Inspection on 18/03/09 for Greenleigh

This inspection was carried out on 18th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenleigh 05/12/07

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Greenleigh 219 Wolverhampton Road Dudley Sedgley West Midlands DY3 1QR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Greenleigh 219 Wolverhampton Road Dudley Sedgley West Midlands DY3 1QR 01902664023 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Select Health Care (2006) Limited care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 36 The registered person may provide the followng categories of service only: Care Home with Nursing (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 (OP) 36 Physical Disability (PD) 6 Date of last inspection Brief description of the care home Greenleigh is a purpose built care home registered to provide care to a maximum of 36 people. Since the last inspection the home no longer provides nursing care. The home has two floors. Bedrooms, bathrooms and toilets are situated on both floors, communal 0 6 Over 65 36 0 Care Homes for Older People Page 4 of 34 Brief description of the care home areas, lounges, conservatory and the dining area on the ground floor. Kitchen and laundry facilities are also provided on site. The home has parking facilities to the front and side of the property. The home is situated on the A459 Wolverhampton Road and is on a main bus route between Dudley and Wolverhampton. The home does not currently list the cost of fees in the Statement of Purpose or the Service User Guide. Some items that will not be covered by the weekly fee include hairdressing, non NHS chiropody, toiletries and newspapers. Care Homes for Older People Page 5 of 34 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 inspection was carried out over two days by one inspector. The home did not know we were going to visit. The focus of inspections we undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that Care Homes for Older People Page 6 of 34 it meets the needs of people living there. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at to make sure that the home was being managed well. Where people who use the service were able to comment on the care they receive their views have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: The care plans and risk assessments needed to be kept up to date and inform the staff as to how the people living in the home were to be assisted to keep them safe. The care files needed to be arranged so that staff could look at the care plans to remind themselves of how each person wanted to be assisted. The managment of medicines in the home needed to be improved to ensure that the people living in the home received their medicines as prescribed. Activities organised in the home should be linked to the interests of individuals to ensure that their social needs were met. Staffing levels did not always meet the needs of the people living in the home. Completed surveys returned to us indicated that more staff were needed, people were putting in very long hours. One comment summed this up as there is a great deal of pressure on the staff to be available at all times, e.g. if one or two residents need help Care Homes for Older People Page 8 of 34 to the toilet it is the old saying you cannot be in two places at once. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information was available to help people decide whether the home was suitable for their needs. People were assessed prior to admission into the home so that they could be assured that their needs could be met. Evidence: There was a statement of purpose and service user guide in place that people trying to decide whether the home was suitable for them could use to help them decide. A copy was seen in the bedrooms of the people living in the home. No information was included about the range of fees that people could expect to pay except for respite care which indicated that the rates were at the local authority rate. We looked at the assessment process for someone who had been admitted to the home since the last inspection. We were told that the individual did not visit the home before moving in but that a relative did, however, this had not been recorded. Completed surveys returned to us told us that people had been to visit the home Care Homes for Older People Page 11 of 34 Evidence: before they moved in. An assessment undertaken by Health and Social Care was available ensuring the home had information about the individual from the placing authority to help them decide if they could meet the individuals needs. The manager also carried out an assessment which covered several areas including getting up, washing and bathing, going to the toilet and personal care. All these areas said that all help was needed but did not specify what help. There were risk assessments in place but they also included little detail. For example, mobility assessments asked does person need aids and appliances to move independently, the form states yes but no information about what the aid may be. The assessment asked if bed rails were needed and again it said yes, but no reason as to why. The form asked if relative or service user consent had been obtained and it said yes but their was no evidence of this. The assessment procedure needed to ensure that their was sufficient information included on what the individuals needs were and how the home would be able to meet them. Following the assessment the manager wrote to the individual telling them that their needs could be met at the home. Individuals were provided with a statement of terms and conditions of residence that included the room that would be occupied and the fees that would be paid. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care given to the people living in the home was appropriate but the care plans and risk assessments in place were not up to date and did not support the staff to know how to assist the people living in the home in the way they wanted. Individual preferences were not always observed. People living in the home were assisted to see the appropriate health professionals as needed. Medication management in the home did not ensure that the people living there were always given their medicines as prescribed. Evidence: The care for two people was tracked in detail and two were looked at briefly. This means that we observed care, looked at care plans and other documents, and, spoke to staff to determine if their needs were being met appropriately and as they wished. One of the people whose care was tracked had moved to Greenleigh from another home run by the organisation. The individual had been in the home for nearly 6 weeks. The care plans and risk assessments from the previous home had been sent with the individual however, new care plans and risk assessments had not been Care Homes for Older People Page 13 of 34 Evidence: written up so that they were specific for Greenleigh. This meant that the staff were working to care plans that had been written up 6 months earlier and needs could have changed. Risk assessments were pertinent to the previous home and not to Greenleigh. For example, the care plan for mobility stated that staff needed to provide reassurance and ensure she is comfortable, to use the zimmer frame, observe physical and mental state before using the frame. We were told by staff that the zimmer frame had not been sent by the previous home and so the individual was not mobile. The risk assessment for falling indicated 30 minute visual checks were to be maintained and a mattress to be placed on the floor whilst in bed. There was no evidence that 30 minute checks were being undertaken and we were told that a mattress was not used at Greenleigh. At the previous home blood pressure and blood sugar levels were being monitored regularly however this had not been continued at Greenleighs and there was no indication of how it was going to be monitored. The second person had lived in the home for several years and had been reassessed as no longer needing nursing care when the home changed from providing nursing to residential care only. The care plans in place did not always include sufficient detail for staff to know how to assist the individuals in a person centred way. For example, one care plan for personal hygiene stated that the individual needed all help with washing and dressing due to becoming frail. The individual liked to get up at 8am and go to bed at 8.30pm. The person liked a bath and shower, hair combed and nails cut weekly. The actions to be taken by staff were, offer daily bath, shower; let X do as much as she can for herself; respect privacy and dignity; let X choose clothes; hair combed, teeth cleaned. Another care plan said that X needed assistance with eating and drinking due to poorly condition at times, need to encourage and monitor intake of food. The actions to be taken included, encourage X to feed herself; weigh monthly, offer choice of food, give smaller portions. The care plan said nothing about having a pureed diet, which was observed on the day or the fact that staff had to give full assistance at meal times. This did also not reflect what was written up on the care plan overview which stated there were no special dietary needs. The nutritional assessment also gave a zero score indicating no risk. This was not consistent with what was being observed. Some efforts had been made to record preferences such as the favourite drinks, waking and retiring times, preference of bath or shower and dress, however these were not always complied with. For example, it stated that the person was not partial to meat, this was not reflected in her diet, it stated that the preferred dress was trousers, blouses, jumpers however, during the inspection it was noted that the Care Homes for Older People Page 14 of 34 Evidence: individual wore a skirt with pop socks. Risk assessments were in place but some had not been reviewed for over 12 months. The falls risk assessment said that the individual should be referred to the GP and there should be clear guidelines to follow in the care plan to ensure supervision and assitance are provided at times when the risk of falls has been identified as being higher. No guidelines were seen. Bed rails were in use and they were checked regularly however, there appeared to be a lot of movement in them. The manager needed to ensure that they were suited to the type of bed and that the person checking them had been trained to do so. The risk assessments needed to show what other options had been considered to keep the individual safe. The care plan stated that the individuals medication was to be added to the food with the Doctors consent to enable easy digestion. There was nothing from the Doctor to confirm this. Pressure relief was being provided. There was a pressure mattress in use on the bed and a pressure cushion on the chair. It was observed that whilst the individual was sitting in the chair in the lounge area her feet did not touch the floor. It would be more comfortable for her legs to have the support of a stool. Daily recordings for the people living in the home were very limited. They did not give an overview of the individuals day. On some occasions they stated when visitors had been or when they had been seen by medical professionals otherwise comments made were usually comfortable day, no changes and diet taken. The records did not indicate how individuals had been assisted to make choices. Weights were not always being regularly recorded. This means that individuals could not be referred for medical intervention quickly if they had lost or gained unexpected amounts of weight. People living in the home were registered with a local doctor. One of the doctors held a weekly surgery at the home and visits could be made at other times if needed. People living in the home were assisted to have their medical needs met by having access to opticians, dentists, chiropodists and district nurses. During the inspection we spoke to one of the visiting nurses who stated that they were quite happy with the care given at the home. We also spoke to a visitor during the inspection who said they were quite happy with the care provided in the home. However, there were sometimes no staff to escort people to the hospital at night if Care Homes for Older People Page 15 of 34 Evidence: they needed to go. This issue was discussed with the manager who confirmed that this was the case if relatives could meet the ambulance at the hospital. There were two lockable metal trolleys available for the storage of medicines. There was a specimen signature sheet in place so that the signatures on the MAR (medicines administration record) could be checked against the list if there was a query as to had dispensed the medicines. We were told that there was no one living in the home who was able to look after their own medicines. Some practices in the management of medicines were not safe. On the first day of the inspection the medication trolley was stored in the medication room however, the keys were left in the trolley. It was inappropriate to leave the keys in the trolley for any period of time as it would leave the contents accessible to others. During the second day of the inspection it was observed that medicines were being dispensed into medicine pots which were then being taken to the individuals. This was poor practice as it could mean that the medicines could become mixed up, given to the wrong person or dropped. We were told that one person was given dispersible aspirin to be taken as a tablet as they would not take it dissolved. This medicine was not being administered according to the prescribing instructions. This matter should be discussed with the GP to access a non dispersible format. The instructions on the MAR chart did not reflect this issue and it was not indicated in the individuals care plan. There were occasional gaps on the MAR charts. On some occasions this meant that medicines had been given, as they were no longer in the blister pack, but they had not been signed for by the person administering the medicine. On other occasions it could not be determined whether the individual had been given the medicine or not. On some occasions medicines carried forward from one medication period to the next, the amounts administered and the tablets remaining in the boxes did not tally. This meant we could not determine that the medicines had been administered as prescribed. One person who needed a pain relief patch did not always receive it as required because the new supply had not been received on time. We were told that there had been problems with getting the supplies, however, we were told that requests for a new supply were not requested until two days after the last patch was applied. This meant that the individual did not have the appropriate pain relief for 5 days. Care Homes for Older People Page 16 of 34 Evidence: Some staff administering medicines were not always sure what the medication was for and did not know how it was to be administered. This was particularly concerning as one of the MAR charts and the bottle stated to be given as prescribed by the prescriber. The manager must ensure that there are sufficient administration details on the MAR charts so that staff know how the medication iss to be used. Some medicines were not returned to the pharmacist at the end of the medication period, or the amounts remaining in the home were not recorded on the MAR charts so that it was not possible to audit the tablets. The manager was advised that liquid medicines could be measured more accurately with a syringe as it appeared that more of one liquid medicine had been dispensed that should have been. The manager had accessed some syringes by the end of the inspection. The manager needed to ensure that eye drops were being dated on opening. Some eye drops had been received in January 2009 and were still in use at the time of this inspection even though the instructions said to be discarded after 28 days. Therefore it could not be determined whether the eye drops were still safe to be used. The controlled medicines storage and records were satisfactory and medicine fridge temperatures were checked on a regular basis to ensure that medicines were stored at the correct temperatures. There was confusion about the recording of creams that were being applied. Some creams were not being recorded on the MAR chart that they had been applied and there were no cream records in the bedrooms. The manager must ensure that there is an adequate system to record that the creams are being applied as prescribed. The need for medication audits to be carried out was discussed with the manager. Care Homes for Older People Page 17 of 34 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. Some activities were available for the people in the home but these could be improved on. People living in the home enjoyed the meals provided which were well presented and nutritious. Evidence: The AQAA told us that forthcoming events and activities were recorded on the notice board. This was seen during the inspection. Activities recorded included special celebrations such as St Davids Day, TV and radio, Optician, fun with Fay, clothes party, and entertainers coming into the home. Church services are available for those wishing to attend. Daily records did not always reflect the activities taking place. We were told by one person living in the home that there had been a St Patricks Day celebration, and exercise session the week of the inspection however, this was not reflected in the records looked at. An activities coordinator was employed in the home and we were told that trips out were being organised for the warm weather. The activities should reflect the likes and dislikes of the people living in the home on an individual basis as well as providing the Care Homes for Older People Page 18 of 34 Evidence: opportunity for group activities. Visitors to the home were encouraged at all times but asked to avoid mealtimes. During the inspection visitors were seen to come and go at various times and were made welcome. There appeared to be good relationships between staff and relatives. Telephone numbers for advocacy groups are available on the notice board. Staff we spoke to said that they felt that there were not enough staff available to undertake all the activities they wanted to and often the activities organisor had to help out on care shifts. We were able to observe tea time on one day and joined with the people living in the home for lunch on the second day. Staff went around the day before to ask people what they wanted ensuring they were given a choice. We were told that if the following day they had changed their minds this was accommodated. There was a four weekly menu in place. Everyone spoken to said that they enjoyed their food. Support was given where needed and special diets were catered for. It was recommended that at tea time the drinks trolley and food trolley were better co ordinated so that people received their drinks and food within a shorter time period. it had been observed that the food trolley started in one lounge whilst the drinks trolley started in another lounge meaning that some people had finished their drinks before they got their food and vice versa. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can feel confident that the home will listen to and act upon their views and protect them from abuse. Evidence: No complaints had been received about the home since the last key inspection and no issues of adult protection had arisen. The complaints register did not have any complaints recorded in it. Completed surveys returned to use stated that 8 people knew how to make a complaint and two people said they did not. The complaints procedure was not looked at but has been seen on previous inspections. The training matrix showed that most staff have undertaken safeguarding training and staff spoken with knew what to do if they suspected abuse. They felt that their concerns would be listened to and acted on. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home live in a well maintained, clean and comfortable environment. Evidence: The home was found to be clean and well maintained. Bedrooms seen during the inspection were found to have the appropriate furniture and furnishings. They had been personalised to the individual occupants liking. People were encouraged to bring small items into the home with them. The lounges and dining room were comfortable and nicely decorated. There was an additional conservatory that could be used by a small number of people. There were a number of aids and adaptations available in the home such as grab rails, assisted baths and a wheel in shower. There was a passenger lift available and emergency call system in place. Hoists were available in the home as well as wheelchairs and other walking aids. During the day a visiting professional to the home was seen using a wheelchair without the footrests and one of the wheelchairs only had one foot rest in place. This could put the people living in the home at risk of injury. The manager must ensure that people are moved around the home safely. Care Homes for Older People Page 21 of 34 Evidence: At the time of the last inspection it was noted that the toilets near the dining room did not have a sufficient supply of hot water. At the time of this inspection it was noted that the water supply to one toilet was limited but the others were adequate. There were no offensive odours in the home and infection control procedrues were satisfactory with gloves and aprons in use. One of the commodes seen had torn padding on the seat which would mean that it would be difficult to keep clean. Care Homes for Older People Page 22 of 34 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 recruitment procedures in the home were robust safegarding the people who lived there. Staff received training to equip them to assist the people living in the home safely. There were not always enough staff available to assist people as required. Evidence: At the time of the start of the inspection there was a senior care assistant and two care assistants on duty. The manager came in once she had been informed of our arrival. The staffing rota showed that there were always a minimum of three staff. Often this included the manager who on the rota provided appeared to have two supernumary days although we were told that she had three days supernumerary. We were told that as the number of people living in the home had gone up an additional care staff had been agreed. In addition to the care staff there was an activities co ordinator. The rota showed that this person also did some care shifts. When this individual was on care duty no one else was allocated to organising activities. We were told that due to staff shortages the activities co ordinator was needed to cover care duties. We spoke to three staff who all had concerns about the staffing levels in the home. We Care Homes for Older People Page 23 of 34 Evidence: were also told that they felt supported by the manager and felt that they could raise any concerns. We were told that there were between 12 and 14 people living in the home that needed the assistance of two staff. Staffing levels did not appear to reflect this high level of need. Completed surveys returned to us included the following comments about staff: concerned a recent drecrease in staffing levels, the staff are very good, the staff are very kind and help me, in the main staff listen, but it is obvious that for some their break is sacrosanct, there is a great deal of pressure on the staff to be available at all times eg if one or two residents need help to the toilet is the old saying, you cannot be in two places at once, the staff are always willing to listen and help as and when necessary, the staff are always willing to listen and come up with a solution to any problem, seems to be insufficient staff, due to management reorganisation. The staff worked very hard putting in long hours doing their best under difficult circomstances, as times goes on it becomes increasingly obvious that the home is run largely for the financial benefit of the owner, especially with regards to the number of carers that are on duty at any one time. One more at least is required during daylight hours. We looked at two staff files. We were told that there had been no staff employed by the organisation. The personnel files were well organised and showed that the appropriate checks had been undertaken. Supervision records looked at did not appear to meet the required levels needed to ensure that people were given the opportunity to discuss issues arising in the home or to ensure that they were up to date with current good practices. Care Homes for Older People Page 24 of 34 Evidence: There was a training matrix in place showing when training had taken place. It showed that the majority of staff had achieved training in NVQ level 2 or above ensuring that they had the skills and knowledge to care for the people living in the home. Care Homes for Older People Page 25 of 34 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 manager does not appear to have sufficient time to keep records updated and monitor the practices of staff in the home to ensure that the people living there are assisted as needed. Evidence: The registered manager is a qualified manager who has several years experience of running the home. Since the last inspection the home no longer provides nursing care. A number of people living at the home were previously living there but have had their needs reassessed and it was determined that they needed residential care. The registration certificate still shows that nursing care can be provided. This situation should be addressed to ensure that there is no confusion about the services that can be provided in the home. We were told that the manager was given 3 days to carry out her management role. For a home of this size it is recommended that the managers hours are all Care Homes for Older People Page 26 of 34 Evidence: supernumeray to the care rota. This will enable her to ensure that the care plans, risk assessments, management of medicines, daily records and so on are all kept up to date and practices in the home are safe. There were systems in place for measuring the quality of services provided. These inlcude regular monthly visits by the providers representative. Surveys are sent out to stakeholders to ask about the service provided by the home and there is an annual performance review however this doesnt clearly show what has been achieved and what is planned for the future. Meetings for the people living in the home were carried out about every three months giving them the opportunity to express their views about the home. Small amounts of money were looked after by the manager on behalf of the people living in the home. The records checked were satisfactory with signatures, receipts and running balances in place. The files of two staff looked at showed that they had not received any supervision since November 2008. We were told that staff were able to speak to the manager when they needed. The environmental health officers had given the home four stars indicating that cleanliness and infection control were being well managed in the home. Examination of the fire checks showed that equipment had been serviced as required. The weekly fire alarm test had not been recorded since 6.3.09. Fire alarms must be checked on a weekly basis to ensure that they are in good working order to safeguard the people living and working in the home. We were told that this had occured because the person who normally undertook the checks had not been available. Someone must take responsibility for ensuring that the checks are undertaken if that individual is not available. Fire training and drills were undertaken regularly to ensure that the staff knew what to do in the event of an emergency. Bedrails, wheelchairs and water temperatures were being checked on a regular basis. The organisation needed to ensure that the person checking bed rails etc was competent and confident that they knew what to check for. This would protect both the individual and the people living in the home. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 (4) Risk assessments must be 01/01/2008 kept up to date and be consistent so that people are not placed at unnecessary risk. Not met. will be repeated. Care Homes for Older People Page 28 of 34 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 7 15 Care plans must be current and ensure that staff know how to assist the individual whilst retaining any independence they have. This will ensure that individuals will receive the assistance they need but also retain as much independence as possible. 15/05/2009 2 8 13 Risk assessments must clearly show the risk, what actions have been taken to minimise them and how the individual will be safeguarded. This will ensure that people living in the home are kept safe without having undue restrictions put on them. 30/04/2009 3 9 13 The records for the management of medicines must be accurate. 30/04/2009 Care Homes for Older People Page 29 of 34 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 will ensure that people living in the home get their medicines as prescribed. 4 9 13 The manager must ensure that the prescribing instructions are clear on MAR charts. This will ensure that the staff know how medicines are to be administered. 5 9 13 The manager must ensure that medicines are ordered so that they are available when required. This will ensure that the people living in the home do not go without their medicines. 6 9 13 Documented agreements must be in place for medicines that need to be disguised in food by people who can make this decision on behalf of the people living in the home. This will ensure that individuals will get the medicines they need for their well being whilst retaining some decision making powers. 30/04/2009 30/04/2009 30/04/2009 Care Homes for Older People Page 30 of 34 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 7 9 13 The manager must ensure that staff put out medicines for one person at a time only. This will ensure that the people living in the home get the right medicines. 30/04/2009 8 9 13 Medicines must be stored safely at all times. This will mean that only people who should have access to medicines would do so. 30/04/2009 9 9 13 Medicines must be administered according to the directions given. Where this is not possible the matter must be reviewed by the prescriber. This will ensure that the people living in the home will get their medicines as prescribed. 30/04/2009 10 27 18 The manager must show that there are sufficient staff. This will ensure that there are sufficient people on duty to meet the needs of the people living in the home. 30/04/2009 Care Homes for Older People Page 31 of 34 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 11 38 13 The person checking the suitability and safety of bed rails must be competent to do so. This will ensure that the people living in the home are kept safe. 30/04/2009 12 38 23 There must be evidence in place to show that the fire alarms are tested on a weekly basis. This will ensure that the equipment is in good working order. 30/04/2009 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 1 The service user guide should include information about the fees that are charged in the home. This will help people decide if the home is suitable for them. Pre admission assessments should clearly show what help individuals would need and how staff would provide this. This would ensure that people moving into the home were assured that their needs would be met in the way they wanted. A record should be kept of when people visit the home before deciding whether it was suitable for them or not. A record should be kept if it is not practical for someone to visit. This will show that everyone has the opportunity to visit the home prior to moving in. People should be provided with appropriate support where their feet does not touch the floor when seated so that they are comfortable. Page 32 of 34 2 4 3 5 4 7 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 5 8 Weights of individuals need to be recorded on a regular basis to ensure that some one has oversight of any unexpected weight loss or gain. Risk assessments should be reviewed regularly to ensure that they remain relevant and safeguard the individual. The manager must ensure that eye drops are dated on opening and discarded after the appropriate timescales. This will ensure that medicines are discarded when no longer safe to use. The manager must ensure that adequate records are kept of creams that must be applied. This will ensure that the people living in the home have their creams applied as needed. The activities should reflect the individual needs of the people living in the home. This will ensure that everyones needs are met. Daily records of care provided should be detailed enough to show how the needs of the people living in the home have been met including social needs. This will ensure that the people living in the home receive person centred care. The manager should ensure that the people living in the home do not have to wait for their drinks or food when this is served in the lounge areas. The manager should ensure that the people living in the home are moved around safely in wheelchairs with footrests in place. Torn commode lids should be removed as this is not conducive to good infection control. The registration of the home should be amended to show that nursing care is no longer provided at the home. Staff should be supervised so that they receive a minimum of six sessions a year. 6 7 8 9 8 9 9 12 10 12 11 15 12 22 13 14 15 26 31 36 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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