Inspection on 09/06/09 for Godolphin House

This inspection was carried out on 9th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Godolphin House 27/06/08

Godolphin House 11/06/07

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Godolphin House 42 Godolphin Road Helston Cornwall TR13 8QF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ian Wright     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Godolphin House 42 Godolphin Road Helston Cornwall TR13 8QF 01326572609 01326569432 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) : Ablecare (Helston) Ltd care home 31 Number of places (if applicable): Under 65 Over 65 5 5 31 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 The maximum number of service users who can be accommodaed is 31. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP - maximum 31 places Dementia aged 65 years and over on admission - Code DE(E) - maximum 5 places Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission - Code MD(E) - maximum 5 places Date of last inspection Brief description of the care home Godolphin House is near the centre of the town of Helston. There is a bus which goes past the home to the centre of town. The home provides residential care for up to thirty-one elderly people, five of who may have a dementia or mental illness. The home also provides some day care. Care Homes for Older People Page 4 of 35 Brief description of the care home Accommodation is over 4 floors with a shaft and stair lift provided. There are two lounges on the upper ground floor and a small lounge on the lower ground floor. The home has three double rooms which can also be used for single occupancy. There is a small garden at the front and parking space at the back of the home. A copy of the inspection report was available in the hallway at the time of the inspection. The range of fees at the time of the inspection is £425 to £550 per week. There are additional charges e.g. for chiropody and newspapers. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service 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: This key inspection took place, by one inspector, in fifteen and three quarter hours over two days. All the key standards were inspected. The methodology used for this inspection was: (1)To case track three people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussion with staff about their experiences working in the home. (3) Discussion with other people using the service, and their representatives. (4) Discussing care practices with management. (5) Inspecting records and the care environment. (6) Carrying out a postal survey of the views of people who use the service, staff who work in the service and health and social care professionals who work with the service. Care Homes for Older People Page 6 of 35 Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgments made in the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 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. Information provided (e.g. regarding services offered) to people who use the service is to a good standard . For example people who use the service receive a statement of terms and conditions of residency or contract and a copy of the service user guide. This assists them to know their rights and responsibilities. Pre assessment procedures are good and should assist the registered provider to ensure the home can meet peoples needs before admission is arranged. Evidence: The home has a satisfactory statement of purpose and service user guide. A copy of the service user guide is available in each bedroom. People also receive a copy of the homes brochure when an initial enquiry is made about vacancies. We inspected the pre admission assessments for three people. There is a satisfactory pre admission assessment policy and pre admission assessment format. Completed Care Homes for Older People Page 10 of 35 Evidence: assessments contained satisfactory information regarding the needs of people assessed. Our postal survey results said the majority of people using the service said they received satisfactory information to help them decide if the home was the right place for them. The manager of the home said a full pre admission assessment is completed with the prospective resident before admission is arranged. We viewed the contracts / statement of terms and conditions of residency for the same group of people. Copies of the information provided on peoples files was satisfactory. Our postal survey results said the majority of people using the service said they received satisfactory information regarding the homes terms and conditions once they had moved in. People who are privately funded receive a contract regarding their accommodation and care arrangements. Care Homes for Older People Page 11 of 35 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. Some improvement is required to care planning systems to ensure health and personal care needs of some people living in the home are satisfactorily promoted and met. It is essential more care is taken to ensure medication is always administered, and recorded. Although care staff are viewed positively, we are concerned about some of the comments we have received from people using the service and other stakeholders. The registered provider needs to work to ensure these concerns are addressed. Improvement in these areas will help to give more assurance that people are receiving appropriate care at the home. Evidence: The home caters for a diverse group of people. There is a small group of people with either mental health needs and /or dementia. Some people are physically and mentally able. There are some people who are almost at the end of life stage of care, for example, they spend the majority of their time now in bed, and receive their care there. The registered provider has employed some nursing staff to improve standards of care. This is a satisfactory development although it is important people using the Care Homes for Older People Page 12 of 35 Evidence: service, their representatives or external professionals do not perceive, or are led to perceive, the home is registered to provide nursing care. We inspected the files of three people who use the service. A care plan was available on all files inspected. Care plans are stored in the managers office. A summary of the information is contained in files accessible to staff, but we think the primary information should be more accessible to staff. Senior staff are currently in the process of introducing a new care planning system, and this has been introduced for the majority of people using the service. The new format appears to be generally good, although it should include a brief pen picture / social history of each person. This should include basic family history, the persons previous occupation, likes/dislikes, their interests etc. There is only limited evidence that care plans are reviewed. For example of the four files assessed one care plan was reviewed in June 2009, one was reviewed in June 2008, and there was no record of review for the other two people-although they had been living in the home since last summer. It is essential that regular review takes place, and this should give suitable detail regarding the persons changing needs and how their care should subsequently be delivered. People who use the service, who we spoke to, were generally positive about the care they receive. We also spoke to some relatives of people using the service, who again were generally positive about the care provided. In our postal survey half of the respondents said their care and support needs were always met, with the remainder stating their needs were met usually, with a minority stating their needs were only met sometimes. Where negative comments were made people said there should be more staff around to attend to their needs, staff should answer the call bell more quickly and there should be more time for staff to talk to people living in the home. One person said to us one member of staff did not knock on their door- the management said they would discuss this matter with the staff member concerned. However, the majority of people said they thought care was good, staff were attentive and they could not think of any improvements that should be made.The majority of people said they were always listened to, although a small majority said this was just usually or sometimes the case. Staff who answered our postal survey, and who we spoke to, said they thought peoples needs were well met, and they did their best to ensure people were well supported. People who use the service, who answered our survey or who we spoke to, said they Care Homes for Older People Page 13 of 35 Evidence: were satisfied with the health care support they receive. There is evidence on file that GPs and district nurses visit people at the home. It was however difficult to determine when people last saw other professionals such as a dentist, chiropodist, or optician. Senior staff said these services were available and are organised, so it may be a case of improving record keeping in this area. The care planning system needs to be developed to ensure staff can ascertain when support from external professionals was last received (e.g. at a glance), and then it can easily be determined when the person next needs to have support and treatment with the relevant professional. The chiropodist who answered our survey said people are happy, and staff will inform her if someone needs treatment. She said staff will always follow any advice given regarding chiropody needs. We received a response from a health professional who said there had been some concerns regarding care. However, there are now regular meetings with the home, and it is hoped the new manager will improve standards. We inspected the medication system. Medication is stored in a dedicated clinical room. Medication is supplied in a monitored dosage system supplied from a local pharmacist. Storage of general prescribed medication is satisfactory. Some controlled drugs are kept in the home, and administration and recording of these are satisfactory. However, we had some concerns regarding the operation of the system: (1) Staff did not administer the medication for one person on the morning of the inspection. Medication was given when we discussed the matter with senior staff-but administration did not occur until 11am. (2) Some medication which was prescribed for people using the service was not on the medication sheet. The medication concerned was either only occasionally administered, or administered by external professionals. However it is essential there is a record of its storage and administration. Extra care needs to be taken to ensure medication is administered correctly. Training regarding medication appears satisfactory. Care Homes for Older People Page 14 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines,food and opportunities generally meet the needs of the people living in the home Evidence: People using the service, who the inspector spoke to, said they could get up and go to bed when they wished, and said routines in the home are relaxed. We observed throughout the inspection a relaxed and friendly atmosphere in the home. People got up and came downstairs at a leisurely pace and there did not seem a rushed atmosphere despite staff being busy. People who answered our survey said they were aware of activities which are organised. On the day of the inspection an entertainer was present, with an organ, singing songs with some of the residents in the main lounge. This seemed an enjoyable occasion. Some of the staff motivated people to sing and dance, and this seemed spontaneous and genuine rather than for our benefit. Activities records are kept. These show a number of entertainers visit the home so there is musical entertainment approximately twice a month. Staff also arrange Care Homes for Older People Page 15 of 35 Evidence: activities sessions regularly for the resident group. For example there have been gentle exercise groups, reminiscence sessions, bingo, film afternoons etc. Some people we spoke to said they would like more trips out. Records show people have been accompanied to the Helston Flora Day, and also to the local supermarket. The registered provider said he has purchased a minibus, but people using the service have so far been reluctant to go out in it. Some further discussion with people using the service would seem appropriate so this resource can be better utilised, and peoples wishes met. Some people receive regular visitors, and some people go out with relatives. There is suitable space for people to receive visitors in private. A choice of main meal is always provided. For example on the day of the inspection people had a choice of roast meats, or another option could be provided if they did not want a roast dinner. People could make their mind up at the dinner table so it was not necessary to make a decision in advance. This seems excellent. People are offered a choice of evening tea from a number of options available to them. The lunch time appeared to be a relaxed occasion, and staff seemed to be attentive to peoples needs. Regular drinks and biscuits are provided to people throughout the day, and evening. People who answered our survey said they were usually happy with the food, with only a small group stating they were always or sometimes happy with the food. The vast majority of the people we spoke to at the inspection said they were happy with the food provided. The kitchen was inspected. It is generally clean, and well equipped. There was a satisfactory supply of stock. Suitable records of meals are kept. The Food Standards Agency Better Food, Better Business hygiene system is in place. For example there is a cleaning schedule in place and records of food temperatures are kept. The environmental health department inspected earlier in the year, and issued a number of requirements. Some of these are still outstanding. For example the temperature in the kitchen is very hot due to a lack of ventilation. This is probably in breach of health and safety regulations and the registered provider needs to take appropriate action regarding this matter as soon as possible. The registered provider said he had obtained a quotation to improve ventilation in the kitchen and the work would be completed in the next few months. Outstanding issues in the Environmental Health Officers report need to be addressed so the kitchen complies with legal guidance. Care Homes for Older People Page 16 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures in the home are satisfactory, and people who we contacted did not have any significant concerns about staff or the care they received. Adult safeguarding procedures, and training regarding adult safeguarding needs to be improved. This will ensure staff have suitable knowledge, and they are clear what they should do if there are any concerns about abuse. Evidence: The registered provider has a satisfactory complaints procedure. A summary of this is contained in the homes statement of purpose and service user guide. The registered persons have not received any complaints regarding the home. The Commission for Social Care Inspection, and subsequently the Care Quality Commission have also not received any complaints about the home. From our survey about half of the people who responded said they felt they had someone they could speak to informally if they were unhappy. About half of the respondents said they knew how to make a formal complaint. All the staff who responded to our survey said they knew what to do if someone had a concern or a complaint. Everyone who we spoke to on the day of the inspection said they would feel comfortable approaching staff or management if they had a concern or complaint, and the majority felt the matter would be dealt with to their satisfaction. Care Homes for Older People Page 17 of 35 Evidence: Some amendment should occur to the Complaints Policy- for example details of the Care Quality Commission should be included within this documentation. This should include details of the commissions national call centre. Details of Cornwall Councils complaints department (or other authority if the person is funded by another body) should be included in the service user guide of the person using the service. If the person is funded by a public authority they have a right to use the statutory complaints procedure of the funding authority, and subsequently they should be made aware of their rights. The registered persons Adult Safeguarding Procedure needs improvement. For example the policy needs to state staff should report any allegations to the relevant local authority (and where necessary the police). It is the responsibility of the local authority, in liaison with the registered provider and other stakeholders, to make a decision how any subsequent investigation takes place. Management at the home should not investigate allegations, unless this has been agreed at any adult safeguarding strategy meeting. It is of concern that we issued a requirement at the last key inspection in June 2008 to improve the policy. The policy was reviewed in April 2009, but it does not seem that any changes were actually made to the policy. Subsequently we are re notifying the previous requirement. There have not been any adult safeguarding alerts regarding the service since the last inspection. When we assessed staff training records 6 out of 13 of the files assessed had evidence that these staff had received some adult safeguarding training. Other staff need to receive this training, and it is important management attend alerters training so they are aware of what their role is should there be any safeguarding concerns. The home has a restraint policy. This should be reviewed in line with guidance regarding the Mental Capacity Act and Deprivation of Liberty guidance. CQC has guidance regarding these matters on our website. Care Homes for Older People Page 18 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Godolphin House is a suitable care facility for people living there. Evidence: The building was inspected. Godolphin House is a large building, with bedrooms over four floors. The home is a large Victorian building which has been extended. Floors in the main part of the house are connected by stairs with a chair lift which can be used if people have physical disabilities or are unsteady on their feet. The building has been extended, and the extension has four floors connected by a staircase and a shaft lift. The home has a large dining room, and a large lounge. The lounge can be divided in two via a partition. There is also a small quiet lounge which people can use. There are suitable toilets and bathrooms. Some of the bathrooms have assisted baths for example Parker style baths which are specially designed for people with physical disabilities and /or are frail. The registered provider said thermostatic valves are fitted to limit the temperature of bath water (essential to minimise the risk of scalding). It is important, at least monthly, the temperature of hot water is tested and these tests are recorded, so the provider can be assured the system is working effectively. All parts of the home are well decorated and maintained. Furnishings and decorations are to a good standard. However we noted one of the grab rails (in the downstairs Care Homes for Older People Page 19 of 35 Evidence: toilet by the main stair case), needs to be painted or replaced as it is badly chipped and its condition could present a infection control risk. We also noted the toilet seat, (in the toilet on the first floor) needs replacing as the covering is very worn and also could present a infection control risk. The registered provider said he would address these issues. Bedrooms we inspected were all to a good standard. There are two designated shared bedrooms (currently let as single bedrooms), and twenty seven single bedrooms. Three of the single bedrooms have an en suite toilet and wash hand basin. Decorations, and furnishings in bedrooms is to a good standard. Many of the bedrooms do not have a lock. People using the service should at least have a lockable facility e.g. for personal possessions or valuables, if it is not appropriate for them to have a lockable bedroom door. It should be a default position that all bedrooms have a lockable bedroom door, and people are issued with a key unless they lack capacity. The home was clean on during the inspection and there were no unpleasant odours. As stated in the previous section of the report, some of the requirements issued by the environmental health officers report still need to be addressed. For example replacing floor covering in the kitchen and food stores, repainting the kitchen, ensuring the recessed window sill in the kitchen is always clean, and improving the ventilation in the kitchen as the heat in this area is very oppressive and potentially against health and safety at work regulations. People who we spoke to said they were happy with their accommodation. One person said they would like to leave their bedroom door open so they did not feel so cut off from the rest of the home. We spoke to the registered provider about this, and it was agreed the matter would be discussed with the person so a satisfactory resolution could be agreed. From our postal survey the majority of people who use the service said the home was either always or usually fresh and clean. One person said they felt the home was at times dirty and smelly although we did not see any evidence of this on the day of the inspection, or from the feedback from other people. Care Homes for Older People Page 20 of 35 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. Staffing levels,although satisfactory, need to be kept under review to ensure people using the service receive suitable levels of support. Recruitment and training provision requires improvement. This will ensure people using the service can be more confident the support they receive is from staff who have been recruited, vetted and trained according to legal standards. Evidence: On the day of the inspection there were four care staff on duty from 07:00 to 13:30 ( An additional member of the care staff was sick). From 13:30 to 17:00 there were three care staff. (An additional member of staff was sick). From either 16:45 or 17:00 to 22:30 there were three care staff. There were two waking night staff from 22:3008:00. There were also managerial staff, and other ancillary staff such as cooks, and cleaners. The registered provider has employed a registered general nurse. As stated in the Health and Personal Care section this person must not practice as a nurse while working in the home as the home is not registered to provide nursing care. It is an offence should nursing care be provided by staff employed to work in the home under its current registration. There are mixed feelings from people using the service, staff and some user representatives regarding the amount of staff support people receive. Many people we Care Homes for Older People Page 21 of 35 Evidence: spoke to said they felt staff did their best, were kind, supportive and respectful. They all said staff did their best to meet their care needs, and put right anything needing improvement. Some people we spoke to said staff should respond more quickly when the call bell rings, or staff should have more time to talk with them. We received some comments that there should be more staff around in the communal areas such as the lounge in case people needed support. Some people said at times it was difficult to find a member of staff. We also felt this. This is partly due to the layout of the building, and possibly due to staff attending to peoples needs in their bedrooms. We observed that staff always looked very busy, however we concluded staff did their best particularly as there was one member of staff sick on the first day of the inspection. From the postal survey we completed, half of the people said there was always enough staff available, with the other half of respondents stating there was usually or sometimes enough staff to assist. The majority of respondents said they usually rather than always felt they received the care and support they needed. From the responses to the survey we received from staff, all the respondents said there was usually enough staff to meet the needs of people who use the service. As outlined earlier in the report the home accommodates a diverse group of people with varying needs. It is important that their needs continue to be met. The staffing levels on the days of this inspection do appear to be higher than when we inspected the home in 2008 (where we perversely received less negative comments), and we deem the current levels acceptable. However, it is essential the registered provider keeps them under review so peoples needs are met. Personnel records were inspected for eleven staff (i.e. care staff on duty during the 24 hour period on the day of the inspection). Personnel records inspected were to an adequate standard. Records need to include two references. A Protection of Vulnerable Adults First check (POVA First) and a Criminal Records Bureau check (CRB) need to be completed. These checks ensure people employed are not on a list which states they are deemed not fit to work with vulnerable people (POVA), or have a criminal record (CRB) which may deem them unsuitable to work in an environment with vulnerable people. Staff must have completed an application form, containing work history, provide evidence of their identity and a self declaration of medical fitness. Most records were satisfactory although it is essential: (1) All staff sign a thorough declaration of medical fitness. There was no declaration on six files, and other records in this area were generally very basic. (2) There are always two references (one person in the sample did not have any references, and two people only had one reference). All three staff commenced employment since September 2008. It is important a reference is always taken up from the previous employer, and strongly advisable that a reference is taken up if the person has worked previously in a caring Care Homes for Older People Page 22 of 35 Evidence: capacity, and they have not given this employer as a referee. (3) All staff must have a POVA First check unless a satisfactory full CRB check has been returned before they commenced employment. There was no record of these checks for two people who commenced employment since the last inspection. (4) All members of staff must have a CRB check, and must be supervised, according to the criteria outlined in the guidance, until this is received. There was no check for one person who had commenced employment since the last inspection-only a copy of this check from the persons previous employer. We did not see this person being actively supervised during the inspection, as is required by the regulations. Staff surveys, and interviews stated that staff thought suitable checks had been completed regarding them prior to them commencing employment. We have subsequently issued the registered provider with a statutory requirement regarding improving staff pre employment checks We looked at whether staff had a National Vocational Qualification in care. According to the registered provider 70 of care staff employed (28 staff) have an NVQ 2 or above in care. It is important a copy of the persons certificate is always maintained on the persons training file. We checked records of training staff have received. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level). (3) All staff must have manual handling training and regular updates of this (e.g. annually). (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. Staff also need to have training to meet the needs of people who use the service such as dementia, mental health needs etc. From the records of the eleven staff we inspected, all staff have a record that they had received an induction, there was satisfactory numbers of staff with a first aid certificate on duty on each shift , staff had a record of fire training, and there were staff who had been trained to handle medication on each shift. We were told care staff do not handle food, although some staff have received some training in this area. However, some improvement is required regarding: (1)Manual Handling TrainingThree people did not have a record of any manual handling training. Three staff have received this training in the last year. (2)Infection Control Training-Three staff did not Care Homes for Older People Page 23 of 35 Evidence: have training in this area. (3) Dementia-only two staff had training regarding this area. (4) Mental Health- We did not see a record of any training regarding this area. (5) We would advise that all night staff receive training in first aid. (6) It is advisable that a different system is developed to record internal fire training. It was difficult to assess that everyone had received this training,although this did appear to be the case. According to our survey staff were viewed by the majority of external health and social care professionals as either sometimes or usually having the right skills and experience to support peoples needs. Staff responded to state initial induction was to a good standard, training was satisfactory, and they felt they either usually or always had enough support, experience and knowledge to meet the different needs of people who live at the home. We are renotifiying the registered provider regarding training provision. We have issued a requirement regarding this matter now on three occasions. Failure to provide satisfactory training provision, within the timescale, could result in enforcement action being taken by the commission. Care Homes for Older People Page 24 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider needs to ensure an application for a registered manager is submitted to the commission. Some improvement is required to quality management in the home. Health and safety standards are generally satisfactory although improvement is required to health and safety standards in the kitchen and in regard to staff training. Management arrangements regarding peoples finances seems satisfactory. Improvement in the areas highlighted will give stakeholders more assurance the home is managed effectively and to a good standard. Evidence: The registered provider is Ablecare (Helston) Limited. The registered manager post is vacant. The last registered manager resigned at the end of August 2008. The registered provider has recruited several people to the managers post but none have proved to Care Homes for Older People Page 25 of 35 Evidence: be acceptable to meet the providers needs. There is now a new manager in post, who has been promoted internally within the home. We have not received an application for this person to be registered. The registered provider has said an application will be submitted in July 2009. We have raised concerns that the registered manager of the providers other home is spending significant time managing Godolphin House. The person is now described as the organisations Area Manager. The commission has sought clarification of management arrangements at the registered providers other home, so we can ascertain whether the registered persons are meeting their legal responsibilities regarding that service. When we spoke to people who use the service and to staff, we were told management was supportive regarding peoples needs. The staff survey also said the manager gave them enough support. One survey respondent said the management do appear to always have the residents needs as their top priority. Another respondent said they were positive about changes currently happening in the home. Another respondent said the new manager was extremely approachable. However, it is important that the registered provider submits an application for the manager to be registered-if she is deemed suitable by the them to manage the home. We have been concerned there has been a significant gap in their being a registered manager at this home, although the registered provider has kept us updated regarding the difficulties in recruiting a suitable person to manage the home. The registered provider has a Quality Management Policy. Surveys have been completed regarding the views of people who use the service and other stakeholders. A summary report of this was subsequently completed. One of the managers said they regularly audit bedrooms to ensure cleaning is completed thoroughly and records are kept regarding this. We did request an AQAA from the registered provider (Annual Quality Assurance Assessment-an annual return required by the commission which includes a self assessment and data regarding the service). The provider said our request was not received, although we have a record of our email request. We have sent out a second request for this return to be competed by 9/7/09. It is an offence not to provide the commission with this information. The registered provider does need to make further improvements to quality assurance processes in the home. For example to ensure suitable systems are in place regarding ensuring compliance with the National Minimum Standards and Care Homes Care Homes for Older People Page 26 of 35 Evidence: Regulations. It is disappointing that we have had to renotify some statutory requirements since the last inspection; for example training still does not meet legal requirements. We are therefore re notifying the previous requirement regarding quality assurance systems. We assessed arrangements regarding the management of the finances of people who use the service. The registered provider, or staff working in the home, do not act as appointee for peoples monies or financial benefits. Records kept for the management of individual monies are satisfactory. Any expenditure on behalf of people who use the service is invoiced to the person acting as their representative, and cash is currently not kept on behalf of people. One of the managers confirmed any valuables kept on behalf of people who use the service are kept securely, and records are kept in the individuals file. The registered provider has a health and safety policy. There is also a fire risk assessment. Staff in the home carry out appropriate checks on the fire system. At the inspection, records for testing of emergency lighting could not be found. These were forwarded after the inspection. It is important these are always available for inspection for CQC and the fire department, and staff know where they are kept. Suitable checks on the fire system, and regarding fire extinguishers are carried out by external contractors. Portable electrical appliances were last tested in May 2009. There is a certificate to state the electrical circuit has been tested and is deemed satisfactory (20/08/2007). The home has a gas certificate deeming the boiler and appliances safe (12/3/2009). There are health and safety risk assessments in place. There is a policy regarding the prevention of legionella. Regular checks are completed to help ensure the risk of Legionnaires Disease is minimised. The nurse call system has been tested (2/4/09). Assisted baths have been serviced (8/1/09). The lift and stair lift have also been serviced on 25/2/09. Some improvement to standards in the kitchen are required as outlined earlier in the report. As stated in the staffing section, training regarding health and safety issues needs some improvement. A current certificate of insurance was displayed in the home. Care Homes for Older People Page 27 of 35 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 9 13(2) The medication system must 01/10/2008 be operated and managed to a satisfactory standard (For example in line with the Care Homes Regulations 2001 and Royal Pharmaceutical Society Guidelines). The issues outlined in the report must be satisfactorily addressed. People who use the service can then be assured their medication is managed to a satisfactory standard. (Previous timescale of 27/02/08 not met Second Notification) The registered persons need 01/02/2009 to: Ensure all current staff employed complete the current training plan within 6 months of the date of this report (e.g. where gaps exist on the training matrix supplied to CSCI) Provide CSCI with an update of training provided to all staff within 6 months of the date of this report. These measures will ensure staff receive training required by law, meets health and safety requirements and meets the needs of people who use the service. (In regard to the delivery of Page 28 of 35 2 29 18. 19 Care Homes for Older People staff training timescale of 27/02/08 not met- Second Notification) 3 33 7, 9, 12, 13, 24 Further develop the quality 01/10/2008 assurance system to monitor regulatory standards in the home. Measures taken should be included in the quality assurance policy. This will help improve service quality and help minimise risks to staff and people who use the service. Care Homes for Older People Page 29 of 35 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 19 The registered provider 01/02/2010 needs to ensure staff receive training required according to legal standards, and according to the needs of the people who use the service. (Timescale of previous requirement 01/02/09 not met. Third Notification) This will help people who use the service to be more confident that staff receive training to meet their needs, and according to the law. Care plans must contain suitable detail to inform and direct staff to provide care to people using the service. Care plans need to include information regarding when people last saw medical professionals. Care plans also should include some information about the persons social interests and personal history. Care plans 01/10/2009 2 7 15 Care Homes for Older People Page 30 of 35 need to be reviewed, to a satisfactory standard, preferably monthly. Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 3 9 13 The medication system must 01/08/2009 be operated and managed to a satisfactory standard (for example in line with the Care Home Regulations 2001 and Royal Pharmaceutical Society Guidelines). The issues outlined in the report must be addressed. (Previous timescale of 01/10/2008 not met Third Notification). People who use the service can then be more assured their medication is more appropriately according to national guidance. 4 18 18 Staff and management must 01/02/2010 have suitable training regarding adult safeguarding. This will help to ensure staff and management are aware of current guidance regarding adult safeguarding so they can help ensure people using the service are protected from abuse. 5 18 12 The adult safeguarding 01/10/2009 (protection) policy must be updated to reflect guidance issued by the Department of Care Homes for Older People Page 31 of 35 Health No Secrets guidance and local authority guidance. For example any allegation of abuse must be reported to the local authority. As outlined in their guidance, they will act as the lead agency to coordinate appropriate action. (Previous timescale of 01/10/08 not met. New timescale 01/10/09 Second Notification) This will help to ensure any safeguarding issues are appropriately reported and coordinated by the local authority. This will help to ensure people using the service are protected from abuse, and suitable procedures are followed should suspected abuse occur. 6 19 23 Complete action required, as 01/10/2009 outlined in the report by Cornwall Council Environmental Health Department. This will ensure there is a safer working environment for kitchen staff, and minimise any health and safety risks regarding food preparation for people living in the home. 7 26 18 The registered provider must ensure employment checks required by the regulations are always completed for all staff who 01/08/2009 Care Homes for Older People Page 32 of 35 commence employment (e.g. POVA First, CRB, two written references etc.) This will help to assure people who use the service that staff who work with them are suitable people to work with the vulnerable. 8 31 9 The registered provider must submit an application for a registered manager. This will ensure management arrangements meet legal requirements. 01/10/2009 9 33 24 Further develop the quality 01/10/2009 assurance system to monitor standards in the home for example regarding care planning, environmental standards, health and safety etc. Measures taken should be included in the quality assurance policy. (Previous deadline of 01/10/08 not met-Second Notification) This will help improve service quality and help minimise risks to staff and people who use the service. 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 16 Ensure information regarding social service department / health department complaint procedures are included in individualised service user guides. This will help to ensure Care Homes for Older People Page 33 of 35 people, funded by these authorities, are aware of their statutory rights to use these procedures if they have a concern or complaint. 2 18 Update the homes use of restraint policy in line with guidance outlined in the Mental Capacity Act and Deprivation of Liberty guidance. Management should attend training on this legislation if they have not done so already. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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