Inspection on 20/01/10 for Hollybank Nursing Home

This inspection was carried out on 20th 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 but made no statutory requirements on the home.

Other inspections for this house

Hollybank Nursing Home 20/01/09

Hollybank Nursing Home 28/05/08

Hollybank Nursing Home 31/05/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Hollybank Nursing Home 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN     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: Judith Stanley     Date: 2 0 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 32 Information about the care home Name of care home: Address: Hollybank Nursing Home 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN 01617235756 01617249693 hollybankdualreg@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): QNS Residential Limited Name of registered manager (if applicable) Mrs Margaret Halliday Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE (10). The maximum number of service users who can be accommodated is: 49 Date of last inspection Brief description of the care home Hollybank is operated by QNS Residential Limited. The home provides 24-hour care for up to 30 older people. The property is on Bolton Road Radcliffe and is about one mile from the town centre. There is a bus stop on the main road close to the home and there are shops nearby. The accommodation is provided on two levels with a lift giving Care Homes for Older People Page 4 of 32 Over 65 0 49 10 0 2 0 0 1 2 0 0 9 Brief description of the care home access to the first floor. The home has fourteen single bedrooms and eight rooms that are shared. There are two lounges and there is a separate dining room. Toilets and bathrooms are provided on both floors. The home has a garden area with seating that can easily be reached from the conservatory. A Service User Guide that describes the homes services is readily available in the home and the staff give other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report, the homes Statement of Purpose and copies of the homes policies and procedures are also displayed in the home. At the time of this inspection the weekly charge for accommodation and services range from 380:00 pounds with a top up fee of 10 :00 pounds. Additional charges being made for hairdressing and chiropody services. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and included a site visit. The inspection was completed on one day over a period of 10 hours. A pharmacist inspector from the Care Quality Commission (CQC) accompanied the inspector to check the homes medication systems. During this inspection a Code B notice of the Police and Criminal Evidence Act was issued. The reason for serving this Notice is because the CQC believes an offence may have been committed. A Code B notice is issued to protect the homes rights in case the CQC needs to take any further action. Prior to the inspection the home was sent an Annual Quality Assurance Assessment (AQAA). This self assessment focuses on how outcomes are met for the people using the service, what they have improved on and their plans for the future. We use this information, in part, to focus our inspection activity. Care Homes for Older People Page 6 of 32 We also sent surveys to the home for residents and staff to complete telling us what they think about the home and the services provided. We received one completed survey from a member of staff, who told us that, Residents are well looked after and the owners are always working on areas of improvement in order to make the home very comfortable for staff and residents. During the course of the day we looked around the home, looked at a selection of care plans and staff files, checked the medication systems and other relevant information. Full feedback was given by both inspectors to the owner, the homes consultant and the manager. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Recording of residents information needs to be improved with regard to the pre admission assessments, risk assessments and care plans. All areas of medication handling are unsafe. Effective procedures must be in place to help staff handle medicines safely. Medication must be stored safely and securely at all times. Records about all aspects of medication must be clear and accurate, to show that medication is given properly and can all be accounted for. Details about how to give medication prescribed as when required or as a variable dose must be recorded so staff can give medicines safely and consistently. Full assessments of risk must be recorded when prescribed medication is kept in bedrooms. All medication must be given as prescribed; this includes checking exactly what medication people should be taking when they first come to live in the home. Prescribed medication must be available in sufficient quantities in the home so residents can have the correct dose of medication at the correct time. Staff who handle medication must be properly trained and must be assessed as competent to administer medication safely. The manager must make checks to ensure medication is handled safely. Unsafe medication practices put residents health and wellbeing at risk of harm. The manager must plan and develop, with the help of residents a full activity Care Homes for Older People Page 8 of 32 programme for events inside and outside the home that meets their needs and expectations. The manager must ensure that all rooms that residents have access to have hot running water which is regulated to 43c. The manager must ensure that all staff are suitably trained to carry out their role. The manager must adhered to robust health and safety procedures within 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process does not ensure that peoples care needs were being properly assessed therefore people can not be sure they will receive the right type of care. Evidence: A statement of purpose and a service user guide has been made available to prospective residents, relatives, and for people already living at the home. This tells people about the services and facilities they can expect if they should make a decision about moving into the home. There is also a colour brochure provided which gives an overview and pictures of the home, some of the information referred to in the statement of purpose and the brochure does not correspond with what the inspectors found at the time of their visit. The home is advertising a day care facility. Day care is not registered by the Care Quality Commission and the manager must ensure that if a day care service is provided it does not impinge on the residents currently living at the home and that there are enough staff available to work in the day care service. Care Homes for Older People Page 11 of 32 Evidence: There was evidence to show that each residents receives a contract and a statement of terms and conditions regardless of how their care is purchased. Prior to any resident moving in to the home a pre admission assessment is carried out to make sure that the home and staff can meet the needs of the individual. We looked at three residents files, only one had a pre admission assessment which had been completed by the manager. The one pre admission assessment seen was found to be lacking detailed information and some of the sections were left blank, for example there was no indication on the assessment of food and medication allergies which the care plan now indicates, no list of current medication, lack of information on oral hygiene, foot care, social interests, mental state (this resident has a diagnose of a dementia related illness) and any other professional involvement. The home is registered for ten people with a dementia related illness. We were told that there is only one person with a diagnosis of dementia, however twenty four other residents were confused. In light of this information Dementia Awareness training should be a priority for all staff. According to the training matrix only one person had completed dementia training. The manager told us that training had been booked for another eight members of staff. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of medicines is unsafe and puts the residents health and wellbeing at risk of harm. Evidence: The information contained in the care plans and on the pre admission for one resident was basic and therefore did not provide staff with information needed to offer the appropriate care. For example in one file it states, the resident can at times become angry and can take it out of others. There was no guidance for staff on what to do should this happen. Staff do not have the necessary skills and training to offer appropriate care to so many people with varying levels of confusion, residents who can be challenging and residents with dementia. On further inspection of files it had been highlighted by the family regarding their concerns over their relatives diet. There was no evidence to show that this had been acted on and that systems were in place to monitor food intake. Information was not recorded in enough detail regarding any treatment required to a resident with obviously sore and heavily bandaged legs. Residents general health and well being was being neglected as several had not been Care Homes for Older People Page 13 of 32 Evidence: offered their medication appropriately. During the inspection the specialist pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly. This was because at the previous inspection some areas of medication handling needed to be improved. Medication was stored securely in a dedicated medication room. The room was cluttered and some of the cabinets were in a very poor state of repair. There were a large number of dressings in stock, some of which had been dispensed almost five years ago and were for people who no longer lived in the home. Some of the medication was out of date. If out of date medicines are used residents health could be at risk. We saw that some prescribed medication, creams, was kept in residents bedrooms on their bedside cabinets. It is important that all medication is stored securely at all time so that it not misused. Records about medication administration were poor and did not always show exactly what medication had been given residents or that it could be accounted for. Staff did not record the quantity of medication that arrived in the home for residents, or the current amount of medication held for each person. The records about medication that had been refused or was no longer needed had not been completed for over a month. There were gaps on the medication administration record sheets (MARs) where staff had failed to sign to show if they had given or omitted medication. We compared the medication in the home with the records and found that some medication had been given to residents but had not been signed for. There were symbols used on the MARs such as O meaning other but staff failed to record an explanation as to what other meant. We found that some medicines were in the home for residents but there was no record of them being there. Other records about medication were also poor. No information was recorded in the care plan for staff to follow about how to give medicines which were prescribed as a variable dose or when medication was prescribed when required. If staff do not have enough information to follow to give medication safely and consistently then residents health could be at risk. Records showed that creams were kept in residents rooms but there was no information recorded that checks had been made to ensure it was safe to do so. We found that residents were not given medication as prescribed and their health may have been placed at significant risk form harm. Care Homes for Older People Page 14 of 32 Evidence: One new resident who had recently come to live in the home and had not been given all of her medicines on the day she arrived because staff did not record all of her medication on the MARS properly. She was not given her medication properly on the following day either, no explanation was recorded or given to us. On the day of our inspection visit, this lady did not have any of her prescribed medication apart from one dose of Ibuprofen at tea time. The manager told us that this resident did not have morning medication because it was taking time for the resident to settle in. This resident along with all the other residents who were prescribed medication at lunchtime and tea time were not given their medication on the day of inspection. One resident was not given medication usually prescribed to prevent epileptic seizures. The manager explained that she did not want to disturb the inspectors. If residents are not given their prescribed medication at the correct time or at all their health could be at significant risk. Another resident could not have some prescribed medication for 17 days because there was none available in the home for her, the manager told us that her medication often ran out, the records confirmed this was not the first time medication was unavailable for this lady. Another resident who had also recently come to live in the home was unable to have some of his prescribed medication for 4 days because there was none available, this medication included tablets for diabetes. This gentleman was also given some medication, which had been discontinued by the consultant at the hospital 4 weeks earlier, for 12 days. The staff had failed to check with the hospital or the doctor exactly what medication this gentleman was prescribed when he first came to live at Hollybank. This failure could have placed his health at significant risk. Some residents were given medication from other residents prescribed and labeled boxes, even though both residents had their own supply of the medication. Records showed one resident had cream applied but he was not prescribed any cream we asked the manager to explain what cream had been used but she was unable to do so. The doctors had given permission for their patients who live at Hollybank to be given homely remedies, medicines that could be brought over the counter such as Paracetamol and Lactulose. However despite the records showing that people were given these remedies there was no stock of this type of medication. The manager told us that nurses give residents their medication; the training records showed that only one nurse had had any medication training. We did not see any assessments to show that nurses were assessed as competent to administer medication, nor did we see any evidence that the manager made any checks to ensure medication was being handled safely. Care Homes for Older People Page 15 of 32 Evidence: On the day of the inspection it was observed that the dignity of the residents did not appear to be a priority. We observed, along with staff that an outside professional was tending to a residents feet in the lounge area. This was not challenged by the manager or staff as to why the resident was not taken to a private area. It was also observed that another client who was in a recliner chair looked very uncomfortable and kept sliding down. When staff were asked regarding the residents comfort, we were told, he always does it, he cant sit up properly. The inspector requested that the suitability of the chair be assessed for this individual making sure that it was appropriate for this persons comfort and safety. We also noted that in one bathroom was a list of residents names who required continence products. This is not very dignified and we asked for it to be removed. Also there was poor storage for continence products which were seen in a bathroom and in the hair dressing salon. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of provision of social activities that means people do not have the opportunities to participate in stimualting and meanful activities of their choice. Evidence: The statement of purpose and the service user guide has a comprehensive list of residents activities including board games, going for walks, maintaining life long hobbies, outings away from the home including visits to the garden centre, tea dances and visits to restuarants for lunch followed by afternoon themed caberets. There was no evidence to show that these activities were taking place on a regular basis. In one care plan seen the activities recorded were poor, for example, came in to lounge talking to X, watching TV and chatting to staff. These cannot be classed as having participated in a planned activity. We did not observe any activities taking place on the day of our visit. The manager informed us that she is looking to employ an activities coordinator. This should be actioned as a matter of priority as residents are lacking social and mental stimulation. Although there were no visitors at the home during the time of our visit to speak with, we were informed that visitors are welcome at any time. There are no restictions imposed as to when people can visit. Care Homes for Older People Page 17 of 32 Evidence: Some residents have the capacity to make there own choices and decisions, however as there are so many residents with varying levels of confusion, staff need to assit them with decision making. As we have had no returned responses to our residents feedback surveys it is difficult to assess the level of choices residents make for themselves. One resident did comment that, The food was good and you could have want you want. The chef was available to speak with and discussed the menus with the inspector. Menus were well planned and offered choices and variety. The main meal of the day was served at lunch time and on the day of our visit residents were offered a choice of cauliflower and brocolli gratin or roast chicken, roasted and creamed potatoes, carrots, garden peas and gravy. The inspector tried the lunch and found it to be tasty and nicely presented. The chef had made two sponge puddings and custard, one of which was suitable for diabetics living at the home. The chef will cater for any special diets and preferences required. The chef confirmed that there was always adequate suppplies of food and deliveries of fresh products. It was noted that only a few residents went into the dining room for their lunch. Whilst we appreciate that residents have the choice to dine where they wish, they should be encouraged to use to dining room to promote socialisation with others, increase mobility and get a change of scenery. This also applies to residents in chairs where the staff have to assist them. This also gives them a change of atmosphere. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The poor medication systems and practices within this home demonstrated that residents health and welfare is not protected and promoted. Residents were at risk of neglect and potential harm. Evidence: The home has a complaints file and a complaints procedure. A suggestions box is available to allow people to make complaints, offers ideas and give their opinions without having to go to a member of staff. According to the AQAA there had been two complaints made since the last inspection, there was only evidence of one being recorded and resolved. At the time of our visit there had been no safeguarding referrals or investigations within the last twelve months. It was a requirement from the last inspection in December 2009 and discussed at the inspection of May 2008 that all staff must be suitably trained in the Protection of Vulnerable Adults. This has not happened, therefore several staff at the home are lacking knowledge and experience in protecting vulnerable people in their care. Dangerous practices and poor record keeping regarding medication are placing residents at potential risk of harm and neglect. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to continue with is ongoing programme of maintenance to ensure that residents live in a well maintained, comfortable and pleasant environment. Evidence: From a tour of the premises it was evident that the home, in the old part of the building is in need of some refurbishment. It was evident that work was ongoing and that some rooms had been decorated. The newer part of the home was maintained to a satisfactory standard with comfortable lounges and dining area. Bathrooms and bedrooms were more modern. In the old part of the home the lounge and dining area were comfortable and bright. Some of the bathrooms were dated and looking tired and the decor did not lend itself to offer a relaxed bathing environment. In two bathrooms we found that there was no hot water coming out of the hand basins. In another bathroom the water was so hot that residents could have been at risk of scalding. (We have since been informed that this has been addressed). There was also evidence of communal toiletries being used and block soap on sinks. All residents should have their own toiletries in their rooms which are taken into the bathrooms when residents are ready to bathe. Also to reduce the risk of cross infection communal block soap and cloth towels should not be used. At the time of the inspection the first floor was unoccupied. There is a lot of work to be actioned before these rooms are fit for purpose. The management team are aware of this. It was also noted that some of the radiators on this floor were exceptionally hot and this will need to be addressed before Care Homes for Older People Page 20 of 32 Evidence: rooms are occupied. It was noted and brought to the attention of the management that in some rooms the wallpaper was coming off and in one bathroom there was a dark, grey damp patch. In one residents room there was a strong smell of urine, this must be eradicated. Some of the residents had brought some of their own possessions with them when they moved in to the home and most rooms were personalised. The home is set in mature gardens, which would be very pleasant for residents to enjoy sitting outside . On approaching the home we noticed the outside area looked unsightly, with a chair, old wheelchairs and other items thrown outside. This created a poor first impression and the items need removing. It was observed that staff wore protective clothing when completing different tasks. However to reduce the risk of cross infection no block soap or cloth towels should be used. In the sluice room, which was not locked we noticed a bottle of bleach,. We asked for this to be removed immediately. The laundry is sited away from areas that residents have access and does not interfere with them in any way Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hollybank do not receive care and support from a well trained staff team. A lack of staff training in all areas could potentially place residents at risk of harm. Evidence: On the day of the inspection there was an adequate number of staff on duty. However the competency of some of the staff was questionable. The home has more than half the staff quailfied to NVQ level 2 in care. All staff working at the home have a duty to report to senior management any areas of poor practice that they might have picked up on. It is not one persons responsibilty to administer medication, however several staff have overlooked the poor and dangerous practices we found. This included, the manager, trained nurses and care staff. Staff training is poor with several staff including the manager not having completed mandatory training, for example information on the self assessment indicated that no staff have received training in food hygiene and only one person has had medication training. It was seen that other staff training was lacking. We looked at some staff recruitment files. These were seen to contain an applicaton form, two references, CRB disclosure and other forms of identification. Care Homes for Older People Page 22 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management systems do not ensure the safe and efficient running of the home and ongoing improvements of the service. Evidence: Since the last inspection in December 2009 the home now has a registered manager. The manager has had previous experience in managing a care home both for residential and nursing residents. We had serious concerns about the way the home was currently being managed. The health and well being of the residents did not appear to be the central focus. There were inadequate systems in place to ensure that people were being properly cared for and their social needs accomodated. The quality assurance systems within the home need to be improved. There was no evidence of regular audits for example on the care planning, medication or activities. Monthly reports from the owner are completed. The last residents meeting was in October 2009. Care Homes for Older People Page 23 of 32 Evidence: Some of the residents have handed over small amounts of money for safe keeping. Some of this was checked and no discrepancies were noted. Safe working practices within the home need to improve in areas such as food hygiene, infection control, safe storage of hazardous substances (bleach) and the safe regulation of water temperature and radiators. The homes accident book was checked and accidents and incidents had been recorded. Information on the self assessment form told us the maintenance of equipment within the home had been serviced and tested. A random inspection of some the certifcates were seen to be up to date and valid. Care Homes for Older People Page 24 of 32 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 9 13 That a record is maintained of all medicines destroyed/returned to the chemist. To ensure an accurate account of all medicines is maintained to ensure they are being safely managed. 28/02/2009 2 16 13 Arrangements are made to ensure that safeguarding training is provided to those staff who have not been provided with such training since the last inspection. To ensure that residents are cared for and supported safely by staff who are appropriately trained in safeguarding issues. 28/02/2009 3 29 19 That all prospective employees provide an explanation of any gaps in their employment history and make a declaration in respect of their physical and mental health. To ensure as far as possible that residents are being supported and cared for by suitable people. 28/02/2009 4 30 18 That arrangements are made 28/02/2009 to ensure that staff are Page 25 of 32 Care Homes for Older People 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 provided with ongoing relevant training. To ensure that residents are cared for/supported properly by competent staff. 5 33 24 That a system is established and maintained that evaluates the quality of the service provided at the care home. To help ensure the home is run in the best interests of residents. 6 38 13 That arrangements are made 28/02/2009 to ensure pipework and radiators are guarded or have guaranteed low srface temperature surfaces. to minimise unnecessary risks to the health and safety of residents. 7 38 23 Make arrangements for 28/02/2009 persons working at the home to receive suitable training in respect of fire prevention and undergo fire drills. To ensure that fire safety precautions in the home are adequate and appropriate. 28/02/2009 Care Homes for Older People Page 26 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 A detailed pre admission 31/03/2010 assessment is to be completed to ensure the home can meet the needs of the individual. To enable staff to offer the care needed on admission. 2 4 18 You must ensure that staff are suitably trained to care for people who require specialist care, for example residents with dementia. To ensure that staff are able to provide the appropriate care needed. 30/04/2010 3 7 15 You must ensure that all residents have a detailed care plan as to how their needs are to be met. To enable staff to provide the individual care needed. 31/03/2010 Care Homes for Older People Page 27 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 9 13 There must be an effective 19/03/2010 auditing process in place to ensure that managers are confident that medicines are being handled safely. To help make sure that people who live at the home are kept safe. 5 9 13 Effective arrangements must 19/03/2010 be in place at the home to ensure that all medication records regarding, receipt, administration and disposal are completed accurately. So that medicines can be fully accounted for to prevent mishandling. Records must show that medicines are being given correctly and peoples health is not at risk from harm. 6 9 13 There must be effective information recorded to enable staff to administer medication safely and know how to store medication safely. To prevent residents health from being harmed by the misuse of medication. 19/03/2010 7 9 13 There must be effective systems in place to ensure that staff that handle medicines are trained in 19/03/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action medicines handling and are competent to do so safely. To help make sure that people who live in the home are kept safe. 8 9 13 Effective arrangements must 19/03/2010 be put in place at the home to ensure that all medication is administered to residents in exact accordance with the prescribers direction. Because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. 9 10 12 You must make suitable 31/03/2010 arrangements to ensure that the home is conducted in a manner which respects the privacy and dignity of residents. That any visits to residents from outside agencies are carried out in a private area. 10 12 16 You must consult with residents about a programme of activities arranged by or on behalf of the care home, and provide facilities for recreation so suit their needs. To make sure that residents 31/03/2010 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action can enjoy a wide and varied range of activities to suit their needs and expectations. 11 18 13 You must make sure that 31/03/2010 measures are in place to prevent residents being harmed of suffering abuse or being place at risk of harm or neglect. To make sure that residents are safe and their health and well being is maintained at all times. 12 27 18 You must ensure that all staff have the skills to meet the needs of the residents. To make sure that the individual care needs of the residents are met. 13 30 18 You must ensure that all 31/03/2010 staff receive training that is appropraite to the work they are to perform. To ensure that residents are in safe hands at all times and their care needs are met. 14 31 9 You must ensure that residents live in a home which is run and managed by a person who is fit to be in charge and is able to 31/03/2010 31/03/2010 Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action discharge her responsibilties fully. To make sure that the home is run in the best interests of the residents. 15 33 24 You must ensure that there is a system for reveiwing at appropriate intervals the quality of care provided at the home. To ensure that the home is run in the best interests of the residents, 16 38 13 You must ensure that that unnecessary risk to the health and safety of residents are identified and eliminated. To ensure that residents live in avsafe and secure environment. 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 31/03/2010 31/03/2010 1 10 To ensure the dignity of all residents information regarding residents continence products should not be listed on the bathroom wall. To continue with the refurbishment of the home to make sure that residents live in comfortable and pleasant surroundings. 2 19 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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