Inspection on 12/08/09 for Fenland Lodge

This inspection was carried out on 12th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fenland Lodge 07/01/10

Fenland Lodge 11/02/09

Fenland Lodge 11/06/08

Fenland Lodge 28/11/07

Fenland Lodge 28/06/07

Fenland Lodge 02/02/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR Lead Inspector Joanne Pawson Key Unannounced Inspection 12th August 2009 10:20 DS0000067620.V377106.R01.S.do c Version 5.2 Page 1 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. 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. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 2 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 Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fenland Lodge Address Soham Road Stuntney, Ely Cambridgeshire CB7 5TR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01353 668971 01353 772734 fleuropeancare@aol.com European Care (Central) Limited Post Vacant Care Home 49 Category(ies) of Dementia - over 65 years of age (49), Old age, registration, with number not falling within any other category (49) of places Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th February 2009 Brief Description of the Service: Fenland Lodge is owned by European Care and is situated between Ely and Stuntney. The home is registered to provide care and support for up to 49 places for older people, some of whom may have dementia. There are 45 single occupancy bedrooms and two shared rooms. All have en-suite facilities. The weekly fees range from £354 to £642.37 depending on the needs of the resident. Additional costs include those for hairdressing, private chiropody and toiletries. A copy of the inspection report is available on request from the home or via our website at www.cqc.org.uk A vacancy has arisen for a registered manager. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This summary includes reference to a random unannounced inspection (RU) that we carried out on the 7th May 2009. The purpose of this inspection was to assess the management arrangements within the home and to discuss some concerns that had been raised with us about the service being provided. As a result of this inspection four requirements were made and these were about respecting privacy and dignity when people were receiving personal care; the logging of all complaints made about the home; the recording and reporting of any allegations of abuse and to ensure that the residents had easy access to call bells. The timescale for action to meet all of these four requirements was to be taken by the 21st May 2009. Since this RU of the 7th May 2009 was carried out we have been made aware of serious concerns about the health and welfare of some of the residents who were living at Fenland Lodge and as a result of these concerns we attended a safeguarding meeting in August 2009. These concerns included the standard of care plans and the standard of care provided to some of the people who had complex health care needs such as nutrition and diabetes. On the basis of such concerns we, The Care Quality Commission (CQC), carried out this unannounced key inspection, by two Inspectors, between 10:20 and 18:35 taking just over 8 hours to complete. During this inspection we looked around the premises and we also looked at some of the documentation. We case tracked three of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking and we spoke also to some of the other staff. At the time of our inspection a health care professional was visiting the home and we spoke with this person. We spoke also with the Acting Manager, her interim line Manager and a visiting Chief Operating Officer representing European Care (Central) Limited, the registered provider for Fenland Lodge. For the purpose of this inspection report we have referred these senior personnel as ‘the management team’ unless we have specified otherwise. For the purpose of this inspection report people who live at the home are referred to as people, person, resident’ or residents. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 6 What the service does well: People can be confident that they will have their needs assessed in a detailed way to make sure that the home is a suitable place for them to live there. Those people we spoke with said that they had enjoyed their lunch and we saw some of the people eating sandwiches and cakes for their tea. The home is accessible for people with difficulties in their mobility as it is on one level. The home aims to provide a comfortable place for people to live there and this included inner courtyards with flower beds and garden ornaments and indoor corridor walls had pictures and items to touch and feel. The inside of the home has named corridors to help people know where they are. What has improved since the last inspection? What they could do better: Each resident should have a care plan which gives the staff detailed information about the resident’s needs and what staff need to do to meet those needs. We were told by a member of staff at the start of the inspection that not all the care plans were up to date and that they did not reflect the current needs of the resident’s. We confirmed this when we looked at the care plans and completed our case tracking. One resident we spoke with told us that he would like a bottle of Guinness each evening but that some members of staff told him that he was not allowed this as he was diabetic. When we looked at the residents care plan to see what had been written about his diabetes we found that he did not have a care plan. All residents should have an up to date care plan so that staff know how to meet each residents needs. The home is responsible for the health and welfare of the residents and this includes monitoring their intake of food and fluids and taking action when these are not sufficient. Our case tracking showed that staff are not always ensuring that the fluid intake is sufficient or contacting the relevant health Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 7 professional for advice when needed. The home must take the appropriate action to ensure the health and welfare of the residents is maintained. The home must ensure that the residents receive their medication as prescribed. This will help to ensure that the residents are not in pain and that they are not put at risk from taking the wrong medication. There must also be accurate recording of the administration of medication to ensure that the residents receive there medication as prescribed. Staff must help to promote the residents’ dignity. Resident’s were seen wearing dirty and stained clothing and one resident was seen walking around the home in a dirty nightdress and no slippers or dressing gown. One resident was seen drinking out of a jug with a straw rather than a glass. Residents must be treated with respect and their dignity promoted. All staff working in the home must understand what may constitute abuse and what procedures should be followed if they suspect any abuse may have taken place. This will help to ensure the safety of the residents. When we looked at the staff files we found that one member of staff had been employed to work in the home before his police checks and references had been received. All checks must be received before staff commence work to ensure that they are suitable to work with the residents’. A new member of staff who had no previous experience of care work confirmed that she had not received an induction when she started work at the home. All staff must complete a thorough induction to ensure that they have the knowledge and skills necessary to work with the residents in a professional and safe manner. 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. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. Prospective residents can be confident that they will have their needs assessed to ensure that the home can meet their currently assessed needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: As part of our case tracking we looked at the people’s pre-admission assessments and we found that the home had completed these in detail and before the person moved into the home. This was to ensure that the home was a suitable place for people to live in. The home does not provide intermediate care and therefore Standard 6 is not applicable. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience poor quality outcomes in this area. Due to poor record keeping and poor standards of personal care and medication practices people are placed at unnecessary risk of harm to their health, welfare and safety. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the start of the inspection we were told by a member of the staff that not all of the care plans were up to date and not to the expected standard; we found that, as part of our case tracking, that this was the case. Although we saw that improvement had been sustained in some of the people’s care plans we found other areas where the care plans did not meet the associated standard or associated regulations. For example we noted from examination of a person’s medication records that the person was prescribed controlled drug medication; Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 11 we found no care plan to tell staff how the person was affected with their pain; what to look for should their be any side effects of such pain relief and how to monitor how well the person’s pain was responding to their medication. Inaccurate or no assessment of pain can be a major barrier to effective management. Poor documentation can result in a persons inability to accurately describe their pain or the lack of importance placed, by the staff, on the resident’s experience of pain. The staff we spoke with agreed that there was no care plan available for monitoring this person’s pain or their pain control. For another person, who was admitted to the home on the 28th July 2009, there were evaluations made of the care plans, such as breathing, communication and personal care although there were no actual care plans developed. The person was self-medicating although there was no risk assessment and there was no care plan carried out for such a self-care task. The same person had been assessed as being at high risk of falls although no care plan had been developed as to how staff were to reduce such an identified risk to the person. The person told us that they liked to have a drink of ‘Guinness’ in the evening but they said that the staff had denied them such pleasure. We found no care plan to evidence why the person was denied their request: this indicates that there may be unnecessary restrictions posed on this person. The pre admission form also stated that this person should be on a diabetic diet but there was no care plan stating what the persons diet should be. We took copies of some of the person’s care records as evidence of the breach of the associated regulation. A newly recruited member of the staff, who had no previous experience in caring for people, told us that they had not seen any of the care plans as she was told about the needs of the people they were caring for, by word of mouth. This indicated that the care plans may not be used as a working document to guide the staff in how to meet the needs of the people. We saw in the people’s care plans, and during our discussion with some of the staff, that people have been seen by a physiotherapist, occupational therapists and speech and language therapists. We noted that some of the residents have active involvement by the community psychiatric services and district nursing services. There are some people who have been placed at risk to their health and welfare. For example we noted that, following a medication error, a general practitioner had not been contacted by the home as soon as the error was noted. This omission of contacting the doctor was also confirmed by the Acting Manager. We saw, as part of our case tracking, a person had a recorded history of self neglect with their food and drink. On the 24th July 2009 the person’s care Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 12 notes indicated that a district nurse had assessed the person and made recommendations with regards to monitoring and providing the person with sufficient drinks and nutrition. We noted that the fluid balance chart, for the 28th July 2009, the person was not given any drinks from 12:00 midday for the rest of the day: the reason for such omissions of care was recorded that the person was ‘asleep’. We looked at the person’s fluid balance charts for the 10th and 11th August 2009 and found that the person had drunk less than half a litre of drink for each of those days. For the 12th August 2009 the person had taken no more than 6 teaspoons of drink during the day. We were unable to tell, from the records, how much urine the person was passing and what it was like (this would be one of the measures to say if the person was dehydrated). We found no record that the person’s doctor had been contacted about the person’s reduced fluid intake. Whilst we were at the home a visiting health care professional prompted the home to contact the person’s doctor and this ultimately resulted in the person being admitted to hospital on the same day. The Acting Manager alerted us to medication errors that had occurred the week beginning the 3rd August 2009. We examined the controlled drug register with the Acting Manager and we found that one of the people, who we case tracked, was prescribed a strong pain killer; the controlled drugs register indicated that the person had enough of the supply of medication for three weeks up to the 4th August 2009.Although an entry to the register indicated that medication had been received this was not the case. According to the Acting Manager there was no such medication received in the home and this was also confirmed by the dispensing pharmacy i.e. they had sent no such medication to the home. We spoke with the staff, including the Acting Manager and there was no request made since for a renewal of the prescription; the person had been without their prescribed medication for at least eleven days. This indicated that there is no control of the ordering of medication, at least on this occasion. From further examination of the controlled drug register, and from discussion with the Acting Manager, the evidence indicated that the person had been given another person’s prescribed medication, other than their own which had run out of stock. This medication was a different type of controlled drug. The controlled drug register also indicated that the level of stock balances were incorrect; the Acting Manager told us that she had noted where gaps in recording were found a member of the staff had completed these retrospectively, including over writing one of the stock balances. In discussion with the Acting Manager the discrepancies were noted on the 4th August 2009 although no doctor was notified, the police were not contacted and the safeguarding team were also not consulted. The members of staff responsible for giving out such medication were not asked about what had happened. As a result of this non-action some of the people remained at risk to their health, welfare and safety as the home did not follow correct policies and procedures to protect the people from the reccurrence of such harm. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 13 The controlled drug register did not contain the name and address of the dispensing pharmacy and thereby it would be difficult to account for missing medication as there was no clear audit trail. We took copies of the two of the pages of the controlled drug medication where there were such discrepancies. We noted, from our examination of some of the medication administration records (MARS) and observing a member of the staff administer medication and complete the MARs that they were correctly recorded only after the medication was given. Variable doses were recorded some but not all of the time and therefore there is a risk of giving a person too much medication. We noted that one of the people was prescribed pain relief and this was to be taken four times each day. However according to the MARs this medication was not always given as prescribed; the code used when the medication was not given was the code for medication to be used ‘as necessary or as required’ although the medication was prescribed to be given on a regular basis. We could find no care plan to tell us the justification why this medication was not given as prescribed. This suggests that the staff may be making medical decisions that they are not qualified to do so. It was unclear how the home was to record a person’s medication when they gave it to themselves, with supervision, as the records were inconsistent in recording on the MARs and within the district nursing records. Such standard of record keeping poses a risk of the person not receiving their medication as prescribed. We discussed the issues of medication with some members of the management team who agreed with our findings. In bathroom number 43 we found a person’s prescribed medication (shampoo) in a cupboard that was not locked. This is not a safe practice in the way prescribed medication is stored and does not show the respect of the person’s personal property i.e. their medication. We did not look at other methods of the storage of medication on this occasion. A requirement was made at the last inspection with regards to residents receiving personal care in private and we found that this requirement had been met as we did not see any person receiving personal care in open view. We saw that the standard of personal care for some of the people did not value their dignity: their clothes were stained and dirty with food and their nails were less than clean. We also saw a person walking outside of their room into the main foyer of the home, with the help of a member of staff: the person was wearing a stained night dress, they were wearing no dressing gown or similar ‘over’ clothing and they were walking without anything on their bare feet. When visiting their room, as part of our case tracking, we saw that they were offered a drink of orange juice, via a straw from a measuring jug, rather than a Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 14 glass or beaker. Such care practices indicated that these people’s dignity was not valued, at least on these occasions. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. Residents are encouraged to make choices. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Although we did not assess the standard of activities in detail, on this occasion, we saw that some of the people were reading a newspaper and some were sitting in front of a television that was switched on. One of the residents was holding a doll as part of their therapy. However we saw very little activity being carried out by the care staff and one of the people told us that there was nothing to do and that they were ‘bored’. Although we did not assess in full how people’s choices were respected a member of the staff told us, unsolicited, about when and how people are helped out of bed in the morning and this was in line with their choice or need. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 16 We saw in those rooms that we visited people were allowed to have their personal items such as pictures and photographs and ornaments. We saw people receiving their guests in the lounge areas. The people we spoke with said that they had enjoyed their lunch and we saw that in the afternoon people were sitting at the dining tables eating sandwiches and cakes. We did not fully assess the standard of food provision, on this occasion. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience poor quality outcomes in this area. People can be confident that any concerns they may have will be listened to and action taken in response to their concerns. Due to the level of the staff awareness in protecting people from abuse, people may be at a high risk of harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A requirement was made following our RU in May 2009 for the home to keep a record of complaints made. This requirement has been met as we saw that action had been taken. The home has received one complaint since our last inspection and this was responded to within the 28- day required time period. We considered the response to the complaint was satisfactory and of a listening nature. We asked a member of the staff what they would do if an allegation of physical abuse was made by a resident with the allegation that they had been physically harmed by a member of staff. The member of the staff told us they considered such abuse would not happen and would ask the alleged perpetrator to go and speak with the resident who had made the allegation. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 18 We asked an agency member of staff about two residents’ behaviour as this may have constituted abuse of a sexual nature. The agency staff member was unaware of the potential risk of abuse. A requirement was made following our RU inspection in May 2009 that stated ‘Allegations of abuse must be appropriately recorded and reported to the local authority safeguarding team as soon as possible. This will help to ensure the safety of the residents.’ There remains a breach of this regulation as we have also recorded within Standard 9 of this report. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 People using the service experience adequate quality outcomes in this area. People live in a comfortable place that could be more homely. Some of the people may be at risk of the spread of infection. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is situated on one level and has internal courtyards that had flower beds and garden ornaments. Indoors the corridors have names to help people know where they are and there are pictures and ‘fiddle’ boards. In bathroom number 43 we noted that this could be less clinical and more homely as, for example, toilet rolls, disposable gloves and incontinence pads were in full view. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 20 We discussed this with the management team and expect action to be taken to make such areas more homely. A requirement was made for people to have access to call bells. We noted that some of the people were calling for assistance, with the use of a call bell. We also noted that there was at least one member of staff present within the vicinity of the lounge area where some of the residents were sitting. This requirement has been met. Generally the home was clean and some, but not all of the areas, smelled fresh. We noted that some of the areas had a smell of stale urine. In bathroom number 43 we found used disposable razors stored with unused disposable razors, in a drawer of a cabinet. It was unclear if these used razors belonged to any individual resident and there was no separate storage of the used razor blades. Although we did not observe the staff using these razors there remains a risk of cross infection should these used razor blades be in current use. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience poor quality outcomes in this area. People cannot be confident that they will receive safe and proper care due to the standards of training and recruitment of the staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: According to the management team the home has had, since our inspection in February 2009, a moderately high turnover of staff and whilst waiting for vacancy posts to be filled agency staff are being supplied to the home. On the day of our inspection, information provided from examination of the duty roster and from discussion with the management team, there were at least 5 members of permanent staff not able to work, therefore action was taken by the management team to increase the number of agency staff to work for the three different shifts operated by the home. The duty roster was clear to read although we found that the agency staff supplied to the home were entered on the duty roster with their first names only. Action was being taken to improve this standard of record keeping ensuring that there was information available for a robust audit trail. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 22 We noted, via our case tracking, that at least one of the three people had increased health needs although the agency member of staff told us that there was not enough staff to provide the care that the person required. Following our inspection the home provided details of the number of care staff, including one agency care staff and how many of these had a National Vocational Qualification in Care (NVQ)) level 2 or equivalent. From these details we calculated that the home currently has 54.5 of the care staff with this qualification. The information provided told us that there are 5 other members of care staff working towards the NVQ level 2 in care. We looked at three of the staff recruitment files and we spoke with one of the members of staff and we spoke with some members of the management team. For two of the three files we found that there was full and satisfactory information about the person and we were confident that the staff were working in a supervised capacity whilst waiting for their criminal record bureau check (CRB) to be returned. For the third recruitment file information was provided to us, by senior care staff, including the Acting Manager and this information included the member of staff’s employment history and information about their past medical history. However not all of the information given to us was included in the person’s recruitment record and we found that the application form had such information missing in their employment history but had signed and dated the application form to verify that the information was accurate. The interview notes provided no information about this missing information, on the application form, although the staff told us that the member of staff’s employment history was known by at least one of the interviewers. This evidence indicated that the interviewers may not have been competent to carry out such a duty in the recruitment process. Within this same recruitment file there was also information missing within the person’s health declaration that they had signed and dated as confirmation that the information provided was accurate. Any inconsistencies should have been checked by the interviewer. We also found within the same recruitment file that there was proof of the person’s identification, including a photograph. We found recorded evidence that the member of staff was allowed to start working at the home on the 28th April 2009 when a CRB was applied for on the same day, rather than an application made before they started working at the home. A POVA (protection of vulnerable adult) check was received by the home on the 26th June 2009 i.e. after they were allowed to work at the home. In addition two written references were received after the person was allowed to work at the home. Such recruitment practices pose a risk of harm to the residents from unsuitable staff. One of the senior managers of European Care agreed with our findings Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 23 In discussion with a recently recruited member of the staff they told us how they were supported and supervised in how to provide personal care to the residents. They told us that they had been provided with an induction training booklet although no one had discussed with them the contents of this induction training. Although we have not inspected the staff training records we found evidence that if any staff training had been attended, such as in care planning, medication and safeguarding awareness, this was not embedded into care practices (See under Standards 7,8,9 and 18 of this inspection report). During our discussion with the management team it was acknowledged, by them, that action needed to be taken with regards to improving the training and competencies of the staff. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience poor quality outcomes in this area. People cannot be confident that they live in a place that is managed at a safe level. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since our last key unannounced inspection, that took place in February 2009, interim management arrangements have been pending the successful recruitment of a permanent manager. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 25 The overall quality rating for this service was assessed, in February 2009, to provide good quality outcomes for the people who lived at the home i.e. 2 stars. Due to the poor overall management of the home we have, from this inspection of 12th August 2009, re-assessed the overall star rating to provide poor quality outcomes for the people who live there i.e. 0 star. This is because people who live at Fenland Lodge have been placed at unnecessary risks to their health welfare and safety, due to poor management of the home. Evidence of this can be found within other Standards of this inspection report. The quality assurance systems of the home have not been robust enough to ensure that the people living at the home are safe. For example, within the last report, of a visit made in June 2009 by a representative of European Care (Central) Limited, we found there were audits of some of the records and of the environment although there were no audits of the controlled drug register; there were no audits of the care plans and there were no audits of the staff recruitment files. We found evidence that there have been breaches of regulations in these areas. As part of our case tracking we counted the three people’s monies and the amounts counted reconciled with the record of the balances. We spoke with a recently recruited member of the staff who told us that they had attended training in fire drills and fire safety equipment. We spoke with another member of the staff who told us that they show all new staff about such fire safety matters but was not sure who was responsible for such training when they were not on duty. We discussed this issue with the management team. Records for emergency lights and fire alarms and fire drill were seen and these were satisfactory. Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 x x 3 x x x 2 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x x 3 Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must be up to date and provide clear guidance; drawn up in consultation with people. This is to ensure that staff have up to date guidance in how to meet the current needs of the people and to ensure that people are consenting to their care. When there is an identified need staff must assist residents to eat and drink adequate amounts. The food and drink must be accurately recorded on the relevant charts so that it can be monitored. This will help to ensure the health and well being of the residents. Residents must be referred to the relevant health professional when needed. This will help to ensure the residents health and well being. People must receive there medication as prescribed. This will help to promote their health and well being. There must be accurate recording of the receipt and DS0000067620.V377106.R01.S.doc Timescale for action 15/10/09 2. OP8 12 18/09/09 3. OP8 13 18/09/09 4. OP9 13(2) 18/09/09 5. OP9 13(2) 18/09/09 Fenland Lodge Version 5.2 Page 28 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13(2) 9. OP10 12 10. OP18 13(6) 11. OP18 13(6) administration of medication. This will ensure that people receive the right medication. There must be a risk assessment completed for any person who wishes to self medicate. This will ensure they are suitable to self medicate. There must be an adequate stock available of the residents prescribed medication. This will help to ensure the health and well being of the residents. When people are prescribed a varying dose of medication the amount administered must be accurately recorded. This will ensure residents do not exceed the prescribed dose. People must receive proper health and personal care to ensure that they are clean. This is to protect people from the risk of harm to their health and to value and promote their dignity. All staff must be aware of what constitutes abuse and what procedure they should follow if they suspect a resident has suffered any abuse. This will help to keep the residents safe. Allegations of abuse must be appropriately recorded and reported to the local authority safeguarding team. This will help to ensure the safety of the residents. This is a repeat requirement the previous timescale of 21/05/09 was not met. Failure to meet the new timescale may lead to the commission taking enforcement action. The home must be kept free from offensive odours. This will give the residents a pleasant DS0000067620.V377106.R01.S.doc 18/09/09 18/09/09 18/09/09 18/09/09 18/09/09 18/09/09 12. OP26 16(K) 18/09/09 Fenland Lodge Version 5.2 Page 29 13. OP26 13(3) 14. OP27 18(1)(a) 15. OP29 19 16. OP29 18 17. 18. OP30 OP30 18 2 b 18 19. OP31 10 20. OP33 24 environment to live in. All toiletries (including razors) must be safely stored and named so that there is no risk of cross infection. This will help to ensure the safety and well being of the residents. There must be an adequate number of staff at all times to meet the needs of the residents. This will help to ensure the residents needs are met in a timely manner. Staff must not be employed to work in the home until satisfactory references and POVA 1st check have been received by the home. This will help to ensure that only people who are suitable to work with vulnerable people are employed. Only staff with the relevant training and experience should be involved in the recruitment and employment of new staff. This will help to ensure that suitable people are employed. All new staff must receive an appropriate induction and supervision. The home must ensure that staff are trained and competent to do their job. This will ensure that the residents are care for in a safe and appropriate manner. There must be a manager who has the qualifications skills and experience to manage the home. This will help to ensure that the residents are not placed at unnecessary risks to their health, welfare and safety. The home must have robust quality assurance systems to ensure that the people living at the home are safe. 18/09/09 18/09/09 18/09/09 18/09/09 18/09/09 15/10/09 18/09/09 18/09/09 Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fenland Lodge DS0000067620.V377106.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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