Inspection on 27/08/09 for Gills Top

This inspection was carried out on 27th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gills Top 13/08/09

Gills Top 15/08/07

Gills Top 06/09/06

Gills Top 20/02/06

Gills Top 07/11/05

Gills Top 02/02/05

Gills Top 07/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Gills Top Scar Street Grassington Skipton North Yorkshire BD23 5AF     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: Carol Haj-Najafi     Date: 2 7 0 8 2 0 0 9 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 32 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 32 Information about the care home Name of care home: Address: Gills Top Scar Street Grassington Skipton North Yorkshire BD23 5AF 01756752699 01756751804 judith.gibbs@anchor.org.uk www.anchor.org.uk Anchor Trust care home 27 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Gills Top provides personal care and accommodation for up to 27 older people and is owned and managed by Anchor Trust. The home is a detached property within a short walk of Grassington village centre. The accommodation is purpose built and is spaced over two floors and all areas are accessed by a vertical passenger lift. The home is set in its own grounds. There is a car park to the front of the home. The weekly fees on 27 August 2009 ranged from £375.77 to £515.00 and did not include costs for hairdressing, chiropody, toiletries and newspapers and magazines. People who use the service/relatives and other interested parties are able to have access to inspection reports as they are displayed in the main hallway of the home. Information about Gills Top including current fees, a statement of purpose and service user guide are available from the home 0 Over 65 27 Care Homes for Older People Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.cqc.org.uk. We have reviewed our practice when making requirements, to improve national consistency. 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 last key inspection was carried out in August 2007. We carried out this key unannounced inspection earlier than planned because we received information that raised serious concerns about the home. We also sent a questionnaire for the home to complete but they did not complete this when we asked them to. We sent out surveys Care Homes for Older People Page 5 of 32 but none were returned. We completed an annual service review and decided that we should visit the home. Two inspectors were at the home for one day from 9:15am to 5:00pm. We spoke to ten people who live at the home, five visitors including two health care professionals, seven staff, the acting manager and a support manager. We handed out four staff surveys and these were returned to us before we left. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We observed how staff interacted with people who live at the home. Feedback was given to the acting manager and support manager at the end of the visit. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: A risk assessment could be completed for everyone who self medicates. This must identify that they know what they take, when to take them and the consequences of not taking them. It must also show that the person understands they must not leave medicines lying around where someone else may take them. Staff could receive suitable medication training to ensure their practice remains safe. This will make sure people get the right medication. Care Homes for Older People Page 7 of 32 CQC has recently been involved in a safeguarding investigation that has highlighted some concerns about Gills Top. The home did not follow safeguarding procedures and concerns were raised about recording and reporting systems. The safeguarding investigation revealed there had been other safeguarding incidents that had not been dealt with properly. Any allegations of abuse or other safeguarding incidences could be responded to and reported much more appropriately. This will make sure people who use the service are safeguarded from abuse. The safeguarding incidents within the home were not reported to the local safeguarding team, or to the CQC. There are also several accidents that should and were not reported to CQC. The temporary manager should have been given training in the safeguarding procedures as soon as it was determined she would stand in for the absent manager. The service could be managed, supported and monitored much better. Copies of reports that are written by the area manager during visits are to be sent to us so we can check the home is being properly monitored. This will make sure people who live at the home are protected. Information provided to people thinking about moving in to the home could include an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Gills Top. Information gathered during the initial assessment process could be detailed enough to develop a care plan which will help make sure peoples needs are known. The care plans of several people with high dependency needs had not been reviewed or updated to reflect the current support required. The care plans contained risk assessments but several of these were out of date and incomplete. The care plans could be further developed and reviewed on a monthly basis to ensure they remain up to date. This will make sure staff know what level of support they need to provide to people. The home had identified that this is an area where they need to improve. Daily records are written in different sections of the care plan so it is difficult to gain a holistic picture of how each person is or what they have been doing, and the records do not always contain enough detail. They could have more information about peoples welfare to ensure that when the care plan is reviewed the information used is up to date and current. This will help make sure peoples health and welfare can be properly monitored. Some people raised concerns about staffing levels and said they sometimes have to wait for support. Some felt that the home has changed because people who live at the home need more help than before but there are not more staff to provide the extra care. Staffing levels could be reviewed as peoples needs and dependency levels change. This will make sure there are adequate staff to meet the needs of the people living at the home. Staff could receive further training that will help them understand peoples needs and a higher percentage of staff could hold the NVQ level 2 award or above. This will help make sure staff are appropriately trained and peoples needs are identified and met. If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 32 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are satisfied with the support they receive when they move into Gills Top. Their needs are properly assessed as they move in but more information could be obtained before they move into the home, which would make sure their needs are fully known. Evidence: An information guide was seen during this inspection and it contained some of the information necessary to allow people to gain an understanding of what Gills Top has to offer. This document could be further improved by including an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Gills Top. We talked to one person who had recently moved into the home, and two relatives of people who had moved into the home. The person who moved in said they were happy with the move and knew all about the home before they moved in. Relatives Care Homes for Older People Page 11 of 32 Evidence: said they thought the admission was well planned and they received enough information about the home. Before anyone is admitted to Gills Top a basic assessment of the help and support they need on a daily basis is carried out. The information seen in the case files was very basic and did not contain a lot of detail. These assessment documents would benefit from more detail. This would then ensure that their needs could be met at Gills Top. Once admitted to the home a base line assessment is carried out, this is done within the first twenty four hours. This information was more detailed and explained what help was needed. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, people are happy with the care they receive. Care plans contain some good information but other important information is missing. The plans are not regularly updated, which could result in peoples care needs being overlooked. Evidence: We talked to people who live at the home. They are generally very happy with the care they receive. One person said, Staff are always popping in to see me in my room, Im very fortunate and lucky. Another person said, Were always told its your home. Its lovely with lots of banter and warmth. People told us they get good support with healthcare. Some people raised concerns about staffing levels and said they sometimes have to wait for support. Some felt that the home has changed because people who live at the home need more help than before but there are not more staff to provide the extra care. We have covered this in more detail in the staffing section of the report. We spoke to several visitors. They told us they are happy with the care people Care Homes for Older People Page 13 of 32 Evidence: receive. Staff also told us, in the main, the home provides good care although raised concerns about staffing levels. They said it is friendly and because it is a small home people know each other well. We spoke to two visiting professionals. They said they did not have any concerns about the home. One person said it satisfactorily meet peoples healthcare needs and follow advice. They said there had been occasional lapses in communication. The case files for five people were seen and each of these contained a care plan. The plan indicated what level of help and support was required by the individual concerned. Daily records are not consistently maintained and this means a holistic picture of the person cannot be developed. The care plans have not been reviewed every month so the accuracy of the care plans could not be determined. During the inspection several people with high dependency needs were identified and these care plans had not been reviewed or updated to reflect the current support that people need. The care plans contained risk assessments but several of these were out of date and incomplete. Staff meeting minutes from May 2009 confirmed that they had identified a problem with the care plans and some care plans had nothing in them and they need bringing up to date. A deputy manager from another Anchor home is working at Gills Top to support the acting manager. She has been allocated a task to review the care plans. She told us although she had only looked at one care plan, she has already identified that they need some work and one section is not being completed correctly. The staff were observed dealing with people throughout the day and it was clear that they were aware of the level of support required by each individual. They were seen to take their time, use the persons preferred name and explain what they were doing, especially if they were using equipment. People who live at the home knew the staff well and referred to them by name. Staff had good knowledge about the people who live at the home and were able to talk about their likes/dislikes and family members. People told us they have a bath at least once a week but some said they would like one more often. Staff said some people have a bath more often than once a week if this is identified in their care plan, and those that are identified as having a bath once a week are offered them more often when staff have time. Care Homes for Older People Page 14 of 32 Evidence: Medication is provided in monitored dosage boxes. The medication was found to be stored securely and the staff that dispense the medication have received training from the pharmacy. There was no evidence that this training was sufficiently detailed. One person was identified as managing their own medication, they had secure storage for this but there was no risk assessment in their file. Care Homes for Older People Page 15 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living at the home and have a stimulating and varied lifestyle. Evidence: People who live at the home told us everyone gets along. One person said, We all have a word with one another, were very happy. We have some fun. Another person said, I know when Im well off. We get good choice and lovely food. People also said they are happy with the level of activities. One person said, We do baking, drawing and have some good entertainers. Local community groups visit the home. One person who lives at the home showed us the September newsletter which gives people good information about Gills Top. People who live at the home actively contribute to the newsletter. Some people said the laundry service was very good. One person said, Its an excellent service. I get my clean clothes on hangers, and they always sew my buttons on and do little repairs. We received very positive feedback from relatives and friends. They told us they can visit anytime and are always made to feel welcome. One visitor said, Its lovely, we Care Homes for Older People Page 16 of 32 Evidence: are made to feel very welcome. Everyone we spoke to said that the food was exceptional. The meals are planned on a four weekly basis and suggestions are gathered from people in the home by the catering staff. They also discuss menus at meetings held by people in the home. The meals are mainly traditional but newer foods are being introduced such as lasagne and curry. Breakfast was a leisurely meal with people coming down to the dining room when they were ready. Likewise lunch was relaxed and people were assisted discreetly if they needed help. At the lunch meal there was a choice for both the main course and the sweet and people spoken with said the meals are wonderful they are always nice Special diets are catered for and advice would be sought from the dietician if staff thought there was a need for this. There is a cold water machine in the dining room and upstairs lounge and filtered coffee is available in the dining room all day. People are offered plenty of snacks throughout the day. Care Homes for Older People Page 17 of 32 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. Safeguarding practices are not robust and do not safeguard people who live at the home. Evidence: There is a comprehensive complaints procedure in place, which is displayed on the information board as well as being in the Service User Guide. All of the people we talked to said they would take any concerns to the manager or their key worker. A relative said they would not hesitate to take any concerns to the manager. They said the management were always available and they were confident any concerns would be dealt with properly. One person who lives at the home said they often talk to staff on an evening when they bring the drinks trolley around. There is also a minor complaints book this covers issues found on a daily basis such as water not hot enough, filtered coffee had run out, entrance ramp was slippery. Information was available in the book about the immediate action taken, any follow up action taken and the conclusion to the complaint. Staff said they always pass on concerns and usually get good feedback from management about what action has been taken. Although on occasions they do not always get feedback so dont know if things have been dealt with. We have recently been involved in a safeguarding investigation that has highlighted Care Homes for Older People Page 18 of 32 Evidence: some concerns about Gills Top. The home did not follow safeguarding procedures and concerns were raised about responding to allegations of abuse, and recording and reporting systems. The safeguarding investigation revealed further safeguarding incidents that had not been dealt with properly. As a result of the concerns we carried out our key inspection early. At a safeguarding meeting, a representative from Anchor acknowledged the home had not dealt with some safeguarding incidents appropriately and it had not followed procedures. The representative said the incident was not reported appropriately and records of the incident were not completed satisfactorily. An Anchor Safeguarding Policy is in place and covers the protocol required in reporting suspected abuse situations. It states to report to the manager then area manager and local safeguarding team as well as CQC within 24 hours. There is evidence this has not happened. We received an improvement plan from Anchor Trust that told us how the home is going to improve. The acting manager was not familiar with the plan which raises questions about the effectiveness of the plan. We asked staff what they would do if any allegations of abuse were made. They said they would report it to the team leader or manager. They did not know what the manager or team leader should do. We spoke to the acting manager who did not know that allegations should be reported to the local safeguarding team. Staff could describe types of abuse. Twelve staff including the manager have recently attended safeguarding training. The manager has been told by Anchors training department that she should attend a more in depth safeguarding training course. Care Homes for Older People Page 19 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a very pleasant, comfortable and clean environment. Evidence: People who live at the home and visitors told us the home is always clean and tidy. When we looked around the home it was clean and tidy. One person who lives at the home said, I like spending time in my room and it feels like its mine. They make sure I have my call bell. Another person said they have their room and en-suite cleaned every day. A visitor said, Its very clean every time I visit. There is a large lounge and dining room on the ground floor with a smaller lounge on the first floor. There is a passenger lift and a staircase that allows access to all floors. The home is set in very pleasant grounds and these are kept in a good condition. A large garden to the rear of the property can be accessed from the lounge. Some bedrooms on the ground floor have doors leading to the garden. People said they enjoy sitting out in good weather. Several people living at the home showed us their rooms. All rooms seen were clean, free of odour and maintained to a good standard. People have been able to furnish their rooms with pieces of their own furniture, pictures and photographs. All bedrooms have en-suite toilet facilities. Care Homes for Older People Page 20 of 32 Evidence: Assisted bathrooms and toilets are situated near to peoples bedrooms and communal areas on both floors. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. Hand cleaning facilities are situated throughout the home. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported by a caring staff team but staffing levels are sometimes inadequate so people do not always receive the care at the time they want it. A robust recruitment process is in place which helps safeguard people. Staff receive basic training but they would benefit from further opportunities so they have a better understanding of peoples specialist needs. Evidence: People who live at the home and visitors were complimentary about staff. People described the staff as lovely, caring, friendly and jolly. One person said sometimes you cant get attention at lunch time and its as though staff are having their break when everyone is eating. People told us sometimes staffing levels are satisfactory although at other times there are not enough staff. Two people who live at the home gave examples when they have had to wait for support. One person said, They say just a minute when you ask to go to the toilet but then dont come back in a minute. Another person said they also wait for a long time for staff. Some people said dependency levels have changed and people generally need more care but the staffing levels dont reflect this. Care Homes for Older People Page 22 of 32 Evidence: Staff also said that staffing levels can sometimes be a problem and gave examples when it can be very busy. For example, at times they only have three staff on duty. One staff member has to stay in the lounge to observe because one person has had a lot of falls, a team leader may be giving out medication, which only leaves one staff to support people with personal care. No domestics are employed on a weekend so carers have to do the basic cleaning tasks such as emptying bins but there are no set domestic tasks. We were told that it would be better if there were three waking staff during the night, and one team leader and three care staff at all other times. In addition to talking to staff we asked some staff to complete a survey during our inspection. Three out of the four surveys suggested the home could improve by having more staff. The rotas showed us that the home has consistently met their target staffing levels of one team leader plus three carers on a morning and one team leader plus two carers on an afternoon, and two waking night staff. At least one female staff member is on duty with a male employee so gender preferences are considered and respected where possible. Concerns were raised that the home uses a lot of agency staff, especially on a night and this does not always provide continuity of care. We spoke to four care staff, the activity co-ordinator, a team leader, the administrator, support manager and acting manager. We received some positive feedback and a good range of comments of what the service does well. Staff told us the team generally works well together. Staff meetings are held four times a year. In the AQAA the acting manager told us they have robust recruitment procedures in place and are supported by a central recruitment team. We looked at four staff files and these contained all the records that are needed when carrying out a robust recruitment process. Staff files also contained training records which showed us staff had attended regular training courses. Staff told us they have attended training that helps them do their job well although some said they would benefit from additional training. They suggested palliative care, dementia training and care planning. These types of training will help staff have a better understanding of how peoples needs should be met. In the AQAA the acting manager said eight care staff out of twenty care staff hold NVQ level 2 or above, which is below the recommended percentage is 50 Care Homes for Older People Page 23 of 32 Evidence: Care Homes for Older People Page 24 of 32 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. The lack of a consistent management team and effective management systems has led to the home failing to provide a safe and consistent service to people who live at the home. Evidence: The current registered manager is away from the work place and a care manager, who we have referred to as the acting manager, has stepped up to cover her absence. Anchor Trust wrote to us and confirmed these management arrangements. The acting manager has had little training in the management processes, and only recently received support one day a week from the area manager. From 24th August a deputy manager from another Anchor Trust home been assigned to support the acting manager on a full time basis for one month. The acting manager is currently supernumerary but from the 1st September she will have to cover some team leader hours. Care Homes for Older People Page 25 of 32 Evidence: The acting manager has not received sufficient support to enable her to carry out the responsibilities and duties of the registered manager sufficiently. There have been several safeguarding incidents within the home that have not been reported to the local safeguarding team, or to the Care Quality Commission. The temporary manager should have been given training in the safeguarding procedures as soon as it was determined she would stand in for the absent manager. One staff suggested they would benefit from an emergency checklist that they could refer to if they had to deal with emergency situations i.e. a death because this is not in place. Regulation 26 visits are carried out and these have identified that the staff are unsure as to the future of the registered manager and they dont appear to have confidence in the current management arrangements. A representative of the home should visit the service at least once a month to make sure it is running smoothly. Three visits were carried in June 2009 but we did not see any evidence of visits between Feb and June. An annual quality assurance assessment (AQAA) was sent to the service on 16th June. The accompanying letter said it is a legal requirement to fill in an AQAA when we ask for one and it must returned by the 14th July. We had not received the AQAA so contacted the home on 10th August and were told they didnt think it had been completed. We sent out a reminder letter on 10th August stating the AQAA must be returned by 18th August. We received the AQAA on 19th August. We did not receive the AQAA in time for our annual service review, which is one of the reasons we brought our inspection forward. The AQAA gives us important information about how well outcomes are being met for people using the service and some numerical information about the service. When we did receive the AQAA it contained some good information about the service but it did not accurately reflect what was happening at the home. The improvement plan we received from Anchor Trust identified that the home should improve in eight areas including business management but this detail was not included in the AQAA. During our inspection we identified areas where the home should make improvements. These had not been identified in the AQAA. Anchor Trust has quality assurance systems in place and audits have been completed, including monthly quality indicators. However, in light of the findings at our inspection it is evident that the systems have not been effective. Monthly falls and incidents have been recorded but we could not see that anything was done with this information. Care Homes for Older People Page 26 of 32 Evidence: The home can contact the Community Matron to do a falls risk assessment if people have too many falls and follow up work is done by the Rapid Response team. Its important to carefully monitor falls so people get the right support to reduce the risk of further falls. The home must tell CQC about important events and incidents involving the people who use their service which includes any serious injury that results in a consultation with a medical practitioner. The home has failed to do this on many occasions. Accident records showed us that a number of people had accidents and had been taken to hospital but this was not reported appropriately. CQC has received some notifications when people have died or had accidents. One notification told us a person had been admitted to hospital but the information about the reason for the admission to hospital was not accurately reported. People who live at the home or their families are generally responsible for managing finances although the home holds small amounts of money for some people. We looked at personal allowance records for two people. Financial transactions were recorded and the balance on the record sheets corresponded with the amount of money held in the safe. We were told the administrator is very helpful and is good at carrying some of the business management tasks. Staff should receive formal supervision at least six times a year. Some staff told us, and the acting manager confirmed that supervision has not been provided to all staff on a regular basis. In the AQAA the acting manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. The registration certificate and insurance certificate were displayed in the entrance to the home. The home was awarded a good hygiene award following an environmental health visit in August 2008. The certificate said they have very good controls in place and a high standard of cleanliness. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 A risk assessment must be 31/10/2009 undertaken for everyone who self medicates. This must identify that they know what they take, when to take them and the consequences of not taking them. It must also show that the person understands they must not leave medicines lying around where someone else may take them. This will make sure people get the right medication. 2 18 13 Any allegations of abuse or other safeguarding incidences must be responded to and reported appropriately. This will make sure people who use the service are safeguarded 30/09/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 33 26 Copies of the report generated by the Regulation 26 visit must be sent to the Care Quality Commission (CQC) until further notice. This will make sure the service is being properly monitored 30/09/2009 4 38 37 The Care Quality 30/09/2009 Commission (CQC) must be notified of significant events that affect the health and welfare of people who live at the home. This will make sure the regulatory authority receives appropriate information and can monitor the health and welfare of people who are living at 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 1 Information provided to people thinking about moving in to the home should include an equality and diversity statement that outlines the different strands of the larger community whose needs could be met at Gills Top Information gathered during the initial assessment process should be detailed enough to develop a care plan and include all of the elements of Standard 3 of the National Minimum Standards for Older People. Daily records should also be maintained to ensure that 2 3 3 7 Care Homes for Older People Page 30 of 32 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 when the care plan is reviewed the information used is up to date and current. This will help make sure peoples health and welfare can be properly monitored 4 7 The care plans should be developed and reviewed on a monthly basis to ensure they remain up to date. This will ensure that staff know what level of support they need to provide to people. Staff should receive suitable medication training to ensure their practice remains safe. Staffing levels should be reviewed in line with changing dependency levels of people in the home. This will make sure there are adequate staff to meet the needs of the people living at the home. The home should have a higher percentage of staff with NVQ level 2 or above. This will help make sure peoples needs are met. Staff should receive further training that will help them understand peoples needs. This will help make sure peoples needs are identified and met. The home should be managed more effectively. This will make sure the home fulfills its stated purpose and objectives. The quality of the service could be better monitored through the homes quality assurance system. This will help improve the quality of the service and make sure the homes aims and objectives are being met. Accidents/incidents should be reviewed for each individual at their monthly review to ensure the care plan remains up to date. 5 6 9 27 7 28 8 30 9 31 10 33 11 38 Care Homes for Older People Page 31 of 32 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. 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