Inspection on 21/09/09 for Homeleigh

This inspection was carried out on 21st September 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 but made no statutory requirements on the home.

Other inspections for this house

Homeleigh 04/11/08

Homeleigh 07/11/07

Homeleigh 10/01/07

Homeleigh 25/01/06

Homeleigh 18/10/05

Homeleigh 17/03/05

Homeleigh 27/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Homeleigh Avenue Road Erith Kent DA8 3AU Lead Inspector Rosemary Blenkinsopp Key Unannounced Inspection 21st September 2009 09:30 DS0000006793.V377897.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Homeleigh DS0000006793.V377897.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homeleigh Address Avenue Road Erith Kent DA8 3AU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01322 339691 01322 350291 susan.ilott@kcht.org.uk www.kcht.org Kent Community Housing Trust Susan Jacqueline Ilott Care Home 48 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (32) of places Homeleigh DS0000006793.V377897.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 32) Dementia - Code DE(E) (of the following age range: over 65 years) (maximum number of places: 16) The maximum number of service users who can be accommodated is: 48 4th November 2008 2. Date of last inspection Brief Description of the Service: Homeleigh is a large detached building situated in a pleasant residential area of Erith. It is near to local shops and facilities, and has bus routes and train stations within easy travelling distance. It is owned and managed by Kent Community Housing Trust (KCHT), which is a charitable (not for profit) Trust, and who have other care homes for older people within the region. KCHT are currently re-branding and with that a name change. The home is set into a hillside, and has four floors, of which three form the care home. There are bedrooms, bathrooms and toilets on each floor. There are a number of lounges, a dining room and an activity room on the ground floor. All levels can be reached via a passenger lift. As the home is on a hillside, the gardens are accessed from the first floor at the rear of the building, and there is a spacious patio area, walkways, a lawn and mature shrubs. The home provides day care for up to five people each day. This service is not inspected by CQC; however the impact on other people living in the home is taken into consideration. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.2 Page 5 Homeleigh DS0000006793.V377897.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection was conducted over a one day period by two inspectors and an expert by experience Ms Gillian Ayling. The manager facilitated the site visit assisted by the deputy manager and staff on duty. Periods of observation were undertaken in the communal areas. Ms Ayling’s report is based on the following observations: • • • Observations of the home regarding the quality of the environment The opportunity for activities and whether they meet the individuals needs Quality of support received and whether residents feel this is meeting their needs, particularly staffing levels Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. The AQAA contained good information regarding the service. Twelve comment cards were received during the site visit, including four from residents, two from relatives and six from staff. During the visit we met with several relatives and residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: Homeleigh DS0000006793.V377897.R01.S.doc Version 5.2 Page 7 Residents benefit from being able to view the home and facilities before moving in. Residents have their needs assessed prior to moving in to the home. Staff had a good knowledge of infection control measures and how to prevent the spread of it. The environment is maintained in homely fashion and residents are encouraged to personalise their bedrooms. 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 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. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the 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 about the service is made available to prospective residents and they benefit from being able to view the home and facilities before moving in. Assessment information is not fully completed and therefore staff have in some cases, little on which to base care initially. EVIDENCE: At the time of the inspection we were advised that there were 43 residents on site. A sample of care plans with assessment information were selected for inspection on different floors. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 10 We were advised that all residents were admitted based on a full assessment of need. A full time assessment officer is employed by the company who completes most of the pre-admission assessments for homes in the organisation. The assessment officer remains involved with admissions until residents have their first placement review meeting. Assessment information outlines the areas of need in physical, mental and emotional care. We looked at the pre-admission records in relation to five people and found that all had the organisation’s record of assessment completed. However, these were of a mixed standard with four not being signed or dated, incomplete and quite basic. In particular the section for emotional care was sparse or incomplete in all those viewed . In most of the assessments there was some information on the person’s past life including their social history. Part of the assessment process also includes obtaining the “joint assessment papers” i.e. information obtained from various agencies who have been involved in the person’s care. We were advised assessment information is received prior to any placement from the funding authority ,we found this information to be in place for each person. It was good to see in one care plan that there was information that the resident had taken up a “guest visit” prior to placement. They had done this because of their level of anxiety. The Statement of Purpose was available although this will need to be updated to reflect the change in the Regulatory body to CQC. With the re-branding of Kent Community Housing Trust (KCHT), comes the revising of their information, including Statement of Purpose, Service User Guide and complaints information. This is currently on the website as well as available in written format. Considering the capabilities and diagnosis of the people living there a format more suitable to their needs should be produced, for example: a DVD, audio or pictorial. Please see requirement 1 Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care documentation is not always fully completed and when problems are identified they are not always actioned hence health care is only partially addressed by staff in the home. The home ensures that residents receive the correct medications at the correct time. EVIDENCE: Health care is addressed by the staff team supported by members of the multidisciplinary team who visit the home. The dentist was in the home as we visited. Each resident has an individual care plan which sets out the care and support they need and from which staff can deliver the care. Care plans which Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 12 were inspected were well organised. It was nice to see them written in the first person, i.e. I want, I can do, I prefer etc. All care plans have a photo of the resident on them. Those care plans seen were in parts sparse and incomplete. One resident who had been admitted 18/9/09 was without a manual handling risk assessment and the document headed “Generic Residential Risk assessment”, was also blank. There was no initial care plan in place either hence staff would not be able to deliver the care as no instructions were available. Supporting records again were limited and we noted weight charts were poorly completed, when weight loss was identified no action taken to investigate the reason. This was of concern as one resident who was underweight had no evidence of monitoring or interventions to address it. Another care plan had a manual handling assessment though no nutritional assessment, and weight records were absent although there was a care plan for nutrition. One resident had in place a behaviour monitoring chart and documented in their daily events were many references to verbal aggression yet their was no care plan or other management strategies for staff to follow to ensure consistent and appropriate interventions were used. Daily events generally reflected the care given. Information and records made by members of the multidisciplinary team were in the care plans. Tippex was used on some documentation – this must be avoided and any errors in records simply scored through and initialled. On the frail elderly unit the following was found: One assessment showed the resident to have a number of different health and personal care needs including diabetes, epilepsy, depression and alcoholism. On viewing the care plan we found some person centred care plan entries such as for dressing “ I may need some help as I am suffering pain in my rib”. However there was no indication of the specific help required . More detail is needed on the support required so staff can address care correctly. We noted that this care plan also showed the person needed a diabetic controlled diet, that they suffered seizures and required medication for this. However there was a lack of information on what further action needs to be taken to meet their diabetic and epilepsy problems. We also noted that the records showed them to have poor nutrition and the resident had lost two stone in weight before coming to the home. Many lunch Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 13 times this resident is taken in the pub. There was no indication as to how this is being managed i.e. balancing risks with independency etc. We found two records of weight taken in July 09 and September 09 having been admitted in June 2009. From these records the individual was putting on weight but the information did not show how the diabetes and alcohol issues were being addressed. Another care plan had information detailing that the person suffered with diabetes, hypertension and risk of stroke. The care plan detailed a number of needs such as mobility, personal care, social needs, medication, nutrition, continence and emotional needs. The care plan was more specific about number of carers required to assist and the support required. There was limited information about how the person’s diabetes was to be managed except for diet. It was clear that a district nurse was involved at times in monitoring the blood sugar levels. However once again we found no risk assessment for pressure sore, diabetes, stroke care, moving and handling or nutrition despite there being indication that there were risks in these areas. We found records of health professional visits including physiotherapy and district nurse visits. We did not find any records relating to regular weighing and little information regarding chiropody or vision. This is a key part of the monitoring for a diabetic as well as regular health checks required for individuals. Another care plan detailed basic areas of need but once again no risk assessments in place. It is clear from those files viewed that the care plans are of variable quality and do not give the full information that enables staff to provide the full care required. Key information was missing and this means people may have needs left unmet or be put at risk. There were not risk assessments for moving and handling, nutrition or any risk assessment relating to alcohol, diabetes or epilepsy nor was there any information regarding vision or chiropody etc. We discussed our findings in relation to the care plan records and we were told by the manager that a lot of new guidance had been issues. The guidance was in places confusing i.e. saying terms like incontinence were not to be written, this had led to a level of uncertainty and confusion as to what should be written. The manager stated that training through the use of DVDs and a new training provider was tailoring their sessions to reflect changing practices. This progress on this needs to be monitored. We inspected the systems for storage recording and medication administration. All staff who administer medication are trained to do so as they have attended a sixteen week college course in safe administering of medications. The home Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 14 uses the Boots monitored dose system. It was the day of the new cycle so new stocks had been received and new charts in place. Those charts seen had the medication received recorded and were completed with the resident’s photograph and allergies stated. Eye drops had been recorded as received although the date of opening was omitted on those seen, once pointed out this was rectified immediately by the team leader. Some of the eye drops waiting to be returned from the previous month were also without their date of opening written on them. This is important as eye drop have a short life once opened and it needs to be very carefully monitored . Records for medications returned to the pharmacy were in place indicating the amount returned and signed by the staff member. The pharmacist also signs to confirm the records. We were told residents have an annual review of their medication with the GP. Medication had been audited January and May 2009. Appropriate storage was provided to safely stored all medications including Controlled Drugs and those which needed refrigeration. Records were in place to ensure medications are stored in the fridge and the clinical room at the correct temperature. At the time of the visit there were no residents who were requiring Controlled Drugs although previous records indicated correct records were retained. During the tour we did observe that betnovate cream had been left in the lounge on side table all morning next to a resident. Please see requirement 2 Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are limited and do not provide sufficient stimulation for residents, nor do they provide active leisure periods and fulfilling social lives EVIDENCE: We inspected different areas of the home and spent time observing the daily routines of the residents. Overall it was noted that there was little in the way of organised activities, the main one being the TV playing. In the top floor lounge several resident were sat in front of the TV with their eyes closed. There were limited signs of engagement either with one another or the staff. On the frail elderly unit we found that during the morning there were no carers in this area or any interaction, until a carer came to offer mid morning refreshments. Residents were asleep for most of the morning. It appeared to be very task orientated-with few opportunities for positive interaction. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 16 Gill Ayling made the following observations: The lounge on the upper floor for the people with dementia was again a room with chairs around it. Most people just sat, some gazing at the television, others sleeping. There was a book shelf in the corner with books and knitting, including needles upon it. The staff members were apparent, but there was not always a staff member in this lounge as I would expect for the needs of people with dementia. One lady was knitting, which I was pleased to see, an activity other than watching television, however not knowing the tendencies of the people living in this area, I would be concerned regarding the safety of having knitting needles, firstly with this lady and secondly on a book shelf. I found the Activities Room, which was open. The room was full of books, puzzles, games and crafts. However I did not find anyone carrying out these activities. I asked some residents about activities. They said they enjoyed them but that they did not happen very often. I was told of a session of bingo that occurs but several people agreed it would only be around twice a month. I felt this area to be distinctly lacking at Homeleigh. There is a BT payphone in the main corridor just outside my office which a few service users use and on which many more receive outside calls. Also a couple of service users have mobiles. Two people said they would like to go out more but did not have family to take them. There did not seem to be any other system in place for trips out to the shops, known to the residents. The manager told us “, because of the local geography we have to do shopping trips using the minibus and we have had four since the summer, two of which are organised with families so that they can meet or accompany their relatives, including having lunch out, as they could not manage to take them out in a car”. I attended the lunch on the ground floor. Staff were in attendance available to those that needed them. There was a choice of meal, both of which looked appetising, and was said to be so by the people with whom I spoke. The food was described as “lovely” and “you can’t find any fault”. The meal I ate (specially prepared as I am wheat free), was fresh, tasty and appetising. The staff were friendly but not too intrusive, allowing people to eat at their own pace. One gentleman on my table began to feel unwell. I summoned a staff member, who unknown to me, was an agency staff member who only started at Homeleigh today. She went off to tell her colleagues where there was some hesitation as to the correct procedure for helping this man. When the Team Leader became aware of the situation she jumped into action, asked me to care for her medication trolley and rushed off for a vomit bowl. She then cared for the man concerned at the table. On leaving the room for a second time she asked a staff member to care for the open trolley. She was caring, and immediately reacted to the situation however on reflection should have sent a Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 17 staff member to collect vomit bowels without leaving her trolley or locked it quickly. Although she knew I was with the inspection team, she was ultimately responsible for the drugs contained within the trolley. Upon her return to the dining room with the second bowl, one of the care staff suggested that perhaps out of respect for the other people, this man should have care in his room. At that moment the Team leader had become aware of another person having swallowing difficulties. She again reacted quickly to the aid of this lady and assisted her. The Team Leader was professional and calm – a good role model for the care staff, she should I spoke with many residents and two family members. All spoke highly of the staff members. They were happy with the time taken to answer the call bell, and night time was equally as good. Everyone was appropriately dressed for the time of year, clean and groomed. The only negative comment made was that there had been the odd occasion when the bank staff members had not spoken good English, so communication was an issue; however, they were seen to be very caring “with a heart of gold”. Visitors felt very welcome, always offered tea, and were happy that the staff offered good care to their relative. Please see requirement 3 Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns and complaints will be dealt with and staff have sufficient knowledge to take appropriate action. EVIDENCE: A complaints policy and procedure was provided and included in the Statement of Purpose. People are made aware of raising concerns through the “Making your views known” information leaflet. The complaint’s policy sets out response times for actioning concerns and/or complaints. This will need updating to include the Care Quality Commission (CQC) contact details as the new Regulator. A system is in place to record complaints made about the service. Standard complaint forms are used to record complaints. The complaints log for the period from 9 March to 20 September 09, showed five complaints had been received. These were about the meals, care practice and one from a hospital regarding the state of a resident on admission. The manager notifies us about significant events that occur in the home and seeks advice from other agencies such as Social Services. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 19 One resident has been referred to and assessed under the Deprivation of Liberty legislation and this remains in force with certain restrictions in place. Staff with whom we met said that abuse training had been provided. Those spoken to were asked about the action they would take in suspect or actual abuse. They were well aware of how to recognise it and the need to report it although information regarding external bodies was limited. Staff must have this information available and be reminded of it. In relation to whistle blowing staff understood the term and how it should be actioned. One agency staff we interviewed was unaware of what whistle blowing was or how to deal with it. The manger advised us that all agency staff used should be updated and familiar wit this topic and this is something that she will raise with the agency. All staff need to be familiar with this subject. The AQQA told us that staff had received customer care training and that other subjects such as the Deprivation of Liberty and Mental Capacity Act training was ongoing. In addition the recording of this information in care plans was due to be standardised. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a homely style environment although the fabric of the building is now old and requires ongoing maintenance. More attention is required to ensure that all areas of the home are kept clean. EVIDENCE: A tour was undertaken by all of us and the following is a summary of the findings. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 21 On the top floor the areas were clean and there had been efforts to make the lounge area homely. Bedrooms were personalised. There was a toilet which was found to be very dirty; this was brought to the attention of staff on duty. On the frail elderly unit we found the environment to be clean, generally well furnished, homely and comfortable. There were some areas in need of attention such as ensuring the handles on windows are fixed or replaced. Two windows on the ground floor lounge had either a missing or broken handle. One of the toilets/ bathrooms on the ground floor was filled with items and could not be used. It also needs some updating such as ensuring the boxing is cleaned up. Other toilets had tiles missing off the walls and one bathroom radiator was rust marked. However they all had basic resources including soap and hand towels and a call bell. Corridors are wide and airy and the dining room benefits from large windows that allow the light in. The flooring ensures it is easy to keep clean. Individual rooms viewed appeared comfortable and personalised with mementoes. Ms Ayling made the following observations on the environment: I began a solo tour of the ground floor, looking into bedrooms, toilets, bathroom, and lounges. I first passed the Activities Board, which had nothing on it relating to activities. The overall smell of the home was good; however I did note that two of the bedrooms had a distinct smell of urine. All rooms visited were neat and tidy, with personal effects such as photos and flowers, apparent in each room. On speaking to some of the residents they were happy with their rooms, several noted how large their rooms were, and having their personal effects connected them to their families. On visiting toilets I found one, 58 which was unclean, toilet paper on the floor and seat, and a dripping tap; toilet 55 was out of order; toilet 59 had missing tiles behind the toilet. The bathroom 80 on the same corridor was obviously not used by residents for bathing. It had old boxes and drying laundry inside with unclean tiles. The fabric of the building is old and certainly in need of modernisation however it was noted that many areas had recently had new carpet and decoration. A light smell of paint was noted in two areas, and a workman was on the premises carrying out his tasks. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 22 The dining room was large, with plenty of space for wheelchairs and those walking with aids. The tables were neatly laid, linen table cloths, and napkins provided. The decoration was clean and in good repair. The floor was laminate, easy to clean and walk on. The AQAA told us the following: There is an ongoing programme of redecoration, replacing furniture, personalising bedrooms. In the last twelve months a new secure patio was made outside the dining room used by residents to grow pot plans/vegetables and the kitchen has been redecorated. Please see requirements 4 and 5. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient staff to ensure resident’s needs are met at all times and have appropriate supervision. Robust recruitment procedures are in place and staff are provided with sufficient training to do their job. EVIDENCE: There is a Registered Manager in post supported by two assistant managers, team leaders and care assistants. Further support is provided by an activity coordinator, cooks, domestic assistants, maintenance person and administrative staff. Vacancies are covered by agency staff. The organisation uses a central agency to co-ordinate use of agency staff and undertake the checks. We asked the question about who checks that the agency is doing their job as they should be. How can they assure themselves that the people entering the home are safe. The manager was not sure and agreed to discuss this during a management meeting. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 24 During the course of the inspection we found two agency staff with no proof of identity. One of these staff works regularly within the home and is therefore known to staff. We looked at the checks completed for agency as well as permanent staff. All three had the information as required under the regulations. It was evident that no one is employed without a CRB, references or identity checks. Pre employment health screening is also undertaken. Contracts and job descriptions were retained. Notes are taken during the interview of the answers that the prospective employee gives. One agency staff worker had a record of induction, a NVQ 3 certificate and a CRB dated 25/04/08. We found no other record of checks completed. The home is reminded that Regulation 19 requires the home to obtain written confirmation that checks have been completed. Ms Ayling was told the following by residents and relatives with whom she spoke: Staffing levels was an issue discussed with visitors and residents. It was thought that staff levels were too low, especially at the weekends. The work load does not change from one day to the next. There were further comments made in respect of lack of staff particularly domestics and Ms Ayling was told the following : I had related to me of more than one occasion when toilets had been left by others in a very unclean state, faeces smeared around the room, so bad that the person concerned would not use the toilet. The AQAA told us the following : The home has a high ratio of NVQ qualified staff. The home has a low staff turnover. Staff are keen to undertake further training e.g. 3 staff have volunteered for the Health & Social Care degree course. We looked at a record of the training matrix. There are 43 permanent and relief care staff. The matrix recorded approximately 28 of the care staff with NVQ 2 or above. The training matrix also detailed the training received by staff although the record did not show actual dates of training. This makes it difficult to determine when some of the core training took place and therefore when updates are required. Seventeen staff had completed manual handling-training although no ancillary staff were included. This needs to be addressed . In addition 16 staff had first aid certificates ,13 had done dementia training and 5 of the 6 kitchen staff with food hygiene. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 25 The records did not record the induction training provided for staff i.e. Common Induction Standards or the equivalent. Training certificates are retained in personnel files. Equal opportunity monitoring is part of the recruitment process. Supervision was an area where there was little evidence that it was being conducted regularly and staff confirmed that this was the case. We were told that the team leaders keep the supervision records with them although the manager is arranging new storage for the records to remain on site. Please see requirement 6. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced individual. Measures are in place to monitor the quality of service delivered. Health and safety is addressed to ensure the home is safely maintained . EVIDENCE: The manager has been in a management role with KCHT for a number of years and therefore has experience of managing a service. She is also well qualified including a Post Graduate Diploma in Management, Registered Managers Award, Leadership in Dementia. She also ensures she is updated with current practices and core training. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 27 We sampled a number of service and contract certificates and found the equipment and services to be examined regularly and safe to use. The Environmental Health Officer during a food hygiene inspection in March 2009 detailed a number of issues. We were informed that these have now been resolved. We also looked at the fire records and found a fire risk assessment in place, weekly testing of the fire alarm system as well as regular servicing of the system and equipment used. Fire drills are now taking place more regularly as required at the last inspection. However there is still a need to ensure the records make clear as to the involvement of night staff and the number of times the drills takes place as required by the Fire Authority. The organisation has a number of processes to monitor and audit the way the service is run and the quality of car provided. Staff, management and residents meetings take place, although not as regularly as they could be. The home is a member of Investors in People and accredited to ISOQAR both have external audits. The internal audit system involves monthly audits of various aspects of the quality of care (and part of the ISAO system).We looked at the records of these audits from May to August 2009. The system involves auditing of sections to take place as planned for the year and where non compliance found this is checked at the next. The records of the monthly audit show the systems in place to be satisfactory. However on viewing the actual evidence of the audit these are limited and do not show how the “rating” was justified. Considering our findings in some of these areas we are not clear how objective the audits are. We also looked at the copies of the reports of the Regulation 26 visits between January and August 2009 and found that the reports for April, May and June were missing. There may be justifiable reasons for this such as the person responsible for undertaking the reports not available. Where this occurs particularly for this length of time other arrangements should be made. Residents’ money is safely stored in the safe. All expenditure has a receipt to confirm the amount spent. For items purchased through the in house shop petty cash vouchers are issued. Two staff sign for any expenditure. Finances are audited twce a year by a member of KCHT ,the last one was 30/06/09.Money checked was correct and receipts cross referenced the expenditures recorded. Any valuables brought in are also safely stored in the safe although families are encouraged to take these home. Policies and procedures across the whole organisation are standardised. Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X x x x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 2 X 3 Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 OP3 2. OP7 15(b) Standard Regulation 14 Requirement Full assessment information must be completed to ensure staff have sufficient information on which to base the initial care. All residents must have care plans that are fully complete reflective of needs and have upto-date information. Timescale 30/04/07, 03/03/08 not met. Enforcement action is now being considered. Daily lives and social activities must afford sufficient stimulation entertainment and engagement so that residents’ recreational needs are met. All areas of the home must be maintained to an adequate and safe standard . All areas of the home must be maintained in a clean and odour free manner. Staff must be supplied in sufficient numbers to meet resident’s needs and provide adequate supervision. Timescale for action 30/11/09 30/11/09 3 OP12 12 30/12/09 4 OP19 5 OP26 6 OP27 16 16 18 30/11/09 30/11/09 30/11/09 Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3 OP29 4 OP36 Staff need to be adequately supervised and receive formal supervision to be able to do their jobs properly OP3 OP7 Refer to Standard Good Practice Recommendations The company should consider providing all information in other formats suitable for the resident’s it serves. Staff should sign and date care plans they are responsible for completing. Confirmation of recruitment checks should be retained Homeleigh DS0000006793.V377897.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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