Inspection on 13/02/09 for Goldenley

This inspection was carried out on 13th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Goldenley 24/11/08

Goldenley 14/08/07

Goldenley 27/09/06

Goldenley 12/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 20/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Goldenley 11-15 Richmond Avenue South Benfleet Essex SS7 5HE     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: Michelle Love     Date: 1 8 0 2 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: Goldenley 11-15 Richmond Avenue South Benfleet Essex SS7 5HE 01268758487 01268758176 christine.webster@excelcareholdings.com 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) : Goldenley Healthcare Ltd care home 38 Number of places (if applicable): Under 65 Over 65 28 38 dementia old age, not falling within any other category Additional conditions: 0 0 The service users` bedrooms with an area of less than 10 sq.m will be used only following a written assessment. The assessment should include consideration of whether the facilities in the room are suitable for, and acceptable to the service user, taking into account their mobility needs. The service user plan should reflect the assessment of findings. Date of last inspection Brief description of the care home Goldenley is a purpose built home providing accommodation for up to 38 older people. The Registration category permits the home to provide care to older people and a number of these may have dementia. The layout of the premises consists of two separate lounges. One is a very large lounge and the other is smaller. There are also a few small areas scattered around the home with one or two chairs for residents use. None of the bedrooms have ensuite facilities. Goldenley is situated close to the local shopping area of South Benfleet. There is good Care Homes for Older People Page 4 of 35 Brief description of the care home bus and train links to the area. There is limited parking to the side of the property, but two public car parks are very close if needed. The weekly fees for residents range from 366.66 to 433.37. Additional costs are incurred by people living at the care home in relation to hairdressing, chiropody, magazines/newspapers and other items of personal shopping. 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 was an unannounced key inspection. The visit took place over two days by one inspector and lasted a total of 12 hours, with all key standards inspected. Medication practices and procedures were examined by a specialist pharmacist inspector. Additionally, progress against previous requirements and recommendations from the last key inspection were also examined. An Annual Quality Assurance Assessment was provided to us as requested. This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. Care Homes for Older People Page 6 of 35 As part of the process a number of records relating to people living in the care home, care staff and the general running of the home were examined. A partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Surveys for residents, staff and healthcare professionals were requested to be forwarded to the care home and where we have received comments, these have been incorporated into the main text of the report. The total number of surveys returned to us included, 2 from relatives, 4 from healthcare professionals, 4 from staff and 11 from people living at the care home. On the first day of inspection the Team Leader, Operations Manager and other members of the staff team assisted us and on the second day of inspection the registered manager was present. Feedback on the inspection findings, were given as a summary to the registered manager, Team Leader and Operations Manager. The opportunity for discussion and/or clarification was given. 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 Care Homes for Older People Page 8 of 35 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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. A robust assessment process ensures that people wanting to move into the home know that their needs can be met. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective service users needs. Admissions are not made to the home until a full assessment is undertaken. The pre admission assessment document was noted to be comprehensive and detailed and where appropriate additional information had been sought from the persons placing authority and or hospital. We saw from looking at 2 care files for those people newly admitted to the care home, evidence showed that pre admission assessments were completed by the management team prior to the persons admission. Information recorded was detailed and Care Homes for Older People Page 11 of 35 Evidence: informative. There was clear evidence to show that where appropriate the pre admission assessment process had been undertaken with the service user and/or their representative and people are offered an opportunity to visit Goldenley prior to admission. Written confirmation was available from the service, verifying that the needs of the prospective person could be met. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. The AQAA details that since the last key inspection to the home, both documents have been reviewed so as to make these easier to read and more user friendly. We looked at both documents and information was recorded in larger print/pictorial format. Surveys forwarded to us, confirmed that people had received sufficient information about the home prior to their admission. The home does not provide intermediate care. Care Homes for Older People Page 12 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. Whilst we acknowledge improvements in relation to medication practices and procedures, people cannot be assured that their care needs and risks to their well being will be clearly recorded within a plan of care. Evidence: In November 2008 a random inspection was undertaken to the care home as a result of us having received several Regulation 37 notifications from the home, relating to the healthcare needs of individual people. As part of that site visit, a random sample of 6 care files were examined. Some records were poorly completed and they were not up to date and not reflective of peoples current care needs. An action plan was promptly provided by the registered provider detailing action to be taken to address requirements made. We were advised that following the random inspection, audits were devised and implemented by the management team to ensure compliance to the above, internal communications have been reviewed to reinforce procedures for contacting healthcare professionals and 8 members of staff have received care planning training. Care Homes for Older People Page 13 of 35 Evidence: As part of this site visit 5 care plans were randomly examined. These showed that there is a formal care planning system in place to help staff identify the care needs of individual service users and to specify how these are to be met by care staff. Some elements of the care planning processes for individual people, were seen to be detailed and informative, recording peoples physical, healthcare, emotional and social care needs, however this is not consistent. Further development in care planning and risk assessing continues to be required so as to ensure the care needs of individual people are clearly recorded and staff have the most up to date information to ensure appropriate levels of care delivery. The care file for one person showed their plan of care was not devised for several days after they were admitted to the care home. This was discussed with the Team Leader at the time of the site visit and we were advised that information could be located within their archived file. It was not. No rationale was available to specify why the persons care plan had not been devised sooner. The care file for another person recorded them as having poor skin integrity and being at risk of developing pressure sores. The care plan pertaining to the above was seen to be appropriate and detailed and there was evidence to show that interventions and treatment were initiated by care staff and being provided by a healthcare professional. A risk assessment was devised, however there was a discrepancy between this and the care plan, relating to the frequency of the persons positional changes e.g. the care plan stated this should be undertaken every 4 hours and the risk assessment recorded this as being needed every 2 hours. Staff spoken with were unclear as to which of the above figures were accurate. On inspection of turn charts, records showed that neither of the above was being consistently followed by staff. Additionally the above persons care file made reference to them being at high risk of poor nutritional intake, requiring full assistance by care staff to eat their meal and to have a drink, requiring encouragement to eat and drink between meals, food and fluid to be recorded each day and for their weight to be monitored each month. Although the plan of care recorded the persons weight being monitored on a monthly basis, additional records showed the above instruction had been reviewed and their weight was to be recorded each week (not updated on care plan). On inspection of records, these were inconsistently completed and were not being undertaken in line with the above instruction. Observation during the morning showed the person was provided with a drink at 11.20 a.m., however no support or assistance was provided by care staff until 1 hour and 10 Care Homes for Older People Page 14 of 35 Evidence: minutes later. We discussed the above with the Team Leader and queried the temperature of the drink, which when touched was noted to be cool. The drink was removed and another drink was provided 10 minutes later. No evidence was available during the morning to show the person was provided`with snacks or nutritional supplements between breakfast and the lunchtime meal. Other documentation showed the resident was seen by a healthcare professional at the beginning of January 2009 and their weight deemed stable. The weight records showed the person as continuing to lose weight, however no further interventions had been requested by the staff team of the home for continued healthcare professional input. On inspection of food and fluid records (current and archived), these were seen to be incomplete with many gaps. No risk assessment was devised for the above detailing the specific risk and how this was to be minimised. On inspection of another persons care file, nutritional records were also poorly completed and no risk assessment had been devised. Training records show that not all members of staff have received training relating to nutrition. The care file for another person was examined. This person was seen to be resistant to care and exhibiting challenging behaviours on occasions. Their plan of care made reference to this, but provided unclear guidelines for staff as to how to deal proactively with situations so as to ensure the persons and others safety. Staff spoken with demonstrated a basic awareness of known triggers relating to this persons behaviours, but were unclear as to how this should be consistently managed. On inspection of the training matrix, this showed 4 members of staff as having received training relating to managing behaviours. The manager wrote to us after the inspection and advised that these figures had been recorded inaccurately and that 13 members of staff had received this training. We saw that behaviour monitoring records have been completed, however when cross referenced with daily care records, not all entries had been recorded and staff interventions and outcomes were not consistently highlighted. An entry in the homes log book recorded on 3/2/09, could you please do some behaviour sheets for (name of resident) as CPN in tomorrow. Ta, December and January required. This is poor practice and suggests that some records are completed retrospectively. The care plans for some people who are prescribed medication on a when required basis were examined but there was no written guidance for staff on the circumstances such medication can be given. This is not in line with the homes own policy which states liaise with GP and write up clear guidelines for use of medicines. Additionally for two people who have diabetes, there were no guidelines in care plans as to the frequency of blood sugar monitoring, how these would be done and what action should be taken if they were outside the accepted range. Although some improvements were noted following the random inspection of November 2008, shortfalls remain, which potentially place people at risk of not having all of their care needs identified and met. Care Homes for Older People Page 15 of 35 Evidence: Risk assessments were not devised for all areas of assessed risk and at the time of this key inspection, it was evident that risk assessment processses are not clearly understood by staff or the management team of the home. The AQAA details under the heading of what we do well, all service users have a detailed care plan, that includes risk assessments which enables the staff to support the individual resident. Documentation and evidence of our findings were shown to the team leader and operations manager with our findings. The Regulation 26 visit report completed by the organisation for December 2008 recorded, the care plans were checked and some were found to not be very person centred. More robust auditing needs to be undertaken by the manager around care plans and medication. As part of this inspection, we looked at how care staff interact with individual people living at Goldenley. It was evident that some members of care staff have a good understanding and basic awareness of individuals care needs and rapport in some instances was seen to be positive. However, people in the lounge area were left unsupported by care staff on several occasions. Staff were observed several times to walk through the lounge area and not to interact with residents, on occasions to ignore people who were calling out and some staff were observed to talk over residents. Some interactions with people living at the care home were seen to be solely task orientated. One resident was overheard on several occasions to call out where are you, come and help me, help me, help me, please come and help me, help and please please come and help me. Staff were observed to walk through the lounge area, but to ignore the residents request for assistance. On inspection of Regulation 26 visit reports, the above issues were highlighted by the Operations Manager in December 2008 and January 2009 and included, staff interact with the residents, but it needs to be around more than when tasks are carried out and staff interact with the residents, however some staff can be a little loud in their approach and were observed to talk over the residents. On several occasions, some members of staff were seen to talk exclusively with one another. A dependency tool is completed for all people living at the care home and this is reviewed each month. Evidence showed that the majority of people at the care home fall within the medium to high to totally dependent range. Of 13 surveys returned to us from people living at the care home and their representatives, the majority of comments received in relation to care and support provided by care staff was recorded as positive. Comments included, staff are very kind and helpful, Im very happy here, I have everything I need, sometimes I have to wait ages for the toilet, I waited nearly an hour the other night and there are not enough staff to work as is needed and the needs of my member of family are not always met. Four staff surveys returned to us, recorded that not all felt they were provided with sufficient information about individual people living at the care home. Out of 4 healthcare professional surveys returned to us, 3 recorded positive comments and 1 survey raised some concerns. Comments relating to the latter recorded, some Care Homes for Older People Page 16 of 35 Evidence: concerns about manual handling techniques have been raised and most staff need an update, we are very concerned about uniform policy and wearing of jewellery and false nails. When some staff are approached they dont seem to understand the importance of this. As a result of several poor medication practices and procedures highlighted at the random inspection of November 2008, a pharmacist inspector examined practices and procedures for the safe handling, administration and recording of medication at this site visit. The home has good clear written policy and procedures on the safe use of medicines to protect residents but some aspects of these procedures are not followed. Senior staff on duty could not find where these documents were. People are encouraged to look after and take their own medicines and where this happens the risk to themselves and other people have been assessed well. When we arrived, a number of residents were being given their medication in the lounge/dining area of the home. The staff member was seen to adminster medication to residents with regard to their dignity and personal choice but the method of administering the medication meant that this was a lengthy process and the medication round did not finish until 10:55 a.m. The senior carer said that the lunchtime medication was usually given around 2:00 p.m. The lunchtime medication round was seen to be undertaken at 2:10 p.m. This means that people are at risk of receiving doses of medication too close together. The procedure for giving medication to people should be reviewed to ensure this does not happen. Secure storage is provided for medication to prevent unauthorised access but the key to the storage room hangs on a chain at the side of the door. This could mean that access to medicines by unauthorised people is possible and it is also against the homes own policy. The temperature of the storage room is recorded regularly but has been found to be above the recommended maximum of 25C on a number of occasions. The failure to keep medication at the right temperature could result in people receiving medication which is ineffective. The cupboard used to store controlled drugs does not comply with the relevant regulations and is against the homes own policy for this. Medication record forms and medication in use were examined for a number of residents. Records are kept of when medication is received into the home, when it is given to residents and when it is disposed of. These records were of a very high standard providing a good clear audit trail and no discrepancies were found. The homes management carry out regular audits of medication and medication records and this is good practice. Medicines are only administered to residents by staff who have been trained to do so. The level of training is high and staff are assessed that Care Homes for Older People Page 17 of 35 Evidence: they are competent. Care Homes for Older People Page 18 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. People who use the service can be assured that their social care needs will be met and that they will receive a varied diet. Evidence: An activities co-ordinator is employed at the care home for 36 hours per week Monday to Friday, however the hours are flexible to cover events held during the evenings and at weekends. There is an annual budget of 2075.00 provided by the organisation so as to fund events, external entertainers and for materials. The activities co-ordinator confirmed through discussions with us that they have received training pertaining to dementia awareness/later stages of dementia and provision of activities (Level 2). Activities undertaken by individual people are recorded each day and there is an activity profile form completed for each person depicting their life history and social care preferences, likes and dislikes. Records clearly showed that wherever possible, the activities co-ordinator liases with people living at the care home and their representatives so as to gather the above information. A varied programme of activities is available for people at the care home and includes, mobile sensory trolley, manicures, hand massage, arts and crafts, relaxation, Scrabble, communication for Care Homes for Older People Page 19 of 35 Evidence: people who cannot communicate, word association, bingo, discussion group, reminiscence, religious observance etc. An activity provision and have your say brochure is devised and readily available for residents and their representatives. A 12 week activity programme, including forthcoming social events is displayed and a copy provided for each person. Since the last key inspection, the activities co-ordinator has implemented a new recording system so as to evidence how the social care needs of people living at Goldenley are met. This includes daily session plans, a resources plan, 12 week activity monitoring sheet and risk assessments for each activity. It was evident from discussions with the activity person that they are committed and keen to ensure that people at the care home receive a varied programme of social stimulation. We were advised that resident meetings are undertaken approximately every 12 weeks and suggestions for new activities are discussed. People are provided with a varied diet each day. People are given the choice of where they have their meals e.g. dining room, lounge area or in the comfort and privacy of their room. Dining tables were attractively laid and where appropriate, people are provided with specialist aids e.g. special cutlery, plate guards etc. Portions of food were observed to be attractively served and in sufficient quantities. Where people require assistance, people were seen to be provided with appropriate support that was both sensitive and respectful, however staff did not interact verbally with individual residents. People spoken with were positive about the quality of meals provided. Comments included, I like the food here, Its very tasty and Yes, the foods alright. During the morning of the first day of inspection, mid morning drinks were poured for residents by a member of staff, with milk and sugar added. Residents were not given a choice of drinks and only tea was provided. When questioned one member of staff stated, only one resident asks for coffee, and tea is more gentle on their stomach. This is seen as poor practice as little consideration is given to supporting peoples individuality and ability to make choices. This requires reviewing. Both the Team Leader and Operations Manager were advised at the time of the site visit. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are assured that any issues or concerns raised, will be dealt with and managed effectively. Evidence: An appropriate complaints policy and procedure was seen to be in place. The AQAA detailed that within the past 12 months, the home has received 5 complaints relating to lack of staff interactions, one resident feeling that staffs attitude and approach was disrespectful, missing residents clothing, missing dentures and someone else wearing the persons dentures, sensory room still not up and running and an medication error. Records showed clear details of each issue, investigation, action taken and outcome. We were advised that each of the complaints were upheld. Records showed that people were satisfied with the outcome. From residents surveys forwarded to us, there was evidence to show that not all people who live at the care home, know how to make a complaint and if the need arose would know who to speak to. Safeguarding policies and procedures were in place. Within the last 12 months there have been 3 safeguarding issues raised, which we were made aware of. Appropriate procedures were followed by the management team of the home and external agencies contacted. Staff spoken with demonstrated a basic understanding and Care Homes for Older People Page 21 of 35 Evidence: knowledge of safeguarding procedures. On inspection of the staff training matrix, not all staff working at the care home have received behaviour management training. Care Homes for Older People Page 22 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. People live in a home that is pleasant, clean and safe. Evidence: A partial tour of the premises was undertaken at this key inspection. The premises were seen to be clean, tidy and odour free and no health and safety issues were noted. A random sample of individual peoples bedrooms were inspected and these were seen to be personalised and individualised. The AQAA told us that within the past 12 months, flooring has been replaced in some areas, several bedrooms have been redecorated and additional chairs have been provided. We were advised that a maintenance person is employed at the care home for 21.5 hours per week, Monday to Friday, however these hours are flexible to cover evenings and weekends. The training matrix provided to us was examined off site, however this does not provide any evidence that the maintenance person has up to date training relating to fire awareness, manual handling, health and safety, infection control, COSHH (Control of Substances Hazardous to Health) or safeguarding. The AQAA details that within the next 12 months a new maintenance programme for redecoration and refurbishment will be implemented. Care Homes for Older People Page 23 of 35 Evidence: A random sample of maintenance records/certificates were examined pertaining to records of fire drills, emergency lighting, fire risk assessments, fire equipment, hoists, passenger lift certificate, electrical installation certificate and gas certificate and all were seen to be in date/well maintained. Records showed that a visit was undertaken to the care home by Essex Fire and Rescue Authority in October 2008 and the home was not fully compliant with their regulatory requirements. The fire officers report recommended that fire doors on escape routes to be fitted with self closing devices and the fire risk assessment for the home to be updated so as to include details of all persons at risk and control measures. Both recommendations remain outstanding. The training matrix showed that the majority of staff working at the care home have up to date fire awareness training. Care Homes for Older People Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there is a robust recruitment process in place, the level of staffing and gaps in training identified, potentially restrict the ability of the service to deliver person centred care and place people at risk of not having their care needs met. Evidence: We were advised by the Team Leader and manager that staffing levels at the care home are 5/6 care staff are on duty between 07.00/08.00 and 13.00/14.00, 5/6 care staff are on duty between 13.00/14.00 and 20.00/21.00 and 1 senior and 2 members of care staff between 20.00 and 08.00 each day. In addition to the above there is a senior member of staff between 07.45 and 20.15 and a Team Leader between 08.00 and 16.00 (hours are flexible). The managers are supernumerary to the above, Monday to Friday 09.00-17.00. Additionally anciliary staff are employed and these include a maintenance person, cook, laundry person, housekeepers and administrator. We were advised that an additional 6 hours per day has recently been agreed for increased staffing. On inspection of 4 weeks staff rosters, these showed that staffing levels as detailed above have not always been maintained. This was also confirmed from inspection of the homes log book. We have not been notified via Regulation 37 Notifications when staffing levels have not been attained and the measures undertaken by the management team of the home/registered provider to address the shortfalls. Mixed comments relating to staffing levels were recorded within surveys returned from Care Homes for Older People Page 25 of 35 Evidence: peoples representatives and care staff. These included, the care home is brillantly run as I say, brilliant manager and staff, just need a few more staff per shift and a few more sheckles to keep them happy and We need to have 6 carers on all day but sometimes only work with four, this does not work well. We looked at 3 staff recruitment files for the newest people employed at Goldenley. Robust recruitment procedures were noted to be in place, ensuring that people who live at the care home are protected. Each person was observed to have completed an induction in line with Skills for Care. Of those staff surveys returned to us, some people recorded their induction as being inadequate, however this was not evidend from the files examined. Training is provided by external trainers/organisations and through E Learning. On inspection of a random sample of individual staff training records and the training matrix, records showed gaps in both core subject areas (fire awareness, health and safety, COSHH, safeguarding, first aid, food hygiene and infection control) and other specialist areas associated with the needs of older people (managing behaviours, pressure area care, catheter care, nutrition, diabetes, parkinsons disease) etc. On inspection of the Statement of Purpose, this details all staff are trained in manual handling, protection of vulnerable adults, fire safety and food hygiene. This did not concur with records examined and the training matrix. The AQAA details that more than 50 of staff have achieved an NVQ qualification. Care Homes for Older People Page 26 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. Whilst management arrangements within some aspects of the service are either good or adequate, shortfalls and deficits in some key areas, could potentially affect positive outcomes for people living at the care home. Evidence: The manager has over 18 years experience within a care field setting and has been managing Goldenley since 2006. The manager is registered with us and has attained the Registered Managers Award in 2007, NVQ Level 3, D32/D33 Assessors Award and undertaken a variety of training in both core and specialist subject areas. The majority of resident/relative surveys returned to us were positive about the manager and the management of the home. In general people felt that the manager was approachable, however some staff surveys returned to us recorded that they did not have regular support or meetings with the manager. We were advised by the manager that the ethos of the service is to provide, a friendly Care Homes for Older People Page 27 of 35 Evidence: relaxed environment for the people who live at Goldenley and for them to receive care in line with their care needs. We were advised of barriers to achieve the above and these include, high dependency levels of existing residents (people who require 2 staff for hoisting, 2 staff required to provide personal care and assistance to some people with eating/drinking), some staff working within the care home providing care that is task orientated and not person centred, high turnover of staff and difficulties in providing care and support as a result of the layout of the building and loss of unitisation. It is evident at this inspection that further development is required in relation to some apsects of care planning/risk assessing, ensuring that care to individual people living at the care home is provided in line with their care and healthcare needs, care provided is person centred and not task orientated, that there is an appropriate training programme in place for staff which enables them to update their existing knowledge and ensuring that staff receive regular supervision. All sections of the AQAA were completed and the document returned to us when requested. The information recorded provides a general picture of the current situation within the service, however in some cases, there is limited evidence to support the claims made within it. Evidence of this is highlighted within the main body of the report. We were advised by the Operations Manager that the registered providers expectation is for all care staff to receive a minimum of 6 formal supervisions (1 of which is an observation of practice) and an annual appraisal each year. On inspection of a random sample of 6 peoples supervision records, these showed that not all people had received regular formal supervision in line with National Minimum Standards recommendations or the organisations requirements. Where records were in place, these showed that not all issues discussed or actions required, had been actioned. For example one persons records showed that on occasions they found it difficult to use the hoist or undertake manual handling procedures, however additional training was not provided for over 4 months. Records also showed that where people disclosed issues relating to poor team work and low staff morale, no action was formalised by the management team of the home to address this. We were advised that a quality assurance (satisfaction survey) was conducted in January 2009, however the results had not been collated at the time of the site visit. We were shown the results of surveys from Spring 2008. Records showed that out of 63 surveys issued to people living at the care home, their relatives and friends and visiting professionals, 27 were returned. Comments recorded were seen to be generally positive and included, the home is always welcoming, they work very hard Care Homes for Older People Page 28 of 35 Evidence: to do activities with the residents. Staff are very helpful and I have a good working relationship with them, staff have always been very helpful and happy with standards, carers work hard, entertainment very good. Other comments included, staff dont communicate sometimes with a friendly attitude, some of the staff dont seem to be happy, it builds us up when they are happy and I am kept waiting far too long at times for assistance. Regulation 26 visits have been regularly conducted at the care home since November 2008, however these were not undertaken during June and November 2008 as a result of having no Operations Manager assigned to Goldenley. Records of both staff and resident meetings were readily available. The AQAA provides a list of policies and procedures currently available within the home. As previously stated there are gaps in training pertaining to health and safety, COSHH and infection control. A monthly health and safety audit is completed to highlight issues that require addressing. Care Homes for Older People Page 29 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 7 15 Care planning at the home must identify, and be effective in meeting all residents assessed needs and be regularly updated/reviewed to reflect the most up to date information. Previous timescale of 16/12/2008 not fully met. This will ensure that people living in the care home have their care needs met and that staff have the information to provide appropriate care. 16/04/2009 2 7 13 Risk assessments must be devised for all areas of assessed risk. Previous timescale of 16/12/2008 not fully met. So that risks to individual residents can be minimised. 16/04/2009 3 8 12 The health and welfare of 31/03/2009 individual residents needs to be promoted and actively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact Page 30 of 35 Care Homes for Older People healthcare professionals and to provide appropriate interventions. Previous timescale of 16/12/2008 not fully met. So as to ensure residents health and wellbeing are maintained. Care Homes for Older People Page 31 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 8 17 Where people are at risk of losing weight, maintain appropriate nutritional records, including weight gain or loss and appropriate action taken. So as to ensure peoples wellbeing. 01/04/2009 2 9 13 Medication, including 01/04/2009 controlled drugs, must be stored properly and securely at all times, and under suitable environmental conditions. To protect residents medication from access by unauthorised people, comply with relevant legislation and maintain the quality of medicines in use. Where medicines are prescribed on a when required basis there must be clear guidelines for their use. 01/04/2009 3 9 13 Care Homes for Older People Page 32 of 35 This will protect residents from harm by ensuring medication is used appropriately. 4 18 13 Ensure that all staff receive appropriate training relating to dealing with challenging behaviour. So that staff will feel confident, have the skills to deal effectively with issues raised and people in the home are protected from harm. 5 27 18 Ensure there are sufficient staff, on duty at all times. So as to ensure the needs of residents are met according to their specific needs and dependency. 6 30 18 Staff receive appropriate training to the work they perform. This refers specifically to core subject areas and those conditions associated with the needs of older people. This will ensure that staff, have the competence, confidence and ability to meet peoples care needs and people living at the care home will feel reassured that their care needs will be met by suitably trained staff. 7 36 18 Ensure that staff, receive regular supervision. 01/04/2009 01/07/2009 01/04/2009 01/06/2009 Care Homes for Older People Page 33 of 35 This will ensure that staff, feel supported and able to carry out their role. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 9 15 16 Review the procedure for the administration of medicines to ensure that medicines are not given too close together. A choice of drinks should be offered to people living at the care home. Make appropriate arrangements to ensure that all people within the home know how to make a complaint and feel confident and assured that their concerns will be listened to. 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. 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