Inspection on 17/12/09 for Heath Bank Nursing Home

This inspection was carried out on 17th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heath Bank Nursing Home 11/03/09

Heath Bank Nursing Home 26/10/06

Heath Bank Nursing Home 22/02/06

Heath Bank Nursing Home 17/08/05

Heath Bank Nursing Home 21/01/05

Heath Bank Nursing Home 06/07/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Heath Bank Nursing Home Linden Road Halifax West Yorkshire HX3 0BS     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: Gillian Walsh     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Heath Bank Nursing Home Linden Road Halifax West Yorkshire HX3 0BS 01422352299 01422365557 heathbankoffice@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Philip Bennett (Heath Bank New Co) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 57 The registered person may provide the following category of service only: Care home with nursing - Code N 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, maximum number of places: 47 Dementia - Code DE, maximum number of places: 10 Date of last inspection Brief description of the care home Heath Bank Care Home offers 24 hour nursing care to 47 people. This includes a general nursing unit and an eight bed unit for people who are living with dementia. The registration also includes the provision to offer nursing care for three named persons Care Homes for Older People Page 4 of 35 Over 65 0 47 10 0 1 1 0 3 2 0 0 9 Brief description of the care home under the age of 65 years. The home is in a quiet residential area of Halifax,approximately 10 to 15 minutes walking distance from the town centre. The home offers single and shared bedrooms, a number of rooms have en suite toilets, some rooms also have en suite showers The home was extended at the end of 2005 when 18 new bedrooms,additional bathrooms and toilets and a large lounge were added. The Care Quality Commission were informed in December 2009 that fees for living at the home are between £565 and £600 per 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out to assess the quality of care provided to people living in the home. We made the visit earlier than scheduled as we had received some concerns about the service. The inspection process included looking at the information we have received about the home since our last key inspection as well as a visit to the home. Two inspectors carried out the visit over one day and it lasted for approximately 8 hours. During the visit we spoke to people living in the home, some visiting relatives, some members of staff, the assistant operations manager and acting manager. We observed care staff delivering care, looked at various records and looked around the home. We have sent an Annual Quality Assurance (AQAA) document to the home so that they can tell us how they think the home is doing, any improvements they have made or Care Homes for Older People Page 6 of 35 have planned and any problems they may be facing. The document also provides us with some numerical information about the home to assist us in our inspection process. However, as we had received some concerns about the service, we brought forward the date of our inspection and this report was written before the date given to the home for the return of their AQAA. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 35 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 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 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not always work with the information contained within the pre admission assessments and this can lead to people losing some independent living skills. Evidence: The acting manager said that before people are offered a place at the home, either he or a senior member of staff will visit them to make an assessment of their care needs. This is to make sure that staff at the home have the skills needed to meet the individuals needs. We saw completed pre admission forms in the care files we looked at and saw that they contained some good information. We were concerned however that this information is not always used to make sure that people retain the skills and independence they may have had before moving into the home. An example we saw of this was people not being supplied with the walking aids they had been using before their admission. Care Homes for Older People Page 11 of 35 Evidence: It is also of concern that people are being being admitted to the dementia care unit with needs that staff have not had sufficient training to meet The home does not provide intermediate care. Care Homes for Older People Page 12 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always receive the care they need and a lack of safe systems for management of medication could put people at risk. Evidence: We looked at care plans for five of the people living at the home, three from the general nursing unit and two from the dementia care unit. The care plans are based on the activities of daily living which includes eating and drinking, mobility, personal hygiene, sleeping, communication and social and leisure needs. The care files also included a number of assessments such as nutrition, moving and handling and pressure sore risks. Whilst there is some good information in the care files, particularly on the general nursing unit, we saw that the staff do not always follow the care plans. Care Homes for Older People Page 13 of 35 Evidence: An example of this is when we saw that a persons walking frame had been left in their bedroom and that they were using a wheelchair. The acting manager told us that the person does not use their walking frame. However the care plan, which had been in place for less than two weeks, said that the person should use their frame to walk short distances regularly throughout the day in order to maintain their level of mobility. Another example is where a person had previously been on a peg feed (fed by a tube directly into the stomach)but now, according to the care plan was taking thickened fluids and a soft diet. We saw that the person was not being given thickened fluids and although was given a soft diet at lunchtime, the daily record said that the person had had toast for their breakfast. We also noticed that the nutritional information sheet for this person had not been reviewed and updated since the peg feeding had stopped and therefore still gave instruction to feed via the peg. We were concerned that the care plans for people who live on the dementia care unit were almost identical in their content and therefore not developed around the individual needs and abilities of the person. Examples of this are care plans saying establish a night time routine, address by given name, offer a well balanced diet, offer at least a a weekly shower monitor for signs of constipation Statements such as these are not personal to the individual and do not give staff any specific direction or information about the individuals needs and choices. We also saw that care plans included general good practice instructions to staff, such as nurse to administer medications in occurrence with NMC guidelines, ensure COSHH are stored away correctly and ensure outside doors are closed correctly. Again these are not specific to the individual. We saw in one persons file an excellent life history booklet which included lots of detail about the persons life and interests, photographs and details of family. This good practice should be continued for all of the people particularly on the EMI unit,to enable and assist staff to recognise peoples individuality and to use as an aid for orientation activities. Prior to the inspection we had received details of a complaint made by the family of a person living at the home. The complaint was mainly around care issues including people not being taken regularly to the toilet and lack of appropriate application of prescribed creams. Care Homes for Older People Page 14 of 35 Evidence: We saw in care plans on the EMI unit instruction to staff to take people to the toilet every two hours. However in the three hours we spent on that unit we did not see anybody, other than one person who was independent in this area, being taken to the toilet. We had noticed a smell of urine in some areas of the unit. We saw a chart in one persons room for staff to sign when they had applied the persons prescribed cream. The chart said to apply the cream twice each day but did not say where on the body it should be applied. We asked the acting manager but he was unsure. We saw that the cream had only been signed as applied once in the morning in the six days recorded on the chart and five times in the evening. This meant that the person had received only half of the prescribed course of treatment. We saw tubs and tubes of creams in many of the bedrooms. A large amount of the containers had part of the label from the chemist with the name of the person the cream had been prescribed for removed. This suggests that the cream had not originally been prescribed for the person to whom it was being applied. This is very poor practice and is also a potential source of cross infection. We also saw dressings in one persons bedroom that had been prescribed for another person in the home. We saw a gentleman who staff had not supported to shave properly. When we asked why not staff said that the person had become aggressive whilst they tried to assist him with his shave that morning. We did not see staff attempt to try again and when we looked in the persons room we saw that the razor in the room was very dirty and clogged and therefore would have caused the person pain if staff had tried to use it. We saw a person sitting in the lounge with an open sore on their head. We also noticed that this person had not been provided with socks to wear. We looked at systems for receipt, storage and administration of medication. systems on the general nursing unit appeared well managed but people on the EMI unit are being put at risk through very poor management of medication. We saw that the majority of MAR (Medication Administration Record) sheets were not dated and therefore it was impossible to track exactly what medications had been administered and when. We also saw that record is not made of medications delivered to the unit. We saw a daily record in one persons daily notes that said when they had been given the full dose of their PRN (as required)sedation, they had become over sedated. We saw that that the prescription for this medication was 0.5 - 1mg. No record had been Care Homes for Older People Page 15 of 35 Evidence: made on the MAR of the dose given to the person each time they had been given it. We also saw that the medication had not been signed as given on the MAR chart on an occasion when it was written in the care notes as being given. We saw that one person had not been given their prescribed four times daily pain relief for over ten days. A recording code of O had been made on the MAR. Two explanations for the use of this code had been written at the bottom of the sheet. One said that the medication was out of stock and the other said that the medication was not required. The acting manager said the person did not need this medication but, when we asked, the nurse in charge said that the medication was out of stock. There was no record of any actions taken by staff to make sure that this medication was obtained by the home. We also saw that the same person had not been given another of their prescribed medications for over ten days. No record had been made to explain why this was and the nurse and the acting manager could not explain. On the general nursing unit we saw a bottle of anti fungal medication which is dispensed directly into the mouth from a dropper, in the bedroom of a person not named on the bottle. This medication is prescribed as a course and as the bottle was half full and the person for whom it had been prescribed had left the home several weeks before the inspection, this meant that the person had not been given their prescribed course of medication. Care Homes for Older People Page 16 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people living at the home have choices within their lives or opportunity for social and recreational activity. Evidence: The home employs an activities coordinator to make sure that peoples social and leisure needs are met. We noticed that on the general nursing unit most people were sitting in either the lounge or in the conservatory. People sitting in the lounge did not appear to be engaging in any activity other than when they were served with drinks. People in the conservatory were listening to seasonal music, reading newspapers and magazines and staff were interacting socially with them. We asked staff if people had choice in where they spent their time and staff said that they did. On the EMI unit, which is situated on the first floor, all but one person were sitting in Care Homes for Older People Page 17 of 35 Evidence: the lounge. Other than the television, which was playing constantly, we did not see any activity or social stimulation offered to the people sitting there. The acting manager had explained that an activities programme is not in place but that care staff would engage people in some form of social or leisure activity on a daily basis. During the afternoon a musical entertainer came to perform for the people living at the home. The majority of the people living in the general nursing unit were assisted to go to join in the entertainment but only one person from the EMI unit was taken to watch. We saw people came to visit their relatives and could sit either in their bedrooms or in the communal areas. We noticed that during one persons visit, staff spent much of the time talking across the person who lives at the home, to their visitor. Whilst it is important for staff to make visitors feel welcome, it is important that they do not take over the visit as this can be frustrating and isolating for the person being visited. We spent three and a half hours on the EMI unit and witnessed very little interaction between staff and the people who live there, we did not see any social interaction. We saw one person asking a member of staff to help them in remembering where they had lived. The staff member just said they didnt know and continued to walk past. We saw a large personal collection of CDs in one persons bedroom but nothing to play them on. We asked the acting manager if this person was ever supported and enabled to listen to their music. The acting manager said that they didnt as they spent all their time in the lounge. This individual had clearly enjoyed listening to music before moving into the home but it did not appear that staff had done anything to support this person to continue to enjoy their music. When the lunchtime meal was served on this unit, only one person was seated at the dining table which was in the lounge where everybody was sitting, others were served their meals on over bed tables which were pulled to their chairs. This meant that people did not move at all before their meals were served and did not have any orientation to the fact that it was a meal time. The television was left playing throughout the meal. The meals came to the unit ready plated. We saw that everybody had been given savoury mince although we had seen that pasta was also on the menu. We also saw that despite fruit scones being on the menu for dessert, only a mousse type dessert Care Homes for Older People Page 18 of 35 Evidence: was provided. One person who had been sitting in their bedroom was not asked if they would like to come to sit in the room with the other people for lunch and was given their meal fifteen minutes after it had arrived plated up onto the unit. We brought this to the attention of the asssistant operations manager who intervened and asked for the meal to be replaced. We also asked why the people on this unit were not given the fruit scones and cream which we had seen on the menu. After we asked, some scones were provided. After the meal the tables were moved away and people continued to sit where they had been since we arrived at the home in the morning. We did not observe the meal on the general nursing unit but people told us that they thought the food was adequate. One person said its not good but its usually ok The dining room on this unit was nicely arranged with the menu showing the choices on the wall. We saw from the menu that one of the options for the midday meal was savoury mince and the warm option at tea time was a keema curry, another meal made with mince. We saw that not many people chose the curry and those who did had not eaten much of it. One person tried to speak with one of the inspectors. As the inspector did not understand what the person was saying an apology was made and the inspector immediately alerted the acting manager to the fact that the person was trying to say something and appeared distressed. The acting manager said that the person usually didnt make much sense. We looked at the persons care plan and found that their first language is not English and they spoke in their own language. We saw nothing in the care plan to show that any effort had been made to facilitate communication with this person other than to ask closed questions so that the person could reply yes or no. Some of the people who live in the home, particularly those who who have the ability to make their own choices and are able to maintain some Independence, can enjoy their lifestyles. However the people we saw on the EMI unit appeared to have little or no social or recreational stimulation, choice or quality of life. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be sure that the home will learn from complaints made and procedures are not in place to protect people. Evidence: Prior to the inspection we had been made aware of a complaint made to the local authority about care and other issues within the home. A full and thorough response to this complaint had been made by the operations manager and several elements of the complaint were upheld. It was confirmed in the response that changes would be made and that staff would receive further training to make sure that the care provided in the home was improved. We found that some of the concerns raised were still evident. This included people not being shaved appropriately, people not in correct footwear, people not being taken to the toilet regularly, creams not being applied appropriately and staff not working to care plans. This means that although the home properly acknowledged and investigated the complaint, they did not make sure that that all necessary changes were made to make sure that the issues did not continue to affect people living in the home. We saw in one persons daily records that there had been a number of safeguarding issues where the person had been physically aggressive to other people who live in Care Homes for Older People Page 20 of 35 Evidence: the home. There was no evidence that these incidents had been reported under local safeguarding policies and procedures and the acting manager confirmed that they had not. There was also no evidence of any action taken to make sure that this persons behaviour was being managed to protect them and other people living at the home. We asked the acting manager if he knew how to refer to safeguarding and he was very unsure. This means that appropriate steps are not being taken to make sure that people living at the home are safe. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home looks nice but standards of maintenance and infection control do not always assure peoples comfort. Evidence: During the visit, we walked around all of the communal areas in the home and looked in a number of bedrooms. We saw that generally, particularly on the general nursing unit, the home looked clean, comfortable and homely. The home had also been nicely decorated for Christmas. On the day of the visit it was snowing and we felt that it was not very warm in the lounge and conservatory on the general nursing unit. Several of the people we spoke to said that they felt cold. The assistant operations manager contacted the handyman to come and adjust the boiler. However we noticed later in the day that the lounge felt very cold again. The catering staff told us that a large window in the kitchen would not close properly and the very cold air was coming in from that. We were disappointed that staff had not thought to keep the kitchen door closed to make sure that people were not cold. We also saw that a number of the bedroom windows had been left open despite the Care Homes for Older People Page 22 of 35 Evidence: freezing temperatures outside. This meant that had people wanted to return to their rooms they would have been very cold. The bedrooms on the general nursing unit were generally very pleasant, had been personalised by the occupant and were nicely furnished. Staff had also made sure that peoples Christmas cards were nicely displayed. We did see some areas however that were in need of better cleaning and one persons bed had been made with blood stained sheets. We also saw a plastic shower chair with a large crack in the seat. This could have caused a painful injury if it had been used and the assistant operations manager removed it immediately. The EMI unit was much more sparsely furnished and not all of the bedrooms had been personalised. There was a smell of urine in some areas. We saw in one persons room a solution to use for washing the body when MRSA is present. This solution did not appear to have been used and the acting manager was not able to tell us if the occupant of the room had MRSA or if they had been treated for it. There were no facilities for waste disposal in this room. As previously mentioned in this report we saw large amounts of tubs of cream in peoples rooms which had had the name of the person for whom it had been prescribed removed. This suggests that infection control is not being managed effectively in the home. We saw bath temperature record books in the bathrooms but these had not been filled in for several months. We saw that staff had recorded temperatures of between 35 degrees C and 39 degrees C, none of which are warm enough for a comfortable bath. We checked the temperature of the running water in some of the bathrooms and found a temperature in one bathroom of 35 degrees C and in another of 32 degrees C. The recommended temperature of running water is 43 degrees C. The acting manager confirmed that people who live at the home had been using these baths. This means that people have been bathing in only tepid water which would be uncomfortable and unpleasant. We also found that the water temperature at a sink in one of the bath temperatures exceeded 50 degrees C which could have caused scalding. Water temperatures in bedrooms on the EMI unit were checked and found to be between 30 and 33 degrees C. Again this is not warm enough for a comfortable wash. We left an immediate requirement relating to water temperatures and received confirmation the following day that they had been properly set. Care Homes for Older People Page 23 of 35 Evidence: Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training and supervision is not sufficient to meet all of the needs of people living in the home. Evidence: Since the last key inspection there have been a number of staffing changes at the home. The current acting manager was previously a senior nurse at the home and a nurse support manager has been appointed. The nurse support manager works half her time as a nurse and half assisting with the management of the home. The staff rotas showed that there are plenty of staff on duty at all times but none have time dedicated to engaging people in meeting their social and leisure needs. This is particularly important for people living on the EMI unit and people who are unable, due to illness to meet their own needs in this area. We saw that staff undertake regular training in areas such as moving and handling and fire safety and we were informed by the acting manager that over half of the staff are trained to at least National Vocational Qualification (NVQ) level 2 in care. Although training is ongoing we saw that not many staff have taken training in caring Care Homes for Older People Page 25 of 35 Evidence: for people who are living with dementia. As the home has a dedicated EMI unit, all staff working on this unit should undertake this training. It is also important that where an activities co-ordinator is not involved, staff receive some training in engaging people in social and leisure activities. Training in both of these areas should be arranged. It was evident from the inspection that staff, including the acting manager, need refresher training in safeguarding and protection of vulnerable adults Although infection control training has been taken by some staff it was evident that refresher training is needed. It is also important that when staff have undertaken training that, through supervision, their understanding and ability to practically apply the training is checked. The acting manager confirmed that all new staff work through a three month induction period in line with the Skills for Care Councils core standards. We checked three staff files and found that recruitment practices are generally safe. However we found that not all references were appropriate with one being from the father of the employees friend. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are not robust enough to make sure the home is run in the best interests of the people who live there. Evidence: The acting manager has been in post for approximately two months, prior to this appointment he worked as a registered nurse in the home for approximately three years. He is working through an induction period with the assistant operations director who was present throughout the visit. The acting manager is putting together his application to the Care Quality Commission to be registered as the manager. He has achieved NVQ level five in management and is undertaking further training. We did not see any evidence within the care files we saw that people in the home have had any assessment of their mental capacity in line with recent legislation.It is important that these assessments are completed for people who may be subject to Care Homes for Older People Page 27 of 35 Evidence: restrictions on their liberty such as not being able to move around the home freely or leave the home unaccompanied. Several of the issues identified during the inspection including medication problems, water temperatures and cross infection issues could have been identified and dealt with before the inspection if the home had an effective system in place for monitoring quality issues in the home. It is important that such systems are put in place to ensure the comfort and health and safety of the people living at the home. The issues highlighted also demonstrate that the home is not being managed well. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 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 19 12 Water temperatures must be 01/01/2010 safe and appropriate to the needs of people living at the home. To ensure peoples safety and comfort. 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 Care plans must be personal 22/01/2010 to the individual and staff must follow the prescribed care. So that people receive the care they need in the way they prefer. 2 8 12 Arrangements must be 22/01/2010 made to make sure that people recieve the treatment they need. This includes making sure people recieve their prescribed medications including creams and lotions. So that people recieve the treatment they need to promote their health and well being. Care Homes for Older People Page 30 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 13 Systems for managing medications must be made safe. This must include recording of medication received into the home, correct recordings of administration and making sure that all prescribed medications are available to the person for whom they have been prescribed. To make sure that people receive their medication safely. 22/01/2010 4 12 16 All people living at the home 22/01/2010 must be consulted about and have access to social and recreational activities of their choice. So that people can enjoy their lives as much as possible. 5 14 12 People must be supported and encouraged to make choices within their lifestyles. So that people retain their individuality and dignity. 22/01/2010 6 15 16 All people living at the home 22/01/2010 must be offerred choice and variety of meals. meals must be served at the appropriate temperature. 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 So that people can enjoy their meals. 7 16 22 Actions must be taken in response to complaints to make sure that the issues are not repeated for other people in the home. So that people can be confident that their complaint will be taken seriously and acted upon. 8 18 13 Arrangements must be made to safeguard people living at the home. Local procedures for safeguarding people must be followed. To keep people safe. 9 19 13 Arrangements must be made to make sure that the risk of cross infection is minimised in the home. To minimise risk of cross infection and keep people safe. 10 27 18 Staff must be available to meet all of the needs of people living at the home. This must include meeting social and recreational needs. 12/02/2010 22/01/2010 22/01/2010 22/01/2010 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 So that people in the home are supported to have a good quality of life. 11 33 12 People who have any 22/01/2010 restrictions on their liberty must have their ability to make decisions about their lives and care assessed in line with the mental capacity act. To protect peoples rights. 12 33 24 Arrangements must be put in place to make sure that systems for monitoring the quality of care and services are put in place. To make sure that people recieve good quality of life. 13 38 12 Systems must be put in 22/01/2010 place and followed, to ensure the health and welfare of people who live at the home. To make sure people are safe and comfortable. 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 22/01/2010 1 3 Staff should use the information contained within the pre admission assessments to make sure that peoples Page 33 of 35 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 independent living skills are retained. 2 12 Efforts should be made to enable effective communication with people living in the home whose first language is not English. Staff should make sure that people are warm and comfortable. Appropriate references must be sought for all new employees to make sure that they are suitable to work with vulnerable people. 3 4 19 29 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. 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