Inspection on 15/01/10 for Highfield Residential Care Home

This inspection was carried out on 15th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield Residential Care Home 26/05/09

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Highfield Residential Care Home Culver Street Newent Gloucetsershire GL18 1JA     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: Sharon Hayward-Wright     Date: 2 6 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 50 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 50 Information about the care home Name of care home: Address: Highfield Residential Care Home Culver Street Newent Gloucetsershire GL18 1JA 01531821007 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Accommodating Care (Newent) Limited care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 27 The registered person may provide the following category of service only: Care Home only - Code OP to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Highfield House is a converted and extended Victorian property located approximately half a mile from Newent town centre. The Care Home provides accommodation and personal care for up to 27 older people on three floors. A shaft lift is available to assist those unable to manage the stairs. In addition, a variety of aids and adaptations that include hoists and hand rails are provided throughout the property to assist those living in the Home. The communal facilities comprise of a large lounge and dining area, plus a conservatory overlooking the attractive garden. There are additional smaller sitting rooms provided on the ground and first floors. The majority of the bedrooms Care Homes for Older People Page 4 of 50 Over 65 27 0 Brief description of the care home have en-suite facilities; many have the advantage of delightful views over the surrounding countryside. The fees for this home are from 340.85 pounds to 477.75 pounds per week. Additional services not included in the fees are chiropody, newspapers and hairdressing. The home makes available to people a copy of our reports and their Statement of Purpose and Service Users Guide. Care Homes for Older People Page 5 of 50 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 by two inspectors over 2 days in January 2010. One of the inspectors was a Pharmacist who examined the system the home has in place for the management of medications. Before we visited the home we sent surveys to the home in order to get the views from people who use the service, their relatives/friends and staff. We received 5 from people who use the service, 4 from relatives/friends and 3 from staff. The results of these have been used in the report. We brought this key inspection forward due to the concerns we had received, therefore we did not have time to request an Annual Quality Assurance Assessment (AQAA). We looked at other information we have received from or about this service from other stakeholders. This includes notifications from the home regarding incidents that effect the well being of those who use the service. We looked at a number of systems the service has in place to include care records, Care Homes for Older People Page 6 of 50 activities, complaints, food provision, ongoing maintenance of the home and staff training, supervision and recruitment. Since the last key inspection the Registered Manager has left and a new acting manager has been appointed. As we had a number of concerns about the service and how peoples needs are not being met, the Registered Provider met with us on the second day of the inspection. He was very keen to work with us and address the shortfalls in the service. Care Homes for Older People Page 7 of 50 What the care home does well: What has improved since the last inspection? What they could do better: The home must make sure that they do not admit people to the home that are outside of their registration category and that when new people are admitted they must make sure they can meet their needs. Otherwise it means people may have to leave the home and undergo another assessment process for another home. Care plans must be in place for all peoples assessed needs and kept under review. These plans must provide staff with clear directions on how to meet peoples assessed needs. They should also contain peoples individual choices. Risk assessments must be devised and actions listed for how staff can minimise risks to people. These must also be kept under review and updated as necessary. The home needs to devise a system so that people can be assessed to determine if they are nutritionally at risk and a system needs to be put in place to manage this. Some of the medication systems used by the home need to be reviewed and monitored to make sure they are safe and people are not placed at unnecessary risk. The home needs to provide people with an activities programme based on their needs, choices and preferences. The home also needs to look at providing activities for people who choose to stay in their rooms. At the present time people are not offered a choice over their meals. For lunchtime people are only offered one choice of meal, however alternatives are provided. The tea-time meal also tends to be sandwiches again people are not being offered a choice. No snacks are available for people to help themselves. The staff need to be mindful that some of their practices could place people at risk of harm or possible abuse for example, unsafe medication practices, poor care planning and the lack of risk assessments. The lack of choices for people and how the staff failed to manage the recent outbreak of diarrhoea and vomiting. The majority of the decor in the environment needs to be updated as it is tired looking in places. Carpets in a number of areas need to be replaced as they are heavily stained. Some of the communal rooms are very cluttered and this needs to be removed so that people live in a pleasant environment. Staff require training in a number of areas to improve their knowledge and skills, for Care Homes for Older People Page 8 of 50 example the home recently had an outbreak of diarrhoea and vomiting but the staff did not realise this and act quick enough to put strict infection control procedures in place. We had to tell the staff that they need to do this. This is not acceptable as it places people who use the service at risk and visitors to the home. For the home to move forward more emphasis needs to be placed on improving the staff morale. A quality assurance system needs to be devised to make sure the home is run in the best interests of people who use the service and not the staff. Because we have concerns about the kitchen area and the fire systems the home has in place we have contacted the local Environmental Health Department and the Fire Service and requested that they visit the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 50 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 50 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being admitted to the service without full consideration of all their care needs and staff have the skills and knowledge to meet these needs. Evidence: We examined the pre admission assessment of a person who was recently admitted to the home for respite care. The acting manager had completed the assessment whilst the person was still in hospital, however the assessment was not dated or signed. The assessment was brief but did contain some information about this persons care needs. However on reading the additional information that had been provided by the Gloucestershire County Councils Community and Adult Care Directorate (CACD) we found that this person had been attending day centers for people with dementia. The home is not registered to care for people with a diagnosis of dementia. The information from both the pre admission assessment completed by the acting manager and the information from CACD mentioned that this person had some challenging behaviour and short and long term memory problems. On the second day Care Homes for Older People Page 11 of 50 Evidence: of the inspection the acting manager said the home felt they could not manage this persons needs and had requested a mental health assessment. The person who completed this assessment should have examined all the information they had in more detail before accepting this person into the home. If this person is not ready to be moved back to their own home then they will now need to be moved to another care home who can meet their needs. We did not see a copy of the letter the home needs to send to people or their representatives confirming if they can meet their needs following an assessment. On the first day of the inspection we found that several people had diarrhoea and vomiting, and one person who had been discharged from hospital the day before was also having these symptoms. The staff had not recognised that because a number of people were displaying these symptoms that they need to instigate strict infection control procedures. We found that people were in the communal areas whilst having episodes of diarrhoea and vomiting, thus allowing this to spread to other people who use the service. We discovered information about people having diarrhoea and vomiting was written on the food records sheet used for the kitchen. It was not recorded anywhere else in the home. This is very poor practice and places people at risk. We observed one member of staff who was serving hot drinks to people physically handing people biscuits with out using gloves or tongs, which is poor practice. As the staff had not recognised the significance of this no notices had been put on the door warning visitors to the home. This is discussed further in Environment. We also have concerns about the knowledge and skills of staff when caring for people who have dementia. For example on the first day of the inspection another person who was also admitted to the home with a diagnosis of dementia and has had episodes of challenging behaviour was sitting in the main lounge. The staff had placed a table in front of them which could be seen as a form of restraint, and the staff left them a town and country magazine to read. From our observations on that day this person had very little social interaction with other people and staff as they are confused and it was obvious to us they were not able to read the magazine. This is poor practice. We did not witness any activities taking place for this person or any other people. This inspection has highlighted a number of serious concerns about how the home is caring for people who use the service. These are discussed throughout the report. Highfield House does not provide intermediate care. Care Homes for Older People Page 12 of 50 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 health and personal care that people receive is not based on their individual needs. Care plans lack clear direction for care staff to follow and are not up to date. The principles of respect, dignity and privacy are not always put into practice. There are still a number of weakness in the way medicines are managed that can be a risk to the health and wellbeing of people living in the home. Evidence: As part of the inspection we case tracked two people. This includes reading care records, speaking to the person if able and staff members and observing and interactions between staff and the person. We also examined a number of other peoples care plans. One person was recently admitted to the home and the other person had been at the home for a number of years. The new person did not have an ongoing assessment of need in place only the assessment completed prior to admission. The other person had a care needs assessment in place but this was very brief and any needs were assessed Care Homes for Older People Page 13 of 50 Evidence: from low to high rating. This was last reviewed in November 2009, however it was very clear that this persons care needs had drastically altered since this and that the assessment was very out of date. This assessment must be updated with this persons current care needs. The home uses computerised care plans and from the ones we examined there is a set format for each care need. Both people had the same care plan in place for maintaining a safe environment and this mentioned that the home has locks on all exits, keys are available to each persons room and that call bells are in all areas of the home. Both people would not be able to manage the locks on their rooms, one person didnt have access to a call bell in their room because it was across the other side of the room and the other person was not able to use it. The care plans for maintaining a safe environment were not pertinent to either person. We found that other care plans were very task orientated and not about the individual needs of each person. It also appeared that people were not offered any choices, for example in one persons care plan for personal care it mentioned that they have a bath on a Tuesday pm and wash their hair when they have a bath. Another care plan stated that staff must check for pressure sores and apply Conotrane if they are sore. However there was no record that this person had any pressure sores or sore areas so this care plan was about the task and not the persons actual need. This was also the case for the majority of care plans. One person was visited by a Speech and Language Therapist who had left instructions for the staff to follow but these were not included in a care plan. If external health care professionals leave important instructions for staff to follow they must be included in the appropriate care plan. One person did have a care plan that was mostly about their individual needs but the staff had written another persons name in the middle of the care plan therefore indicating that this plan relates to another person. For the person who had been at the home for a number of years we found that their care plans were very out of date. In their care plan for communication it stated that the key worker had set up pictorial communication boards but we could not find them in this persons room or the pictorial menu. The person who was recently admitted to the home did not have any risk assessments in place for moving and handling, falls, nutrition or their risk of pressure sores. The person who had been at the home for a number of years had a brief moving and handling assessment which states they are able to transfer and use a walking frame for mobilising. This was not the case as care staff said they need to be hoisted and they are not able to mobilise independently. The home had no system in place for monitoring peoples nutrition. No weights were found and one person was of low body weight. Both people who were case tracked were on fluid and food charts, however we could not find any for one person. It appeared that the majority of time staff were completing them for the second person but there was no evidence to suggest that staff were monitoring these. We were also concerned that the staff were Care Homes for Older People Page 14 of 50 Evidence: not able to recognise people who are nutritionally at risk. Risk assessments must be in place for all for assessed risks with actions on how the staff are going to manage these. The care plans we examined were not up to date, lacked peoples individual needs and choices and care plans were not in place for all peoples assessed needs. Care staff must have access to detailed individualised care plans with specific instructions on how to meet peoples needs. This will also make sure people receive a consistent approach from all care staff in meeting their assessed needs. In the surveys we sent to the home for staff, we asked them are you given up to date information about the needs of the people you support or care for (for example, in the care plan) 1 staff member said always, 1 staff member said usually and 1 staff member said sometimes. Staff spoken with at the inspection confirmed they do have input into peoples care records. Each person has daily records completed by the staff and one person has had a number of falls. Following the inspection we asked that these were investigated fully as one fall resulted in an admission to hospital and we were not notified of this. Whilst the home had contacted the GP in respect of the fall that resulted in the admission to hospital, the staff should have contacted external health care professionals for advice on how to manage this. No risk assessment or care plan was in place in relation to falls. At the inspection we did witness staff speaking to people in a respectful manner and people spoken with had no concerns about how staff maintained their privacy and dignity. However we have concerns about how the staff respect people and maintain their dignity for example, people were left unsupervised in the communal area and they were observed banging on a table to get the attention of staff. Also leaving people unsupervised in their own rooms and again no access to the call bell as it is over the other side of the room. We did see evidence in peoples care records that they have access to external professionals and these include GP,s Community Nurses and one person has seen a Speech and Language Therapist. However as previously mentioned the instructions from this professional were not recorded in a care plan. We asked people in the surveys we sent to the home, do you receive the care and support you need, 3 people said always and 2 people said usually. Comments we received include, Staff help us when we need it, the home does most things well, Care Homes for Older People Page 15 of 50 Evidence: staff could be more prompt and the staff order us about to much and to quickly. We asked relatives, carer/advocates in the surveys we sent them do you feel the care service meets the needs of your friend/relative, 2 had replied always and 2 replied usually. Comments we received included, very caring towards the residents with great patience and politeness, Provides a warm caring atmosphere like a large family home, Perhaps have a Chiropodist available for those who would like the service and I have noticed that agency staff unfamiliar with the individual needs of residents has caused confusion and at time distress to my mother. Prior to this inspection we received a number of concerns related to care planning and risk assessment not being in place and not up to date. We found this was the case. We were also told that staff do not know how to move people safely. We did not witness staff using moving and handling equipment at this inspection therefore we are unable to comment on this concern. They also said staff do not know what equipment to use to move people safely. The acting manager confirmed that a hoist was out of action and they were waiting for it to be repaired. We were also informed that people are having two continence pads put on so the staff do not have to change people very often or the use of continence pads need to be reviewed as they are not meeting the persons needs. The acting manager and a member of staff confirmed that people have been found with two continence pads in place, which is poor practice. However the acting manager said this has now been addressed with all staff. Pharmacist inspectors report about arrangements for the handling of medicines. As a part of this key inspection one of our (the Care Quality Commission) pharmacist inspectors specifically examined some of the arrangements for the handling of medicines. We looked at some stocks and storage arrangements for medicines and various records about medicines. We spoke to the manager designate, team leaders and carers on duty. We visited and spoke to one person and their relative in their bedroom and at lunchtime saw the team leader giving some medicines to people who lived in the home. The inspection took place during a seven and half hour period on a Friday. Because of the number of concerns about medicine arrangements we found at this inspection we sent a letter to the registered provider about the issues he needs to attend to urgently in order to comply with the law and safeguard the people who are living in this home. We asked for a response from the provider by 1st February 2010. This report includes these issues as well as other issues about the medicine arrangements that need attention. Care Homes for Older People Page 16 of 50 Evidence: We received a letter and action plan from the registered provider on 1st February 2010 telling us about the actions taken and arrangements put in place to address the issues in our urgent action letter. We will be checking that these arrangements are effective at a future inspection. Designated team leaders were responsible for administering medicines. There was a list of these staff with their training. One person had no training noted and other training was not sufficient. The manager designate told us about a formal training course that some staff who administer medicines had recently completed. On the day of the inspection a new team leader, who had started working in the home in January 2010, was administering medicines. He was inexperienced and had not undertaken any formal training other than being shown within the home what to do. During the afternoon the team leader who came on duty was not trained for administering medicines. Another experienced bank team leader came on duty at 5pm to administer the medicines during the evening. We were told that normally the manager designate would have been on duty but was off sick on the day of the inspection although she did come in to the home for part of the inspection. At the time of the inspection the team leader told us that nobody living in this home was self administering their medicines except for single items like particular eye drops or inhalers. People were therefore totally dependent on the staff for this part of their care. On the morning of the inspection the team leader had finished giving out most medicines at 10.30am. At lunch time we saw that he administered the medicines at the right time. There were two proper medicine trolleys so that medicines could be taken around the home and safe practice followed to administer medicines. We were told that the trolley would be taken to other floors as there was a lift. During the morning we had to point out about safe practices for medicine administration. For example only signing for what medicines were administered after seeing the person swallow them rather than as we saw when the medicines were taken form the packet. Also not walking around the home just with a cup of medicines. Carers were responsible for applying prescribed creams, ointments and lotions for people they were looking after. Carers we spoke to said they apply the various creams then at end of shift or handover sign the medicine charts. They had notebooks with peoples names and creams written against this. We were concerned that the records may not be accurate if completed at the end of the shift. The staff recalled about some people and what they had applied. They said they had no training about applying creams but confirmed they wore gloves. Care Homes for Older People Page 17 of 50 Evidence: We looked at some of the arrangements for recording medicines. Accurate, clear and complete records about medicines are very important in a care home so that people are not at risk from mistakes with their medicines because of poor records and so that there is a full account of the medicines the home is responsible for on behalf of the people living here. There was a medicines stock control file and a record book for medicines returned to the pharmacy when no longer needed. Every month the pharmacy provided a printed medicine administration record chart for each person with details of their medicines and space for staff to indicate each time they administered a particular medicine. We found some weaknesses and concerns with some of these records. Some charts were handwritten or with handwritten additions. As these are critical records good practice is for these to be signed and dated by the person writing these with a second signature by another authorised person as a check that this was correctly written. Handwritten medicine charts also need to include full date information (day, month and year) with a starting date. We found a number of records where this was not happening. We were concerned that these records were not always accurate and complete. Where medicines were prescribed to allow a variable dose (one or two tablets for example) records often did not include the dose given on each occasion administered. There were gaps in some administration records with no explanation so we could not tell if people had taken their medicines as prescribed or had missed doses for whatever reason. We found two different tablets remaining in packs for a particular day and time for one person yet the medicine records were not clear about the reason for this or the entry could have been staff initials. One person was prescribed two tablets three times a day when required. The additional information with the medicine record stated two three times each for pain in back but with no more detail. Records for administration since 28th December 2009 showed that on some days this was given four times each day. Staff were signing medicine records of another person for two tablets each night. As this was a controlled drug we were able to look in the record book and this indicated one tablet was given. There a number of other discrepancies in records in the book for these tablets. There were other examples where the medicine chart and record book did not agree so we do not know what was the correct record for what this person had taken. There were discrepancies in the recorded stock balances and when we counted the stock with a member of staff during the inspection this did not agree with the recorded total. On two pages some patches were shown as being in stock but these were not in the cupboard. These were last used in March 2009 which was before the manager designate started in post but this must be investigated to find out what happened to these. There were no regular recorded stock checks for controlled drugs. Care Homes for Older People Page 18 of 50 Evidence: This is poor practice and would have identified these discrepancies much sooner if this was in place. One person was being treated with particular tablets one day each week and different tablets on two other days. The medicine chart we looked at starting 28th December 2009 showed that these medicines had not always been given on the right day and the tablets due two days each week had been given every day from 9 to 14 January 2010. The team leader later told us he had found he had given these incorrectly. This was a medicine error and advice from the doctor was needed. This was a treatment where we pointed out to the manager designate that there is specific national guidance to follow that needed to be put in place (www.nrls.npsa.nhs.uk/resources/type/alerts/). A specific care plan about more complex treatments like this should always be considered. This person was prescribed two tablets for pain relief twice each day at 8am and 8pm. When we spoke to this person at 11.45am the 8am dose had not yet been given and records also showed that one of these tablets was not in stock so the dose the medicine chart indicated should have been given at 8pm the evening before could not be given. This person told us she had some pain. Records did show that other tablets also prescribed for pain relief had been administered. We pointed this out to the manager designate and one of the tablets was given at 12 noon. The records were signed as given at 8am which could be misleading for staff later in the day coming to give the next dose. The team leader had included this in the handover report for staff on the next shift. The manager designate told us that both tablets had been ordered and had been due for delivery the day before. On contacting the surgery during the inspection she was told that the doctor had discontinued one strength of the tablet yet this information was not apparent within the home. Before we left we were assured that the pharmacy would definitely be delivering the other strength of the tablets that evening as the last dose had been given at noon on the inspection day. We also had to point out to the team leader that the eye ointment in use for this same person had been opened on 30.11.09 and should have been replaced with a new container after 28 days in use (as indicated on the label) to reduce risks of infection. The label on this tube had left eye written on but the team leader told us this was applied to both eyes. The team leader later showed us there was a new supply in stock to use. This is a concern as we found the same situation at our inspection in May 2009. For this person an eye drop and an eye ointment were being administered twice each day at the same time but the team leader did not know why. Advice from the doctor or pharmacist should be obtained as it would not be likely that these two products would be given at the same time. A number of people living in the home were prescribed medicines where a variable dose was prescribed or to use when required. There were sometimes other forms Care Homes for Older People Page 19 of 50 Evidence: with the medicine administration charts giving extra information to guide the staff about how to make decisions to use medicines with these sorts of directions but were not in place for all medicines with these directions and those that were in place were often not up to date or did not contain sufficient and specific information for that person. We saw one general sheet of information for as required medicines but this was only about pain and was not person specific but giving general indicators for using. The provisions of the Mental Capacity Act 2005 must also be taken into account. For example one person was prescribed a sedative type capsule when required at night and records were signed as administered every night since 28th December 2009. There was no guidance for staff about using this, no explanation about why doses were administered or if the person could take part in a decision about whether they wanted this. One person who had difficulty with swallowing was prescribed a thickening agent to add to every drink to help prevent choking. The medicine records indicated this was not available to use between 6th and 8th January 2010. Not using this would put this person at increased risk from choking. Locked cupboards and medicine trolleys were provided to keep medicines safely. We were concerned about the position of one medicine cupboard and consider this should be put in better location that is more secure and less likelihood of being too hot because of heat from the sun. The medicines in the stock cupboard need to be organised so that those applied externally are segregated (separate lower shelf for example) from those that are swallowed rather than kept together. There were thermometers and temperature record charts for the medicine units and medicine fridge but these had not been filled in at all in January 2010 despite a notice to record daily. The temperatures we noted on the day of the inspection were safe for storing medicines. Another concern was that medicines that had been delivered by the pharmacy were left in an open box in the office for a few hours during the afternoon. There were people in the office during most of this period but this was poor practice. The problem was that during the afternoon there was no staff member on duty trained to check and book these in as the team leader had no medicines training yet. Wasted doses of medicines were all placed in a pot on the medicine trolleys for return to the pharmacy. There was lack of accountability for these as records did not indicate where a refused dose was returned to the pharmacy for disposal or where it still remained in the packs. The manager designate showed us a medicine policy that was in the office and there was a procedure for the actual administration of medicines with the medicine charts. Care Homes for Older People Page 20 of 50 Evidence: There was therefore information about how staff were supposed to manage medicines but action was needed to make sure that staff are trained and understand this information and that it is readily available for them. At the last key inspection in May 2009 some similar issues were identified with the arrangements for medicines and we had received an improvement plan indicating how these were being dealt with. The results from this inspection show there are still actions to be taken to make sure that medicines are managed safely for people living in the home. Care Homes for Older People Page 21 of 50 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not offered the opportunity to participate in a varied activities programme to help meet their recreational interests. Meal choices are very limited and people do not have access to snacks or fresh fruit. Evidence: We were informed that the home has recently appointed a new activities coordinator but they had not taken up this position at the time of the inspection. This member of staff is the housekeeper and will need training in this area. We were told that the home has plans to provide activities for people every day and these will be provided by the activities person or care staff. We witnessed an external entertainer visit the home on the second day of our visit. At other times we did not witness any activities provided by the staff. On the first day several people were sitting in the main communal lounge with no interaction between them. Music was playing but we are not sure if this was the choice of the staff. We witnessed very little interaction in this room between staff and people as staff were assisting other people with personal care. On the second day of the inspection more people were witnessed in this area and people were observed to be talking more with each other. The acting manager and administration person confirmed that no activities are provided for people who wish to stay in their rooms and this is an area that needs to be addressed. We were shown an Care Homes for Older People Page 22 of 50 Evidence: activities list for January 2010 and this stated that the home has visits twice a month from external entertainers. One person sits in a small lounge by themselves with the television on and the staff explained that this person gets anxious with groups of people. However the staff were not checking what was on the television as at one point childrens programmes came on and we had to ask staff to alter the station for this person as they are not able to do this. We did not witness very much interaction between staff and this person. People we spoke with said they are happy to do their own activities as they like to read and spend time in their rooms. A hairdresser visits the home weekly. No outings have taken place and at the present time none are planned. Religious services take place on the second Monday of each month and the Christian Fellowship visit the home every couple of months. We were told that for the people who are Catholics they receive visits from their Church as often as they request it. We were told visiting to the home is not restricted and we spoke to a number of visitors who confirmed this. However as part of a complaint we received from a visitor they said at one time they had to wait too long to get the door answered. A member of staff said it was because only 3 staff were on duty and one of these was preparing food in the kitchen. We asked people in the surveys we sent to the home, does the home arrange activities that you can take part in if you want, 3 people said always, 1 person said dont know and 1 person did not answer the question. During the tour of the home we observed that people had their personal belongings on display in their rooms. People we spoke with said they are able to make decisions about their daily lives, for example people can choose to have their meals in their rooms. People said they can choose whether they take part in the group activities but at the present time these are limited. As mentioned before for people who chose to stay in their rooms they are not provided with any activities. One person did make a comment in their survey about staff ordering them about too much. We asked people in the surveys we sent them do the staff listen to you and act on what you say, 2 people said always and 3 people said usually. We examined the kitchen with the kitchen assistant because the cook was off sick. During our examination of the food records we became aware that a number of people were having symptoms of diarrhoea and vomiting. The food records we examined were not always completed in full. Prior to this inspection we received two complaints Care Homes for Older People Page 23 of 50 Evidence: about food provision and one was about the lack of choice for people with the evening meal and that it was for the majority of the time sandwiches. The food records we examined confirmed this. We looked at the menu and found that people are only offered one choice for the main meal at lunchtime, however we were told that alternatives were available. On the first day of the inspection when the cook was off sick people were given a different meal because the kitchen assistant had to prepare and cook this. Whilst we appreciate that this was a difficult time due to the absence of the cook the meal did not look very appetising and people were unhappy as they wanted fish because it was a Friday. We were also told by the reviewing officer from Community and Adult Care Directorate that one person was given this meal of sausages and they do not like them. We observed staff wearing protective clothing when giving out meals but we are not sure if these were changed when giving meals to people who were unwell with diarrhoea and vomiting. The pudding was hot and staff were observed delivering them all over the home without covering them. This is poor infection control practice. Our impressions of the kitchen area was that it was not very clean especially the tiles and parts of some of the equipment was broken, for example the fridge had brown tape around the top of it and a draw was broken in the freezer. We decided that following this inspection we would contact Environmental Health Department and ask them to visit. Other concerns we received in relation to food was the use of value range of food from supermarkets, no fresh fruit or biscuits and cakes for people. We found that the home did use some value food ranges but not all. We did not see any fresh fruit available for people to help themselves or snacks. We did observe some fresh fruit in the storage area. We observed a morning drinks round where people were offered biscuits, however we did not witness an afternoon drinks round but the kitchen assistant said cakes are offered to people. This was discussed with the Registered Provider on the second day of the inspection. We asked people in the survey we sent them, do you like the meals at the home, 2 people said always, 2 people said usually and 1 person did not answer the question. Care Homes for Older People Page 24 of 50 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure, however record keeping in this area needs improvement. The home does not have effective safeguards in place to protect people from possible risk of harm or abuse. Evidence: Prior to this inspection we received a number of concerns about the home. We wrote to the Registered Provider about one of these concerns but they did not respond within the 28 day timescale as per their complaints policy. The Registered Provider said he thought that because we had spoken with the acting manager he did not need to respond. We explained that if we or any person sends in a written complaint then they must receive a written response. As we had received a number of concerns we decided to bring forward this inspection. In this report we have looked at these concerns and mentioned them in the appropriate outcome group. The acting manager had received 2 written complaints since she has been at the home. We saw copies of the letter of complaint and a letter in response. However the acting manager was not able to find all the investigation findings that led her to the outcome for each complaint. We were concerned about these complaints as they relate to the conduct of the staff in the home and we feel they should be looked at in more detail and decision made about whether more training is need for staff or other action. We asked people who use the service in the surveys we sent them, is there someone Care Homes for Older People Page 25 of 50 Evidence: you can speak to informally if you are not happy, 1 person did not answer this question, 3 people said yes and 1 person said no. We also asked do you know how to make a formal complaint, 1 person did not answer the question, 1 person said yes and 3 people said no. We asked peoples relatives/friends/ advocates in the surveys we sent to the home for them, do you know how to make a complaint about the care provided by the care service if you need to, all four had responded yes. We also asked has the care service responded appropriately if you or the person using the service have raised any concerns, two responded always and two responded usually. The acting manager said the home has policies and procedures in place to safeguard people and these include, abuse, whistle blowing, missing persons, harassment and the use of restraint. We did not examine all of these but we did find that a number of these need to be updated with the latest legislation. Some staff have undertaken the Alerters guide training provided by the local County Council in 2007 and the acting manager provided copies of certificates for training in safeguarding that was undertaken by staff in November 2009. We are concerned about the understanding of staff about what is abusive practice and how some of their actions could be viewed as such. We are unsure about the staff understanding of restraint, because when they place tables in front of people which prevents then from getting out of the chair this is a form of restraint, also the use of bed rails without a proper assessment and consent form. We did find that one person who has bed rails in place had a brief assessment but this needs to be improved. Following this inspection we referred the home to the local County Councils Adult Protection Unit due to the number of concerns we have found. These include for example poor care planning and the lack of risk assessments, unsafe medication practices, lack of activities, lack of choices in relation to food and how the home failed to manage the outbreak of diarrhoea and vomiting. The acting manager said she has completed training in the Mental Capacity Act and Deprivations of Liberty and has started to book other staff on this training. Care Homes for Older People Page 26 of 50 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Highfield House is not a purpose built care home and improvements are needed to the environment to make sure people live in a clean, hygienic and safe home. Evidence: We toured the home and viewed a number of rooms belonging to people who use the service with their consent. Highfield House is not a purpose built care home, but they do have aids to support people, for example assisted bathing and shower facilities, grab rails in corridors and a small shaft lift. We found that the pathway to the main entrance of the home needs to be cleared of debris and the shrubbery trimmed back. The paint work on the main entrance door looks tired and we informed the Registered Provider that this does not create a welcoming entrance to the home. On entering the building the carpets by the main entrance are heavily stained and must be replaced. This was identified at the last key inspection. At this visit there was an odour of urine. We noticed that all radiators were covered with wet towels and on the first floor landing the radiator had a bed protector cover hanging on it. This is poor practice. It does not create a good impression of the home. We were told that the tumble dryer was not working properly, however this needs to be fixed with immediate effect. We received a concern from a relative about this. We also found that washing was hanging up in a bathroom where the bath is broken and in the small room off the main lounge area. By the second day of the inspection the tumble dryer had been repaired and washing was no longer being dried around the home. We also noticed that the Care Homes for Older People Page 27 of 50 Evidence: towels hanging to dry around the home were very old looking and faded. This was reported to the Registered Provider who purchased new towels by the second day of the inspection. We were told that only the shower is working and that baths were not accessible, this must be looked into by the Registered Person and addressed asap. During the tour of the home we found that the bathroom on the first floor and the shower room on the ground floor were very cluttered with packets of continence pads, gloves and aprons and shampoos etc. The cleanliness of these room also needs to be improved. Bars of soap were also found and these are an infection control risk. All bathrooms/shower room and toilets need to be de-cluttered and the decor updated. Generally the decor in the home is very tired and outdated and serious consideration needs to be given to redecorating the home. Visitors to the home who were spoken with and comments in the surveys we received also felt the same. One relative commented that the drinking glass in their relatives room has not been washed for a long time, this is poor practice and must be addressed. We examined the lift following concerns about this from a relative. We found that the lift does not stop in line with the ground floor which can be a risk to people and staff. We were told by a relative that the lift often breaks down and it is not very big and it is difficult to fit a wheelchair and person in the there. This was given as a reason why people do not attend activities or go downstairs. The issue with the lift breaking down needs to be addressed and we will discuss with the Registered Provider about improving this. We observed that staff transfer people on transfer chairs, however these look like commodes and for peoples dignity they should be transfered on to a dining chair at meal times. We observed a number of commodes in peoples rooms and found that some were rusty and broken, these must be replaced. We were informed that the call bell system does not have an emergency call, this will also need to be rectified. As mentioned in previous outcome groups the staff in the home did not manage the situation where a number of people were displaying diarrhoea and vomiting symptoms correctly. Infection control procedures were not put in place and they did not inform visitors to the home or contact the appropriate agencies. This placed people who use the service at risk. The home must now make sure that staff are aware of the infection control procedures to help minimise risks to people in the future. The cleanliness of the home also needs to improve. Care Homes for Older People Page 28 of 50 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. Increasing staffing numbers will help to meet peoples needs. However the skills and knowledge of the staff needs to be improved to make sure people are not being place at unnecessary risk. Evidence: We discussed the staffing numbers with the acting manager. She has made several changes to the staffing numbers and skill mix. The staffing numbers for care staff has increased for the morning shift. Following a discussion with the Registered Provider on the second day of the inspection he agreed to review the afternoon staffing levels as care staff have to prepare the evening meal and undertake other non care tasks to include laundry. An additional member of staff will be appointed to undertake the preparation of the evening meal and with the cleaning up of the meal to enable care staff to concentrate on meeting peoples needs. The night staffing numbers remain the same. Ancillary staff are available to assist care staff and following the last key inspection a maintenance person has been appointed for 6 hours a week. We feel that due to the issues identified with the environment more than 6 hours is needed. We received feedback from staff both during the inspection, in the surveys we sent them and telephone calls. Staff said they enjoy working at the home but some felt they are being given too much training all at once where as others were happy with this. Some staff said the morale was very low and at times this had caused some tensions between the staff group. The feedback we received from people who use the service Care Homes for Older People Page 29 of 50 Evidence: and their relatives/friends all praised the staff for their hard work and they were appreciative of the care they receive. We asked people in the surveys we sent them, Are the staff available when you need them, 1 person said always, 3 people said usually and 1 person said dont know. We asked peoples relatives/ advocates in the surveys we sent for them, Do the services care workers have the right skills and experience to look after people properly, 3 replied usually and 1 relative/advocate commented they would hope so. In the staff surveys we sent to the home, we asked, Are there enough staff to meet the individual needs of all people who use the service, 2 staff said sometimes and 1 staff member said never. The comments we received include We give good quality of care from staff who do care, the permanent staff have in the main good relationships with the residents and have their well-being at heart, employ more staff to take the pressure of the other staff and with the new manager efforts are being made to train staff and put in place good record keeping and efficient systems. The acting manager said the home exceeds the recommended number of care staff with or undergoing an NVQ 2 or above Health and Social Care. We examined the recruitment records of 3 staff who have all started since the acting manager has been in post. All had the required recruitment checks in place except that not all staff had a full employment history and therefore any gaps cannot be explored. One member of staff did not have a reference from their last employer which is not good practice however they were not in a care position and the acting manager had obtained a reference from when they were working in care. All new staff also need to have a photograph. Independent Safeguarding Authority (ISA) Adult first checks were in place prior to any staff starting at the home and in the case of one member of staff they did not start working at the home until the Criminal Records Bureau Disclosure (CRB) had been received, which is best practice. The home needs to demonstrate that all new staff are supervised until their CRB has been received by the home. We raised concerns about one member of staff who was appointed into a senior position despite not having worked in a care home before as they are required to supervise and support the other staff. The acting manager said she was confident that this member of staff could fulfill the senior position with her support. The acting manager said that she has put in place a new induction programme based Care Homes for Older People Page 30 of 50 Evidence: on Skills for Care Common Induction Standards. We examined the induction for one new member of staff. The acting manager said she is the supervisor for this person but this needs to be recorded. Supernumerary arrangements are in place for new staff and this is dependent on how long the member of staff has worked in care. We were concerned that on the first day of the inspection both team leaders on duty were new to the home and one had only worked 6 shifts and they were left in charge. They also confirmed they had not been shown the fire arrangements for the home. This is unsafe practice especially as another member of staff had to come into the home to assist one new team leader with the medications. The acting manager explained that this was because she was off sick on this day. We looked at the training records for staff. The acting manager was able to provide a list of training that had been undertaken and what was being booked. Staff had been provided with training in infection control in November 2009, however this clearly was not enough as staff did not put into place strict infection control procedures when they had the outbreak of diarrhoea and vomiting. The acting manager said she also plans to arrange more training with the Care Home Support team. Staff spoken with confirmed that training is provided as one member of staff felt they were having too much. We asked staff in the surveys we sent them, Did your induction cover everything you need to know to do the job when you started, 1 staff member said very well, 1 said mostly and 1 said partly. These 3 members of staff confirmed they are are being given training relevant to their role, keeps them updated with new ways of working and gives them knowledge about health care and medication. Care Homes for Older People Page 31 of 50 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 home is not being run in the best interests of people who use the service and therefore people are being placed at risk of harm or abuse. Evidence: Since the last key inspection the Registered Manager has left the home and a new acting manager was appointed in October 2009. She said she has 20 years experience working with older people and people with learning disabilities. The acting manager has completed the Leadership and Management course and is waiting for her certificate. She also confirmed that she undertakes training relevant to her role. We received mixed feedback from staff about the new manager and this was shared with the Registered Provider and acting manager. At this inspection we found numerous areas that cause us great concern for the well being of people who use the service. On the second day of the inspection the Registered Provider met with us and we were able to give him detailed feedback. He was very willing to address the shortfalls as a matter of urgency. Care Homes for Older People Page 32 of 50 Evidence: We did not request an Annual Quality Assurance Assessment (AQAA) as we had to bring this key inspection forward due to the serious concerns we had received. The acting manager was able to show us some surveys she has sent to people who use the service, their family and staff. There are several that she said she wishes to contact to discuss further and will then look at devising an action plan to address the issues raised. No auditing of the home is taking place and this needs to be addressed. Regulation 26 visits(where the Registered Person undertakes unannounced visits of the service and completes a report) are taking place but we are not in receipt of all the reports. The ones we have received are very brief and we explained that the purpose of these is for the Registered Person to assess the service and identify any shortfalls. These monthly reports must continue to be sent to us at our Newcastle address. The acting manager said that residents meetings are taking place and at the last meeting each person was able to choose the lunchtime meal for one day. We looked at the system the home has in place for storing peoples monies. Each person is provided with a lockable facility in their room and records of any transactions are also kept in peoples rooms. One persons monies is stored in another area by the home and we checked this and all was correct. We also checked one persons in their room and again all was correct. The home needs to look at auditing this system. The acting manager said that she does not have a staff supervision system in place as yet. She has done some sessions with some staff but not all. Staff meetings are taking place and minutes of these were seen. The home must make sure that they are notifying us of any incidents that are required under Regulation 37 of the Care Home Regulations 2001. Training for topics in relation to health and safety we have mentioned in the staffing outcome groups. This is ongoing and staff need training in these areas especially again in infection control. We looked at records for the servicing of equipment and services in the home. One hoist is waiting to be repaired and we were informed that this would be done as soon as possible. No risk assessment was in place for Legionella and this needs to be addressed. We were not able to examine the fire risk assessment or the evacuation procedure for people who use the service as these could not be found. Some records relating to fire equipment checks were not in place. As a result we have requested that the local Fire Service visit the home. Care Homes for Older People Page 33 of 50 Evidence: Some people have bed rails on their bed and the home must make sure they have a safe system in place for their use and this includes a full assessment of the person and a consent form. Care Homes for Older People Page 34 of 50 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 22/11/2009 make sure that people have care plans in place for all assessed needs. Care plans must be current and provide staff with detailed information on how to meet peoples needs. Ongoing reviews must also be in place. This will help to make sure that staff are provide with detailed information about how to meet peoples assessed needs and that they are up to date. This requirement remains outstanding. 2 9 13(2) The registered person must 26/05/2009 make sure that staff do not administer medication that is passed its manufactures shelf life. This will help to make sure that people are not put at risk by the actions of staff. This requirement remains outstanding. 3 9 13(2) The registered person must make sure that people who are prescribed prn or as required medication have a 30/09/2009 Care Homes for Older People Page 35 of 50 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 plan in place, that provides staff with details of how the medication should be used. This will help to make sure a consistent approach is used by all staff when using this medication. This requirement remains outstanding. 4 9 13(2) The registered person must 30/08/2009 make sure that accurate records are maintained of all medication administered in the home. This will provide a detailed record of when people receive their medication. This requirement remains outstanding. Care Homes for Older People Page 36 of 50 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 make sure that people are not admitted to the home until an assessment of their needs has been completed and the home can demonstrate they can meet their needs. This will help to make sure that only people whose needs can be met are admitted to the home. 30/04/2010 2 7 15 The registered person must make sure that people who use the service have care plans in place for all assessed needs. They must accurately reflect peoples current needs and be kept up to date. This will help to make sure care staff have access to up to date information about how to meet peoples assessed needs. 28/05/2010 Care Homes for Older People Page 37 of 50 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 7 14 The registered person must 30/04/2010 make sure that all people have an ongoing assessment of needs in place and this is kept under review and updated as required. This will help to make sure that care staff have access to up to date information about peoples needs. 4 8 12 The registered person must make sure the home has a system in place to monitor peoples needs in relation to nutrition. This will help to make sure that the health and welfare of people who use the service is monitored. 30/04/2010 5 8 15 The registered person must make sure that people who use the service have risk assessments in place for all assessed risks. These must include how the care staff can manage these risks. This will help to make sure that care staff have access to up to date information about how to meet people assessed needs. 30/04/2010 6 9 13 Make sure that there are always staff on duty that have the appropriate 01/02/2010 Care Homes for Older People Page 38 of 50 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 training, skills and a level of competence to safely administer and manage medicines for people living in this home. This is to help make sure that people living in the home are not put at increased risk of mistakes with medicines. Included in letter for urgent action. 7 9 13 Arrange to review medicine 15/02/2010 records and care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure people living in the home receive the correct amounts of their medicines in a consistent way in line with planned actions. Included in letter for urgent action. Care Homes for Older People Page 39 of 50 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 8 9 13 Make arrangements to be sure that staff do not administer medicines which have passed the manufacturers shelf life. This will help to make sure that people are not put at risk by the actions of staff. Repeat requirement. Included in letter for urgent action. 01/02/2010 9 9 13 Make sure that all the arrangements for storing medicines are suitable and safe. This is to make sure medicines are stored securely and in accordance with published good practice guidance. Included in letter for urgent action. 01/02/2010 10 9 13 Always keep accurate and 01/02/2010 complete records in the controlled drug record book. Investigate the stock balance anomalies identified at this inspection and take appropriate action to resolve these and notify the Care Quality Commission about the outcome. This is to help make sure that all these medicines are properly accounted for and Care Homes for Older People Page 40 of 50 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 have received the correct doses. Included in letter for urgent action. 11 9 13 Make sure that when medicines are administered to people living in the home staff always follow practices that are safe and in accordance with best practice guidance. This is to help make sure that people living in the home are not put at increased risk of mistakes with medicines. Included in letter for urgent action. 12 9 13 Review and make sure that 01/02/2010 there are in place robust arrangements that make certain that people living in the home always receive their prescribed medicines in accordance with the directions of their doctor and that this is supported by accurate, clear and complete medicine administration records that provide full accountability for all prescribed medicines including those products applied topically to the skin. This is to help make sure that the health and wellbeing of people living in 01/02/2010 Care Homes for Older People Page 41 of 50 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 the home is not put at risk by not having their correct prescribed medicines or because of poor recording arrangements. Included in letter for urgent action. 13 12 16 The registered person must 30/04/2010 devise an activities programme for all people who use the service based on their needs, interests and choices. This will help to provide people with stimualtion and activities that meet their own personal needs. 14 15 16 The registered person must make sure that they provide people with suitable, wholesome nutritious food which is varied to meet peoples needs and choices. This includes making sure that people have access to snacks and fresh fruit. This will help to make sure that people are provide with a nutritious diet based on their needs and choices. 15 15 17 The registered person must 30/04/2010 make sure that records are maintained of all food provided to service users in sufficient detail so that it can 30/04/2010 Care Homes for Older People Page 42 of 50 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 be determined whether the diet is satisfactory. This will enable staff and external professionals to monitor the food provision in the home. 16 18 13 The registered person must make sure that people who use the service are not subject to the use of restraint in the form of placing a table in front of them to stop them moving around and the use of bed rails (unless these are have been appropriately assessed and risk assessments and consent are in place.) This will help to safeguard people from possible risk of harm by the actions of the staff. 17 18 13 The registered person must 30/04/2010 make sure that all staff have received training in relation to abuse and are aware of how their practice may place people at risk of harm or possible abuse. This is to make sure people who use the service are safe from possible risk of harm or abuse. 19/03/2010 Care Homes for Older People Page 43 of 50 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 18 19 23 The registered person must make sure that the carpets identified at the last inspection and this one are replaced. This is the main entrance and by room 25. This will help improve the environment for people who live there and visitors to the home. 28/05/2010 19 19 23 The registered person must devise a programme for redecoration and refurbishment of the home and this must include the lift, call bell system and bathrooms. This will enable us to see how the environment will be improved for the people who use the service. 30/04/2010 20 19 23 The registered person must inspect all commodes and replace any that are rusty and broken. This will help to make sure that people are not placed at unnecessary risk when using equipment in the home. 30/04/2010 21 26 13 The registered person must make sure that the home has suitable arrangements in place to prevent the spread of infection. 30/04/2010 Care Homes for Older People Page 44 of 50 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help to make sure that any risks to people who use the service are minimised. 22 29 19 The registered person must make sure that if the home appoints a new member of staff without a full Criminal Records Bureau Disclosure being received that they; appoint a member of staff who is appropriately qualified and experienced to supervise the new worker, Ensure as far as possible that the staff member is on duty with the new member of staff, The new worker must not escort people who use the service away from the care home unless they are accompanied by the staff member. This will help to make sure that people are safeguarded form possible risk of harm or abuse. 23 29 19 The registered person must 30/04/2010 make sure all the required recrutiment checks are in place prior to a new member of staff starting work at the home. This includes a full 30/04/2010 Care Homes for Older People Page 45 of 50 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 employment histroy together with a satisfactory written explanation of any gaps. This will help to make sure people who use the service are safeguarded from possible risk of abuse or harm. 24 30 18 The registered person must make sure that any new staff undergoing induction training are appropriately supervised and, appoint a member of staff who is appropriately qualified and experienced to supervise the new worker. Ensure as far as possible that the staff member is on duty with the new member of staff, The new worker must not escort people who use the service away from the care home unless they are accompanied by the staff member. This will help to safeguard people who use the service from possible risk of harm or abuse. 25 30 18 The registered person must make sure that staff undertake training 31/05/2010 30/04/2010 Care Homes for Older People Page 46 of 50 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 appropriate for the work they are to perform. This include the activities coordinator and that staff receive more training in infection control. This will help to provide staff with the skills and knowledge to meet peoples assessed needs. 26 31 8 The registered person must put forward the acting manager to apply to us to be considered for registration. This will help to make sure the manager has the required skills and experience to run the home in the best interests of people who use the service. 27 33 24 The registered person must devise a system for evaluating the quality of the service provided at this home. This will help to make sure the service is run in the best interests of people who use the service. 31/05/2010 09/06/2010 Care Homes for Older People Page 47 of 50 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 28 36 18 The registered person must devise a system to make sure all staff working at the home are appropriately supervised. This will help to make sure that the staff are meeting peoples needs and they have the skills and knowledge to do this. 31/05/2010 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 3 4 7 7 8 9 Care plans should include peoples choices for example what time they like to get up and go to bed. Words like regular should not be used as care staff require specific information about how to meet peoples needs. Instructions from health care professionals should be recorded in the appropriate care plan. Introduce regular audits of medicine arrangements with appropriate actions taken following each audit to improve on any shortfalls and risks found. Medicines for external use to be stored segregated from those that are swallowed. Make sure that handwritten entries on medicine charts are signed and dated by the staff member writing this with a second staff member checking and signing as correct. Introduce regular recorded checks of the controlled drugs record book and stocks. This is to make sure that these medicines can always be accounted for and any discrepancies are quickly identified and dealt with. The staff in the home should leave out snacks for people to help themselves and this should also include drinks. Page 48 of 50 5 6 9 9 7 9 8 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 9 18 Staff need to be mindful that when placing tables in front of people who are sat in chairs that they can still get out of the chair and move around. The use of bed rails should only take place following a full documented assessment of the persons needs and consent from the person or their family/representative. The home will also need to make sure that the appropriate checks are undertaken on the bed rails once they are in place. The home should consider replacing the lift. Records should be made of each new workers supervisor and provide records that they are supervised during their induction and whilst waiting for the full CRB to be received. The home should consider obtaining information from the Health and Safety Executive website in relation to the use of bed rails and the checks that should be carried out. A risk assessment for Legionella should be devised. 10 18 11 12 19 30 13 38 14 38 Care Homes for Older People Page 49 of 50 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 50 of 50 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!