Inspection on 16/02/09 for Haven Lodge Residential Home

This inspection was carried out on 16th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven Lodge Residential Home 04/08/09

Haven Lodge Residential Home 19/05/09

Haven Lodge Residential Home 22/04/09

Haven Lodge Residential Home 06/11/07

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Snydale Care Home

Hawkhills

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Haven Lodge Residential Home Wakefield Road Normanton Wakefield W Yorks WF6 1BP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gillian Walsh     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Haven Lodge Residential Home Wakefield Road Normanton Wakefield W Yorks WF6 1BP 01924220013 01924895464 traceybed1@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Carestream Limited care home 32 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: 32 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 needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Haven Lodge is situated in Normanton on the main road between Wakefield and Castleford and is on a bus route. Set in its own grounds, there is parking provided to the front and side of the home and a large walled garden area at the back, accessible to people living at the home. 0 Over 65 32 Care Homes for Older People Page 4 of 33 Brief description of the care home The home is registered to Carestream Limited although is currently in the hands of the receivers and is being run by the administrators. The home provides a service for up to thirty-two older people. In relation to the accommodation, there are two main lounges and a good size dining area. In addition, there is a large conservatory at the back of the home which people can use at their leisure. All the bedrooms are single and there are good toilet, bathing and washing facilities. There is a pleasant reception area. Outside, there is good access to the home at the front and back. Ramps are in place. Inside, there is access to the first floor by means of two stair lifts. The home is generally spacious. The provider makes information about the service available to enquirers when initial enquiries are made, and a copy of the Service User Guide, on admission to the home, which includes the Commission for Social Care Inspection contact details. The weekly fees in February 2009 are £388. Hairdressing and chiropody are charged extra to these fees. Care Homes for Older People Page 5 of 33 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: This was a key inspection which included a visit to the home. The visit was undertaken by two regulation inspectors, one of whom works with the Commission for Social Care Inspections enforcement team. The key inspection was brought forward from planned timescales due to the Commission receiving some concerns about the service and the home currently being run by the administrators due to being in receivership. On this occassion we had not asked for the home to complete and return an Annual Quality Assurance Assessment (AQAA) and we did not sent surveys to service users. During the visit we spent time speaking with the manager, people who live at the home, some staff and some visitors and relatives. Care Homes for Older People Page 6 of 33 We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Several areas of concern were identified during this inspection. Action needs to be taken to make sure that: People must not be admitted to the home without an assessment of their needs taking place to make sure that staff working in the home have the experience and competancies to meet their needs. Care plans need to be up to date and reflect good detail of the needs of the individual and what actions staff need to take to meet these needs. This is essential to make sure that people recieve the care they need in the way they prefer to receive it. A safe system for moving and handling people needs to be established. People could be put at risk of injury due to staffs poor practice in this area. Staff must make sure that people receive the care they need. This must include taking people to the toilet, making sure people receive drinks and making sure people recieve good pressure area care. A safe system for handling medication in the home must be established. This must include making sure that people receive their prescribed medication and pain relief as prescribed. Staff must take actions to make sure that people who live at the home have their privacy and dignity needs met. People living at the home need to be supported and encouraged to make decisions about about their care and their lifestyles. People living at the home need to have access to social and leisure activities. People need to have choice in what they have for their meals. Complaints made to the home need to be taken seriously, investigated properly, actions taken to address the issues and feedback given to the complainant. Staff need to know what to do if they suspect abuse. Actions need to be taken to make sure that the home is safe and clean. Staff need to receive regular training. This must include moving and handling, dementia care and safeguarding and abuse. Care Homes for Older People Page 8 of 33 The management of the home must be improved to make sure that people are cared for effectively and safely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always have their needs assessed before being admitted to the home. Evidence: The home manager said that prior to any new people coming into the home, she would make an assessment to make sure that the home was able to meet their needs. One of the pre admission assessments seen did not contain any details of the the persons medical history and files for two people who receive respite care at the home did not contain any pre admission assessment at all. The home does not provide intermediate care. Care Homes for Older People Page 11 of 33 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 are being put at risk due to poor care practices, poor moving and handling and unsafe systems relating to management of medication. Evidence: Care plans had been developed for each person living at the home but included little detail of the persons personal preferences and choices relating to their care and lifestyles. The care planning system is based on the individuals activities of daily living. However several of the care plans seen were in need of review as they contained incorrect and conflicting information. For example one of the care plans seen had not been reviewed to reflect the fact that the person had become very frail and was being cared for in bed. Another care plan said that the said that the person did not wear glasses but a recent prescription for glasses was in the file. Care Homes for Older People Page 12 of 33 Evidence: A further care plan said that the person needed staff to assist them to mobilise and that they were to use their walking frame or stick. However a needs assessment completed in November 2008 stated that the person now uses a wheelchair to mobilise. Another person was observed during the visit to use a wheelchair for mobilising however their care plan said that they mobilised using a zimmer frame. Inspectors witnessed staff members handling people and using moving and handling belts in a manner which could cause discomfort and injury to people living at the home. Many of the staff were seen wearing handling belts but when asked by the inspectors why this was, one member of staff said they didnt know. A care plan had not been developed for a person inspectors were informed by staff uses a hoist. No information was available about which hoist or sling were to be used. Pressure care charts and fluid balance charts were in use for some of the people living at the home but in several cases were being completed inappropriately. An example of this was staff repeatedly recording No response mouth care for a period of at least two days on a pressure care chart. The entry mouth care had also been recorded in both the intake and output columns of a fluid balance chart. One person who the manager said had been using a special pressure mattress for months and had a pressure care chart in place had not had a care plan relating to pressure care developed. The Commission had received concerns that people living at the home were not being assisted to the toilet regularly and that people were being left in bed due to a lack of staff availability. One persons fluid balance chart indicated that they had not been assisted to the toilet between 8pm one day and 1pm the following day. Another chart showed that the person had not been assisted to the toilet between 12 midday on one day and 2.45pm the following day. Documentation for a person who the manager said went to bed for a couple of hours each afternoon, showed that on the four days prior to the inspection visit the person Care Homes for Older People Page 13 of 33 Evidence: had been taken to bed early afternoon but there was no indication that they had got up again. This was of particular concern as the speech and language therapist had left instruction that this person must sit up for all dietary and fluid intake and for a period of time afterward. Care charts did not indicate that the person was moved again after being taken to bed. Peoples weights are recorded but there is no evidence of any action being taken to investigate or report weight loss. For example one persons weight records indicated that they had lost 11 pounds in one week but this has not been included on their nutritional assessment and no record of any actions taken was available. Evidence was available to show that the services of healthcare professionals such as district nurse, GP and optician are requested. However records showed that on one occasion the district nurse had left instruction for staff at the home to change a persons dressings every seven to ten days. No record was available to show that these dressings had been changed at all. A member of staff told inspectors that one person who lives at the home had been reported by another staff member as screaming in pain two days prior to the inspection visit. Records showed that a district nurse made sure that pain relieving equipment and medication was in place at the home to be used if and when this person experienced pain and had left instruction to contact her to set this equipment up when the need arose. At the time of the visit the district nurse had not been contacted and therefore the person had not received any painkillers. When asked about this the home manager said that the carer involved had no right to report that the person was in pain. The manager went on to say that the person was not in pain despite the fact that she had not been present in the home for the previous two days. The medication records for this person also showed that they had been previously been prescribed a seven day course of anti-biotics. However only three days of the anti-biotic was given and course complete written on the medication administration record (MAR) sheet. Another persons MAR sheet showed 29 signatures of administration where only 28 tablets had been prescribed. A further MAR chart showed a stock balance of 11 Sodium Valproate tablets on 13 February 2009. Six tablets were signed as administered on 14 February with the stock Care Homes for Older People Page 14 of 33 Evidence: level then recorded as 6. Another person had been prescribed Eumovate cream to be applied twice each day. The MAR chart showed that it was being applied only once a day but a carer said it was in fact being applied three times each day. A relative of a person who lives at the home told the inspector that there had been a delay in the home obtaining some newly prescribed medication for their relative. When the person asked the manager on numerous occasions what was happening she said dont know. Eventually the relative collected the prescription from GP surgery and the tablets from the chemist themself. Both inspectors saw evidence that the dignity of people living at the home is not always considered or met. Several ladies were seen without stockings although the manager said they should be wearing them. One person was seen sitting in a chair which had dried faeces on it, despite being pointed out to the manager, this situation was only attended to at the request of the inspector. Another person was seen being assisted by staff to walk from the lounge area and down a corridor with their trousers having fallen down exposing their bottom. Staff took no action to remedy the situation. A care plan seen for one person said that staff staff make sure hearing aid in place or the person would withdraw from social groups. This person had not been provided with their hearing aid on the day of the visit. Care Homes for Older People Page 15 of 33 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. People receive minimal level of social activity and a lack of choice of meals and drinks. Evidence: Care plans seen did not include details of the individuals needs and preferences in relation to their social and recreational needs. The manager said that the home does not employ an activities organiser but staff try to engage people in activities when they can. Very little evidence of activities was witnessed during the visit. One member of care staff was observed to sit alone in a room where none of the people who live at the home were seated. When the inspector pointed out to the manager, she instructed the carer to commence some activity. The carer was then seen engaging a person in a game of scrabble. Approximately fifteen minutes later inspectors saw that the carer had left and the person was sitting alone looking at the scrabble box. The home manager informed the inspectors that a Nintendo Wii had been purchased to engage people in activities. This is not an appropriate activity for the majority of the people living at the home due to dexterity and understanding required to operate Care Homes for Older People Page 16 of 33 Evidence: the game. The television in one of the lounges was noticed to be playing loudly throughout the visit. This continued at lunchtime even though the dining table had been set up in the lounge for people to eat their meals at. When asked about this by the inspector a carer said that the people in the room would react badly and be upset if the television was turned off. However the carer did turn the television off and the people sitting in the room became engaged in conversation with each other at the dining table. Interaction and socialisation such as this should be encouraged. Concerns had been received by the Commission that people who live at the home do not receive drinks on a regular basis between meals, particularly people who are cared for in their rooms. During the visit people were seen to be given drinks mid morning and mid afternoon however the care charts for a person who spends long periods in bed did not indicate that they had provided with drinks or food from lunchtime onwards for the period of four days of the charts seen. No choice was available for the mid morning drink but the manager said that there should be. The manager told the inspectors that the cook had left and that a senior care assistant was doing the cooking. When asked about weekends she said that they did not have anybody organised to do the cooking the coming weekend. The manager said that she had some application forms and hoped to employ a cook in the next four days. Inspectors informed The manager that it would not be possible to interview, obtain references and clearances for a new cook in four days and suggested that she quickly look into making alternative arrangements to make sure that the people living at the home got their meals at the weekend. The lunchtime meal consisted of a choice of soup, shepherds pie with vegetables and a dessert. A vegetarian shepherds pie was made for a person requiring this diet. Meals were presented already plated up. One person was heard to say to staff dont give me peas However the pre plated meal was presented with peas on it. The person again said I dont like peas can I have one without The carer told the person just to leave the peas. Nobody was offered gravy or sauce with their meal. When asked about choices, the cook said that people were told what the meal was and Care Homes for Older People Page 17 of 33 Evidence: could request an alternative if they wanted one. This would be difficult for people with dementia who often need visual choices at the time the meal is being served. No evidence of people being offered choice was available. During the afternoon it became apparent that there was not enough bread in the home to make the tea time sandwiches. The manager said this was due to her not doing the shopping as the inspectors were in the home. Bread was bought in time for the meal. Although there are two adjoining dining rooms, one of these rooms is used primarily by staff and a dining table is set up in one of the main lounges for some of the people who live at the home. The manager may wish to consider changing this arrangement to provide people with proper dining room space if they wish to use it. Visitors were seen in the home during the visit. Some were visiting in the communal areas whilst others saw their relative in the privacy of their own room. Care Homes for Older People Page 18 of 33 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 do not have confidence that their Complaints are dealt with. People could be put at risk through poor safeguarding knowledge and procedures. Evidence: Prior to the inspection, the Commission had been contacted by a person who had concerns about the care of their relative in the home. The person said that they had approached the manager but they did not feel as though she was taking their complaint seriously or taking any action to remedy matters. During the visit the complaints book was seen. There was evidence that the manager was looking into a current complaint, but little evidence that they had made response to people who had previously made complaints. It was also evident that the manager had failed to look at documentation relating to the current complaint held within care records. During the visit people told the inspectors of complaints they had made to the manager which were not included in the complaints book. One complaint which had been documented related to an alleged theft within the home had been investigated by the manager but she had failed to refer the matter under inter agency safeguarding procedures. Care Homes for Older People Page 19 of 33 Evidence: Staff spoken with knew what constituted abuse but were unsure of how to report abusive situations appropriately. Records showed that seven staff had not yet received any training in abuse and protection. Care Homes for Older People Page 20 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safety of the people living at the home could be put at risk by poor environmental standards. Evidence: Several radiators within the home were turned up to full which gave them a very high surface temperature. None of these radiators were guarded which meant that people who live at the home could be at risk of burning themselves. During the morning the inspector noticed that two convector heaters in the conservatory had furniture pushed against them. Although neither of the heaters was turned on, the inspector brought the situation to the attention of the manager as a potential safety risk. Despite this, when the inspector checked the heaters in the afternoon, both had been turned on and the furniture was still pushed against them. Additionally a very hot, free standing, oil filled radiator was against one of the chairs being used by one of the people who lives at the home. One of the people who lives at the home pointed out to the inspector that the stair lift to the back stairs could not be used with the footplates in place as the footplates Care Homes for Older People Page 21 of 33 Evidence: stopped the chair lift from moving when going down the stairs. This is potentially very dangerous to anybody using the stair lift. The manager was required to make immediate arrangements to make this stair lift safe. This she did during the visit. The restrictor to one of the windows in one persons bedroom was broken and the handle to another window had fallen off. Inspectors were told that this had been reported to the manager but no action had been taken. The manager was required to make immediate arrangements to make this window safe. This she did during the visit. A visitor told the inspector that the homes doorbell had been broken for six weeks which meant that visitors had to telephone the home from outside to gain entry. Eventually the visitor bought and fitted a new doorbell for which they had not been reimbursed. Inspectors were also informed that visitors had had to buy and replace light bulbs in the home. The main lounge was without ventilation due to vents in French windows being broken. Several areas of the home smelled very unpleasant. A visitor said that it was not as bad as it usually was and showed one of the inspectors some photographs they had taken of overflowing clinical waste bags in the home. Despite the manager being made aware of the very unpleasant smell at the beginning of the inspection, it was still present in the evening. Generally the furniture in the home was worn and in some areas not clean. The manager said that two cleaners work at the home but both work in a morning which means there are no cleaning staff available in the afternoon or evening. Care Homes for Older People Page 22 of 33 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. People living at the home could be put at risk as a result of staff working very long hours and not having the skills and training they need. Evidence: Prior to the visit the Commission had received concerns relating to insufficient staffing and some staff working very long hours. Staff rotas seen during the visit showed that two senior care assistants had worked 60 and 69 hours respectively the week prior to the inspection. In addition to these hours both senior care assistants had been on the on call rota to be contacted during the night if needed. Rotas also showed that in the three weeks prior to the visit, there had been four occasions when only two staff had been on duty at night instead of the three staff there should have been. One care assistant said its very difficult at the moment As previously recorded, the cook had also recently resigned and although a senior care assistant was taking on these duties, there was no arrangement in place for anybody to be doing the cooking the weekend following the inspection visit. Care Homes for Older People Page 23 of 33 Evidence: The recruitment records for the last three people employed at the home were checked and contained all necessary information and evidence of checks and clearances being taken prior to commencing employment. It was of concern to inspectors that the manager thought that she would be able to employ a new cook before the weekend as this would not allow time for interviewing, taking references and obtaining preliminary clearances. Training records showed that fifty per cent of care staff had obtained National Vocational Qualification (NVQ) to at least level two in care. Only four of the current staff team had undertaken training in caring for people with dementia and this had not been updated since 2006. As the home is registered to care for people living with dementia it would be expected that all care staff have undertaken formal training in this area. Training records also showed that nine staff had not completed moving and handling training, this was evident from observations during the visit. Records of the induction training for one person were looked at. The person had commenced employment in December but induction training did not commence until 5th January. Records were unclear about who had supervised this person during their induction. This person had not yet undertaken any mandatory training, including fire and moving and handling training. Care Homes for Older People Page 24 of 33 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. Poor management systems could put people at risk. Evidence: The registered manager has the NVQ level 4 qualification in care and is currently studying a business administration course. She does not hold the registered managers award. It was of concern throughout the visit that the manager was unaware of many of the identified issues of concern and felt that any problems were due to the failings of the care staff, also that she had failed to take action in relation to several complaints and concerns brought to her attention. There was no evidence of any systems for quality assurance in the home. Some questionnaires had been sent out and returned but no actions had been taken by the manager in response to the questionnaires. Care Homes for Older People Page 25 of 33 Evidence: Regular relative and resident meetings are not being held. This is particularly important at the moment due to the the home currently being run by the administrators due to being in receivership. Small amounts of money is retained in the homes safe for residents who wish to have some money held safely on their behalf. Amounts and accounts were checked and all were correct and appropriate. Several issues which could adversely affect the health and wellbeing of people who live at the home were highlighted during this inspection. This includes lack of staff training, environmental issues, poor moving and handling practices and unsafe systems relating to medication. Fire alarm testing is not being carried out on a weekly basis and processes are not in place to prevent the spread of infection within the home. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23(4)(a)13(4) The registered person must ensure that there are arrangements in place for completing fire system and running hot water temperature check in the absence of the person designated to do them to ensure people are safe. 23(4)(a)13(4) The registered person must ensure that there are arrangements in place for completing fire system and running hot water temperature check in the absence of the person designated to do them to ensure people are safe. 18(1)(a) 30/11/2007 2 25 30/11/2007 3 27 The registered person must 30/11/2007 ensure that there are enough staff on duty at night to meet people?s needs appropriately and that they are adequately supervised. The registered person must ensure that two satisfactory references are obtained before people start work at the home. 30/11/2007 4 29 19(1)(c) Care Homes for Older People Page 27 of 33 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 People should not be admitted without first being given confirmation, as a result of assessment, that their needs can be met at the home. To make sure that people are not put at risk by being admitted to a home where staff are unable to meet their needs. 10/04/2009 2 7 15 Care plans must be up to 10/04/2009 date and include details of the actions staff need to take to make sure that the needs of the people who live at the home are met. To make sure that staff know how to support people to meet their needs in the way they would prefer. 3 8 13 A safe system for moving 10/04/2009 and handling people must be in place at the home. Care Homes for Older People Page 28 of 33 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 prevent people being harmed. 4 8 12 Proper provision must be made to ensure the health, welfare and treatment of people who live at the home. To make sure that people receive the care they need to promote their health and well being and comfort. This includes timely referrals to healthcare professionals and carrying out prescribed treatment. 5 9 13 Arrangements must be made for the safe handling and administration of medications in the home. To make sure people receive the treatment they are prescribed and are safe. 6 10 12 Arrangements must be made to promote and ensure the privacy and dignity of the people who live at the home. So that peoples privacy and dignity is not compromised. 7 12 16 People who live at the home must be consulted about their social interest and the home must make 10/04/2009 10/04/2009 10/04/2009 10/04/2009 Care Homes for Older People Page 29 of 33 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 arrangements to enable people to engage in activities either within the home or outside the home. To make sure that people who wish to, have as active and fulfilling lifestyle, considering their personal preferences, as they need. 8 14 12 People living at the home must be offerred choice and enabled to make decisions about their care and lifestyle. So that people have choice within their lives. 9 15 16 People must be provided with choices of wholesome and nutritious food which is varied and suited to the needs of the individual. So that people receive the nutrition they need which meets with their personal choice. 10 16 22 All complaints must be investigated and responded to as per the homes complaints procedure. So that people have confidence that their complaints will be taken 10/04/2009 10/04/2009 10/04/2009 Care Homes for Older People Page 30 of 33 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 seriously and managed appropriately. 11 18 13 Arrangements must be made, by training staff or other measures, to prevent people being harmed or suffering abuse or being placed at risk of harm or abuse. To keep people safe. 12 19 13 All parts of the home 10/04/2009 accessible to people who live there must be as far as reasonably practicable free from hazards to their safety. To keep people safe. 13 26 13 Suitable arrangements must be made to keep the home clean and prevent the spread of infection. To provide people with a pleasant living environment. 14 27 18 Suitably qualified staff must 10/04/2009 be available in sufficient numbers to meet the needs of the people who live at the home. To make sure people are cared for safely. 15 30 18 Staff working at the home 10/04/2009 must receive training appropriate to the work they are to perform. This must 10/04/2009 10/04/2009 Care Homes for Older People Page 31 of 33 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 include moving and handling, fire and adult protection training. To make sure people are cared for safely. 16 33 24 A system for reviewing and 10/04/2009 improving the quality of care provided at the home must be established and maintained. So that the services provided to people can be improved. 17 38 11 The home must be conducted in a way which promotes and makes proper provision for the health and welfare of service users. So that people are safe. 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 10/04/2009 1 15 The manager may wish to consider some reorganisation to provide all of the people whop live at the home with dining room space. The registered manager should establish systems to make sure that she is aware of how care is being delivered in the care home. 2 31 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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