Inspection on 30/09/09 for Hatfield Haven Residential Care Home

This inspection was carried out on 30th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hatfield Haven Residential Care... 10/10/07

Hatfield Haven Residential Care... 27/09/06

Hatfield Haven Residential Care... 18/10/05

Hatfield Haven Residential Care... 13/04/05

Hatfield Haven Residential Care... 22/10/04

Hatfield Haven Residential Care... 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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: Hatfield Haven Stortford Road Hatfield Heath Bishops Stortford Essex CM22 7DL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 3 0 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 36 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 36 Information about the care home Name of care home: Address: Hatfield Haven Stortford Road Hatfield Heath Bishops Stortford Essex CM22 7DL 01279730043 01279730043 hatfieldhaven@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hatfield Haven Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 18 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 18 persons) Service users must not be admitted to the home under the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 The total number of service users accommodated in the home must not exceed 18 pesons Date of last inspection 0 0 Over 65 18 18 Care Homes for Older People Page 4 of 36 Brief description of the care home Hatfield Haven is registered to provide personal care and accommodation for 18 older people over the age of 65 years of age with dementia. The home is a large detached house located on the edge of the village of Hatfield Heath that provides access to public transport and shopping facilities. The home has bedrooms with ensuite facilities located on both the ground and first floors of the premises as well as three communal bathrooms. The upper floor is accessible through the passenger lift. The homes grounds are accessible to both the service users and their visitors. The home is equipped to meet the needs of the current service user group and provides aids and adaptations to assist residents with limited mobility. The current rates of fees are between £550 and £650 per week, depending on whether a room is a single or a shared room. Additional charges are made for hairdressing, chiropody, toiletries, papers and magazines. Information about the home is made available to prospective residents in the Statement of Purpose and Service User Guide. The current inspection report is also available. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for a day and met with the deputy manager and the care team. On the day it was also possible to meet with the proprietors and an external consultant that they had engaged to work with them at the home. Prior to this we reviewed all the information that we already had on the home and this included the proprietors Annual Quality Assurance Assessment. The proprietor was asked to complete this and this tells us how well they think are doing, what they think they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. This is a legal document as required by law. As discussed in section seven of this report and referred to throughout the report, the AQAA needs to be an accurate reflection of standards in the home. On the day of the inspection we interacted with 3 residents. Due to their dependency, they were unable to help us by providing feedback on the home. Three staff at the home were also spoken to along with two relatives, and prior to that we sent out Care Homes for Older People Page 6 of 36 surveys to residents/relatives, asking for feedback on the home. We received eight responses and comments from these are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 36 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. Residents can not be fully assured that they would have the information they needed in a format suitable for them or that they would receive a comprehensive assessment of their needs so they could be sure the home would be suitable for them. Evidence: The last inspection reports for the home are displayed in the main entrance hall along with a copy of the current service user guide. This document requires review to bring it up to date. Whilst the guide contains some good pictures, more could also be done to make the guide more user friendly for the resident group. The proprietors AQAA says that we specialise in caring for people with dementia and the service user guide needs to reflect this. The AQAA also said that there were plans in place to review the service user guide. Relatives who commented on our surveys generally said that they had enough information on the home at the time of admission. Relatives spoken to during the inspection had not seen the service user guide. Care Homes for Older People Page 10 of 36 Evidence: A pre-admission assessment for a resident recently admitted to the home was reviewed. The deputy manager had handwritten notes in her notebook along with a completed personal fact file form. A set pre-admission assessment form had not been used as the deputy manager said that she was rushed. A blank pre-admission assessment form was not able to be found on the day of the inspection for us to review and the deputy said that there were plans to redesign this form.The deputy had completed some good notes on the residents physical needs along with person centred information on personal preferences and life history. Despite a diagnosis of dementia and needs in relation to mental health, there was no evidence to show that these areas were covered or assessed. In addition to this there was no evidence of any risk assessments being undertaken. The personal fact file also contained some good person centred information which would be valuable to care staff, however all the assessment information was not available to staff as it remained in the deputies notebook. An recent assessment from social services was available but on review it was not fully appropriate to this admission as it related to providing a home care package. Despite some significant care needs a care plan had not been put in place since admission, nearly three weeks previously. On discussion with staff, they knew limited information about the resident as an individual and their needs or family background. The proprietors AQAA said that we already have a robust pre-admission assessment and we also assess for safety and potential risks and compatibility with other residents. The evidence would not fully concur with this statement. Care Homes for Older People Page 11 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive a basic standard of care which means that the outcomes they experience may not always be the best they could be. Evidence: At the time of the inspection there were several care planning systems in use at the home. 3 care plans were reviewed and one further care plan was used to cross reference. Overall the care planning and in some cases the care delivery in the home was seen to be poor. As stated in section one of this report, a resident had no care plans or risk assessments in place. This resident had a diagnosis of dementia and had some mental health needs and there were no records pertaining these needs at all. Some aspects of the pre-admission assessment identified risks in relation to mental health, diet and pain and none of these were referred to in the care records. Only basic daily notes had been recorded and these primarily evidenced that the resident had slept well and had no problems and had had a bath once. Recently the daily notes showed that resident had been seen by a specialist nurse and exercises were prescribed to stop joints stiffening. There was no evidence in the records that the resident was being encouraged or supported to do these exercises and staff spoken to Care Homes for Older People Page 12 of 36 Evidence: did not highlight this as a need with the resident. It is not felt that this residents care needs were being met in a proactive or person centred way and that the risk of deterioration for this resident would increase without the appropriate care. It was also noted that the resident had not been weighed on admission or subsequently, despite dietary intake being highlighted as a concern on social services referral information. The other care plans reviewed contained more assessment information outlining residents needs in relation to both physical and mental health/social needs. However the documents were often not dated so it was difficult to tell how up to date the information was. There were some care plans in place, but these did not cover all the residents identified needs, for example, mental health needs, osteoarthritis, refusal of care and meals and management of acute medical conditions such as cellulitis. The care plans were often a statement, for example, prefers own company, with very limited or no real management/support guidance for care staff. The care plans were not seen to be person centred even for residents who were able to express their needs and views. The care plans are not regularly reviewed and the reviews seen show no changes to the residents care over significant periods of time. From discussion with staff and relatives, they are not all a true reflection of current needs. Daily notes showed that residents were bathed and had access to a hairdresser and that care was provided.Throughout the care plans there are key pieces of information that would help staff to plan and care for residents in a proactive way. However the care plans are very mixed up, using different formats and this adds to the overall limitation of the plans. The care provided by staff is primarily intuitive and not knowledge based and because of this residents are not optomised and the care is reactive rather than proactive. Staff training records show that the majority of staff are not trained to care for people with dementia and also have limited training on conditions associated with old age. Residents had some risk assessments in place, for example, on manual handling and pressure sores, but these were not consistently applied and in some cases were not kept under review. The risk assessments were not always linked to the care plans, so the management of the risk was not always clear. In one case a resident was identified at high risk of developing pressure sores but the assessment was not dated. A care plan was in place and this was quite detailed but had not been reviewed for 5 months and the resident did have a pressure sore. There is evidence that a resident has developed pressure sores whilst being cared for in the home and this has contributed to a decrease in their overall wellbeing. The proprietors AQAA says that each resident has a moving and handling risk assessment on the day of admission. Care Homes for Older People Page 13 of 36 Evidence: The evidence shows that this is not the case. The AQAA also states that risk assessments are also carried out for mental wellbeing, continence and falls. These were not evident in the care plans sampled. Records showed that residents were either not being weighed or were being weighed inconsistently with long periods between checks, for example, 13 months. Residents did not have nutritional risk assessments in place. One resident was noted to have seen a dietitian and was prescribed supplement drinks and the care plan reflected this. However, on the medication administration sheet these were not being signed for as given and the code was being used that indicated they were not required. There was no evidence in the care records that this had been revisited with the dietitian. The proprietors AQAA said that do not carry out nutritional screening in one section, in another section it said that they were completed and under plans for improvement it said we will monitor residents weighs and introduce nutritional screening to ensure they remain healthy. It is a concern that there is this confused approach to residents nutrition and also a concern that in a home that specialises in the care of people with dementia nutritional screening is not already in place. Records indicate that residents are seeing their doctors for acute medical conditions and are attending any hospital appointments that are needed. Residents were also seeing the Community Psychiatric Nurse if needed on a regular basis and this input helped in ensuring that medication was reviewed. Residents were seen to have specialist pressure relieving equipment in place such as mattresses and sheepskin products. Residents were seen to be spending all day sitting in wheelchairs, not moving to chairs at lunchtime etc. This means that they are not moving around much and this can lead to joint stiffening and potential muscle wastage. A review of this practice is needed to ensure that this practice is in the best interest of residents. The service users guide says that there is a key worker system in place and the deputy manager says that they are currently updating this due to staff changes. One of the key workers responsibilities if to look after residents laundry. On review items of clothing belonging to one resident were seen in another residents wardrobe. On checking in the laundry, where there are individually named baskets, the wrong items were in the wrong baskets. In the surveys returned to us relatives said more care should be taken with residents clothes and the residents should always appear clean and tidy. Often the wrong clothes are returned to the wrong rooms. It is important for the carers to appreciate that it is essential for residents dignity to be maintained at all times. It was noted that the shared room requires a new privacy curtain and the Care Homes for Older People Page 14 of 36 Evidence: deputy manager said that this was being arranged. Relatives spoken to said the staff need to be acting in the residents best interests more and those who commented in surveys said permanent staff show genuine respect and affection, staff use common sense and efficiency when calling other agencies in, e.g Gps and dont rely on families to act so much in a crisis such as taking residents to hospital in emergencies as there are not enough staff. Overall relatives who commented on the surveys said that sometimes the residents got the care and support they needed and sometimes the staff were available to residents and listened and acted upon what they said. The team at the home use a blister pack system for administering medication. The deputy said that they were arranging for the residents doctor to come in a spend some time reviewing all the medication as this needed addressing. Records showed that the medication is checked in and that the administration charts were clear. The administration charts were being signed well and staff were generally using the omission codes appropriately. Dates of opening were recorded on liquid medications, which is good practice for auditing purpose sand the blister packs checked matched the records of tablets given. The supplying pharmacist recently undertook an audit but it was not possible to find a copy of this for review. At the time of our visit the deputy reported that there was no internal auditing system in place although the proprietors AQAA said we carry out a routine audit of our medication records and ensue that staff attend external training before administering medication. Staff training records showed that not all staff administering medication had up to date training in place, with some not attending training since 2003. The storage and administration of controlled medication was reviewed. Records and items were checked and found to be in order. The medications are stored in locked cupboard in a locked cupboard but this is not attached to the wall. This should be reviewed in light of guidance for the the storage of controlled medication from the Royal Pharmaceutical Society, to ensure safe storage. The team, although this has been reduced, are still holding a lot of medication stock. We were told they have stopped automatically ordering repeat prescriptions. This may require ongoing review to ensure unused items are returned. One senior said to us that she gives all the residents their tablets on a spoon to make sure that they take them - this does not allow for resident choice and should be reviewed. It was noted that many of the residents are using barrier or medicated creams and the care plans did not evidence the rational for the use of such products and neither did the prescription which often stated use as directed. Pots of cream were also seen, unlabeled in bathrooms, and such use can be a infection risk if staff are using the product communally. One resident was noted to be refusing medication and care records did not indicate Care Homes for Older People Page 15 of 36 Evidence: that this had been referred back to their Doctor for advice/action. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not experience the level of choice and variety in their lives that they should in relation to daily routines, social care and mealtimes. Evidence: From records and discussion with staff, the routines of the day are not primarily resident led. Some staff do talk about residents in a person centred way, for example, identifying choice and preferences and others do not, saying, for example that there is an agreement with the night staff that the day staff put the doubles to bed and the night staff get them up for us. Residents were also referred to as hoisters meaning that they had care needs which mean they needed a hoist to be moved. Staff also identified times for toileting residents, which is not led by individual residents needs. Residents who we met during the day were unable to comment on the daily routines. Due to a shortage of care staff, the activities officer confirmed that she has been working as a carer and has been cramming activities in. On discussion she said that once the home has settled she plans to develop the service so that care staff are involved, as they are not at the current time. The activities officer said that she had visited the Alzheimers Disease Society for advice and recording guidance and she plans to get this going again soon. At the current time she uses the personal fact file Care Homes for Older People Page 17 of 36 Evidence: to record any hobbies and aims to provide activities linked to recorded preferences and past interests. The activities officer knew the residents quite well and outlined some 1 to 1 person centred care that she was providing, for example, walking with residents to the local shops and visiting the church for coffee. Whilst this is positive, there was not evidence to show that residents independence was promote along with their self worth or the retention of skills. Staff spoken to said, we promote their independence when we get them up but other than that we dont really, no encouragement to lay the dining tables or anything like that. Staff also, in some cases, knew very little about the residents social needs and interests. The activities officer said that there are no outings for residents other than walking to the local shop as when they went out last time it was too difficult, as the residents have deteriorated. This needs review along with the activities offered to ensure that residents abilities are optomised and that where possible residents are able to visit the community and local places of interest to stimulate them further. Records showed that there was no programme of activities in place and that whilst there was some evidence of 1 to 1 time, overall the activities provided were repetitive and not particularly linked to any resident preferences or past hobbies. These included skittles, musical bingo, memory joggers and manicures. These options were noted to be very similar to those provided when we inspected in 2007 and it is possible that some development in this are may be needed. The proprietors AQAA said we feel that residents are a independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. We would not fully concur with this statement. The carer who undertakes activities was observed interacting with residents using reminiscence items and residents were responding positively toward this. The social care plans in place were limited. Some residents did not ave them in place. Those seen did identify residents needs but again gave staff limited guidance, for example, involve in 1 to 1 activities but the plan did not give any guidance as to what these may be or that the resident had been consulted. Social care records kept by the carer taking the lead on activities did not evidence that 1 to 1 time had been spent with this resident with no records being available. Relatives who commented in surveys said more activities are needed, more activities and the entertainment programme available to the residents is good. When we arrived at 09.35 a.m, four residents were sitting in the dining room either after or still having breakfast. Three of the residents were asleep, one of which had tea and toast before them. Staff were observed to be in the room and even sit at the table with this resident. The resident was not spoken with to wake and encouraged to Care Homes for Older People Page 18 of 36 Evidence: eat, but was taken to the lounge without either items being touched. It is a concern that these highly dependent residents are not being given the opportunity to eat properly and possibly at a time that suits them. Lunch was also observed. Tables did not have table mats or cloths and no condiments were available to residents. Orange squash was poured out to drink and no choice for drinks was seen or heard to be offered. The organisation of lunch was observed as the staff have several residents who either need to be fed or require support. Residents were seen to have their meals put in front of them and they sat there getting cold until a member of staff either helped the resident or interacted with them. For at least 2 residents this was at least 15 minutes by which time, the meals which initially looked very appitising when dished up, would be cold. Staff do have access to a hot trolley, so the serving of meals could be delayed and residents were eating in both the lounge and the dining room, so meals could be staggered. Staff were observed to give limited interaction to residents who may benefit from some encouragement, staff comments included heres lunch and gave no other interaction for example, telling them what the meal was or offering condiments or checking everything was acceptable. One staff member was heard to offer a resident an alternative desert when they refused the menu option. It was observed that residents who were being fed, were primarily being fed off ridged plates which gave them a meal of approximately 6 inches in diameter. Staff were seen to feed these residents and then move off to help another without offering more food, although this was available. Residents were also noted to be having pureed diets when there was no identified swallowing risk. These practices, combined with the lack of nutritional screening, are of concern. Staff were observed to be standing and feeding residents which is not seen as good practice because this can be intimidating and not respectful. Relatives spoken to said that the food provided is good and those who commented in the surveys also confirmed this. Some said more fresh fruit should be provided. No drinks were observed to be available other than at mealtimes or drinks rounds and this should be reviewed to help ensure that residents have an adequate fluid intake. The proprietors AQAA says that we believe our residents have nutritious and attractive meals and snacks at a time and place to suit them and ensure we achieve this through: care planning, meals/diets, offering choice, our facilities and timing and availability of meals. We would not fully concur with this statement. Care Homes for Older People Page 19 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can not be assured that their complaints would be dealt with properly or that they would be protected from abuse through staff training, procedures or other systems in the home. Evidence: The complaints procedure, dated 2005, is displayed in the main hallway. The format needs review as the print is very small and not user friendly for the resident group and possibly visitors to the home. The content also requires a review as the wording does not fully inform the individual of all avenues of possible help. The complaints log was reviewed and contained one complaint in the last year. We are aware of further complaints made to the home, that have not been recorded, relating to care standards at the home. The AQAA submitted said following our recent relatives meeting we have received a number of complaints. There was no evidence of these complaints being recorded or acted upon. The AQAA also noted that 3 complaints had been received in the last year, 2 of which were upheld and only 66 respond to within an acceptable time frame. The complaint seen, related to lack of activities, staffing levels, appearance of the home, lack of outdoor space and broken equipment. A very open response was sent, late, to the complainant, apologising for the shortfalls. Out of the eight surveys returned, completed by relatives on the residents behalf, six of them said that they did not know how to make a formal complaint and only 3 said that there was someone Care Homes for Older People Page 20 of 36 Evidence: to speak to informally, if they were not happy. This needs to be addressed so that concerns can be easily raised and dealt with. The proprietors AQAA said if our residents or their family are unhappy with the care home, they or their relatives know how to complain. The evidence does not concur with this statement. The deputy manager was aware of and could locate the local guidance on the protection of vulnerable adults. Staff spoken to showed some understanding of such matters and the training records showed that out of 14 staff only 1 person had up to date training in adult protection. The proprietors AQAA said, under the Complaints and Protection section that all senior staff and many of our care staff have attended training. The evidence would not concur with this. There have been two adult protection referrals recently regarding the care and staffing at the home, both of which remain under investigation and will be reflected in the next inspection report. Residents can not be fully assured that they would be protected by a robust recruitment process for any new staff. Records showed that staff had started work without the required checks in place and no references. When the checks were returned and were in question, these had not been followed up with the employee. This is poor practice. The proprietors AQAA said we have a robust recruitment process and all staff have undergone a POVA check prior to commencing duties and are supervised until a satisfactory CRB is obtained. The evidence would not concur with this. Care Homes for Older People Page 21 of 36 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. Residents can not be guaranteed that they will live in a safe and well maintained home although it is clean and odour free. Evidence: At the time of our visit the major building works were underway in order to extend the number of bedrooms in the home on the ground floor and provide more communal and improved living space. These rooms had yet to be registered but were being used in part for communal space whilst the lounges etc. were being worked on. Whilst this was not an issue in itself and the proprietor said that the building had been signed off by building control, it was noted that fire exits were not appropriately signed. This was highlighted to the proprietor and site manager who dealt with this matter on the day of our visit. It is important that the management of the home fully risk assesses any arrangements that they have to put in place during the building works to ensure resident and staff safety as far as possible. A partial tour of the home was undertaken with the deputy manager. All communal areas and bathrooms were seen along with half of the bedrooms. Overall the home was seen to be clean and no odours were noted. However some relatives did comment in surveys that they felt the cleaning in the communal parts of the home could be improved upon. Residents who we interacted with were happy with their bedrooms. Relatives who commented said I feel that the residents rooms are very basic e.g Care Homes for Older People Page 22 of 36 Evidence: broken handles on wardrobe doors and renovation of the existing accommodation is overdue. Signage around the home is poor, especially for a home primarily for people with dementia. Bedroom doors only had numbers on them and nothing for the individual residents to relate to. This does not promote their independence. On discussion the deputy manager, she said that specialist signs and memory boxes were on order for all bedrooms and bathrooms etc. and these should be in place in the near future. This was highlighted at the last inspection in July 2007 and is only now being addressed. The proprietors AQAA acknowledged that this was an area for improvement. Only one bathroom is currently in active use in the home along with one shower room. Plans are in place to change two bathrooms into wet rooms. At the time of our visit one bathroom was being used for storage of old equipment and the toilet was also not available for use. This should be reviewed to ensure that there are sufficient toilets for residents use upstairs. Refurbishment has recently started on the existing bedrooms in the home and it is planned that they will have new furniture, beds,carpets and curtains. One bedroom was seen to have been started. The deputy manager also said that they were about to order new bedding, which is needed as some of the items seen were of a poor quality. Since the last inspection, new corridor lights have been fitted in the home, improving lighting in the home and a new fire alarm system has also been installed. Records show that the alarm has been tested weekly since its installation 3 week previously. No records were available for weeks prior to that. Records do not show evidence of staff undertaking any fire drills and the emergency lighting has not been tested regularly. The management team have a fire safety risk assessment in place but this requires review as it was completed in July 2009 prior to the installation of the new system. The risk assessment also does not take into account the ongoing building works and at such times it should be kept under regular review. The proprietors AQAA said we carry out regular fire drills and training, which is carried out in house and an outside contractor assists with the training. Staff training records show that the majority of staff do not have up to date fire safety training. The evidence does not concur with this statement. The home has a secure courtyard garden to the rear. This contains a washing line, rubbish/boxes, old water cooler bottles and a carpet cleaner. Staff spend their breaks here and use it as a smoking area and the smoke travels into the laundry where clean clothes are stored. It is not a suitable or pleasant area for residents to spend time and Care Homes for Older People Page 23 of 36 Evidence: attention is needed to address this so that residents can go outside should they wish. Facilities for staff to smoke also requires a review. The proprietors AQAA says there is an attractive rear courtyard garden. We would not fully concur with this statement. The AQAA also acknowledges that access to the garden as been restricted during the building works. The deputy manager said that there are temperature control valves on all the hot water outlets in the home and on checking the temperatures were satisfactory although some rooms did not have hot water. We were told that the management of the home was aware of this and it was being attended to. At the time of our visit the home had two maintenance men working in the home full time in order to help with the refurbishment of the home. A request book for staff to use has just been introduced along with records that show that water temperatures are now starting to be checked. Training records show that only one member of the care staff team has attended training in infection control, three years ago. Care Homes for Older People Page 24 of 36 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. Residents can not be confident that they would be cared for by a well trained, supervised and supported care staff team. Evidence: The staffing levels at the time of our visit were 4 staff in the morning, 3 in the afternoon and two at night. The day rotas show that these levels are being maintained with regular agency staff use as there has recently been a high turnover of staff following a change of manager. However the rota was not clear as it did not have the full names of agency staff for the record. It was also noted that care staff are working full days, the morning, afternoon and evening shifts, sometimes three days in a row and this is not seen as beneficial for both the residents and staff and should be reviewed to ensure it is in the best interests of the residents. Relatives who commented said the continuity of staff really is an ideal that should be made a priority, the home needs more staff and teamwork should be promoted in the services they provide, more training for staff in caring for dementia residents is needed, employ more staff, the staff that are still there look after the residents very well and dont rely on agency staff so much. The night rotas are not recorded and therefore there is no record of who has worked in the home on any one night. This must be addressed as this is a legal record of the staffing in the home. There are currently care vacancies at the home on days and Care Homes for Older People Page 25 of 36 Evidence: nights and agency staff are being used to support the care team. The proprietors AQAA shows that out of 14 care staff, 6 have achieved NVQ level 2 or above. This is below the desired 50 trained staff standard. Three staff files were reviewed in order to check the robustness of the recruitment procedures in the home. The files were of a variable quality. Some were poor with no references or appropriate checks prior to the individual starting work and others had references but also did not have the required checks in place prior to starting work. Two out of the three files had no interview records, which are seen as good practice, and where issues had subsequently arisen from late checks, these had just bee filed and not followed up with the employee. Staff did have appropriate identification in place. Overall the recruitment procedures followed in the home by the proprietor and the management team are not sufficiently robust to fully protect residents. The proprietors AQAA says we feel that our residents can have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. The evidence would not concur with this statement. The training records show that the level of training offered to staff in the home is poor. There are significant gaps in mandatory training and in relation to the specialist needs of residents with dementia and the general care of older people. The kitchen staff are also not up to date with their food hygiene training. Two new staff have started recently and there is no evidence of their induction. The deputy manager confirmed that they had not been properly inducted to work in the home. The proprietors AQAA says we do our best to ensure our residents needs are met and they are well supported by staff who get the relevant training and support from me and my senior team. We do this through induction and training and development and we follow the Skills for Care induction in addition to our in house induction, with new staff mentored by experienced staff. The evidence does not concur with this statement. Care Homes for Older People Page 26 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has not been effective and this has adversely affected outcomes for residents and also meant that the home has not always been run in their best interests. Evidence: The registered manager has recently left the employ of the home. A new manager has been appointed to the home and is due to start fully during October 2009. The new deputy manager has been in post since July 2009 and relatives speak highly of her and changes that she has already made in the home. The proprietor engaged the services of an external consultant to undertake visits to the home to complete Regulation 26, provider reports on his behalf and to complete the AQAA. In many sections the AQAA was not an accurate reflection of the current standards in the home, but did acknowledge that there were shortfalls in the management arrangements and that this had affected the running of the home. The deputy manager was unsure whether she had a copy of the AQAA for day to day reference. The deputy manager said that staff meetings have been held but there are no minutes Care Homes for Older People Page 27 of 36 Evidence: to evidence this. Whilst it is acknowledged that the proprietor has employed a new manager, it is a concern that standards in the home had deteriorated significantly over quite a period of time and this is reflected, for example, in the current state of the staff training in the home. As the proprietor had an external consultant visiting the home regularly and the AQAA also sates that the proprietor and his wife also visit very regularly it is not acceptable that this deterioration should have gone on so long and has adversely affected outcomes for residents. It is also noted that there has been a lack of development in the home since our last visit in 2007, especially in relation to the specialist care of people with dementia. The service users guide says that residents meetings are held quarterly. Some records, such as external consultant reports, show that only relatives meetings have taken place but there are no dates and no minutes to review. Over the last year the management team at the home have not undertaken any quality assurance feedback. The deputy manager was able to show us that she has just started to address this and has had two questionnaires returned. It is clear that relatives now feel that shortfalls are being addressed and have hope that the standards of care and facilities will now improve. Relatives who commented said the new manager and the deputy have a lot of work to do at this home. The proprietor says in the AQAA that they do not have any involvement with residents finances and families or representatives are encouraged to support them with this aspect of life in the home. On discussion with the deputy manager, there is no staff supervision system in place and no records to show that this has been undertaken for quite some time. The proprietors AQAA says we ensure that our residents get good quality support because our staff are now better supervised and well supported. On touring the home it was noted that the domestic cupboard had been left unlocked and this contained a significant amount of chemical storage. This was pointed out to the deputy manager who addressed the matter straight away. Staff need to understand the potential risks to residents, especially those who are mobile and have dementia. The domestic staff spoken to by the deputy manager said she had not seen the COSHH sheets for the cleaning products used for a long time. There were no previous accident records for review and the deputy manager said that there was no accident book in use previously but showed us that they had one now to complete should any accident occur. The proprietors AQAA said the environment is safe for residents and staff because we Care Homes for Older People Page 28 of 36 Evidence: carry out good health and safety practices. There is no evidence to support this statement. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 30 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Residents must have a comprehensive assessment of their needs prior to admission. So they can be assured that the home can meet their needs. 16/11/2009 2 7 15 Based upon an up to date 30/11/2009 assessment of need, residents must have detailed care plans in place that outline how those needs are to be met and these must be kept under regualr review. So that residents receive the care they need, delivered in the way that they would wish. 3 8 13 Residents must have the risk 30/11/2009 assessments in place that are appropriate for their needs, outlining the management of any identified risk and these Care Homes for Older People Page 31 of 36 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 assements must be kept under review. So that residnets are safe. 4 8 12 The nutritional status of residents must be assessed and kept under regular review. To esnure that residnets have suitable diet for thier needs. 5 9 13 Provide senior care staff with up to date training in the safe handling and administration of medicines. So that residents can be assured that their medication will be dealt with correctly. 6 10 12 Through a review of the 30/11/2009 laundry system and the promotion of person centred care, ensure that residents dignity is maintained. So that residents feel comfortable where they live. 7 12 16 Residents or their representatives should be consulted and their social needs assessed and care planned for. 14/12/2009 14/12/2009 30/10/2009 Care Homes for Older People Page 32 of 36 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 So that both their individual and group social needs are met in a proactive way. 8 15 16 Staff need to ensure that 16/11/2009 residents have all the food they want served at an appropriate temperature and in a way that meets their assessed needs. So that residents experience a more pleasant mealtime. 9 16 22 Residents and/or their representatives must be made aware of the complaints procedure and any complaints must be dealt with in line with that procedure. So that residents can be assured that their complaints would be listened to and dealt with properly. 10 18 13 Residents must be protected 14/12/2009 from abuse through staff training and robust recruitment practices. So residents can be assured that they would be safe in the home. 11 19 23 Through staff training and robust systems, fire safety standards in the home need to improve. 30/10/2009 16/11/2009 Care Homes for Older People Page 33 of 36 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 To help ensure the safety of residents, staff and visitors. 12 29 19 A robust recruitment procedure must be in place and followed for all employees. To help ensure the safety of the residents. 13 30 18 All staff working in the home 31/12/2009 must be appropriately trained to undertake the roles and responsibilities that they have. So that the residents are cared for by a competent staff team. 14 31 10 The management of the home needs to be more responsible, robust and effective. So that standards in the home improve, continue to develop and that outcomes for residents are better. 15 38 13 Through audit and staff education, kept all parts of the home free from hazards to residents. So that residents are safe and risks are reduced as far as possible. 30/10/2009 31/12/2009 16/11/2009 Care Homes for Older People Page 34 of 36 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 Review the service user guide and ensure the format is user friendly for the resident group and that it is easily available to them. Develop a person centred approach to care planning and delivery based upon consultation with residents and thier representaitves. Review the practice of some residents spending all day sitting in wheelchairs. Develop an internal medication auditing system for the home and take advice about the safe storage of controlled medication. Review the use of barrier and medicated creams for residents in the home and where appropriate care plan for their use. Develop a more resident led/person centred approach to the provision of social care and the routines of the day. Provide residents with choices at mealtimes that also promote their independence and dignity. The garden should be attended to and made availbale for residents use. Signage around the home, to promote residents independence and self worth should be put in place. Staff should attend training on current infection control practice and thinking. A full and clear copy of the staff rota must be completed and retained for the record. Staff should be encouraged to complete NVQ training in order to help bring the standards of care up in the home. All new staff must be properly inducted into the home and the work they are to undertake. Quality assurance systems in the home, based upon obtaining the views of stakeholders should continue. A staff supervision system must be put in place to support staff and address any shortfalls in performance. 2 7 3 4 8 9 5 9 6 7 8 9 10 11 12 13 14 15 12 15 19 19 26 27 28 30 33 36 Care Homes for Older People Page 35 of 36 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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