Inspection on 11/01/10 for Forest Edge Rest Home

This inspection was carried out on 11th 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.

Other inspections for this house

Forest Edge Rest Home 16/12/09

Forest Edge Rest Home 09/10/09

Forest Edge Rest Home 01/09/09

Forest Edge Rest Home 17/04/09

Forest Edge Rest Home 17/04/07

Forest Edge Rest Home 16/02/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Forest Edge Rest Home Southampton Road Cadnam Hampshire SO40 2NF     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: Michelle Presdee     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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Forest Edge Rest Home Southampton Road Cadnam Hampshire SO40 2NF 02380813334 02380814963 forest.edge@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: John Henry Hughes,Mrs Linda Susan Hughes care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Forest Edge is a twenty-two bedded residential care home, opposite a garden centre, situated on the outskirts of the New Forest at Cadnam. The home is just less than four miles from the centre of Totton and close to the New Forest. The home is registered to accommodate twenty-two older people, including people with dementia or mental Care Homes for Older People Page 4 of 29 Over 65 0 0 22 22 22 0 1 6 1 2 2 0 0 9 Brief description of the care home health problems. Forest Edge has twenty-two single bedrooms, all provided with an en suite toilet. Care Homes for Older People Page 5 of 29 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 unannounced inspection took place on 11th January 2010 between 9:55AM and 6:45PM. The Commission (we) took two inspectors and were assisted by the providers, Mr and Mrs Hughes, who were both in the home at separate times during the inspection. The home is currently without a registered manager. The manager who was not registered and deputy manager stopped working in the home just before Christmas 2009. The home has been without a registered manager since July 2007. We were advised on the day Mrs Hughes one of the providers is going to apply to the Commission to become the registered manager. Since the key inspection we have received information, which indicates Mrs Hughes is not going to apply to become the registered manager of the home. The rating from the last two key inspections has been poor, demonstrating the home has consistently provided poor outcomes for people living in the home. The overall rating on the home after this key inspection remains poor, the home is still providing Care Homes for Older People Page 6 of 29 poor outcomes for people living in the home. Following the last key inspection in October 2009 a statutory requirement notice was served regarding practices around medication in the home. A random inspection by the Commission took place in December 2009 with a specialist pharmacist inspector and regulation inspector. At this time it was found the statutory requirement notice had been complied with. Four care staff on duty were part of the inspection. Thirteen people are currently living in the home; two residents are currently in hospital. The majority were involved with the inspection, some in more depth than others. One visitor and one health professional visiting the service on the day of the inspection have contributed to this inspection. On the day of the visit social service staff were also in the home, looking into current safeguarding concerns, which have been raised. The home sent us their Annual Quality Assurance Assessment (AQAA) back on time, which detailed information on the home. Paperwork including assessments, care plans, menus, staffing records and safety checks were seen. A tour of the home including all communal areas, the kitchen and all occupied bedrooms was taken on the day. All this information has helped form judgements in this report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. When the home begins to accommodate new residents, we were advised they will have a pre admission assessment before they move into the home. Evidence: On this visit due to there being no new admissions since the last two key inspections this standard was not looked at in detail. Mrs Hughes is aware of the need to carry out a pre admission assessment to ensure the home can meet their needs before they move into the home. Care Homes for Older People Page 10 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of up to date detailed information in care plans does not ensure peoples needs will be known or met. People have access to health professionals, whose information needs to be incorporated into the care plans, so that peoples changing needs are responded to. People are treated in a manner which respects their privacy. Medication procedures are being followed correctly. Evidence: In the AQAA we were advised we have introduced a clear and easy to follow care plan file system, the care plans are accurate and reflect the care needs of the resident. We ask for the residents advocate to approve the care plans and sign to that effect. The care plans are evaluated every month. Residents are encouraged to make their own daily decisions. The care plans of three people were viewed at length and discussed with Mrs Hughes. There had been little change in the care plans since the last key inspection, where it was evident they did not reflect the persons current needs or give staff clear information on how to care for the person. Care plans for the last three key Care Homes for Older People Page 11 of 29 Evidence: inspections have consistently failed to reflect peoples current care needs and demonstrate how these are met; enforcement action may be considered. Mrs Hughes reported she had been concentrating on getting the medication procedures correct in the home. When discussing the care plans in detail Mrs Hughes could see they were not reflecting the persons current needs and were not person centered. She stated she had changed the second section of the care plan relating to personal hygiene. Mrs Hughes stated this would give a clear picture of personal care to be given in the morning and a snapshot of how the person usually spent their day and this would be kept in the persons room. Care plans seen had photographs of the person and detailed all key contacts for the person. Individual preference plans were still available and were at the front of each care plan. The care plans were split into twelve sections which detailed the care needed and the care action to be taken. However the care plans as agreed with Mrs Hughes did not reflect the persons current needs or the care to be given. In two care plans it stated the person enjoyed and received two baths a week. However for both these people bathing records demonstrated they had a bath once a week. In the other care plan it reflected the person did not enjoy a bath. However the reasons for this and how their personal hygiene needs were now met were not detailed. In discussion with this person they stated there is too many people in the bathroom and they were not used to this. However the care plan did not reflect this situation or try and detail how this could be avoided. In one care plan it was difficult to establish if a person was doubly incontinent some of the time or always. The care arrangements around this part of the care plan were not clear and one member of staff claimed sometimes the person was not washed when the pad was changed. The care plan did not detail what should happen. The person had had a small pressure sore and the care plan was unclear what should happen at night regarding moving and checking the person and in what time frame. The care plan reflected the person had an air mattress but instructions on checking the weight as detailed in the care plan had not been followed or recorded. In this persons care plan it stated the person was to be shown a picture book to aid with communication. When asked to see this book it had pictures of different meals and could only aid communication in the choice of meals, but there was no evidence of this in the nutrition section of the care plan. The care plan stated the person was unable to choose their clothes and care staff should pick out the persons clothes. When asked why this was, Mrs Hughes reported the person had dementia and may pick out clothes not specific to the weather or clothes which were colour coordinated. When looking in this persons room, no container for false teeth could be found. Mrs Hughes reported she was unsure if the person had their own teeth or false teeth. The Care Homes for Older People Page 12 of 29 Evidence: information could not be found in the care plan. In discussion with another resident they stated how their feet had started to swell and they were having severe headaches. This information had not been incorporated into the care plan. The care plan did not detail how care staff should care for the persons swollen feet. It was possible to establish the doctor had been called to discuss the persons headaches and the daily records noted the changes in the medication, but the medication care plan was generic. Care plans did not detail aids and adaptations in peoples room and around the home. It was not possible to establish who had assessed residents for these aids and adaptations in their own rooms. Alarms had been fitted to peoples doors, which we were advised were put on at night for various people as they wandered and they alerted staff. However no assessments or details were provided in care plans. Evidence was found in one care plan the residents family had agreed to the alarm being fitted. It was noted in two care plans seen, the wrong name had been recorded for the service user. Reviews had been completed on a monthly basis. We were advised these were used to cover all sections of the care plan, however they were very short and gave no specific information on changes in any areas of the care plan. In the AQAA we were advised residents have access to the doctor of their choice, district and surgery nurses, chiropodist, hairdresser, incontinence nurse, community psychiatric nurse. Access to dental care, yearly sight tests and hearing test and aids can be arranged. It was possible to establish a range of health professionals visit the service as details are now recorded on pages at the back of the care plan. Where necessary as outlined the outcomes of these visits needs to be detailed and incorporated into the care plan. The last two key inspection identified the medication procedure was not being followed and requirements were made in this area. A statutory requirement notice was served regarding medication practices in the home following the last key inspection. A random inspection was completed on 16th December 2009 to check compliance with this notice. On this visit it was found the home had complied with the notice and medication procedures were carried out safely. On this visit the medication trolley kept downstairs and the controlled medication in Care Homes for Older People Page 13 of 29 Evidence: the home was checked. We were advised the same process is being used with the staff involved with the medication wearing two red tabards so staff know not to interrupt them. Staff involved with medication spoken to stated, they felt the system was working well. It was noted one staff member now involved with the medication had previously been working as the cook. They stated they had attended the training session provided by the pharmacist and had some in-house training. They stated they felt competent to be involved with the medication. Medication checked matched the records held and records had been completed appropriately. On this visit it was noticed staff respected peoples privacy and dignity. Staff were observed knocking on doors and waiting for a response before entering. Care plans detailed how a person wished to be addressed. One health professional visiting stated the home always considered the persons privacy and staff would always assist them to take the person into their own room. They reported the home always called them appropriately. One person raised concerns about too many people in the bathroom, which is why they did not want a bath. Care Homes for Older People Page 14 of 29 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. Choice are available in the home but attention to detail is needed to ensure these choices are accurate, available and what people want. Evidence: From observations on the day it appeared service users had flexible routines, which reflected what they wanted. Some people spent time in their rooms, whilst others reported they enjoyed the communal areas of the home. Some people had lunch in the dining room whilst others stayed in their rooms. In the AQAA we were advised the home has a visiting clergy and two people attend church. The mobile library visits the home on a regular basis. On the notice board there was a list of daily social activities, which staff arranged. It was noticed the activities could have been written up in a larger print as it would have been difficult for people to read the small print. It was also noticed the activity detailed was reminiscence therapy but bingo was being played. One resident who spent a lot of time in their room felt there was not a lot going on but enjoyed spending time in their room. This person stated they enjoyed colouring but they had filled in all their colouring books. Later in the day a staff member came into the office and asked for some scrap paper so this person could do some colouring. Care Homes for Older People Page 15 of 29 Evidence: Daily activities are listed in each persons care plan, but it was noticed these had not been completed for the last few days. In the morning some residents were sat in the lounge listening to music, others were in the other part of the lounge with the television on. However the residents appeared not to be watching television. In the AQAA we were advised residents visitors are always made welcome to the home and can see their relative in private. During the inspection we spoke with one visitor to the home, who confirmed they were a regular visitor to the home. They stated they were always made welcome by staff members and were happy with the care their relative was receiving. People spoken to on the day stated they were pleased with the meals they received. Some people stated they were offered a choice others could not remember. People were pleased they could have their meals in their rooms or in the dining room currently used. The menu was displayed on the notice board, but this stated chicken curry with a side salad or vegetable gratin was for lunch. However residents spoken to stated they had enjoyed sausages with mashed potatoes and vegetables. Bowls of fresh fruit and jugs of juice were available in the lounge. Care Homes for Older People Page 16 of 29 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. People are not always confident if they make a complaint it will be dealt with appropriately. Staff have received training in the area of abuse and the home has ongoing safeguarding referrals, which are being looked into by social services. Evidence: In the AQAA we were advised the homes operates a straight forward and accessible complaints procedure, this includes the stages and dates. A copy of the complaints procedure was seen in the home, which included all the relevant information including addresses, telephone numbers and timescales. Mrs Hughes reported she has had contact with one relative since the last inspection, who has raised concerns regarding the running of the home. Residents spoken to stated they would be able to discuss concerns with staff members. Some staff members who have recently left the home have made allegations that Mrs Hughes would not look into some areas of concern they raised with her. In the AQAA we were advised all staff are made aware of the homes whistle blowing policy. The staff have received formal training in the protection of vulnerable adults Staff records demonstrated staff had received training in recognising abuse and adult protection. The home currently has safeguarding referrals which are on going in relation to care planning and the care of residents which Hampshire County Council are monitoring. Care Homes for Older People Page 17 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of the environment need attention to ensure all people have access to safe equipment, which is in full working order. Evidence: A tour of all communal rooms, the kitchen, the laundry and all bedrooms currently in use was undertaken. No unpleasant odours were detected, except in one room where we were advised the person had an upset stomach. The home has two lounges, which have been decorated in different colours. All communal rooms have new furnishings of chairs, tables, curtains and carpets. The carpets are very busily patterned, which could cause confusion for some residents who have dementia. One lounge has the dining room on one side of the room, which also has new furniture and the decor matches the lounge. At lunchtime the tables were set with linen napkins and condiments. Each lounge had a white board with information, but as stated care needs to be taken to ensure the information recorded is accurate with reference to the menu and social activities offered. The home has two new furnished bathrooms. In the bathroom upstairs it was noticed the cover over the bath seat was in need of cleaning. The dormer window and the extractor fan were in need of cleaning. One tile was chipped. The hot water coming from the sink tap was very hot and took a while to come through. We were advised that the delay in water being available from both this tap and the hot water tap in the Care Homes for Older People Page 18 of 29 Evidence: bath was due to an air block. The home also has another bathroom upstairs, which we were advised is currently not in use, however this room was not locked and it was clear people were still using the toilet in this room. A large oxford hoist, which we were advised is not being used, is being stored in this room. The hoist took up half the floor space and posed a risk to anyone walking around it to get to the toilet. We were advised the shower in this bathroom is not workable due to the small space inside the shower and the large step into the shower. Mrs Hughes said that consideration was being given to refurbishing this room to make it more accessible. The temperature of the water from the hot water tap in the sink was very hot. The temperature in one sink in the downstairs toilet was so too hot to put your hand under, which could pose a risk to residents as they could scald themselves. Whilst we were in the home the plumber was called and we were told this sink had been isolated. In various bedrooms it was noticed adaptations were being used. One person had an aid by their bed, which we were informed This stops the pillows falling and helps the person to grab onto when going to bed. However it was not clear what this aid was called and who had assessed the service user as needing it. No details were in the care plan. Raised toilet seats had also been fitted to some toilets, but again there had been no formal risk assessment and these had been fitted by the home. Each room occupied by a resident was viewed. In some rooms it was found there was no towel holder, wall lights did not work, a light in someones en-suite did not work, call leads form the old call system were still fitted. The current call bell was not where people were sat in their rooms but at the other end of the room. Boxes where dentures were put at night were very dirty and there was no evidence of any cleaning substance to leave dentures in soak, only toothpaste and tooth brushes. We were advised by Mrs Hughes she has a stock of denture cleaning tablets in the home. Hair brushes were seen in peoples rooms but these were in need of cleaning. In one bedroom it was noted the taps on the sink had no signage or colour coding to enable people to know which was hot and which was cold. The laundry was seen, which had a smell of stale urine. Items of washing were on the floor waiting to be loaded into the washing machines. Mops and buckets were stored in this area but there was no evidence of colour coding these to ensure they were not mixed up with regards to infection control and protecting people from the risk of cross infection. The health and safety notice was displayed, but had not been filled in. Mrs Care Homes for Older People Page 19 of 29 Evidence: Hughes stated she was unaware the home should have an in-house health and safety person listed on the notice. Linen baskets with a photograph of each person were available for all clean washing. Mrs Hughes reported there is no designated person to do the laundry; it is decided on each day. It was noticed this room was not locked and washing powder and fabric conditioner were left out on display, residents could have wandered into this room. Latex gloves were available; these had been taken out of their individual packing and put in one large box. A deep cleaning chart was seen in the office. From this it could not be established any room had been deep cleaned since October 2009. Mrs Hughes reported she was not sure as this was a domestic responsibility. Care Homes for Older People Page 20 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is not possible from the duty rota to ensure the home is always staffed by people who can meet peoples needs. People must be sure the home has undertaken the correct recruitment procedure for staff so they are protected from harm. A training programme is available, but this must be offered to all new staff. Evidence: On the day of the visit three carers, one domestic and a cook were on duty. Soon after we arrived, Mrs Hughes arrived. The duty rotas for the last two weeks were looked at and were photo copied under code B. The home has two copies; one is kept in the office and one is kept in the staff room. Both copies were different and it seemed most changes were made on the copy kept in the office. It was not possible to establish from the duty rota what role each person had, so it was not possible to establish, for example, who was the senior member of staff on duty each day. It was also noticed the cook has now started working as a carer but whilst being down on the duty rota in one week to cover five, 8-8 and one 8-2 care shifts, she was also recorded on the duty rota for the same time working five days as the chef working 8-2. For other days it was not possible to establish what hours staff worked and how many staff were on duty. Staff spoken to stated they felt there was enough staff to meet peoples needs. Two staff who often work 12 hour shifts reported this was their choice. Residents spoke to had praise for the staff, stating they worked very hard. One resident stated sometimes they had to wait when ringing their bell but thought this was acceptable. Care Homes for Older People Page 21 of 29 Evidence: In the AQAA the home advised us we operate a strict recruitment procedure, all staff have criminal reference bureau checks (CRB), and two references are obtained. The recruitment records of three members of staff were viewed. It was found all the necessary checks and references had been obtained. It was noted for one person they had filled out an application form and received a contract for a job as a cook but was now working as a carer. It was advised if their role changes a new application form and contract should be issued. From records seen it was clear training had been provided in a wide range of areas including infection control, dementia, emergency aid, fire safety, health and safety, medication, moving and handling and nutrition. Training had been provided by a company coming into the home to give the training. Staff spoken to felt the training had been good and they had learnt a lot. One new member of care staff reported they had received no training since starting work in the home. Care Homes for Older People Page 22 of 29 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. People are not receiving a well managed service where their health and safety is considered, which could leave them at risk. Evidence: The manager who was not registered and deputy manager have recently left the home. Both have made claims they were not supported and were not allowed to manage the home. The home has not had a registered manger since July 2007 despite three people being appointed as the manager. On the visit Mrs Hughes reported she is going to apply to the Commission to become the registered manager. Mrs Hughes reported she has no formal qualifications in care. She reported she has registered to complete a National Vocational Qualification Level 4 in Health and Social Care and after completing this will go on a leadership in management course. Since the key inspection we have received information which indicates Mrs Hughes is now not going to register as the registered manager. The homes history shows that they have not been proactive at undertaking Care Homes for Older People Page 23 of 29 Evidence: monitoring of the service or developing a good quality assurance model and most improvements have been as a result of issues raised through inspection. Requirements are repeated and then when they meet these, requirements are issued in other areas. Requirements regarding medication have been repeated twice and have now been met. Requirements regarding care plans have been made on two occasions and will be repeated in this report. During this inspection Mrs Hughes seemed to lack the understanding of the responsibility of a registered manager. When asked questions, there was a lack of clarity when answering. For example the deep cleaning rota in the office detailed deep cleaning of rooms had stopped in October 2009. Mrs Hughes stated she would have to ask the cleaner as these were her records but the cleaner had gone home. When discussing the duty rota Mrs Hughes could see the lack of clarity could be an issue, but had not realised this before it was raised. When the hot water was found to be too hot, the plumber was called, but this had not been identified before the inspection took place. Mrs Hughes seemed unaware of her responsibilities as manager and it was of concern that she did not appear to know what was going on in the home. Mrs Hughes reported questionnaires had been sent and received from residents and their visitors. We were advised the results of these are being analysed. A brief look showed people were generally happy with the service, but issues raised involved items going missing from the laundry, the differing charges for hairdressing and one person was unhappy with the quality of correspondence. One relative spoken to stated they were kept informed on their relatives progress, but had not seen an inspection report in the home and was unaware there was such a report. Mrs Hughes reported she is going to next try and get the views of professionals who visit the service. We were advised since the last inspection the home does not become involved or hold any money for service users. Training has been undertaken by staff in infection control, basic food hygiene, fire training and moving and handling. One new member of staff reported they had received no training and only a very basic induction. Mrs Hughes could not find any of this persons induction records. However, it could not be evidenced everyone was aware of health and safety issues in the home. As already stated concerns have been raised over cleaning regimes, hot water temperatures, items stored in bathrooms and aids being fitted without an assessment of a qualified person. When looking in the kitchen it was noted two areas had tiles missing, the edges of work surfaces were chipped, one wall was just plastered and in need of cleaning and painting. One cupboard drawer did not shut. The flooring did not fit very well and cupboards did not reach the floor and food had fallen underneath. The cooker had two control handles Care Homes for Older People Page 24 of 29 Evidence: missing and the wall next to the cooker was in need of cleaning. It was noted food stored inside the fridge was covered and being stored appropriately. In the office it was noticed three sharps containers were being stored. These had not been completed with a date of assembly, date of closing and the person carrying out these tasks had not been identified. Care Homes for Older People Page 25 of 29 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 7 15 Service user plans need to clearly state all a persons needs and state how these should be met. Clear support plans will ensure that a persons needs and choices will be met. 30/07/2009 Care Homes for Older People Page 26 of 29 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 24 16 Some parts of the environment need attention to ensure all people have access to safe equipment, which is in full working order. All equipment must be safe for people to use in the home. Adaptations must be assessed by qualified people. 15/03/2010 2 27 17 Peoples roles must be 15/03/2010 clearly identified to ensure there is enough staff on duty to meet peoples needs. Without accurate records it is not possible to establish the home has staffing levels which can meet the needs of people. Poor records also make it impossible to establish what role people have worked as in the home . Care Homes for Older People Page 27 of 29 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 3 31 8 The registered providers must appoint a registered manager to improve the areas of the home which have been identified as deficient. 15/03/2010 The home needs a manager to ensure the home is run in a safe manner for the protection and safety of service users. 4 38 13 Infection control and health and safety procedures must be followed to ensure the safety and good health of people. Without clear policies and procedures staff do not have the information on how to provide safe care to people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 15/02/2010 Care Homes for Older People Page 28 of 29 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. 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