Inspection on 10/08/09 for Hepworth House

This inspection was carried out on 10th August 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hepworth House 28/10/09

Hepworth House 30/11/07

Hepworth House 16/02/07

Hepworth House 05/12/05

Hepworth House 20/04/05

Hepworth House 13/10/04

Hepworth House 05/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Hepworth House 1 St Georges Road Bedford Bedfordshire MK40 2LS     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: Louise Trainor     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Hepworth House 1 St Georges Road Bedford Bedfordshire MK40 2LS 01234262139 01234272927 hepworthhouse@waitrose.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr and Mrs Hepworth Lloyd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Hepworth House is situated in a pleasant residential area of Bedford. It is within easy walking distance of the town centre and close to local amenities such as local shops, schools, and Churches. The home is converted from two domestic style properties. There is a garden surrounding the home, which is laid to lawn and flower- beds. There is unrestricted road parking in the area for staff and visitors. The home has undergone many changes in the last few years and currently provides accommodation for 18 residents over the age of 65 years. 16 of the rooms are single rooms with ensuite facilities. There are two lounge/diners and a sunroom on the ground floor and a lounge on the first floor. Communal bathrooms and toilets are located on the ground and first floor. The fees for this home vary from £425.86 per week for residential placements, to £455.00 per week. 0 0 Over 65 18 18 Care Homes for Older People Page 4 of 32 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 in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of the key standards for the provision of a care home for older people that takes account of service users views and information received about the service since the last inspection Evidence used and judgments made within the main body of the report include information from this visit. This was a two star home and had therefore not received a Key Inspection since November 2007. This inspection was carried out on the 10th of August 2009 by Regulatory Inspector Mrs Louise Trainor, between the hours of 11:00 and 17:30 hours. During this inspection we picked two residents to case track in detail, and looked more briefly at the documentation relating to another. We spent time observing care practices and informally chatting with staff and residents. Care Homes for Older People Page 5 of 32 We examined three staff files, all documentation relating to their recruitment, and other records relating to staff training and supervision. A full tour of the premises was carried out, and documentation relating to health and safety checking procedures, medication administration, complaints, accident and incident reporting and residents finances were also inspected. The home manager was present to assist throughout this inspection, and the Responsible Individual was present for the final feedback session. Feedback was given periodically throughout, and at the end of the inspection. We would like to thank everyone involved for their assistance and support. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: This home has a statement of purpose and service user guide which details the service offered by the home and facilities available, however these documents do not contain all the required information. Staff do not adequately record health issues within individuals care plans. Medication storage systems are poor and place people in this home at risk. Some residents are consulted and listened to regarding the choice of daily daily living, but this process could be improved. Safeguarding policies are out of date, and do not give the correct guidance for staff to follow in the event of a safeguarding alert. We were also concerned that visitors were entering the home freely via a back kitchen door entrance, this meant they could enter without staff knowledge and without signing in. This is leaving residents open to an increased risk of abuse. Care Homes for Older People Page 7 of 32 Staffing levels may not always meet the needs of the people who live in this home, and recruitment procedures and safe working practices are not always followed. The AQAA was returned without being fully completed and did not give as a reliable picture of the service. There is a limited understanding of person centred thinking and the manager lacks knowledge relating to some of the core processes that safeguard the people living in this 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 8 of 32 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 9 of 32 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. Pre admission assessments are carried out on prospective residents prior to admission to the home. This home has a statement of purpose and service user guide which details the service offered by the home and facilities available, however these documents do not contain all the required information. Evidence: During this inspection we looked at the information documents for this service. These had been kept under review. Documents were detailed and contained all the appropriate information relating to service facilities, however there was no information relating to fees included. A summary of the complaints procedure was also incorporated into this documentation. Recent changes relating to The Care Quality Commission had not yet been amended. Care Homes for Older People Page 10 of 32 Evidence: We looked at the pre admission documentation for a resident that had been recently admitted to the home. This had been completed by the home manager, and included basic information relating to the individuals needs and how they should be managed. It also identified past medical and mental health conditions. Prospective residents and / or their representatives are encouraged to view the home and its facilities prior to admissions taking place. We looked at the contracts of terms and conditions for three residents, these were signed and dated appropriately and included individuals fees. This home does not provide an intermediate care service. Care Homes for Older People Page 11 of 32 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. Staff do not adequately record health issues within individuals care plans. Medication storage systems are poor and place people in this home at risk. Evidence: During this inspection we looked at the files of three residents. One of these residents spent time with us while looking at her file, and was fully aware of the content of her care plans. All the files that we looked at contained basic care plans for mobility, moving and handling and continence, and these were supported by risk assessments. However not all key areas of care for each individual were addressed in the care plans and therefore there was no continuity of care being promoted. For example one residents profile identified that she was a diabetic, and although there was a diet sheet, which identified food likes and dislikes, there was no care plan in place to give staff information relating to how they may recognize if this persons sugar levels were too high or too low, when the district nurse was visiting to administer insulin and test blood sugar levels, or to identify when staff may need to Care Homes for Older People Page 12 of 32 Evidence: seek medical advice from the doctor or district nurse. Another resident was identified as MRSA positive, there was no clear care plan as to how staff should manage this on a day to day basis. We would expect to find some information for staff to follow reflecting universal infection control precautions. Another resident presently has a wound on her heel, but there was no care plan for staff to follow. We appreciate that the district nurse visits and manages this wound, however there should be a basic care plan of instructions for staff in the home delivering the daily care. Generally it was very difficult to audit the care plans because of the the way the care plans and information sheets were being filed. The basic care plans that we looked at were being reviewed on a regular basis. Observations of care revealed residents being addressed with respect by staff, and being assisted with care in a dignified way. Prior to lunch time we heard a member of staff offering meal choices to residents in the front lounge. However during the lunch service we observed one resident being assisted to eat. Generally there was minimal conversation being exchanged, but we heard the carer say. You have custard and prunes now. There was no indication of a choice being offered to this individual. We also spoke to one resident who was chewing the meat and then leaving it on the table, when we asked if he would like something else, he immediately responded with a resounding yes please. We advised the staff of this and they informed us that he did not like beef burgers, which was the alternative. We then had to ask the staff to find an alternative that he did like and could eat. If we had not been present we believe this would not have happened. We looked at the Medication Administration Record (MAR) Sheets for all the residents in this home. These were well completed with signatures and omission codes where necessary, and reconciled correctly with stocks remaining in the home. We did however identify several concerns relating to the medication storage in this home. Despite there being a Controlled Drugs(CD) cupboard in situ. This was being used to store residents money not the CDs that were prescribed for one resident. We also found insulin, eye drops and a hydroxocobalamin injection stored in the fridge in the kitchen. Neither the fridge or the kitchen doors were locked, and we saw three visitors enter the home via the kitchen. Therefore this medication was freely Care Homes for Older People Page 13 of 32 Evidence: accessible to anyone entering this area. Our final concern was that there were no individual profiles or photograph attached to the MAR sheets, and individuals allergies were not identified. One of the residents that we case tracked was allergic to Penicillin, this was not identified on the MAR sheets. We did not see any care plans related to individuals wishes in the event of serious illness or death, and on two of the three files that we looked at the basic information relating to this matter had not been completed. We appreciate that this can be a sensitive subject to approach, however basic information should be obtained on admission to the service. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some residents are consulted and listened to regarding the choice of daily daily living, but this process could be improved. Evidence: We arrived at this home at 11:00 hours. At this point there were eight ladies watching television in the front lounge, and a further ten residents in the back lounge with the television on although few were watching it. With the exception of a drinks trolley going round and a carer asking residents in the front lounge what they would like for dinner, there was minimal interactions between staff and residents, and no evidence of any activities. Activities are usually led by a part time worker who works three afternoons a week but is presently on leave for a month. There was an activity programme on display, which identified a range of leisure activities such as; newspapers, outings, armchair exercises, bingo and board games. The activity identified for Monday afternoons was outings - cars. There was nothing to suggest this happened on the Monday afternoon of our visit. Care Homes for Older People Page 15 of 32 Evidence: When asked the residents about how they spent their time, two residents told us that they never did anything much. This matter was also identified in some of the residents surveys that we received, however one resident was keen to tell us about the church services she attends and her trips out with her key worker on Sundays. Visitors are welcome into this home at any time, however we were concerned that during the course of this inspection we saw three visitors entered via the back door in the kitchen. This meant that they could enter without the knowledge of staff, and without signing in. We looked at the signing in book, which indicated that there had been no visitors for the past five days, which included a weekend. Staff confirmed that this was not the case and there had been several visitors over the weekend. We reminded the manager that this is a health and safety risk. If for any reason the home needed to be evacuated, no one would know how many heads to count. This home had a four week rolling menu plan, which offers a wide variety of dishes, which are cooked daily on the premises. We observed the service of the midday meal, and noted that everyone was served their meal in a bowl. When asked why dinner plates were not being used, the cook advised us that they only had four dinner plates. When we addressed this with the manager, she suggested that they had been put into storage while the kitchen was being refurbished, and staff had failed to return them to the kitchen. Although some residents were being asked what they would like to eat, we believe this was not the case for everyone. As discussed earlier in this report we observed two residents in particular where choices were not clearly offered. Care Homes for Older People Page 16 of 32 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. There is a complaints policy in place which is easily accessible to anyone entering the home. Safeguarding policies are out of date, and do not give the correct guidance for staff to follow in the event of a safeguarding alert. Evidence: This home has a complaints policy that is summarized in the service information documents and easily accessible to residents and visitors to the home. We did notice some minor amendments were required to this document, such as details of the Care Quality Commission. We looked at the complaints and compliments file. There had been no complaints received and recorded since the last inspection, but there were letters of thanks and compliments. During this visit one residents asked to speak with us, and showed us a copy of a short letter she had sent out to friends at Christmas last year. It was advising friends that she had recently moved into Hepworth House, it read. I am very happy here: the staff are wonderful and I have a lovely room with en suite facilities, which is a real blessing, and if I do need assistance I only have to ring. She told us that as she believed it was Gods Will that she was here, she had recently stood up in church and Care Homes for Older People Page 17 of 32 Evidence: given a testimonial to the home. She was very happy. Safeguarding is addressed with staff in this home through the induction process, and is also included in the mandatory training schedule, via a long distance learning programme. The training matrix and certificates indicated that all staff have attended this training. We were however very concerned that when given a scenario and asked how they would manage it, both the manager and the Responsible Individual, gave us an account of how they would investigate the matter and inform CQC, the GP, Social Worker and perhaps the police if it was really serious. Neither responded confidently about how to contact the Safeguarding Team, and neither addressed the suspension of staff until we reminded them. We looked at the homes Safeguarding policy, this was last reviewed on the 29/09/2004 and does not contain the appropriate guidance in line with local protocols. We advised the manager to contact the local Safeguarding team immediately and obtain a copy of their up to date protocols, and look into further training opportunities. As detailed elsewhere in this report, we were also concerned that visitors were entering the home freely via a back kitchen door entrance, this meant they could enter without staff knowledge and without signing in. This is leaving residents open to an increased risk of abuse. We issued an immediate requirement at this inspection, relating to safeguarding, and failure to comply within the set timeframe may result in enforcement action. Care Homes for Older People Page 18 of 32 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 provides a physical environment that meets the specific needs of the people who live there, however there is direct access to the rear of the home from the public footpath,via an open gate. This may compromise the safety of the people who live here. Evidence: During this inspection we undertook a full tour of the premises, inside and out. The home was clean, homely and free from offensive odours throughout. There are two communal lounge areas, one at the front of the building on the ground floor, and one to the rear off the dining room which although rather small provides sufficient seating for residents to dine comfortably. There is additional dining facilities in the rear lounge. Bedroom facilities are spread across three floor of this home. We were shown one of the ground floor bedrooms by the resident who resides in it. She was very happy with her en suite facilities and drew our attention to a colourful window box. She told us that she had been able to bring some of her own furniture with her and this made it more like home. Other rooms that we looked at were individually decorated and furnished with Care Homes for Older People Page 19 of 32 Evidence: personal assets that reflected individuals personalities and life histories. There is a small enclosed garden to the rear of the building, however we were a little concerned that the back gate was left open, giving direct access and entry to the rear of the home from St Georges Road by anyone. During the inspection we witnessed three visitors entering the home freely and not accompanied by staff. This could compromise the safety of some residents. Care Homes for Older People Page 20 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels may not always meet the needs of the people who live in this home, and recruitment procedures and safe working practices are not always followed. Evidence: The current staffing levels in this home are; Three carers on an early shift (08:00 14:00), supported by a cook who works from 08:00 -14:00 hours six days a week, and a cleaner who works from 07:00 - 11:00 hours also six days a week. The afternoon shift (14:00 - 20:00) has three care staff on duty, and the night shift has one waking carer and one sleeping in who works until 23:00 hours and also from 05:00 - 08:00 before going off duty in the morning. The manager generally works a 09:00 - 17:00 hour shift. She told us that on Mondays and Wednesdays there is an extra senior carer on duty to catch up with the weekend work. We were unable to ascertain exactly what this meant. We looked at the rotas for July 2009, the month prior to this inspection, and it was evident that these numbers are not always achieved. For example on Monday the 28/07/09 and Wednesday the 30/07/09 there was no evidence that the extra senior care was on duty, and on Wednesday the 15/07/09 although four staff were rostered on duty, three of them were allocated to do fire training. Care Homes for Older People Page 21 of 32 Evidence: We also noted from the rotas that throughout this period, from the 6th July - 3rd of August 2009, one senior carer had only one day off, and another only had two days off. These are unsafe working practices which must be addressed. We looked at the files of three members of staff during this inspection. All had fully completed application forms, Criminal Record Bureau and POVA first checks, various forms of identification and references. We were however concerned that one senior carer was working on a student visa allowing him to work 20 hours per week, however his contract stated 40 hours per week. When we queried this with the manager, she showed us a letter from the company supporting his training. This stated that because of the practical elements of the training, the Home Office Regulations allow him to work 35 - 40 hours per week. There was no letter supporting this from the Home Office. We suggest the manager follows this up and obtains a letter from the Home Office confirming this. We went on to look at this individuals rostered hours from the 06/07/09 - 03/08/09. The rotas show that in addition to working four night shifts a week, which is 48 hours, this individual is working day shifts on his nights off, increasing his hours in excess of 50 hours every week. During the four week period that we looked at, this person had only taken two rest days. This is both unsafe and against Home Office regulations. We advised the manager this must be addressed immediately. At approximately 14:00 hours we met a lady who was sitting in the lounge with a large box containing balls and other equipment. When we spoke to her it transpired that the activity organiser in this home was on leave for a month, and he had asked her to stand in for him. She had not been interviewed by the home manager / company or gone through any of the recruitment checks with the home. The Responsible Individual advised her that she could not stay. When we asked to see the file of the activity organiser who is on leave, she advised us that she did not have a staff file for him. Because he also works as a volunteer in the local hospital she did not think it was necessary to complete the recruitment process for him or carry out the required CRB / POVA list checks. An immediate requirement was issued relating to this. We looked at the staff training matrix during this inspection. This identified a range of courses both mandatory and more specialist, that are available for staff. The matrix showed that generally staff attend the mandatory training as required. We noticed that the cleaner had not attended safeguarding training, and when we asked the manager why, she told us that as a cleaner he did not believe this was necessary. We Care Homes for Older People Page 22 of 32 Evidence: advised her that all staff within the home should understand all aspects of the safeguarding process. All the staff in this home are either working towards, or have already achieved NVQ certificates in care. Despite the issues that we found, feedback from surveys received from residents and their representatives was very positive relating to staff. One read. The staff at Hepworth House should be recognised for the energy motivation and genuine interest they put into providing invaluable care and attention to the residents. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The AQAA was returned without being fully completed and did not give as a reliable picture of the service. The is a limited understanding of person centred thinking and the manager lacks knowledge relating to some of the core processes that safeguard the people living in this home. Evidence: The manager Mrs Roy has been working in this home, in this role, since 2007, she is appropriately qualified and has a passion for the residents that she cares for, however we identified some gaps and omissions in some core processes such as recruitment and safeguarding, that indicate that there is a need for her to up date her own knowledge further. Feed back from staff surveys indicated that Mrs Roy is well respected, and practices in a supportive way. Observations throughout this inspection also indicated that there is mutual respect and friendship between the residents and Mrs Roy, and the residents Care Homes for Older People Page 24 of 32 Evidence: trust her implicitly. The last completed Annual Quality Assurance Assessment (AQAA) we received from the home was in November 2008. This was not fully completed, for example policy review dates were not included. This is an important element of the document as it identifies the home awareness to keep up to date with changes in processes. In particular for policies such as safeguarding, it is crucial these follow local/ national protocols and are updated accordingly. The policy for safeguarding in this home was last reviewed in 2004. We also noted that some of the improvements had not yet been achieved ten months on. For example the introduction of training in Diabetes, and more person centered care. Questionnaires are given to residents frequently on a rotational basis in order to identify any problems within the home. However the Quality Assurance report for this year is not yet in place. We look forward to seeing the completed report. This home keeps money for five of the people who live there, however this is kept in the CD cupboard as there is no safe facility. This is not acceptable and should be addressed as a matter of urgency. We checked the accounts of all five residents. These all balanced correctly with funds remaining. All transactions were clearly recorded, and supported by receipts. We looked at the supervision documentation for staff in this home. This was rather sporadic, with very little evidence of formal supervision taking place so far this year. We appreciate that informal 1:1 discussions with staff take place, but records must be kept. Two of the files we looked at had no evidence of any supervision since June/July 2008. We looked at the health and safety records. These showed that appropriate checks on fire call points, water temperatures, food and freezer temperatures, fire equipment, door closures and window stops are being carried out. Regulation 37 notifications are submitted appropriately, and accident forms are completed in a timely fashion. Where accidents have occurred, this is clearly recorded in the individuals files and followed up by medical attention where necessary. However some of the documentation/ records, in particular the care plans, that we looked, at failed to address specific conditions for residents that could compromise their health and well being if not recognized and managed appropriately. We also noticed that residents files were being stored in a cabinet in the dining room which Care Homes for Older People Page 25 of 32 Evidence: was not secure, and could be accessed by anyone entering that area of the home. Unfortunately the manager was not clear about the correct procedures to follow in the event of safeguarding allegations being made, and the policies that were in place were out of date and did not reflect either local or national protocols. An immediate requirement was issued relating to this. Care Homes for Older People Page 26 of 32 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 27 of 32 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 18 13 The registered person shall 12/08/2009 make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. People who live in this home must be protected from abuse. 2 29 19 The registered person must 13/08/2009 ensure that no staff work in the home until all documents specified in paragraph 1 - 7 of schedule 2 have been obtained in relation to that person. People who live in this home must be protected by the recruitment policy and procedures. 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 service user guide must provide information on current fees for the home, and detail accurate information relating to The Care Quality Commission. 14/09/2009 Care Homes for Older People Page 28 of 32 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 Prospective residents must have access to all the required information within the service user guide. 2 7 15 The registered person shall prepare a care plan that clearly identifies how the residents health and welfare needs should be met. This should include the individuals wishes in the event of illness or death. People who live in this home should have a care plan that clearly identifies all areas of care that need to be addressed by staff. 3 9 13 The registered person shall 24/08/2009 make arrangements for the safe and appropriate storage of all medication in this home. People who live in this home should have their medication stored appropriately. 4 27 18 The registered person must ensure that all persons working in the home receive appropriate training and time off. The people who live in this home must be protected by safe working practices. 14/08/2009 14/09/2009 Care Homes for Older People Page 29 of 32 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 5 31 8 The manager must keep her own knowledge and skills relating to core policies and procedures up to date. The people who live in this home be cared for by a manager whose knowledge relating to policies and safe working practices, is current and up to date. 31/08/2009 6 33 24 The registered person must supply a copy of the current quality assurance report to CQC People who live in this home must have access to a report that identifies how the quality of care is being kept under review. 30/09/2009 7 35 16 The registered person must ensure that there is an appropriate place to hold residents money and valuables safely. People who live in this home must have an appropriate place for the safekeeping of their money and valuables. 31/08/2009 8 36 18 The registered person must ensure that all staff recieve regular supervision. . 28/12/2009 Care Homes for Older People Page 30 of 32 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 People who live in this home must be cared for by staff that are appropriately supervised. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 15 25 The home should consider the need to purchase further crockery. The home should consider securing the back gate so that they are in control of who enters and leaves the premises. Care Homes for Older People Page 31 of 32 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. 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