Inspection on 16/09/09 for Highfield House Nursing Home

This inspection was carried out on 16th September 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield House Nursing Home 05/12/07

Highfield House Nursing Home 26/03/07

Highfield House Nursing Home 03/01/06

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Highfield House Nursing Home 33 Queens Road Ryde Isle of Wight PO33 3BG     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: Anita Tengnah     Date: 1 6 0 9 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 33 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 33 Information about the care home Name of care home: Address: Highfield House Nursing Home 33 Queens Road Ryde Isle of Wight PO33 3BG 01983811015 01983614713 info@sciohealthcare.co.uk www.sciohealthcare.co.uk Scio Healthcare Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability Additional conditions: The maximum number of service users to be accommodated is 46. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical disability (PD). Date of last inspection Brief description of the care home Highfield House is a registered care home providing personal care, nursing care and accommodation for up to forty-six older people. The home is situated on the outskirts of Ryde within a few minutes walk of the main shopping centre and amenities of the town centre. There are good bus links to Ryde town centre and Newport with a bus stop located Care Homes for Older People Page 4 of 33 Over 65 0 0 46 46 Brief description of the care home close to the home. The home offers accommodation arranged over three floors, accessible to thelservice users via two passenger lifts. All the bedrooms offer single accommodation. Communal space comprises a large dining room and lounges over the three floors, with quiet areas that afford privacy if required. There is a large central courtyard garden with seating for use by the people who use the service. The area to the front of the home has been converted to provide car parking. The home does not have a registered manager at the time of this inspection. Information such as service users guide and the statement of purpose are available at the home. Care Homes for Older People Page 5 of 33 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: An unannounced visit was undertaken on 16 September 2009 as part of our inspection. The evidence used to write this report was gained from a review of all the information we have received about the service since the last inspection and a visit to the home. The visit was carried out by two inspectors and lasted eight hours. During the visit we spoke with people who live in the home, visiting relatives, staff on duty, the manager and the responsible individual. Documents relating to the running of the home were inspected that included care plans, assessments records, staff and the service users records. We looked at some of the service users bedrooms with their consents and the communal areas around the home. We sent out our Annual Quality Assurance Assessment ( AQAA) to the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people Care Homes for Older People Page 6 of 33 using the service. It also gave us some numerical information about the service. We received the completed AQAA and this gave us good information about the service. This is included in this report, as was information gathered by the Commission since the last inspection to contribute in assessing judgements in this report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: There is a lack of clear care planning and reviews to ensure that care is provided safely. Peoples weights are not always monitored and records of fluids are inadequate. Medication management needs further improvement so that people are not put at risk, as this was not adequate at the time of the visit. There are systems in place to respond to complaints. However the complaints record is not always completed. This means that peoples complaints may not be investigated and action may not be taken to resolve the problem. Recruitment checks are not fully completed prior to staff starting work. Staff feel under pressure due to inadequate staffing to meet the needs of people. The service must appoint a manager and ensure that this person is registered with the Care Homes for Older People Page 8 of 33 commission in order to provide stability. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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. There are some information in assessments but it is not sufficient for the home to make a fully informed decision as to whether the home is suitable for prospective service users. There is a good intermediate care service provision available at the home. Evidence: We looked at the pre admission process that the service has in place such as assessments that are completed prior to admission. The AQAA from the service indicates that all new service users are assessed prior to admission. We looked at four pre admission assessments records. One of these contained an assessments from a care manager. The home had not undertaken their own assessment. The manager reported that the process is following referral and care managers assessment the home should also complete their own assessment, to Care Homes for Older People Page 11 of 33 Evidence: ensure that they are able to make a decision to meet this persons needs. One of the service users had been transferred from another home and the manager stated that they needed a continuing care bed. The records did not contain evidence that the home had undertaken their own assessment prior to admission. The record for one service user contained a care managers assessment and the manager stated that this person was admitted as an emergency and the home was not able to complete their own assessment. The record for another service user had been completed by the Primary Care Trust (PCT) contained detailed assessments that included maintaining safe environment, moving and handling, pressure areas risks, diabetic assessment and oxygen therapy. We also looked at the record of a service user who had been admitted for respite care. According to their past records, this showed that this person was totally dependent on staff for their care. Their records showed that the assessment had not been reviewed on admission to ensure that any changes in their needs since the last visit had been clearly identified. This put the person at risk of not receiving appropriate care to meet their needs. The home was providing care to two people who receiving intermediate care at the time of the visit. The manager reported that there is good support and joint working with the local primary care trust (PCT). A separate designated area was available for this service at the home. The manager reported that medical support was good and included regular visits from the senior doctor responsible for these service users. Care Homes for Older People Page 12 of 33 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. The assessments and care plans do not fully meet all the needs of the service users in order that care can be provided safely. The access to external healthcare is well managed. The medication management at the service is not adequate and put people at risk of not receiving their medicines and care appropriately. Evidence: We looked at the records for five service users as part of this visit to assess how the home was meeting the needs of people accommodated. Care plans and risk assessments had been developed and there was information from the local primary care trust team (PCT) to help support people living at the home. One of the care plans from the PCT contained detailed assessments of needs and care plans had been developed to demonstrate how this persons needs would be met. The care for continence management for example showed that the person had a urinary Care Homes for Older People Page 13 of 33 Evidence: catheter with details of catheter changed and the type of catheter in situ to inform staffs practices. Other care plans for this person included bowel care,pressure areas, moving and handling, oxygen administration and weight chart. Care records seen contained risk assessments and care plans for falls as appropriate and one record seen contained details of consent for bed rails. The care records for a service user who had been transferred to the home showed that they did not have a care plan in place, the manager reported that this was not available as staff has not yet completed this. Risk assessment for fall had been completed , however no care plan. The records showed that they have a pressure ulcer and the wound assessment chart has not been reviewed/ updated since admission. This failed to show how the staff was managing the pressure ulcer. A record to indicate that the wound had been re-dressed on the day of admission, a copy of the extended care plan / transfer form have been submitted following the inspection, but were not available at the time of the visit. A moving and handling assessment and weight chart were in place as completed on the day of admission. The record states that that fluid is being monitored but no nutritional assessment or care plan for eating and drinking were available to support care staff and provide effective care. We viewed the record of a service user who has been admitted for respite care. The care plans and assessments had not been reviewed for the current admission to reflect their current needs and provide clear guidance for staff. For example under the heading appetite it states that the service users appetite and fluid intake is poor. The identified risk stated that the service user was at risk of dehydration and weight loss. However there was no nutritional assessment or detailed guidance for staff to follow to ensure that the service user was having enough fluid and intake of food. Evidence from previous records showed that the service user had been losing weight. The records of food and fluid charts being maintained to monitor the persons health were poor. The fluid balance record showed that they had received a total of 190 mls of fluids on the 15 September 09. The weight chart record indicated that they had been losing weight and the last weight was recorded in June 09 at 41 kg from 47 kg in February 09 and no further weight record was available. The records for a service user who was receiving their feeds via a percutaneous endoscopic gastrostomy (PEG) tube showed that a nutritional assessments and food and fluid care plan had been developed. The nutritional assessment care plans gave details of the type of feed and the volumes that were being administered. A fluid balance record was also maintained. The care plans for this person showed that staff were reviewing these monthly as required to reflect any changes in their needs. The Care Homes for Older People Page 14 of 33 Evidence: nutritional assessment record and eating and drinking plans did not correlate and gave different information about the type of feeds despite that these had been reviewed by staff. Another service user record showed that they required regular turning/ tilting, the staff recorded this on a turn chart. We found that this record was variable and not always appropriately completed and had large gaps. This was brought to the attention of the responsible individual who stated that care given was recorded on a different sheet. We looked at the medicines management that the home undertook on behalf of the service users. The home was using a monitored dosage system and the medication was stored in the clinical room. The manager stated that only the registered nurses had access to and were responsible for the medication. The medication was stored safely in the clinical room that included controlled medicines and another cupboard contained medication and a large quantity of wound dressings that the home was using as bulk. The staff kept a record of medicines that they administered on behalf of the service users on their medication administration record (MAR) charts as required. One of the service users records contained detailed care plan for their as required medication that included analgesia and bowel medicines. We found that there was some evidence of good practice, however this was not consistent in all the records. The MAR for a person receiving PEG feeds were not accurately completed when this was administered as the MAR record contained gaps. Care was not supported by good record keeping. We carried out a random audit of medication that had been administered and the remaining balance. This showed that the amount did not correlate with the record of administration which put the service users at risk of not receiving their medications correctly. A random sample of medicines that we audited showed that for one of the medicines there were six missing and another had eight extra tablets left. These show that some people were not receiving their medicines as prescribed. All medication received were not recorded on the MAR charts and staff failed to record variable dosages as required. This puts people at risk of not receiving their medicines safely. Care Homes for Older People Page 15 of 33 Evidence: One service user was receiving a medication that was prescribed as one daily on the MAR chart and had different instruction on the bottle. Staff had hand written on the MAR chart to be given three times a day as required. There was no record to show on whose authority the prescription had been changed or the date that this was changed. There was no care plans available for some of the service users as required medications at the time of the visit in order to inform the staffs practice and to guide staff as to when they should give these medicines to these people. The record for a service user showed that they had been refusing their medication for a week on two previous admissions. There were no records to show what action the staff had taken to ensure this persons healthcare needs were met. We observed a service user had a PEG feed being administered at the time of the visit. The bottle feed did not have a label to indicate what was being administered, as the staff had failed to record this on the container as required. The manager stated that the staff are aware that the feeds must always be labelled. However this was not being carried out at the time. This poses a risk to the health and safety of people and they may not receive their prescribed care as required. The home had a large quantity of medicines,creams, ointments and wound dressings that the manager confirmed were used as bulk. However there was no procedures in place to show how these were being managed. There was no evidence that the staff had completed an assessment and deemed competent to enable them to prescribe these medicines. Following receipt of the draft report the provider has advised us that the staff have received suitable training, however the evidence was not included/ missing. The home is required to ensure that accurate records of all medicines received and administered to the service users are maintained. An ointment was removed from the bulk dispensing cupboard, as the label had been taken off and staff was unable to identify who this had been prescribed for. The home has a procedure in place for returned medicines and they have contracted with an external agency for their disposal as required. We found that medicines including tablets had been discarded in the sharps containers at the time of the visit. The staff have failed to ensure that all medicines are disposed of safely. There were also a number of medicines that were no longer on the service users current MAR charts that remained at the service. This shows that although there is a procedure for returned medication, this was not being effectively managed. We observed staff Care Homes for Older People Page 16 of 33 Evidence: practices and spoke to six people who said that their privacy was respected. The staff attended to the service users in a respectful manner when supporting them with their care. Visitors we spoke to said that their relatives were treated with respect and the carers did their best and were helpful when providing care. This was also supported by a number of thank you cards that were available at the service. We noticed that one of the communal toilets door had see-through glass that may compromise the privacy of the service users. This was brought to the attention of the manager who confirmed that action would be taken. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an activity programme that people take part in as able. The meals at the home are varied, choices are offered and meet with the satisfaction of the service users. Evidence: The home has an activity coordinator who has developed a programme of activities for the service users. The AQAA states that activities are provided six days a week and they were planning to introduce activities also on Sundays. Staff reported that the activities programme included painting, craft, gardening. We saw evidence of creative arts displayed at the service that included painting and bottle crafts. Two service users said that they enjoyed doing things in the day. Another service user said that they were bed bound and enjoyed the television and did not take part in activities. Another service user stated that they did not know of activities available and did not take part. The activity coordinator said that she worked weekdays and found that small group activities worked well with the current client group. Care Homes for Older People Page 18 of 33 Evidence: The visitors we spoke to were not aware of an activity programme and another said that they took their relatives out regularly to the sea front and coffees. The home has an open visiting policy and the visitors book demonstrated that people visited at different times throughout the day. Three people said that they visited regularly and there was no restriction on visiting times. Tea and coffee were available in the entrance foyer for visitors to the home. The AQAA states that as part of listening to people the service has introduced high carbohydrate snacks in-between main meals, particularly for service users who have dementia and those who have swallowing difficulties, many of whom can manage only small portions of food at a time. This includes freshly made fruit smoothies. There is a separate dining area for people with dementia. The service has a planned menu that is rotated on a four weekly basis. The catering manager stated that all residents are assessed for dietary choices/needs and are provided with colour co-ordinated menus and special dietary charts so that staff can check that the diet is correct. Residents are asked each day for their choices daily for the meals the following day. The manager reported that the smoothies offered had since been reviewed due a lack of uptake/demand. We observed the lunchtime meals on the day of the visit. We found that the service users were offered a choice of meals and three different meals were provided on the day. People we spoke to said that the food was very good and they had choices. Relatives also said that the food is good and my dad seems to enjoy his meals. Comments were good dinner and plenty to eat. I have a small appetite but the food is always nice. There is always plenty to eat and the puddings are good. Lovely food. We observed three staff were providing support to three service users in the lounge and this was carried out in a sensitive manner and meals were not rushed. Another staff member was seen supervising three people in the small dining area. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to respond to complaints. However failure to complete the complaints records does not demonstrate that staff have a clear understanding of their responsibilities. This means that peoples complaints may not be investigated and action taken to resolve problems. Staff have an understanding of their responsibilities to respond to allegations of abuse. There is a failure to thoroughly check staff as part of recruitment procedures and a lack of follow ups to safeguarding concerns. Peoples nutritional needs monitoring are inadequate and does not ensure the full protection of people living in the home. Evidence: The home has a complaints procedure, which is given to people as part of the service users guide. The procedure sets out who will respond to complaints and the timescales within which the home aims to resolve them. Two relatives we spoke to said that they would go to the office if they had any concerns. A service user said that they would talk to the staff but wanted to stress that the staff were very kind. Care Homes for Older People Page 20 of 33 Evidence: We observed that there were at least a dozen thank you cards that were displayed in the entrance hall from the service users. We looked at the complaint log that the home is required to maintain as part of Regulation records at the service. A complaint log was available and this showed that some of the complaints/ concerns had been responded to, including a response from the responsible individual. There was some evidence of good practice but this did not apply to all the concerns/ complaints recorded. Records must include evidence of investigations undertaken and their outcomes and responses made to the complainants. This is needed to ensure that people are confident that their concerns/ complaints would be listened to and dealt with.These should be used by the service as part of improving outcomes for the service users. The AQAA states that there has been 24 safeguarding alerts reported to social services and there has been two investigations. These alerts included unwitnessed falls that the home has agreed to send to social services as required. Information that we have received indicates that there has been fourteen safeguarding investigations and some of these had been closed. Allegations of under staffing has formed part of wider investigation. Many concerns have been raised as an ongoing factor in relation to staffing levels and levels of dependency of clients. Some of these complaints about staffing levels were from the service users relatives. We looked at the records of safeguarding referrals that the home maintained and this showed that the previous previous service manager had started to follow up safeguarding referrals to record their outcomes. This has not been been fully completed and did not contain follow up outcome/action as required. We found that the information that we have received did not correlate with the safeguarding records as maintained at the home. The AQAA states that they plan to improve the level of training on safeguarding to more fully include the use of, and understanding of local procedures rather than the general information currently provided as part of the induction programme, however this is not yet in place. Care Homes for Older People Page 21 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are provided with a well maintained, clean and homely environment that suits their needs. Infection control procedures are in place and staff practice showed that they were aware of good practice guidance. Evidence: Information that we have received from the AQAA states that the main building work is now complete and the home continues to upgrade and refurbish the older parts of the home. Some of the recent refurbishment included redecoration of the corridors in the older part of the building, new lighting which is more domestic in character. Two rooms have been upgraded in the older part of the building to the newer standard and full en-suite wet rooms installed. A third upgraded room includes an en-suite bathroom and another room has been fully redecorated with new carpet. The staff reported that work will be continuing in the basement to improve the laundry facilities and new machines have been purchased. We looked at some parts of the home as part of our visit that included a number of the service users bedrooms, communal lounges, bathrooms and the laundry. The home was warm and homely with a good standard of decoration, furnishing and fittings. We found that the service users bedrooms were personalised and it was Care Homes for Older People Page 22 of 33 Evidence: evident that people were supported to bring in items of personal belongings. The service users and the visitors were all complimentary about the homeliness of the service and commented that the home was always clean. We did not detect any unpleasant odour when we looked around the building. It was evident that there was a cleaning programme in place and the home was fresh and clean. Comments from the service users included: My room is cleaned everyday and I am very happy here The home is always clean and the staff work very hard. I have lots of my things around and it is very homely. I have lots of family photos and I have them all around, which is very nice. The manager reported that as part of the development plan work, they are looking at upgrading the old part of the building to the same standard as the new build. The home has a laundry in the basement that the staff reported was planned for refurbishment sometimes this year. The laundry was equipped with industrial washers and driers and infection control procedures were in place for dealing with soiled laundry. The laundry staff stated that the service users clothing are marked with their room numbers to prevent them being lost/ misplaced. Equipment such as gloves and aprons are available as part of infection control measures. Care Homes for Older People Page 23 of 33 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. The service does not always have adequate staff to meet the needs of people. The recruitment process in inadequate to ensure that people are not put at risks of harm. There is an ongoing training programme to support the staff. Evidence: We looked at the staffing roster that the home has in place as part of our visit to assess the staffing arrangements. Information that we have recently received raised concerns during monitoring visits, regarding long periods of call bells not being answered and people left unsupervised in the lounge for long periods of times. We monitored the call bells during a period in the morning and found that call bells were ringing for between five to seven minutes and unanswered. This was raised with the responsible individual who stated that the staff were attending to the call bells but these were not switched off according to him so that they remember to go back. However this meant that people were still left waiting for the staff to return to meet their needs. Care Homes for Older People Page 24 of 33 Evidence: The duty roster showed that there are 2 nurses on day duty and only 1 nurse on night duty. The morning shift has seven carers and six carers in the afternoon. Night duty has 1 nurse and three carers. The three staff we spoke to said that they felt rushed and there was inadequate staff to care for the service users. On the day of the visit they told us that there were three carers on one floor to look after 15 service users and the staff stated that it was very difficult, as it also depended on the moods of the service users. They tell us that the service users have high care needs that often required two staff members to attend to them. Comments were it is always a rush to get things done. People we spoke told us that staffing has been a problem with not enough staff to care for their relatives. One person said that things got a bit better since change in management. The service users whom we spoke to said that staff do their best, but bells can take a while to answer. Another comment was it depends how busy they are, the staff try hard. Night duty has one trained nurse and given the complex needs of the service users and the layout of the environment, this is not sufficient to safely meet the needs of people accommodated. The AQAA states that on night duty all the service users require two staff to attend to their needs. The complaint log also showed that concerns had been raised about the lack of staffing. The response from the senior representative of the company was that that this was the case as several staff members would go off sick and replacement agency staff were unavailable.Family felt that it was the responsibility of the home to fulfil their responsibility and they should ensure that sufficient staff are available to provide adequate care. We looked at the recruitment records for two staff recently employed at the service. All applicants completed an application form and employment history was recorded. We found that one of the staff records contained one reference and a POVA first check. The AQAA states that CRB at enhanced levels is undertaken and POVA first check is obtained before any new staff commence work. We noted that the staff did not have an enhanced CRB clearance and was working at the service. There was no record to show what type of supervision has been put in place. Care Homes for Older People Page 25 of 33 Evidence: The other staff record contained a reference from their last employer, another reference and a copy of disclosure details. The second reference was not from someone on their employment history. There was no evidence to show what action had been taken to follow this up. The manager reported that all new staff completed a three days in house induction. We did not see records of these. The service has an ongoing training programme and this is shared with the sister homes. We did not look at training records as the training manager was away at the time of the visit. One staff member said that there was training available and they felt supported. Another staff stated that they had recently completed training in health and safety and infection control. The AQAA states that the staff have implemented a dementia workshop and plan to involve service users and their relatives in this group. Other development planned is more on developing person centred approaches within the home and staff through the standards developed by the Alzheimers Society using Today and Tomorrow resources. The AQAA states that 10 permanent and 4 bank staff have completed national vocation qualification (NVQ) at level 2 or above and 6 staff were undertaking this training at present. We do not currently have information about the number of carers that the home employs. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no current registered manager at the service with responsibility for day to day management. There are systems in place to protect the health and safety of people. However the lack of clear care planning, reviews, medication management and recruitment checks do impinge on the quality of care and reflects a lack of organisational leadership. Evidence: Information from the AQAA states that the service have achieved the Investors in People award as a company and continues to develop action plan in this area of work. Since the last inspection the provider has appointed a new manager for the home. The manager submitted an application for registration with the commission. However the manager has since left the service, and there is no registered manager responsible for the home at the time of the visit. The service has appointed an interim manager from Care Homes for Older People Page 27 of 33 Evidence: one of the sister homes and the responsible individual stated this person would be applying to register with us. The responsible individual also reported that other management changes included the departure of a senior representative who was was providing management support to the staff. We wrote to the responsible individual following concerns we had received about staffing and proposed restricting admission to the service. We have not received a response as the responsible person stated that they were still waiting for a meeting with social services. Given the concerns regarding staffing in this report, this must be addressd so that the current service users receive appropriate care to meet their needs. The home has an internal audit system in place and the responsible individual showed us a sample of a recent survey. This indicated that the sevice has an internal process to seek the views of people living at the home. The AQAA states that focus on health and safety is continuing. Information we have from the AQAA shows that checks on equipments are completed at regular intervals to ensure that these are fit for purpose. We receive regular reports as required by Regulation and the provider keeps us informed of incidents that affect the welfare and safety of people living at the home. Peoples assessments and care plans as reflected in previous sections of this report are inadequate to ensure that they receive the care they need in a safe manner. There are inadeqaute processes to ensure that people receive their medication safely and as prescribed. All necessary staff checks to protect people living at the home from the risk of poor practice and harm were not available. There is no registered manager with clear lines of accountabilty and to provide continuity of care. Care Homes for Older People Page 28 of 33 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 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must ensure that staff follow the assessment process and people are assessed prior to admission and receiving care. To ensure that the home is able to meet their needs. 30/11/2009 2 7 15 The registered person must 30/11/2009 ensure that the service users plans contain details of assessments and plans of care are developed to reflect the current needs of people. So that people receive the appropriate care to their needs. 3 8 14 The registered person must 30/11/2009 ensure nutritional screening are undertaken and a record of nutrition, fluids, weights are recorded. Care Homes for Older People Page 30 of 33 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 To ensure that food and fluids intakes are monitored and their needs are met. 4 9 13 The registered person must ensure that arrangements are in place for the recording, handling, safe administration and disposal of medication received into the service. So that people receive the medication they are prescribed safely. 5 16 17 The registered person must ensure that a record of all complaints and action taken are maintained at the service. To ensure that people are confident that their concerns will be listened to and responded to as appropriate. 6 18 12 The registered person must 30/11/2009 ensure that all allegations of abuse are reported and action taken is recorded. To protect the welfare of people accommodated at the home. 7 27 18 The registered person must ensure that there are adequately trained staff and in sufficient numbers to 30/11/2009 30/11/2009 30/11/2009 Care Homes for Older People Page 31 of 33 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 meet the needs of the service users at all times So that people receive their care safely to meet their needs. 8 29 19 The registered person must ensure that all necessary staff checks are completed prior to employment . To ensure that people are not put at unnecessary risks of harm. 9 31 18 The registered person must ensure that following appointment of a manager they are registered with the Commission. So that there are clear lines of accountability for the service. 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 30/11/2009 01/12/2009 Care Homes for Older People Page 32 of 33 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. 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