Inspection on 15/12/09 for Haven House

This inspection was carried out on 15th December 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven House 13/04/10

Haven House 02/01/09

Haven House 05/11/08

Haven House 03/07/08

Haven House 08/01/08

Haven House 30/05/07

Haven House 11/05/06

Haven House 01/09/05

Haven House 04/05/05

Haven House 23/11/04

Haven House 29/04/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN     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: Sandra Wade     Date: 1 5 1 2 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 39 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 39 Information about the care home Name of care home: Address: Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN 01926641714 01926641714 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Haven House Residential Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 20 Date of last inspection Brief description of the care home Haven House is a conversion of three period houses in the large village of Kineton. There are twenty single bedrooms, nineteen of which have en-suite facilities. There is a shaft lift as well as two staircases, one at each end of the home. There is a sitting room and a dining room, and there is level access to the garden at the rear, which gives access to the car park. At the time of inspection the car park was in partial use due to building materials being stored. Haven House is within a few minutes walk of the village centre of Kineton which has three churches, hairdressers, a variety of shops, restaurants, pubs, banks and a post office. There are also two doctors Care Homes for Older People Page 4 of 39 Over 65 20 0 0 6 0 2 2 0 0 9 Brief description of the care home surgeries, a chiropodist, an optician and a dentist nearby. There is a limited bus service to Stratford-Upon-Avon, Banbury, Leamington Spa and surrounding villages. Nursing care is not provided. People in need of attention from a nurse have access to the community nursing service, as they would in their own homes. At the time of this inspection the fees for the service were not published. Details of the fees should therefore be obtained by contacting the service direct. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 15 December 2009. This inspection took place between 9am and 7.45pm. Three people who were staying at the home were case tracked but specific care issues relating to other people were also reviewed. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Care Homes for Older People Page 6 of 39 A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing some information about the care and services provided. Questionnaires were also forwarded to people living in the home to ascertain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report where appropriate. Records examined or requested during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. People were observed in the lounge and dining areas to ascertain what daily life in the home may be like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: A Service User Guide should be available to people who visit the home so that they have all the information they need to make an informed decision on whether to stay. The home must ensure that they only allow the admission of people whose primary care needs fall within the services registration category. This is so that people who use the service can be confident their needs will be met. Prescribed medicines must only be used for the people they have been prescribed for. This will ensure peoples health and welfare is maintained. Care plans need to be developed for each persons needs and include the action to be taken by staff to meet those needs so that staff have access to the information they need and people can be confident their needs will be met. The needs of people need to be effectively reviewed so that changes in health are Care Homes for Older People Page 8 of 39 clearly identified as well as the staff actions required to make sure peoples health is maintained. Menus need to detail all meal, snack and drink options that are available so that it is clear people have access to alternatives. The service needs to demonstrate that people are being given choices in the way care and services are being delivered. Effective systems need to be in place for recording and managing complaints and concerns. All areas of the home need to be kept in a clean and well maintained condition consistently and any unpleasant odours removed. Staff told us I dont think the cleaning is good enough, we could do with a full time cleaner really. A review of staffing arrangements is required to make sure there are sufficient numbers of staff to care for people effectively as well as enable services to operate effectively in meeting the needs of people living in the home. One person has commented that something the service could do better is more staff so we dont have to wait. All pre-employment checks need to be completed for new staff so that it is clear they have been deemed safe and suitable to work with vulnerable people. The home needs to identify timescales for statutory training to be completed and ensure staff comply with these timescales. This is so staff knowledge and skills are kept up-to-date to care for people safely and appropriately. Staff induction training needs to be based on the Skills for Care common induction standards so that staff can build on their competencies to care for people appropriately. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 39 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 39 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 about the home is not readily available to ensure people have all the information they need to make an informed decision on whether to stay. People can be confident that their needs will be assessed but less confident that the care home will meet these needs. Evidence: We were told that information about the home is available in a Service User Guide and a copy is given to any visitors to the home. A copy of the Service User Guide was requested but was not made available. We were advised that the manager had been working on this document and no extra copies had been printed off. It was agreed that a copy would be forwarded to the Care Quality Commission once the manager had returned. This has not been received at the time this report was completed so we cannot be confident that sufficient information is being made available to people who may be interested in staying at the home. Care Homes for Older People Page 11 of 39 Evidence: Three peoples files were requested to see if their needs had been assessed prior to them coming to live at the home. Two files contained pre-assessments detailing the needs of people and the staff support required to meet these needs. One person had been living in the home for some time and their original assessment information was therefore not available. The original date of admission was also not detailed. Original assessment information should be retained on file so that staff can identify over time any improvements or deterioration in health as well make sure any past history information in relation to illnesses they may have had can be fully considered when developing and reviewing care plans. We found that two people who had been accepted to live at the home had identified care needs outside of the homes category of registration. We were told that it was considered the home could meet the needs of these people. One of these people we were told had been diagnosed with Alzhiemers Disease prior to their admission. Staff training records showed that not all staff had completed training in dementia to demonstrate they were fully aware of the needs of people with this condition and how they should support them. During the inspection this person was seen to wander around the home and they stated on several occasions they were pretty cross. Care Homes for Older People Page 12 of 39 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. People do not benefit from having a detailed and up-to-date care plan necessary for making sure their care needs are met. Evidence: The AQAA completed by the Deputy Manager told us We care for our residents according to our care plans. Medication is very good and we follow all policies and procedures. We case tracked three people, part of this process involves looking at the care plans that staff follow to meet their needs. We found that in some cases care plans had not been developed for specific needs and where care plans were in place, care needs were not always up-to-date to ensure these were being met effectively. Care plans were also not always dated so it was not clear when some of the care needs were identified. For example we were told that one person had a pressure sore. There were no care plans in place showing when this sore developed, the location, or how staff should Care Homes for Older People Page 13 of 39 Evidence: manage it. Staff spoken to were able to explain how they applied creams and sprays to the area and advised that the district nurse was visiting once a week. The absence of a specific care plan for staff to follow in regards to pressure sore prevention and management could result in an oversight in care and deterioration in the health of the person. The provider has subsequently confirmed that staff read the district nurse notes to help them deliver appropriate care. These records however do not belong to the home and are for use by the visiting nurse. The home should develop their own care plans detailing all risks and staff actions to manage the prevention and ongoing monitoring of any pressure areas. Another person was observed during the inspection to look thin and frail and their care plan was requested and this showed they had consistently lost weight over a five month period totalling a loss of one and a half stone resulting in a very low weight. The dietary care plan made no reference to any loss of weight and the care plan review also made no reference to loss of weight. There was no recorded evidence to show that this matter had been discussed with the GP to agree how this should be managed. We were told that staff were not recording this persons food or fluid intake but it was acknowledged they should be. Staff said on Xs sleepy days it is difficult to get food into X. Staff spoken to said Not eating as well as used to, having more sleep days, X has lost a little bit of weight. X was prescribed Fortisips but then was taken off them because X was eating again. X has lost weight I dont think X has lost a lot say 2 or 3 lb in last 4 or 5 months. Care plan reviews consisted of one written paragraph each month for all care plans and risk assessments we looked at. It was not clear from this what aspect of care had been reviewed. Changes in health were not consistently identified in the reviews and it was also not clear if staff support should remain the same or change. Staff spoken to said that care plans do not always contain up-to-date information. A care plan for one person who we were told was registered blind and had a hearing impairment stated that the person would not wear the hearing aid but did not state how their poor hearing and loss of sight was to be managed. This person had sustained three falls in a three month period, one of which resulted in a serious injury, none of these had been reported to the Care Quality Commission as required showing actions the home had taken to reduce the risk of the person falling again. On speaking Care Homes for Older People Page 14 of 39 Evidence: with the person they stated their wound from the most recent fall was painful and they would not wish it upon anyone. They stuggled to hear and stated they are supposed to be sorting my hearing but the care plan made no reference to this being addressed. Staff confirmed that there would be a follow appointment for their injury but no information was volunteered about the persons hearing problems. We spent some time observing how staff interacted with people. We saw that staff were kind in their approaches with people and attended to any care needs in a friendly manner. Visitors spoken to said their relative was happy in the home and they had identified some positive changes taking place since the new manager had started working at the home. People spoken to made various comments such as they are pretty good to us here, some days are a lot better than others if you know what I mean and they have got some good girls. Medications on the whole were being managed appropriately but there were some areas identified for attention. Creams were found it two peoples rooms that did not belong to them suggesting these were being used for people they had not been prescribed for. This practice could place the person at risk of harm and staff should therefore only use creams that have been prescribed for the person. In one case there were more tablets left than there should be when we looked at the amount received, given and remaining. This could mean that records have been signed to say the medicine has been given when it has not. A cream and medicine prescribed to be used each day was not being given as prescribed. Staff were recording N on the records for PRN which means as required but these medicines had not been prescribed as required. One medcine had been prescribed one or two, four times a day staff had not recorded whether one or two had been given so it was unclear how much medicine the person had received. One medicine had been prescribed to be taken every six hours. The timings on the medicine chart showed that this was being given once after five hours and once after seven hours which is not as it has been prescribed. This practice could impact on the effectiveness of the medicine in maintaining the persons health. Generally the privacy and dignity of people was being met. For example we observed people being discreetly taken to the bathroom for assistance and staff knocking on doors before entering. There was one incident where a person in the lounge had their Care Homes for Older People Page 15 of 39 Evidence: thighs exposed for a long period of time, although there was blanket available this was either on the floor or had slipped off the persons legs and staff did not seem to notice this. Care Homes for Older People Page 16 of 39 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. There are some opportunities for people living in the home to participate in social activities to help maintain their social wellbeing. People have some choice of meals provided but it is not clear all peoples nutritional needs and preferences are met. Evidence: The care files of people involved in case tracking recorded some information about their interests, life history and family relationships. This should mean that staff have information about the cultural preferences of people. Information in some files was more detailed than in others, for example in one file the social activity section stated X will join in most activities and very sociable and always has been, loves company but there was no specific information about their interests and what they liked to do. There is no dedicated Activity Organiser at Haven House. The social activities that take place are carried out by the care staff which means staff have to make time to provide this in addition to their caring duties. Staff confirmed there is no specific social activity schedule and they therefore plan any activities on a daily basis. Staff spoken to about providing activities said it is a rush but best part of the job is activities with the residents that is my favourite part of job and we have a thing Care Homes for Older People Page 17 of 39 Evidence: where one member of staff does laundry, one does activities and one does teas if everyone wants the toilet at same time then it throws us out of time. Daily activity sheets had been completed showing the social activities that people had participated in each day. These showed that on most days people had participated in a social activity. These included I Spy, visiting clothes party, ball games, craft making, organ music, Holy Communion, chatting about old days and bingo. On some days people had not participated in any social activity. Comment cards from people living in the home stated we would like to do more activities but not with staff all the time and we have been on trips but we could do more On the morning of the inspection the television was on in the lounge and some people were sitting in chairs with their eyes closed. Some were awake but were not watching the television or conversing with anyone. The staff were busy getting people up so were not around during this time other than to bring people into the lounge. At around 11am some visitors arrived and there was more interaction between people. Staff offered people tea or coffee before bingo started at around 11.40am. This took place for around half an hour and people seemed to enjoy it, one person said it was good wasnt it. Staff were seen to assist those people to play who were less able and most people ended up getting a prize. One person was not happy that the television had been turned off for the bingo to take place and on several occasions asked for it to be turned back on. Staff said they would put it back on after the bingo. The home is limited to one main lounge which does place restrictions on peoples choices if they do not wish to participate in activities as there are no other communal lounge areas for them to go. Following the bingo staff assisted people into the dining room for lunch. The dining room had one large table where everyone was seated. On the day of inspection the main meal was liver and bacon or beef casserole with cauliflower, broccoli, mashed potato and mixed vegetables followed by rhubarb and pear crumble made with sweetener or fruit cocktail. The use of sweetener was questionned and staff confirmed that specific deserts are prepared for those people who are diabetic but not everyone has sweetener. People spoken to about the meals said the food was very good and its not too bad. A comment card received from a person at the home stated I enjoy all the food. Care Homes for Older People Page 18 of 39 Evidence: Menus showed that on most days there is a choice of two main meals, the exception being on days when a roast of the day is served. We could not evidence that people are receiving these choices each day as food records were not being kept. Menus indicated that cereals, toast and preserves are served for breakfast but there were no cooked breakfasts or cooked items indicated to give people an extended choice. We were told that that cooked breakfasts were not provided but they did have eggs sometimes. Menus did not reflect this. One person spoken to said yes I would like a cooked breakfast indicating that peoples preferences may not always be met with current menu choices. The teatime menu showed that sandwiches were being provided each day and on some days there was a second hot option but on others there was not. Menus indicated drinks and snacks available on request but it was not evident what snacks were available to people or what choices of drinks there were. The deputy manager said that people had hot milky drinks around 7.30pm with crisps, biscuits, chocolate, cheese and biscuits or other snacks. Care Homes for Older People Page 19 of 39 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. People cannot be confident that their concerns will be appropriately recorded and acted upon to ensure they are safeguarded from potential harm. Evidence: We asked to see the complaints records for the home but were told the complaints folder could not be located to confirm if any complaints had been received or recorded by the home. We were told that some verbal complaints had been received. A complaints procedure was available but this did not give the names, contact addresses and telephone numbers of people who could be contacted to pursue a complaint. The contact details for the Care Quality Commission were out of date and it would have been difficult for people to make independent contact with us. During the review of care files a rough handling allegation was found which the person felt had resulted in an injury to them. It was not evident whether this had been appropriately acted upon by the home. The deputy manager said that the person had completed moving and handling training again. Training records viewed showed that most staff completed training in relation to the protection of adults in 2008 but some staff were still to complete this. Staff spoken to gave differing responses in regards to how they would deal with an allegation of abuse. Some were clear this needed to be reported to management and others Care Homes for Older People Page 20 of 39 Evidence: presumed this was what they would need to do. Staff were not clear about what the manager would then do with this information. A member of staff confirmed they had read through the procedures relating to abuse and protecting people but also said there was so much to take in. Care Homes for Older People Page 21 of 39 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. People do not benefit from a clean, well maintained and odour free environment. Evidence: We walked around the home with the deputy manager and looked at the communal areas and several bedrooms, including those belonging to people involved in case tracking. There was one communal lounge and one dining room both of which were comfortable and homely for people who live in the home. There were no unpleasant odours noted in the communal areas of the home although we did find areas of the home dusty and in need of a deep clean. One room seen had been personalized with lots of trinkets and personal items. The door to this room had no door knob and had a vinyl floor, we were told that the vinyl floor was what the person wanted and they had agreed to it. Notes of a resident meeting recorded X likes her room demonstrating they were satisfied with the facilities provided. The ensuite in this room had a deep groove in the floor area which could place people at risk of falling. The fan and toiletry cabinet were dirty and in need of cleaning. We were told that the person in this room did not use their ensuite so the uneven flooring would not be a risk to them. We were advised the person chose to use the commode in their room instead. Care Homes for Older People Page 22 of 39 Evidence: Another room seen was large and airy and had been attractively decorated and personalised so it was clearly identifiable as their own. We were told the room had been painted in a colour of the persons choice and on speaking to the person it was evident this was one of their favourite colours. There were matching soft furnishings and the deputy manager said the persons own light fitting had been installed at their request. The room was warm and had a call bell for the person to alert staff if they should need to but we did find several areas in the room to be dusty and in need of cleaning. In one bedroom there was a very strong unpleasant odour and when the light was put on in the ensuite it made a loud noise. The bathroom cabinet was dirty and paint chipped and the paint was scuffed on the walls. Of the seven comment cards received four people felt the home was always fresh and clean and three felt it usually was. Visitors spoken to stated the cleanliness of the home was patchy. Since the last inspection action has been taken to fit radiator guards around the home to protect people from the risk of burning themselves if they should lean or fall against them. Several areas around the home had exposed wires from the ceiling to floor, the deputy manager advised that areas of the home were being rewired and these would all be boxed in when the wiring was complete. The bathrooms in the home had portable bath hoists to assist those people with limited mobility to get into the baths. In one bathroom there was a blue bag on the floor with a used incontinence pad inside it. We were told that this was not normal practice and that there are designated bins where pads should be disposed of. In another bathroom the vinyl floor was bubbling and the handwash sink was not fixed flush against the wall leaving a gap between the wall and the sink. The home has a small garden at the back which is accessible to wheelchair users via a ramp. This has a circular footpath to enable people to walk around it, beyond the garden is a small car parking area which can be accessed by an entrance situated at the side of the home. The laundry is located in a separate building outside of the home. Gloves and aprons were available to maintain good hygiene but open weave baskets were in use for dirty Care Homes for Older People Page 23 of 39 Evidence: items which are difficult to clean. Staff spoken to were aware of how to maintain good hygiene practices and were able to explain the process of cleaning and emptying commodes to ensure these are kept clean and hygienic for people. Care Homes for Older People Page 24 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The deployment of staff across the home is not always sufficient in making sure services are provided effectively and peoples care needs are met. Evidence: On the day of inspection there were 15 people in the home and one person in hospital. The manager was not available due to being on sick leave and the deputy manager was therefore covering the home. The deputy manager explained that the compliment of staff working in the home was based on the current occupancy. We were told there were three carers on the early and late shift one of which would be a senior carer and three carers on at night, two of which stay awake. We were told that care staff are required to complete some ancillary duties such as laundry, light cleaning and assistance with catering tasks. The deputy manager said that both she and the manager always work in a supernumerary capacity. Duty rotas confirmed that these staffing numbers were being achieved and that the manager and deputy manager both work part time. The manager had been rostered to work four days per week and the deputy two days per week. Neither the manager or deputy had worked at weekends and there was one day per week when they both Care Homes for Older People Page 25 of 39 Evidence: were on duty at the same time. Duty rotas did not show the shift times and hours worked by some staff including the manager and deputy. This means the service cannot be sure sufficient staff hours are being allocated to meet the needs of people effectively. Comment cards received from seven people showed that four people felt there was always staff available when they needed them, two stated there were sometimes and one stated there usually was. It was evident that some comment cards had been completed with staff support which can impact on people giving an independent view. The home should seek independent advocates to allow people to be appropriately supported in completing these surveys. People told us in the comment cards the staff treat me as their family and look after me well, friendly staff, they look after me well. One person has stated that something the home could do better is more staff so we dont have to wait. There is one cook in post who is assisted by carers at mealtimes and carers also do the laundry for the home. Staff spoken to were asked if they had sufficient time to complete ancillary duties such as any cleaning and laundry whilst also caring for people in the home. We were told sometimes its really hard work... it depends on what frame of mind the residents are in, sometimes it can be a bit of a push, you have to pace yourself I dont think the cleaning is good enough, we could do with a full time cleaner really. There is one cleaner who works from 9am till 2pm three days per week and we were told that sometimes the maintenance person also completes some cleaning. It was not clear from duty rotas that this arrangement was in place. One duty rota showed there was no cleaner working for the whole week. In some cases the shift times of the cleaner and cook had not been indicated so it was not clear that sufficient hours were being provided for these services to support people appropriately. We found areas of the home in need of cleaning and it is therefore evident that the current cleaning arrangements are not sufficient to maintain the cleanliness in home effectively. We were told that there are 14 carers working at the home and of these there are seven with a National Vocational Qualification II in Care. This means the home are achieving the 50 minimum standard required. The deputy manager said that further staff were being put forward to complete this training. This training helps staff to Care Homes for Older People Page 26 of 39 Evidence: develop skills in identifying and responding appropriately to peoples needs. The training schedule for the home showed that staff had also completed statutory training including moving and handling, fire and food hygiene. It was not evident that future training had been arranged for the staff that had not completed this training. Records showed that some staff are yet to complete food hygiene and fire safety training. Some staff had completed dementia awareness training and the deputy manager had completed more comprehensive training in this area. Staff spoken to knew what training they needed to do which included fire, first aid, and infection control. A review of two staff files was undertaken to determine the process used by the home for recruitment. One file contained all of the required checks and the start date for the person had been clearly documented. In the second file the start date of the person was not recorded. The member of staff confirmed the date during the inspection and it was evident the Criminal Record Bureau check had been obtained prior to this date as required. There was only one written reference on the file as opposed to the two required and it was not clear in what capacity this person knew the applicant. A new member of staff had an induction checklist on file but it was not evident the training provided was in accordance with the Skills for Care common induction standards. This training enables staff to build up their competencies over a number of weeks so they can care for people safely and effectively. The deputy manager agreed to follow up this matter with the manager. Care Homes for Older People Page 27 of 39 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. People who use the service cannot be confident that the service will always be managed in their best interests but can be confident their needs will be responded to sensitively. Evidence: Since the last inspection a new manager has been appointed and we were told they had been in post since 1 June 2009. They have not yet applied to us for registration as required. The manager is supported by a deputy who has worked at the home for several years. The Annual Quality Assurance Assessment (AQAA) forwarded to the Care Quality Commission contained very limited information about the care and services provided, how the service had improved and what evidence was available to show how care standards were being met. This was discussed during the inspection with a view to ensuring the service can demonstrate an ongoing commitment to improving the quality of care and services provided to people. Care Homes for Older People Page 28 of 39 Evidence: We found two people had been admitted to the service outside the services categories of care. This means people cannot be confident the service can effectively meet the needs of these people. Since the last inspection some action had been taken to develop satisfaction surveys for relatives to complete. Four had been received by the home in January and February 2009. Questions included is your relative happy, comfortable and relaxed always, sometimes, never. Two answered always and two stated sometimes. Another question was are the bedrooms clean and in good decorative order, three stated always and one stated sometimes. We were told staff surveys had also been undertaken but these could not be located. It was not evident any quality satisfaction surveys had been undertaken with people living in the home. A resident meeting had taken place in July 2009 where issues such as food and social activities has been discussed. The service had received some thank you letters from people demonstrating their satisfaction with the care provided but not all of these were dated so it was difficult to be sure these were current. Staff meetings had taken place and notes of a meeting in November 2009 showed several issues had been discussed including medication, night checks, social activities, the use of wheelchairs and cleaning of commodes. We viewed accident records and found that some of these had not been reported to us as required. In some cases medical intervention had been sought including a hospital visit for one. Accidents of this nature should be reported to us so that people can be confident the service are taking appropriate action to meet their needs and minimise any potential risks. We viewed the personal financial records for people case tracked and found records and monies kept were accurate. Receipts had been obtained for any transactions carried out on behalf of people living in the home. Health and safety records checked showed that electrical appliances and wiring checks had been undertaken. Further electrical wiring was taking place during the inspection we were told due to a fault on the cabling. Care Homes for Older People Page 29 of 39 Evidence: The AQAA stated that the hoists had been serviced in 2009. We found the hoists, lift and legionella checks had all been completed as required. We were told the cooker and tumble drier had both been recently checked but the certificates had not been received as yet. Care Homes for Older People Page 30 of 39 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 31 of 39 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 12 The home is not registered to provide care and support to people whose primary care need is dementia care and the service must not therefore provide services for people requiring specialist dementia care. This is so that people who use the service can be confident that their needs will be met. 31/01/2010 2 7 12 The care needs of people 31/01/2010 must be effectively reviewed and any changes or deterioration in health clearly recorded and addressed by staff as appropriate. This is so people can be confident their health will be appropriately managed. 3 7 15 Regular and frequent reviews of care plans must be undertaken and care 28/02/2010 Care Homes for Older People Page 32 of 39 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 plans updated in light of any changing needs so that staff have access to information they need to support the person appropriately. This is to ensure peoples needs are met. 4 9 13 Medicines must be given as 31/01/2010 prescribed. This includes ensuring the person receives their medicine within the timings stated by the GP. This is to ensure the medicine is effective in maintaining or improving the persons health. 5 9 13 Medicines prescribed must only be used for the person they have been prescribed for. This is to ensure the health of the person is effectively maintained. 6 16 22 A written record of any 31/01/2010 complaints received must be kept as well as any actions taken to resolve the issues raised. This is so people can be confident any concerns raised will be managed to appropriately to secure their protection. 31/01/2010 Care Homes for Older People Page 33 of 39 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 18 12 Any allegation of potential 31/01/2010 abuse such as rough handling must be reported to the Local Authority in accordance with the local arrangements for safeguarding to obtain guidance on what, if any, action is required which then must be carried out. This is to make sure people who use the service are safeguarded from potential abuse. 8 25 16 The home must be maintained in a clean condition consistently. This includes attention to ensure surfaces are dust free as well as the removal of unpleasant odours. 31/01/2010 This is so people live in a clean and hygienic environment to protect their health. 9 27 17 The duty rota must include the full name, staff designation and start and finish times of staff so there is an accurate record of who is working at the home and in what capacity. This 28/02/2010 Care Homes for Older People Page 34 of 39 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 includes the manager and deputy manager. This is so that it is clear there are sufficient numbers of staff on duty to meet the needs of people living in the home. 10 30 18 All staff must complete statutory training including food hygiene and fire safety within the timescales required. The required timescales must be demonstrated. This is so people living in the home can be confident staff are suitably trained to maintain their health and safety. 11 31 12 The person carrying on the management of the care home must apply to be registered with the Care Quality Commission. This is so people can be confident the service is being managed by a suitably competent and qualified person who will ensure the service is being managed in peoples best interests. Care Standards Act Section 11 28/02/2010 31/03/2010 Care Homes for Older People Page 35 of 39 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 12 37 37 All accidents which require medical intervention and which impact on peoples health and wellbeing must be reported to us. This is so we can be sure the service is taking appropriate action to safeguard people. 31/01/2010 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 A Service User Guide which contains all the necessary information about the home needs to be available to people so that they can make an informed decision on whether to stay. A protocol should be developed where one or two tablets/capsules are prescribed so that staff are clear how to record this on the medicine administration record (MAR) and it is clear how many the person has received. The privacy and dignity of people needs to be maintained at all times. This includes ensuring people are appropriately covered when seated in communal areas. A review of social activities should be undertaken with people who live in the home to ensure there is a suitable range of stimulating activities that regularly take place in accordance with peoples preferences and wishes. The home need to be able to demonstrate that people are being given choices in regards to the care and services that are being provided. This includes for example the completion of food records to show choices detailed are being provided consistently. Menus should demonstrate all meals, snacks and drinks that can be provided so that people know what choices and options are available to them. Page 36 of 39 2 9 3 10 4 12 5 14 6 15 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 7 16 The complaints procedure needs to include named contacts, addresses and telephone numbers so that people living in the home know who to contact should they wish to raise a complaint. The procedure should also include details of external agencies such as the Local Authority. Attention is required to the vinyl floor covering in the bathroom identified showing signs of bubbling to make sure people are not placed at risk of tripping or falling. The handwash basin in the bathroom identified should be appropriately fitted so that it is flush to the wall to make sure this is safe for people to use. Action should be taken to repair the broken door handle identified as well as any damaged toiletry cabinets so that people are able to live in a pleasant and well maintained environment. The deep groove in the floor surface in the ensuite identified during the inspection needs to be addressed to ensure people are not placed at risk of injury or falls. Incontinence pads need to be disposed of appropriately to help prevent the spread of infection. Staffing levels should be kept under review to make sure there are enough staff on duty to meet the needs of people using the service. The number of staff hours allocated to completing laundry duties needs to be demonstrated so that it is evident there are sufficient hours allocated to complete peoples laundry effectively. All recruitment checks need to be completed for new staff so that it can be demonstrated they have been deemed suitable and safe to work with vulnerable people. This includes two written references. Staff induction training should be provided in line with the Skills for Care Common Induction Standards so that staff are suitably trained to care for people safely and appropriately. The quality assurance system should be further developed to assist in the identification of shortfalls to enable suitable improvements to be planned and carried out. This should Page 37 of 39 8 19 9 19 10 19 11 19 12 13 26 27 14 27 15 29 16 30 17 33 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 ensure that quality of the service is improved and is kept under constant review. Care Homes for Older People Page 38 of 39 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). 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