaining information from care managers where appropriate, or other professionals. In surveys of the six people who returned surveys before out inspection visit all said they had enough information to help them to decide if this was the right place before moving in. At our inspection visit we looked at the records held for four of the people who had moved into the home or come for a trial since the last inspection. We noted that some alterations and improvements had been made to the information obtained prior to admission including more detailed mobility risk assessments, assessments regarding community access and those in relation to mental capacity. Care Homes for Older People Page 11 of 31 We did not see written evidence of confirmation that the home can meet peoples needs and the manager agreed to include that in the assessment. We noted that two people, from observations, conversations and the sample of records viewed, had been admitted to the home with additional needs that the home cannot demonstrate that they are able to meet. Staff are not trained in a range of mental health needs and those of people who are alcohol dependent. The potential risks of those needs re-emerging and strategies to support them were not assessed and care plans were not in place detailing how staff should intervene should emergencies ocurr. Care Homes for Older People Page 12 of 31 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. 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. Revised information in the care plan and the accessibility of them to staff has not ensured that all peoples specific needs, including health care needs have been met which puts people at risk of harm. This is a repeated area of concern. Staff competence in medication procedures has not been assessed and mistakes are being made meaning that people are at risk of not receiving the correct medication from skilled staff. Privacy, for some people living in the home is compromised. Evidence: At the last inspection we noted that care plans were not easily accessible to staff working in the home making it difficult for them to monitor care needed and provided. These are now available in a locked cupboard on the ground floor and a staff member confirmed that they have access and use them. The two staff members spoken with some knowledge of the needs of the people they provided care to. A staff member said they said are kept up to date through daily reports and handovers between shifts and staff are involved in reviewing care plans. After the last inspection in the report we required that all care plans, daily records, and risk assessments must be up to date with clear guidance for staff such as for when working with aggressive behaviour, or meeting all short and long-term health needs. In the AQAA the manager told us that these things were in place. We viewed four care plans when visiting the home and met some of the people that they related to. We found that the care plans included details of a range of issues Care Homes for Older People Page 13 of 31 including, mobility, skin care, continence, hobbies and interests, diet, family contact, communication, foot care and health issues. There was evidence of recent reviews for people who had been in the home for a while with further dates set. Plans also included likes dislikes, and although they had no signatures from people living in the home they referred to, their wishes choice, independence, privacy and respect. Care plans were not, however, all up to date. One person was recorded in the care plan as needing a food supplement due to severe weight loss. This had stopped. The manager said that this was because person had gained weight and found a record of this in the day to day records but the care plan had not updated did not therefore give staff clear details about current needs. For two people with specific needs we noted that risk assessments and care plans relating to the risk of deterioration in their conditions were neither fully risk assessed or planned for which puts these two people at risk of harm if their specific needs are not met. We brought this to the attention of the manager during our visit and wrote to the home after the inspection due to the seriousness of this concern. In our survey before the inspection we received positive comments about the care provided. One person said Nothing is too much trouble the staff always listens and always supports me. A family member of another said that their relative in the home was looked after well. During our visit to home we spoke to four people living their about care provided. Two people were very positive about the care and all confirmed that aspects of their care were met. One person was concerned about their health and this was raised with the manager who said that she often had conversations about it with the person. The manager agreed to follow this up. However, these conversations were not documented and a plan to meet these emotional needs was not viewed in the care plan and the person was clearly anxious. Therefore there was no structured plan to inform staff how to respond to this persons needs. The service failed to recognise and respond to this need despite being aware of it. In the previous report we also identified some examples of where dignity and privacy were compromised. We advised that training staff in a shared bedroom, the managers office being accessed through a persons bedroom and also using one for hairdressing, compromised dignity and privacy and the manager agreed to address this. Action taken or improvements were not referred to in the AQAA. However, at the home the manager said that training and hairdressing no longer took place in peoples rooms. Her office, we noted, has not been changed meaning that two peoples privacy is still affected because the office can only be reached by crossing a shared bedroom to reach it after the bathroom. This seriously compromises residents rights, both in terms of personal space and privacy. We also raised issues in the last report about guidance needing to be available about as required medication so that staff could be informed of how the person would make decisions about it or know if it had been stopped. Although the manager said that each person now has their own medication file action taken or improvements were not referred to in the AQAA. During our visit we noted that some general assessments had been made but were not relating to specific medication. There continues to be no specific guidance about when people should receive as required medication, putting Care Homes for Older People Page 14 of 31 people at risk of not receiving their medication as intended according to prescribed guidelines. Creams for one person were found in their room and were not recorded on the medication sheets viewed. They were also stored open in the room on a shelf above a radiator. We viewed some of the medication administration records and noted gaps meaning that some people may not have received their medication at those times. We noted that three people were recorded as having missed a medication dose on one occasion and one of these people on another date. This was discussed with the manager who said that the monitored dosage containers for those dates had been returned to the chemist. We looked at the medication disposal record book and noted that returns of medication had not been made since April 2009. We checked day to day records for the people involved to see if errors had been recorded and followed up and found no entries. Therefore the home has no process in place to ensure that medication is always given as prescribed. The manager said that staff competence, in the administration of medication, has not been assessed although she plans to introduce a system for this. Care Homes for Older People Page 15 of 31 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home: enjoy a range of activities regularly organised in and out of the home taking individual needs into account; receive visitors and enjoy good meals that they like. Evidence: At the last inspection we noted that the exits to the home were locked and that there were people in the home who were assessed as needing support to go out of the home or they would be at risk. We saw that there were risk assessments in place in files on this visit. We had also noted that there were no specific plans in place at that visit for those who can go out freely. This was discussed with one person who goes out of the home independently and that person said that they were happy with arrangements and felt able to go out when wanted. A staff member said that the code had been given to one person who had trouble remembering it and so staff opened the door for them when wanted. The manager in, the AQAA spoke of a regular programme of activities and trips out for people and support for people to go out independently if they are able. From observation of afternoon activities, talking to people, and staff we found evidence that these are happening. We heard about people going to a Chinwaggers club weekly by bus with staff support and help from volunteers. There are people who go weekly and others who go less often. The manager told us about activity co-coordinators and we noted that one was in the home in the afternoon taking an exercises session followed by a quiz. Staff said that they had time to sit and talk to people. A person living in the home said that these activities were regular, that entertainment happened once or Care Homes for Older People Page 16 of 31 twice a week and the staff had time to play games. The person said that they were able to do the things they wanted to do and keep to their routines. One person living in the home spoke with us about visitors and said that they were welcomed into the home. We noted comments from two people in the surveys who said that relatives were welcomed and able to have meals. We heard a member of staff greet visitors in a friendly and helpful manner explaining the reason for signing in and finding chairs. We noted that staff help people with some of the day to day social and emotional issues and were actively involved in supporting people who were either upset or agitated and could explain how they were supporting them. In the AQAA the manager said that people likes and dislikes regarding food were recorded in care plans, that they made day to day choices and that the annual quality assurance questionnaire included food. We saw evidence that all of these things had been carried out. Staff said that they had time to help people at mealtimes and help was noted to be provided . In the surveys received people said they like the food received. The two people spoken with about this agreed. One said they got the food they liked and another said it was plain, good and adequate. We noted that there are recording systems in the home for noting what people have eaten. Where sampled for one person food and fluid intake was being recorded. Care Homes for Older People Page 17 of 31 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for people to feel able to raise issues with the home there are not clear processes to ensure that all staff have received training in safeguarding. Evidence: The manager reported to us that there have not been any formal complaints to the home since the last inspection. She also told us that the complaints procedure is available to people in the front entrance to the home. Surveys all eight people said there is someone they can speak to if they are not happy and they know how to make a formal complaint. A member of staff said that said the home is responsive to people and families and does not have many complaints and concerns raised. There are emotional issues that staff work with and provide support. At the last inspection we noted that incidents had occurred in the home that had not been reported through the local safeguarding procedures and there was insufficient evidence that incidents had been followed up. We told the manager to report the matter and reported it ourselves. This matter was then followed up by social services and we were informed that matters were resolved in December 2008 and all staff had been sent on a recording course. A staff member said that they had done the training and the manager said that all staff had done the training over a period of time this year although certificates were not available in the home. In the last inspection report we made a requirement that all incidents in the home affecting the wellbeing of the people living there must be reported to CSCI(now CQC) and when this includes harm to others must be reported to the nearest social services office under the adult safeguarding procedures agreed with the local authority. This is to ensure that appropriate action is taken. We have noted that the manager has been making referrals of incidents and occurrences in the home since that inspection. These have not needed referral under the safeguarding procedures and the manager said she Care Homes for Older People Page 18 of 31 had not made any referrals since the last report. Therefore the requirement had been met. However, following this inspection we made a referral to adult protection due to the issues identified in the first section of this report. We noted in the last report that adult protection procedures had not been followed although there was some evidence of staff training. In the AQAA for this inspection the manager said that training in adult protection had been planned in the last twelve months but we were not provided with information about training received. Conversations and observations with staff showed that they are supporting people with more difficult behaviours in the home. A member of staff spoke about having received training in dementia. The person was aware of the need to ensure that concerns about peoples safety should be reported to social services but was not sure when they last had training in adult protection. Another member of staff was recorded as having had training in 2007. This is referred to in the staffing section. Care Homes for Older People Page 19 of 31 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a warm, friendly, comfortable environment for people to live in which is clean, hygienic and regularly improved but infection control training is not clearly evidenced to show that people living in the home are supported by trained staff. Evidence: In the AQAA received before the inspection we were told that there were ongoing improvements to the environment although details of plans were not provided. During our visit to the home we viewed some of the shared areas of the home and a selection of bedrooms. We noted that the home was fresh, clean, adequately decorated in areas viewed. Adaptations were noted and included assisted baths and a chairlift. We noted that risk assessments have been developed for the environment. (These are referred to in the section on management). A housekeeper is responsible for the cleaning and is on the rota for the morning five days a week. There is a system for organising maintenance in the home we noted that a list of tasks for completion is kept with the rota. The manager told us that The home has a maintenance contract for all appliances such as gas water electric hoists fire detectors extinguishers nurse call points door alarms stair lift. These are all maintained in line with regulations. We noted that as found at the last inspection there were a number of items about the external areas that detracted from an other wise attractive environment. Records of induction for one staff member were not available to evidence that guidance had been given re infection control. Certificates for another person did not refer to recent training or updates in infection control and were not in place for induction. In the AQAA the manager had told us that ten of the staff had been trained in infection control and that a policy is place in the home. During the last inspection in June 2008 we noted that some staff were receiving training that day. However, easily Care Homes for Older People Page 20 of 31 accessible records must be in place to evidence the training so that it shows the home is monitoring and ensuring that staff maintain the skills they need to meet needs. This is referred to in the staffing section. People told us in the surveys that the home is fresh and clean. In bathrooms viewed facilities included adequate hand washing facilities. The manager told us that there is a contract for soiled waste disposal last reviewed in January 2009. Care Homes for Older People Page 21 of 31 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by caring and friendly staff in sufficient numbers which are reviewed. The recruitment process is not robust enough to provide adequate protection. People living in the home are receiving support from staff who have not had sufficient training to meet their needs. Evidence: We noted that staff and manager were very friendly and supportive to people during our visit, and showed patience with the more difficult behaviours to deal with. One of the people living in the home said that the staff were brilliant and that they have all the help that they wanted. Another said that they were very happy. Staff were providing continual support and there were two staff and one working as a cook in the morning as specified on the rota plus the manager. Staff said that there were usually two carers plus the cook and a housekeeper as recorded as working in the weekday mornings. Staff asked thought this was adequate but more staff were used at lunchtimes to support with meals. Overnight one staff was working awake and on was sleeping in. We noted however, that at tea time one person was in the kitchen with another in the lounge. A staff member said that this was what usually happened. However, one person during this period needed a staff members help to have a cigarette. We also noted that one person had been upset on and off during the afternoon and two people were disagreeing and needing staff intervention. We also note that those staff would need to respond to calls to people in their rooms and the manager reported that one person living in the home had been assessed as needing nursing care. A member of staff had said that this person usually needed two people for moving and handling. This meant that there was a risk of not enough staff being available to meet all of the needs at once. Following the inspection the manager said that there was a system in the home for reviewing staff levels and that more staff were used when necessary. Care Homes for Older People Page 22 of 31 In the AQAA the manager said that pre employment checks are in place but at the inspection visit we found that records were insufficient to support this. We found that for one person evidence of neither a POVA First or full Criminal Record Bureau (CRB) check could be found and the one reference available were not from the previous employer. For another person there was no references from the previous care employer or testimonial as to why a care role was left. This was discussed with the manager and an immediate requirement notification was left and a followed up by a letter regarding the lack of POVA first or CRB check. We discussed induction for new staff. The manager said that one person was following a twelve week induction and that person had the records. The manager said that the person had received support and guidance but had not had formal supervision and that there was no management record of that induction. For a second person, there was no induction record and they had not had supervision. The manager told us that there are 4 people with an NVQ level 2 and 2 with a level three showing a reduction still under 50 of care staff. One persona said that they were about to start doing NVQ showing that the manager does support people to be assessed. The manager told us that staff had been having a series of training since January including Food Hygiene, Moving and handling, first aid, recording, and osteoporosis. A member of staff confirmed this. Another had done two of the courses and was doing a distance learning course in equality and diversity. The manager said that she was prioritising staff training. However, we noted that in one staff file certificates were held for training done in a previous care role and none for training completed at this home. The manager said that she did not have any of the certificates and was waiting for them to be sent from the providers office. So training is being organised but records need to be improved to provide a full account of the range of training provided to demonstrate that needs can be met. We note from discussion with the manager and staff that staff have not all been trained in supporting mental health or alcohol dependence although in respect of the latter the manager said that it was being considered. Care Homes for Older People Page 23 of 31 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. 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. Monitoring of systems and practices in the home are not organised sufficiently to demonstrate that the home is fully run in the best interests of the people living in the home. This is demonstrated by the requirements made in this report which indicates potential risk to people living in the home. Evidence: The manager has worked in the home for several years and is registered and is working on her NVQ level 4. She indicated that she had done some training since the the last inspection health and safety. Staff said they felt supported by the manager and most people we received comments from were positive about the support provided. Some of these are in the summary at the front of the report. In the last inspection report we judged that more management monitoring was needed in the home to ensure that it could be demonstrated that all needs are met. We noted that the AQAA provided for this inspection was sent to us late and did not update us on all the issues raised in the last inspection report or give us enough information about plans to develop the home. The manager in the AQAA had said that they had regular questionnaires to survey people about the home and have used this to influence menus. Whilst comments from people about the food were positive, the information in the homes questionnaires has not been collated leading to a report of findings. A record of planned improvement based on the consultation was not available for the inspection or people living in the home. Care Homes for Older People Page 24 of 31 At the inspection the manager said that she recognized that improvements were needed in all aspects of the home and that she was concentrating on supervising and staff training. She showed that she had made improvements including examples such as some aspects of the care plans, more risk assessment and consideration of elements of privacy. However, requirements made in other sections of this report show that work is still needed to achieve this effectively. We have made requirements in other sections about care plans, risk assessments, staff training, recruitment, medication, and, assuring people their needs can be met before admission meaning that the home is not satisfactorily managed and organised in the best interests of the people living there, putting them at risk of needs not being met. Although the manager said that there were regular visits by one of the registered providers and a representative, she had not been provided with reports of these visits. This means that there was inadequate evidence to show that the standard of practices in the home are being monitored by the providers. The records should be kept at the home so that they inform and improve day to day service provision. Through conversations with people, the manager and observations of records we note that the manager is considering the Mental Capacity of people living in the home and introducing assessments into the admission process. Finances were reported to be managed by the manager for one person only when we visited and records showed that no money was held. The manager reported to be seeking funds. Health and safety was discussed with the manager and some of the records relating to this was viewed. The manager has completed some household risks assessments since being trained at the end of last year and had a file of recent risk assessments showing action to be taken to minimise risks. There was also a fire risk assessment completed by an external professional and this had identified a number of action points. The manager said that these had been carried out but the fifth one had not. This meant that the boiler is left in the hall with the dials exposed and not hidden as the risk assessment advised. The manager agreed to follow this up. We were not able to view the report of the health and safety audit that the manager referred to in the AQAA as it was not available in the home. We noted that there was written evidence of fire training by an external person and an internal session and saw records of both showing that training had been provided in Care Homes for Older People Page 25 of 31 September 2008 and April 2009. We noted that records showed that night staff, where sampled had been included. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes √ No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 All care plans, daily records, 17/07/2008 risk assessments must be up to date with clear guidance for staff such as for when working with aggressive behaviour, or meeting all short and long-term health needs. Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 You must have evidence of a POVA first check or a fully completed CRB check before people start working in the home. This is to ensure that the safety of people living in the home is safeguarded 30/06/2009 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 3 14 People moving into the 23/07/2009 home must be provided with assurance that their specific needs can be met before moving in. This is to ensure that the home can meet assessed needs. 2 9 13 The manager must ensure 23/07/2009 that proper arrangements are made for the storing and administration of medication with accurate records held. This is to ensure that people received their medications prescribed by the doctor. 3 9 18 The manager ensure that staff are competent before they are involved in 23/07/2009 Care Homes for Older People Page 28 of 31 administration of medication, and provide any additional training assessed as needed. This is to ensure that people living in the home are supported by correct medication procedures. 4 10 12 The registered person must 09/08/2009 ensure that the dignity and privacy of all people living in the home is maintained. The manager must ensure 23/07/2009 that there is full evidence of employment checks available in the home including written references, employment gaps, and testimonials about why people left previous care employment. This is to ensure that people living in the home are safeguarded by the recruitment process. The registered person must 09/09/2009 have clear records to demonstrate that staff are trained in relevant skills including infection control, adult protection and specific needs such as mental health and alcohol dependence. This is to ensure that staff have the skills required to meet needs. 7 33 24 The manager must review 09/10/2009 information received in quality audits of the home and through consultation and ensure that it informs a plan for development and is made available to people living in the home or their representatives. Page 29 of 31 5 29 19 6 30 18 Care Homes for Older People This is to ensure that people are consulted and know that their views are taken into account. 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 Care Homes for Older People Page 30 of 31 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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