Inspection on 21/04/09 for Holywell Bay Care Home

This inspection was carried out on 21st April 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holywell Bay Care Home 11/11/08

Holywell Bay Care Home 24/04/08

Holywell Bay Care Home 08/10/07

Holywell Bay Care Home 16/05/07

Holywell Bay Care Home 04/12/06

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holywell Bay Care Home Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT     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: 2 2 0 4 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 35 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 35 Information about the care home Name of care home: Address: Holywell Bay Care Home Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT 01637830801 01637831119 holywellbay@yahoo.co.uk 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) : Newport Care Limited care home 45 Number of places (if applicable): Under 65 Over 65 45 45 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 Service users to include 1 adult under the age of 65 years. The maximum number of service users who can be accommodated is 45. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Denentia aged 65 years and over on admission - Code DE(E) - maximum 45 places Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission - Code MD(E) maximum 45 places Date of last inspection Brief description of the care home Holywell Bay provides care and accommodation for up to 45 older people- all of whom may be diagnosed with dementia and/ or mental disorder. The registered provider is Newport Care Limited. The registered manager is Ms Sherran Thompson. Holywell Bay care home is situated in the village of Holywell Bay, which is on the north Care Homes for Older People Page 4 of 35 Brief description of the care home coast of Cornwall near the town of Newquay. The home has pleasant views of the sand dunes, golf course and sea. The home is a large two-storey property which has been extended. There is a choice of communal areas for example a large dining area, which also has a seating area, a large lounge, a TV lounge, and a smoking room. There are also other rooms which the registered manager said the provider is planning to redecorate so they can be used. The home also has an enclosed garden which residents can use. At the time of the inspection fees were between £540 and £2000 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the homes management or the CQC website. Care Homes for Older People Page 5 of 35 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: How we carried out this inspection: This key inspection took place, by one inspector, in seventeen and a quarter hours over two days. All the key standards were inspected. The methodology used for this inspection was: (1)To case track five 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) Discussion with other people using the service, and their representatives. (4) Observing care practices for example by carrying out a formal observation exercise. (5) Discussing care practices with management. (6) Inspecting records and the care environment. Care Homes for Older People Page 6 of 35 Since the last key (full) inspection on 24th April 2008, we also completed a random (short, targeted) inspection on 11th November 2008, to check improvement was occurring and compliance with the regulations. 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 judgements made in the report. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 35 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 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided to people who use the service needs improvement. For example people who use the service must receive a statement of terms and conditions of residency or contract, containing the information required in the regulations regarding payment for nursing fees. This will ensure that people using the service receive transparent information about fees payable. Pre assessment procedures are generally satisfactory and should ensure the registered persons check they can meet a persons needs before admission is arranged. Evidence: The home has a satisfactory statement of purpose and service user guide. A copy of the statement of purpose is available in the hallway of the home. The registered manager said a copy of the service user guide is available in each persons bedroom. We inspected the pre admission assessments for five people. There is a satisfactory Care Homes for Older People Page 10 of 35 Evidence: pre admission assessment policy and a comprehensive pre admission assessment format. Completed assessments generally contained satisfactory information regarding the people who moved to the home. However some were only partly completed, and needed to be signed and dated. One pre admission assessment initially could not be found, and this was a concern as the person concerned also did not have a care plan. However, the registered manager later found the assessment and it appeared the nurse in charge had not filed it correctly. We viewed the contracts / statement of terms and conditions of residency for the same group of people. The information for people who are privately funded-or who partly contribute to their fees needs improvement. There should be a clear statement of how nursing fees will be paid (i.e. it needs to be clear the State will fund this part of the fee, and individuals are only paying for board and personal care). The registered persons need to check the records for all people using the service, and ensure information provided is appropriate. Where necessary the person using the service and their representatives need to be provided with this information. Care Homes for Older People Page 11 of 35 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. Some improvement is required to care planning systems to ensure health and personal care needs of some people living in the home are satisfactorily promoted and met. Medication is generally managed to a satisfactory standard although it is essential more care is taken to ensure medication is always administered if it is signed for. Although care staff are viewed positively, we are concerned about two incidents where people who use the service may not have received appropriate care. It is essential thorough investigation occurs regarding these matters, and if necessary improvement occurs regarding practice. This will help to give more assurance people are receiving appropriate care at the home. Evidence: We inspected the files of five people who use the service. A care plan was available on the majority of files inspected. Care plans are accessible to staff. However care plans were absent for two of the five files assessed. Both of these people were admitted during the week prior to the inspection. For two of the people the pre-assessments Care Homes for Older People Page 12 of 35 Evidence: were not on the file. One person had been admitted as an emergency and there was a letter from the social worker regarding their needs. The assessment of the second person was later found and had not been filed correctly. In regard to care planning for these people, one of the people had a pre printed generic list of needs staff should look at to provide care, but this was not individualised and not a particularly helpful source of information for staff. Even if people are admitted on an emergency basis to the home, it is essential a basic, individualised care plan is developed which outlines individual needs. This will inform and guide staff to the persons needs, and help to ensure the persons needs are met. There is evidence care plans are reviewed, but reviews should be more detailed. The care plans of some people had not been rewritten in some cases since the person was admitted or from when the care planning system had been introduced approximately 18 months ago. The registered manager said this was due to the needs of people not significantly changing. This is acceptable, if this is the case, but reviews should detail changes more thoroughly, and/or what staff are trying to achieve to assist the person to maintain and/or develop a persons skills / independence. We suggest there should be a brief pen picture / social history of each person as part of the care plan. This should include basic family history, the persons previous occupation, likes/dislikes, their interests etc. The registered manager said it had been difficult to obtain this information as for some people contact with relatives was limited. However, this information can be obtained at the pre admission stage from the social services assessment, from relatives or the person themselves. It may be an interesting project for care staff to develop a life story book with individuals. People who use the service, who we spoke to, were positive about the care they received. We also spoke to some relatives of people using the service. They were also very complementary about the service provided. We completed a formal observation exercise. This showed us, during the observation period,people were well cared for, content, happy and staff worked well with them. However we do have two significant concerns. Firstly, an incident was reported to us regarding the care of one person by an ambulance crew attending the home. This is being handled under adult safeguarding procedures and our own enquiries. Secondly, we noted that a member of staff used restraint techniques with a person using the service. The person concerned had been verbally aggressive to another carer. However, the service user did not have a care plan, and there was nothing in the pre admission assessment to suggest restraint may be required. No incident report had been submitted to the registered manager under the homes internal procedures.We requested the registered manager to ascertain what had occurred, report this to Care Homes for Older People Page 13 of 35 Evidence: Cornwall Council as a safeguarding issue if this was required, and confirm in writing action taken to us. We have not received any response from the registered persons. We will follow this matter up. People who use the service said they were satisfied with the health care support they receive. There is some evidence on file that GPs and chiropodists have visited, but it was difficult to determine when people last saw other professionals such as a dentist or an optician. The care planning system needs to be developed to ensure staff can ascertain when support from external professionals was last received (e.g. at a glance), and then it can easily be determined when the person next needs to have support and treatment with the relevant professional. We did raise a concern whether one person had received dental treatment following a GP consultation in 2008. For example there was no evidence in the care plan or review system that this occurred. The registered manager agreed to check this after the inspection. We inspected the medication system. Medication is stored in a dedicated clinical room. Medication is supplied in a monitored dosage system supplied from a local pharmacist. Storage of general prescribed medication is satisfactory. Some controlled drugs are kept in the home, and administration and recording of these are satisfactory. We did note one recording error where one persons medication was signed for, but it remained in the blister pack. Extra care needs to be taken to ensure medication is administered correctly. Otherwise, the operation of the medication system and recording is satisfactory. Training regarding medication appears satisfactory. Care Homes for Older People Page 14 of 35 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 generally 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, and said routines in the home are relaxed. We completed a Short Observational Framework for Inspection exercise at the home. This methodology was developed by the Commission for Social Care Inspection (which was the regulatory body which existed prior to CQC) and Bradford University, which has an specialist academic interest in dementia care. We use the tool primarily in homes which accommodate people with dementia or severe learning disabilities. The methodology used for SOFI is for the inspector to, for example, sit in one of the communal settings in a care service. Subsequently the observer records at five minute intervals whether people using the service appear contented, whether they are engaged in some form of activity, and whether staff positively work and communicate with them. The observation is carried out for a two hour period. Care Homes for Older People Page 15 of 35 Evidence: Our observation was carried out in the main lounge of the home, between 10:15am and 12:15pm. Staff were engaged throughout the period either assisting people using the service with personal care, one to one activity or a group activity. Some people we observed were engaged with their own personal activity talking with each other or with staff. Others may have been asleep at times, or sitting quietly. People seemed generally content. For the majority of time people appeared to be positive in mood, with a minority of people asleep for some of the time of the observation. Staff provided satisfactory levels of supervision of people at all times. Interactions between staff and people using the service were positive, and we had no reason to have any concerns regarding staff attitudes towards people using the service. The inspector spent approximately two hours in the lounge on the second day of the inspection, and carried out an informal observation while inspecting records. We concluded similarities in our observation with the results of the day before. The only observations we had to improve practice are: (1) There should be an improved provision of books, magazines and newspapers. There were a few reading materials which people looked at, but these were not necessarily current. The improved provision of these would be of benefit to people in the home e.g. 2-3 daily newspapers, a couple of weekly / monthly magazines etc. (2) The provision of a clock, calender with todays date. (3) There should be a menu displayed of meals available for that day. (4) Improvement of food provided for some people-as outlined below. The registered provider has employed an activities worker. The member of staff has made a positive contribution to the home, and assists people to engage in a variety of activities each week day. On the day of the inspection some of the people were engaged in model making, and there are plans to grow some vegetables in the garden. The member of staff made time to speak with each person when he came on duty, which was excellent. Some people receive regular visitors, and some people go out with relatives. There is suitable space for people to receive visitors in private. People are positive about the food provided. A cooked breakfast-such as egg on toast can be provided. The main meal is served at lunch time. There is a choice of cooked tea or sandwiches at tea time. Regular drinks were served to people throughout the days of the inspection. The main meal on the day of the inspection was served in the dining room, and the majority of people were assisted through to that area. Some people remained in the lounge to have their meal. Staff assisted them in eating where this was necessary. Assistance was to a good standard, staff fed people at the individuals pace, and talked Care Homes for Older People Page 16 of 35 Evidence: with the person when the person wanted this. We would suggest that staff always finish off the interaction by some form of verbal closure e.g. asking them if they enjoyed their meal. In some incidents we observed that staff finished assisting with feeding, and then moving on to the next person without saying anything. We were concerned about how soft diets were served. For some people pureed foods were not separated out. It is essential this always occurs so food looks presentable and appetising. One person refused their main meal. Staff tried to encourage the person, but the person still refused. The person was not offered an alternative. The person ate their pudding, and continued to scrape the bowl with their spoon after the pudding was finished. It was a pity the person was not offered seconds of this as they so obviously enjoyed it, and had not eaten their main course. The kitchen was inspected. It is clean and well equipped. There was a satisfactory supply of food. Suitable records of meals are kept. The Food Standards Agency Better Food, Better Business guidelines hygiene system is in place. However there was no cleaning schedule in place, although the cook said the registered manager was developing this. However, the kitchen was very clean and it is evident there must be some form of informal deep cleaning routine in place. Care Homes for Older People Page 17 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and adult safeguarding policies are generally satisfactory. However, we do remain concerned about some incidents which have occurred which may indicate that some staff care practices do not protect people from abuse. We therefore are seeking clarification regarding matters of concern. Improvement in these areas should assist in giving people who use the service more confidence about how complaints and adult safeguarding processes are managed by the registered persons. 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 regarding the home. The Commission for Social Care Inspection, and subsequently the Care Quality Commission have also not received any complaints about the home. Amendment should occur to the 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. 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 Care Homes for Older People Page 18 of 35 Evidence: funded by a public authority they have 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. We have received one safeguarding referral since the last key inspection. This was received from the South Western Ambulance Service NHS Trust regarding what was alleged as poor care by care staff prior to the ambulances arrival. Although formal proceedings have been concluded by Cornwall Councils Adult Safeguarding department, the commission has raised concerns regarding the methodology used for the investigation, and is seeking further information. Subsequently we may conduct further enquiries about this matter should we remain dissatisfied. We do not know if the registered persons subsequently plan to conduct their own investigation into this matter. We have also raised concerns about the use of restraint used in an incident with one person using the service. As stated in the Health and Personal Care section of the report we have written to the provider, as we have not received a requested response to our concern. We have informed Cornwall Council regarding this matter. Care Homes for Older People Page 19 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there has been some improvements, significant development of the building is still required to make it a suitable facility for people living there. Evidence: The building was inspected. Holywell Bay is a large building, with lots of space for the people accommodated. There are several communal rooms. A large lounge, a large dining room with a lounge area, a TV lounge, a smoking room, a Chapel room (currently not used) and a hairdressing salon. The garden is accessible to people living in the home if the door is not locked. Bedrooms are primarily situated along two long corridors. There is a large kitchen, and laundry areas. The home has a sluice facility. The lounges, dining room and the TV room are all reasonably decorated and have suitable furnishings. Part of the downstairs facility (smoking lounge, chapel area and hairdressing area) need significant improvement. We were told by the registered persons these areas would be improved, but this has not occurred. As with the previous inspections the smoking room is very scruffy and furnishings are very poor. The toilet in this area also needs redecoration as it is only decorated to a very utilitarian standard, and is not a particularly inviting facility. We have made a requirement about standards of facilities, and also written to the registered provider regarding this matter due to the lack of action which has occurred. Care Homes for Older People Page 20 of 35 Evidence: Bathroom facilities are still unsatisfactory. Although many of the bedrooms have bathroom facilities, these are in many cases inappropriate for the group of people accommodated. The majority of people using the service cannot use these facilities. Currently there are three working communal bathroom facilities. One area of the home has no communal bathroom facilities. The people accommodated in this area need to use an assisted facility, and cannot use the en-suite domestic type facility. The registered provider did plan to have a walk in shower facility upstairs. However, the siting of the proposed facility was not satisfactory, as it was next to one of the existing facilities. The plan did not resolve the problem of not having a communal bathroom in the area discussed. We are concerned that no action has occurred in the year since the last key inspection. We have written to the registered provider to express this concern and to request a plan of what action will be taken to resolve this matter. If suitable action does not occur in the timescale set we will need to consider taking enforcement action. All bedrooms were inspected. The registered manager has ensured some bedrooms have been redecorated and new furniture has been purchased as this has become possible. The majority of bedrooms are to a satisfactory standard, although as stated above many of the en suite bathing facilities are not suitable for the people accommodated. There have been several leaks from the roof. Although these have been repaired, some rooms have subsequently become unusable for a limited period. Many of the bedroom doors do not have a lock. It should be a default position that all bedrooms have a lockable bedroom door, and people are issued with a key unless they lack capacity to do so. All people should have a lockable space for valuables in their bedrooms, although we do note that some of the new furniture purchased does have a lockable drawer. Corridors have been redecorated and decorations here are now satisfactory. The outside of the building has been repainted and this has improved the look of the building. The home was clean on during the inspection and there were no unpleasant odours in the home. Care Homes for Older People Page 21 of 35 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 good 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 suitably skilled and knowledgeable staff in sufficient numbers to meet their needs. Evidence: On the day of the inspection there were five care staff on duty from 07:00 to 19:00. There was one registered mental health nurse on duty from 07:00 to 19:00. There was one registered general nurse on duty from 08:00 to 16:00. There is an activities coordinator on duty in the afternoon during weekdays. There were ancillary staff on duty such as kitchen, laundry and administration staff. At night there were three care staff on duty from 19:00 to 07:00, and one registered general nurse on duty from 19:00 to 07:00. Personnel records were inspected for fourteen staff (i.e. staff on duty during the 24 hour period on the day of the inspection), plus a sample of some of the other staff employed. Personnel records inspected were to a good standard, and generally contained suitable information required by regulation. For example staff employed since the last inspection had two references. Staff had a Protection of Vulnerable Adults First check (POVA First) and a Criminal Records Bureau check (CRB). These checks ensure people employed are not on a list which states they are deemed not fit to work with vulnerable people (POVA), or have a criminal record (CRB) which may Care Homes for Older People Page 22 of 35 Evidence: deem them unsuitable to work in an environment with vulnerable people. Staff had an application form, containing work history, evidence of their identity and a self declaration of medical fitness, as required by the regulations. We noted that the photocopies of nurse registration were not current for some nursing staff. The registered manager assured us all nursing staff had current registration with the Nursing and Midwifery Council (NMC), and she would obtain updated copies of nurses registration certificates. We looked at whether staff had a National Vocational Qualification in care. According to the Annual Quality Assurance Assessment-AQAA (an annual return provided to the commission on an annual basis) 56 of care staff employed (9 out of 16) have an NVQ 2 or above in care. We checked records of training staff have received. 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 service such as dementia, challenging behaviour. The fourteen records assessed demonstrated that all staff have received appropriate training in these areas. The registered manager has made an excellent effort to ensure training standards have improved and now meet regulatory requirements. We checked records of clinical training obtained by nursing staff. These were satisfactory. Links have been made with the National Health Service (Cornwall Partnership Trust) training department, and staff have been on several courses such as venapuncture, tissue viability and catheter care. This needs to continue to develop so nursing staff all receive regular updates regarding current practice. Care Homes for Older People Page 23 of 35 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. The registered manager has suitable experience and knowledge to manage the home, and has made substantial improvement to the day to day management of the home since she has been in post. We are seeking further information regarding the registered provider as we need to ensure there are satisfactory monitoring and management arrangements in place by the owner. We remain concerned there has not been sufficient improvement to the structure and facilities of the home, and that we have had to repeat requirements regarding these matters. Health and safety standards are adequate, but require some improvement so we can be assured people in the home remain safe. Improvement in the areas notified will ensure people benefit from a well run service. Evidence: The registered provider is Newport Care Limited. The responsible individual is Afta Chiles. The registered manager is Ms Sherran Thompson. Care Homes for Older People Page 24 of 35 Evidence: We have written to the registered provider; Mr Johal to clarify the situation regarding senior management arrangements. We understand Mr Chiles or Mr Johal has not visited the home for approximately one year. We understand a Mr Christoforou has visited the home on several occasions in the last year. The registered provider also has appointed a Mrs J Franks to complete monthly visits to the home on behalf of the registered provider. Reports have been completed of these visits and they appear comprehensive. Ms Thompson is registered with the commission to manage the home. Ms Thompson is a qualified registered mental health nurse and also has completed the Registered Managers Award (RMA). It is clear to us Ms Thompson has worked very hard and effectively to improve standards at the home, supported by her management and staff team. Ms Thompson is suitably experienced, skilled and knowledgeable to manage the home. Staff we spoke to said they felt supported by management, and felt the team worked well together. The report notes improvements made to the service since the last key inspection in April 2008. However, we remain concerned that the registered provider has not made satisfactory improvement to the building and we have concerns about some aspects of care practice, for example as outlined in the Complaints and Protection section of the report. We are concerned that the registered person(s) have not taken appropriate action regarding these matters, and have written to them regarding our concerns. We inspected the registered providers Quality Management Policy. This appears to be an off the shelf policy and does not necessarily reflect practices in the home. We discussed this with the registered manager, and she said she would re-write the policy based on current practices. The registered manager has ensured there have been some improvements to decorations in the home, improved general standards of care, staff recruitment and training. The registered manager has introduced an internal quality assurance audit system to ensure standards are maintained and improve. A survey of stakeholder views e.g. people using the service and their relatives, was completed in 2008 and results of this were positive. The registered manager said this survey would be completed this year. A representative from the registered provider has visited the home on a monthly basis, and reports were present at the home. The reports are comprehensive and look at various aspects of practice and the management of the home. Care Homes for Older People Page 25 of 35 Evidence: The AQAA supplied by the home was completed to a satisfactory standard, was accurate and contained information requested. We assessed arrangements regarding the management of the finances of people who use the service. Records kept for the management of individual monies were satisfactory, and monies kept tallied with the records maintained. The registered provider has a health and safety policy. There is also a fire risk assessment. The registered manager said the maintenance worker completes checks on the fire system. However, records kept were not comprehensive and need improvement. They need to clearly state what tests are completed and when, as recommended by the fire authority. Testing of fire extinguishers and the fire system appears to have been completed appropriately by external contractors. Staff records demonstrate they have received suitable training regarding fire prevention. The fire officer visited in November 2008 and stated precautions at the time were satisfactory. Portable electrical appliances were last tested in June 2008. There is a certificate to state the electrical circuit has been tested and is deemed safe (11/7/2006). The boiler was serviced in July 2008. The cooker was serviced in July 2008. A gas safety certificate was obtained in November 2008.There is a record that the lift was serviced in March 2008 (and therefore now needs servicing). Hoists and hospital type beds have been checked and serviced by an external contractor in May and September 2008. There is a policy regarding the prevention of legionella. The registered manager has received conflicting information regarding whether current precautions are safe, and the registered persons are strongly advised the check with the Health and Safety Executive (HSE) regarding whether current precautions are satisfactory and do not put people at risk. There is no record the Health and Safety Executive (HSE) has visited the home under the current ownership. The environmental health officer inspected the food premises, and deemed arrangements to be satisfactory. The registered manager has commissioned a plumber to fit thermostatic valves to baths, showers and wash hand basins. Work is outstanding regarding baths and therefore we have renotified this requirement. As stated in the staffing section, training regarding health and safety issues is to a very good standard. Care Homes for Older People Page 26 of 35 Evidence: A current certificate of insurance was displayed in the home. Care Homes for Older People Page 27 of 35 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 19 16, 23 The home must have suitable 01/10/2008 bathing facilities, in sufficient numbers to meet the needs of people accommodated in the home. Bathing facilities must be suitably adapted to meet the needs of the elderly and disabled. Bathing facilities must be within a suitable distance to the bedrooms of people who use the service. The registered persons must 01/10/2008 improve health and safety standards in the following areas: (1)Ensure a risk assessment is completed regarding the prevention of legionella, and any necessary preventative measures are taken to prevent Legionnaires disease. (2)Emergency lighting and fire doors must be tested at intervals prescribed by the fire authority. (3) Thermostatic valves must be fitted, where appropriate, to wash hand basins and baths- in line with HSE guidelines. 2 38 13, 23 Care Homes for Older People Page 28 of 35 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 Comprehensive pre admission assessments must be completed, maintained on file, and be accessible to staff This will help ensure people who use the service know suitable assessment information is obtained, and is made available to staff, which should assist in ensuring their needs are met. 01/09/2009 2 6 5 Information issued to people 01/09/2009 who use the service (i.e. statement of terms and conditions of residency / contract) must provide detailed information regarding how nursing costs are met as outlined in the regulations. This will ensure people have clear information about how their costs of care will be paid. Care Homes for Older People Page 29 of 35 3 7 15 All people using the service must have a care plan. Care plans must contain suitable detail to inform and direct staff to provide care to people using the service. Care plans need to be reviewed, to a satisfactory standard, at least monthly. Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 01/07/2009 4 9 13 Medication must only be 01/07/2009 signed for if it is administered. If medication is not administered a reason should be given in care notes / on the rear of the medication sheet. People who use the service can then be more assured their medication is more appropriately according to national guidance. 5 10 12 The registered provider must ensure the home is conducted to promote and make proper provision for the health and welfare of people living in the home. We require the registered persons to investigate an incident where restraint was used, report this as an adult safeguarding matter as necessary, and provide the commission with a report regarding action taken. 12/06/2009 Care Homes for Older People Page 30 of 35 This will help to ensure people living in the home receive a service where they are treated appropriately and with respect and dignity at all times. 6 15 16 Meat and vegetables should be served separately when pureed. This will help to ensure that meals served to people who use the service are always appetising. 7 18 12 The registered persons 01/06/2009 must ensure that restraint is not used unless in emergency situations and/or in line with agreed guidelines (e.g. as outlined in the homes policy /individual care plans). The individual use of restraint must be only used in line with deprivation of liberty /Mental Capacity Act guidance. The use of restraint must always be reported by staff to the registered persons, and subsequently reported to the commission and other relevant authorities, as required by regulation. The registered persons are required to complete an investigation regarding one incident, and report to relevant authorities as necessary. This will help to ensure 01/06/2009 Care Homes for Older People Page 31 of 35 people who use the service are protected from practices which may be deemed as abuse. 8 19 23 Improve facilities identified, 11/11/2009 as outlined in the text of the report. This will ensure Holywell Bay provides a suitable facility for the people living and working there. 9 21 23 The home must have 11/11/2009 suitable bathing facilities, in sufficient numbers to meet the needs of people accommodated in the home. Bathing facilities must be suitably adapted to meet the needs of the elderly and disabled. Bathing facilities must be within a suitable distance to the bedrooms of people who use the service. (Timescale of 01/04/2009 not met. Third Notification) This will ensure there are satisfactory bathing facilities for the people accommodated in the home. 10 31 7 Clarify current roles and responsibilities of people in responsible individual / registered provider role This will help the commission to clarify who is responsible for carrying on the service, and improve management and accountability in the service 30/06/2009 Care Homes for Older People Page 32 of 35 11 33 24 Further develop the quality 01/09/2009 assurance system to monitor standards in the home for example regarding care planning, environmental standards, health and safety etc. The quality assurance policy needs to accurately reflect systems in place. An improvement plan has been requested regarding requirements made in the report This will help improve service quality and help minimise risks to staff and people who use the service 12 38 13 The registered persons must 01/09/2009 ensure there are suitable health and safety precautions in place. For example: (1) Thermostatic valves must be fitted to baths and showers in line with HSE guidelines. (Timescale of 01/04/09 not met Fourth Notification) New deadline 01/09/09 (2) There must be suitable records to evidence fire equipment is tested in line with the requirements of the fire authority. (3) The lift must be serviced in line with manufacturers guidance, and HSE Care Homes for Older People Page 33 of 35 requirements (usually annually) (4) The registered persons are advised to check with the HSE that current precautions to ensure the prevention of legionella are satisfactory. These measures will help minimise health and safety risks to staff and people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 15 16 People using the service should be offered an alternative meal and/ or seconds if they wish for this. 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. Care Homes for Older People Page 34 of 35 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). 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. 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