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Inspection on 07/01/10 for Fenland Lodge

Also see our care home review for Fenland Lodge for more information

This inspection was carried out on 7th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff were answering the call bells quickly during the inspection and were seen giving the residents choices such as what time they would like to get out of bed. Residents we spoke to confirmed that their relatives/friends could visit them and were made to feel welcome. All of the residents we asked about the food in the home stated that there was plenty to eat and that it was of good quality.

What has improved since the last inspection?

The care plans have improved since the last key inspection. Although there is still room for further improvement the care plans we looked at contained more detailed up to date information so that the staff would know how to care for the residents. The food and fluid intake charts sampled were being completed consistently with the food/fluid intake and the amounts. This will help the staff to monitor the health and wellbeing of the residents. We asked staff what they would do if they suspected a resident had suffered any abuse. All of the staff spoken to were able to tell us what procedure they would follow in the event of an alleged incident of abuse. Risk assessments had been devised for use when the boiler in the home was not working and staff were transporting hot water to rooms. The risk assessment also covered how the home was to ensure the safety of portable heaters during this period.

What the care home could do better:

We recognise this has been a difficult period for the home with a manager being appointed and then leaving the home. However we feel that if the homes quality assurance monitoring system had been applied this would have highlighted earlier any outstanding improvements required. European Care has made members of their senior management team available to the home but the following concerns still remain. Although the recording and administration of medication had improved after the commission served a statutory enforcement notice in October 2009 at this inspection we found that there were errors/omissions in the recording of the administration of medication for at least nine residents. The bathing records suggest that residents are not being offered a bath on a frequent basis. One resident who according to their records had not had a bath since the 29th December stated they, `felt grubby`. On the first day of the inspection we looked at the staffing rota and found that it was not clear who the first aid trained member of staff was for each shift. The management team could not confirm that there was always a member of staff available in the home that had completed first aid training. Staff have been issued with a Common Induction Standards workbook. Staff told us that they had not been supported or assisted to complete this. Three staff case tracked as part of this inspection stated that management had not checked that their induction workbook had been completed. Some staff who commenced working at the home last year had recently commenced an induction programme but there were no planned dates for its completion. Staff have not received formal training in specialist areas such as diabetes and catheter care to ensure their competence in meeting the needs of residents. Not all staff have received regular supervision sessions with a line manager. Although the operations manager had been working closely with the acting manager there was no recorded evidence of a formal supervision for this member of staff.

Key inspection report Care homes for older people Name: Address: Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR     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: Joanne Pawson     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR 01353668971 01353772734 fleuropeancare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: European Care (Central) Limited care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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. Additional costs include those for hairdressing, private chiropody and toiletries. 0 0 Over 65 49 49 Care Homes for Older People Page 4 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use the service experience poor quality outcomes. 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. This inspection was carried out over two days. We spoke also with the Acting Manager, their line Manager and two Chief Operating Officers representing European Care (Central) Limited the registered provider for Fenland Lodge. For the purpose of this inspection report we have referred to these Care Homes for Older People Page 5 of 33 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. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We recognise this has been a difficult period for the home with a manager being appointed and then leaving the home. However we feel that if the homes quality assurance monitoring system had been applied this would have highlighted earlier any outstanding improvements required. European Care has made members of their senior management team available to the home but the following concerns still remain. Although the recording and administration of medication had improved after the commission served a statutory enforcement notice in October 2009 at this inspection we found that there were errors/omissions in the recording of the administration of medication for at least nine residents. The bathing records suggest that residents are not being offered a bath on a frequent basis. One resident who according to their records had not had a bath since the 29th December stated they, felt grubby. On the first day of the inspection we looked at the staffing rota and found that it was not clear who the first aid trained member of staff was for each shift. The management team could not confirm that there was always a member of staff available in the home that had completed first aid training. Staff have been issued with a Common Induction Standards workbook. Staff told us Care Homes for Older People Page 7 of 33 that they had not been supported or assisted to complete this. Three staff case tracked as part of this inspection stated that management had not checked that their induction workbook had been completed. Some staff who commenced working at the home last year had recently commenced an induction programme but there were no planned dates for its completion. Staff have not received formal training in specialist areas such as diabetes and catheter care to ensure their competence in meeting the needs of residents. Not all staff have received regular supervision sessions with a line manager. Although the operations manager had been working closely with the acting manager there was no recorded evidence of a formal supervision for this member of staff. 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 8 of 33 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 9 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed prior to moving into the home so that they can be assured that the home can meet their needs. Evidence: In August 2009 when the rating of the home was assessed as providing poor outcomes for the residents European Care made the decision that until the quality of care provided in the home improved they would not admit any privately funded residents. At the time of the inspection European Care were still not admitting privately funded residents. The council are currently not placing any new residents at the home. As a result there have been no new admissions to the home. It was not possible to look at any pre-admission assessments for anyone moving into the home since the last key inspection. We briefly looked at the pre-admission assessments for the residents we case tracked as part of the inspection and found that they had pre-admission assessments on file that contained all of the relevant Care Homes for Older People Page 10 of 33 Evidence: information. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans sampled had been reviewed and updated and included information on the care needs of individuals. The people living in the home can not be assured of the accurate administration of medication. This leaves residents at risk to their health and welfare. Personal care needs in respect of bathing do not promote dignity and choice. The food and fluid intake charts we looked at were being completed consistently. We have made this judgement using a range of evidence, including a visit to this service. Evidence: We looked at the care plans in detail for three residents. We found that the information provided had improved since the key inspection in August 2009. When staff told us that the needs of a resident had recently changed we also looked at their care plan to ensure this change was reflected. We found that care plans had been reviewed and updated. One resident we case tracked had a history of sleeping problems and staff were working with her to encourage her to sleep in her bedroom at Care Homes for Older People Page 12 of 33 Evidence: night. The actions that care staff should take were recorded in her care plan. The staff on duty confirmed that the care plan was being followed. For the residents we case tracked records of visits from G.P.s, district nurses, chiropodists and dieticians showed that when there is a need the relevant health professionals are contacted. The care plans could be improved by making sure information/issues are followed through. When an event has been recorded such as a resident being taken ill the outcome is not always recorded. In October 2009 a statutory requirement notice was served on European Care because there was a breach of regulation 13 (2) in respect of medicines and a requirement was made that medicines be safely administered and accurately recorded. In November 2009 the pharmacist inspector for the commission carried out an inspection of Fenland Lodge and found that there had been an improvement in the administration and recording of medicines so the notice had been complied with. Despite the improvement found at the inspection to the service in November further failures in the recording and administration of medicines was found during this inspection indicating that any improvements made had not been sustained. At this inspection we looked at the administration and stock levels of medication. The creams and lotions are kept in a separate drugs trolley so that they are easily accessible to the care staff. The care management team informed us that care staff should apply the cream and then sign their initials in the medication administration records to show that it has been applied. However when we looked at the records for the creams and lotions we found that for nine residents there were omissions of signing for the administration of the creams. The management team told us that although they could not say why the staff hadnt been signing them they had told the staff on several occasions that this must be done and that it was an ongoing problem. Although in some peoples daily notes there are records of the cream being applied it is not recorded consistently in the notes or the medication administration records. One cream was recorded as being out of stock on the 24th December and although none had then been delivered was recorded as being applied on the 26th December. The Monthly Programme Manager Report completed by a senior manager for European Care in December also confirmed that staff should be signing the medication administration sheets (MARs) when they apply creams and also states the home must continue to monitor gaps on MARs. Care Homes for Older People Page 13 of 33 Evidence: The tablets and liquids are kept in another drugs trolley. The majority of tablets are provided in blister packs but some are in their original packaging. When we looked at the administration records we found that there were omissions for the signing of the administration of medication for at least nine residents (we didnt look at the records for all of the residents). We also checked that the stock levels reflected the number of signatures on the records. We found that for two residents there was one extra tablet, for another resident there were 2 extra tablets and for another resident there were 3 extra tablets. This would suggest that the tablets have been signed as given but not actually given to the resident. Any refused medicines are separately recorded and stored until such time as the pharmacy collects them. For one resident there were two tablets missing from the box. This suggests that the tablets have been given to the resident but not signed to say they have been administered. Medication has been the subject of previous enforcement action. The Commission is considering further enforcement action due to the shortfalls found at this inspection. We also checked the controlled drugs register. There was only stock for one resident and the stock accurately reflected the records. At the random inspection on the 1st of December 2009 we reported back to the management team in the home that according to the records, residents were not being offered a bath on a frequent basis. The management team felt that this maybe a recording issue and that staff would be told to record the offering and refusal of baths as well as when any residents actually had a bath. The county council carried out a monitoring visit on the 29th December and also reported to the home that they had concerns that the residents were not being offered baths frequently. When we spoke to one resident she told us she had not been offered a bath since the Christmas period. We looked at her bathing log and personal hygiene chart. According to the personal hygiene chart and the bathing log the resident had last had a bath on the 29th December, and previous to that had had one on the 1st December and the 1st November. The resident said that because they were not having regular baths they felt grubby. The personal hygiene chart showed that in November they had received a wash on most days apart from the 1st (when they had a bath), 11th, 14th and 23rd. In December the records showed that they had received a wash on most days apart from the 2nd, and 23rd and in January there was no record on the personal hygiene chart for either a wash or a bath on the 1st, 2nd, 3rd and 9th. Care Homes for Older People Page 14 of 33 Evidence: For another resident the bathing logs showed that they had had a bath on the 22nd November, 7th December and the 3rd January. We also looked through the daily notes for December for the resident to see if an offer of a bath had been recorded there but the only reference in December was on the 7th. The personal hygiene chart had been ticked to show that the resident had a wash each day in December apart from on the 6th, 14th, and 22nd when there was no record for either a wash or a bath on the personal hygiene chart. Another resident stated that they would like more regular baths and that they thought they hadnt been offered them because there was a problem with the hot water. The bathing log showed that they had had a bath on the 3rd December, none were recorded for November, two refusals in October and the last recorded bath before December was on the 14th August 2009. The bathing log for a different resident showed that they had had a bath on the 3rd of October, 11th November and 7th of December. There was no record on the log of refusals between these dates. For another resident the personal hygiene chart had does himself written on it. However the care plan stated X always has assistance with bathing and shaving, this information was updated on the care plan on 25th November 2009. The bathing log showed that they had had a bath on the 25th August and then there was no record until the 11th November and then no record after that date. It was confirmed in the residents bathing log that the person is assisted by staff. Another resident stated that they would like a bath as often as possible. Their bath chart recorded their last bath as the 6th December. The management team stated that they thought the residents were being offered frequent baths but that as the staff team had changes to the paperwork over the last six months they were not sure where they should record it. One member of the care staff thought that residents had been refusing baths more often because there was a problem with the heating. There is also a wall chart in the room where the care plans are kept with the dates on that the residents last had a bath. These dates reflected the dates in the bathing logs/hygiene charts that we looked at. This requirement remains outstanding and the commission may decide to take enforcement action. Care Homes for Older People Page 15 of 33 Evidence: The residents were seen to be treated with respect and dignity by the staff throughout the inspection. The food and fluid intake charts we looked at were being completed consistently and in a detailed manner. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are not organised to take into consideration the residents needs, likes, dislikes and personal interests. Residents are able to keep in touch with family and they are encouraged to visit and are made welcome. Residents meals are plentiful and food provided is of good quality. We have made this judgement using a range of evidence, including a visit to this service. Evidence: The senior management team have acknowledged during the safeguarding meetings that the daily activities offered to the residents need to be improved. We were told by the management team that the member of staff responsible for the daily activities had been on sick leave for a number of weeks. We would have expected another person to be given the responsibility of organising the activities as soon as this person went off sick so that the residents were not left with little to do during this time. We looked at the activities log for December. We could find very little evidence of activities being undertaken in December. The acting manager stated that although they hadnt been recorded activities had taken place during December. Care Homes for Older People Page 17 of 33 Evidence: For one resident there were five entries of activities in November but only one for December which had been talking to the activities co-ordinator about forthcoming events. We looked at the activities care plan for another resident which stated X is a lively character who enjoys socialising, music, keeping up with current affairs, conversation and the radio. There were 14 entries for activities in November but only two entries in December. The resident had expressed an interest in fine arts and stated that they would like to go to an auction. When we talked to the resident about this they told us that they hadnt heard anymore about the possibility of going to a fine art auction but would also like to visit an antiques shop and get out more. We looked at the activities log for another resident the recorded activities were watching a film, quiz, writing xmas cards, sticking pictures onto paper and a dance. The activities care plan for another resident stated that they enjoyed a hand massage, church service and small group activities. However the only activities recorded for December were on the 1st Tea and a chat and on the 30th a chat. We talked to one resident who showed us the dolls and teddy bears they had purchased before moving into the home. They stated that they would like to make costumes for them but that they needed some materials to be able to do this and no one was able to take the person to the nearby town to shop. They also stated that they used to visit craft markets and would really like to go again. There was an entry in the daily activities log for the manager that showed that a bar had been purchased and reconditioned to be used in the dining room for pub nights. The management team told us that two members of staff had recently been given the responsibility of organising the activities. Residents that we spoke to confirmed that their relatives/ friends could visit them and were made to feel welcome. One resident told us that their relative had joined them for Christmas dinner. One resident stated that not many of their family visited at the same time as although they had searched the home they could not find spare chairs to take into her bedroom for them all to sit on and although they could see people in the communal areas of the home it would be nice if there was an area with plenty of seating where they could receive visitors in private. The acting manager has stated that if a resident would like to see there family in a private area and needs a larger room then this can be provided. Care Homes for Older People Page 18 of 33 Evidence: All residents we spoke to about the food in the home stated that there was plenty to eat and that it was of a good quality. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have received basic training in safeguarding procedures and are aware of the procedures to follow in the event of an allegation of abuse. Policies and procedures for safeguarding and complaints are in place. The home is responding to concerns raised by the Local Authority safeguarding adults team. We have made this judgement using a range of evidence, including a visit to this service. Evidence: There have been a number of safeguarding meetings regarding the care of service users in the home. The Local Authority have withdrawn their contract with European Care. European Care are challenging this decision. We spoke to the staff about what they would do if they suspected a resident had suffered any form of abuse. All of the staff spoken to were aware of the reporting procedure that must be followed. We saw the reporting procedure flowchart on the notice board in the room where the care plans are stored. Policies and procedures for safeguarding adults and complaints are in place. The majority of staff have received safeguarding training from European Care. One member of staff had received safeguarding training but couldnt remember that they had. It would be good practice for staff to complete the local authority safeguarding Care Homes for Older People Page 20 of 33 Evidence: training. The annual quality assurance assessment (AQAA) completed by a member of the management team stated that they encourage residents to voice their complaints or suggestions. The AQAA also states that the home has received 23 complaints in the last twelve months, 100 of these were resolved within 28 days, 22 of them were not upheld and one was waiting for an outcome. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean on the day of the inspection and provides a homely atmosphere for people to live in. We have made this judgement using a range of evidence, including a visit to this service. Evidence: Before the inspection we received a notification from the home in December that one of the two boilers was not working and that the residents would be moved to parts of the home where the heating was working until the boiler was fixed. On the day of the inspection the second boiler had also stopped working although this was fixed by the end of the day. The notification we received from the home stated that residents would be moved to bedrooms where the heating was working. We were not informed that there was a problem with supplying hot water to some of the residents bedrooms. One resident told us that they had not been able to have a bath in their en suite for some time as there was no hot water to the bath. Another resident told us that they had no hot water to the bath or the sink in their en suite and that staff had to bring the hot water using a bucket. Care staff also confirmed that Care Homes for Older People Page 22 of 33 Evidence: there was no hot water supply to several bedrooms. A risk assessment had been completed about the use of portable heaters and carrying hot water through the home. All areas of the home were seen to be clean and free from offensive odours however we saw a moving and handling belt in a toilet used by the residents that was soiled. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place for the recruitment, training and supervision of staff do not protect residents from the possibility of receiving poor quality outcomes. Evidence: We looked at the recruitment records for three members of staff. The first member of staff had commenced employment in the home in November 2009. Although references had been received the criminal records bureau check was still outstanding. The management team told us that the member of staff always works with another member of staff when carrying out any personal care. The carer had completed dementia awareness, infection control and health and safety all on the same day and understanding the principles of care and safeguarding on another day. There was no record of fire, moving and handling or first aid training in their file. We were later given a list that showed that the carer had received basic training on fire extinguishers and fire doors. The European Care policy on induction states that new employees should complete their induction using the 2005 common induction standards using materials form Skills for Care in the first twelve weeks of their employment. There was a new workers induction assessment tool which had printed on the front Date Induction Completed and next to it had recorded 17/12/09 although only one of the 8 modules and one exercise about the module had been completed according to the record. When we Care Homes for Older People Page 24 of 33 Evidence: asked about the carers induction we were told it was due to start in January. We looked at the recruitment and training files for a second carer who had also commenced employment in November 2009. An application form had been completed. There was one written reference on file and a record of a verbal reference from a care home and a faxed reference sheet attached to it with just the dates of employment at the other home and a signature on the same day as the carer commenced working at Fenland Lodge. The carer had received training in understanding the principles of care, safeguarding and moving and handling all on the same day. However the certificate for the Moving and Handling training stated that it was an all day session. When we asked the management team about this we were told that there was probably a small group of people training so it would not take as long therefore allowing all three subjects to be covered in one day. The carer had received training on infection control, food hygiene, dementia awareness and health and safety on another day. There was no evidence of any induction training workbook having been completed and we were told that they were due to start their induction in January. The monthly programme manager report completed by a senior manager working for European Care in December asks Have all staff received induction training (as determined by Common Induction Standards) and had been answered Yes. However the evidence from the three files we looked at did not show us this was the case. When we asked the management team about this they stated that the form was a bad design and asked for a yes or no answer. However on other areas of the form see below had been entered and then more information had been added into the comments section. When asked about their induction one member of staff stated they had an induction and were given the induction booklet which they flicked through but no one went through the induction with them. The member of staff also stated that they would like diabetes training as they were not aware of what to look for. A second member of staff also stated that they were given an induction booklet to look through but that no one had gone through it with them or even checked if they had read it. We looked at the staff file for this member of staff who started work in October 2009 and the only certificates they had recorded on file was safeguarding and understanding the principles of care. A training matrix supplied to us identified that Care Homes for Older People Page 25 of 33 Evidence: this person had received training in infection control, health and safety, people moving, principles of care and safeguarding. The member of staff when asked whether they had attended safeguarding training stated that they did not know. We looked at the recruitment checks for a third person and found that they had four references. However one of them was from the member of staff interviewing them for the post, one was a character reference and was not dated and neither of the other two references were sought from the carers last place of work in a care home. There was a completed application form. During the previous key inspection in August it was acknowledged by the management team that action needed to be taken with regards to improving the training and competencies of staff. During safeguarding meetings held with the Local Authority it was highlighted that the district nurses would be willing to train the staff on catheter care and caring for a resident who has diabetes. Also at the same safeguarding meeting a member of the senior management team stated that there would be ongoing audits of supervision and training. The outcome of staff not being competent in the management of catheter care for one of the residents was demonstrated in November 2009. The commission were notified that staff at Fenland Lodge had called out Suffolk Doctors stating that a residents catheter had come out, patient in pain please come ASAP. However when the district nurse arrived the resident was in no pain and the catheter was in situ. He was in discomfort due to the fact that the persons leg bag needed emptying. The night bag was connected to the leg bag, the valve was open but the night bag still had the cap on it (it had been forced in place). We were notified in December that the same residents subsidary night catheter bag had been due to be changed on the 25th December and when the district nurse attended the resident for another reason on the 27th they saw it still had not been changed and they had to request that this was done immediately. When we asked the management team if the staff had received training on catheter care or diabetes we were told they hadnt. When we asked why not we were told that a member of staff told the management team that the district nurses were not willing to give the training so it had not been followed up. This requirement therefore remains outstanding and the commission may decide to take enforcement action. On the day of the inspection we were given a folder which had been compiled by the management team which contained evidence of the improvements made. Section 1 Care Homes for Older People Page 26 of 33 Evidence: stated that the rota must show who takes responsibility for each shift and who the first aider is. The timescale was immediate and ongoing. To be monitored by the programme manager and chief operating officer. However when we looked at the rota we found that although there was a list of six staff at the bottom who had completed first aid training this did not cover all the shifts. One member of staff worked in the kitchen from 6am until 4pm, two were domestic staff who finished at 4.30, one was on sick leave, one was a night worker and one was a senior. Therefore not all shifts were covered with a first aider. When we asked the management team about this we were told we are counting the nurses as first aiders but aware they shouldnt be. We also asked when the member of night staff who was first aid trained was not working who was the first aider. We were told they didnt know but would check with the agency to see if their staff were first aid trained. On the first day of the inspection there were three senior members of staff and 6 care assistants on the am shift. It was noted that one member of staff seemed to be working long hours on a regular basis. One week they were due to work 60 hours and the following week they were due to work 66 hours. This could place the staff member and the residents at risk if staff do not have appropriate time off. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some improvements to the provision of care have been made, the quality assurance and management of the home have not ensured that these have been sustained leaving residents at the possible risk of harm to their health, welfare and wellbeing. The money and records held on behalf of residents were found to be accurate. Fire safety checks were found to be satisfactory. Evidence: At the safeguarding meeting in August 2009 the senior management team acknowledged that there had previously been problems with the quality of the care at Fenland lodge and that an investigation into how this had been allowed to happen again would be undertaken. They also said at the meeting that although audits had been completed and action plans developed they hadnt been followed and the organisation had failed to follow up on concerns. We were assured that even when the new manager commenced working in the home the manager they had brought in from another European Care home would remain working in the home until the quality of care had improved and was consistent. This was not the case and after a short period Care Homes for Older People Page 28 of 33 Evidence: of working with the new manager the acting manager returned to work in the other home. However as this report has highlighted although there has been an improvement with care plans and risk assessments and European Care have regularly sent improvement plans stating that improvements are progressing there are still areas that have not improved in a timely manner i.e. staff training and competence, supervision, daily activities. When asked about this the senior management team stated that they were told by the previous manager that these improvements were being made when they werent. However it is the responsibility of European Care as providers to ensure that the quality assurance system used was robust and evidenced any improvements made against the outcomes and actions taken and ensured that they were being sustained. In December 2009 the local authority took the decision to withdraw their contract with European Care. European Care are challenging this decision. Since this decision was made there has been more senior management input into the home and the areas of concern highlighted again. It is of concern that the majority of the same areas highlighted at our inspection in August 2009 are still to be resolved or show a sustained improvement. In August 2009 we made a requirement that staff should receive supervisions. However we could not find evidence of any supervision for three members of staff. One of them was the acting manager and when asked if they had received supervision they stated that although they had not had a formal supervision they regularly worked with their line manager. The majority of staff had received at least one supervision since the last inspection in August but as this was highlighted as an issue at this time the expectation would have been that more than one supervision would have taken place. The money and records held on behalf of three service users were checked and found to be accurate. The records for the testing of the fire alarms were checked and found to satisfactory. A risk assessment had been completed for the temporary use of heaters throughout the home whilst the boiler was being repaired. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R 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 8 12 All residents must receive 15/12/2009 the support they require on a regular basis with their personal care. (Outstanding 01/12/2009) This requirement remains outstanding. The timescale was not extended. This is to ensure that the persons dignity is upheld and their personal hygiene requirements are met. 2 30 18 The home must ensure that staff are trained and competent to do their job. (Outstanding 30/11/09) This requirement remains outstanding. The timescale was not extended This will ensure that the residents are cared for in a safe and appropriate manner. 30/11/2009 Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Promote and make proper 01/03/2010 provision for the health and welfare of service users by putting in place arrangements to ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labeled and supplied for. This will help to promote their health and well being. 2 9 13 Put in place suitable 01/03/2010 arrangements to ensure that medicine administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration record; that the meaning of any such codes are clearly explained on each record; and that the Page 31 of 33 Care Homes for Older People 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 person administering the medication completes the Medication Administration Record in respect of each individual service user at the time of administration. receive the right medication. 3 12 16 Regular activities must be organised for the residents taking into consideration their likes, interests and hobbies. This is to ensure that people have something to do that they are interested in. 4 29 17 There must be two written references one of which must relate to the last employment in a care setting received before staff commence work. This will ensure that the right people are employed. 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 01/03/2010 01/03/2010 1 33 We strongly recommend that the provider ensures the staff use the system in place for qulaity assuring the service and record the evidence of their findings. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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