Inspection on 08/12/09 for Holly Bank House

This inspection was carried out on 8th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly Bank House 19/01/10

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 18/02/2010.

Key inspection report Care homes for older people Name: Address: Holly Bank House Royston road Churchinford Taunton Somerset TA3 7RE     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: kathy McCluskey     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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 37 Information about the care home Name of care home: Address: Holly Bank House Royston road Churchinford Taunton Somerset TA3 7RE 01823601447 01823602816 alutarius@aol.com www.alutarius.com Alutarius 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 22 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 22. The registered person may provide the following category of service only: Care home with nursing - Code N 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 Hollybank Nursing Home is situated in the village of Churchinford which has a pub and small shop. The town of Taunton is approximately 7 miles away. The home is registered with the Care Quality Commission to provide general nursing care to up to 22 older people. The home is not registered to provide a service to people where their primary care needs are their dementia or other mental health Care Homes for Older People Page 4 of 37 Over 65 22 0 Brief description of the care home problems. Earlier this year the home approved an application for Alutarius Ltd to become the registered provider. The responsible individual is Mr Neil Plummer. The registered manager has recently left this post and the home is currently without a registered manager. Up to date information about fees should be obtained from the home. Care Homes for Older People Page 5 of 37 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 unannounced key inspection was conducted over one day (9.25hrs) by regulation inspector Kathy McCluskey. An acting manager was available at the home from 1500hrs. We were given unrestricted access to all parts of the home. We were able to talk to staff on duty and a number of people using the service. We were informed that 13 people were currently residing at the home. As part of this inspection we sent comment cards to people using the service, staff and health care professionals to seek their views on the quality of the service delivered. These were sent to the home to distribute. No completed comment cards have been received by the Commission. The term we used throughout this report refers to we the Commission. Care Homes for Older People Page 6 of 37 We would like to thank all involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Information about the homes management arrangements need to be updated to reflect the current situation. The registered provider needs to ensure that appropriate management arrangements are in place so that the home is effectively managed in the absence of a registered manager. Records did not demonstrate that staff had the skills or training needed to meet the needs of people using the service. Concerns were raised at this inspection regarding the homes failings in care planning procedures. We found that care plans were not always reflective of peoples assessed needs. We also found that care plans were not always kept up to date. The home was not able to demonstrate that it was meeting peoples health care needs. We issued an immediate requirement requiring the home to take appropriate action within 48hrs regarding the nutritional needs of one person using the service. People are not always being weighed on a monthly basis. We found that risk assessments relating to moving and handling needs, reducing the risk of pressure sores and nutrition were not always being completed. We found that care plans had not always been raised where concerns had been identified. The homes procedures for staff recruitment are not robust and could put people using the service at risk of harm or abuse. Recruitment files examined did not contain evidence that all required information had been obtained before the individual commenced employment. We issued an immediate requirement at the time of this inspection. We were unable to see evidence that staff had completed an appropriate period of induction on commencement of employment. Records indicated that not all staff had received the basic mandatory training. There was no evidence of any specialised training. We were unable to see evidence that staff received formal supervisions at least six times a year. Staff spoken with and records examined confirmed that staff have not received training in the protection of vulnerable adults. There was no evidence to demonstrate that procedures were in place to monitor and improve the quality of the service delivered. Care Homes for Older People Page 8 of 37 Records to confirm up to date health and safety procedures were in place were not available. 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 37 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 37 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. The home has produced information about the home and services offered. Information about the management structure need to be reflective of the current situation. The home has procedures in place which ensure people are assessed before they are offered a placement at the home. The home were unable to demonstrate whether staff have the skills or experience to deliver the services and care which the home is registered to provide. Evidence: The home produced a Statement of Purpose and Service User guide at the point of registration earlier this year. These documents were not re-examined at this inspection. In the reception area of the home we found a brochure which contained information Care Homes for Older People Page 11 of 37 Evidence: about the company and the various services it offers. Within this we found a one page document about Hollybank. This contained information about a registered manager which was factually incorrect. It named the acting manager Clare as the registered manager. The Commission have not received an application to register an individual for registered manager. This document should be updated to reflect the current situation. We asked to look at the care file for the most recent admission to the home so that we could examine the homes pre-admission procedures. This file contained evidence that the individual had been assessed before a placement was offered. An assessment form an involved health care professional was also in place. During this inspection we were able to meet with the majority of the people using the service. One individual was able to recall that they had visited the home prior to moving there. We were unable to examine peoples contracts/statement of terms and conditions as these could not be located for this inspection. Although people told us that they felt there needs were met by staff, we were unable to ascertain whether staff had received the mandatory or specialised training needed. We spoke with four members of staff at this inspection and examined four staff recruitment files and a training matrix made available to us. We found no evidence of any specialised training having taken place and this was also the case for the registered nurses. Not all staff had completed a period of induction or all of the mandatory training requirements. Full details of this are given under the outcome heading of staffing. Care Homes for Older People Page 12 of 37 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 homes care planning procedures do not ensure that peoples needs are identified or that needs are regularly reviewed. The home are unable to demonstrate that peoples health care needs and nutritional needs are met. People may be at risk because the home have failed to ensure that appropriate assessments are in place to meet peoples moving and handling needs. This is also the case for assessments to reduce the risk of pressure sores. The homes procedures for the management and administration of peoples medication require some improvements. People are treated with respect though the home needs to consider the dignity of people when storing continence products. Care Homes for Older People Page 13 of 37 Evidence: We were informed that 13 people were currently residing at the home and that two people regularly receive day care at the home. We were informed that there were currently no people being treated for pressure sores. We examined four care plans at this inspection and a number of shortfalls were identified. We found that care plans were not always being raised to address peoples needs, care plans were not up to date and had not been reviewed monthly. Risk assessments were not in place where required. Moving and handling assessments were not in place. The home were unable to demonstrate that they were meeting peoples health care needs. The following is a summary of our findings; CARE PLAN 1 This related to an individual who has dementia. We were informed that the individual had become increasingly confused, was becoming aggressive towards others and was wandering at night. We found that no care plans had been raised to meet these needs. There was no evidence that the home had sought CPN/specialist advice or input. A care plan was seen which stated that the individual had a small appetite and needed encouragement to eat. This contained only basic information for staff. A nutritional assessment was not in place. It is recommended that peoples weights are monitored at least monthly. Records for this individual only contained weights for Feb, May, June, July and Oct. Records confirmed weight loss from 52.2kg to 48.6kg. There had been no reference to this weight loss and the care plan had not been updated to reflect this. It was confirmed that the home were not monitoring the individuals intake. A pressure sore risk assessment was in place dated 08/06/09 and there was no evidence that it had been reviewed since this date. CARE PLAN 2 - This did not contain a photograph of the individual. Pre-admission assessments identified that the individual was at risk of developing pressure sores and that a pressure relieving mattress needs to be in place. Pre-admission information also identified continence needs. A pressure sore risk assessment was available in the care plan but this had not been completed. No care plan had been raised to address either of these assessed needs. There was no evidence that the individuals weight had been checked on admission to the home 5.5 months ago and no evidence that the individual had been weighed during this period. No assessments were available relating to nutrition or moving and handling needs. CARE PLAN 3 - We were informed that this individual was immobile with left sided paralysis and for some time had been experiencing difficulty swallowing with poor diet and fluid intake. This was confirmed by staff spoken with and had also been recorded on the individuals daily records. We found that weights were not being monitored monthly. Records indicated a significant weight loss from 96.3kg in January to 78.1kg in October of this year. A nutritional assessment was not in place and a care plan had not been raised. Staff confirmed that they were not monitoring the individuals daily intake. It was concerning that the individual was offered a normal diet of sausages, mashed potato and vegetables when it was clear that this was not Care Homes for Older People Page 14 of 37 Evidence: appropriate. We were unable to see evidence that the home had sought advice/input from the GP until the day before this inspection. At the time of this inspection we issued an immediate requirement which had to be actioned within 48hrs. The home were required to ensure that appropriate assessments and care plans were in place to meet the individuals nutritional needs. A pressure sore risk assessment was in place dated June 2009. There was no evidence that this had been reviewed monthly. The individual was assessed as being at very high risk of developing pressure sores. No care plan had been raised to address this assessed need. We did not observe this person being given assistance to change for the duration of the inspection. Although we had been informed that the individual was immobile and dependent on staff to move, a moving and handling assessment was not available in the plan of care. Care plans in place had not been reviewed since September 2009. CARE PLAN 4 - A care plan was in place relating to epilepsy but we were unable to see any evidence that the home were monitoring the frequency of any seizures even though the individual had recently been admitted to hospital following concerns. We were informed that the individual required a hoist to transfer though a moving and handling assessment had not been completed. A pressure sore risk assessment identified the individual as being at high risk of developing pressure sores. A care plan had not been raised to address this. Records demonstrated that the home were not monitoring the individuals weight on a monthly basis. We examined the homes procedures for the management and administration of peoples medication. Medicines were found to be securely stored though the room storing the medication exceeded the acceptable temperature of 25c. The room is small and has no natural light or ventilation. A room thermometer was reading 30c. The nurse in charge confirmed that they were not checking or recording the daily temperatures of the room or of the fridge storing medicines. A requirement has been raised. We examined the pre-printed medication administration records. These contained photographs of individuals to aid identification. We found that hand written entries and changes to the printed prescription had not always been confirmed by two staff signatures. This is needed to reduce the risk of errors. We found a hand written entry changing the time of a prescribed medicine. We were unable to see evidence that this had been discussed with or agreed by the GP. Only one signature confirmed the entry. We found a hand written entry for enemas on one persons mar chart. This had only been confirmed by one staff signature and the amount received into the home had not been recorded. We found that the majority of entries on the MAR charts did not indicate what the medicine was for or how it should be taken. The majority of entries stated as directed. We have recommended that the home discuss this with the prescribing GP. During a tour of the premises we found opened prescribed creams in peoples bedrooms which had not been marked with an open/expiry date. A Care Homes for Older People Page 15 of 37 Evidence: recommendation has been raised as creams have a limited shelf life once opened. During the inspection we heard staff communicating with people in a kind and respectful manner. People spoken with during the inspection were generally positive about the staff. Many commented on the kindness of staff though two said that the staff could be bossy. We could not get them to elaborate further. The majority of ensuites contained large quantities of opened continence products. This can have an impact on peoples dignity as they are in full view of peoples visitors. This was also the case in communal bathrooms/toilets. We have recommended that these products are stored more discreetly so as to promote peoples dignity. Care Homes for Older People Page 16 of 37 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. People have the opportunity for social stimulation. The home ensure that visitors are made to feel welcome and that people can see their visitor in private if they wish. Meals are cooked at the home by the cook and care staff. People are offered choice. Evidence: The home employs an activity worker who is available at the home weekdays between 1000hrs and 1500hrs. A programme of in-house activities is displayed in the reception area of the home. The home does not have a mini bus and we were informed that some people are taken out by their visitors. People using the service told us that there were activities going on if you wanted to join in. We were informed that visitors were welcome at any reasonable time. People told us that their visitors were made to feel welcome and that they could chose where to see their visitors. All visitors are required to sign in and out. All meals are prepared at the home. The home employs a cook who works week day Care Homes for Older People Page 17 of 37 Evidence: mornings. We were informed that care staff cover kitchen/cooking duties in the absence of the cook. We were told that these duties were normally carried out by care staff in additional to the care hours on duty but that this was not always the case. People told us that they had enough to eat and that they were given choices. We were able to see lunch being served during this inspection. People were given plated meals from a hot trolley. Although the meals looked appetising, we noted that gravy had already been put on the meal thus taking away peoples choice. The home should, where appropriate, consider the use of serving dishes rather than plated meals as this will help to promote independence and choice. Care Homes for Older People Page 18 of 37 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. The home has produced a complaints procedure though not all people are aware of how to make a complaint. The homes procedures do not ensure that people are protected from the risk of harm or abuse. Evidence: The home has a complaints procedure in place though not everyone spoken with knew how to make a complaint. We have recommended that the home takes appropriate action to address this. The acting manager was unable to locate records relating to complaints. This included an anonymous concern which was passed to the provider to investigate. The Commission had not received a response to this concern. The acting manager recalled a company representative visiting the home to discuss the concern but any documentation relating to it could not be located. All records relating to complaints need to be maintained at the home. We spoke with staff and examined staff training records and were unable to find evidence to confirm that staff had received training in, or were aware of safeguarding adults procedures. The registered person must take appropriate action to address this so that people using the service are safeguarded from the risk of harm or abuse. Care Homes for Older People Page 19 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hollybank, though not purpose built, provides a comfortable environment for people. The standard of decor and furnishings are generally good though some areas are looking tired. People have their own rooms which they can personalise. The home has limited storage for wheelchairs, hoists and linen and the home need to keep the current storage arrangement under review so that it does not pose a health and safety risk to people. Arrangements are in place to reduce the risk of the spread of infection. Evidence: During this inspection we viewed all communal areas and eight bedrooms. Communal areas appeared comfortable and had been decorated to an acceptable standard. We found that some bedrooms would benefit from redecoration/refurbishment. Carpets in two bedrooms viewed looked worn and stained. One bedroom was found to have a divan bed which was looking worn. The majority of en-suites appeared cluttered as there was limited storage available. This was also the case in corridors and bathrooms where wheelchairs, hoists and linen are stored. In the absence of sufficient storage areas, the home need to ensure that the current arrangements do not pose a risk to Care Homes for Older People Page 20 of 37 Evidence: people using the service. We were informed that the home no longer employs a maintenance person and that any requests have to be made through head office. We were told that this sometimes results in delays. People told us that they were happy with their bedrooms and it was apparent that people were able to personalise their rooms. We were able to see that people had access to a call bell and people told us that staff were generally good at responding. Staff hand washing facilities were seen to be appropriately sited throughout the home. Protective equipment was seen to be available. We found a bin in an upstairs bathroom was missing a lid. We were informed that laundry duties were covered by a designated staff member four days a week from 0700-1400hrs. We were informed that care staff undertake laundry duties as part of their care hours at all other times. A cleaner is employed and we found the standard of cleanliness to be acceptable. Slight malodours were noted in some areas. Care Homes for Older People Page 21 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home were unable to demonstrate that staff have the skills, experience or training to meet the needs of older people with general nursing care needs. Staffing levels need to be kept under review so that they remain appropriate to the dependency levels and numbers of people using the service. The homes procedures for staff recruitment are not robust and could place people at risk of harm or abuse. Evidence: We were informed that 13 people were currently using the service and that two people regularly used the service for day care. No additional staff are on duty. We were informed by the nurse in charge that minimum staffing levels were one registered nurse during the day and night with 2 carers during the day and one at night. We were informed that there were 4 people who required a hoist or two staff to assist. We were informed that there was currently nobody with complex nursing needs. The nurse in charge stated that staffing levels were alright at the moment. We were informed that it is sometimes difficult when care and nursing staff had to undertake laundry and catering duties. People using the service did not express any concerns about staffing levels. Given the number of people who require two staff to assist them, Care Homes for Older People Page 22 of 37 Evidence: we have recommended that staffing levels during the day and night are kept under review so that there are sufficient staff on duty to meet the dependency levels of people using the service. We were unable to confirm that staff on duty had the skills, experience and training needed to meet the needs of people using the service. During the afternoon of this inspection the registered nurse in charge of the shift was a mental health nurse who had no experience in general nursing care. We examined a staff training matrix made available to us and looked at recruitment files to ascertain what training staff had received. We found that not all staff had received even the basic mandatory training and there was no evidence of any specialised training. One member of staff, who had no previous care experienced, confirmed that they had not received an induction on transferring from maintenance duties. We found that not all staff had fully completed an induction programme. We found only basic in-house induction programmes in place and there was no evidence that the homes induction programme were following the recommendations of the Common Induction Standards. We were unable to ascertain how many care staff had achieved or were working towards a minimum of an NVQ level 2 in care so this standard was not assessed. We examined the homes procedures for staff recruitment and found a number of serious shortfalls. We issued an immediate requirement at the time of this inspection. File 1 - this did not contain photo ID for the individual. File 2 - NMC Pin registration had expired and there was no evidence that this had been checked by the home. The reference from the previous employer was dated 8 days after employment commenced. A second reference was not available. An enhanced CRB was dated 2 days after employment commenced and there was no evidence that a POVAFirst had been obtained and no risk assessments were in place. File 3 - There was no evidence that the home had rechecked an NMC registered nurse pin number which had expired. File 4 - We found gaps in employment history and there was no evidence that this had been explored by the home. We found no evidence that the home had applied for or checked the authenticity of the two references on file. One reference was addressed to whom it may concern and was dated 11 months prior to employment commencing. The second reference was not addressed to the home and was dated 15 months prior to employment commencing. No photo identification was in place and there was no evidence that the overseas employee was permitted to live or work in the UK. Care Homes for Older People Page 23 of 37 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 registered person has failed to ensure that the home is effectively managed in the absence of a registered manager. The home does not have procedures in place to monitor and review the quality of the service provided. Staff are not appropriately supervised. The home could not demonstrate that up to date health and safety procedures were in place and not all staff have received basic mandatory training. Evidence: Prior to this inspection we had been alerted by an anonymous concern that the registered manager had left employment. We found this to be the case and the Commission had not been informed of this by the registered provider. Care Homes for Older People Page 24 of 37 Evidence: During this inspection we met with the acting manager. It was confirmed that the acting manager had no previous experience in management or general nursing care. It was also confirmed that the acting manager, who is a registered mental health nurse, works on shift as the nurse on duty and does not have any supernumerary management time. Given the failings noted at this inspection, it is evident that appropriate and effective management procedures have not been put in place. We have made a requirement that the registered provider takes appropriate action to address this. We were unable to obtain any evidence that the home has introduced quality assurance procedures to monitor and improve the quality of the service provided. The Care Homes Regulations 2001 require a company representative to visit the home on a unannounced monthly basis and to produce a report which is to be kept at the home. The acting manager was unaware of any such reports being held at the home. We were informed that the home is not currently assisting any person to manage their money. Therefore, this standard was not assessed. We were unable to see any evidence that staff are appropriately supervised. We spoke with 3 staff members and examined 5 staff files. Two of the three staff members stated that they had received one formal supervision this year. One had not received any supervisions. Of the five staff files examined, three contained no evidence of any supervisions, two contained evidence of having received one supervision session this year. The registered person is required to ensure that all staff are appropriately supervised. Staff should receive formal supervision sessions at least six times a year. Not all required records relating to health and safety could be located at this inspection. We have required that the registered person forwards these records to the Commission by a given date. We found records relating to checks on the homes bath hot water outlets. These were being checked monthly. In house checks on the homes fire alarm systems had only been checked on a weekly basis up to 09/11/09. There had been no further recorded checks until 01/12/09. As previously mentioned in this report, we were unable to see evidence that all staff had received up to date mandatory training. The Commission have not received any Regulation 37 notifications from the home informing us of any deaths or significant events since the change in provider. We examined the homes register and found that since July 2009, there had been three recorded deaths and one admission to A & E. When we discussed this with the acting Care Homes for Older People Page 25 of 37 Evidence: manager, we were informed that the notifications may have been sent to the incorrect address. Care Homes for Older People Page 26 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 8 12 (1) The registered person 10/12/2009 must ensure that appropriate nutritional assessments and a plan of care are in place to address the nutritional needs of the identified person using the service. This is to ensure that the individuals health care needs are met. 2 29 19 &Schedule 2. The registered 08/12/2009 person must ensure that staff do not commence employment until all required information has been obtained. This is so that people using the service are not placed at risk of harm or abuse. 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 4 18 (1)The registered person 31/01/2010 must ensure that at all times suitably qualified, competent and experienced persons are working at the home This is so that you are able to demonstrate the homes capacity to meet the needs Care Homes for Older People Page 28 of 37 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 (including specialised needs) of individuals admitted to the home. 2 7 15 (1) The registered person 31/01/2010 must ensure that up to date care plans are in place which clearly identify how an individuals assessed needs are to be met. This includes any psychological needs. This is to ensure that the assessed needs of individuals can be met. 3 8 13 (5) The registered person 31/01/2010 must ensure that appropriate assessments are in place which identify peoples moving and handling needs. These assessments should also contain information about any equipment to be used. This is to ensure that peoples assessed needs are met and to ensure the health and safety of people. 4 8 12 (1) The registered person 31/01/2010 must ensure that appropriate assessments are in place to reduce the risk of pressure sores and that care plans are raised to address an assessed need. Care Homes for Older People Page 29 of 37 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 is to ensure the health and welfare of people using the service. 5 8 12 (1) The registered person 31/01/2010 must ensure that appropriate assessments are in place and that care plans are raised to address peoples nutritional needs. This is to ensure the health and welfare of people using the service. 6 9 13 (2) The registered person must ensure that all medicines (except those requiring refridgeration) are stored at a temperature not exceeding 25c. This is because medicines can be affected if stored at temperatures above 25c. 7 9 13 (2) The registered person 31/12/2009 must ensure that any changes to an individuals prescribed medication is authorised by the prescriber. This is to ensure the safe administration of peoples medication. 8 18 13 (6) The registered person 31/03/2010 must take appropriate action to ensure that all staff receive up to date training in 05/02/2010 Care Homes for Older People Page 30 of 37 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 protection of vulnerable adults and that they are aware of action to be taken should they suspect any form of abuse. This is so that people using the service are protected from the risk of harm or abuse. 9 27 18 (1) The registered person must ensure that the status of registered nurses is checked with the Nursing and Midwifery Council (NMC). This is so that at all times, suitably qualified nurses are on duty at all times. 10 29 19 (1) The registered person must ensure that staff do not commence employment until two satisfactory references have been applied for and obtained by the home and that the employer is satisfied to the authenticity of the references. This is to ensure robust staff recruitment procedures are followed and so that people are not placed at risk of harm or abuse. 05/01/2010 31/01/2010 Care Homes for Older People Page 31 of 37 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 11 29 19 &Schedule 2. The registered person must take action to ensure that all required information for employees identified at this inspection is in place/completed by the date shown. This is so that people using the service are not placed at risk of harm or abuse. 05/01/2010 12 30 18 (1) The registered person 31/01/2010 must ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers as are appropriate for the health and welfare of people using the service. This relates to the completion of an appropriate induction programme and mandatory training for newly appointed staff. This is so that the needs of people using the service are fully met. 13 31 10 The registered person must make arrangements to ensure the home is effectively managed by a person who has the skills, experience and training needed. 22/01/2010 Care Homes for Older People Page 32 of 37 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 the home is effectively managed 14 33 24 (1) The registered person 19/02/2010 shall establish and maintain a system for reviewing and improving the quality of the care provided. The home should seek the views of people using the service and other stakeholders. This is so that people receive an improved quality of service. 15 33 26 (2-5). The registered person 31/12/2009 must ensure that a responsible individual visits the home on a monthly unannounced basis in accordance with this regulation. Written reports must be maintained at the home. To ensure the quality of the service is monitored and reviewed. 16 36 18 (2) The registered person 31/01/2010 must ensure that staff are appropriately supervised. Staff should receive formal supervision at least six times a year with records maintained. Care Homes for Older People Page 33 of 37 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 is so that staff are appropriately supported and that any training needs can be identified and actioned. 17 38 37 The registered person must ensure that the Commission is notified of all significant events at the home as detailed in this regulation. This is so that the Commission are aware of all significant events at the home including any deaths. 18 38 13 (4) The regsitered person 22/01/2010 must supply the Commission with evidence of up to date servicing/checks for: All mobile and bath hoists, the shaft lift, portable electrical appliance checks, and external servicing for the homes fire alarm/detection systems This is to ensure the health and safety of all persons at the home. 19 38 13 (4) The registerecd person 31/03/2010 must ensure that all existing staff receive up to date mandatory training. 22/01/2010 Care Homes for Older People Page 34 of 37 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 is to ensure the health, safety and welfare of staff and persons using 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 1 2 1 7 Information about the home should be updated to reflect the current management situation. Peoples care plans and assessments should be reviewed at least monthly to ensure that they remain reflective of their needs. The home should ensure that people are weighed at least monthly so that any concerns can be identified and actioned. Because creams/lotions have a limited shelf life once opened, any items in use should be marked with the open/expiry date. To reduce the risk of errors, hand transcribed entries on individuals medication administration records (MAR) should be confirmed with two staff signatures. The home should liaise with the prescriber and request more information to be provided as to what a medicine has been prescribed for and how many times a day it should be administered. To ensure the safe storage of medicines, the home should monitor and record the temperature of the room storing medicines on a daily basis ensuring the temperature does not exceed 25c. The actual, minimum and maximum temperature of the medicine fridge should be recorded daily to ensure that temperatures remain within acceptable limits of 4 & 8c. To promote peoples dignity, the home should store peoples continence aids more discreetly. Page 35 of 37 3 8 4 9 5 9 6 9 7 9 8 10 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 15 To further promote independence and choice for people, the home should (where appropriate) consider the use of serving dishes for the main meal rather than offering plated meals. The registered person should ensure that people using the service, staff and any visitor to the home, are fully aware of the homes complaints procedure. The registered person should ensure that the current arrangements for the storage of hoists, wheelchairs and linen are kept under review so that they do not pose a risk to the health and safety of persons at the home. Documented risk assessments should be maintained at the home. The registered person should keep current staffing levels under review to ensure they remain appropriate to the dependency levels and number of people using the service. The registered person should review the current application for employment form so that it requests at least 10 years employment history. Any gaps in employment should be explored and reasons documented. The registered person should ensure that staff undertake a 12 week induction programme which follows the recommendations of the Skills for Care Common Induction Standards. The registered person should ensure that weekly in-house checks are maintained on the homes fire alarm/detection systems and that monthly checks are maintained on the homes emergency lighting. 10 16 11 19 12 27 13 29 14 30 15 38 Care Homes for Older People Page 36 of 37 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 37 of 37 - 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!