Inspection on 04/08/09 for Haven Lodge Residential Home

This inspection was carried out on 4th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven Lodge Residential Home 19/05/09

Haven Lodge Residential Home 22/04/09

Haven Lodge Residential Home 16/02/09

Haven Lodge Residential Home 06/11/07

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Hawkhills

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

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:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David White     Date: 0 4 0 8 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 35 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 35 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. The home is registered to Carestream Limited although is currently in the hands of the receivers and is being run by an administration company called Vantis. The home Care Homes for Older People Page 4 of 35 Over 65 32 0 Brief description of the care 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. The most recent inspection report is available and on display in the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We went to the home without telling them we were going to visit. This report follows the visit that took place on 4 August 2009. The visit lasted from 08:30 until 15:40. The inspection visit was undertaken by a regulation inspector and an inspector from the regional enforcement team. The enforcement team were involved to check compliance with a statutory requirement notice (SRN) that had been issued on 27 May 2009. The SRN had been issued to the organisation and the registered manager as they had been found to be in breach of the Care Homes Regulations 2001 at the random inspection carried out on 20 April 2009. The purpose of the visit was to check compliance with the statutory requirement notice issued in May 2009 and with other requirements made at the last inspection. Since the previous key inspection visit in February 2009, the home has also had a random inspection visit in April 2009 to check compliance with previous requirements. Another Care Homes for Older People Page 6 of 35 visit was carried out by a CQC (Care Quality Commission) pharmacy inspector in May 2009 to specifically look at the homes medication systems and procedures to check whether previous requirements in relation to medication issues had been met. Information has been used from various sources for this report. These sources include reviewing information that has been received since the last inspection visit. This included a SRN that was issued to the registered manager on 11 March 2009 in relation to peoples health and welfare and a compliance visit to check whether the SRN had been complied with that was carried out on 20 April 2009. A random inspection was also carried out by a CQC pharmacy inspector on 19 May 2009. Surveys were received from people living in the home, in some cases with the help of a relative. Health and social care professionals who visit the home also returned surveys to us. During the site visit time was spent talking to people who live in the home, members of the care team, the cook, a visiting health professional and the acting manager. The acting manager was available throughout the visit and the findings were discussed at the end of the inspection. At the time of the site visit on 4 August 2009 the weekly fees for the home were 396 pounds with additional costs for hairdressing and chiropody. 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. The previous key inspection visit took place on 16 February 2009. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Some improvements have been made to the care plans so they are now up to date and include more information about peoples individual needs and the actions staff need to take to meet these. A safe moving and handling system is in place so that people at the home are no longer at risk from unsafe working practices. Referrals are made to healthcare specialists when concerns about peoples health is identified. This has been helped by improvements in the information contained within risk assessment information that clearly details when concerns need to be passed on to others. This helps in making sure peoples health needs are properly met. Improvements to care practices have helped in making sure that people receive the care they need. This includes people having their fluid and nutritional needs met, being assisted to the toilet and having pressure care to minimise risk of sores developing. There have been improvements to the medication systems. This includes the introduction of a risk assessment that supports people who are safe to do so to selfadminister their own medication. Medication is more safely administered and recorded and this has helped in making sure that people receive their pain relief and medication as prescribed. Support is now provided in a discreet and sensitive manner. A health professional visiting the home said, staff are always helpful and try to maintain peoples dignity. One person living at the home said, when I receive support when bathing, staff take any necessary measures to save me from embarrassment. People at the home said that they are able to make their own choices about their daily lives and are involved in decision-making in such things as menu options and activities. This aspect of peoples care still needs developing further. Complaints are now taken seriously and properly acted on. This encourages people to voice any concerns and helps to protect people from possible harm. Staff have undertaken training on how to safeguard people from abuse and other measures have also been put in place so they understand about abuse and their responsibilities in reporting it in the event of it happening. The home is now cleaner and on the day of the site visit there were no odours. The Care Homes for Older People Page 8 of 35 garden has also been tidied up so that people can sit outside on benches. This makes the home a more pleasant and comfortable environment for people to live in. Staff have undertaken training in moving and handling, fire safety, safeguarding people from abuse and dementia. This helps in making sure people receive the care and support they need in a safe way. Staff say that the home is more relaxed and this has made the atmosphere in the home more pleasant. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 9 of 35 order line 0870 240 7535. Care Homes for Older People Page 10 of 35 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 11 of 35 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. No admissions have been made to the home since the previous inspection visit. However, from past information it is clearly evident that pre-admission procedures will need to be improved to make sure that peoples needs are fully known and the home through its assessment procedures can confirm they are able to meet the persons needs. Evidence: The home has not had any new admissions from the previous inspection visit. This is because local authorities made a decision to suspend placements at the home due to serious concerns about the service. At the previous inspection visit it was identified that the care records of some people who had been admitted to the home did not contain any pre-admission assessment information at all. Therefore the home was admitting people without as a result of assessment being able to confirm that they could meet peoples needs. The care Care Homes for Older People Page 12 of 35 Evidence: records looked at during this site visit did include pre-admission assessments that had been carried out by the home to assess the persons needs. The acting manager also said that in future no person would be admitted to the home before confirmation was given that following the assessment their needs could be met. Some care records contained information that had been obtained from placing authorities prior to the persons admission. This information included an assessment of the persons needs and a care plan identifying how these were to be met. However, other care records did not include this type of information and only had the homes assessment information. This meant information had not been obtained from other valuable sources such as placing authorities, GPs and relatives. This could lead to information about peoples needs not being considered including any possible risks to the person or to others. All the surveys returned by people living in the home said that they had been given enough information by the home prior to moving there. A person living at the home who was spoken to at the site visit said, my relative came and had a look around the home before I moved in. The home does not provide intermediate care. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the care practices and medication systems so that peoples needs are now met more safely. Further improvements are needed in the way that care is planned and to the medication practices to enhance this further. Evidence: Each person living in the home has a care plan detailing their needs and how these are to be met. The care plan information is based on various aspects of daily living. The care plans had improved from the previous inspection visit so that they are now more up to date and clearly detail the actions that staff are to take to meet peoples needs. There is also more person centred information within the care plans about such things as peoples preferred times for getting up in a morning and their likes and dislikes. One care plan specified how one person likes to be assisted with washing. Some care records contained information about peoples past history and their background. Peoples care needs are regularly reviewed by the home and the persons key worker carries out a monthly summary of any changes to the persons needs. Care plan review meetings are also held and involve the person where possible, their relatives and health and social care professionals. One person living at the home said, Care Homes for Older People Page 14 of 35 Evidence: staff are good and helpful and always have a smile for you. Other people said, staff are always well mannered and staff are very caring to me and my family. At the previous inspection visit a number of concerns had been raised about the homes moving and handling procedures. Since that time all staff have undertaken moving and handling training and the acting manager is planning further more indepth training with the local authority. As a result of this training staff now know how to use all the moving and handling equipment and so people are being helped with their mobility in a safe way as could be seen during the site visit. Staff are no longer wearing handling belts and said that they feel much more confident in supporting people with their mobility. A survey returned by a social care professional said that the service needed to make sure that staff do not manually lift people when their care plan states that a hoist is to be used. During the visit staff were observed to be using hoisting equipment to assist people with their mobility. Risk assessments are done in relation to falls, pressure sores, nutrition, moving and handling and the use of bedrails. Where necessary plans are put in place to show how these risks will be managed. These plans included information about the type of equipment that was to be used and the number of staff that were needed to support people in meeting their needs. One persons care records showed that the person is at risk from lack of nutrition and pressure sores. A nutritional assessment had been carried out and this included information about at which point referrals are to be made to specialist services where concerns exist and this had been done. The person had also developed an increasing risk of pressure sores. This issue had been referred to healthcare specialists and appropriate equipment had been put in place to minimise any risks. Peoples weights are monitored and recorded and the records of four people all showed that their weight has remained stable or increased. The care records for one person showed that bedrails were in use. The risk assessment did not explain why bedrails were being used and there was no evidence to show that the person, their relatives or others involved in their care had been involved in decision-making about their use. Daily records were up to date and reflected the care given. This included information about such things as a persons nutritional and fluid intake and output and pressure care. Records were maintained as to when people had been in the bath or had a shower. However, the record sheet did not include a section for when people had a bed bath or a strip wash so it appeared that the person had not been washed. The acting manager gave assurances that this was not the case and agreed to amend the recording sheets to include the additional information. The care plans contained a lot of information, especially about peoples physical needs and need to focus more on Care Homes for Older People Page 15 of 35 Evidence: peoples social, emotional and spiritual care needs to enable care to be planned in a person centred way. Information in the care plans was often duplicated. Reorganisation of the care records would help in avoiding this and in making information more easier to access. People living at the home have access to a GP and other healthcare services. Five out of six surveys returned by health and social care professionals said that peoples health and social needs were properly monitored and reviewed, one said this is sometimes the case. All said that advice is usually sought about any health and social care matters and that peoples privacy and dignity is always respected by the staff. One social care professional said, the home is good at managing complex needs and encouraging peoples independence and staff have empathy for the people they care for. A relative who had assisted a person living at the home to complete a survey commented the home keeps me continually informed about my relatives well-being and give me feedback about such things as GP visits. However, another relative did not feel this happened. Since the previous inspection visit there has been an improvement with medication management. A pharmacy inspector had visited the home in May 2009 and had found that some improvements had been made to the medication systems and procedures since the previous inspection visit in February 2009. Following the pharmacy inspectors visit the home has since introduced a risk assessment framework for people who wish to self-medicate and are able to do so safely. Some aspects of the medication practices could be improved further. Creams that have been administered are currently recorded on a separate sheet to the Medication Administration Record. This could lead to the creams not being applied and the acting manager said she would address this issue. There was also no record of staff specimen signatures for those staff who administer medications. This should be done so that it is clear which staff has administered medication and to provide an audit trail if discrepancies occur. One person takes a particular kind of medication that needs close monitoring. The dosage of the medication can vary dependending on results from blood tests. Currently this information is held separately to the persons medication records. This could potentially lead to medication errors. Discussion was held with the acting manager about one person who chose to lay in bed in a morning and have medication on getting up. This person is also on lunchtime medication and this issue needs addressing as the person is taking their morning and lunchtime medication within a relatively close space of time. The acting manager said she would speak with the persons GP to review this. People living at the home said that staff always treated them with respect. This could Care Homes for Older People Page 16 of 35 Evidence: be seen at the time of the visit. Support was provided in a discreet and sensitive manner. A health professional visiting the home said, staff are always helpful and try to maintain peoples dignity. One person living at the home said, when I receive support when bathing, staff take any necessary measures to save me from embarrassment. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some progress has been made in enabling people to have opportunities for activities. However, further improvements are needed to help people pursue their personal interests. Evidence: Although care plans did contain information about peoples likes and dislikes, this information is limited about peoples social and leisure interests. Surveys returned by people living at the home said that there needed to be more activities for people to take part in. One person said more activities are needed, especially external trips. Another person said, We dont have enough stimulation. More stimulation would help to keep our minds active. Recently the home has employed an activities co-ordinator who works four hours a day for five days a week. This person is developing an activities programme for individuals and people said he has made a positive impact since starting working at the home. At the time of the visit people were seen taking part in bingo sessions. The activities co-ordinator was also seen playing draughts with one person. An entertainer was due to visit the home on the evening of the site visit to sing old time songs. Planning was also being made for a trip to Hornsea, a summer fete has been planned Care Homes for Older People Page 18 of 35 Evidence: and one person had been out shopping with the activities person. The activity coordinator is developing a file detailing individual peoples interests. He is also planning to record all activity sessions so that he can see which activities people are enjoying or otherwise. This is especially important for people who are unable to communicate their needs. People living at the home sat mainly in lounge areas where they could watch television. There is also a conservatory where people can sit quietly. The recent progress in developing a programme of activities for people needs to be continued and developed. One person at the home said, it would be nice if we could get out more. Relatives and others could visit the home whenever they wanted as was seen during the site visit. A survey returned by a healthcare professional did say that staff could spend more individual time having conversation with people in the home. The home employs a cook throughout the week. At weekends agency staff are currently being used although another cook is about to be recruited pending satisfactory police checks. Overall people said that they enjoy the food. One person said, I especially like the puddings and cakes. Menus are rotated on a 4 weekly cycle although the cook is in the process of reviewing the present system. People said that they are asked what they would like for their meals before the shopping is done. The lunchtime meal consisted of a gammon dish with potatoes and vegetables. Egg, chips and beans were offered as an alternative meal. Specialist meals are catered for and pureed foods are prepared individually so that they are presented in an appetising way. One person said staff could give larger portions to people who want them. A mealtime was observed and whilst the portions of food offered were adequate people were not asked if they wanted any more food. People are offered snacks and drinks between meals. During the mid-morning break it was observed that only tea and dilute pop were being offered. Staff explained that people would ask if they wanted an alternative drink but some people with communication difficulties would be unable to do this. The acting manager said that she would be addressing this issue. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns are now being listened to and properly acted on. Staff now have a better understanding about safeguarding people from abuse and procedures about this are being followed to keep people safe. Evidence: The home has a complaints procedure that is on display in different parts of the home. People living in the home said they know who to speak to if they have any concerns and felt confident that any concerns would be properly dealt with. During the visit the complaints book was seen. The acting manager said that the home has not received any complaints but did mention that a relative had raised a concern about a bucket being used at the entrance of the home to dispose of cigarettes. The acting manager said this had been dealt with to the satisfaction of the person raising the issue. However, this had not been recorded and it was discussed with the acting manager that this needed to be done to show that the persons concern had been listened to and dealt with satisfactorily. All the surveys returned by professionals who visit the home said that any concerns that had been raised had been acted on appropriately. Since the previous inspection visit there has been an incident which resulted in the company and registered manager being served with a statutory requirement notice for breaching the care homes regulations for failing to keep people safe from abuse. Part Care Homes for Older People Page 20 of 35 Evidence: of this visit was to check compliance with the statutory requirement notice. The evidence showed that the statutory requirement notice has been complied with. One recent safeguarding incident is still under investigation and the staff member concerned was currently suspended from their duties. The home has updated their policies and procedures on how to safeguard people from abuse and this now reflects the policies and procedures used by the local authority. Staff are asked to read and sign the policy to confirm their understanding of it. All staff have now had training on how to safeguard people from abuse and staff spoken to at the time of the visit demonstrated a good understanding about safeguarding issues. The acting manager said that staff are regularly questioned about their understanding of the procedures. There has been an incident between two people living in the home and because these people were at potential risk the home had passed on information to the local authority safeguarding team so that proper measures could be taken to keep people safe. After the site visit a survey was received from a relative. They said that the home had not responded to their concerns properly in the past and this resulted in the relative passing the concerns on to the local authority. The local authority had investigated the issues and the relative said this has resulted in a marked improvement in standards of care. Care Homes for Older People Page 21 of 35 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. Whilst some improvements have been made to benefit the comfort and safety of people living at the home, further work is needed to further enhance this. Evidence: Accommodation is over two floors and can be accessed via stair lifts. There is also ramped access to the home so enabling people with mobility problems to have access to and from the home. On the day of the site visit one stair lift was being repaired because it was not working. This had been reported immediately to the appropriate people so that work could be undertaken quickly to rectify the problem. Some improvements have been made to the home since the previous inspection visit. Parts of the home have been re-decorated to make it brighter, cleaner and more pleasant for people although more work is needed to update other parts of the home and this has been planned for. The garden area has been tidied up and people can now sit outside on benches and there are plans for the garden to have more colour. During a tour of the environment all window restrictors looked to be working properly and none were broken. The doorbell to the entrance of the home was working as were the ventilation systems in the main lounge. Aids and equipment that were not previously being used are now in use to help people with bathing and their mobility. Whilst acknowledging the progress that has been made to some aspects of the Care Homes for Older People Page 22 of 35 Evidence: environment other areas need to be improved to maintain peoples comfort and safety. Since the previous inspection visit some work has been undertaken to fit guards to radiators but several radiators remain unguarded. This potentially puts people at risk from scalding especially when radiators are fully on. Some beds are also situated close to unguarded radiators and one bed had a fabric homemade cover on because of the heat. These issues need addressing as a matter of priority to minimise any fire safety risks. Whilst a risk assessment was in place to minimise risks from the unguarded radiators this was basic and did not properly address the risks to people. The hot water temperatures had been checked the previous week and some abnormalities had been found which needed the thermostatic valves to be adjusted. However, the staff member had been unable to do this and no further action had been taken. Whilst a risk assessment was in place to minimise risks from this, it did not detail what needed to happen if problems arose. These matters were discussed with the manager who said these issues would be addressed. Further reference to these aspects of health and safety can be found later on in the report under the heading of Management and administration. Staff said that to minimise risks to people from unsafe water temperatures when assisting them with bathing they test the water first with their hands. This form of testing could be unreliable and it is recommended that thermometers are acquired so that the testing is more accurate and can be recorded. Whilst looking around the home it was observed that there is little signage for people who have communication difficulties and may be confused. It is recommended that bedroom doors are personalised if people in these rooms agree to this and bathroom and toilets areas have pictorial signs to help people to maintain their individuality, independence and orientation. A survey returned by a person living at the home after the site visit said, the armchair I sit in is uncomfortable, I think the springs have gone. The home is now much cleaner and at the time of the visit there were no odours. Surveys returned by people living in the home said that the home is usually fresh and clean. One person commented staff could go into bedrooms on a daily basis with air freshener so there are no stale smells. When told about this the manager said that this routinely took place on a daily basis and at the time of the visit no stale smells were evident. Cleaners are employed at all times including weekends to help maintain standards of cleanliness and hygiene. Peoples clothing looked clean and tidy. The home has a separate laundry facility and laundry assistants help to make sure clothing is well maintained. All personal clothing is individually labelled to help prevent clothing going missing. Infection control procedures were seen to be followed. Care Homes for Older People Page 23 of 35 Evidence: Care Homes for Older People Page 24 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in staffing levels and training now mean that there are always sufficient numbers of staff who are better equipped to meet the needs of people living in the home. Evidence: Since the previous inspection visit there have been improvements in the staffing levels. There are currently 21 people living at the home. In a morning there are 4/5 staff on duty, on afternoon there are 4 staff and at night 2 staff with 1 staff member on call. Three members of staff are normally on duty through the night, however, two permanent night staff workers have recently left the home. Staff have been recruited to cover these vacancies but have not started working at the home until the acting manager has received confirmation of satisfactory CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) checks. In addition to care staff, cleaners, catering staff, and a housekeeper are employed. A handyman has also been working at the home but was not doing so at the time of the visit and the home was using a handyman from another service to complete maintenance tasks. Staff said that staffing levels are good and the manager commented that only 1 shift had to be covered by agency staff during the last month. One member of staff said, we are not overworked and all the people living in the home who were spoken to said that call bells are always responded to promptly as was seen at the time of the site visit. Care Homes for Older People Page 25 of 35 Evidence: The training records showed that over 50 of the care have obtained NVQ (National Vocational Qualification) to at least level 2 in care. The remaining staff are registered to do this. The staff file of the most recently recruited member of staff showed that all the necessary checks had been undertaken and that robust procedures had been followed. In the past the homes induction programme for new staff was basic and did not prepare them properly to start their new job. Since the last inspection visit the acting manager has introduced an induction programme that is based on the Skills for Care programme. This provides staff with more in-depth information about the aims and objectives of the service, policies and procedures, their responsibilities and knowledge and skills to meet peoples needs. The training records showed that all staff have now completed training on moving and handling and how to safeguard people from abuse. All but 4 staff have now completed fire safety training. The acting manager she talks through the training with staff who are awaiting full training. Further fire safety courses have been booked for those staff who have not yet received the training. Course have also been booked for those staff who have not received infection control training. The home accommodates people with dementia care needs and a number of staff have recently completed some dementia awareness training and training on how to meet peoples nutritional needs. Other staff also need to complete this. The acting manager now has a training matrix to keep records of training that has been completed and when updates are needed. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management difficulties mean that the home is not being run in a consistent way although some improvements have been made to the way the home is being managed. The home now has better systems in place to enable peoples views to be listened to and acted on in order to provide better outcomes for the people living there. Some aspects of health and safety need addressing in order to make sure people are kept safe. Evidence: The registered manager is currently suspended for not carrying out the required actions after the home were found to be in breach of some of the care homes regulations. The home is currently being managed by the deputy manager. She has no previous management experience but says she is feeling well supported by the management. Staff said they had noticed some positive changes since the deputy manager started managing the home. A person living at the home commented the home is pretty well Care Homes for Older People Page 27 of 35 Evidence: run. One staff member said, the home is much more relaxed and the atmosphere is more pleasant. Another staff member said, she is more accessible than the other manager and has a more hands-on approach. Some improvements have been made to the quality assurance system and these will help in making sure that the care and service on offer are properly monitored and improved on. A meeting has been planned with people living at the home and relatives to discuss the current situation with the home. This will be welcomed by one of the people living in the home who said, we are aware of changes but are not sure what is happening and it would be nice knowing. Staff meetings are now being held monthly and staff receive supervision every two months to support them in meeting peoples needs. Staff said they now feel their opinions are valued and listened to. The home have been working with the local authority to devise questionnaires that are to be sent out to relatives and professionals who visit the home. A member of the management team is visiting the home at least fortnightly and is making a report of their findings and any actions to be taken from their visits. Audits are carried out in relation to the medication systems however does not extend to other aspects of care practice and health and safety. This would be useful in monitoring standards and identifying any areas for improvement. Small amounts of money is kept in the homes safe for people wishing to have money held safely on their behalf. Two signatures are required for any transactions to reduce the risk from errors occurring and to help provide a clear audit trail if any discrepancies occur. There have been some improvements in the way that peoples health and safety is maintained although some issues need addressing to make sure people are kept safe and are not put at risk. Staff have undertaken a range of health and safety training and now know how to use equipment properly so that people are not put at risk from unsafe working practices. Measures have been put in place to make sure that proper procedures are followed in response to any abuse. There have also been improvements to the way that medication is managed. As previously mentioned earlier in this report under the heading of Environment some issues of concern remain with regard to minimising risks from hot water temperatures and unguarded radiators and these issues need addressing as a matter of priority. Written information was received from the administrators shortly after the inspection visit. This explained that a plumber had been contacted to correct the problems with the water temperatures and that this work was ongoing. Plans have also been made to have all the radiators covered. This work is underway and dates were provided as to Care Homes for Older People Page 28 of 35 Evidence: when the neccessary work would be completed by. The risk assessments that were in place to minimise and manage any risks from hot water temperatures and unguarded radiators were basic and are being updated so that necessary action can be taken to reduce any risk of harm to people in the interim period until the issues regarding the hot water temperatures and radiators have been resolved. A selection of health and safety certificates were looked at during the site visit. These mostly confirmed that the necessary checks had been satisfactorily completed and were up to date. However, a previous check of the homes fixed wiring certificate in July 2008 was found to be unsatisfactory with a number of urgent actions required. The findings from this report put people at risk from unsafe electrical wiring systems. Whilst the acting manager believed that the necessary action had been satisfactorily completed there was no updated certificate or any other information to confirm this. Written information was received shortly after the site visit from the electrical contractors who had carried out the work. This confirmed that the required work from the Period Inspection Report of the homes electrical systems had been satisfactorily completed and an updated certificate had been provided. During a look around the environment it was found that the date for the servicing of the fire extinguisers had elapsed. Written information was received on the day of the site visit from the fire company responsible for this to say that the checks would be undertaken within 10 days of the site visit. The heath and safety records also stated that the fire alarm system had last been tested on 7 July 2008. This check needs to be carried out weekly so any problems can be quickly acted on to reduce fire safety risks to people. Information received from the administrators soon after the visit confirmed that a fire alarm test had been carried out since the inspection visit and this would be done weekly thereafter. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 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 When people are admitted to the home information must be obtained from all available sources beforehand. This will help in making sure that staff are fully aware of the persons needs and any risks associated with them before the home confirms that they are able to meet the persons needs. This will help in making sure only suitable people are admitted to the home. 04/10/2009 2 7 15 Where bedrails are being 04/10/2009 used the risk assessment must be clear about the reasons for this and that the decision to use bedrails has been agreed with the person and/or their representative. This will help in making sure that bedrails are being used appropriately and as agreed Care Homes for Older People Page 31 of 35 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 with the person and/or their representative. 3 38 13 The fire alarm systems must 04/09/2009 be tested on a weekly basis to show that it is in full working order. This will help in making sure that systems in place to protect people in the event of a fire and will help in making sure any problems with the system can be detected at an early stage and acted on to keep people safe. 4 38 13 The risk assessment that is 04/09/2009 is place for the risk of scalding from hot water temperatures must be reviewed and updated. This must include the actions staff must take when hot water temperatures exceed the recommended temperatures. This will help ensure that the risk of scalding is minimised. The risk assessment that is in place for the risk of burns to people from unguarded radiators must be reviewed and updated. Particular attention must be given to those radiators in bedrooms where peoples beds are 04/10/2009 5 38 13 Care Homes for Older People Page 32 of 35 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 positioned against the radiator. This will minimise fire safety risks and potential risk to people from burns or scald injuries. 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 2 7 7 Care planning information should be better organised to avoid duplication and to make information easier to access. Care plan information needs to contain more information about peoples social needs and emotional needs. This will enable care to be planned in a more person centred way. Staff who administer medication should provide a specimen signature. This will mean that it is clearer as to who has administered medication and will help in providing an audit trail if any discrepancies occur. Information about one particular type of medication for one of the people living at the home should be held with the persons medication records. This will help in making sure the person receives their accurate dosage of medication and will reduce the risk of medication errors occurring. Any prescribed creams when administered should be recorded on the Medication Administration Record. The activities that are on offer to people should be further extended to suit individual needs and outcomes from activities should be recorded. This will help in monitoring what people enjoy doing and will enable activities to be planned in a person centred way. People should be offered a wider choice of drinks in between meal times and additional food at mealtimes. Any concerns should be logged so that it is clear what the 3 9 4 9 5 6 9 12 7 8 15 16 Care Homes for Older People Page 33 of 35 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 nature of the concern is and what actions have been taken in response to this. 9 19 Arrangements should be put in place to check the comfort and state of the armchairs and furniture and to take action where issues arise so that peoples comfort and safety is maintained. Further work should be carried out to update the decor in the parts of the home that have not already been redecorated. This will make the environment brighter and more pleasant for people living there. Picture signs could be used to identify toilet doors and bathroom areas to help people who have communication difficulties with their orientation and independence. Thermometers should be obtained for bathroom areas to assist staff in testing water temperatures before people have a bath. This will help in making sure water temperatures are safe when people are having a bath. Audit systems should be put in place to monitor care practices and health and safety matters so that any areas of concern can be identified and acted on. 10 19 11 19 12 19 13 33 Care Homes for Older People Page 34 of 35 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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