Inspection on 17/09/09 for Granville House

This inspection was carried out on 17th September 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granville House 11/08/09

Granville House 18/10/07

Granville House 16/02/07

Granville House 21/11/05

Granville House 26/04/05

Granville House 19/01/05

Granville House 01/06/04

Granville House 02/03/04

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

Key inspection report Care homes for older people Name: Address: Granville House 40 Woodgreen Road Wednesbury West Midlands WS10 9QS     The quality rating for this care home is:   one star adequate 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: Mandy Beck     Date: 1 7 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Granville House 40 Woodgreen Road Wednesbury West Midlands WS10 9QS 01215022654 F/P01215022654 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Amarjit Kaur Sandhu,Mr Avtar Singh Sandhu care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home Only (Code PC); 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 (OP) 21 Dementia - over 65 years of age - (DE(E)) 21 Date of last inspection Brief description of the care home The home is an adapted and extended traditional detached property that is sited within a short distance of Wednesbury Town centre with access to good transport links and the M6 motorway. Accommodation in the home includes three lounges, a conservatory, dining area with toilets and bathrooms on every floor. Communal areas are divided into separate units with a number of key padded doors around the home to assist with security for people. There are fourteen single and three shared rooms, these on three floors, with only the first floor accessible via shaft lift. There is parking to the front and Care Homes for Older People Page 4 of 30 Over 65 21 21 0 0 Brief description of the care home rear of the home and a patio and small garden area to the side and rear. There are a number of aids available including adapted baths, raised toilet seats and call system. The home is run by a manager who oversees staff including seniors and carers. The home provides a service to older people with dementia. Whilst nursing may be provided by primary health care staff on occasions (such as district nurses) the home does not itself offer any nursing care. The current range of fees is not included in the service user guide and readers of this report are asked to contact the home directly for this information. Care Homes for Older People Page 5 of 30 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 inspection carried out by two inspectors over one day. The home did not know we were visiting. An expert by experience was also present for part of this inspection. An expert by experience is a person who, because of their shared experience of using services visits a home with an inspector to help them get a picture of what it is like to live in or use the service. We looked at all the information we have received, or asked for, since the last key inspection November 2007 and our random inspection August 2009. This included information about how the service has managed any complaints. What the service has told us about things that have happened, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last twelve months and relevant information from other agencies. We spent time talking to some of the people who use the service and to the staff who support them. Care Homes for Older People Page 6 of 30 We looked in depth at the care of three people who use the service. This is part of our case tracking process and helps us to make judgements about the homes abilities to meet peoples needs. We sent surveys to the home and to the people who live there. Their comments have been included in the report. We have also asked the home to provide us with an Annual Quality Assurance Assessment (AQAA), they have not done this. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: People told us, there used to be much more time for us to go out and enjoy ourselves but since the staffing has been reduced this doesnt happen so much. The home will need to improve the level of activity for people, especially those people who cannot get out and about. People have told us there is alot of staff unrest at the present time and this is making them feel uncomfortable. They said there are little cliques of staff and it can make you feel very uncomfortable. They also told us they are aware of a lot of tension between the staff group. One person told us there is a culture of telling tales here its very uncomfortable. The home will need to address this situation so that people do not feel uncomfortable living in the home. The home environment has improved since our random inspection August 2009, however the home will need to keep improving the home with more decoration, replacement of worn and broken furniture and deep cleaning. The home needs to make sure that the recruitment procedures are improved and that serious issues are responsibly dealt with so that people are safeguarded. The staffing levels and deployment of staff thoughout the home needs to be reviewed and action taken to ensure peoples needs are met appropriately in a timely manner at all times by people who know them well. Staff need training in a number of areas to Care Homes for Older People Page 8 of 30 ensure they have the competencies and skill to meet the needs of people living in the home. Strong leadership is needed across all areas of the home to ensure the home is run in an effective and efficient manner that meets needs and expectations of the people living there. The home needs to develop the quality assurance system so that an up to date action plan can be published. This will demonstrate to people when and how the home plans to improve and make changes to the service it provides in peoples best interests. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People choosing to live in the home are given ample time to look around and make sure they like the home before they agree to move in. The home will make sure that peoples needs are assessed in full before they are admitted. Evidence: Before people agree to move into the home the manager will spend time with them completing an assessment of their needs. This is done to make sure the home is able to meet peoples needs and that it will be the right place for them. We looked at the needs assessments of three people during this inspection and found that each one had been completed and provided a sound basis for staff to be able to plan care for people. People choosing to live here are given ample opportunity to sample the service before they agree to move in. We were told that people are encouraged to spend time in the home on trial visits. Comments from people included We must admit that we wouldnt Care Homes for Older People Page 11 of 30 Evidence: have chosen this home given the poor decoration in side the home but it was recommended to us and the care is very good we cant fault that. The home does not provide intermediate care facilities at this time. Care Homes for Older People Page 12 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can feel confident their healthcare needs will be met and there are good systems in place to manage their medication. Evidence: We looked at the care records of three people during this inspection. This is part of our case tracking process. We found that each person had their own individual plan of care. The home has taken time to sit with people to discuss their needs and preferences and as a result care plans have been tailored to individuals need. The home makes sure that each person is assessed for their risk of developing pressure sores, being malnourished and falls. Where risks are highlighted the home completes a risk management plan and records what action they will take to reduce the risks to people. All care plans are kept under regular review and are updated to reflect any change in a persons condition. People who answered our surveys told us the staff never hesitate to contact our mums doctor if they have any concerns and I am well treated and like it here. One Care Homes for Older People Page 13 of 30 Evidence: person commented staff at Granville House treat me with respect and look after me when I have a bad day, all the staff are respectful to all residents and to us as a family. We spent time talking to staff during this inspection and they were able to give us a detailed account of peoples needs and the support they wanted. They told us We are told by the nurses who needs what care but most of the time its nice to sit with the resident and ask them. The home is also supported by community services such as doctors, psychiatrists and community mental health nurses. People also have access to dentists, chiropodists and opticians, as they need it. People told us if I feel under the weather there is no hesitation in calling for the doctor. We looked at the systems in place for the ordering, safe storage and administration of medication. We found the home has good systems in place and medication is administered as the doctor has prescribed it. There are safe systems in place for the storage and administration of controlled drugs. The home has recently begun using a new supplying pharmacy. The home told us they hope to improve the service people get from their pharmacy as a result. We have made some good practise recommendations for the home to follow in order to further improve upon their own systems. For example the home needs to record the amount of medication that is being carried over each month on the medication administration record (MAR) sheet, this will assist the home in medication audits of peoples medication. When staff handwrite an entry onto the MAR two staff should check and sign this entry in order to reduce the risk of errors in transcribing occurring. Where people are prescribed a variable dose for medication such as one or two tablets, staff must record the actual dose that has been given, this will enable the home to keep an accurate record of the exact amount of medication that has been administered. We spoke to some of the people living in the home during this inspection. They told us staff here are very good. We asked if staff paid particular attention to their dignity and need for privacy. They said, Oh most definitely they are very caring. We saw staff talking to people in a polite manner and when they were giving assistance to people they did so sensitively and did not rush people. Staff told us we care well for the service users and their needs, we offer choice promote dignity and independence. We try to go the extra mile. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to develop the in house activity programme for people who are not able to access the local community. The meals in the home are well balanced and people do have a choice about what they eat. People are encouraged to keep in touch with their families and friends. Evidence: We have received a variety of comments about the activity provision in the home. On the whole people living here are unhappy with the lack of opportunity to take part in some form of activity. The manager told us that regular trips out to the pub and to bingo are still happening. Staff told us this happens when we take people in our own time, people using the service said there used to be much more time for us to go out and enjoy ourselves but since the staffing has been reduced this doesnt happen so much. Other people commented on the type of activity they would like to see being available, such as I would like more board games, more things to do in the home rather than sitting about, it would be nice to have some physical activity, I feel like I have no purpose. Another person told us I am able to take my mum out alot I think this is making all the difference to her. Care Homes for Older People Page 15 of 30 Evidence: The home will need to look at the way it plans activity for people and to make sure that those people who are unable to leave the home have the opportunity to take part in some activity. Staffing levels should be reviewed so that more activity can be built into peoples lives. We had the opportunity to speak to some relatives during this inspection, they told us the home is very good and always try hard, other people said you wouldnt pick this place for the decor but you would for the care they give. The home encourages people to have visitors when they want to. People have the opportunity to see them in the privacy of their own rooms or in any of the communal areas. We looked at peoples bedrooms as part of our case tracking process, and also to check that improvements are being made following our last random inspection in August 2009. We found that most of the rooms have been personalised by the people occupying them with ornaments, pictures and other favourite belongings from home. Other rooms looked sparsely decorated and some had an offensive odour that the home will need to address. Meals are freshly prepared on site. The catering staff are currently undertaking National Vocational Qualifications (NVQ) in catering. During this inspection an assessment of their work was being undertaken. We were told by people the food is very nice, there is always plenty of it, one person told us they fill my plate so high I cant eat it, I dont think there is a need for this. We observed meal time and heard people saying that the food was very nice and one person told us she had put weight on since being in the home. People all had the same main course but there was a choice of lamb chop or beef casserole on offer. There was also a choice of dessert available. We saw people being assisted by staff in a sensitive and caring manner. The menu for the day is displayed on the wall by the kitchen, we have recommended the home produce a pictorial menu for those people with dementia as this may enhance their ability to choose their own meal. Since our last inspection the dining room has been redecorated, new tables and chairs and flooring have been supplied, this makes the room look far more appealing and a pleasant place to eat a meal. Care Homes for Older People Page 16 of 30 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. The home will respond to peoples concerns but not everyone feels confident they will be acted upon. The does have systems in place for the protection of vulnerable people but improvements are needed. Evidence: The home has a complaints policy for people to use. People gave us mixed responses to how the home deals with their concerns. They said We are completely happy with the care and with Granville House staff management and policies, both management and staff endeavour to integrate and involve residents on a daily basis, I find the manager to be very approachable but the owner doesnt seem to want to help. The manager told us I try to respond as quick as I can to any complaints, my door is always open and people know this. The manager also told us that there have been no complaints received since our annual service review November 2008. We have been made aware of several concerns about the service that people are receiving. This has prompted us to make referrals to the local authority safeguarding team and to complete a random inspection in August 2009. At present the local authority is continuing to investigate the concerns raised. The home is working with them in trying to bring about some resolution to the process. In addition to those concerns people living in the home have told us about the atmosphere between staff. They have told us there are little cliques of staff and it can make you feel very uncomfortable. They also told us they are aware of a lot of tension between the staff Care Homes for Older People Page 17 of 30 Evidence: group. One person told us there is a culture of telling tales here its very uncomfortable. Staff responded to our surveys and told us someone is trying to cause trouble by hiding care plans and records, when we come on duty there is an atmosphere and you dont know who you can trust. The home clearly needs to manage this situation. We were told by the management team at Granville House that steps are in place to do this. It is clear that staff understand the whistle blowing policy and how to safeguard vulnerable people. Staff have been very proactive in reporting their concerns about standards of care, the reduction in staffing levels and the effect this has on peoples lives and the poor state of repair the home environment. The home has also arranged training for staff in the safeguarding of vulnerable adults which is planned to take place in October 2009. The manager is aware of her role and responsibility in recognising and reporting allegations of abuse or poor practise. Staff have told us they have not received training in the principles and practise of the Mental Capacity Act 2005 and the deprivation of liberty safeguards. The manager has said this training has also been arranged. This will help staff to understand their role in supporting people who may not have the capacity to consent to all aspects of their treatment or health care. We looked at recruitment and selection of staff and found that although the home does take steps to undertake the required security checks against the Protection of Vulnerable Adults list (PoVA) and a Criminal Records Disclosure (CRB). They did not take suitable action in order to protect the vulnerable people living in the home. Risk assessments did not explore serious issues sufficiently enough to satisfy us people were not being placed at risk. People who begin working in the home with only a PoVA first check must have suitable arrangements in place for their supervision until such time as the CRB is returned. We found evidence that showed us new workers supervisors were not working the same shift as them and in once case two new workers were being supervised by the same person on a night shift when they were the only staff on duty. The home will need to improve its recruitment practises if people are to be safeguarded. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers adequate facilities for people to use. The home is not always clean but improvements are being made. Evidence: We visited the home in August 2009 and we were very concerned about the poor state of repair we found the home to be in. We found many areas for improvement and we gave the provider immediate requirements to address some of the more serious concerns we had identified. This means we wanted the home to take urgent action to meet those requirements. We found at this inspection the home has made a start at improving the living conditions within the home. We were told that the boiler has been replaced and there is now a consistent supply of hot water throughout the home. We looked at hot water records to confirm this. We saw the home is now recording temperatures and taking appropriate steps to address any temperatures that are not within the recommended limit. The blocked toilet we saw during our last inspection has now been replaced as part of the total refurbishment of that particular bathroom. Repairs have also been made to the drains so that this problem should not occur again. The refurbishment of other toilets and bathrooms in the home has yet to take place. Work was being undertaken Care Homes for Older People Page 19 of 30 Evidence: in one of the bathrooms during this inspection. This will help make the bathing facilities a cleaner, brighter and more hygienic place to bathe. The small lounge at the back of the home has been redecorated and has new lighting, curtains and carpets. The room is much cleaner and does not have the offensive odour which was present during our last visit. The dining room has been decorated and new flooring has been laid. There are new tables and chairs. It is a much brighter and pleasant place for people to eat their meals or to relax with their friends. One person told us its looking much better now, it was a bit tired. We looked at peoples bedrooms during this inspection we found that most of them have been personalised and decorated with peoples belongings, there were some that had no personal effects and it was difficult to tell if anyone actually occupied the room. Some of the carpets in peoples bedrooms continue to be worn and stained and this is an area the home will need to continue to improve upon. Bedroom furniture is worn and dated, in shared bedrooms people have to share a washbasin and we noted that some of the splash back tiles were chipped and cracked. Three peoples bedrooms we saw had a very strong smell of urine and the home will need to address this for peoples comfort. The laundry facilities in the home have been improved upon. The room has been given a thorough cleaning and plastic cladding has been fixed to the wall to give an easy clean surface. We saw that mops are being stored inverted this helps them to dry and helps stop infection spreading. We spoke to staff responsible for laundry they told us its much better, a lot cleaner. The home have also put a key coded lock on the door that prevents unauthorised people from entering. The home needs to develop a cleaning schedule that is maintained by all staff in order to keep the laundry clean in future. Care Homes for Older People Page 20 of 30 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. Staffing levels do not offer the people the support they want. There is unrest amongst the staff group that is unresolved and this is making life uncomfortable for people using the service. The recruitment practises and procedures need to be improved if unsuitable people are to be prevent from working with vulnerable adults. Evidence: We have already identified in this report there is a considerable amount of staff unrest that the home will need to take effective action with. We have also looked at staffing levels within the home. Staff who answered our surveys told us more staff would be good, there is not enough for extras like taking people out or activities. When we visited the home in August 2009 we also identified that there were no housekeeping staff on duty. The home had not taken action to cover the housekeepers absence and as a result care staff were expected to take on these extra duties. Care staff already assist with laundry and kitchen duties, extra cleaning chores meant that even less time was being spent with the people living in the home. During this visit we have seen that a new housekeeper has been recruited. This will have a twofold effect, the home will be regularly cleaned and care staff will have a little more time to spend with people. We have said that people are having their health care needs met by the home but there is little provision for anything other than basic care within the current staffing Care Homes for Older People Page 21 of 30 Evidence: levels. We have recommended the home looks at this again. People using the service have told us staff are in cliques and you have to be careful who you talk to, some are more supportive than others. Staff working in the home told us they are supported in training, many of the staff have achieved their National Vocational Qualification (NVQ) level 2 in health and social care. We were also made aware of the catering staff undertaking their NVQ level 2, catering at this inspection. We looked at the way in which the home recruits and selects it workers. We did this by looking at the staff files of four people. We found there are improvements to make. The home needs to make sure that when people are recruited with only a PoVAfirst check in place suitable risk management strategies are put in place. The person should be supervised at all times until a satisfactory CRB disclosure is obtained. The home must also make sure that when a CRB is returned and it is not satisfactory they must be able to demonstrate through robust risk assessment that people living in the home are not being placed at risk. We were not satisfied they had done this and left them with an immediate requirement to take action. An immediate requirement means we have serious concerns about this aspect of the service delivery and we want immediate action taking to correct this. We visited the home four days later to check that risk assessments and required actions had been taken by the home. We were satisfied this had been done and people were not being placed at risk. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not as responsive to peoples requests as it should be. It is slow to address concerns with the environment and as a result peoples health and safety is not always protected. Evidence: The manager of the home is Wendy Francis. Mrs Francis has the required qualifications and experience to manage the home. She told us the recent staff unrest has been very upsetting and she is trying to support the staff team through the difficult situation. Mrs Francis also told us that she is doing her best not to let the current situation impact too much on the daily life of the people living in the home. We have identified in this report areas for imrpovement that the management team will need to address in order to keep people safe. This includes recruitment and risk assessment, the home must make sure that people are protected and as such must have robust systems in place for this. Care Homes for Older People Page 23 of 30 Evidence: The home must keep up the improvement programme with the environment for peoples comfort. Regular audits of the environment and production of action plans with a timescale for completion are recommended. This will show that the home is recognising areas of weakness and is taking action the put them right. The home has a quality assurance system that seeks to obtain peoples views about the service they receive. They do this by asking people to complete questionnaires and to give them feedback. We have included some of the comments from the recent survey. They included I have rarely seen any recreational activities taking place. I am concerned with the poor decor in xs bedroom, the poor condition of furniture in the lounge and the dirty carpet in the lounge. I feel that the apparently excellent care is let down by the very poor decorative condition of the home and the shabby furniture and do not feel able to bring my grandson to visit because of the dirty condition of the lounge carpet. I feel that all staff treat my mother with kindness and care thank you. Mum always seems to enjoy her meals and yes she has a good choice. Carers always stop and listen to anything regarding our mum. there is no daily exercise or activity for any of the resident, I feel that this would help everyone. I am able to take mum our, mom and myself enjoy our outings very much, the environment is suitable but it could do with lick of paint and carpets replaced. The home has not yet produced an action plan to demonstrate how it intends to deal with the points raised as a result of this survey. The home must supply the commission with an Annual Quality Assurance Assessment (AQAA) when we request it. The home has not done this. We were told during this inspection the AQAA would be sent to us but this has not happened. The completion and return of the AQAA is a legal requirement that has not been met and we will be taking further action with the home in order for this to happen. The home will also need to develop staff understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguard. There are no clear policies and Care Homes for Older People Page 24 of 30 Evidence: procedures in place for staff to follow. When we spoke to staff they did not know about the Mental Capacity Act and the deprivation of liberty safeguards. The home does have suitable arrangements in place to deal with peoples money. The home will keep only personal allowances for people and they obtain receipts and signatures for all transactions made. The manager told us that occasionally there can be some difficulty in obtaining peoples money from their relatives. This has meant that some people have not been able to take part in activities as a result. We have recommended that when this becomes a problem the home should make the persons social worker aware so that this can be addressed. The manager told us this has already happening in one case. We looked at the health and safety arrangements in the home and found that routine maintenance and servicing of equipment is being kept up to date. We noted that staff training however is hit and miss and needs to be addressed by the home so that staff are kept up to date with current best practise. The provider told us during this inspection that training was due to begin again later this month (September 2009) for all staff. There is evidence to show that staff are undertaking monthly safety checks. For example monthly recording of hot water temperatures, staff do also need to record any remedial action they have taken so that there is a written record of what they have done when temperature fall outside of the recommended limits. We saw records of fire safety checks and fire drills. We noted that at present only day staff have been included in the fire drills and have recommended that in future night staff are included as well. All staff should know what to do in the event of fire breaking out. Care Homes for Older People Page 25 of 30 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 26 13 Staff must have further 16/09/2009 training in infection control. This training should be based upon current best practice. People will be less likely to be placed at risk by poor practice if staff are appropriately trained. 2 26 13 The home must make sure there are sufficient staff to keep the home clean and free from dirt at all times. People should be able to live in a clean environment and be free from infection. 17/08/2009 Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must record the variable dose of medication given to people, where this is prescribed. This will enable the home to keep an accurate record of the amount of medication people are taking. 30/10/2009 2 12 12 The home should review the 16/11/2009 staffing levels so that people have the opportunity to take part in activity. This will help people to lead an active life 3 29 19 The home must make sure 30/10/2009 that new staff who begin work with only a PoVa first check in place are supervised by an identified senior worker until such time as a satisfactory CRB is returned. This will help protect vulnerable people. Care Homes for Older People Page 27 of 30 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 4 33 24 The home has not returned the AQAA as we have requested. This is a legal requirement and the home is obliged to complete this document and send it to us when we request it. 09/10/2009 5 38 23 All staff must take part in a fire drill. They must do this so that the home can be satisfied staff will know what to do in the event of fire breaking out. 30/11/2009 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 9 All handwritten entries on the MAR sheet should be signed by two staff, this will reduce the risk of errors in transcribing occurring. The home should record the amount of medication being carried forward each month on the MAR. This will enable an accurate audit of medication to be done. The home should develop a comprehensive cleaning schedule for the laundry, so the spread of infection can be effectively managed. The home should include infection control audits into the quality assurance system so that any areas of concern can be identified and addressed. The provider and the manager need to address the current staff unrest for the benefit of the people living in the home. Page 28 of 30 2 9 3 26 4 26 5 31 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 6 33 A report detailing the actions the home will take in response to the recent surveys it has conducted should be produced and published for peoples information. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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