Key inspection report
Care homes for older people
Name: Address: Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR 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: Claire Lee
Date: 1 7 0 2 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR 01519333323 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lea@hawthornelodge.co.uk Stirrupview Limited Property & Estates Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Hawthorne Lodge is registered to provide personal care for twenty five older people. The home is owned by Mr Hornby. The manager is Ms Pauline Lynes. The accommodation is a mock Tudor style building located on the corner of two busy streets in Bootle. Due to its location there is good access to public transport and many local facilities are a short journey away. The shared areas include two lounges, a dining Care Homes for Older People
Page 4 of 35 Over 65 25 0 1 9 0 8 2 0 0 9 Brief description of the care home room and small back garden. Bedrooms are either single or double rooms. The home has a passenger lift and there are chair lifts to access rooms that have a number of stairs to them. A keypad fitted to the front door and other doors are alarmed so that staff are aware of and can offer assistance to any resident who wishes to go out. Bathrooms have equipment to help residents with bathing arrangements. Residents have the use of a call bell with an alarm facility. CCTV cameras view certain areas in the home. There is car parking space to the side of the premises. The weekly fee rate is three hundred and eighty three pounds a week. 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: Unannounced site visits took place as part of the inspection process. The site visits were conducted over three days for a duration of approximately sixteen hours. The visits were conducted by two inspectors and a pharmacy inspector. A separate site visit took place on 22nd February 2010 to check how medicines were being handled because we found serious shortfalls on two previous pharmacist visits. Information for the key inspection was gathered in a number of different ways and at the site visits we spent time reading service records and looking at different areas of the building. All of the key standards were inspected and also previous requirements and recommendations from the last key inspection in August 2009 and the more recent random inspection carried out in January 2010. There was a change of manager during the site visits and the owner has appointed Pauline Lynes as the proposed registered manager for the service. Care Homes for Older People Page 6 of 35 Case tracking was used as part of the site visit. This involves looking at the support a resident gets from the manager and staff including their care plans, medication, money and accommodation. Two residents were case tracked, however this was not carried out to the detriment of other residents who also took part in the inspection process. Time was spent meeting with residents, visitors and staff to gain their opinions of the overall service. We sent out satisfaction surveys prior to the inspection, so that residents and staff could share their views of the service. A number of comments from interviews at the time of the site visits and surveys received have been included in the report. The term residents is used in this report as this is what people who live at the care home like to be called. The last key inspection was conducted in 19th August 2009 and there have been a number of random inspection following this. These inspections have focused on our concerns as to how the service is managed and how it is operating. They also enable us to follow up on the requirements and recommendations made at the key inspection. They enable us to monitor the service and provide support to the provider (owner) and manager. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? No new staff were handling medicines since our last visit when we found all relevant staff had received formal training and had been assessed as competent to give and record medicines. We checked how controlled drugs (medicines that can be misused) were handled. The controlled drug cupboard had now been properly attached to the wall so it now met the requirements of the law. No controlled drugs were currently prescribed, so it was not possible to assess if they were being handled safely at this site visit. Following the key inspection in August 2009 a number of improvements have been made to ensure the residents health and social care needs are being met. The residents care records had good information as to the level of care and support needed by the staff to keep them well and safe. Care documents included care plans, risk assessments and daily records. These were found to be up to date and the details reflected the care given by the staff. The district nurse service has been coming in to the home to offer clinical support to the staff. This has assisted staff with their learning, skills and knowledge to provide care for the residents according to need. Care files showed evidence of appointments with external health care professionals either at the home or within the community. These had been arranged to help monitor the residents health and general well being. The owner has purchased furniture for the lounge, dining room and a number of bedrooms to help improve the standard of accommodation for the residents. This is however, discussed further under, What the Service Could Do Better, as improvements to the environment are still required. The standard of cleanliness in the home has improved. Following environmental health inspections, infection control procedures have been reviewed, new policies introduced and staff have received training in infection control. This helps to ensure good standards of hygiene are maintained. Standards of hygiene have been improved in the laundry and equipment seen, such as wheelchairs, were clean. The staff have also received health and safety training, to help them care for residents safely and in accordance with current legislation. An ongoing programme of training has commenced for the staff and this includes courses in safe working, such as moving and handling and infection control. This helps Care Homes for Older People
Page 8 of 35 to ensure staff have the skills and knowledge to carry out their work safely. This is discussed further under What The Home Could Do Better as training needs to be provided in other areas relevant to the work place. A number of residents have been assessed as needing a wheelchair to help maintain their independence. Previously wheelchairs were seen without foot rests and therefore there is a greater risk of injury for the residents. At the site visits the foot rests were in place to ensure the comfort and safety of the resident. The fire service have visited the home since the key inspection in August 2009. They looked at fire prevention records and gave advice on how to improve fire safety within the home. Fire prevention records which were looked at were in good order and evidenced that fire prevention equipment is being tested regularly and that staff are receiving fire prevention training. This helps to ensure the ongoing protection of people in the building What they could do better: Overall we found some improvements in the handling of medicines but found some medicines were not given to people because new stock had not been obtained in time. Going without medicines can seriously affect a persons health and wellbeing. CCTV cameras are installed in the home and the use of these cameras must be recorded in the Service User Guide and Statement of Purpose (these documents provided information about the service provision). This ensures that people are aware that their movements, as they go about their daily activities, are being recorded in certain areas of the home. The owner must also complete an assessment, which looks at the impact this has on peoples privacy within the care setting. The placement of one of the CCTV camera is concerning. It is positioned in the lounge and therefore records all movements in this room. The use of a CCTV camera in this room is intrusive, excessive and impinges on a persons right to privacy and dignity. The camera must be removed. The care files looked at showed that as part of planning the residents care, they had assessed risks that might affect their welfare. The risk assessments should record more detail, so that staff have sufficient information as to the level of support a resident needs to help keep them safe. At present social activities are arranged in an informal way. A dedicated budget for the provision of entertainment, such as bringing in singers or musicians should be provided. It is important that people are provided with activities that suit their lifestyle and maintain their interests. Staff surveys make reference to the need for this and a resident said she would like more singing. Staff are now receiving training in how to identify abuse and how to safeguard people. Staff were not really aware of the wider picture in terms of understanding how investigations are conducted and the role of statutory agencies such as social services. It is recommended that future training includes these elements, so that staff are more aware of the broader picture in terms of safeguarding of vulnerable adults. This is particularly important for senior staff who may be left in charge of the home. Any in house training for safeguarding, needs to reference the local policies and the wider picture in terms of how abuse is reported and investigations are carried out. Care Homes for Older People Page 9 of 35 Staff should be aware of the Deprivation of Liberty Safeguards that have been introduced under the Mental Capacity Act 2005. Guidance from the Department of Health can be obtained for the staff and a policy should be drawn up, so that the staff are aware of their roles and responsibilities for these safeguards. Although the provider (owner) has responded to our direct requirements to improve certain areas of the home, we remain concerned that there remains a lack of overall planning by the provider with regard to continued maintenance and planned upgrading of the home. This is evidenced by a lack of any proactive planning or evidence of an ongoing maintenance programme. This should be drawn up. Residents must live in safe, comfortable accommodation. During the visit we observed many snagging jobs that needed to be attended to. For example, broken secondary glazing in some bedrooms, windows in poor condition and either not able to be opened or failing to close properly due to ill fitting frames or obstructing safety chains (mentioned last inspection). We also observed makeshift heaters in some bedrooms with trailing wires, which may be a health and safety hazard. The homes risk assessments must include attention to any trailing electrical wires and effective measures must be put in place to negate any risk to people living in the home. Although the previous manager, Joanne Gledhill, had started to carry out risk assessments and checks of environmental standards in the home the observations we made (on a brief tour of the home) have not been particularly noted. Again, these need to be actioned so that residents are assured they live in safe surroundings. We asked the owner about any plans to maintain the external windows, as some are in particularly poor condition and may be at risk of letting the weather in. We could not get any confirmation for this. External windows must be kept in a good state of repair. This ensures the home is maintained appropriately and fit for people to live in. Currently the environment is adequate and there are no systems in place to ensure ongoing monitoring. Also without any projected budgetary plan to ensure the home is maintained the risk remains that without constant regulatory input the home will fail to meet standards and inconsistency will continue. When the pharmacy inspector carried out a visit on 22nd February 2010, we found Joanne Gledhill had left and a new manager was in post. We again visited on 26th February 2010 to meet with the new manager and to check whether proper recruitment checks had been made. We, as the regulatory body, had at that time no written notification of the new manager and, up to the point of the manager arriving, had also had no verbal notification. We are concerned about the lack of communication with us regarding such a key change to the management of the home. We asked that the owner formally notify us of the appointment of the new manager. Mr Hornby, the owner, did so following our site visit. We spoke with the new manager, Pauline Lynes. She confirmed she had commenced duty on 22nd February 2010. We asked for her staff file to evidence necessary recruitment checks had been made, as these had not been in place for the previous Care Homes for Older People
Page 10 of 35 manager. There was no documents present on site. We left an immediate requirement notice for these to be produced (these documents have now been sent to us). We have made a further requirement that all staff records must be kept on site for inspection purposes. Overall we remain concerned regarding the lack of continuity of management for the home. There has been a recent change of manager for the home. There has been no registered manager (registered with the Care Quality Commission (CQC)) for some time and this must be addressed with urgency. Since our visits, the owner has submitted an application for the proposed registered manager, Pauline Lynes. This application is, however, incomplete and is being returned. This must be resubmitted so that her application can be processed. The concept of self management and quality assurance must be taken on board by the owner so that the home continues to make progress, to plan and improve care standards on an ongoing basis. This would involve close working with the manager of the home. We asked for evidence of an annual development plan for the home but this is not available. This is a concern with respect to ongoing management as it means that the home are reactive (only responding to regulatory action) rather than being more proactive. An annual development plan is required to evidence good management principals and ongoing / proactive management of the home. 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 11 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 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The use of CCTV cameras must be recorded in the Service User Guide. This is required so that people who use the service are aware that their movements, as they go about their daily activities, are being recorded in certain areas of the home. Evidence: Information regarding the home was recorded in a Service User Guide and Statement of Purpose. There have been no new admissions to the home since the last key inspection in August 2009, however these documents have been reviewed to ensure the information accurately reflects the service provision. The manager is aware that the Service User Guide and Statement of Purpose need to be given to prospective residents and their families to help them to decide whether the home can provide the care and support they need. Both documents were available in the main hall way for people to look at. With regards to the content of the Service User Guide and Statement of Purpose, information about the use of CCTV cameras in the home must be documented. This ensures that people are aware that their movements, as they go
Care Homes for Older People Page 13 of 35 Evidence: about their daily activities, are being recorded in certain areas of the home. The provider (owner) agreed to include this information in these documents. The use of CCTV cameras is discussed in more detail under Standard 10 (see health and personal care) of this report. As there have been no new admission to the home, the assessment process could not be fully explored. Following the last key inspection in August 2009, the previous manager, Joanne Gledhill, had reviewed how the initial assessments are conducted. A new assessment document has been introduced and this covers different areas of daily activities. For example, a residents previous medical history, their medication and the level of support they may need with washing, dressing, meals and communication. The residents care files seen evidenced ongoing assessments in respect of looking at their dependency levels to help ensure the staff continued to provide the right level of care and support. We discussed the need to assess peoples mental capacity at the point of admission to the home following the advent of the Mental Capacity Act. This helps to ensure that peoples ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted to the home. We would recommend that the manager and staff review this and ensure that such assessments are built into the admission and ongoing assessments. The home does not provide intermediate care and therefore this standard was not assessed. Care Homes for Older People Page 14 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. Peoples rights to ensuring their privacy and dignity are compromised by the use of CCTV cameras in the lounge. Although improvements have been made in medicine administration concerns still remain regarding the handling of medicines and supporting people who are administering their own medicines. This may place them at risk. Evidence: Residents had an individual care file with details of the support and care they needed. Case tracking took place for two new residents to review their care documents. The residents had a plan of care and this recorded their care needs and how staff would provide the necessary support. This was seen for daily activities such as, personal hygiene, mobility, sleeping, and toileting. Care plans were also see for conditions where by staff needed to provide extra support with the help of external professionals to keep them well. Care staff had also completed a number of care records to support the resident. This included family information, daily written reports by the staff and risks to the residents. For example, risk assessments were seen for mobility and risk of falling. Risk assessments should record more detail, so that staff have sufficient
Care Homes for Older People Page 15 of 35 Evidence: information as to the level of support a resident needs to help keep them safe. Residents were being weighed to ensure they were receiving a good nutritional intake and also staff had completed a basic nutritional assessment assessment. This helps to identify any concerns about weight loss. The district nurse service provides clinical advice and treatment to residents, as the staff are not qualified nurses. None of the residents were receiving treatment at the time of the site visit, The previous manager said that the staff were benefiting from a weekly drop in visit by district nurse to provide support and advice to the staff to help meet the needs of the residents. The care files also showed regular medical appointments made on behalf of the residents by the staff and this included hospital appointments, referrals to the falls clinic and physiotherapist. It was evident that the staff are now prompt in making the necessary referrals, as part of monitoring the residents general health and well being. Care documents had been reviewed regularly, so the information was up to date and there was written confirmation the the residents agreed to their plan of care. Residents interviewed said they received help and support when they asked for it. They said the carers came when they rang their call bell for assistance. As part of the inspection a pharmacist inspector visited on 22 February 2010 to check how medicines were being handled because we found serious shortfalls on two previous pharmacist visits. Overall we found some improvements in the handling of medicines but found some medicines were not given to people because new stock had not been obtained in time. Going without medicines can seriously affect a persons health and wellbeing. We found the records of medicines received into the home, given to people and disposed of were usually signed and up to date. Clear systems of record keeping were in place that made accounting for medicines simple and easy to do. We checked current stock against the medicines records and found medicines were now being given and signed for correctly. When medicines were not given a clear reason was recorded and records of refused medicines were now clear and accurate. However, we found some medicines were not in stock on the first day of the new medicines cycle and so some people went without important doses of their medicines. One person that was taking a food supplement missed eight doses because it had not been reordered and obtained in time, this was a repeated concern because on our last visit we found this person was not being given it correctly and as a result was losing weight. Going without prescribed medicines can seriously affect a persons health and wellbeing. Care Homes for Older People Page 16 of 35 Evidence: We looked at a sample of care plans for medicines handling and related health issues. We found some improvements in one persons short term care planning because a detailed plan had been written about how to support them while they were taking medicines for swollen ankles and a skin infection. We checked how people were supported to look after their own medicines and found two people had up to date risk assessments and care plans about the support they needed. However, one person that we spoke with was looking after an inhaler for breathing problems but had no risk assessment or care plan about how they were to be supported even though we had highlighted this type of issue on a previous visit. Having up to date information about peoples health needs is important to help make sure they are supported properly. We checked how controlled drugs (medicines that can be misused) were handled. The controlled drug cupboard had now been properly attached to the wall so it now met the requirements of the law. No controlled drugs were currently prescribed so it was not possible to assess if they were being handled safely. No new staff were handling medicines since our last visit when we found all relevant staff had received formal training and had been assessed as competent to give and record medicines. We looked at how homely remedies (medicines that can be bought from the pharmacy) were used. Since our last visit all homely remedies had been disposed of by returning them to the community pharmacy and we saw some records about this. However, pages from the homely remedy recording book that we had seen on our previous visit had been removed meaning records of these medicines had not be properly kept. Managers and staff could offer no reason why these pages had been ripped out. Records of medicines kept in the home must be kept for at least three years so that all medicines can be fully accounted for. Staff were observed helping residents with different activities. For example, walking to the dining room for lunch and helping with the lunch time meal. The support was given in a friendly and polite manner. Attention was paid to ensuring clothing was appropriate and ladies were wearing make up and jewelery. Residents spoken with said the staff were polite and caring in their manner and approach. At this inspection privacy and dignity were assessed in respect of the CCTV cameras, which are position in different areas of the home - the corridors, lounge, office and medicine room. The provider (owner) stated that these were installed for security purposes. There was no documentation available to evidence that residents Care Homes for Older People Page 17 of 35 Evidence: and staff had been consulted with regard to their use. As previously stated under Standard 1 (see choice of home) of this report, this is required to ensure people are aware that their movements are being recorded in certain areas of the home, as they go about their daily activities. Under the Data Protection Act 1988 the owner must ensure their use is effectively managed. An assessment is required to asses the impact this has on the residents rights to privacy and dignity in the care home and to ensure standards are met under the CCTV Code of Practice 2008 for their use. This Code covers areas such as, siting the cameras, using the equipment, looking after the recorded material, using the images recorded and their deletion. The owner forwarded a letter to the Commission stating that the cameras had been installed by a registered company, There was no evidence of the completion of any form of assessment and how the cameras impact on the lives of people accommodated. The camera sited to record movements in the lounge must be removed. This is an invasion of the residents rights to privacy, as they go about their daily tasks. Use of the camera in this room is excessive and intrusive. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities in the home need to be expanded. This will help to ensure residents are given opportunities to participate in stimulating and meaningful activities of their choice. Evidence: The routine in the home appeared relaxed and residents were comfortable with the staff. Visitors were seen at different times of the day and were able to meet their family member in the lounges or in their private room. Holy Communion is offered to residents, so that they can continue with their chosen faith. The previous manager, Joanne Gledhill, had introduced a general programme of activities in the home for the residents to take part. This includes bingo, films, manicures and cards. A poster was displayed in the main hall in picture format and words to let the residents know what was going on. There was no dedicated budget for the provision of entertainment, such as bringing in singers, musicians or for forthcoming trips out from the home. This should be looked into, as this would provide more stimulation and enjoyment for the residents. It is important that people are provided with activities that suit their lifestyle and maintain their interests. Staff surveys made reference to providing more choice and a resident said, I would like
Care Homes for Older People Page 19 of 35 Evidence: more music. The staff are now completing record of social activities undertaken by the residents, this can be expanded upon as the activities programme develops. Staff surveys made reference to the need for this, as the staff feel residents would benefit from a wider choice of interests and social activities. Residents were offered a choice of two hot meals at lunch time. The meal was served in the dining room; the dining room tables were attractively laid with tablecloths and flower arrangements. If preferred the residents can have their meals in their own room though most people get together at lunch and tea time. A four week menu is offered to the residents and the menu of the day was displayed in the hall and on the dining room tables. Residents said they were offered an alternative if they did not want what was on the menu and that they could have drinks at any time of the day. There was plenty of fresh fruit and vegetables and the fridges and freezers were well stocked. This helps to ensure residents receive good well balanced meals. The cook said she was aware of what the residents liked to eat so that they received meals they enjoyed. Residents comments included, the meals are First class and Meals are always served on time. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may be placed at risk as the staff are not fully aware of of the wider picture in terms of understanding the role of agencies involved in safeguarding people and how the investigations are conducted. Evidence: There was a complaint policy and procedure and details of this were recorded in the Service User Guide and Statement of Purpose for people to access. A summary of the complaints procedure was also displayed in the main hall. These measures help to ensure people know how complaints are handled and investigated. A resident said, I would speak up if things were not right, I would talk to Joanne (previous manager). There were policy documents to help safeguard people and this included an abuse policy and also local guidelines for reporting an alleged incident. Previously the staff have been unsure regarding how to deal with an incident of this nature, however the staff are now attending an ongoing programme of safeguarding training. This helps to ensure people are protected from harm or injury. Staff spoken with were knowledgeable about identifying abuse and said they were confident about reporting this to the manager. Staff were not really aware of the wider picture in terms of understanding how investigations are conducted and the role of statutory agencies such as social services. It is recommended that future training includes these elements, so that staff are more aware of the broader picture in terms
Care Homes for Older People Page 21 of 35 Evidence: of safeguarding of vulnerable adults. This is particularly important for senior staff who may be left in charge of the home. The Commission made a safeguarding referral for a resident at the home following a previous inspection in 2009, as we had concerns about the welfare of this person. This has been investigated and actions taken to the satisfaction of all parties prior to this inspection. An external safeguarding referral was made for a resident who required hospital treatment and again this has been resolved. Care Homes for Older People Page 22 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. Although currently adequate there needs to be continued monitoring and effective proactive planning to ensure standards continue to be met and the home is maintained as a comfortable and safe environment for people to live in. Evidence: There have been improvements to the general environment of the home over the past two inspection visits. These have been in response to requirements made. For example standards in the laundry have been improved, so that there is now a reduced risk of cross infection. We found the home to be generally clean and again this has improved. Some areas such as the dining room and some bedrooms have been decorated, so the home appears brighter. There has also been some new furnishings provided in the dining room and some bedrooms. We discussed these findings with the previous manager, Joanne Gledhill and also the provider (owner). Although having responded to direct requirements made by us (the regulator), we remain concerned that there remains a lack of overall planning by the provider with regard to continued maintenance and planned upgrading of the home. This is evidence by a lack of any proactive planning. The previous manager, Joanne Gledhill, showed us a projected decorating programme over the next 4/5 months which she had devised but the owner would not commit to. We were advised by the manager that the budget for any decorating was £30 weekly from petty cash. This
Care Homes for Older People Page 23 of 35 Evidence: was confirmed by the owner. Some of the decorating of the home has been carried out by care staff as they felt this would brighten up the home for the residents. During the visit we observed many snagging jobs that needed to be attended to. These included broken secondary glazing in some bedrooms, windows in poor condition and either not able to be opened or failing to close properly due to ill fitting frames or obstructing safety chains (mentioned last inspection), the cooker in the kitchen had a number of knobs missing and the cook said it was very difficult to turn the gas on and off. We also observed makeshift heaters in some bedrooms with trailing wires, which may be a health and safety hazard. Chairs in the lounge were badly stained, however on the second day of the visit these were found to have been replaced. The shower room on the ground floor still requires work so that it can be used by the residents. Although the previous manager, Joanne Gledhill, had started to carry out risk assessments and checks of environmental standards in the home the observations we made (on a brief tour of the home) have not been particularly noted. Therefore there is no action plan to remedy them. The provider (owner) seemed unaware of these and preferred to put responsibility on the manager although had equally not picked up these issues on any visits to the home including the monthly regulatory (Regulation 26) visits. The reports following these visits were brief and did not identify work that needed completion. We asked the provider (owner) about any plans to maintain the external windows as some are in particularly poor condition and may be at risk of letting the weather in but we could not get any confirmation. Our concern is that, although currently adequate, without systems in place to ensure ongoing monitoring and with out any projected budgetary plan to ensure the home is maintained the risk remains that without constant regulatory input the home will fail to meet standards and inconsistency will continue. We received a good number of staff surveys and staff reported that the environment could be improved. Staff surveys refer to the home as needing better furniture, a lick of paint, modernising and decorating. We have again made specific requirements regarding some of the more obvious issues. We would, however, strongly recommend that the provider (owner) ensures continued monitoring and effective proactive planning. This is to ensure standards continue to be met and the home is maintained as a comfortable and safe environment for people to live in. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns remain as to how new staff are recruited to ensure the ongoing protection of people who use the service. Evidence: Sufficient numbers of staff were on duty to provide care and support to the residents. This was confirmed by looking at the staffing rota and talking with the residents and staff. On the day of the inspection the manager was on duty with three care staff including a senior carer. Three care staff are on duty throughout the day and two are at night. The manager is on call to offer support at a night time. Residents said they were pleased with the standard of care they were receiving. Comments included: They are all good They always take care of me The staff are all alright. if I need them I just buzz (refers to call bell for assistance) Staff are being trained in NVQ (National Vocational Qualification) in Care at Level 2 and above. There are sixteen care staff and seven have achieved a NVQ in Care. This training needs to carry on to ensure the home has at least 50 of care staff with an NVQ in Care. NVQ in Care provides evidence of formal learning for the development of the staff. We looked at training records kept by the previous manager, Joanne Gledhill and
Care Homes for Older People Page 25 of 35 Evidence: these showed that they are now generally up to date with most of the statutory training, such as moving and handling and safeguarding (abuse awareness). Further training is planned which has been assessed around current need; for example medication training for some staff as well as first aid. (currently no first aider on site). This is an improvement and shows that the manager is aware of the need to ensure staff are properly trained to carry out care. Staff spoken with commented that they felt things had improved with the previous manager, Joanne Gledhill and that staff moral was much improved over the last six months. They felt now there was some direction and support in place for them. The provider (owner) has now appointed a new manager and it is important that this direction and support continues to offer stability and reassurance for the staff. We were only able to assess recruitment in respect of the new manager. No new care staff have been employed over the last two inspection visits. We looked at the staff files that were previously deficient in recruitment checks and found that these were now satisfactory. With regards to the appointment of the new manager, there was no staff file at the home. The provider (owner) was contacted and he stated that he had received references and a check of the new vetting and barring scheme (independent safeguarding authority), as part of the necessary police check for someone to work with vulnerable people. This information was not available at the care home. We completed an immediate requirement notice for the owner to produce evidence of this information within 72 hrs. This was received by us within the timescale and it evidenced the information we requested. A requirement had been made under Standard 37 (see record keeping) of this report; a lack of documentary evidence at the home again raises concerns as to how recruitment is managed by the provider (owner). The new manager said she had been shown round the home when she started and had been given a job description and contract of employment. There was no evidence of a formal written induction for her. There were certificates for courses undertaken by the manager to evidence her prior learning. 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 overall management of the home remains inconsistent with evidence of poor communication systems. This means the home is not always run in the best interests of the people living there. Evidence: The key Inspection was carried out over three days, this included two visits to look at general standards and also a visit by the pharmacy inspector. On the first visit the manager Joanne Gledhill was present. Joanne was appointed six months ago when the home had been inspected and rated as poor overall. We spoke at length and Joanne was able to evidence progress in many key areas of the home although understood that work still needed to be done to meet all requirements and standards. We were concerned, however that she raised concerns regarding relations with the provider (owner) and how this had acted as a barrier to further improvement. An example given was a meeting planned with residents and relatives for an evening but she had been given no flexibility to be present by the provider
Care Homes for Older People Page 27 of 35 Evidence: (owner) who insisted she works 9am-5pm. Joanne had made the point about the need for flexibility, as she needed to see night staff (for example) but there was an unwillingness to accept this from the owner. Another example was the lack of ongoing planning and budget around the decor in the home. The manager had no identified budget apart from a weekly sum of £30. This has meant, for example, some decorating work being carried out by care staff. It had been difficult to agree an adequate decorating plan with the provider (owner). We remain concerned, as there seems to be poor communication and agreement between the provider (owner) and manager of the home regarding how the home should be run. We spoke at length to the provider (owner) about these concerns. He said that he had spent a lot of money on the home and wanted CQC to tell him exactly what was needed and he would endeavour to put this in place. The provider (owner) must take on board the concept of self management and quality assurance so that the home continues to progress and improve care standards on an ongoing basis. This would involve close working with the manager of the home. We asked for evidence of an annual development plan for the home but this is not available. This is a concern with respect to ongoing management as it means that the home are reactive (only responding to regulatory action) rather than being more proactive. The provider(owner) now completes a formal report following a monthly visit to the home. The reports were brief and did not refer in detail to the work needed to improve the environment for the residents. Residents finances appeared to be managed safely. Staff signatures and receipts were available for transactions made. This helps to protect the residents financial interests. A number of contracts for safe working were looked at. This included the certificate for the gas and eclectic supply to the home, maintenance of the lift and fire prevention equipment. These were found to be in date. A certificate could not be located for the moving and handling equipment (hoists and bath aids). A call to the company who serviced them confirmed they had been tested and were safe to use. When the pharmacy inspector carried out a visit on 22nd February 2010, we found Joanne Gledhill had left and a new manager was in post. We again visited on 26th February 2010 to meet with the new manager and check whether proper recruitment checks had been made. We, as the regulatory body, had at that time no written notification of the new manager and, up to the point of the manager arriving, had also had no verbal notification. Care Homes for Older People Page 28 of 35 Evidence: We are concerned about the lack of communication with us regarding such a key change to the management of the home. We asked that the provider (owner) formally notify us of the appointment of the new manager. Mr Hornby, the provider (owner), did so following our site visit. We spoke with the new manager, Pauline Lynes. She confirmed she had commenced duty on 22nd February 2010. As previously stated under Standard 29 (see recruitment) we asked for her staff file to evidence necessary recruitment checks had been made, as these had not been in place for the previous manager. There was no documents present on site. We left an immediate requirement notice for these to be produced. We have made a further requirement that all staff records must be kept on site for inspection purposes. Overall we remain concerned that the home still has no registered manager (registered with the Care Quality Commission (CQC)), as no application was received from the previous manager who has now been replaced. Since our visits, the provider (owner) has submitted an application for the new proposed registered manager. This application is however, incomplete and is being returned. The report evidences examples of poor communication from the provider (owner) with the regulatory body. This inconsistency and lack of long term planning around the management of the home can be very unsettling for staff and also people using the service. There were no policy documents available which refer to the Deprivation of Liberty safeguards. These have been introduced under the Mental Capacity Act 2005 and the manager has arranged training for the staff so that they understand how these safeguards work to help protect people who may lack capacity to make their own decisions regarding their welfare. Guidance from the Department of Health can be obtained for the staff and a policy should be drawn up so that the staff are aware of their roles and responsibilities for these safeguards. (see choice of home). A number of new policies and procedures have been introduced to promote safe working for the staff and to help protect people. These was easily available for the staff to refer to. Accidents affecting the residents welfare had been recorded, so that staff were aware of the incident and any treatment the resident required. Daily care records had been completed to evidence this information. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 Put in place effective 12/11/2009 arrangements to ensure that any service user who selfmedicates is assessed to ensure that they can do so safely This will help to ensure the health and welfare of the residents 2 29 23 All bedrooms must be 17/12/2009 checked to ensure that windows provide for easy and safe ventilation of the home and can be opened and closed when necessary. This is with particular reference to those rooms identified on the inspection visit This will help to ensure people living in the home can moderate the temperature in their rooms 3 38 13 There must be suitable arrangements for the training of staff in first aid This helps ensure that care staff have the ability to deal with accidents and health emergencies 17/12/2009 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 1 37 17 The provider must produce evidence of recruitment checks made prior to the employment of the manager of the home. This is required so that the home can evidence that people who work in the care home are fit to care for vulnerable people. 01/03/2010 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 1 5 The use of CCTV cameras must be recorded in the Service User Guide. This will ensure people who use the service are aware that their movements, as they go about their daily activities, are being recorded in certain areas of the home. 26/04/2010 2 9 12 Regularly prescribed medicines must not be allowed to run out of stock. This will help make sure peoples health and wellbeing is protected. 26/03/2010 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 3 9 17 Records of all medicines kept in the home must be retained for a minimum of three years. This will help make sure all medicines can be fully accounted for. 26/03/2010 4 10 12 The CCTV camera which views the lounge must be removed The use of a CCTV camera in this room is intrusive, excessive and impinges on a persons right to privacy and dignity 26/04/2010 5 10 12 A privacy impact assessment 26/04/2010 must be completed for the use of CCTV cameras in the home The use of CCTV cameras must be assessed in respect of their use and the impact they have on peoples lives 6 19 13 The homes risk assessments must include attention to any trailing electrical wires and effective measures must be put in place to negate any risk to people living in the home. This helps ensure that the environment is maintained safely. 26/04/2010 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 7 19 23 Externally all windows must be kept in a good state of repair. This ensures the home is maintained appropriately and fit for people to live in. 23/08/2010 8 33 24 An annual development plan 26/04/2010 must be developed for the home, which sets clear aims and objectives for the management of the home and includes outcomes for people living there. This will evidence good management principals and ongoing / proactive management of the home. 9 37 17 There must be a record kept 26/04/2010 in the care home of all persons employed, which includes all statutory checks included in Schedule 2 of the Care Home Regulations. This is required so that the home can evidence that people who work in the care home are fit to care for vulnerable people. 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 1 3 We would recommend that assessments for peoples mental capacity are introduced to the pre admission and ongoing assessments. Risk assessments should record more detail, so that staff have sufficient information as to the level of support a resident needs to help keep them safe A dedicated budget for the provision of entertainment, such as bringing in singers or musicians should be provided. It is important that people are provided with activities that suit their lifestyle and maintain their interests. Any in house training on safeguarding needs to reference the local policies and the wider picture in terms of how abuse is reported and investigations are carried out. We would strongly recommend that a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. NVQ training for the staff needs to continue to ensure that 50 staff have achieved an NVQ in Care at Level 2 or above. The assessed gaps in the training of staff must be addressed. This includes medication training and training of staff in first aid. The manager should continue with her application for the position of Registered Manager for the service. Staff should be aware of the Deprivation of Liberty Safeguards that have been introduced under the Mental Capacity Act 2005. Guidance from the Department of Health can be obtained for the staff and a policy should be drawn up so that the staff are aware of their roles and responsibilities for these safeguards. 2 8 3 12 4 18 5 19 6 28 7 30 8 9 31 38 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). 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. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
