Inspection on 29/07/09 for Felixstowe Care Home Ltd - Merryfields

This inspection was carried out on 29th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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Felixstowe Care Home Ltd -... 15/09/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Random inspection report Care homes for older people Name: Address: Felixstowe Care Home Ltd - Merryfields 7 Mill Lane Felixstowe Suffolk IP11 7RL new service which has yet to be given a quality rating The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Tina Burns Date: 2 9 0 7 2 0 0 9 Information about the care home Name of care home: Address: Felixstowe Care Home Ltd - Merryfields 7 Mill Lane Felixstowe Suffolk IP11 7RL 01394285528 Telephone number: Fax number: Email address: Provider web address: sue@felixstowecarehome.co.uk Name of registered provider(s): Name of registered manager (if applicable) Ms Sally Ann Royal Type of registration: Number of places registered: Conditions of registration: Category(ies) : Felixstowe Care Home For The Elderly Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 4 dementia old age, not falling within any other category Conditions of registration: 0 0 The home may provide personal care and accommodation to 4 named people who have been identified to the Care Quality Commission on the 2nd July 2009. The primary needs of these people shall be: Dementia - Code DE Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Felixstowe Care Homes Ltd - Merryfields has been registered as a care home since 9th July 2009. It is currently registered to accomodate four named people with dementia but an application has been submitted to the Commission to increase the numbers to Care Homes for Older People Page 2 of 13 Brief description of the care home ten. The home is situated in a residential area of Felixstowe close to the town centre and sea front. There is an enclosed garden at the rear of the premises with seating and flowerbeds and a car park at the front for staff and vsitors. All areas of the home are wheelchair accessible. Shared facilities include a lounge, sun room, dining room and two shared bathrooms. All bedrooms are single with ensuite toilet and wash handbasins. Care Homes for Older People Page 3 of 13 What we found: This random inspection was undertaken by Tina Burns, Regulation Inspector, and Karen Howman, Local Area Manager. The purpose of the visit was to see how the service was operating since it had become registered following the Commissions decision not to prosecute for initially running the home without registration. On arrival we were welcomed into the home by the deputy manager who asked us to sign the visitors book. One of the Directors, Suzanne Bolton was present and we advised that we were undertaking a random inspection. The registered manager, Sallyann Royal was not on duty but Mrs Bolton told us that she would ask her to join us later in the day, which she did. Mrs Bolton gave us a tour of the premises and introduced us to staff and residents. The security of the home was maintained through the use of a number keypad on the front door to exit and CCTV cameras which were focused on the exterior of the building. The front of the building was tidy and made more attractive with hanging baskets of flowers. Whilst we did not go outside into the garden on this occasion Mrs Bolton confirmed that the gardens to the rear of the property were fully accessible and secured by fencing to ensure the safety of residents. A portion of garden had been allocated to each resident to plant with flowers of their choice. Three of the existing residents had bedrooms on the ground floor and one on the first floor. In viewing a number of the bedrooms we found a pile of clothing and items of correspondence addressed to someone who was not one of the four named residents living at the home. We were advised by the Mrs Bolton that the items belonged to someone who due to be admitted to Merryfields but their admission was stopped at the point when the service was found by the Commission to be operating as an unregistered service. We were advised that the person in question was still resident at a care home in Ipswich although their relative was keen for them to move in. Mrs Bolton stated that she was concerned about the stressful situation that the relatives were in and that she had considered offering a placement at the home but not charging. Mrs Bolton asked if this would be alright and we advised her no and reminded her that she was registered for four named people only and that as explained previously that there was no automatic guarantee that the additional beds would be approved by the Commission. We expressed concern that the belongings were still being held by the home and that by doing this the relatives may be given a false picture of the situation. Mrs Bolton agreed to liaise with Social Services and the relatives. We spoke with social care services following the site visit and they confirmed that the person concerned was indeed still placed in another care home. Bedrooms were found to be of a good size, all for single occupancy and with en-suite toilets and wash basins. Each room had a large number on the door so that the room was easily recognisable and in one instance it was noted that a poster identifying the name of the resident had been added. Carpets were also colour co-ordinated with rooms to help with orientation. One resident about to go out to day care confirmed that they was settling in very well and liked their bedroom. Residents had started to personalise rooms. At the time of this site visit one of the bedrooms was being used by Mrs Bolton to sleep in and another as an office. Care Homes for Older People Page 4 of 13 The home had two assisted baths, one on each floor. Windows on the first floor had restrictors in place to ensure safety and the passenger lift could be accessed from each landing to ensure that residents could have full access to the building. We also saw that the home had a mobile hoist. Call bells were in place although not heard during the course of the inspection. Child safety gates had been fitted to both doors to the kitchen and to the office to prevent one resident accessing these areas. We were advised that this was because this resident liked to come in and tidy up and would potentially be at risk in the kitchen. The home had been decorated throughout to a high standard and fixtures, furnishings and fittings were comfortable and homely. Residents had a choice of sitting areas. There was a lounge with television, a conservatory overlooking the garden and a dining room with seating for ten around two tables. The communal areas were clean and tidy and enhanced with fresh flowers. During the inspection a relative came to visit and was welcomed by staff although she had not been aware that their relative would be attending day care that day. They told us that they had been most impressed by the standard of accomodation and so far they had found all the staff attentive, helpful and approachable. During the inspection we observed a member of staff beginning their morning medication round. They had dispensed the medication for three residents from blister packs into pots and put them on a tray, with no form of identification. We pointed out that this procedure was not safe as there was a high risk that residents could be given incorrect medication. They said later that they should have known better as they had undertaken medication training. Mrs Bolton also confirmed that a suitable medication trolley had been ordered and they were waiting for delivery. Staff were observed to wear protective clothing as appropriate and it was noted that they had good access to appropriate hand washing faculties to ensure good infection control. However we had some concerns about the laundry room which had limited space for sorting clean and soiled laundry and although there was a suitable washing machine and dryer in place there was also a sluice machine in the same confined area. We discussed the matter of infection control and the handling of soiled clothes and linen with Mrs Bolton who advised that all dirty linen was put into linen bags and stored in a cupboard in the corridor for collection by a contractor at agreed intervals. We explained that we were concerned about potential hazards and odours, consequently Mrs Bolton agreed to seek advice from the infection control advisor as a matter of urgency before reviewing the arrangements in place. During the inspection we were advised that a fire officer had been to inspect the home. Mrs Bolton told us that they had not provided a report but they had been very satisfied and no requirements or recommendations had been made. We could see from an entry in the visitors book that the fire officer had been on 20th July 2009. The deputy manager confirmed that a system of health and safety checks has started so we looked at the records in place for the monitoring of hot water temperatures. We could see from records that the first set of checks identified that with the exception of the outlets at hand basins in three vacant rooms all hot water temperatures were within an acceptable range. The records did not tell us whether any action had been taken to address the temperatures exceeding an acceptable range but we were advised that the Care Homes for Older People Page 5 of 13 matter had been addressed and in the future a record would be maintained. We checked hot water temperatures in two of the residents en-suites, one was forty degrees centigrade and the other was forty one. A previous visit to the home by the Commissions regional enforcement inspectors and subsequent interviews by the Commissions registration team identified concerns with regard to lack of pre-admission assessments, care planning and recruitment. Consequently we looked at the records of all of the residents and all of the staff. The residents records we examined did not include any evidence of local authority assessments. They did include copies of pre admission assessments that had been undertaken by the manager but it was not clear whether the assessments had been undertaken before or after admission. Further more the detail of the assessments was sparse and bearing in mind the conditions and diverse needs of the residents we met there was insufficient information to develop a needs led, person centred care plan. Consequently the care plans we looked at did not clearly specify the needs and preferences of each resident or the tasks that needed to be undertaken by staff. Mrs Bolton told us that it was their intention to improve in this area, she showed us some sample care plans that the local authority had recently provided for them to look at and advised that they would develop the care plans as a matter of urgency. Daily records had been maintained on each residents file and they included reference to support and assistance provided. However, with the absence of a detailed care plan it is was difficult to assess whether the care provided matched the residents needs. Despite that there were clear records of matters relating to peoples health or behaviour and the support provided or action taken. This included evidence of consultation with relatives and a range of professionals. However records relating to how people were assisted to keep stimulated or occupied were minimal with little evidence of activities. Mrs Bolton and Ms Royal felt strongly that this was a shortfall in recording and they said that they would address the matter with their staff team. At a meeting with the Commission on 24th July 2009, Mrs Bolton advised that they had ten carers in post and all but two had Crimininal Record Bureau Checks (CRBs) in place. A separate meeting was held with Ms Royal, the manager and she advised that there were ten staff in post including Mrs Bolton, a cook, cleaner, the deputy manager and herself and that two staff were still working on a povafirst check. Ms Royal advised that two new carers had been appointed and had povafirst checks in place but would not start until later in August. During this visit we looked at the staff rota and all recruitment records with the exception of Mrs Bolton and Ms Royal. Their documents were inspected as part of the registration process. We were provided with a copy of the staff rota for the period 1st July 2009 to 31st July 2009. The rota did not specify job roles nor did it identify support provided by the weekend cooks, one of whom also provides support with cleaning or Mrs Boltons hours when she undertakes the cooking. The rota showed that for the first five days in July, there was one member of staff on duty at night and on each day cover was provided by someone with a povafirst check only rather than a full CRB. On the 5th July 2009 the rota showed that one member of staff covered the whole day on their own with another member of staff without a full CRB disclosure covering the night. Mrs Bolton has since confirmed that the local authority had also provided agency staff with full CRB clearance during this time, however we did not ask to see evidence of this during our visit. Care Homes for Older People Page 6 of 13 It was also evident that one of the two new carers referred to in our meetings on the 24th July had already worked at the home. On the 20th July 2009 they had worked as the second carer on duty alongside the manager and on the 26th July 2009 they had worked an 8am to 2pm shift alongside another carer, both of them having a povafirst check but neither a full CRB disclosure. The rota did not identify any other supervisory arrangements in place and again it was unclear as to how residents had been fully safeguarded. An action plan drawn up with Suffolk County Council dated 13th July 2009 identified the need for all members of staff who were not yet CRB cleared to be supervised in their resident contact, with the member of staff supervising them to be CRB cleared. We looked at all recruitment records and confirmed with both the manager and Mrs Bolton that no other recruitment records were held elsewhere. The files showed that three of the existing staff did not yet have a full CRB. Another director of the home was observed working in the garden and around the house during the course of the inspection and we were advised that they did not have a CRB or povafirst clearance. Once this issue was raised they left the home at the request of Mrs Bolton. Recruitment records showed evidence of applications, health declarations and identification although a number did not contain any photographic ID (photographs that were in place were from photocopied passports or driving licences). It was evident that the manager had provided a reference for four of the staff on the basis that she had been their manager at their last place of employment. Whilst the manager had openly stated that she was completing the reference as the manager of another care home until January 2009, staff had remained at this home after she had left and it would therefore been more appropriate to seek a reference from the other home. In one instance the manager had acted as a second referee to one staff member even though they had not given her name or the other care home as the previous employer. In another instance a member of staff had identified that they had had a criminal conviction however there was no evidence on file that this issue had been explored or any evidence of risk assessment given that this person did not yet have a full CRB. The manager advised that she knew the person and the issue had been discussed but acknowledged that there was nothing recorded to confirm this. In one instance the reason for someone leaving a previous care home was not recorded in the application form and there was no evidence that a reference from this employer had been sought. We had previously been advised that all care staff had received training in administration of medication, fire safety, manual handling, food hygiene and safeguarding adults. At the time of this site visit the service had not yet received certificates. Mrs Bolton confirmed that she was able to evidence that training had been provided through an invoice which she was unable to access at the home that day but agreed to forward to the commission by Friday 31st July 2009. Evidence of previous training for some staff was held on file and a list of training undertaken at Merryfields was held in a central training file. The date training undertaken was not entirely clear in all staff records and there was no list available for one of the carers. It was positive to note that staff with NVQ qualifications had copies of their certificates on file and evidence of an NFCE level 2 certificate in nutrition and health had been provided by one of the cooks. Care Homes for Older People Page 7 of 13 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 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 9 13 Medication must be 29/07/2009 administered to residents directly from the original container or blister pack; the practice of secondary dispensing must not take place. This is to reduce the risk of medication errors and ensure that people receive the correct medication. 2 29 19 To continue working at the 29/07/2009 home the named person must have a Criminal Record Bureau Check (CRB) This is to ensure that people are appropriately safeguarded. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 27 17 The staff rota must clearly specify the names of everyone who works at the home, the capacity in which they are employed and the hours they are rotered to work. This is to ensure that staff are deployed in a way that safeguards residents. 17/08/2009 Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 2 29 19 All staff personnel records 31/08/2009 must include a photograph for ID purposes and two suitable written references. This includes a reference relating to the persons last period of employment. References provided by the registered manager, having known them previously, are not sufficient and alternative references must be sought. This is to ensure that recruitment procedures are thorough and protect residents. 3 29 19 Staff that have had a Pova first check but are still waiting for their CRB clearance must only work under full supervision. This is to ensure that residents are appropriately safeguarded. 13/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The service should ensure that all residents have up to date and comprehensive assessments in place. Where assessments have been undertaken by the local authority a copy of the assessment should be obtained. This will help them to develop care plans that focus on peoples specific individual needs. Staff training records should more clearly specify what training has been undertaken and the date it took place. Page 11 of 13 2 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. 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