Inspection on 26/05/09 for Hawthorn Lodge Care Home

This inspection was carried out on 26th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hawthorn Lodge Care Home 02/10/08

Hawthorn Lodge Care Home 15/04/08

Hawthorn Lodge Care Home 13/11/07

Hawthorn Lodge Care Home 17/04/07

Hawthorn Lodge Care Home 27/04/06

Hawthorn Lodge Care Home 26/01/06

Hawthorn Lodge Care Home 24/06/05

Hawthorn Lodge Care Home 04/05/05

Hawthorn Lodge Care Home 09/12/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Hawthorn Lodge Care Home Beckhampton Road Bestwood Park Nottingham NG5 5LF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karmon Hawley     Date: 2 6 0 5 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 40 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 40 Information about the care home Name of care home: Address: Hawthorn Lodge Care Home Beckhampton Road Bestwood Park Nottingham NG5 5LF 01159676735 01159671815 managerhawthorn@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd care home 60 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Within the total number of beds, a maximum of 30 may be used for the category DE(E) Within the total number of beds, a maximum of 60 may be used for the category OP Date of last inspection Brief description of the care home A copy of the most up to date report is found in both the managers office or the senior carers office. Hawthorn Lodge is a large home registered to provide personal care for up to 60 older people. It has several lounges and one large dining room as well as eating areas in some of the lounges. Some of the bedrooms are ensuite. There is a passenger lift to the first floor, making it accessible to any wheelchair users. The home is set in its own grounds with a pleasant enclosed garden. It is in a residential area with easy access to shops and bus routes. Care Homes for Older People Page 4 of 40 Over 65 30 60 0 0 0 2 1 0 2 0 0 8 Brief description of the care home There are hoists available for people who require hoisting and there are suitable bath and shower facilities available for people accommodated who need assistance with bathing. The fees for the service are dependent upon peoples assessed needs and are discussed at the point of enquiry. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service delivery that needs further development. A review of all the information we have received about the home was considered in planning this visit and this helped decide what areas were looked at. Two regulatory inspectors conducted the unannounced visit over 1 day, including the lunchtime period. The main method of inspection we use is called case tracking which involves selecting the care plans of four people and looking at the quality of the care they receive by Care Homes for Older People Page 6 of 40 speaking to them, observation, reading their records and asking staff about their needs. As some people living in the care home have dementia care needs this has limited the number of their views and opinions that have been included in this report. We therefore used a specialist tool called Short observational framework for inspection (SOFI) this is a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. Two hours were spent observing the care given to a small group of people. All observations were followed up by discussions with staff and examination of records. The acting manager and three members of staff were spoken with during the visit. People using the service and one relative were also spoken with during the visit to gain their views and opinions of the service. We also undertook a full tour of the care home, which included looking at the bedrooms of those people who we case tracked and communal areas of the home. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: Improvements in regard to involving people in the care planning process and reviews is needed to ensure that people are enabled to have their say about their needs and preferences. Plans of care and risk assessments must be in place for specific needs and contain enough information to enable staff to support people in meeting their needs and keeping them safe. Staff practices need to improve so that people using the service are treated with respect at all times and their privacy, dignity and right to confidentiality is maintained. Staff practices and attitudes also need to improve so that staff support people using the service in an appropriate manner when they need assistance. Management must investigate and eradicate poor staff practices so that people using the service are protected. The complaints policy needs updating so people have the correct information should they need to make a complaint. Management need to reassure people using the service that they can make a complaint should they feel the need to without fear of reprisal. The concerns voiced during our inspection need to be investigated and resolved. Care Homes for Older People Page 8 of 40 The availability and deployment of staff needs to be assessed in regard to the dependencies of people using the service to ensure there are sufficient to meet their needs. Improvements in regard to the recruitment and selection practices needs to be improved to make sure that people using the service are protected from unsuitable people being employed. Staff training needs to be improved so that all staff have completed compulsory training and have the necessary knowledge and skills to support people using the service. The general management and communication within the care home needs to improve to ensure that peoples health, safety and well being are maintained. The general management of junior staff needs attention to ensure that they follow good practice when the management are not at the care home. Improvements in regard to record keeping and storage is needed to ensure that these are available for inspection and the service can be monitored. Staff supervisions need to improve so that staff are supported in their training and development so they are able to meet the needs of people using the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 40 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 40 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. People are generally assured that their needs will be assessed and that staff are able to meet these before they make a decision to move into the care home. The service does not offer intermediate care. Evidence: Before people make a decision to move into the care home, the acting manager visits people within the community to carry out an assessment to make sure that staff are able to meet their needs. There is evidence of these assessments taking place within case files examined, however there has been one case despite this taking place that a placement has broken down as staff have been unable to meet a persons need. People and their families may also visit the care home and spend time there to get a feel for what it would be like to live there before they make a decision to move in. People using the service offer the following comments about their experience when Care Homes for Older People Page 11 of 40 Evidence: they first moved into the care home; I have been in the home 4 years, I looked around the home before I moved in, the social worker brought me here, I cant remember if I was given a contract, I am happy here, I have been here 4 years. My son in law helped me choose, I was given a service user guide but I cant remember having a contract. One relative spoken with informs us that they visited the home before their relative moved into the care home. One member of staff spoken with said that they receive enough information about people when they move in so that they are aware of their needs and the support that they require. The service does not offer intermediate care. Care Homes for Older People Page 12 of 40 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. Some people using the service are not supported as needed nor are they fully protected due to the lack of plans of care and risk assessments in place. Peoples privacy and dignity is not always upheld. Evidence: The care planning format in place has been changed since the previous inspection and additional work has taken place in regard to working towards ensuring these are more person centred, however there are a number of plans of care that do remain task focussed and do not highlight peoples personal preferences to make sure that they receive support in their preferred way. On examining case files we can see that not all of these have support plans in place for peoples specific needs such as wandering and the use of a wander mats, swallowing problems, diabetes and behaviour that may be challenging, to ensure that staff are aware of the support that a person may require. In other instances, plans of care are in place in regard to the areas that people may need support however they do not go on to outline how staff are to support people to meet these. Care Homes for Older People Page 13 of 40 Evidence: Although some risk assessments are in place for peoples highlighted needs, such as behaviour that may be challenging, in other peoples files the necessary risk assessments such as the protection of a person should another person using the service enter their rooms, or the risk of falls are in place. As concerns have been raised in respect of one person entering other peoples bedrooms as night we set an immediate requirement so that the necessary risk assessments could be put into place to ensure that people are protected. Although plans of care and risk assessments are being reviewed and evaluated, injuries and episodes of behaviour that may be challenging are still occurring. Daily records show us that there is a lack of attention to peoples personal hygiene needs and there are instances where people have not received a bath or shower for several weeks. Within the daily records of one person using the service we could see that there had been an episode of behaviour that may be challenging, however from the records it portrays that this incident occurred as the member of staff did not listen to what the person was asking for and simply followed their own choice. Despite some people using the service having dementia care needs, there is no evidence that the mental capacity act or deprivation of liberty is being used within support plans to ensure that peoples rights are upheld. During our specialist observation we observed staff sitting with people and go through their case files with them, however whilst these files were out the staff member left them on two occasions, both times this happened two other people using the service picked up the files and started reading them. One person using the service tells us that staff have talked to them about their plan of care, however they have not included them in any reviews, whereas two others tell us that the staff have not discussed their needs or a plan of care at all. People spoken with express the following comments about their care; I get the help I need, I have no complaints, the staff are alright they care for me well, they get me up when I pull the cord and I can go to bed when I want to go, its been a long time since I have had a shower, and they help me with washing and dressing, the staff are kind but there are some I am not so keen on but it is generally alright. Care Homes for Older People Page 14 of 40 Evidence: Whilst we were sat in the lounge we overheard one person talking about the fact that they have not had a shower for a while as they do not feel that they can ask as staff are so busy, they also made a comment about when a staff member had made a comment about their hair being a (swear word) mess. On examining plans of care we can see that people using the service are supported in accessing specialist services such as the doctor, district nurse and optician as needed. During the tour of the building we can see that specialist equipment such as beds, mattresses and hoists are available for people that need them. One member of staff said that they feel that there are insufficient hoists for the people using the service as many people need to use them and due to the amount available people do sometimes have to wait. People using the service offer the following comments in regard to accessing specialist services; the staff always contact my GP promptly when I feel ill and they always phone my family, I see other health care professionals when I need to, and If I am poorly they get a doctor to me quickly and tell my relatives if I am ill. I see other health professionals opticians and chiropodists. There have been concerns about the monitoring of peoples weights and seeking further advice when needed, to address this the acting manager has implemented a new weight monitoring system. Staff who administer medication have been trained to do so and medication records examined show us that people receive their medication as prescribed. Hand written entries are not always signed by two members of staff to show that these have been checked as correct and we found one discrepancy within the prescription and the actual amount of medication a person should take. The deputy manager made the necessary changes as soon as this was discovered to ensure the correct information is available for staff. We can see that audits take place in regard to boxed medication to make sure that people receive their medication as prescribed. We saw a senior member of staff administer medication during the lunch time meal and that she followed good practice guidelines. There have been concerns expressed about the level of privacy and dignity that is Care Homes for Older People Page 15 of 40 Evidence: maintained within the care home, during our inspection we did see that staff shout across the room and do not respect peoples privacy nor the confidentiality of personal information. We heard staff shouting over to other carers and speaking loudly to one another referring to peoples needs, for example XXXX has a sore bum and needs turning. Another carer was heard to call after a carer as they left the dining room I will meet you in XXXX room I will bring the rotunda. We can also see that peoples dignity is not always respected as one person in a reclining chair was dragged backwards through dining room and then back again at end of meal. Staff spoken with state that they have not seen any bad practice and they feel that they maintain peoples privacy and dignity; I knock on peoples doors, cover them up when offering them personal care, ask them what they need and give them choices. I treat people like I would want to be treated myself, staff go to one side to discuss peoples needs, we respect residents privacy and dignity and knock on doors and wait for a response. If we are washing someone we keep the door closed and let carers know where we are so they dont barge in. People using the service have mixed opinions in regard to their privacy and dignity being maintained; my privacy and dignity is respected staff treat me well, they dont ask if I want a male or female carer, my privacy is respected they help me with my showers and close the doors but staff dont knock they just walk in. Staff spoken with feel that there is a policy on male and female carers and peoples preferences. Care Homes for Older People Page 16 of 40 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 people using the service are not supported to live a life that meets their expectations and satisfies their needs. People are not always supported in consuming an adequate diet as staff do not always help them when this is needed. Evidence: During our specialist observation we saw that people using the service spend a lot of time in a passive state, where there are no observable signs of well being but no signs of ill being either. People are awake and alert and may be watching what is happening around them or in their immediate vicinity but they are not contributing actively to this. Some other people spent some time in a positive state when they were interacting with others. We saw evidence of both good and poor staff practices during this time; good where staff supported people and guided them in their care in a kind and caring manner and poor when they treated people disrespectfully or in an infantile manner, portrayed a lack of confidentiality or ignored their requests for help. Staff are currently supporting people with activities such as dominoes, arts and crafts Care Homes for Older People Page 17 of 40 Evidence: and games at present when they have time to do this. Although staff did support some people to join in a game of skittles during the morning, people who attempt to stand up and go somewhere are constantly told to sit down, instead of staff finding out what they want or providing them with assistance to meet their need. Some people have been out for a pub lunch and there has been a karaoke evening held recently and an outside entertainer was visiting the home on the day of our visit. People using the service have various opinions in regard to the activities on offer and some say that there is not much for them to do; we dont have much in way of activities there is not much entertainment, they dont do enough for me, I go to the Redcross once a week and I fold the napkins for lunch, I dont watch TV or play dominoes, I like to knit but we no longer have the knitting club, no one sits with me to discuss my care needs. Others feel that there are some activities such as the karaoke evening, we had a Karaoke evening and I watched it, I didnt get involved in it but I did enjoyed it. Staff spoken with say we dont have time to do many activities with people, do nails or sit and talk, and we are lacking in activities, we are doing things between us but it is hard when only 6 members of staff are on duty. If there is time there is a bit of banter, we play cards or dominoes, we have more time in afternoons. So that people can maintain contacts with people that are important to them there are no restrictions on visiting and visitors may be received in private. We saw several people coming to visit throughout the inspection and they are made welcome by staff. One visitor spoken with confirms that they are made welcome when they visit. One person using the using the service says, I have friends who visit but they are away on holiday at the moment. Staff spoken with feel that the routine of the care home is flexible and people may spend their time as they like, they also feel that it is important to treat people as individuals; I treat people as individuals and as equals, we need to be aware of their likes and dislikes, I am still learning. I like to know about people and their family so I can relate to them. A wholesome and appealing menu is on offer to people using the service with special Care Homes for Older People Page 18 of 40 Evidence: diets catered for and choices available at each meal. The current weekly menu however is not on display for people using the service so they can see what is on offer as the cook is waiting for this typed and printed off, nevertheless the daily menu is written on a board near the dining room. Concerns are expressed by staff in regard to the budget for food supplies, however the cook states they spend what they feel is necessary to ensure that food is available for people using the service and when we visited there is plenty of food in stock and evidence of plenty of home made baking and fresh fruit and vegetables. A senior member of staff has now been delegated to supervise meals and sort out staff deployment during this time due to concerns about food delivery. One staff member spoken with states that they do support people who struggle to eat, however during our specialist observation we saw one person using their fingers to eat custard and one person who had barely eaten anything had their meal taken away and they were not asked if they wanted any more or supported to eat anymore. People using the service offer the following comments about the meals on offer; I think the food is ok, most of the time the food is good, the menu is pretty good, I get a choice, I am diabetic and they make sure the food is suitable for me, and the food is very good, there is plenty and I get a choice. One relative says that their relative does not always like the food and it is sometimes not always hot. Staff spoken with feel that the food on offer is at a good standard and is plentiful, however more variety could be made available. Care Homes for Older People Page 19 of 40 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 using the service are not always assured that their concerns will be listened to and acted upon nor are they fully protected from abuse. Evidence: So that people know how to make a complaint if they feel the need, information about complaints is given to them within the service users guide, however some of this information is out of date in regard to people to contact. They are also given the opportunity to express their views during residents meetings and via the questionnaires. On speaking with one person using the service, they do not feel comfortable to make a complaint, there is no one here to stick up for you if you complain staff take it out on you. The service has received one complaint since the previous inspection in regard to the supply of food and the cleanliness of the kitchen. There is evidence within the complaints file to show that the provider has investigated this complaint as required and at this time it was unfounded. Views from people using the service differ in regard to complaints; staff do shout and scream a lot, they put people to bed early they just do it they dont ask, I would speak to manager or senior and I think a complaint would be dealt with. I feel safe Care Homes for Older People Page 20 of 40 Evidence: with staff I am properly looked after, they come in at night to check on me. I have never heard staff be unpleasant or rude to anyone, if I needed to complain I would speak to a senior but they are always so busy, I feel safe with the staff but I have sometimes seen staff be unpleasant and shout at other residents and if I wasnt happy I would speak to the manager I feel confident she would deal with it. I have never needed to complain. One relative informs us that they have been told about the complaints procedure and they have made a complaint in the past, it was listened to at the time but it is slipping back again, there are always excuses. A member of staff spoken with said that if a resident complains that the lounge gets too noisy they are advised to go up stairs to the quiet lounge. (This lounge has been fitted out in 1940s furniture as a reminiscence room and is rarely used). Staff spoken with are able to discuss how they would deal with a complaint should one be received; If a resident complains I go to the manager, they follow it up. I feel confident that complaints are dealt with, I have never heard staff being disrespectful. Since the previous inspection there have been 12 safeguarding alerts, some of which were made by staff at the care home, the Local Authority and us. These allegations are in regard to numerous things such as a lack of services such as electrical sockets and wander mats to unexplained bruising and injuries. The service is currently working with the Local Authority who are investigating these allegations. Not all of the staff employed have received training in safeguarding vulnerable adults to ensure that they are aware of their roles and responsibilities in ensuring that people remain safe. One member of staff spoken with has a good understanding of their role and explained that they have reported incidents in the past, whereas another did not know what safeguarding is. Staff spoken with are able to discuss how they would deal with behaviour that may be challenging to make sure that people using the service are supported appropriately and they are safe. People using the service state that they feel safe with staff and one relative feels that their relative is also safe, however one person using the service says that they only feel safe when they lock themselves in their room. Care Homes for Older People Page 21 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a satisfactory maintained environment, however due to the current storage problems they are not fully protected from obstacles being left in communal areas. The poor impression gained on arrival at the care home and the offensive odours in several other areas offers a poor impression of a clean and comfortable environment being maintained for people using the service. Evidence: On our arrival at the care home we could see a spilled ashtray at the front door and numerous cigarette ends were on the floor. When this was discussed with the acting manager she stated that one person using the service smokes here. This was not cleaned up throughout our inspection and at the end of our visit this was in fact worse and someone had poured fluid into the now overflowing ashtray and the cigarette ends on the floor had not been cleaned up. When we first entered the care home there is a very strong unpleasant odour which was also present in other communal areas of the care home and peoples bedrooms. The communal toilets are poorly maintained and have been like they are since Regal Care took possession of the service 5 years ago. There are cracked tiles around the toilets and staff spoken with said they find them hard to clean. Care Homes for Older People Page 22 of 40 Evidence: The lids are also broken off the bins in the toilets and we could see soiled pads left in here. A number of carpets are dirty and stained with foot prints Towels and flannels are supplied by the service if required, however some of the ones that we saw are very threadbare and in need of replacement. During the tour of the care home we saw that information about people and the support they need, such as when to check them and the fluids that they require is displayed on their doors, this does not protect peoples confidentiality as anyone walking past can see this information. The upstairs lounge is decorated for reminiscence in a 1940s style, however staff said is never used. Although people may still use the specialist bath in the upstairs bath room, the far corner is used to store a hoist and the vacuum cleaner. The area where a shower has been taken out has not been not repaired and no floor covering has been laid to make this suitably maintained. The paint work in some parts of the care home is badly damaged and chipped, which detracts from a well maintained and comfortable environment. The wheel chairs and hoists are stored under the stairs, as there are limited storage areas. When we first arrived at the care home the large hoist had been left in the main sitting room despite concerns as someone has tripped over this previously resulting in a serious injury. Before we started the inspection we asked the deputy manager to make sure that this had been moved. People using the service offer the following comments; my room is kept tidy but I dont think it gets dusted very often, my room is kept clean and tidy it is done every day, I like my room, I think my room is clean and tidy they make my bed, I like my room it is very nice, and you get your washing done during day and get it back by end of day. One relative says that when they visit, although the room is clean, the bed is not always made. Care Homes for Older People Page 23 of 40 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 using the service are not supported by staff that are fully trained to carry out their job roles nor are they protected from unsuitable staff being employed. Evidence: When examining the duty rota we can see that some staff work in excess of the working time regulations, the acting manager stated that this is through choice and one member of staff spoken with confirms this. It is concerning however when staff work in excess of one hundred hours a week as to how high standards of care are to be maintained, this was discussed with the acting manager who stated that this would be further considered when planning the duty rota. The staff duty rota show that only 3 members of staff are on duty at night, on examining accident records, this is when most accidents have occurred and within plans of care when most people begin to wander. There is a lack of management cover during the weekend and after five at night, however the acting manager said that the management hours during the week are to be staggered to rectify this. People using the service feel that staff do not have a lot of time for them and that some can be unpleasant to them; all the staff say is they havent got time, there Care Homes for Older People Page 24 of 40 Evidence: are a lot of staff but I am not sure what they do. I pulled the cord the other day and it took 2 hours for someone to come, staff shout and scream at each other as well as residents. I feel it is going down hill, I cant understand the staff as their English isnt good and they cant always understand us. Some staff are nice but some are sharp and couldnt care less about you, and they are short of staff sometimes. Staff spoken with feel that there are not enough staff available to give people the quality of care that they deserve and staffing levels need to improve. One member of staff says, there is never any management cover over bank holidays or weekends, the manager never comes out of her office when she is here, when Friday at 5 comes and all the managers go home staff see it as party time. 12 members of staff have attained the National Vocational Qualification level 2 (a nationally recognised work and theory based qualification designed to enhance knowledge and skills in caring for people) and 11 members of staff are working towards this qualification. 3 members of staff have attained the level 3 award. Staff spoken with confirm that they have undertaken this training and that it assists them in caring for people using the service. There is evidence of staff undertaking an induction; working towards ensuring that they are aware of their roles and responsibilities when they first start working at the care home. However records tell us that these are taking several months to complete and there is no evidence of any other training taking place to show that staff being supported in their training and development during this time. The acting manager stated that the induction covers a lot of mandatory training as it is done via Skills Force and they are waiting for certificates to be sent. One member of staff confirms they had an induction which lasted for 3 days when they first started working at the care home. Staff files examined show us that the recruitment and selection procedure does not ensure that people using the service are protected from unsuitable people being employed. When we examined staff files it appears in two cases that staff have started work before their references were obtained, the acting manager assures us that this is not the case and that the storage of documentation has resulted in references being lost or misplaced and consequently meant that these references had to be sent for again. Care Homes for Older People Page 25 of 40 Evidence: We can also see that some staff are employed with only a POVA 1st (a check to see if an individual has been placed on a list of people known to have abused vulnerable people) in place and there is no evidence that these people are being supervised whilst waiting for the Criminal Record Bureau check (CRB - a police check to see if an individual has a criminal record or a caution) to be returned. Also when Criminal Record Bureau checks have been returned and there is a caution or criminal conviction noted there is no evidence to demonstrate that this has been discussed with the member of staff so that a risk assessment can be carried out to ensure that people are protected. Not all staff files contain the documentation required by law such as photographic identification and references from a previous employer where applicable. Both staff spoken with say; I completed an application and had an interview before I started work, I know my references were taken up prior to interview and I had a CRB check and POVA 1st check before taking up the post. There is currently no training programme in place to ensure that all staff have received training in all compulsory areas. On examining the training matrix there are deficits in 1st aid, fire, infection control, safeguarding adults, manual handling, health and safety and food hygiene. The acting manager states that this is due to the fact that she wants evidence to show that staff have completed their training that is why there is a deficit and she has asked staff if they have any copies of certificates so they may bring these in and they can be added to the matrix. The outreach team have done 2 sessions with staff in regard to challenging behaviour and they have picked up on what staff need to know. They are going to set guidance and policy so that can staff adapt plans of care. One member of staff says, there is not enough training given and it is needed here, I had some training but if I had not done the job previously I would not be aware of what to do, it is dangerous and unsafe. People need to do more courses in regard to dementia care, I did one it was fantastic and opened my eyes. A two hour course is not enough, there is too much to take in, you need more time. Care Homes for Older People Page 26 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general management of the care home is poor and the service is not run in the best interests of people living there. Evidence: The acting manager has been in post since November 2008 and she is still in the process of applying to become the registered manager for the service. She has previous experience in regard to care home management and has completed the Registered Managers Award (a nationally recognised work and theory based qualification designed to enhance management knowledge and skills.) She states that she feels supported in her job role by senior management. Since the previous inspection there are concerns in regard to the general management of the service as discussed in the relevant sections of this report and in brief as follows; the lack of care planning and risk assessments to ensure that peoples needs are fully met and they remain safe, poor staff practices in general and in regard to maintaining peoples privacy and dignity, the activities and stimulation on offer, Care Homes for Older People Page 27 of 40 Evidence: concerns about the number of safeguarding allegations that have arisen, missing records and documentation and staff recruitment and training practices. There is also a concern in regard to staff communication within the service, on arrival at the care home we were left standing in the main entrance for 15 minutes as the senior carer had simply let us in and left us to carry on with their task in hand. It was not until the administrator asked if we needed assistance that we were able to inform them why we were at the service. We were then told by the administrator that the acting manager was on holiday, however the deputy manager in charge stated they did not know about this and the acting managers name was still on the of duty rota. The acting manager did however come into the care home and assist us on our inspection once she was informed of our arrival. The acting manager states that she is aware of the improvements that are needed and that she has completed an action plan to address these issues, a copy of which she supplied to us. One person using the service tells us that they do not think that the manager has control over the staff and they just do what they want. Staff spoken with feel that the acting manager is supportive and deals with issues as they arise, however it is felt that she needs to spend more time out on the floor. On looking at staff supervision records supplied, these show us that these have not taken place for sometime. The acting manager however stated that supervisions have taken place and that there are additional records; these were not supplied to us at the time of the inspection to confirm this. The staff supervision records that we did see are brief and in some cases the same within each file, these do not offer evidence as to how staff are supported in maintaining their development and good practice recommendations. One member of staff spoken with confirms that they have had a supervision and that they found it helpful as they could say things in confidence. The area manager visits the service on a monthly basis to carry out a monitoring and auditing visit. We can see from these records that some areas for improvement such as the completion of staff inductions and chasing up peoples references have been highlighted to make sure that the acting manager acts upon these. People using the service and relevant others have the opportunity to express their Care Homes for Older People Page 28 of 40 Evidence: views and opinions about the service by way of questionnaires and a residents meeting should they wish to attend. The previous residents meeting however was not successful as no one attended this, nevertheless several questionnaires that have been returned from people using the service show positive responses about the life at the care home and the care received. The area for improvement is stated to be that of the activities on offer as it is felt that these are poor. Questionnaires completed by relatives also offer favourable comments with the exception of the activities on offer and the staffing levels; we are very happy about the care of my relative. The home is clean and staff are friendly and caring. My only concerns is the lack of activities and outings which I feel would help in preventing boredom and improve mental health, I think care is very good but does lapse from time to time but not in a bad way, the activities are poor, clothes go missing and they could do with more staff on duty. Three completed questionnaire from health care professional also state that staff make them feel welcome and the calls are justified, however is felt that staff sometime do not have all the information needed for instance when the doctor calls. The acting manager is unsure whether these results inform the annual business planning for the service. The acting manager stated that a staff meeting had taken place recently; however the minutes to confirm this could not be located. One member of staff spoken with confirms that staff meeting used to be held on a monthly basis, however there has only been one recently; staff meetings used to be monthly but there has only been one since I started here. Staff are not paid for coming in, therefore some do not attend, I think it was useful but not a lot of people take notice. There is a facility to keep money in the care homes safe should people wish to do so. There are procedures in place to make sure that these remain safe, however one of the four accounts that we checked was incorrect. The administrator says that this inconsistency is unusual and that they will look into this. No one at the care home is responsible for peoples money and people using the service may access this at any time. There has been a concern in the past in regard to someone locking themselves in their Care Homes for Older People Page 29 of 40 Evidence: bedroom and that staff could not find the master key to let them out. To prevent this happening again the master key has been stored in a locked box on the office wall. The deputy manager did not know how many people have keys for their room and there are no formal risk assessments in place to assess if there are any risks about people having their own keys. On examining the accident records, these mainly take place in the evening or during the night when there are less staff working. Some of the accidents that have occurred during the night have not been documented according to the services policy which could result in these not being monitored as required. We examined the certificates for servicing of equipment to make sure that these are taking place as required and people using the service are protected. We can see that this is happening and the gas, hoist and lift have all been serviced as required. Care Homes for Older People Page 30 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 40 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 1 7 13 You must ensure that risk assessments are in place for all highlighted risks. This will ensure that people using the service are protected and risks are managed. 26/04/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 You must ensure that plans of care contain sufficent information for staff to be able to support people using the service effectively. 24/07/2009 This will ensure that peoples needs are fully met. 2 7 12 You must ensure that people 24/07/2009 are supported in maintaining their personal care needs. This will ensure that people remain comfortable and their rights are maintianed. Care Homes for Older People Page 32 of 40 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 3 7 15 People using the service or 24/07/2009 relevant others must be involved in the care planning process. This will ensure that people are given the opportunity to disucss and negotiate their needs and preferences. 4 7 15 Plans of care must be in place for peoples specific needs and these must be reviewed when changes occur. 24/07/2009 This will ensure that people are supported as required and their needs are met. 5 10 12 You must investigate and eradicate the poor staff practices that undermine peoples confidentiality, privacy and dignity. This will ensure that peoples rights are maintained and they are treated with respect. 6 12 16 You must consult with people using the service in regard to activites and stimulation that they would like to be on offer and provide resources for these. 31/07/2009 24/07/2009 Care Homes for Older People Page 33 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that people using the service experience a lifestyle of their choosing which satisfies their needs. 7 16 22 You must investigate and 24/07/2009 resolve the issues of concern raised by peeople using the service. This will ensure that people using the service are assured that their care needs are met and any concerns they have are addressed. 8 16 12 You must ensure that people 24/07/2009 using the service feel that they can approach staff with any concerns they may have and they will not be treated any differently for doing so. This will ensure that people feel that they can approach staff with their concerns without fear of reprisal. 9 16 22 You must update the complaints procedure. This will ensure that people have the necessary information they need should they feel the need to make a complaint. 10 18 13 You must ensure that all staff have received training 24/07/2009 24/07/2009 Care Homes for Older People Page 34 of 40 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 and are aware of their roles and responsibilties in regard to safeguarding vulnerable adults. This will ensure that people using the service are protected from abuse. 11 19 13 You must address the storage concern for equipment. This will ensure that people using the service live in a safe environment. 12 19 23 You must ensure that all parts of the care home are kept clean and reasonably decorated and in a good state of repair. This will ensure that people using the service live in a comfortable and well maintained environment. 13 27 12 You must ensure that people 30/06/2009 using the service receive support and assistance as needed in a timely manner and requests for help are not ignored. This will ensure that peoples needs are met and they are treated with respect. 31/07/2009 31/07/2009 Care Homes for Older People Page 35 of 40 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 14 27 18 You must assess the staffing 31/07/2009 levels and deployment of staff in regard to the dependencies of people using the service. This will ensure that sufficient staff are a available to meet peoples needs. 15 29 19 You must not employ anyone without first obtaining all the required documentary evidence as listed in schedule 2. This will ensure that people using the service are protected from unsuitable people being employed. 30/06/2009 16 29 19 You must ensure that people 30/06/2009 who are employed with only a POVA 1st in place are supervised until a satisfactory Criminal Record Bureau check is received. This will ensure that people using the service are protected from unsuitable people supporting them. 17 30 18 You must ensure that all staff have completed compulsory training. 14/08/2009 Care Homes for Older People Page 36 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that staff have the necessary knowledge and skills to care for people using the service. 18 31 12 You must ensure that management have control over junior staffs actions so that they maintain professional relationships with people using the service and work in their best interest. This will ensure that good practice is maintained at all times and people are treated with respect. 19 31 12 You must ensure 30/06/2009 communication systems improve and that the service is run and managed in the best interests of people using the service. This will ensure that peoples health, safety and wellbeing is maintained and they receive consistency of care. 20 36 18 You must ensure that staff undertake regular supervisions. This will ensure that staff receive support in their development and their work practices are monitored. 24/07/2009 30/06/2009 Care Homes for Older People Page 37 of 40 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 21 37 12 You must ensure that staff do not display personal and confidential information about people using the service in areas where others have access. This will ensure that peoples privacy and rights to confidentiality are maintained. 30/06/2009 22 37 17 You must ensure records are 30/06/2009 completed and stored as required and these are available for inspection. This will ensure that people using the service are protected by systems in place and we are able to monitor the service. 23 38 13 You must ensure that appropriate risk assessment and management plans are in place for those people who have their own key. This will ensure that any associated risks are highlighted and managed. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Re-evaluate the preadmission assessment to ensure that Page 38 of 40 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations this ensures staff are fully able to meet peoples needs before they make a decision to move into the care home. 2 7 Continue to develop plans of care so that these are all person centred to make sure that peoples personal preferences are met. Handwritten entries on medication charts are signed by two members of staff to show that these have been checked as correct. Assess the amount of manual handling equipment available within the care home and the number of people that need to use these to ensure that sufficient is available. Replace the worn towels so that people using the service have access to quality materials. Eradicate the offensive odour so that people using the service live in a comfortable environment. Ensure that staff complete their induction in a timely manner, so that they have the necessary knowledge and skills to care for people using the service. Consult with people using the service in regard to them being unable to understand some members of staff due to their grasp of the English language. You ensure that there is a managerial presence at all times until staff adhere to good practices. Re-assess the auditing procedure in regard to the safe storage of peoples personal finances to make sure these are fully protected. Staff undertake at least 6 supervision sessions a year. 3 7 4 8 5 6 7 26 26 28 8 30 9 10 31 35 11 36 Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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