Inspection on 04/05/10 for Grange Park Nursing Home

This inspection was carried out on 4th May 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grange Park Nursing Home 24/02/10

Grange Park Nursing Home 21/10/09

Grange Park Nursing Home 27/10/08

Grange Park Nursing Home 11/12/07

Grange Park Nursing Home 01/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jean Edwards     Date: 0 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 48 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 48 Information about the care home Name of care home: Address: Grange Park Nursing Home 133 Himley Road Himley Dudley West Midlands DY1 2QF 0138423991 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): grange.park@btconnect.com Grange Park (Dudley) Nursing Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide the following category of service only: Care home only: Code N to service users of the following gender Either 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 number of places 37 Physical Disability - Code PD, maximum number of places 10 Dementia - Code DE, maximum number of places 14 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia: Code DE (14) Old Age : Code OP (37) Physical Disability: Code PD (10) 2. The maximum number of service users who can be accomodated is: 51 Date of last inspection Care Homes for Older People 2 1 1 0 2 0 0 9 Page 4 of 48 Over 65 0 37 0 14 0 10 Brief description of the care home Grange Park is a purpose built care home offering nursing & personal care mainly to older people, though it is able to offer some nursing beds to younger adults. It is situated just outside Dudley town centre and has good public transport links with Dudley and other local shopping centres. There is a car parking area at the front of the premises. To the rear there are patio and lawned areas, bordered by fencing and mature trees in places and presenting a very pleasant outlook. The interior of the home provides single and double occupancy bedrooms on two floors, some of which are en-suite. The ground floor offers a reception area, offices, communal lounges, a dining room, two conservatories, a small smoking room, kitchen, laundry and a range of bathing and showering facilities. Fees stated in the service user guide were £495 per week for nursing care and £395 per week for residential care. Care Homes for Older People Page 5 of 48 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last Key Inspection was on 22 October 2009 and a Random Inspection took place on 24 February 2010. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. Two Inspectors, a Pharmacist Inspector and Local Area Manager visited the home on the first day and two Inspectors visited the home on the second day. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included discussions with the acting manager, a director from the registered company, management consultants and staff on duty during the visit. The Owners of the home had recently employed the services of management consultants, who were introduced to them by their bank. The owners stated that the role of the external consultants was to provide a range of expertise and work along side them for a short period of time to improve services at Care Homes for Older People Page 6 of 48 Grange Park. We talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the Commission. We looked at a number of records and documents. We looked around the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. The home had published the range of fees in the service user guide, which range from £395.00 to £495. There was no information about reimbursement for the Registered Nurse Care Contribution (RNCC) for people assessed as needing nursing care. People are advised to contact the home for up to date information about the fees charged. Care Homes for Older People Page 7 of 48 What the care home does well: What has improved since the last inspection? What they could do better: The provider must recruit a suitably competent permanent manager and submit and application for their registration, as a priority. Care plans must be person centred and give clear guidance about how to meet the needs and support each person in the home, including those with dementia. Peoples health and well being must be carefully monitored, with changes reported appropriately and attention must be sought from heath and social care professionals when necessary, without delay. Some medication practices were potentially unsafe. Storage, administration practices and records must be improved. Each person must be supported with their cultural and spiritual needs. Activities and social stimulation must be provided, appropriate to each persons needs, including people care for in bed, and people with sensory disabilities or dementia. Care Homes for Older People Page 8 of 48 The food provided for people must be suitable to their needs and preferences. The management must diligently follow guidance to keep people safe without depriving them of their rights. All staff must be provided with suitable training so that they understand how to protect vulnerable people and know where they should report concerns. Some parts of the home were not an acceptable standard. A full assessment of the environment and actions with timescales should be developed. The management must be able to demonstrate that there are skilled staff in suitable numbers to meet all the needs of the people living at the home. Staff recruitment must be rigorous to make sure staff are suitable to work with vulnerable people. All staff should receive training and supervision to support them to develop skills to meet the needs of people living at the home. The quality assurance audits must be more robust so that failings can be recognised and actions taken to improve the service. Staff must be trained in the safe use of equipment such as bedrails to comply with health and safety legislation. Financial records relating to money held on behalf of people living in the home should be improved to show that all transactions are properly conducted. All adverse events affecting people living at the home serious pressure ulcers, hospital admissions and accidents must be notified to us without delay to show that people are safeguarded. Records must be monitored and improved, such as, equipment maintenance and accident records so that risks are recognised and controlled. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 48 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 48 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information about the home was not accurate and up to date and not every person living at the home had an up to date contract and terms and conditions of occupancy. This means that people and their advocates do not always have good information regarding their rights and entitlements, and how care will be provided. People cannot always feel assured that all of their needs are appropriately assessed and can be met by the home. Evidence: The homes statement of purpose and service user guide, dated March 2009 was available in the reception area. However, as reported at the last key inspection on 22 October 2009 the information was out of date. The current acting manager gave us copies of the draft updated versions. We saw that the documents could be provided in audio format on request, which would be helpful for people unable to read the written information. It was not provided in any other formats. We noted that some of the Care Homes for Older People Page 11 of 48 Evidence: information about the organisation was unclear and made reference to the external management consultants but we were told that this management consultancy would be providing support and advice for a short time limited period. Though details of the range of fees were included, there was no information about arrangements relating to Registered Nurse Care Contributions (RNCC), otherwise known as free nursing care contributions. This meant that people did not have full information about the service to help them make decisions about the choice of home. We looked at a sample of care records for people living at the home and as reported at the last key inspection there were not contracts and statement of terms and conditions in place for every person. The acting manager told us that new contracts / terms and conditions had been sent to all persons and / or their representatives to be signed and returned. She told us she had not received any signed contracts at the date of the inspection. We looked at the new contract, which was headed Healthcare Management Solutions, rather than Grange Park Nursing Home (Dudley) Limited. We recommended that the contract / terms and conditions should be reviewed using the Office of Fair Trading guidance, Fair Contracts, Terms and Conditions for Care Homes. For example the acting manager could not clarify what additional charges for staff escorts for hospital appointments would be. At the last key inspection, October 2009, we found that pre-admission assessments had been carried out to ensure that the needs of the person moving in could be met by the home and reported that the assessment provided only basic information which would make it difficult to identify all of each persons care needs and choices. There had been no new admissions since the Random Inspection on 24 February 2010. The contract with Dudley Primary Care Trust to provide nine intermediate care beds had been discontinued. The sample of care records we looked at during this inspection had not improved. There was little or no ongoing assessment and review of peoples needs as they changed, and staff with poor recognition and understanding, resulting in people left without appropriate care and attention when their needs increased and condition deteriorated. There was a lack of proactive referrals to appropriate healthcare professionals. For example we saw evidence that three people on the Dementia unit had developed serious pressure ulcers, which were not noticed by staff until a report was made by a visiting social worker. The acting manager told us that everyone on the dementia unit had been body mapped to record any pressure damage following the disclosure on 12 April 2010. However she acknowledged that she was unaware of significant pressures on a person admitted to hospital on 28 April 2010. We made her aware that the hospital staff had referred this persons very poor physical condition Care Homes for Older People Page 12 of 48 Evidence: with multiple pressure ulcers as a safeguarding alert to the Local Authority, as the lead agency. Care Homes for Older People Page 13 of 48 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and risk assessments do not give sufficient guidance to staff to ensure each persons needs are fully understood and met. Staff fail to recognise, report and refer significant changes to ensure people receive appropriate attention from health care professionals. The arrangements for the administration of medication does not ensure that every person at the home receives their medicines as prescribed by their doctor. Evidence: At the last key inspection we issued a requirement that each person must have appropriate and accurate care plans, risk assessments and health care screening tools to maintain their health and well being. The organisation provided us with an improvement plan, which gave assurances of compliance. We assessed compliance at a random inspection on 24 February 2010 and we saw examples of poor outcomes for people living at the home. An example was a person admitted to an intermediate care bed in a seriously deteriorating condition, which had not been recognised by the care assistants and had not been reported to the nurse on duty. At the random inspection Care Homes for Older People Page 14 of 48 Evidence: we required the staff to seek medical intervention, which resulted in the person being re-admitted to hospital. At this key inspection we witnessed a similar situation and we required the acting manager to seek medical attention for a person in a seriously deteriorating condition on the dementia unit. Other examples were: at the random inspection we saw documentation for two other people nursed in bed, who looked very emaciated. Care plans had not been updated and there were evaluations, which stated no changes, which did not accurately reflect the needs of the person, especially for the person requiring end of life palliative care. Special care records did not demonstrate adequate intake of food and fluids or position changes for people at risk of malnutrition, dehydration and skin damage, such as pressure ulcers. At this inspection we saw similar poor care records, where there was no care plan or medical attention for a person nursed in bed, who told us they had been in discomfort with sore, sticky eyes for some weeks. This was despite a record, which showed the person had been treated for an eye infection in October 2009, with the instruction from the doctor for a further referral if the condition persisted. The acting manager showed us an entry in the doctors visits request book dated 19/4/10, which had been crossed through. She told us she thought this meant the visit had not been requested. The entry and crossed through were not signed or initialled and nothing further had been done to alleviate this persons condition. The person also had late stage Parkinsons disease and there was no evidence of specialist support to help manage the symptoms of this condition since October 2009, though the consultant had indicated in a letter the person was to be reviewed. At this inspection the sample of special care records we saw had not improved and where they were in place did not demonstrate adequate food and fluid intake, no outputs had been recorded. We saw turn charts that did not consistently show position changes, which meant that the persons risk of developing pressure ulcers was increased. At the random inspection we saw a person, nursed in bed for end of life care who had developed a grade 4 pressure ulcer, not reported or appropriately treated. Since the random inspection we received information that four people on the dementia unit had developed serious pressure ulcers that were not reported or treated until safeguarding alerts were raised by other professionals. We looked at how a person on the dementia unit was being cared for, we saw her resting in bed on her right side, there was no pressure relieving equipment in place. This person had previously developed a pressure ulcer. We looked at her care records we saw that there had been two visits by the District Nurse a week apart; the wording Care Homes for Older People Page 15 of 48 Evidence: of both entries were exactly the same, District Nurse visited today see daily statement. Upon review of the Daily Statements for both of those dates there was no clear description as to why the District Nurse had visited or the outcome. There was a record to show she had used a Zimmer frame on admission, which was last updated on 27/07/09. There were no further recordings to reflect the persons decreasing mobility and care in bed. The risk assessment for the persons skin condition had not been re-evaluated to reflect the had recently developed a pressure ulcer. The moving and handling risk assessment had not been revised to give staff guidance to assist this person to move safely and we witnessed two staff use underarm assistance, which should not be used because of the risks of harm to the person. The persons falls risk assessment dated 23/05/07, had not been updated despite a history of regular falls. We saw records of falls, the last fall was recorded as 01/09/09, however the most recent fall, resulting in a bruised face had not been recorded. Staff told us that the person had lost weight and was not eating or drinking well. We looked at the nutritional risk assessment, last been updated 26/02/10 but there was no care plan in place to reflect the persons weight loss, and no indication that a referral had been made to a dietician or doctor. At the random inspection we reported that there were no records to show that these peoples weight had been monitored appropriately. For example the MUST (Malnutrition Universal Screening Tool) had not been used and we established in discussions with the acting manager and senior nurse people had not been referred to the community dietician. This meant that they were at risk of lack of adequate nutrition and dehydration causing discomfort and infections. We saw similar situations at this key inspection where there had been no weight monitoring since February 2010. Staff told us that the weighing scales had been broken since February 2010 and they were waiting for new scales. The acting manager told us that she had requested the administration assistant to place an order for the scales to be repaired in February and she had recently discovered the order had not been processed. She acknowledged she had not followed this up and no alternative weight monitoring, such Mid Upper Arm Circumference (MUAC) measurement had been used. This meant that people with poor nutrition and at risk of weight loss were not adequately monitored. We found the care records to be disorganised, confusing, with information difficult to find and and often conflicting. This meant that peoples needs were not accurately assessed or evaluated to ensure their needs were understood and met in a way, which maintained their health and well being. The Pharmacist Inspector looked at the homes medication arrangements. Medicine records were not always documented following good practice guidelines. For example, Care Homes for Older People Page 16 of 48 Evidence: we found that people who were prescribed food supplements or thickeners to be added to their fluids and food were not recorded by the person who gave them. We spoke to two members of staff and they informed us that the Medicine Administration Record (MAR) charts were documented by the Nurse who was administering medicines but this person did not give food supplements or thickeners to people. However, the nurse signed the MAR chart as a record that the food supplement or thickener had been given. The member of staff who gave the food supplement or thickener did not record anything. This meant that records were not usually recorded by the staff who gave the food supplement or thickener, which increased the risk of inaccurate medicine records. Medicine records did not always document specific information about the administration of medicine to people with special requirements. For example, one person was being given their medicines hidden in food or drink, also known as covert administration. We found that the information was not available to ensure staff knew how to give the person their medicines. We spoke to two members of staff who told us that sometimes the medicines were put directly into a sandwich, into cornflakes or into a food supplement. This information was not recorded on the MAR charts or in the persons care plan. Furthermore the food and fluid charts did not always demonstrate that the person had taken food at the times medication was signed as administered. The records were not up to date and were confusing. We were also informed that the medicine hidden in food was not always witnessed as being taken by the nurse who gave the medicine. The MAR chart was recorded by the nurse to show that the medicine was given, however they did not always see that it had been taken. This meant that the person was at an increased risk of not being given their prescribed medicine as the records did not document who had given and seen the medicines taken. People were not always given their medicine as prescribed and healthcare professionals were not informed. For example, we looked at the MAR chart for one person who was prescribed an eye drop. The eye drop was to be given once a day in the morning. We saw that the MAR chart documented that the eye drop had not been given for seven mornings as it had been refused by the person. We saw that there were four records documented as O for other reason why the eye drop was not given but the reason had not been documented. We spoke to a member of staff who informed us that the person often refused the eye drop and did not know if the GP had been informed that the person refused the eye drop. We confirmed that there was no documented mental capacity assessment to demonstrate whether the person could understand the risks of refusing medication and was capable of making their own decisions. This meant that the records showed that the person was not given their Care Homes for Older People Page 17 of 48 Evidence: prescribed eye drops and there had been no communication with a GP to ensure the health and welfare of the person to establish that they were not at risk of harm. The failings constitute a Breach of the Care Homes Regulations 2001. We gave full feedback to the acting manager. We explained the failings identified at this key inspection and that we were concerned about the control and handling of medicines in the service placing people were at risk of harm. We also explained to the acting manager that we were taking copies of records, which we may use in enforcement action to obtain compliance and improvement to safeguard the health and welfare of people at the home. Care Homes for Older People Page 18 of 48 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited social opportunities, there are no assurances that each person has appropriate activities or social stimulation for them. People are generally encouraged and supported to maintain important relationships and friendships. There are choices of nutritious meals but there is not consistent support to ensure everyone has an appropriate nutritional diet. Evidence: At the last key inspection on 22 October 2009 we reported that there was insufficient evidence to show whether the daily routines at the home were flexible to meet each persons preferences. The assessment and care records were not sufficiently detailed to give guidance to staff as to each persons preferred daily routine, such as rising, retiring, bathing, showering and food preferences. At this key inspection evidence was that no improvements had been made. We were told that there was a person who worked four days each week as an activities organiser and each Wednesday as a care assistant. The current acting manager acknowledged that there were no activity planners or records of activities. At the last key inspection the previous acting manager told us there were plans to review how activities were provided to make sure there were more activities, which were Care Homes for Older People Page 19 of 48 Evidence: appropriate to each persons individual needs, especially for people with dementia or cared for in bed. During the inspection visit we did not observe any activities taking place and there was no social stimulation particularly geared to people with dementia, or people nursed in bed. The acting manager told us that two people went out to day centres and two people used to go on shopping trips. She told us that an entertainer visited the home each month. The acting manager told us that there were regular church services from a local church each month but could not give us details. At the last key inspection, October 2009, we found that no information was available for a person who was of the Hindu faith. Staff could not tell us what this persons cultural needs might be and during this inspection there were no staff on duty who could communicate in the persons language. The home had an open visiting policy, which meant that people were able to maintain important relationships. However during the inspection we witnessed a person who was very concerned about his close relative who was ill and he wanted help to find out how his relative was. His requests for help and information were ignored by staff and he became increasing distressed until we intervened and brought the situation to the acting managers attention. We were told at the last key inspection that the menus had been devised in conjunction with the NHS dietician; however there was evidence that the choices were not always followed. We were told that there were plans to consult people living in the home about their preferred options from which menus would be reviewed and expanded. We were also told that the menus would be provided in appropriate formats to help people make realistic choices. There was no evidence that these actions had been carried out. We spoke to some people who told us that they enjoyed their breakfasts and that they could always have cooked options. One person who chose toasted bacon sandwiches told us the bacon was lovely. We noted that a person, who had his medication given covertly in food, did not have his bacon minced, as recorded in his care plan but cut into small pieces and we saw he left a portion on the plate. He was also offered options from the menu, rather than soft diet options. Care Homes for Older People Page 20 of 48 Evidence: The food and fluids records had not been consistently completed, though this issue had been raised at previous inspections and had not improved. At the previous Environmental Heath inspection the home had been awarded four stars and a gold award for food safety and healthy meals. The home had been reinspected in January 2010. The Environmental Health Officers report contained 28 Legal requirements and 2 good practice recommendations and was awarded three stars for food safety. The acting manager told us she had not applied for reassessment for the Health Eating award. She told us that she thought some of the Legal Requirements had been actioned but could not confirm complete compliance. Care Homes for Older People Page 21 of 48 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available to people assist to raise concerns and complaints but there are inadequate assurances that complaints will be investigated and resolved to each persons satisfaction. The arrangements to safeguard people living at the home do not protect them from risks of harm. Evidence: We were shown a draft copy of the updated complaints procedure devised by the consultants and though the complaints procedure gave contact details of the Local Authority and Care Quality Commission, we recommended that the role of the CQC should be amended to be clear and that the contact details of the Local Authority Ombudsman should be added, for people who remained dissatisfied with resolutions offered. We looked at the complaints log at the last key inspection on 22/10/2009. We requested the complaints log from the acting manager. Initially she informed us that there was no complaints log, however, later on, she provided us with a complaints folder. In the folder there were two complaints dated 17/12/2009 and 08/04/2010 respectively. We checked with the acting manager and she said this was the only complaints folder she could find. There were no complaints recorded between these two dates (approximately four months). Care Homes for Older People Page 22 of 48 Evidence: The complaint dated 17/12/2009 was raised by a social worker and was referred as a safeguarding alert to the Local Authority. There was evidence that the previous acting manager had commenced an investigation but this had not been concluded. There was no letter of acknowledgment on file to the social worker or complainant. Therefore, it was unclear as to whether the complaint was resolved satisfactorily. The complaint dated 08/04/2010 was raised by a person living at the home. A letter of acknowledgment was on file also dated 08/04/2010. There was no evidence of an investigation but there was a written request for the person to be reviewed by Social Services also dated 08/04/2010. The complainant was due to be responded to by 06/05/2010. This meant that there was evidence that the provider was not meeting the required standards regarding the management of complaints and that the requirement issued at the last key inspection had not been met. Since January 2010, there had been 11 safeguarding alerts in relation to this home, from a number of professionals, sent to the Local Authority as the lead agency for the protection of vulnerable adults. We discussed the safeguarding alerts, currently in the process of investigation with the current acting manager and consultant. They told us they were unaware of a number of them, including a formal complaint about poor care and severe dehydration of a person from an intermediate care bed, who had to be returned to hospital. There was no record of the complaint and we were told no investigation notes could be found nor the investigation outcome promised to the relative by the previous acting manager. We noted that the three recent safeguarding alerts were made by the current acting manager on 12 and 13 April 2010 only in response to concerns raised by Social Worker when she observed a weeping pressure ulcer on a persons heel, not noticed or reported by staff. It was only when all persons on the dementia unit were examined two addition people were found to have undisclosed pressure ulcers. The acting manager told us she was unaware that another person from the dementia unit had three significant pressure ulcers on various parts of her body when she was admitted to hospital on 28/4/10. This meant that staff were not monitoring and reporting changes to peoples heath, which posed serious risks of harm. We made the acting manager and provider aware that a safeguarding referral had been made by staff at the hospital. Furthermore during a discussion with the acting manager she told us about concerns raised by relatives at a recent relatives meeting. They alleged night staff had told Care Homes for Older People Page 23 of 48 Evidence: people they must not use their buzzer during the night and they must go to bed at time staff say or wait until later. The acting manager acknowledged she had not taken any action or reported these allegations as a safeguarding alert. This meant that there was a management failure to safeguard people, by failing to recognise and act upon allegations, which constituted restraint and abuse. This meant that there was evidence that the provider was not meeting the required standards regarding the safeguarding of vulnerable people at the home and that the requirement issued at the last key inspection had not been met. There was no evidence to show that staff had been made aware and had been given time to read and understand procedures for the protection of vulnerable adults, which was a good practice recommendation issued at the last key inspection in October 2010. We also looked at recruitment checks as part of this inspection visit, recruitment processes were not rigorous and they did not demonstrate people were effectively safeguarded from risks of harm. Care Homes for Older People Page 24 of 48 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is a generally comfortable, pleasant place to to stay. The systems in place for maintenance and infection control are not sufficiently robust. Evidence: Grange Park Care Centre was purpose built and opened in 1987. Each of the two storeys provided care for people with different needs. Kitwood unit provided accommodation for up to 10 people with dementia on the ground floor and people requiring nursing were accommodated on the ground and first floor. Part of the first floor had been completely refurbished to provide 10 beds, on Kinver unit planned for people needing intermediate care. However the contract with the Primary Care Trust had been discontinued and Kinver unit was not currently being used. There was a passenger lift to each floor and there were communal lounges, dining areas, kitchenettes, and communal bathing and toilet facilities. There were some additional smaller areas, such as conservatories for people to see their visitors, have meetings or join in activities. At the last key inspection we were told about plans to reorganise some areas to create improved facilities for people, including Kitwood unit to further develop orientation for people with dementia. The doors were painted in colours to improve orientation and there was good signage for bathrooms, toilets and bedrooms. However no further work had taken place. Care Homes for Older People Page 25 of 48 Evidence: There was parking at the frontage and secure landscaped gardens to the rear, with garden furniture, interesting red coloured paths and a red post box for orientation for people with dementia. The dining room provided tables and chairs for 24 people and at the previous inspections we were told that other people preferred to eat either in their rooms or in the lounges. There were facilities in the dining room to enable visitors to be able to make themselves hot and cold drinks. We saw that there were large attractive jigsaw pictures, completed by someone who had previously lived at the home, which were framed and hung in one of the small lounges. The lounges had been named, such as Engine, Malvern, Clent, and Clee Lounge, by a previous resident. At previous inspections we made a requirement for the compromised double glazed windows to be replaced as there was restricted vision through them. We reported at the last key inspection, October 2009, , there were a number of such windows throughout the home, which had not been replaced. At this inspection the we saw that no action had been taken to replace the compromised double glazed units. As reported at the last key inspection the acting manager acknowledged that the bathing and toileting facilities throughout the home generally needed to be refurbished and made more attractive for pleasurable bathing experience for people living in the home. A shower room on Kitwood unit, out of use at the last key inspection had a notice that it was still out of use. We saw that there was a trolley with clean linen in the shower room and saw signs that the WC was still in use. This did not demonstrate effective infection control measures. This was confirmed by a member of staff, who told us that the linen trolley had been pushed into the shower room out of the way to make room for the medication trolley in the corridor. As reported at the previous inspections there were facilities, which were not cleaned to an acceptable standard to maintain effective infection control. An example was the ground floor sluice, with dirty bowls and vessels, some on the floor. The acting manager acknowledged our findings and confirmed that there were no new cleaning schedules or monitoring in place to make the required improvements. We noted at the previous inspections that a conservatory was cold. The temperature in the conservatories was also very cool at this inspection, though the temperature throughout the main parts of the home was uncomfortably warm. The requirement to maintain the temperature throughout the home at a comfortable ambient temperature had not been met. Care Homes for Older People Page 26 of 48 Evidence: One conservatory was being used as a designated smoking room for people living at the home. We were told two people used the smoking room. The carpet was very stained, the room smelled heavily of smoke and the doors did not close properly, the smoke infiltrating into the adjoining lounge. This meant that the smoking arrangements did not comply with recent legislation regarding provision of clean air for everyone in the home. The previous acting manager assured us she would review and revise the arrangement as a priority. This had not been actioned. We looked at a sample of bedrooms with peoples permission where possible. They were all spacious and had en suite facilities. Some were attractively decorated and personalised according to individual preferences, such as family photographs, ornaments and small items of personal furniture. We saw that there were a number of bedrails in use and improvements had been made to ensure risks were minimised and they were covered with bed rail bumpers to reduce risks of skin damage to people needing to use them. The laundry was well equipped with commercial washers, tumble dryers and ironing facilities. The laundry service was generally well organised and the laundry staff were knowledgable and demonstrated good standards of infection control. We looked briefly at the kitchen, which was tidy and generally organised. However the Environmental Health Officer had inspected the home in January and made a large number of Legal Requirements and Recommendations, which had reduced the homes Star rating for Food hygiene from four to three stars. At the random inspection on 22 February 2010 we reported that there were some improvements, such the out of use shower / WC on the first floor had been repaired and a new nurses station had been created from the wheelchair store. At this inspection we noted that the ground floor bathing facilities in the main home had been cleared of clutter and were usable again. Care Homes for Older People Page 27 of 48 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. The number and skill mix of staff do not always ensure that people receive consistently good standards of care. The recruitment processes do not always provide sufficient safeguards for people living at the home. The training programme does not sufficiently demonstrate that all staff are equipped with the knowledge and skills to meet peoples needs. Evidence: At the random inspection on 24 February 2010 we saw that the staffing arrangements were inadequate to supervise and provide care and attention to the people using the service. We issued an immediate requirement for staffing levels and competence to be improved. We received written assurances and copies of revised staffing rotas. At a meeting we called with the provider on 8 April 2010, which was attended only by the external management consultants, we were told that as the number of people living at the home had decreased, the staffing levels had been reduced accordingly. We were also told staffing and dependency levels of people at the home were being monitored. However, subsequently information relating to four safeguarding alerts about undisclosed pressure ulcers and a hospital admission raised serious concerns about the quality of care being provided. There were 29 people on two separate units with a wide range of dependency levels and different, often complex needs. During this key inspection we saw examples of Care Homes for Older People Page 28 of 48 Evidence: poor outcomes for people living at the home, as highlighted at previous Outcome Areas of this report, notably medication, personal care and safeguarding vulnerable people. The staffing rotas showed that the care and nursing staffing levels had been reduced. The acting manager acknowledged that she had not carried out formal assessments each persons dependency and she had not documentary evidence of ongoing monitoring of dependencies as they changed. She told us she had concerns about the competence of some staff. She acknowledged that she had not taken any formal action to carry out competency assessments or provide structured supervision, support and development for the staff she had concerns about. This meant that the staffing arrangements were based on numbers ratios, without appropriate regard for the quality of the care provided for people living at the home. There was a trained nurse on all shifts and there were generally three carers on each day shift on the nursing / residential unit and two carers, including a senior carer for up to 10 people with dementia on Kitwood unit. Night staffing levels were two night care assistants on the nursing / residential unit and one care assistant responsible for Kitwood unit. Generally, when we spoke to staff they were unable to tell us accurately and in detail about the people they were meant to be caring for. The acting manager told us she shared our concerns about the poor care provided for at least half of the people with dementia on Kitwood unit. However the senior care assistant on duty on Kitwood during the inspection, who appeared to be trying her best, told us that she was only worked one shift each week in charge of the unit, the majority of her shifts were worked in the main house. She stated there were two other seniors who worked three days each and she was filling the gap and did not know the people on Kitwood well. The acting manager told us, part of the problem is that there is no-one in overall charge on the unit. She told us that there was a planned meeting to discuss the management of Kitwood unit. However this did not present an immediate resolution for the high risk situation for people currently living on the unit. We looked at the staff files of the two senior care assistants designated to be responsible on their shifts for Kitwood. On one persons file there was no indication of any recent Fire Safety training, safeguarding training or in depth dementia training. The other persons file indicated she had received more training but a supervision record for 09 February 2010 documented by the previous acting manager, included, Care Homes for Older People Page 29 of 48 Evidence: Kitwood dirty, untidy, used pads left on the floor, poor standards of care delivery. We could not find any follow up action in relation to this. The current acting manager told us she had read the persons file but had not read the supervision record and had not taken any action with this person. We also noted from a personnel file that the recruitment process for a night care assistant, working alone and unsupervised on Kitwood, did not provide sufficient safeguards for people living at the home. The acting manager acknowledged that the person had been employed before receipt of two satisfactory written references or CRB (Criminal Records Bureau Disclosure) and without risk assessments. At a previous inspection we had also seen evidence of employment of a night care assistant, without rigorous employment checks and satisfactory to ensure that the people were suitable and capable of working with vulnerable people in this environment. The acting manager told us that her hours were supernumerary but we noted there were no management hours recorded on the staff rotas. The provider had previously made the decision to remove the deputy manager post with two supernumerary shifts and since the last inspection had reduced the nurses day time clinical hours on each shift and increased the night nurses hours, which meant an overall reduction of seven hours each week, with no time allowed for a verbal handover at each shift change, unless staff did this as unpaid time. The acting manager told us that the nurses were reluctant to take responsibility for the people with Residential status on Kitwood unit. We have highlighted poor record keeping in previous sections in this report and the lack of time meant that effective communication between staff would be further compromised. It also meant that it would be difficult to implement the improvements needed. We were told at previous inspections that there were not sufficient hours to maintain and monitor clinical and care practices. At previous inspections there was insufficient evidence that all nursing staff had undertaken training to update their clinical skills or had assessments of their competency, especially relating to medication management and administration. There had been a high staff turnover in the last 12 months and this appeared to have had an impact on training, for example the number of care staff with an NVQ (National Vocational Qualification) level 2 Award(or above)was 13 at the last key inspection. The acting manager told us at this key inspection there were 6 out of 33 care staff with NVQ level 2 qualifications and one senior carer with an NVQ level 3 care award. Care Homes for Older People Page 30 of 48 Evidence: The acting manager gave us a training matrix she had developed that identified which staff were up to date with training and when they were due for training updates. The acting manager also produced a summary report providing the percentage of staff who were up to date with training as follows: Fire Safety 4 , Fire Drills 52 , Food Hygiene 18 , Moving and Handling 34 , COSHH 0 , Health and Safety 0 , Safeguarding Vulnerable Adults 18 , Infection Control 0 , Nutrition 9 , Safe Handling of Medication 25 , Medication Update 100 , Pressure Care 24 , Customer Care 0 , Care Planning 0 , Challenging Behaviour 36 , Dementia Awareness 44 , Safe Use of Bed Rails 0 . This data clearly demonstrated that the provider was not ensuring staff were fully trained and competent to meet the needs of the people living at the home. Care Homes for Older People Page 31 of 48 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements do not provide effective leadership, appropriate communication systems, monitoring arrangements, or sufficient safeguards for people living at this home. Evidence: There has been no Registered Manager at this home since October 2009. At the random inspection we were told that the services of an external consultancy had been engaged to look at the finances and quality of the service. The previous acting manager commenced employment on 16 October 2009 and we were told by the management consultants that she had left the homes employ following the random inspection on 24 February 2010. We were given conflicting information about the nature of her departure and we were not given the date or shown any documentation, which was unsatisfactory. We were told at a meeting on 8 April 2010 that the interim acting manager role would be undertaken by one of the management consultants, whilst recruitment took place Care Homes for Older People Page 32 of 48 Evidence: for a new substantive manager. However information given to us at the start of this inspection about the employment status of the consultant acting as current manager was ambiguous, until we insisted on clarification. We were then told she was seconded from the external management consultants to the registered company in the acting manager role. We were told that the provider would proactively try to recruit a new competent manager for the home and that the external management consultancy involvement would be time limited until improvements were achieved, which they estimated to be a few months. The acting manager told us she was not aware of an annual development plan for the home but the home had been audited, using the external management consultants quality assurance system. We looked at the audit report, which identified a number of areas for improvement but some findings conflicted with areas of concern highlighted in previous sections of this report such as care planning, risk assessments and medication, staff recruitment, staff training. There were records of visits by the external management consultants on behalf of the provider in compliance of Regulation 26, to monitor the management and running of the home. The reports had not identified the lack of compliance with previous requirements and the homes improvement plan. There had been some staff meetings, chaired by two of the external management consultants; the acting manager told us she had not been present and there were no minutes available. From discussions the topics appeared to be about changes to staff contracts and working conditions. We were told the administration assistants post was being made redundant. There had been one meeting with relatives; there were no minutes available from the meeting, though we were told about some of the topics discussed and some of the concerns raised by relatives, including staff practices highlighted in the Complaints and Protection section of this report. We discussed our concerns that the allegations of people being prevented from using the nurse call system during the night and being denied their choice of assistance for retiring to bed had not been recognised as restraint and abusive and acted upon by the management. We interviewed the acting manager, part of our questions were about what she had done to improve the quality of care for people since her appointment on 01 March 2010. She told us that she had not done enough, fast enough. In relation to required medication improvements, she replied, Nothing. The acting manager told us she had devised a supervision matrix but acknowledged Care Homes for Older People Page 33 of 48 Evidence: that the supervision system was not operational. She also acknowledged that nurses and senior care assistants had not received any training to deliver supervision to be a tool for staff support and development, stating its a gap. This meant that there were no effective systems to support and develop staff to improve their skills for the benefit of people living at the home. As highlighted at the Environment section of this report there was safer use of bedrails, however staff training records, demonstrated there had been no staff training for the use of bedrails to maintain peoples safety, ensuring they being used in accordance with HSE guidance. As highlighted at the Staffing section of this report the records showed that overall staff had not received mandatory training appropriate to their roles, such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training. Record keeping was poor overall. Records relating to peoples health care had not been improved, such as care planning, risk assessments and medication records. Recruitment records were not robust to provide safeguards for people. Regulations had not been followed diligently for example there were no Regulation 37 notifications relating to medication errors when people had not received medication as prescribed and there was no Regulation 37 notification relating to the person admitted to hospital with severe and multiple pressure ulcers. We looked at the records for monies held in temporary safekeeping for people living at the home. The rate of signatures on transactions had improved but the lack of receipts and receipts not being signed demontrated poor auditing. At the previous key inspection in October 2009 we reported that the lift and hoist maintenance documents did not demonstrate satisfactory service certificates in compliance with Lifting of Loads Equipment (LOLER) Regulations. The acting manager acknowledged there was no documentary evidence at this key inspection. Whilst we were looking around the home we noted that one person was being moved using an inappropriate moving and handling technique, which posed risks of injury to the person and potentially to staff. We looked at accident records and the accident analysis, which showed there had been 19 accidents involving people living at the home. However, there appeared to be no action taken to minimise risks, where someone had fallen a number of times; risk Care Homes for Older People Page 34 of 48 Evidence: assessments were not reviewed and revised in accordance with the persons changed needs. We have informed the management of the organisation that we will consider what further enforcement action we need to take to secure improvements for the health, well being and safety of people living at this home. We will continue to undertake inspections to monitor the service. Care Homes for Older People Page 35 of 48 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 3 14 Pre admission assessments must be more detailed and include all areas of risks and needs, and these must be kept under review. This is so that people can be confident that all their needs can be met. 01/12/2009 2 7 12 To ensure that there are 01/12/2009 health care assessments, risk assessments and care plans, which include all of each persons assessed needs, the active involvement of the person / or representative; and are updated to accurately reflect all changes to health and needs. This is to ensure care for each persons health and well being is properly provided at all times. 3 8 12 To ensure that people with 01/12/2009 poor nutritional intake and / or weight loss are monitored using a recognised screening tool as frequently as required by their risk assessment and care plan. This will ensure that staff take required actions to promote peoples health and well being. Care Homes for Older People Page 36 of 48 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 4 8 12 To ensure that special care records such as food, fluid balance charts, turn charts, and wound care records are maintained, with care provided appropriately recorded and monitored and updated. This is to ensure peoples health and well being is maintained. 01/12/2009 5 9 13 The service must make safe 25/03/2010 arrangements for medication when people leave the home for social leave occasions. This is to ensure that medication is given to people according to the directions of a Doctor. 6 9 13 To ensure that all staff who administer medication are assessed as competent and their practice must ensure that people living at the home receive their medication safely and correctly. This is to ensure that the people who use the service are safeguarded. 01/12/2009 7 9 13 The service must make 25/03/2010 arrangements to ensure that all medication is administered at the correct time as directed by the prescriber to the person it was prescribed, labelled and supplied for. Page 37 of 48 Care Homes for Older People 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 This is to ensure that people living in the home are given their medicine safely and correctly. 8 9 13 To ensure that all persons 01/12/2009 living at the home receive their medication as prescribed by their doctor and the Medication Administration Records must be accurately completed to demonstrate either medication has administered or an appropriate code entered to record the reason for non administration. This is to maintain the health and well being of people living at the home. 9 9 13 The records of the receipt, 01/12/2009 administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. This is to maintain the health and well being of people living at the home. 10 9 13 To ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to monitor and inform the relevant healthcare professionals as needed. 01/12/2009 Care Homes for Older People Page 38 of 48 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 This is to safeguard the health and well being of people living at the home. 11 16 22 To diligently record and 01/12/2009 report all complaints, with actions clearly identified to demonstrate robust investigations of all concerns or referrals to other appropriate agencies as necessary; and ensure these records are available for inspection. This is to ensure that the people who use the service are safeguarded. 12 18 13 All staff must receive appropriate safeguarding training and the homes and Safeguard and Protect procedures to protect vulnerable people must be implemented and followed diligently at all times. This is to safeguard all persons living at the home from risks of harm. 13 27 12 To demonstrate that the number of staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 01/12/2009 01/12/2009 Care Homes for Older People Page 39 of 48 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 14 27 12 To formally assess the 15/03/2010 dependency of all persons accommodated at the home; and this must be kept under review; and demonstrate with an action plan and staffing rotas to ensure that at all times suitably qualified, competent and experienced persons are on duty in sufficient numbers to meet the needs and promote the health and welfare of each person using the service. To submit your action plan and revised staff rotas for week ending 28 February 2010 to the Newcastle CQC and Birmingham CQC office by 1300 hours on Thursday 25 February 2010. Furthermore you must submit staffing rotas to demonstrate your compliance until further notice. This is to meet the needs and promote the health and welfare of each person using the service. 15 29 19 To ensure that all staff 01/12/2009 employed at the home are recruited following robust recruitment procedures, with documentary evidence to demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to safeguard people living at the home from risks of harm. Care Homes for Older People Page 40 of 48 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 16 31 39 To notify the CQC of any 01/12/2009 changes to the management of the home, including the name, address and qualifications of the person responsible for running the home. This is to safeguard people living at the home. 17 33 24 To implement effective 01/12/2009 quality monitoring systems, which demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety of people living at the home. 18 37 37 To ensure notifications are 01/12/2009 submitted to the Care Quality Commission of any incident that has affected the health, safety or wellbeing of the people at the care home, without delay. This included medication errors. This is to safeguard the health, well being and safety of people living at the home. 19 38 13 Management systems must 01/12/2009 be implemented to ensure the safe use of bedrails, which includes correct fitting, rigorous risk assessments, diligently followed, documented checks and staff guidance and training Page 41 of 48 Care Homes for Older People 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 relating to bedrails. This is to safeguard the health, well being and safety of people living at the home. Care Homes for Older People Page 42 of 48 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 To ensure that each persons 11/06/2010 assessment of needs, carried out by a suitably qualified, trained, competent person, is kept under review and appropriately revised whenever necessary regarding changes. This is so that each persons heath and well being is maintained and safeguarded. Care plans, which are 11/06/2010 comprehensive, person centred, and identify how all of each persons needs in respect of their health and welfare are to be met must be availlable in easy to understand formats. This is to promote the health and well being of each person using the service. 2 7 15 3 31 9 The provider must recruit a suitably competent 01/08/2010 Care Homes for Older People Page 43 of 48 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 permanent manager and submit and application for their registration, as a priority. This is to ensure management arrangements safeguard people using the service. 4 36 12 A structured staff 11/06/2010 supervision system must be implemented to ensure all staff receive formal supervision at least six times each year to provide them with support and development to meet the needs of people using the service. This is to ensure staff are equiped to promote the health and well being of every person living at the home. 5 38 13 There must be robust risk assessments and rigorous monitoring arrangements to ensure staff do not use inappropriate moving and handling techniques, which posed risks of injury to the person and potentially to staff. 11/06/2010 Care Homes for Older People Page 44 of 48 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that people using the service are safeguarded from risks of harm. 6 38 13 To provide written confirmation of compliance with all Legal Requirements in the Environmental Health Officers Food Safety report. This is to ensure people have food, which is prepared safely. 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 11/06/2010 1 1 The statement of purpose and service user guide should be revised, updated and reissued to people living at the home in easy to understand formats suited to their capabilities. This was a previous Good Practice Recommendation, which was not met. Information in the homes documentation about unspecified charges for staff escorts for hospital visits, should be made clear, should be justified and should not be discriminatory. The contract / terms and conditions of residence should be revised, updated and reissued to each person living at the home to reflect good practice guidance issued by the Office of Fair Trading. This was a previous Good Practice Recommendation, which was not met. Each person should receive written confirmation that the home can meet their assessed needs, including their cultural needs. This was a previous Good Practice Recommendation, which Page 45 of 48 2 2 3 2 4 4 Care Homes for Older People 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 was not met. 5 7 Daily progress records should be revised to ensure all records are accurate, consistent and up to date. This is previous unmet Good Practice Recommendation. Advice from the diabetic specialist nursing service should be sought for any person with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to diabetes. This is previous unmet Good Practice Recommendation. Advice from community dieticians should be sought for all persons assessed to be nutritionally at risk, with records of support and advice offered and that a record be maintained of staff training in relation to nutrition. This is previous unmet Good Practice Recommendation. The correct pressure setting for pressure relieving mattresses should be recorded in each persons care records with regular documented checks. This is previous unmet Good Practice Recommendation. Moving and handling risk assessments should reviewed and expanded to include instructions for the level of assistance and named equipment required for all transfers. This is previous unmet Good Practice Recommendation. Care plans, monitoring and management strategies should be put in place for people described as having agitated, aggressive or other challenging behaviours with ways to evaluate the effectiveness of strategies and use of PRN medication. This is previous unmet Good Practice Recommendation. Activities and social stimulation must be provided, appropriate to each persons needs, including people care for in bed, and people with sensory disabilities or dementia, with planned and spontaneous activities recorded and evaluated. Personal preferences should be accurately recorded for each person and daily routines should be flexible to meet each persons choices. This is previous unmet Good Practice Recommendation. Inventories of personal possessions should be fully completed, signed, witnessed and kept up to date. Page 46 of 48 6 8 7 8 8 8 9 8 10 9 11 12 12 12 13 14 Care Homes for Older People 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 This is previous unmet Good Practice Recommendation. 14 15 Food options and choices for people from other nationalities and cultures should be frequently reviewed with them and their supporters to make sure they are able to have their preferred meals. This is previous unmet Good Practice Recommendation. Staff should be given time to read policies and procedures associated with the protection of vulnerable adults, with signatures obtained to demonstrate their awareness and compliance. This is previous unmet Good Practice Recommendation. All staff must receive appropriate safeguarding training and the homes and Safeguard and Protect procedures to protect vulnerable people must be implemented and followed diligently at all times. This is previous unmet Good Practice Recommendation. Plans should be implemented to ensure the environment meets the needs of everyone living at the home in a prioritised timescale. This is previous unmet Good Practice Recommendation. Assessments should be in place to ensure each person is provided with equipment that is suitable to meet their needs, such as nursing profile beds, and suitable, adjustable chairs. This is previous unmet Good Practice Recommendation. There should be signed and dated receipts for every transaction and a clear audit of money used on each persons behalf. Regular documented accident analysis should ensure that accident records are used in conjuction with risk assessments so that they reviewed and revised in accordance with any changed needs. There should be documentary evidence that maintenance is carried out on all lifting equipment in compliance with LOLER Regs. 15 18 16 18 17 19 18 22 19 35 20 38 21 38 Care Homes for Older People Page 47 of 48 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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