Inspection on 11/02/09 for Hopes Green Care Centre

This inspection was carried out on 11th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hopes Green Care Centre 16/07/09

Hopes Green Care Centre 01/02/08

Hopes Green Care Centre 27/02/07

Hopes Green Care Centre 12/06/06

Hopes Green Care Centre 30/01/06

Hopes Green Care Centre 23/06/05

Hopes Green Care Centre 19/02/05

Hopes Green Care Centre 09/07/04

Hopes Green Care Centre 09/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hopes Green Care Centre 16 Brook Road Benfleet Essex SS7 5JA     The quality rating for this care home is:   zero star poor 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: Michelle Love     Date: 1 1 0 2 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 32 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Hopes Green Care Centre 16 Brook Road Benfleet Essex SS7 5JA 01268752327 01268755518 hopesgreen@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Exceler Healthcare Services Limited Name of registered manager (if applicable) Mrs Philomena Heather Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Personal care to be provided to no more than fifty service users over the age of 65 years. Total number of service users for whom personal care is to be provided shall not exceed 50. Date of last inspection Brief description of the care home Hopes Green Care Centre is a large home providing accommodation and personal care for up to fifty older people aged over 65 years of age who need assistance with personal care. The homes facilities include several communal lounge/dining areas and fifty single bedrooms all with ensuite facilities. The home is situated within easy walking distance of local shops and amenities, with Southend and Canvey Island main shopping centres a short car or train journey away. There are good bus and train links to the area. The garden enables service users to access a patio area and garden safely. Care Homes for Older People Page 4 of 32 care home 50 Over 65 50 0 Brief description of the care home There is ample car parking for visitors and the home has adequate wheelchair accessibility throughout. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by two inspectors and lasted a total of 10 hours, with all but one key standard inspected. Additionally, progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment. This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the Care Homes for Older People Page 6 of 32 general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for residents, relatives, staff and healthcare professionals were forwarded to the home for distribution and for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The manager, deputy manager, and other members of the staff team assisted the inspector on the day of inspection. Feedback on the inspection findings, were given as a summary to the manager, deputy manager and operations manager. The opportunity for discussion and/or clarification was given. As a result of concerns relating to care planning/risk assessing a Serious Concern letter was forwarded to the registered provider and manager. Additionally an Immediate Requirement Notice was issued in relation to poor medication practices and procedures. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current and prospective people are provided with sufficient information so they can make an informed decision as to whether or not Hopes Green Care Centre is the right choice for them. The care needs of individual people are assessed before they are offered a placement. Evidence: Since the last key inspection the Statement of Purpose and Service Users Guide has been reviewed and updated. Both documents were readily available detailing the aims and objectives of the home and the services/facilities provided. All relative/resident surveys forwarded to us, confirmed that people received sufficient information about the care home. One survey recorded, Always get good information that we need. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective service users needs. Care Homes for Older People Page 10 of 32 Evidence: Evidence showed that admissions are not made to the home until a full assessment is undertaken. In addition to the formal assessment procedure, supplementary information is sought from the individual residents placing authority and/or hospital. On inspection of 2 care files for those people newly admitted to the care home, evidence showed that pre admission assessments were completed by the management team of the home prior to the persons admission. Information recorded was noted to be detailed and informative. Records also showed that both pre admission assessments were completed prior to the persons admittance to the care home. The AQAA details that over the past 12 months, improvements have been made to ensure that a thorough pre admission assessment is undertaken. There was evidence to show that the prospective resident and/or their representative were provided with an opportunity to visit the care home prior to admission and were provided with information about the care home. This was confirmed by one person spoken with. The home does not provide intermediate care. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that their care needs, wishes, preferences and risks to their well being will be clearly recorded within a plan of care. Shortfalls were identified in relation to some aspects of medication practices and procedures which potentially place people at risk of not having their healthcare needs met. Evidence: Records show there is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these needs are to be met by care staff, however not all areas of identified need were recorded within each persons care plan and in some cases there was limited information recorded as to how staff were to proactively manage the persons specific care needs. Additionally, formal assessments relating to dependency, manual handling, pressure area care, nutrition and continence are also completed for individual people. At this inspection a random sample of 5 care files were examined. Records showed that further development in care planning/risk assessing is required to ensure that the Care Homes for Older People Page 12 of 32 Evidence: care needs of individual people are clearly recorded and staff have the most up to date information to ensure appropriate levels of care delivery. This refers specifically to the care file for one person identifying the person as being at high risk of falls (score 9). Records showed that a risk assessment pertaining to falls had been devised, however there was little/limited information detailing the specific risk and how this was to be proactively managed and/or minimised. No care plan relating to falls was devised, despite the risk assessment stating that if the score was above 4, then a plan of care must be completed. Records showed that in recent weeks the resident had sustained one fall and on another occasion had fallen off their bed. The above was not an isolated case as on inspection of another persons care file, the falls risk assessment recorded a score of 10 (high risk), however no care plan was compiled. Records also showed the above person as having Parkinsons Disease, however little information was recorded as to how this impacts on the persons ability to undertake activities of daily living, or how this is being proactively managed by the management/staff team of the home. A risk assessment was completed and there was evidence to show this was reviewed each month, with no changes recorded. However following discussion with the person we were advised that over recent weeks they had noticed that their speech could be muddled on occasions, they were finding it increasingly difficult to swallow, their mobility had deteriorated and they had limited movement in one of their hands. It was of concern that the above had not been observed by staff working within the care home and the care plan/risk assessment had not been updated to reflect the above changes in need. The care file for the same person recorded that over the past 6 months they had experienced some weight loss. On inspection of their care plan relating to dietary needs, information relating to their personal food preferences, likes and dislikes, having nutritional supplement drinks prescribed were clearly recorded. Evidence showed the care plan was regularly reviewed, however this made no reference to the person finding it increasingly difficult to swallow or that daily care records consistently recorded the person as having eaten only a small diet/refused meals on occasions. We requested copies of dietary intake records for the above person and were advised by the deputy manager that none were completed for this person as it was felt that the person was not at risk of weight loss. This did not concur with the inspectors findings or the evidence recorded within the persons care file. The resident confirmed they did not always like the food provided at the care home and over recent months had lost weight. The care file for another person recorded their weight to be recorded weekly and for their food and fluid intake to be recorded daily, as a result of them being at risk of regular weight loss. Records showed that over an 8 month period, they had lost Care Homes for Older People Page 13 of 32 Evidence: approximately 7KG. Records evidenced the persons weight was not recorded in line with the requirements of the care plan and no daily dietary and fluid intake records had been instigated and/or completed by staff. There was evidence within one persons care file that information pertaining to their healthcare needs was inaccurate, not up to date and/or reflective of the persons care needs. This refers specifically to their care file recording them as being sensitive to one medication (Morphine) and requiring a specialist diet as a result of having an intolerance to wheat products. It was of concern that the Medication Administration Record (MAR) for the above person recorded them as being prescribed Morphine patches, yet following discussions with both the manager and deputy manager, we were made aware that the above sensitivity was not an issue. Additionally neither the manager or deputy manager were aware that the resident had an intolerance to wheat products, yet the care plan recorded them as requiring specialist cereals/biscuits. Neither care plan had been reviewed and/or updated to reflect the above changes to the persons care needs. Care records for the same person also recorded them as being diabetic (insulin dependent). The plan of care detailed they were able to administer their own insulin and that their blood sugar levels were checked by healthcare professionals. Professional visitors records recorded in recent weeks that the persons blood sugar levels were irregular, however it was of concern that the care plan and risk assessment had not been updated to reflect the above. The AQAA details under the heading of what we do well, Southern Cross care plans have been implemented and are reviewed and audited regularly, to ensure service users have the care to suit their needs. While we recognise care plans examined were reviewed regularly, information recorded was not always accurate and/or reflective of individuals care needs and potentially places people at risk of not having all of their care needs met. As a result of the above, a Serious Concern letter was forwarded to the registered provider and manager. Interaction between the people living at Hopes Green Care Centre and staff was observed to be positive. Staff were noted to be friendly and to provide care and support in a respectful and dignified manner. Surveys returned to us from service users and their relatives, generally recorded positive comments about the care provided at the care home. One survey recorded, My relative is now being cared for wonderfully and being given the time, patience and encouragement that they need. Several people felt that the support and care they received was appropriate, others felt that usually and sometimes care and support provided was satisfactory. One survey returned to us recorded, night staff do not cream all parts of my body that are sore. Not all staff are like that, the other carers are really good. Not all people living in the care home felt they were always listened to and comments recorded included, Care Homes for Older People Page 14 of 32 Evidence: some staff are very rude, as an older person Im not used to it. Medication practices and procedures were examined. It was positive to note that medication profiles are devised for all people living at Hopes Green Care Centre. Information recorded included, the specific dose, frequency of medication to be taken, date commenced, date stopped and purpose of prescribed medication. Care must be taken to ensure that the specific purpose of prescribed medication is recorded for all people. Medication storage facilities were observed to be secure. An audit of controlled drug medication for 3 people were examined. Records and actual medication available were observed to be accurate and well documented. Where medication requires cold storage, the temperature of the fridge was generally recorded daily, however some gaps were noted. The majority of temperatures were noted to be within recommended guidelines, however some temperatures were noted to not be within recommended guidelines. This is important, so as to ensure medication that requires cold storage does not deteriorate and/or lose its effectiveness. The majority of medication is managed through a monitored dosage system (blister pack). On inspection of a random sample of MAR records for those people on the first floor, there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR chart had been left blank and not signed or initialed by staff. Where the code F other (define) and G (see note overleaf) was recorded on the MAR record, the explanation for this was not recorded for several entries within those records sampled. The MAR records for 3 people showed there were anomalies between the quantity of medication received and the number of signatures on the MAR record. For example the MAR record for one person recorded a course of Trimethoprim 200mg Tablets (14 tablets), however records showed 16 signatures on the MAR record. As part of good practice procedures, handwritten MAR records were not double signed to confirm that the medication received was accurately recorded. The AQAA details, the home carries out regular medication audits to ensure that errors have not been made. While we recognise this as good practice, it is of concern that audits carried out did not highlight the above. As a result of the above concerns, an Immediate Requirement Notice was issued. Training records showed that all but one member of staff who administers medication has up to date medication training. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the care home can be assured that they will have their social care needs met and will receive a satisfactory diet according to their individual needs. Evidence: The activities co-ordinator is employed for 25 hours per week, Monday to Friday, however we were advised that these hours are flexible to cover evenings, weekends and special events. The activities co-ordinator has a 90 pound per month budget to spend on materials/projects and to fund external entertainers. We were advised that the latter is very positive, however the cost of some external entertainers means there is little budget left to fund other projects and/or community based activities. As a result of this, fund raising events are planned and undertaken to provide additional funding. An activities profile is completed for all people living at the care home, recording their social care needs, past hobbies, interests and personal preferences. On inspection of 4 weeks activities programme, these showed people have the opportunity to participate in a variety of activites such as bingo, arts and crafts, religious observance, clothes sale, sing-a-long, food tasting, gentle exercises, puzzles, board games, external Care Homes for Older People Page 16 of 32 Evidence: entertainers, coffee mornings and film afternoons. One resident survey returned to us recorded, We have an excellent activity co-ordinator. She doesnt make anyone participate but encourages us. It is a pleasure to be with her. When she is around I dont get time to sleep, it keeps my brain working. Consideration should be made to devise a pictorial activity programme, so that those people who have poor cognitive ability can make an informed choice. The AQAA details that regular community based activities are undertaken and transport is hired on an as and when basis. Community based activities include visits to the Sea Life Centre, Theatre/Opera trips and shopping. The AQAA details that within the next 12 months, it is hoped that more community involvement will be pursued and groups will be invited to visit the care home e.g. from local schools. A newsletter is compiled and distributed to advise people of forthcoming events. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. People spoken with confirmed they are made to feel welcome by care staff. There is a rolling 4 week menu in place and on inspection of this, this showed that people within the home are provided with a varied diet throughout the day. People living at the care home are able to choose where they wish to eat their meals e.g. in the dining room or in the comfort and privacy of their own room. In addition to the main menu, alternatives are readily available. On the day of the site visit, several people were observed to exercise this choice. The lunchtime meal was observed by both inspectors on the ground and first floor dining areas. A menu depicting the choices available was readily available on each table. Not all people spoken with were able to confirm the choices available and it was disappointing that staff did not advise residents. Tables were observed to be attractively laid with tablecloths, condiments, glasses and serviettes. People on the ground floor were noted to be taken and seated within the dining room from midday onwards, however the lunchtime meal was not served until 40 minutes later and one person did not receive their meal until 12.55 p.m. We were advised that 2 people require assistance on occasions from staff to eat their meal. It was of concern that these people did not receive their meal until 13.15/13.20 p.m. Consideration needs to be made by the management team of the home to review the amount of time people spend sitting in the dinning room, waiting for their meal to be served. Despite the above, the staff team serving the meal to residents, were observed to work cohesively and well as a team and to be methodical in their approach. Meals provided to service users were attractively presented and portions of food seen to be appropriate. Where assistance and support to individual service users was required, this was seen to be both respectful and sensitive. Care Homes for Older People Page 17 of 32 Evidence: On the first floor, several people were noted to choose to have their meal in the privacy of their own room. One resident was observed to eat their meal whilst still in bed, and although there was a table placed by the side of their bed, the physical posture of the resident looked uncomfortable. People were individually asked by care staff about their chosen choice of meal and size of meal required, however no condiments were offered. A hot food trolley was used for the majority of food items, however some items were not placed on the trolley and some people received meals which were not hot. Comments from people spoken with on the day of the site visit relating to the quality of meals provided were observed to be positive and included, Its lovely and the food is always good. Surveys returned to us recorded mixed comments and these included, Its not always up to the standard I find acceptable and more choice would be nice for those of us with a specialist dietary need. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints will be listened to and they will be protected from abuse, neglect and self harm. Evidence: There is an appropriate complaints policy and procedure in place at Hopes Green Care Centre. Since the last key inspection 2 complaints have been raised, pertaining to financial issues and care practices. Records showed that the management team of the home dealt with the above and all issues were resolved in a timely manner. The AQAA details that within the next 12 months the manager is to hold a once weekly surgery so that people can discuss issues of concern or raise other matters. Comment cards are readily available in the main reception area for people to complete. The majority of relative/resident surveys returned to us confirmed that people know how to make a complaint and to whom. One survey recorded, If I have any worries, I will mention them to the care home, where I have great confidence. A record of compliments was readily available within the home and included, Thank you for everything you have done for (name of resident), especially towards the end of their life to make them comfortable and cared for and I would like to say what a lovely day I had at your open day. The music was lovely, the surroundings pleasant. It was nice to see all the residents and their families enjoying themselves. It brought a tear to my eye. Well done and thank you. Care Homes for Older People Page 19 of 32 Evidence: Since the last key inspection, 2 safeguarding issues have been highlighted. From discussion with the manager and from evidence of documentation held within the home, there was evidence to show that issues had been dealt with by the management team of the home and Social Services. The training matrix showed that the majority of staff have received safeguarding training. Staff spoken with demonstrated a basic understanding and awareness of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge and/or manager/deputy manager. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is comfortable, safe and homely which meets their needs. Evidence: A partial tour of the premises was undertaken by both inspectors and the deputy manager. A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display e.g. ornaments, photographs etc. The home was observed to be clean, tidy and odour free. One bathroom on the ground floor was observed to be used to store a variety of mattresses, chairs and beds. The bathroom was not locked and was easily accessible to residents. Several COSHH (Control of Substances Hazardous to Health) items were observed on the floor. The deputy manager was advised at the time and immediate steps were taken by the maintenance person to make the room safe and secure for peoples safety and wellbeing. We were advised that a maintenance person is employed at the care home Monday to Friday (07.00-13.00), however their hours are flexible and on call arrangements are in place. The AQAA details there is an on-going refurbishment and redecoration programme in place. A random sample of maintenance records/certificates were Care Homes for Older People Page 21 of 32 Evidence: examined and these showed that fire drills are undertaken regularly, the homes fire system is checked weekly and emergency lighting is checked once monthly. Other certificates were examined in relation to the passenger lift, gas and electrical safety installation, hoists and employers liability and all were noted to be in date and fully operational. The homes laundry facilities were examined and systems in place were seen to be organised and well managed. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are in safe hands, however they cannot be assured that robust recruitment procedures are adhered to at all times or that there will always be sufficient staff on duty. Evidence: We were advised by the deputy manager that the staffing levels at the care home are 7 staff (including person in charge) between 07.30 a.m. and 14.30 p.m., 6-7 staff (including person in charge) between 14.30 p.m. and 21.30 p.m. and 4 waking night staff (including person in charge) between 21.30 p.m. and 07.30 a.m. each day. The deputy manager advised that senior members of staff are on duty 15 minutes earlier to undertake a handover with staff. The manager is supernumerary to the above and the deputy manager receives 1 supernumerary shift per week. In addition to the above appropriate ancillary staff are employed and these include, cook, laundry person, domestics, housekeepers and maintenance person. At the time of inspectors arrival it was noted that the morning shift was short of two members of staff. We were advised by the deputy manager that one person had telephoned in sick and one member of staff had gone to the doctors, but would shortly arrive back to the care home. It was evident from discussions with the deputy manager that arrangements had been made to provide additional cover for the Care Homes for Older People Page 23 of 32 Evidence: member of staff who had gone off sick and mid morning, staffing levels were observed to be in line with the above figures. Despite the above, there was no evidence to show this had an adverse affect on peoples wellbeing. On inspection of 4 weeks staff rosters, these showed that staffing levels as detailed above have generally been met, however there were occasions whereby the roster showed that the above staffing levels were not maintained. We have not been notified via Regulation 37 Notifications when staffing levels have not been attained and the measures undertaken by the management team of the home/registered provider to address the shortfalls. We were advised that over the past year the home has not utilised agency staff to cover staffing deficits, however there is a relief bank system in place which provides continuity of staff for the people living at Hopes Green Care Centre. We were advised by staff spoken with and from comments recorded within staff surveys that Hopes Green is a very pleasant place to work, that staff morale is good and there is good team work. At this site visit, 3 staff files were inspected for those staff newly appointed. The majority of records as required by regulation were evident, however gaps were noted in relation to the employment history for one person not fully explored and the Criminal Record Bureau (CRB) check and POVA 1st for one person received after they had commenced employment at the care home. A record of induction (Skills for Care) was available within each file examined, however there was no evidence of the homes induction having been undertaken and including a tour of the premises, shown fire exits etc. On inspection of the staff training matrix and training statistics sheet, this showed that since the previous key inspection, staff have received up to date training relating to core subject areas (fire safety, fire drills, food hygiene, moving and handling, COSHH, health and safety, safeguarding, infection control and nutrition). Additionally records showed that some staff have received training relating to those conditions associated with the needs of older people. This refers specifically to pressure area care, care planning and dementia awareness. The AQAA details that over the past 12 months a rolling training programme has been implemented within the care home to ensure the day to day training requirements of care staff are considered and met. At the time of the site visit, 15 people had attained NVQ Level 2, 1 person had attained NVQ Level 3, 9 people are currently undertaking NVQ Level 2 and 8 people have commenced NVQ Level 3 training. Care Homes for Older People Page 24 of 32 Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of people living at Hopes Green Care Centre, however identified shortfalls, potentially place people at risk. Evidence: The manager has many years experience in caring for older people and has been managing Hopes Green Care Centre for the past 3 years. The manager attained the Registered Managers Award in 2007 and regularly undertakes other training to enhance their professional practice. The manager was formally registered with us in January 2009, following a successful application and interview. Staff surveys returned to us were complimentary regarding the support provided by the management team of the home. Surveys confirmed that staff are given the opportunity to meet with the manager and feel that she is very understanding, approachable and supportive. Care Homes for Older People Page 26 of 32 Evidence: We were advised that the ethos of the service is to ensure that Hopes Green Care Centre meets individuals care needs, that people living at the care home are enabled to maintain independence and skills wherever possible and to ensure that people receive a good quality of life. It is evident from this inspection that statutory requirements highlighted at the last key inspection have been addressed. Evidence from this inspection show that further development is required in relation to some aspects of care planning and risk assessing, ensuring that information recorded is accurate and up to date and medication practices and procedures within the home are improved, so as to ensure peoples healthcare needs and wellbeing are attained. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was generally informative and detailed and it gave a reasonable account of the current situation within the service, although some elements did not concur with the inspectors findings. There is a quality assurance system in place at the home to seek the views of residents, relatives and other interested parties about the quality of the service provided at Hopes Green Care Centre. The manager stated that the views of people who use the service are sought every 3 months. On inspection of surveys returned to the home, most comments were positive. These included, My relative is very happy at Hopes Green. Their quality of life has improved 100 since their arrival. The staff are very caring and our relative loves them all and My relative is very confused about most things and does not remember us all the time. Our relative is well cared for and feels secure. The AQAA provides a list of policies and procedures currently available within the home. At the time of the site visit the health and safety policy and infection control policy could not be located. The manager advised that this might have been removed as some staff have been completing NVQ training. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Ensure that medication practices and procedures at the care home are appropriate. So as to ensure peoples safety and wellbeing. 16/03/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care planning at the home must identify, and be effective in meeting all residents assessed needs and ensure these are regularly updated and reviewed to reflect the most up to date information. This will ensure that staff have the most up to date information and can provide appropriate care to meet their needs. 31/03/2009 2 7 13 Risk assessments must be 31/03/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the Care Homes for Older People Page 29 of 32 person and steps to be taken to reduce the risk. So as to ensure peoples safety and wellbeing. 3 8 17 Where people are at risk of losing weight, maintain appropriate nutritional records, including weight gain or loss and appropriate action taken. So as to ensure peoples safety and wellbeing. 4 9 13 Residents must be protected 16/03/2009 from harm by having their medication administered safely and in accordance with the prescribers instructions. So as to ensure residents safety and wellbeing. Ensure that when medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. This is to ensure a clear audit trail and to ensure peoples health and welfare. Ensure there are sufficient staff, on duty at all times. So as to ensure the needs of residents are met according to their specific needs and dependency. 16/03/2009 16/03/2009 5 9 13 6 27 18 16/03/2009 Care Homes for Older People Page 30 of 32 7 29 19 Ensure that robust recruitment procedures are adopted at all times and all records as required by regulation are sought. This will ensure that residents and others feel assured that they are safeguarded by the homes procedures. 16/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 Consider devising the activity programme in a pictorial format so that people living at the care home are able to make an informed choice. Review and reduce the amount of time people spend sitting in the dining room waiting for their meal to be served. Consider devising the menu in a pictorial format so that people living at the care home are able to make an informed choice. 2 3 15 15 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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. 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