Inspection on 23/11/09 for Frome Care Village

This inspection was carried out on 23rd November 2009.

CQC found this care home to be providing an Adequate 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Frome Care Village 29/09/09

Frome Care Village 09/02/09

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Frome Care Village Styles Hill, Frome, Somerset, BA11 5JR The quality rating for this care home is: one star adequate 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: Justine Button Date: 0 8 1 2 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. things that people have said are important to them: 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 They reflect the 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: Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia (DE) mental disorder, excluding learning disability or dementia (MD) old age, not falling within any other category (OP) physical disability (PD) Number of places (if applicable): Under 65 Over 65 60 60 Care Home (CRH) 60 PSP Healthcare Ltd riverview@psphealthcare.com Frome Care Village Styles Hill, Frome, Somerset, BA11 5JR 08702869464 60 24 Additional conditions: 1 The maximum number of service users who can be accommodated is 60. 2 The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) - maximum of 24 places Dementia (Code DE) Mental disorder, excluding learning disability or dementia (Code MD). Date of last inspection: Brief description of the care home: Frome Care Village was purchased by PSP Healthcare LTD in 2008. Frome Care Village Care Homes for Older People Page 4 of 33 1 0 0 2 2 0 0 9 can be found just off styles Hill road, set in its own grounds. It is situated on the outskirts of the town of Frome near to Asda superstore. Shops, banks, pubs and restaurants are near by however transport would be needed to reach these facilities from the home. The home is currently situated in two separate buildings (although both are situated on the same site) The Parsonage and Woodlands. The Parsonage is an older building with facilities situated over two floors. The upper floor being accessed by staircase and lift. There are 34 bedrooms spread over the two floors. Both floors have a range of living and dining spaces. The parsonage currently provides care and support predominantly for people who have dementia. The woodlands has 24 single en-suite bedrooms again spread over two floors. This building was constructed in 2000. Again there are a range of living and dining facilities on both floors. The lower floor being accessed by stairs or a passenger lift. Woodlands provides care and support for those people with nursing needs. The two homes share some facilities such as laundry and kitchens. There are accessible gardens surrounding both homes. The home is currently has an interim a manager, Ms Jill Holmes . In addition both The parsonage and Woodlands have a head of care who is responsible for the day to day running of both buildings. The current fee levels range from 518 pounds per week to 1200 Pounds per week. This information was given to us on the 26/02/09. Care Homes for Older People Page 5 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: one star adequate service How we did our inspection: This was an unannounced inspection which was carried out on 23rd and 8th December 2009, over a total of 11 hours by Regulation Inspectors Justine Button and David Smith. Whilst there were two inspectors throughout the report the term we will be used as it is written on behalf of the Commission. At the time of the inspection, 56 people were living in the home. The last key inspection was carried out in February 2009 when the home was rated as also rated as adequate. Since the last inspection we have received a number of concerns and complaints with regard to the services provided at the home. As a result of these concerns we have liaised with the local social services department as they have the lead role in investigating concerns and safeguarding issues. We have also carried out a random inspections Care Homes for Older People Page 6 of 33 As part of this inspection we spoke with people who live at the home, management and staff. We also received surveys form people living at the home and relatives. We have also received feedback from healthcare professionals as a result of the concerns and complaints we have received. We viewed the accommodation. We looked at five individual care plans, and looked at records relating to wounds and their management and staff records. We also spent time observing and recording the experiences of people using the service. The focus of this inspection visit was to inspect the relevant key standards under the Inspecting for Better Lives 2 framework. This focuses on outcomes for people living at the home. The quality of the service is measured under four ratings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 33 What the care home does well: Some people who live at the home commented staff are lovely and food is good. The manager and staff at the home maintain regular contact with visiting health professionals to support the needs of people living at the home. A health professional said the staff treat residents with respect and as individuals. We observed some good interactions between some members of staff and people who live at the home. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. All staff have attended all necessary mandatory training. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. What has improved since the last inspection? Since the last inspection the documentation for people with wounds or pressure area damage has improved. At the random inspection which was conducted in October 2009 it was found that two people who had been admitted to the home did not have any care and support plans to give staff clear guidance on all their care needs. On this inspection it was found that this requirement had been met. What they could do better: PSP Health care took over the running of the home in 2008. Initially a number of significant improvements were seen. These were reported in the last key inspection report. Since this time the home manager left employment and the rate of improvements at the home seems to have slowed. As a result a number of concerns and complaints have been raised with us. In addition some of the requirements from both the last key and random inspection remain outstanding. In order to avoid Care Homes for Older People Page 8 of 33 enforcement action PSP Healthcare must now address the issues raised in this report as a matter of urgency. The home has recently recruited a new manager so it is hoped that improvements at the home will be seen in the near future. The outstanding concerns relate to care planning. It should be noted however that a new care planning system has been implemented recently. The care plans need to give clear and consistent guidance to staff on the care needs of the people living at the home. The home needs to develop the opportunity for people to make choices. This is particularly relevant for people with dementia. All people at the home needs to ensure that all people have access to a nurse call bell and fluids at all times. Charts used to record care need to be accurately completed and influence the care given. Some of the concerns relate to the food. The management need to ensure that they keep the standard of food under review to ensure that it is an acceptable standard at all times. We have received concerns with regard to the standards of cleanliness at the home. This has included concerns about odours. The management need to keep this issue under review. During the inspection we noted some hot water pipes which were exposed and some torn flooring. Both of these could pose a hazard to people at the home. The management need to keep this under review. Some areas of the service require upgrading and decoration. Due to the concerns raised the management need to ensure that the registered nurse have the necessary skills and are available in sufficient numbers to meet the needs of the people at the home. We have not been informed of all incidents that may effect people at the home. This is required under Regulation 37 of the Care Home Regulations. Due to the ongoing concerns and complaints received we have requested that the home forward us details of the monthly visits made at the home. 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. Care Homes for Older People Page 9 of 33 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 10 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 11 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. These standards were not inspected in detail on this occasion. At the last inspection it was reported People have the information they need to enable them to make an informed decision about moving to the home. The home will ensure that people are appropriately assessed before a placement is offered. Evidence: These standards were not assessed on this occasion. At the last inspection it was reported The home has developed a statement of purpose and information for people thinking of moving into the home. A copy of this information was viewed. This document provides all the necessary information and is supplemented with a range of photographs. The Aqaa received prior to the inspection states that this information is also available on request in braille, audio cassette, CD and large print format. Care Homes for Older People Page 12 of 33 New placements at the home have been limited since the home was purchased to enable improvements to be made. As such it was difficult to assess any preadmission assessments made by the home. The documentation for the assessments however was viewed and this contains all necessary information. This assessment will ensure that the home can meet the needs of the individual prior to moving in. It should be noted that the home charges a fee of 47.95 pounds for the completion of these assessments and the development of the initial care plan. Details of these charges are specified in the contract. In addition to the preadmission assessment the homes asks the individual (if possible) and or a family member to come to visit the home to ensure that all parties are happy for the placement to proceed. The home also ask family members to complete a booklet which details information about the individual during their life so that staff have a feel for the person as an individual and can assess their social needs. Assessments are also sought by the staff at the home from other health care professionals or social worker. The home provides each individual with the terms and conditions of their stay (contract). The contract viewed clearly sets out the fees payable, payment terms, notice periods and any additional charges. Fees stated in the contract do not include any Registered Nurse Care Contribution (RNCC). This is a sum of money paid by the government for anyone with a nursing need. Fees do not include hairdressing, visitors meals, newspapers, alcohol, private treatments such as physiotherapy or chiropody, taxi fares, toiletries, dry cleaning and escort duties. A suggested sum of a 100 pounds is paid to the home on admission to cover these costs. The contract states that a trial period of four weeks is in place. Care Homes for Older People Page 13 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 the 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 care planning system needs to be developed to ensure that it gives clear guidance to staff working at the home. All staff need to ensure that they are aware of all the care and support needs of the people living at the home. The management need to continue to monitor the care and support provided at the home to ensure that this is satisfactory at all times Medication standards are satisfactory Evidence: Since the last inspection PSP Health care have introduced a new care planning system. We reviewed the care records for five people living at the home. The care plans need additional development as they are inconsistent and give contradictory information to staff in some areas. One care plan for one person was viewed. This individual smoked tobacco. Staff had completed a risk assessment for this. A care plan had also been developed for this area. One document stated that the individual could smoke independently whilst the other Care Homes for Older People Page 14 of 33 stated that staff support was needed. This may place the individual at risk because if staff read the first document they may leave the individual unsupervised and thus at risk of burns or starting a fire. A risk assessment for moving and handling had been completed. This stated that the individual was at moderate risk and used a stand aid for all transfers. Staff had then completed a falls risk assessment which stated that that the individual was at low risk of falls. The risk assessment asks if any equipment is used to aid moving and handling. Staff had recorded that no equipment was used. This contradicts the moving and handling assessment which stated that a stand aid was used. The falls risk assessment also asks if the individual wears glasses or uses a hearing aid. Staff had recorded that neither were used. However earlier in the care plan it was stated that a hearing aid was used. The care plan stated that the individual was on medication which can make you drowsy. This would make you at increased risk of falling. Again this was not reflected in the falls risk assessment. If the hearing aid, medication and use of equipment had been added to the falls risk assessment then the overall score would have increased . The lack of accurate recording may place the individual at risk as staff may not take appropriate action to reduce the risk of falls. A nutritional assessment had been completed which stated that the individual was obese. This however was incorrect as according to the MUST assessment the individual was not obese according to their weight and height. MUST is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (under nutrition), or obese. It also includes management guidelines which can be used to develop a care plan. The use of bed rails increase the risk of injury and entrapment. Bed rails should only be used where a complete assessment has been completed. A bed rail assessment had been completed for this individual. The assessment asked is resident likely to fall from bed. staff had stated yes. The second question asks is a bed rail the most appropriate solution. staff had stated no to this question. Despite this at the end of the assessment it states bed rails have been fitted. The care plan for another individual was viewed. This individual had had a recent fall resulting in a fractured arm. Despite this staff had not reviewed the falls risk assessment to ensure that no additional support or action was required to reduce the risk of further falls. At the start of the inspection we asked one of the registered nurse in one area how many and who had pressure ulcers or wounds. The nurse told us that no person had or required treatment for pressure ulcers. During the inspection we located the wound Care Homes for Older People Page 15 of 33 care plan file. This showed us that there were two people living in this area who had wounds. It is concerning that the nurse in charge was not aware of this. This could impact on the care and support provided by the nurse and her ability to guide and ensure that the care staff gave the correct support and care. We reviewed the care plans for those people who had wounds or pressure ulcers. At previous inspections it has been found that these were inadequate and did not give clear guidance on the treatment and progression of the wounds. On this occasion the wound care plans had improved and the areas of concern had been addressed. On the whole you were able to see the progress of the wound via the use of photographs, measurements and tracings. As stated we completed a random inspection in September 2009. During the random inspection we found that two people had been admitted to the home for a period of time and staff had not developed any care plans or assessments. As a result of these finding an immediate requirement was left. During this inspection it was noted that this requirement had been met. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids and diet taken and frequency of positional change. Some had been completed accurately while others had not. It is difficult to ascertain how the charts influence the care and support provided by staff. Part of the concerns raised to us related to the removal of a call bell. This resulted in one person not being able to summon help from staff. On this inspection we observed that not everyone in their rooms or in some communal areas had access to a nurse call bell. Where people are not able to use a call bell this should be documented in the care and alternatives should be consider for example increase the frequency of staff checks or alternative call bell fitments. The care plans showed that people living at the home have access to other health professionals including GP, dentist and chiropody. During the inspection we observed the care and support afforded to some people at the home. During the inspection it was noted that some people were frail and as such were nursed in bed. During the inspection it was noted that these people received an adequate level of care including a change of position. A regale change of position helps in the prevention and development of pressure ulcers. The majority of people had access to fluids. It was noted that some people in one communal areas did not have access to fluids. Despite an adequate level of care being provided during the inspection Care Homes for Older People Page 16 of 33 visit it can not be confirmed that this is provided on all occasions. Since the last inspection we have received on going concerns and complaints form a variety of sources. A number of these relate to the direct care provided to people living at the home. Specifically these relate to continence care, pressure area and wound care, levels of personal care and poor moving and handling practices. We have discussed these concerns with the home management. It has been agreed that the management will continue to monitor the care and support provide. In addition we will continue to review the care and support given in conjunction with the local social services. feedback from surveys received and from people spoken to during the inspection visit was very mixed. Some people were very complimentary about the care and support provided whilst others confirmed the concerns received by us. During this inspection staff were seen interacting kindly to residents and were seen knocking on doors before entering. We did not inspect the systems for medication on this occasion. At the last inspection it was reported The homes procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in individuals bedrooms, had been marked with an expiry date however the MAR chart not been signed to confirm that the creams had been applied as per the Prescription. This is recommended. On viewing the MAR charts it was evident that at least one person was an insulin dependant diabetic. On one occasion the blood sugar for this individual was low. Staff had taken appropriate action in response to this. The preprinted MAR charts are delivered by the pharmacy on a monthly basis. There may be occasions during the month that these have to be amended say for example when a GP visits and changes the dose required or introduces a new medication. When this occurs staff have to hand write the new drug onto the medication record. It is good practice that when this occurs the hand written entry is checked by another person to ensure it is accurate. This reduces the risk of drug errors. For at least one person living at the home a GP had visited and altered the prescribed medication. Staff had not re written the new prescription in full merely changed the dose on the existing entry. This had not been checked by a second person. It is recommended that staff rewrite the prescription in full and ensure that this is checked by a second staff member. As previously stated this will reduce the risk of medication errors. Care Homes for Older People Page 17 of 33 Care Homes for Older People Page 18 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 the 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 have the opportunity to join in with a range of activities although the opportunity to undertake daily living tasks needs to be developed. All staff need to have an awareness of peoples social history and preferences. The opportunity to make choices needs to be developed Visitors are made welcome at the home. Evidence: The care planning system has been updated and reviewed since the last inspection. This contains space for documenting social and recreational historys. Staff now need to be proactive in ensuring that peoples social historys and preferences are obtained. Some information was available in three of care plans examined but none in the others viewed. Information provides staff with very useful information about peoples lives, interests and preferences. Staff spoken with said that they found this information very helpful and that it gave them a better understanding of the people living there. The home employs an activities co ordinator. Care Homes for Older People Page 19 of 33 The home has a programme of activities and a copy was made available to us. This offered a good range of group activities and also offers one to one time with people. Individual records are maintained for people relating to activities undertaken. Surveys returned to us prior to the inspection however stated that people living at the home would appreciate a wider range of opportunities being made available to them. The management need to consider this. The home also displays a list of forthcoming events. Throughout the day we spent time observing staff interactions with people living at the home. No activities were on offer on the day of the inspection visit but we observed staff spending time with people. Activities in some areas need continued development. During the inspection it was noted that staff set the tables for lunch. There would be no reason why people living at the home could not have been supported by staff to help with this task. Research into dementia has shown that being supported to continue to complete daily tasks such as making tea, snacks and setting tables helps to support a sense of well being, independence and skills. Relatives spoken with informed us that they were always made to feel welcome at the home and could visit at any time. They told us that they were offered refreshments and could have meals with their relative if they chose to. During this inspection we were able to observe the mealtime experience. The mealtime appeared to be relaxed and unhurried. Staff were observed assisting people in an appropriate and dignified manner. The days menu was available in each area of the home. This needs to be developed in the area providing support to those with dementia. People with dementia may not be able to make verbal choices about the meal that they would like. The staff need to consider developing aids such as photographs and pictures to aid communication. A range of snacks is available at any time. One person who had lost weight recently was observed to have appropriate supplements supplied by staff. The lunchtime meal looked very appetising and plentiful. Soft diets had been attractively presented. Hot trolleys are used to ensure that meals are served at an acceptable temperature. Feedback with regard to the quality of meals was mixed with some people stating that the food provided was of a good quality whilst others stating that the food was not up to an acceptable standard. It should be noted that on the day of the inspection visit the food was of an acceptable standard. As previously stated not all people had access to fluids at all times during the inspection. One of the complaints received by us relates to access to fluids. Care Homes for Older People Page 20 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A number of concerns and complaints have been received with regard to the care and support afforded to people living at the home. Appropriate systems are in place to allow people to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to people living there. Evidence: As previously stated we, CQC, have received a number of concerns and complaints with regard to Frome Care Village. These concerns and complaints have come from a number of sources including people living at the home, ex staff members and relatives. The concerns relate to continence care, moving and handling practices, access to fluids, wound and pressure area care, odours and the cleanliness of the home, staffing levels and one incident of abuse. A number of these concerns are currently being investigated in conjunction with Somerset Social Services. PSP Healthcare the owners of Frome Care Village have given reassurances that they are committed to ongoing improvements at the home and take any concerns seriously. Despite these assurances it remains concerning that the concerns and complaints continue to be received. PSP now need to ensure that they improve the quality of care and support provided. We will continue to liaise with the local services department to ensure ongoing improvement. Care Homes for Older People Page 21 of 33 The home has a complaints procedure available in the home. Relatives, staff and people spoken with during the inspection, did not express any concerns. Relatives and staff stated that they found the acting manager very approachable and would not hesitate in raising concerns if they had any. At the time of this inspection the home was taking appropriate steps to reduce the risk of harm or abuse to people living there. Staff are aware of how to raise concerns and have access to a range of appropriate policies and procedures including whistle blowing and adult protection policies. Staff have been provided with training in these areas. Abuse training is also covered during the induction period. Care Homes for Older People Page 22 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although plans are in place for the redevelopment of the home the management need to ensure that the current homes remain in a good state of repair. The management need to ensure that the home is free from odours and a good standard of cleanliness is maintained at all times. The management need to ensure that there is an adequate supply of equipment to ensure the spread of infection is limited as much as possible. Evidence: PSP purchased the home in 2008. When PSP purchased the service some of the environment was in a poor state of repair and not fit for purpose. We have been told that PSP healthcare have submitted plans to the local planning department to totally re develop the site. This will include a new nursing home for people currently living at the home. Close care flats and bungalows will also be available. This redevelopment will require substantial investment from PSP Healthcare. We have not yet had any firm timescales for the development of the site. Despite this initially PSP recognised that some investment was required to ensure that the current home remained fit for purpose. Some redecoration and upgrading had been completed. Since the last inspection we had been informed that the home was without heating and hot water for a period of time. As a result of this the boiler system in one part of the home has been replaced. We have also been informed that one lift in one Care Homes for Older People Page 23 of 33 area of the home is problematic. Due to the expense of these two repairs the ongoing updating and refurbishment of parts of the home have not progressed as we had expected. As a result parts of the home are in a poor state of repair with poor decor. This is particularly notable in parts of the Parsonage. During the inspection we noted that the flooring in one part of the parsonage was torn. This would cause a trip hazard. In addition some very hot pipes were noted coming from the boiler. This was in an area accessible to people living at the home. This is a burn hazard. Both these issues could place people at risk. These two hazards were bought to the attention of the home manager at the end of the inspection. Part of the concerns that we have received by us relate to the cleanliness of the home and malodours. These concerns have been passed to PSP healthcare who have assured us that they have plan a deep clean of the whole home to deal with this issue. In addition the home has reviewed the system for ongoing cleaning at the home. Cleanliness and odours at the home need to be kept under review to ensure that the home provides a pleasant environment for people to live in. It is advised that PSP Healthcare consider the use of signs/pictures in the dementia unit to assist people with orientation. On the day of the inspection system were in place to prevent the spread of infection. Supplies of aprons and gloves were freely available. Concerns raised to us stated that this was not always the case. The management need to keep this under review to ensure that there are adequate supplies of equipment at all times. Care Homes for Older People Page 24 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels may not be adequate at all times. Mandatory training is in place but the provider needs to assess the skills and competencies of the registered nurses. staff recruitment systems are satisfactory. Evidence: During the inspection visit a copy of staff training matrix was supplied to us. This showed that the majority of staff have received all mandatory training. At the last key inspection it was identified that the registered nurses may not have the skills and competencies to meet the needs of the people living at the home. At this time it was recommended that the management conduct an audit of the skills of the registered Nurses. Given the issues discussed in outcome area two Health and personal care with regard to pressure area care and the ongoing concerns/complaints received by us it is this recommendation remains. Since PSP took over the service there has been a relatively high turnover of staff. This is not uncommon in homes with a change of management style. Due to the high staff turnover the numbers of registered nurses at night have been reduced on some occasions. This has resulted in one registered nurse being available for the two areas (nursing and dementia care units). We consider that this may not be adequate. On the day of the inspection there were 52 people living at the home. We asked the provider Care Homes for Older People Page 25 of 33 PSP Health care to review the numbers of registered nurses on nights. PSP Health care have provided us with details of how they are managing this situation. This has included the registered nurse on the evening shift completing the evening medication round and the details of how care staff can contact the registered nurse in the event of an emergency. PSP Health care informed us that they are currently trying to recruit registered nurses to cover the vacant night shifts. Although there is currently no evidence that people have been adversely affected by these arrangements we consider that there remains a risk to people at the home. PSP Healthcare need to keep the arrangements under review and should consider the use of agency staff to ensure that two night Nurses are available on all occasions. We reviewed four staff recruitment files. All staff files contained necessary recruitment checks including Criminal Record Bureau and POVA checks in place. A robust system is in place to ensure that all new staff have these checks completed prior to commencing employment at the home. All new staff employed have received an in depth induction. Care Homes for Older People Page 26 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 the 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 service has a manager who is not yet registered with us. The new manager now needs to address some of the concerns raised in this and previous reports. The service needs to ensure that the level of care and support provided at the home is an adequate standard. Evidence: Since the last key inspection the registered manager had left employment. As such the home was without a registered manager for a period of time. For this period PSP healthcare offered support to the home. A new manager has now been recruited and has been working at the home for three months. The new manager, Jill Holmes, is yet to register with us although the application is in the process of being completed. Due to changes in the registration processes it would be in the best interest of the manager to complete her application as soon as possible. Care Homes for Older People Page 27 of 33 Ms Holmes is a registered nurse with experience in the care of older people. In addition to Ms Holmes there are two Registered Nurses who take the clinical leads for the two areas of the home. As previously stated since the last inspection we have received a number of complaints and concern about the care and support provided at the home. One of these concerns related to a lack of heating and hot water ( As previously stated this issue has now been rectified) Another of the concerns related to a broken lift. Under Regulation 37 of the Care Home Regulations the management/ provider must inform us of any adverse event effecting people living at the home. We did not receive notification of either of these events. The management must ensure that all notifications are received in line with regulation 37. Due to the numbers of concerns and complaints that we have received the management must ensure that the quality assurance systems that are in place robustly monitor the standards of care and support afforded to people living at the home. In addition a number of requirements made at the last key inspection and the more recent random inspection remain. In order to avoid enforcement action being taken by us these issues now need to be addressed. Under Regulation 26 of the care home regulations the provider of care homes need to visit at least monthly to assess and monitor the services provided. Providers need to prepare a written report of this visit. To help us monitor progress at home a requirement has been made at this inspection for this report to be forwarded to us until further notice. We did not review the arrangements for the safe keeping of personal finances on this occasion. At the last inspection it was reported We were informed that the home does not act as appointee for any people living there but manages small amounts of spending money for people. We looked at the records relating to this and found them to be well maintained. Details of transactions and balances are maintained in computerised format on an individual basis. Statements are forwarded to individuals relatives or representatives as appropriate, on a monthly basis. At last inspection a system of staff supervision had been developed. Due to the lack of a registered manager not all staff have received recent supervision. The new manager told us that she hoped to reintroduce this to all staff in the near future. Health and safety arrangements were not viewed on this occasion. These were Care Homes for Older People Page 28 of 33 satisfactory at the last key inspection visit. Reference should be made to the outcome area relating to environment with regard to the torn flooring and exposed hot water pipes. Action needs to be taken to address these issues to ensure the health and safety of people living at the home. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes 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 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 8 12 11/02/2010 The management need to continue to monitor the care and support provided at the home to ensure that an adequate level of care is given at all times. This should include continence care, wound care, moving and handling systems and personal hygiene needs. This will ensure that the needs of people living at the home are met to an adequate level. 2 8 12 The management need to ensure that all staff are aware of the care needs of 12/02/2010 Care Homes for Older People Page 30 of 33 the individuals living at the home. This should include knowledge of wounds and pressure ulcers. This will ensure that people living at the home received the correct support and care from staff. 3 26 13 The management must ensure that there is an adequate supply of liquid soap, paper towels and aprons at all times This will reduce the risk of the spread of infection. 4 19 16 The management need to 26/02/2010 ensure that the environment remains fit for purpose. This should include the decor, fixtures and fittings. This is particularly relevant to the Parsonage. This should include the accessible hot water pipes and torn flooring. This will ensure that people live in a safe and pleasant place. 5 27 18 PSP healthcare must ensure 12/02/2010 that there are adequate numbers of registered nurses on duty at all times including nights to meet the needs of all people living at the home. This will ensure the health and well being of people living at the home 6 33 26 Regulation 26 visit reports should be forwarded to CQC on a monthly basis until further notice 27/01/2010 11/02/2010 Care Homes for Older People Page 31 of 33 This will help us monitor the care and support provided at the home and monitor any improvements 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 2 3 8 8 14 All people at the home need to have access to fluids at all times. All people should have access to a nurse call bell at all times The staff need to develop systems which allow people to express choices and preferences. This could include the development of pictures and photographs The management need to monitor the standard of food at the home to ensure that this at an acceptable standard at all times. It is recommended that the management conduct an audit of the competencies of the Registered Nurses to ensure that they have the clinical skill and competencies to meet the needs of the people living at the home. PSP Should consider using agency staff to supplement the current staffing levels on nights. All staff should receive regular supervision 4 15 5 27 6 7 27 36 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. 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