Inspection on 12/05/09 for Hollybush

This inspection was carried out on 12th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollybush 13/11/09

Hollybush 13/05/08

Hollybush 23/10/06

Hollybush 07/03/06

Hollybush 10/08/05

Hollybush 08/03/05

Hollybush 02/11/04

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hollybush 45 Glamis Road Newquay Cornwall TR7 2RY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ian Wright     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 36 Information about the care home Name of care home: Address: Hollybush 45 Glamis Road Newquay Cornwall TR7 2RY 01637874148 01637874148 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Nicola Carla Brazier,Mr Neil Edward Brazier care home 14 Number of places (if applicable): Under 65 Over 65 4 14 dementia old age, not falling within any other category Additional conditions: 0 0 Service users to include up to 14 adults of old age (OP) Service users to include up to 4 adults with Dementia (DE(E)) Total number of service users not to exceed a maximum of 14 Date of last inspection Brief description of the care home Holly bush accommodates up to fourteen elderly people, up to four of whom may have dementia. Holly bush is situated in a residential area on the outskirts of Newquay. The home is close to shops and in walking distance of the coast. Mr and Mrs Brazier are the registered providers. Ms J. Pritchard is the registered manager. The majority of bedrooms are situated on the ground floor. Five bedrooms are situated on the first floor and are accessed via the stairs or a stair lift. All bedrooms have en suite facilities. There are assisted bathroom / shower facilities for people with mobility problems. There is a large lounge / dining room, which provides shared space for Care Homes for Older People Page 4 of 36 Brief description of the care home people who use the service to relax in. The home has a conservatory and people who use the service can use the garden. There is car parking available for people who use the service, staff and visitors. The ground floor is wheelchair accessible. A copy of the inspection report is available from management if required, or via the CQC website at www.cqc.org.uk. The range of fees could not be obtained at the time of the inspection. Care Homes for Older People Page 5 of 36 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: one star adequate 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 took place, by one inspector, in six hours in one day. All the key standards were inspected. The methodology used for this inspection was: (1)To case track people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussion with staff about their experiences working in the home. (3) Observing care practices. (4) Assessing information obtained in a postal survey of people using the service, and staff working at the home. (5) Assessing information contained in the homes Annual Quality Assurance Assessment- an annual return required to be submitted by the commission. This includes a self assessment, and also a dataset of information about the operation of the home. (6) Inspecting records and the care environment. (7) Assessment of information sent to us from the registered provider after the inspection. Care Homes for Older People Page 6 of 36 Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgments made in the report. What the care home does well: What has improved since the last inspection? What they could do better: The main concern we had on the day of the inspection was that all of the registered persons were on holiday, were out of the country, and provided staff with no contact arrangements. It therefore was unclear who was accountable for the running of the service during that week and who, in a position of authority, could be approached in an emergency or to make major decisions. We have requested information from the registered persons how they will manage such a situation should it occur in the future. The absence of the registered persons also resulted in us not being able to access certain records which always should always be available for inspection. Again we have requested the registered persons tell us what improvement they will make to adhere to the regulations in this area in the future. The lack of provision of this information may have resulted in us not being able to get a full picture of the operation of the home at this inspection. However, we have done the best we can, with the information available, to provide an accurate assessment of the home. We were subsequently provided with some documentation, within four working days of the inspection, but this was insufficient to enable us to change the overall service rating. We have also issued statutory requirements regarding: (1) Improving records of health care checks. (2) Ensuring there is always a record of any medication administered. (3) Ensuring records are always available for inspection for example staff personnel and training records etc. (4) Making sure people using the service always have access to a call bell-for example to call staff if they need help. (5) There is annual servicing of all gas appliances. (6) Access arrangements for monies belonging to people using the service (which are retained for safekeeping) are improved. (7) Quality assurance procedures and processes are improved. We will request an Improvement Plan from the registered persons, and subject to whether we receive suitable evidence of compliance, may complete a further random Care Homes for Older People Page 8 of 36 (short targeted) inspection before the next Key (full) inspection in a years time. 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 set out 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 36 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 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission procedures appear to be generally satisfactory, although we recommend some improvement in the records kept regarding this process. Suitable information is provided regarding peoples rights and responsibilities. For example people are issued with a service user guide and a contract /statement of terms and conditions of residency when they move in to the home. Evidence: The home has a statement of purpose and service user guide. A copy of the statement of purpose is available in the hallway of the home. We inspected the service user guide at the previous key inspection on 13th May 2008, and it was satisfactory. We were told at this time that people who use the service, and where appropriate their representatives, receive a copy of this information. Information regarding assessment processes is contained in the homes statement of Care Homes for Older People Page 11 of 36 Evidence: purpose. We focused on pre admission assessments for people who moved to the home since the last key inspection. Some information regarding the assessment is contained in individual files of people who use the service. Assessments generally contained satisfactory information. However, from the documentation on file it was not clear whether assessments were always completed prior to admission. For example some documentation was not dated, and some information was dated on the day of admission or the day prior to the date of admission. We did not view any contemporaneous notes of meetings with people for example regarding hospital or domiciliary visits prior to admission. However, the manager of the home did tell us last year senior staff do visit people prior to admission. Two people moved to the home from outside Cornwall. Information was provided by the NHS trusts or social services departments regarding these peoples needs. Although it is accepted, due to the distance involved, the registered persons may not be able to meet these people prior to admission , it was not clear how they checked they could meet the peoples needs. For example whether an assessment was completed via the telephone with the persons keyworker at their previous homes or placements. We were provided with the contracts for two people living in the home and these contained satisfactory information. About three quarters of the people who responded to our survey stated they had received a contract. Other people did not respond to this question or said they had not. The registered persons however state that all people who use the service are issued with this information. We did ask some of the people who use the service about pre admission assessment processes, and whether they received information regarding their residency. People told us they could not remember any involvement or receiving information regarding these matters. Care Homes for Older People Page 12 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People said to us they were happy with the support received to meet their health and personal care needs. However, people using the service always must have access to a call bell so they can alert staff in an urgent situation. Although care planning is generally satisfactory, health care records need some improvement so people can be more assured there is effective monitoring of their needs. Some improvement is required to the medication system, for example it is essential there is always a record medication is being administered. Improvement in these areas will give people using the service more assurance their health and personal care needs are being met. Evidence: People who use the service, who we spoke to, were all positive about the care they received. People said staff generally tried to give them a choice in how care is delivered. People said they could get up when they wanted to and could go to bed when they wished. The staff we spoke to felt they tried hard to meet peoples needs. Care practices were observed as generally appropriate. Care Homes for Older People Page 13 of 36 Evidence: We received a very good response to our postal survey. The vast majority of survey responses were positive. For example people said they receive appropriate care and support. People said they generally felt listened to although one person said staff should always give time to allow them to finish what they are saying and not interrupt. The survey also said staff were supportive and usually available when needed. However there was a minority of comments which said staff were not always available at busy times such as after meals. One person said they often felt they were kept waiting to be moved from room to room. We did raise a concern regarding one person not having access to a call bell. One person was observed in their room trying to alert staff as she needed the toilet. The person had mobility problems and could not get up. When the inspector alerted the staff member they came quickly and assisted the person. However, the inspector called back to see the person half an hour later. The person said, unprompted, that they were distressed about the incident as they nearly had an accident. The persons call bell was tied to their bedside, and when the inspector tried move the cable it did not reach the persons chair. We have issued the registered persons with an immediate requirement to ensure this matter is rectified, to check other call bells work, and are reasonably accessible to people in the home throughout the 24 hour period. We have since received written confirmation that suitable action has taken place. We inspected the files of six people who use the service. A care plan was available in all files inspected. Care plans are accessible to staff. There is evidence care plans are reviewed. Care plans contain a manual handling assessment. The majority of care plans were satisfactory although one care plan needed to be completed more thoroughly. Staff completing care plans need to be careful about the terminology used. For example one person was described as lazy in regard to washing, and another person was described as rude, abrupt and nasty to staff. Objective language needs to be used when describing a persons behaviour. Care plans and care notes must always be signed and dated. People who use the service said they were satisfied with the health care support they receive. Our survey also concluded people were happy with the medical support provided. There is variable evidence in peoples files that treatment from GPs, district nurses, chiropodists, opticians, dentist services has been received. It is not always clear when individuals last saw these professionals, and whether the services are still being provided (particularly in regard to dentists and opticians). Subsequently the care planning system needs to be developed to ensure staff can ascertain when support from these services was last received (e.g. at a glance), whether it is still required /wanted, and when the person next needs to have support and treatment from these services. Care Homes for Older People Page 14 of 36 Evidence: We inspected the medication system. Medication is stored in a dedicated medicines cupboard. This is satisfactory. Medication is supplied in a monitored dosage system supplied from a local pharmacist.Some controlled drugs are kept in the home, and administration and recording of these are satisfactory. One persons medication which had recently been prescribed was not on the medication sheet. It therefore is not clear whether this was being administered as no record was being kept. As training records were not available for inspection, it is not clear what training staff have received regarding the administration of medication. No information regarding this was contained in the AQAA (annual return) provided to us by the registered persons. Care Homes for Older People Page 15 of 36 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. Routines,food and opportunities seem to meet the needs of the people living in the home Evidence: People using the service, who the inspector spoke to, said they could get up and go to bed when they wished. People said routines in the home are relaxed. We observed a friendly, relaxed atmosphere in the home. People said some activities are arranged for example external entertainers visit the home, and staff also facilitate some group activities such as quizzes,keep fit etc. A noticeboard is in the lounge which shows there is at least one activity available each day. Most people, who responded to our postal survey, said there was either always or usually activities available that they could participate in. One person who responded said when they moved in they had been led to believe there would be more activities than there is. Records show the home organises a range of activities at Christmas. The plan over the last few Christmases was very good. There is also a Summer Fete at the home, and other festivities are arranged such as at Easter. Some people receive regular visitors, and some people go out with relatives. Care Homes for Older People Page 16 of 36 Evidence: People we spoke to said they were happy to occupy their time either in the lounge or their bedrooms. People are positive about the food provided. The main meal is served at lunch time. There is a choice of cooked tea or sandwiches at tea time. People were happy with the teas, although one person said they would like larger portions. Regular drinks were served to people throughout the day of the inspection. Suitable records are maintained regarding food provided. Care Homes for Older People Page 17 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and adult safeguarding policies are satisfactory. This should give more assurance that if people living in the home have a concern, the registered persons will deal with the matter appropriately. Evidence: The registered persons have a satisfactory complaints procedure. A summary of this is contained in the homes statement of purpose and service user guide. The registered persons have not received any complaints.The Commission for Social Care Inspection, and subsequently the Care Quality Commission, have not received any complaints about the home. People we spoke to said they did not have any complaints, and felt confident discussing any concerns with staff or management. This was confirmed in the responses we received in our postal survey. Some amendment should occur to the complaints policy, for example, details of the Care Quality Commission should be included within this documentation. This should include details of the commissions national call centre when details become available in the summer. Details of Cornwall Councils complaints department (or other authority if the person is funded by another body) should be included in the service user guide of the person using the service. If the person is funded by a public authority they have Care Homes for Older People Page 18 of 36 Evidence: a right to use the statutory complaints procedure of the funding authority, and subsequently they should be made aware of their rights. The registered persons have a satisfactory Adult Safeguarding procedure. The Commission for Social Care Inspection and subsequently the Care Quality Commission have not received or been made aware of any safeguarding referrals since the last key inspection. The registered persons also have not had to refer any safeguarding concerns to Cornwall County Council. We have not received any information that the registered persons have had to refer any ex staff for inclusion on the Protection of Vulnerable Adults register. (A list of people deemed unsuitable to work with vulnerable adults). Care Homes for Older People Page 19 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hollybush provides a suitable facility for the people living there. Evidence: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and very homely. The lounge has lots of ornaments and pictures, and resembles a large family lounge. There is a very pleasant garden, which people who use the service can use. The garden has a decking area. This has helped the people who use the service to be able to use the garden. Bedrooms are individualised and comfortable. Some of the downstairs bedrooms have uneven floors. Care needs to be taken that people who have mobility difficulties, and who are at risk of falls , are where possible not accommodated in these rooms. Locks are not fitted to bedroom doors. We gave a recommendation in the last key inspection report for these to be fitted. It should be the default position in any care home that each bedroom has a lock on the bedroom door. This is outlined in the National Minimum Standards. People should also have a lockable drawer etc. in their bedroom where they can keep valuables, or medication if they self administer. If people lack the capacity to hold a key to their bedroom door, this should be risk assessed and recorded in their care plan. Care Homes for Older People Page 20 of 36 Evidence: Subsequently to the inspection, the registered provider has stated people are offered a lock on their bedroom door when they are admitted. The registered provider has also stated people can have a lockable space (drawer / cupboard etc.) if they wish. We raised a concern regarding peoples access to the call bell system. An immediate requirement was made regarding this matter. This is discussed in the Health and Personal Care section of the report. A stairlift is provided to assist people who use the service to go upstairs. There are bathing hoists on both of the baths. Bathroom and shower facilities are to a good standard, and staff have done their best to make these spaces homely. Suitable kitchen and laundry facilities are provided. A cleaner and cook are employed. The home was clean and hygienic at the time of the inspection. There were no unpleasant odours in the home. One person said their relative had chosen the home as it was the first one they had visited which did not smell. Care Homes for Older People Page 21 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from receiving support from a suitable number of staff who are viewed by those who use the service as caring and supportive. Staff recruitment procedures appear to be now satisfactory from the information we have inspected. Training provision appears to be at least adequate from the information we have obtained. However, we cannot judge training provision is now satisfactory as we were not able to fully assess records during the inspection as records were not available to us. Evidence: On the day of the inspection there were two staff on duty from 08:00 to 21:30, one person on duty from 21:30 to 22:00, and one waking night member of staff on duty from 22:00 to 08:00. There was also a cleaner and a cook on duty. The registered persons were on holiday. The senior carer came in to meet with the inspector for a short time, although this person was not on duty that day. Staff turnover appears to be low. For example many of the staff on the rota worked at the home when we last inspected in May 2008. As the registered persons were on holiday we were unable to inspect personnel and staff training records. There needs to be arrangements to ensure these records are Care Homes for Older People Page 22 of 36 Evidence: available for inspection if the registered persons are absent. This is discussed in the next section of the report. The registered provider did submit some information to us following the inspection, but this was insufficient to determine the standard is now met. We interviewed one member of staff on duty. The person said when they started they provided the names of two referees, and believed the registered persons had completed a Protection of Vulnerable Adults Check (POVA First-this ensures any person being recruited is not on a list of people who are deemed unfit to work with vulnerable people). They said a Criminal Records Bureau check had been completed. (CRB- this checks someone does not have a criminal record, which may mean they are unsuitable to work with vulnerable people). The AQAA (annual quality assurance return) submitted by the registered manager states appropriate recruitment procedures are in place. The registered provider has stated two members of staff have been employed since the last inspection in May 2008. After this inspection we were provided with copies of records regarding checks completed prior to these two peoples recruitment. This included the completion of an application form, two references for each person, a Protection of Vulnerable Adults first check for each person (POVA First) and a Criminal Records Bureau check (CRB) for one person. It was not clear if a CRB was received for the second person and if not, what arrangements are in place for their supervision. We have recommended to the registered provider that a reference should always be taken up from the persons previous employer-especially if the person worked in a caring capacity. This did not appear to have occurred in either case. Staff working in the home have suitable opportunity to obtain a National Vocational Qualification in care. The homes AQAA states five permanent care staff have an NVQ to level 2. Some certificates regarding staff NVQ qualifications are displayed in the hallway of the home. In regard to staff training, by law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level). (3) All staff must have manual handling training and regular updates of this (e.g. annually). (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. Staff also need to have suitable training to meet the needs of people who use the Care Homes for Older People Page 23 of 36 Evidence: service such as dementia awareness. Up to four people can be accommodated at this home with dementia. We were able to speak with one member of staff, who had commenced employment since the last key inspection. This person said they had received an induction, and also manual handling training via a distance learning provider. They said the registered manager had demonstrated the use of the hoist. The person said they had also read through various training folders, regarding other areas of care practice, which the registered persons had required them to do. We also received three postal surveys from staff members.These said induction was covered very well, management are supportive, and staff feel they have the right support, experience and knowledge to meet the needs of people living in the home. The homes AQAA stated that 9 of the care staff have received training regarding safe food handling ,and two of the catering staff had received this. 13 staff are deemed to have training in the prevention and control of infection. The registered manager had declared in the AQAA that staff are well trained and more external training will be provided in the next 12 months. We asked the registered provider to submit an Improvement Plan after the last Key Inspection in 2008. One of the statutory requirements issued was to improve training. In the Improvement Plan the registered provider said they would take suitable action to oversee and monitor all training. They also said they would enroll staff on first aid courses. Some training certificates are displayed on the wall in the hallway of the home. These demonstrated that some staff had a national vocational qualification in care, some staff have a food hygiene certificate, the registered manager is a fire warden, and two staff had attended training regarding the protection of vulnerable adults. We have not able do a full audit of personnel and training records to check recruitment and training procedures are now to a good standard. This was due to the unavailability of documentation. We were provided with some copies of training certificates after the inspection, but the information provided was limited and not sufficient for us to conclude the standard is now met. We therefore have not removed the previous requirement as we have not been able to validate the action the registered persons have said they have taken. Care Homes for Older People Page 24 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements were not deemed as satisfactory on the day of the inspection. For example it was not clear how or who would support staff in an emergency. We have requested urgent clarification regarding management arrangements when the registered persons are on annual leave in future. Some improvement is required to quality management systems, so we can be assured there is a satisfactory system of quality improvement regarding this service. We need clarification regarding how people using the service can access their monies if the person in charge is absent. Health and safety precautions are only adequate for example a gas safety certificate is required so we can be assured appliances remain safe. Improvement in these areas will help to give assurance that people living in the home live in a safe and well managed service. Care Homes for Older People Page 25 of 36 Evidence: The registered provider is Mr N and Mrs N Brazier. The registered manager is Ms Julie Pritchard. The registered persons have been deemed by the commission as having suitable knowledge, skills and experience to carry on and manage the home.Staff we spoke to said they felt supported by management, and felt the team worked well together. The three responses we received to the staff postal survey also stated this. People living in the home said they were happy with the service and said the management of the home was approachable. However, we were very concerned about the management arrangements on the day of the inspection. We were concerned that both the registered providers, and the registered manager were all on holiday at the same time. When we arrived staff on duty were not clear when the registered persons had gone away or when the owners would be back. There was no contact details for the registered provider or the registered manager should there be an emergency. Details regarding when the registered providers would be back at the home were not in the diary or on the rota etc. There did not appear to be any clear written instructions to the staff group regarding procedures to follow should they need support and assistance in emergency. For example we were told that the registered persons were not in the country and could not be contacted. A senior carer later visited the home and said she had been designated in charge while the registered persons were away. The senior carer told us the registered providers would be back on Friday and the manager would be back the next day. The senior carer said she could contact the registered manager of the other home owned by the registered provider in an emergency. However the person only knew the manager by her first name, and it was not clear to us how knowledgeable this manager is of the staff and resident groups, or with the operation of this home. We left an immediate requirement at the home for the registered provider to write to us to confirm what management arrangements will be put in place when the registered persons are on holiday in the future. There needs to be suitable support for staff, and appropriate arrangements to ensure accountability for example if there is an emergency. If this is not possible, due to unforeseeable circumstances, it is advisable the commission is always consulted. The registered persons have a Quality Management policy. However, this appears to be a policy purchased off the shelf and does not appear to reflect practices in the home. For example it refers to a Total Quality Management approach, refers to a process of having an Annual Development Plan and an Annual Audit. These are all excellent tools but we did not see evidence of their implementation. Care Homes for Older People Page 26 of 36 Evidence: We did however note that there was a record of a survey completed in 2007 of peoples views of the service. The results of this was generally positive. There is also a record on the wall of some checks of office systems. We viewed lots of thank you cards which had been sent to the home. There was a record that 3 staff meetings occurred since October 2007 and 3 resident meetings had occurred since September 2007. The registered manager completed the homes Annual Quality Assurance Assessment (AQAA). This included some plans to develop the service for example in regard to continuing to upgrade the physical environment of the home, develop training, develop activities for the people living in the home, ensuring there is internet access etc. The registered persons also plan to continue to monitor care standards, recruitment and training procedures so standards are maintained. The feedback we received from staff working in the home, and people who live there was generally very positive. However, the homes policy needs to be developed so it accurately reflects practices in place, and any intentions to improve these practices. We did inform the registered providers that they could submit any further information regarding this standardwithin four working days of the inspection- but we only received a copy of the policy, but no further evidence of its implementation. Therefore we have carried over part of this requirement from the last inspection. We understand some monies are looked after on behalf of people who use the service. On the day of the inspection these were locked in the filing cabinet. The senior carer offered to show us the records and the monies when she came in to meet with the inspector. We were concerned about the arrangement as only the senior carer had access to the monies. We were concerned because the senior carer was technically off duty on the day of the inspection. She would not be available in the afternoon and evening, and also the following day. Subsequently people using the service would not be able to access their monies or any valuables kept. However, we were told there was a cash float available to staff, and if residents needed money it could be taken from here and later reimbursed. It is essential people using the service can access their property should they require it. We have asked the registered persons to clarify the current arrangement, and review it as necessary (for example in line with the Mental Capacity Act guidelines.) We did not complete a check on the monies of people belonging to people using the service. At the last key inspection in May 2008, we issued a requirement to improve the management of peoples finances (e.g. develop a system which could be audited and ensure that receipts were obtained for expenditure carried out on behalf of people using the service). The registered providers submitted an improvement plan after the Care Homes for Older People Page 27 of 36 Evidence: inspection. This stated that suitable improvement would occur, which would be monitored by the registered persons. We have however not removed part of the requirement issued at this time as we are not satisfied that current arrangements regarding the management of peoples monies are appropriate. The home has a policy and procedure file. This is kept in the lounge where it can be accessed by all staff. The file contains relevant policies which need to be referred to by the staff group. As the registered persons were on holiday some records, which needed to be available for inspection, were not accessible to us. This included contracts of people who use the service, pre admission assessment information, personnel records, staff training records and work completed regarding quality assurance checks. We understand some of this information is deemed confidential and therefore it is appropriate for it to be locked away. However, it also needs to be accessible for instance if there is an inspection. Consequently, if the registered persons are away, arrangements need to be in place to ensure these records are available for inspection. We left an immediate requirement at the home, and confirmed this in writing to the registered provider. We have since received a response which states a key will be left with the senior carer in future. The registered persons have a health and safety policy. There is also a fire risk assessment. Internal checks on the fire system were satisfactory. We saw some records that fire training had occurred in February 2008. There may have been further training but records were not available for inspection. However there was a certificate to state the registered manager is a fire warden. Testing of fire extinguishers and the fire system appears to have been completed appropriately by external contractors, and a maintenance agreement for the system is in place. Portable electrical appliances were last tested in January 2009 by the registered provider. This arrangement is satisfactory as long as it is agreed with the Health and Safety Officer at the Environmental Health Department. Suitable equipment should always be used to test appliances, and the registered persons need to be assured that this equipment continues to provide accurate readings. The registered persons may need to check with Environmental Health if the registered persons have any questions regarding the current arrangement. There is a certificate to state the electrical circuit has been tested and is deemed safe (23/7/2006). Gas appliances / heating were last tested on 24/4/2008, and 30/4/2008. These need to be tested annually and therefore a new certificate regarding gas safety is now required. Care Homes for Older People Page 28 of 36 Evidence: The hoists have been serviced and are deemed safe. The stairlift was last serviced on 23/5/2008, and a service is therefore imminent. This needs arranging if the registered persons have not already done so. A risk assessment regarding the prevention of legionella was completed in 2006. We issued a recommendation as a consequence of our last visit for the registered provider to copy this to the Environmental Health Department. It was suggested they ask them if the current risk reduction measures were satisfactory. From documentation, it is not clear if this has occurred. As the registered persons were not available on the inspection, we have reissued this recommendation in case the registered persons still need to check their legal obligations regarding this matter. The environmental health officer inspected the food premises in June 2006 and in regard to health and safety in October 2004. As stated in the staffing section, training regarding health and safety issues may require improvement. A current certificate of insurance was displayed in the home. Care Homes for Older People Page 29 of 36 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 33 7, 9, 12, 13, 24 Further develop the quality 01/09/2008 assurance system to monitor standards. Measures taken should be included in the quality assurance policy. Receipts must be provided 01/07/2008 for expenditure carried out on behalf of people using the service. This will help to ensure there is suitable evidence that any expenditure on behalf of people who use the service is legitimate, and any risk of financial abuse of peoples monies is minimised. Staff must receive training 01/09/2008 required by law. This will help ensure people who use the service receive appropriate care and support from staff, who have suitable knowledge and skills. It will also help ensure risks to peoples health and safety are minimised. 2 35 13(6), 20 3 38 10(3),12, 13(5)(6)16(2) (j)18, 23(4)(5) Care Homes for Older People Page 30 of 36 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 7 12 Record keeping regarding when people last saw a medical professional (e.g. dentist, chiropodist, optician) needs improvement. It should be possible to track when someone last had an appointment with each professional. This should help give people more assurance their medical needs are being monitored, and they will receive frequent appointments from these services as required. 01/07/2009 2 9 13 There must be a record of all 01/07/2009 medicines administered for all people using the service. This will give more assurance to people using the service that their medication is looked after appropriately and prescribed Care Homes for Older People Page 31 of 36 medications are being administered. 3 10 12 There must satisfactory 22/05/2009 access to the call bell alarm system in each bedroom. The registered persons must check all rooms used by people using the service have satisfactory access to a call bell, and take suitable action to ensure this. They must confirm in writing satisfactory arrangements are in place. IMMEDIATE REQUIREMENT. This will help ensure people using the service have access to an effective call bell system in an emergency. 4 29 19 Personnel and training records for all care staff must be available for inspection. IMMEDIATE REQUIREMENT This will help to ensure we can check that staff are deemed as experienced, knowledgeable, qualified and suitable to work with vulnerable people. 5 31 7 Satisfactory management arrangements must in place if the registered persons are all on holiday at the same time in the future. IMMEDIATE REQUIREMENT 22/05/2009 21/07/2009 Care Homes for Older People Page 32 of 36 This will ensure there are clear lines of accountability (for example in emergency), and appropriate supervision arrangements are in place for the home. 6 33 24 The registered persons must 01/09/2009 have a satisfactory quality assurance policy and procedure. There needs to be suitable evidence of what processes are in place for ensuring ongoing service improvement. Action in this area will give people who use the service reassurance that satisfactory measures are in place to improve the quality of the service provided. People living in the home must be able to access their valuables and money at any time, if held on their behalf by the registered persons. By 19/5/09, we require the registered persons to inform us what arrangements will be put in place to improve access. IMMEDIATE REQUIREMENT This will help ensure the rights of people using the service are protected. 8 37 17 Records for example as 22/05/2009 outlined in Schedule 3 and 4 of the Care Home Regulations 2001, must at all times be available for 22/05/2009 7 35 13 Care Homes for Older People Page 33 of 36 inspection. The registered provider is requested to inform us by 19/5/09 what arrangements will be put in place for us to access these records in future. IMMEDIATE REQUIREMENT This will ensure records can always be inspected by any person authorised by the Commission to enter and inspect the care home. 9 38 13 The boiler and gas appliances must be serviced annually, and a gas safety certificate obtained. A copy of the certificate deeming equipment safe must be forwarded to the commission within the timescale set. This will give further assurance to people using the service, and other stakeholders, that gas fuelled equipment is safe, and any health and safety risks to people living in the home are minimised. 01/07/2009 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 3 Ensure there is clearer evidence that the registered persons complete pre admission assessments before people move into the home. For example contemporaneous notes of assessments need to be retained. Care Homes for Older People Page 34 of 36 2 16 Ensure information regarding social service department / health department complaint procedures are included in individualised service user guides. This will help to ensure people, funded by these authorities, are aware of their statutory rights to use these procedures if they have a concern or complaint. The registered persons should always obtain a reference from any member of staffs previous employer, and where possible when this person has worked in a caring capacity in any previous employment. The registered provider is advised to send a copy of the homes legionella risk assessment to the Environmental Health Department (Health and Safety) for advice whether any regular checks need to be completed by the provider or a qualified contractor. 3 29 4 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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