Inspection on 04/02/10 for Garden Hill Care Home

This inspection was carried out on 4th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garden Hill Care Home 05/08/09

Garden Hill Care Home 03/09/08

Garden Hill Care Home 23/10/07

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

Key inspection report Care homes for older people Name: Address: Garden Hill Care Home 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Irene Bowater     Date: 0 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Garden Hill Care Home 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN 01914975255 01914975269 gardenhill@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross OPCO Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 40 Date of last inspection Brief description of the care home Garden Hill is a large detached three storeys building in South Shields set in its own grounds. The home can provide general nursing and social care for up to forty people. The home does not provide intermediate care services. There are lounges on each floor and the main dining room is on the ground floor. Bedrooms are on each floor and all are en-suite. Throughout the home are specialist bathing and toilet facilities and there is easy access to the gardens and car park. The gardens are to the front and side of the property with a car park to the front. There is a lift provided which enables people to get to the different floors. An emergency call system is provided in all bedrooms. It is situated in a residential area and convenient for the town centre of South Shields. It Care Homes for Older People Page 4 of 38 Over 65 40 0 Brief description of the care home is close to local train and bus transport. The seaside, shopping outlets, local theatres and social amenities are close by. The local shops and a post office are within easy walking distance of the care home. Fee rates vary in the home dependent upon whether you are receiving nursing or social care. Personal items such as clothing, toiletries, newspapers and outings are not included in the fee rates. Care Homes for Older People Page 5 of 38 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: Before the visit we looked at information we have received since the last visit on the 5 August 2009 and 10 December 2009. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service,their relatives,staff and other professionals. We checked the cost for people living in the home.And the fee rates vary from 438 pounds for social and personal care pounds to 544.30 pounds per week for nursing care. Items such as toiletries,clothing,newspapers and hairdressing are not included in the fee rate. We have reviewed our practice when making requirements,to improve national consistency. Care Homes for Older People Page 6 of 38 Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. The Visit. An unannounced visit was made on the 4 February 2010. This visit was carried out by two inspectors and took eight and a half hours to complete. During the visit we: Talked with people who use the service,staff,relatives and the manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records,which must be kept. Checked that staff have the knowledge,skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean,safe and comfortable. We told senior management and the new clinical nurse lead what we found. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: All pre admission information needs to be developed into a care plan that will support staff to meet the needs of individuals. Care plans need to be detailed, person centred and up to date. This will enable staff to provide more individualised care. Also care staff need to be able to access the care plans so that they know what support and care to give. The advice of specialists needs to be sought, recorded and followed so that people receive a good standard of care. And make sure that falls risk assessments are completed and those who are at risk referred to the falls specialist without delay. Staff need further training in the management of medication. Ensure that everyone is given the opportunity for meaningful social activities and choice in their daily routines and are treated with respect and dignity. The mealtime experience needs to be reviewed. All food provision must be recorded. This is to include fortified and specialist diets. People who have weight loss or poor appetite must have weights regularly recorded and care plans put in place so that their nutritional needs are always met. All concerns and complaints need to be listened to and all actions and outcomes must be clearly recorded. Staff need to follow Local Authority guidance should there be any allegation or suspicion of abuse. All specialist,safeguarding adults and mandatory training must be brought up to date. All staff must have further training in how to respond to complaints and be given training in whistle blowing procedures. Repairs are needed to the shower room flooring and an en-suite toilet.And all rooms must be maintained at a constant, appropriate temperature. Care Homes for Older People Page 8 of 38 Selection and recruitment procedures must be followed so people are protected. Ensure that there are sufficient staff,on a consistent basis,to meet the dependency needs of people living in the home.And make sure staff are suitably qualified and competent to meet health care needs and promote their welfare. Staff must be supported to feel confident that they will be able to meet peoples needs in a professional manner,taking the principles of a person centred approach to care into account. The recruitment of an experienced manager is needed to consistently improve and develop the service and quality of care for people living in the home. Regular meetings with those using the service,relatives and staff need to start so that everyone can understand how the home is to develop and people can express their views. Quality assurance and monitoring systems need to be started. A programme of regular, formal supervision must be implemented to ensure all grades of staff are clear about their roles and responsibilities. All records must be available,clear, up to date and kept in accordance with the Data Protection Act. The Commission must be informed of any event which affects the health,well being and welfare of people living in the home. This includes accidents and deaths. The requirements and recommendations from the last inspection need to be addressed as a matter of urgency. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 38 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 38 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Without personalised and comprehensive assessments peoples diverse needs have not been identified and planned for when they move into the home and staff have not had any specialist training which means there has been a shortfall in care provision. Evidence: Everyone who lives in the home should have detailed pre admission assessments which have been carried out by the care manager,home manager and where necessary the nurse assessor.None of the preadmission information was available in the current plans. Four peoples care was case tracked from admission.None of the assessments were completed in detail.Dates and signatures of staff were missing and some of the information provided was difficult to read. Information about mobility was confusing as the assessment states does not walk Care Homes for Older People Page 11 of 38 Evidence: anywhere but then says has poor mobility and then says walks with two persons. One person has breathing difficulties,however the assessment is not completed and staff would not know what action to take should the person need assistance. Assessments state that some people are at risk nutritionally, but the risk tool (MUST) was not completed. Another assessment states that a person has poor appetite and then states has a good diet. Assessments that say people have memory loss,can be aggressive both verbally and physically, are brief and do not identify any triggers. Assessments miss important information about life histories,likes,dislikes, and cultural needs.Without this information a person centred approach to care delivery cannot happen and peoples needs will not be fully met. Assessments that showed people would exhibit behaviours that may challenge did not gave an initial plan of care. Given the complex needs of those being admitted, the staff have not had any specialist training or advice from falls specialists, tissue viability nurses, and dementia care specialists. The home provides a service for people with dementia ,however,staff have not had the training to be able to give a good quality care. Care Homes for Older People Page 12 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of detailed planning and recording of care means that people cannot be sure that their health and personal care needs will be fully met and puts them at risk of harm. Evidence: Four care plans were examined.The assessment tools include information about the following: pressure ulcer risk,dependency,moving and handling,nutritional assessments, using the Malnutrition Universal Screening tool(Must),continence and falls risk including moving and handling information. Care plans are generally updated on a monthly basis but are difficult to follow.Furthermore the evaluations do not show how the nurse has arrived at a conclusion about any deterioration or improvement in peoples care. Also, the care plans have been the domainof the qualified nurses and senior care staff. This means care staff do not know what the plan of care is for service users and vital information is not passed on, so care delivery is not effective. Care Homes for Older People Page 13 of 38 Evidence: Comments include,no problems for incidents and accidents when in fact this person has fallen out of bed on numerous occasions. And, despite a request for specialist advice from the falls team and request for a profiling bed nothing was done from May 2009 until February 2010.When when trying to cross reference to the accident book,not all of the accidents have been recorded appropriately . Care plans,for eating,drinking and weight loss are contradictory.One plan states normal diet but this person is on thickened fluids,has lost weight and has poor dietary intake.There is no evidence to show that other professionals have been involved or that staff have offered high protein foods and offered extra snacks and milky drinks. Another states that a person takes supplements, has poor diet, then states has a good diet but then has a weight loss, with again, no evidence that other professionals have been involved. The care plan states liaise with the GP and dietician, if significant weight loss.This person was seen by the dietician in August 2009 and advice given to encourage high protein diet, add milky drinks, forticremes and extra Calogen but this has not been transferred in to a plan of care.There is no record of any further input by the dietician. Information about mobility is confusing as one plan states does not walk anywhere but then says walks with two persons.This person was observed to walk quite well with support of two staff at lunchtime. Staff are not provided with sufficient information about which hoist, sling, and slide sheet to use. This could result in the wrong equipment being used and cause injury. Several people living in the home have a dementia type illness.Care plans detail orientate to time and person and give reality orientation, may become aggression especially when being put to bed and can be verbally and physically aggressive. This information has not been transferred into a plan of care and staff have no information of what to do should someone become anxious or distressed. Plans to prevent pressure damage are not clear, for example says to turn two hourly overnight, the charts are not always completed and the information is not always correct. Qualified staff are not seeking specialist advice and service users are not having Mental Capacity Act assessments.Professionals have not been involved in any decision Care Homes for Older People Page 14 of 38 Evidence: making regarding do not resuscitate (DNAR). Concerns have been raised about the rooms being cold and it was found that the staff were turning radiators down or off because they were too hot. On arrival at the home the corridors and stairwells and one persons room in particular was cold.This persons bed was directly under two windows which were open on a bitterly cold February morning.The windows were immediately shut and the person was given a hot drink and the bedding tucked up around her.She was fully clothed under the bedding and said had been up and put back to bed by the staff. At 8:00 am ten people were up ready for breakfast either sitting in the lounge or dining room and two people were up and dressed sitting in their rooms. Another person said she was desperate to get up but knew she would have to wait and wait and this was taking away her privacy and dignity. Care plans still focus on a medical model of care and they do not show how a person centered approach to care is to be delivered. Following safeguarding concerns in December 2009 a Pharmacist from the Commission completed an in depth inspection of medication management by the staff.And staff have been given timescales in which to put things right.A further visit will take place to make sure that appropriate action has been taken. None of the care plans showed that staff had discussed end of life care with individuals and their relatives.There was no evidence to confirm that medical advice had been sought regarding do not resuscitate (DNAR). Staff have not completed any training in end of life care. Care was delivered in private,however the main focus for staff is managing daily routines with little or no time for individualised care provision. Care Homes for Older People Page 15 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited and the mealtime experience is not organised. This prevents people from leading full and active lives and could compromise peoples nutritional status. Evidence: There is an activity organiser who plans social events and there is photographic evidence of past events.There is a weekly activity programme which people can join in if they wish. None of the care plans had information about previous lifestyles or current aspirations and there was only limited information available in the weekly record. Some people said they had enough to do and preferred their own company.Others said the music being played was not to their taste but it was better than listening to people shouting out all of the time. Another person said they never got out of their room as they did not have a suitable wheelchair.They spend all of the time in bed, unable to see out of the window. Care Homes for Older People Page 16 of 38 Evidence: On the first floor many people are being nursed in bed all of the time and there was no evidence of any meaningful one to one or other activity. Others said that they have to wait and wait to get up and have to wait in turn.One person said that they felt their dignity and privacy was being taken away. Bedrooms have been made homely with small personal items and visitors were seen to come and go throughout the day. There is one main dining room on the ground floor which is small and cramped and there is a small coffee room area which is being used at mealtimes. Breakfast time was generally well managed with people having the choice of cereals, porridge,toast,a cooked breakfast with choices of drinks. Lunchtime was protracted,starting before midday and finishing over a hour and a half later. Care staff tried their best but some people had to wait for a considerable time to be supported to eat their meal.Some meals became cold and others left some of the meal as they could not manage. Also staff had to make sure all of the people being nursed in bed had a meal which added to the time it took to finish lunch. Neither qualified nurse was available throughout the mealtime which meant there was no direct supervision and their assistance would have made the mealtime a more pleasant experience. The majority of people need assistance and support to transfer from the dining room to their preferred sitting area,two of them became distressed at having to wait in turn to be helped. The lunch time meal offered choices and was well presented and of ample portion size.People spoken to said it was a nice dinner,meals are enough and warm, and I get plenty to eat. Care Homes for Older People Page 17 of 38 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. Complaints and safeguarding issues have not been well managed and leave people at risk of harm. Evidence: There have been five safeguarding alerts made to the Local Authority since December 2009.This resulted in various meetings with care managers,families,CQC and other professionals. Investigation by the Local Authority safeguarding team resulted in CQC carrying out a random inspection in December 2009.This raised concerns about the health, safety, and welfare of those living in the home. Further concerns were raised with senior management on the day of the site visit. The providers and staff are currently working with all parties to put the issues right. Relatives said they were not listened to and when raising concerns nothing ever changed. Four complaints recorded in December 2009 were not fully recorded.There were no dates,signatures,investigations or outcomes recorded. There was no evidence to show that staff have completed safeguarding training which links into the Local Authority guidance and staff have not completed training in dealing with behaviours that may challenge. Care Homes for Older People Page 18 of 38 Evidence: Although the Company has a whistle blowing policy staff did not feel they could raise concerns with the provider. This means concerns about care practices and management have not been acted upon until a safeguarding alert was raised with the Local Authority. Care Homes for Older People Page 19 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally comfortable and clean,providingpeople with a pleasant place to live in. Evidence: The home has lounges,bedrooms,toilets and bathing facilities spread over three floors.On the ground floor there is a dining room and a coffee lounge.The communal areas are pleasantly decorated and furnished. The majority of the people living in the home use the lounge on the ground floor. This makes this area quite cramped with everyone huddled together.Some may like to spend some time in the upstairs lounges,which are very pleasant and spacious. This would mean they had more room to have visitors and have a little more privacy. Any changes would have to be with individuals consent. Bedrooms all have an en-suite toilet and wash basin.One toilet had been out of use for some time and the person felt that her right dignity and privacy was not being met. This person was offered an alternative room until repairs could be made but she preferred to remain where she was. Not all of the shower and bathing facilities were in use as some flooring needs to be replaced. Care Homes for Older People Page 20 of 38 Evidence: On arrival at the home the corridors and stairwells and one persons room in particular was cold.This persons bed was directly under two windows which were open on a bitterly cold February morning.The windows were immediately shut and the person was given a hot drink and the bedding tucked up around her. Call bells are now in place throughout the home,however those in the communal areas are clipped to the wall and cannot be reached in an emergency. The laundry is compact but is clean and organised. Liquid soap and paper towels are readily available for staff to use. Staff said they were not sure if they has completed Infection Control training but were clear that care staff would inform them should there be outbreak of infection.And they were able to say what action they would take to minimise risk. Most of the areas have foot-operated bins with lids to prevent spread of infection. On the day of the visit the home was clean and odour free. Care Homes for Older People Page 21 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems around selection,recruitment and training are inadequate to meet the range of needs of the people using the service. This means that peoples lifestyles are restricted and overall detrimentally affects their quality of life. Evidence: On the day of the visit there were thirty five people living in the home.Twenty people require nursing care and fifteen receive personal and social care.Four people were in hospital. Staffing levels consisted of two qualified nurses,one was the deputy manager,seven care staff,two domestics,one laundry assistant,kitchen assistant,agency cook,activities organiser and maintenance person.The administrator was on sick leave and the manager arrived about nine am. A review of the off duty shows regular sickness with one week ninety nine hours recorded and another week shows sixty six hours on day duty and twenty two hours overnight.The shortfalls have usually been covered by various agency staff or the home staff covering extra hours. Staff have been allocated floors but there is no named nurse or key worker system used in practice. Care Homes for Older People Page 22 of 38 Evidence: Staff said the first floor is the heaviestwith nine people nursed in bed all of the time and when staff from the second floor have finished getting people up they will come and help. The design of the home makes deployment and supervision of staff difficult especially as a member of staff is allocated to stay in the downstairs lounge at all times. Despite there being nine members of staff on duty there was little evidence to show that the nursing staff were involved in care delivery apart from dispensing medication. Care was delivered on the routine rather than in an individualised manner.For example,there was a toileting regime before meals and mealtimes were rigid. Four staff files were examined. File A. This showed, staff induction in September 2009 with information about nursing qualifications and proof of identity.The application form was incomplete and the gaps in employment were not explained.There were two references but not from the people that were on the application form.There was evidence that the Criminal Record Bureau (CRB)check had been sent off in September 2009 but no evidence that it had been returned. File B.This showed a completed application form and induction in March 2009.There was proof of identity,job description two references and an interview checklist.The file also showed training records which included moving and handling,fire awareness,food hygiene,and safeguarding training. File C.This showed a completed application form,proof of identity,work permit and only one character reference.There was no CRB information or proof of nursing qualifications. Training records showed only moving and handling, and continence training in September and October 2009. File D.This file had no information regarding recruitment and training. There was no evidence of specialist training and mandatory training is not up to date.Information regarding National Vocational Qualifications was not available. People have been admitted with dementia and other specialist needs but staff have had no training to care for complex needs such as Parkinsons Disease,Multiple Care Homes for Older People Page 23 of 38 Evidence: Sclerosis and Dementia. Care Homes for Older People Page 24 of 38 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. Lack of consistent leadership and management has placed people who use the service at risk of harm. Evidence: The home has been without at registered manager over eighteen months.During this time managers from other services have been brought in to manage for short periods. A manager was appointed in April 2009 but she has not completed an application to become registered. A warning letter has been sent to the provider regarding the lack of long term management arrangements in the home. There has been a lack of leadership and staff have had little direction and supervision and have been unsure what is expected of them and then doing what they think is right. Care Homes for Older People Page 25 of 38 Evidence: The focus of supervision has been the task, getting the job done without looking at the individual needs of those using the service.Also the level of sickness,lack of support from senior staff and use of agency staff have added to the problems. Staff meetings have consisted of telling staff what they are doing wrong, without giving guidance and support ,which has affected the staff team and morale in the home. Staff need to be given clear direction about the aims of the service and be informed through supervision and training of the policies, procedures and ethos of the home. Quality assurance and monitoring systems have not been completed. Staff and people using the service cannot be confident that their views are listened to or valued. There is little evidence that regular meetings have been held for some time.Regulation 26 visits have not been completed since October 2009. There have been no concerns raised about how staff manage peoples personal money and systems are in place to regularly audit the accounts. External service certificates are available and internal maintenance checks are completed on a weekly and monthly basis. We could not find any evidence to show that staff have completed mandatory training, although fire drills have been completed. On arrival at the home at 8 am, twelve bedroom doors were held open by various means including chairs,foot stools,plastic door stoppers,bed tables and a chair cushion.This was discussed with senior management who are going to provide door closures which link into the fire alarm system. Accident and incident forms are available.These are incomplete,some are not dated or signed, and there has been no investigation or follow up in regard to falls from beds or falls resulting in skin damage. Information about deaths,admissions to hospital and accidents has not been consistently reported to the Commission. Care Homes for Older People Page 26 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered persons must 01/02/2010 ensure that the care plans are reviewed at least monthly, are person centred and reflect how current and changing social and health care needs will be met. This is to make sure that staff plan and review how they work with people so that everyone in the home works in the same way to ensure peoples needs are being met. 2 8 12 The registered persons must 10/01/2010 ensure peoples nutritional health status be monitored and any changes recorded and updated in care plans. Fluid balance and food charts must be completed in detail to evidence practice. Moving and assisting risk assessments and plans must be detailed. People who have poor appetites and or diet must be reviewed by professionals and their advice acted upon. This will ensure people remain healthy and their health, welfare and safety Care Homes for Older People Page 27 of 38 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 and safety is not compromised. 3 9 13 The registered person must make arrangements to ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. This will safeguard the health and welfare of people living in the home. 10/01/2010 4 9 13 The registered person must ensure that all medicines be stored correctly at temperatures recommended by the manufacturer Staff will then know that these medicines are safe to use when needed. 10/03/2010 5 9 13 The registered person must make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. This will maintain secure storage and prevent misuse 10/03/2010 Care Homes for Older People Page 28 of 38 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 of controlled drugs. 6 15 12 The registered persons must 01/02/2010 review the organisation of mealtimes. And make sure that people are offered choices and alternatives for all meals which are available at flexible times. This will make sure people receive a wholesome balanced diet which meets their assessed needs. 7 33 12,24 The registered person must develop systems to make sure staff understand their roles and responsibilities when on duty. This will make sure that the home is run in the best interests of the people living in the home. 01/02/2010 8 36 18 The registered person must 01/02/2010 ensure that all staff receive formal supervision and ensure that staff are directed and supervised in every day practice. This will ensure everyone living in the home receives a high standard of care at all times. Care Homes for Older People Page 29 of 38 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 3 14 Each person must have a comprehensive assessment of their health and social care needs when admitted to the home. This will make sure that the staff know how to care for individuals and people can be sure their needs will be met. 30/04/2010 2 4 18 All staff working in the home 18/06/2010 must be provided with appropriate specialist training. This will make sure that peoples complex needs will be met. 3 7 15 The care plans must be up to date, detailed, reviewed at least monthly, be person centred and reflect how current and changing social and health care needs will be met. Revised 01/04/2010 Care Homes for Older People Page 30 of 38 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 Requirement. This is to make sure that staff plan and review peoples care so that staff can give a good quality of care. 4 8 13 Peoples psychological health 25/03/2010 must be monitered and advice sought from medical and nursing specialists. Medical advice must be sought before deciding Mental Health and DNAR status.All visits from other professionals must be recorded in detail and their recommendations actioned. This is to make sure that the home promotes and maintains peoples health. 5 8 17 Nutritional screening must 25/03/2010 be completed and a record maintained of nutrition, including weight gain and loss maintained.Advice from other specialists be implemented into a plan of care.And food and fluid charts must be completed in detail. This will make sure individuals nutritional status is met. Care Homes for Older People Page 31 of 38 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 6 8 13 Risk assessments and the incidents of falls must be accurately recorded and those identified at risk referred to specialist services. This will make sure people receive appropriate treatment and they are protected from harm. 25/03/2010 7 8 12 Wound and pressure ulcer care must be recorded and any deterioration or improvement recorded and reviewed on a continual basis. This will make sure that individuals receive the appropraite treatment following the advice of other professionals. 25/03/2010 8 9 13 Medication requirements 31/03/2010 issued by the Pharmacy Inspector on the 10 December 2009 must be met within timescales given. This will safeguard the health and welfare of people living in the home and this will maintain the secure storage and prevent misuse of controlled drugs. Care Homes for Older People Page 32 of 38 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 9 12 16 Ensure that everyone living in the home has the opportunity to enjoy social activity which is recorded in a plan of care. This will make sure people are able to make decisions about their daily routines. 25/03/2010 10 14 12 Ensure that everyone is given the opportunity for choice in their daily routine such as when they get up and mealtimes. This will ensure that people are supported to have some control over their lives and their rights are respected. 25/03/2010 11 15 12 There must be a 25/03/2010 reorganisation of mealtimes and make sure that records of all food provided are recorded. This is to include fortified and specialist diets. This will make sure people receive a balanced diet which meets their assessed needs 12 16 22 All concerns and complaints 05/04/2010 must be recorded and details of actions and outcomes recorded within 28 day timescale. Care Homes for Older People Page 33 of 38 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 This will ensure that people will be confident that their views are listened to,recorded and acted upon . 13 18 18 Staff must have training in how to respond to complaints and be given training in whistle blowing procedures. And all grades of staff must complete safeguarding training which links into the Local Authority Procedural Framework. This will ensure people living in the home are protected from harm. 14 21 23 The bathrooms and en suite toilet must be repaired. This will make sure there are sufficient bathing and toilet facilities in use so that privacy and dignity is not compromised. 15 22 12 All call bells in all areas of the home must be easily accessible. This is to make sure people are able to access help at all times and they are protected as far as possible. 15/03/2010 05/04/2010 03/05/2010 Care Homes for Older People Page 34 of 38 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 16 25 23 The heating in all areas of the home must be maintained over a twenty four hour period. This is to make sure people living in the home live in safe,comfortable surroundings at all times. 08/03/2010 17 27 18 Staffing levels must be reviewed and based on the dependency levels and design of the home. And review staffing levels at peak times. This will make sure people receive appropriate levels of health care and they are kept as safe as possible. 05/04/2010 18 29 19 All staff employed in the 08/03/2010 home must complete thorough recruitment and selection processes including enhanced CRB checks. This will make sure staff are properly vetted and people living in the home are protected from harm. 19 33 24 Quality monitoring and quality assurance systems must be fully implemented. 05/04/2010 Care Homes for Older People Page 35 of 38 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 This will make sure that the quality of the service is regularly reviewed taking account of peoples views. 20 36 18 All staff must receive formal supervision at least 6 times a year with records kept. All staff must be supervised and directed as part of everyday practice. This will ensure people receive consistent care delivered by trained experienced staff. 21 37 17 All records including home 26/04/2010 and care plans must be kept up to date, secure and in good order. This will make sure peoples rights and best interests are protected in accordance with statutory requirements. 22 38 37 The Commission must 08/03/2010 informed of any event which affects the health,well being and welfare of people living in the home. This includes accidents and deaths. This is to make sure people are being protected from harm. 07/06/2010 Care Homes for Older People Page 36 of 38 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 23 38 18 All staff must complete first 05/04/2010 aid,infection control,first aid,food hygiene and moving and assisting training. This is to ensure the health safety and welfare of people working living and visiting the home. 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 7 The social history for each person should be developed so this information can be used to implement a person centred care service. A photograph of each person should be kept with the persons MAR to assist in identification. The homes medication policy should contain guidance on dealing with medication when people go on social leave. All medication received into the home or carried forward from the previous month should be recorded on the MAR and the entry dated and signed It is highly recommended that staff consult end of life care with individuals so that their wishes can be carried out. More than fifty percent of staff should complete National Vocational Training in Care level 2 or above. It is recommended that advice from the fire officer is sought regarding the use of door guards that link into the fire alarm system. 2 3 4 9 9 9 5 6 7 11 28 38 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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