Inspection on 17/03/09 for Foxhill Manor Nursing Home

This inspection was carried out on 17th March 2009.

CSCI 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

Foxhill Manor Nursing Home 08/06/07

Foxhill Manor Nursing Home 05/05/06

Similar services:

Hunter`s Lodge

Lester Hall Apartments

32 Bentinck Road

50 Stoneygate Road

Harvey House

St Bernards

Landmere Care Home

Stoneygate Oaklands

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Foxhill Manor Nursing Home Foxhill Road West Haddon Northants NN6 7BG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathy Jones     Date: 2 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Foxhill Manor Nursing Home Foxhill Road West Haddon Northants NN6 7BG 01788510262 01788510834 snullatamby@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Ramsamy Nullatamby care home 26 Number of places (if applicable): Under 65 Over 65 26 26 26 26 past or present alcohol dependence past or present drug dependence dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 0 0 Service Users under the age of 65 years must not be admitted to the home Service users must fall into at least one of the following categories: past or present alcohol dependence, past or present drug dependence, dementia or mental disorder The home may accommodate three named service users for whom variations were granted prior to April 2002, (the NCSC), who are under the age of 65 years The total number of Service Users must not exceed 26 Date of last inspection Brief description of the care home Foxhill Manor is a care home providing nursing care for up to 26 people of both sexes who are over 65 years of age and within the categories of dementia, mental disorder, past or present alcohol dependence and past or present drug dependence. The home currently has permission to care for three named people under the age of 65 years. Care Homes for Older People Page 4 of 28 Brief description of the care home Foxhill Manor is privatley owned and not part of a group of homes. Foxhill Manor is a large converted house set in its own extensive grounds and situated on the outskirts of a village. Peoples bedrooms are on three floors with the shared lounges and dining room on the ground floor. The majority of people share a bedroom, however there are eight single rooms. Two of the double bedrooms have an en-suite toilet. The following fees were provided by the registered provider/manager as being current at the time of the inspection in March 2009: Weekly fees range between £500 and £975 per week dependent on assessed need. For people funded by the local authority the fee includes the nursing contribution. For people who are funding their own care the nursing contribution is additional. Chiropody and hairdressing can be arranged and these services are charged separatley. A copy of the most recent inspection report is available at Foxhill Manor. Care Homes for Older People Page 5 of 28 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 that people who use this service experience poor quality outcomes. The key standards under the National Minimum Standards (NMS) were inspected during the course of the inspection. The Commission for Social Care Inspection (CSCI) focus on these standards as they are considered to be the standards, which have a particular impact on the health and welfare and outcomes for people who use the service. Prior to the inspection we considered information that we have received about the service since the last inspection. This included information received from other Care Homes for Older People Page 6 of 28 agencies and from the service themselves. This inspection was unannounced and carried out by one regulation inspector over the period of two days. On this occasion the inspection visits took place on a weekday. It was necessary to return for a second visit as not all staff files were made available on the first visit. Judgments reached within each outcome area in the report were reached as a result of drawing together information from a range of sources such as, the reviewing of care plans and other care records including medication records, complaints records and written and verbal communications with the registered provider and registered manager. We found that not everyone was able to communicate their views about their experiences and the care and support provided. We spoke with some people who use the service and also a visitor. We also observed interactions between staff and people who use the service and care practices. This information helped with forming our judgments. To support the information we received, we case tracked two people who use the service which involved sample checking care records (care plans) held at the service in relation to their health, safety and welfare and looked at how there medication is managed. Staff files were sample checked to evaluate how the service ensures people are protected through their staff recruitment, training and support and development programmes. We also looked at a sample of bedrooms, saw the shared areas of the home such as lounges, dining room and bathrooms. We observed the service of the lunch time meal. Feedback on the inspection findings was discussed with the person in charge throughout the inspection. What the care home does well: What has improved since the last inspection? What they could do better: While standards of care were found to be good, we were concerned about shortfalls in the management of the service which places people who use the service at risk. One of the main areas of concern related to the employment of staff without necessary checks such as criminal record bureau checks and references being carried out to ensure that people are suitable to work with vulnerable people. Staff training and quality assurance processes were other areas where we found shortfalls. It is important to ensure that staff have regular training to update their knowledge and skills in caring for people who use the service. Good quality assurance systems are vital in ensuring that good standards of care are maintained. Some environmental improvements are needed, which includes updating and refurbishing bathrooms with equipment to meet peoples needs. This is listed in the services development plan for 2009. The plan also includes the installation of a passenger lift, though plan have not been finally agreed. Some bedrooms are only accessible which is problematic when as was the case at the time of inspection someones mobility decreases. This had resulted in someone sharing a room already Care Homes for Older People Page 8 of 28 occupied by two people on the ground floor. This then impacted on those people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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. The admission process establishes the homes ability to meet the needs of people admitted to the home prior to admission. More detailed information about Foxhill Manor and the needs catered for would help people to make more informed choices. Evidence: Copies of a statement of purpose and service user guide dated 2004 were available in the entrance hall with a copy of the most recent Commission for Social Care inspection report. The documents provide some information about the services provided, however more information about the range of needs and the support and care provided would help people in making more informed decisions when choosing a nursing home. Information should be included about arrangements for people (particularly those occupying a room without lift access) if and when their mobility or physical health deteriorates. Care Homes for Older People Page 11 of 28 Evidence: There is also a brochure which includes extracts from the statement of purpose and service user guide. This contained information about the fees which were quoted as £375.00 to £400.00 per week. However as the document was not dated it was difficult to be sure they were current. It is important that people have information about fees to enable them to plan their finances. The annual quality assurance self assessment submitted by the registered manager states that there is equality in the charging structure, in that privately funded people are charged the same as those who are funded by a local authority. We spoke with a relative about the admission process and they confirmed that visits are encouraged prior to admission and that they were told that they could visit to look around at any time. We looked at records for someone who had been admitted relatively recently and found that an assessment of needs and care plans had been obtained from the placing authority. The information provided was sufficient to enable a decision to be made as to whether the persons needs could be met. This is important in helping to ensure that peoples needs can be met. Intermediate care is not provided therefore this standard was not assessed. Care Homes for Older People Page 12 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall care provided is good with health care services being accessed as appropriate. Evidence: We spoke with people who use the service and a relative during the inspection and observed the care and support that people were receiving. People told us that they were happy with the care and support that staff give them. We observed staff to be calm and gentle in their approach to people. Staff were responsive to peoples needs and were observed to maintain peoples dignity when assisting and supporting them with care including toileting routines. A relative of someone who has recently been admitted was pleased with the attention paid to personal care and appearance. Care plans were in place and a sample check indicated that they identified and were relevant to peoples needs. There was evidence that the level of care and health monitoring is altered as peoples needs change. Care plans are important documents in guiding staff as to the actions they need to take to meet peoples needs and help to Care Homes for Older People Page 13 of 28 Evidence: provide consistent care. Staff spoken with were aware of peoples individual needs. People are supported according to their individual needs. For example records are in place to monitor peoples bowels, however peoples dignity is respected and this is only used where people are not able to manage independently and there health may be compromised. We received feedback in a survey from a health professional in 2008 which included confirmation that the service seek advice and act on it to manage and improve individuals health care needs. They also stated that residents seem well cared for and looked after. Care files contained evidence of involvement of professionals which include General Practitioners, community mental health team and chiropodist. A sample check of medication and medication records indicates that medication is well managed. Stocks are kept to a minimum and records kept of receipt and administration as part of a clear audit trail. There is evidence that peoples medication is reviewed regularly and that requests for medication reviews by the General Practitioner are made and medication altered as and when peoples needs change. Staff were observed to be mindful of peoples dignity and spoke to people in a respectful manner. Care Homes for Older People Page 14 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Visitors are encouraged and welcomed into the home, the food is good with a choice of meals and peoples preferred routines are respected. Evidence: Peoples preferences in terms of daily routines were seen to be respected in that we noted that someones preference to stay up late at night and rise after lunch is accepted by staff as part of their routine. Arrangements for meals are made within this persons preferred routine. There was a friendly and relaxed atmosphere in the home on the day of inspection. Staff were seen to spend time with people who use the service either doing activities or in conversation. External input with activities is also now provided twice a week. One of the planned improvements identified in the development plan is for regular outings in the summer to places of interest. Foxhill Manor has a minibus which helps to make such trips possible. Northamptonshire County Council found from interviewing people who use the service and relatives as part of reviews carried out between March and June 2008 that the Care Homes for Older People Page 15 of 28 Evidence: majority of people felt they would like more access to the outside. They felt that this would benefit people greatly. Staff advised that they do take people for walks when able. During this inspection we observed someone who kept wanting to go outside, initially she was distracted by conversation by staff and after several attempts a staff member took her for a short walk which she seemed to enjoy. Foxhill Manor is set in large grounds however at present people are unable to safely access the grounds independently as there are uneven surfaces and no safe secure area. An area that people are able to safely access independently would enhance the daily lives of some people. We spoke with a visitor who confirmed that visiting arrangements are flexible and that they are always made welcome by staff. People spoken with said they enjoyed the meals and were able to have choices. The Chef asked everyone during the morning what they wanted for lunch. He was aware of peoples individual preferences and needs resulting in a variety of different meals being provided at lunch time. For example the main meal on the day of inspection was sausages, peas, carrots and potatoes, however alternatives seen included lasagna, omelette and ham and egg. Some people needed assistance with their meals. Staff sat with these people and assisted people appropriately according to their particular needs. Care Homes for Older People Page 16 of 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are aware of their responsibilities for reporting any concerns, however out of date policies and poor recruitment practices put people at risk. Evidence: The Commission for Social Care inspection have received one complaint about the service since the last inspection. This was referred to Northamptonshire County Council (NCC) through safeguarding vulnerable adults procedures as it raised concerns about the care and treatment of people at Foxhill Manor. As a result NCC carried out reviews of the care of all the people living at Foxhill Manor. These reviews took place between March and June 2008 and were quite thorough in that they involved speaking with people who use the service, reviewing care records and observations. Advocates assisted with this process. The outcome was that there were no major concerns about the care of people and positive feedback was received from people who use the service, families and advocates. We spoke with a relative, who said that staff keep her informed and she felt that if there were any concerns that she would be able to raise these with staff and that they would be addressed. During this inspection we asked for records of all complaints. We were provided with a folder of comments, suggestions and complaints. Records were poorly kept in that Care Homes for Older People Page 17 of 28 Evidence: there was no running log or filing system to identify recent complaints and outcomes. Some of the documents were not dated and others dated back to 2004. The registered manager advised that there have been no recent complaints apart from the one investigated by Northamptonshire County Council under safeguarding vulnerable adults procedures. A new staff member spoken with was aware of their responsibilities for reporting any concerns that may arise about the care or treatment of people. They had received safeguarding vulnerable adults training prior to starting work at Foxhill Manor. We looked at the policy to see what guidance staff have about the actions they would need to take in the event of any concerns. The policy in place at the time of the inspection was an abuse policy dated 2003, although the annual quality assurance self assessment stated that policies including safeguarding vulnerable adults policy had been reviewed in 2008. We have advised that an up to date policy for safeguarding vulnerable adults must be implemented. From brief review of the document if staff adhere to the policy they may take incorrect actions. For example the policy stated Do not assume abuse, or neglect, investigate. It is important that if an allegation is made, the allegation is reported to safeguarding vulnerable adults and in some cases the police. A multidisciplinary decision will be made about which agency will carry out the investigation. If a staff member or manager has investigated then this may hinder any investigation. This is important both in safeguarding people who use the service and staff. We have made requirements under the staffing section of this report relating to poor recruitment practices which do not safeguard people who use the service. Care Homes for Older People Page 18 of 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas such as bathrooms are in need of improvement and updating and the physical environment does not always meet the needs of someone whose mobility deteriorates. Evidence: Foxhill Manor is located in a rural setting and is set within its own large grounds. The registered provider/manager and some staff live in separate buildings on site which means that additional support is easily accessible in the event of an emergency. There are two lounges, a dining room and a large hall/reception area with a seating area on the ground floor. People are able to and do wander freely around these areas. Rooms have high ceilings and look out onto the grounds. All areas were clean and new furniture had been provided in the dining room. The premises pose some difficulties for providing care for people whose health deteriorates as there is no lift access to bedrooms on the top floor. There is a stair lift to the first floor, however there are a further two steps to part of the first floor which will make these rooms unsuitable for anyone at risk of falls or with poor mobility. The development plan for 2009 provided by the registered provider/manager includes provision of a passenger lift to the first and second floors. No final agreement had Care Homes for Older People Page 19 of 28 Evidence: been made for this at the time of the inspection. At the time of the inspection we were informed that it had been necessary to move someone in to a ground floor room already occupied by two people for a temporary period due to a deterioration in their health and a risk of falls. While we were advised by the registered owner/manager that the decision to do this was based on the clinical needs of the person and the risk, it is an issue which highlights difficulties with the suitability of the premises in meeting the needs of older people whose mobility decreases. While the registered provider/manager confirmed that he had consulted with the people involved, their relatives and the people funding the care, there was no evidence of this within the records. We have advised that careful consideration needs to be given, with consultation with families and funding bodies as to how the needs of people whose mobility decreases can be met without impacting on other people who use the service. The registered provider/manager advised of other planned improvements to the premises which include refurbishment and updating of bathrooms. There is a bathroom on each floor, all were seen to need refurbishment and to be in need of equipment more suitable for the needs of the older people who use the service. For example the bathrooms on the first floor and the top floor contained domestic type baths with no aids or adaptations. The bathroom on the top floor also contained a domestic type shower, which staff advised is used by one or two people, however the majority of people have to be bathed on the ground floor. We noted that bedrooms were very sparsely furnished with little in the way of personal possessions. Feedback from a relative was that although the care was very good, the premises were not as nice as some homes, a bit dark and the bedroom was very basic. They had brought in some pictures but couldnt bring much in the way of personal possessions as they get broken with people wandering in and out of rooms. A sample check of maintenance identified that an inspection of the electrical installation dated 20/11/02 recommended a further inspection in 5 years. This was discussed with the registered provider/manager. When we returned on 20/03/09 the registered manager advised this has now been booked and will be completed by mid April 2009. Care Homes for Older People Page 20 of 28 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. The poor recruitment practices and lack of up to date training put people at risk. Evidence: We spoke with people who use the service and a visitor during the inspection. Some people were not easily able to communicate their views due to their mental health condition, however one person without prompting told us that staff are very good. The visitor we spoke with was positive about the staff team and their caring approach and in particular was pleased with their attention to keeping people clean and well groomed. The registered owner/manager had an appointment arranged for the afternoon of the inspection, however he arranged for us to have access to staff recruitment and training files. On review of the files available we noted that there was no file for a nurse we had spoken with earlier. Closer inspection identified that several staff files were not available and information such as training was minimal and not recent. The record of PIN number (nurses registration number) for the nurse in charge at the time of inspection indicated that it had expired, though the nurse confirmed she did have a current registration. The deputy manager/nurse in charge did not have access to any other staff records, Care Homes for Older People Page 21 of 28 Evidence: therefore we advised that we would need to return to view files. Following the inspection we contacted the registered owner/manager who admitted that four staff had been working in the home without the necessary checks and references being obtained including criminal record bureau clearances. We received written confirmation that these people would not work until satisfactory clearances had been obtained. On our second inspection visit we looked at four staff files and found that criminal record bureau clearances had only been applied for on the 18/03/09 which was the day after our inspection visit even though these people had been working in the home. No checks had been made against the Protection of Vulnerable Adults (POVA) register to ascertain if they were listed as people who shouldnt work with vulnerable people. References had either not been obtained or were inadequate with incomplete employment histories. In one case no documentation was available to confirm that the person was entitled to work in this country. In addition to there being a breach of regulations the poor recruitment practices put people at risk. As found on the first day of inspection, records relating to training were minimal and fragmented and not recent. We asked the registered provider/manager to forward details of staff training undertaken and a training and development plan. Information was received following the inspection which included a sample of staff training records and a list of training planned for 2009. From this information we noted that very little training has taken place in recent years. For example records for a nurse showed attendance at only four training events since 2002, three of which were on fire safety. The other training undertaken was patient handling on 31/03/2004, with no evidence of any training updates. Training planned for 2009 includes, mental health nursing (one had day session) for four staff, Mental Capacity Act 2005 ( two hours) for all staff, Deprivation of Liberties (two hours) for all staff, Protection of Vulnerable Adults for all staff, moving and handling for five staff and movement and handling updates for nursing staff. Dementia care training is also going to be provided on Wednesday afternoons from 13/05/09. The training plan forwarded following inspection also refers to some National Vocational Qualification training and other training to be booked. Care Homes for Older People Page 22 of 28 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. While there is an experienced and suitably qualified manager in post, the service has not been managed in a way that safeguards people who use the service. Evidence: The registered manager is also the registered provider. He has a background in general and mental health nursing. There is a deputy manager in post who oversees the day to day running and care provided. This inspection has highlighted that although the day to day care provided is good, there are serious shortfalls in the management of the home which place people at risk. For example the failure to carry out checks as to peoples suitability to work with vulnerable people. The registered manager advised that he has tried to recruit a manager without any success, he was hoping to step back from some of the management responsibilities. Care Homes for Older People Page 23 of 28 Evidence: We had requested an annual quality assurance self assessment (AQAA) during 2008 and although we had sent reminders we did not receive this until we were on the point of taking enforcement action. The registered provider/manager told us that he has had some periods of absence which prevented him from completing this within the timescale. It is important that in the event of the managers absence there is someone who can take on the management responsibilities. During a safeguarding vulnerable adult investigation carried out by Northamptonshire County Council it was identified that the registered owner/manager has had some periods of absence from the home which we had not been made aware of. There have also been incidents which have occurred in the home that have not been reported to the Commission for Social Care Inspection as required. It is important that in the event of the registered manager being unable to make the required notifications then there are staff that are aware of the requirements and can do this. The AQAA states that policies and procedures were updated in February 2008, however we checked the adult abuse policy and found this to be dated 2003. The AQAA also states that one of the things they do well is the recruitment policy with CRB (criminal record bureau) and POVA (Protection of vulnerable adults) checks. These examples give us concerns about the quality assurance process. The registered manager provided a copy of the achievements and developments for 2007/8 and a development plan for 2009 which confirmed that there is a system of review of the maintenance and development needs of the service in place. No health and safety concerns were identified during the inspection visit in relation to staff practice. Staff observed were using appropriate movement and handling techniques and equipment. As detailed in the staffing section staff training records were poorly maintained and do not confirm that staff have received appropriate training in safe working practices. Following the inspection we have been informed that training has been arranged. Care Homes for Older People Page 24 of 28 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 29 19 Prior to staff being employed 30/07/2007 satisfactory information as detailed in schedule 2 of the Care Homes Regulations 2001 including two references must be obtained. Care Homes for Older People Page 25 of 28 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 5 Up to date information about 26/06/2009 the fees must be available in the service user guide. This is to enable people to make decisions and plan their finances. 2 18 13 There must be up to date 12/06/2009 safeguarding vulnerable adults policies and procedures in place to guide staff in the correct actions to take in the event of suspecting or receiving an allegation of abuse. This is to help safeguard people who use the service. 3 19 23 The development plan must 30/06/2009 include timescales for carrying out works to meet peoples needs. This must include arrangements for meeting the needs of people with deteriorating mobility and upgrading of bathrooms. Care Homes for Older People Page 26 of 28 To ensure peoples needs can be safely and appropriately met. 4 33 24 The management and quality assurance processes must be effective in ensuring legislative requirements are met and people safeguarded. This is to help to safeguard people. 5 38 13 Staff must receive training in safe working practices. To help keep people safe and reduce the risk to them. 26/06/2009 26/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 More detailed information in the statement of purpose about the range of needs met and the ethos of care would help people to make more informed choices. Improved systems for record keeping in relation to complaints should be implemented to provide a better oversight of issues. Consultation should take place with people who use the service, families and funding authorities regarding planned improvements and interim arrangements. 2 16 3 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!