Inspection on 05/05/09 for Hulcott Nursing Home

This inspection was carried out on 5th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hulcott Nursing Home 12/01/09

Hulcott Nursing Home 15/10/08

Hulcott Nursing Home 23/09/08

Hulcott Nursing Home 13/06/08

Hulcott Nursing Home 18/06/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Hulcott Nursing Home The Old Rectory Hulcott Aylesbury Buckinghamshire HP22 5AX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Sidwell     Date: 0 6 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Hulcott Nursing Home The Old Rectory Hulcott Aylesbury Buckinghamshire HP22 5AX 01296488229 01296330834 hulcott@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hulcott Limited The registered provider is responsible for running the service care home 49 Name of registered manager (if applicable): 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: The maximum number of service users to be accommodated is 49 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Hulcott nursing home is located a few miles outside of the centre of Aylesbury in a quiet hamlet location overlooking a green. The home is registered to provide accommodation for up to forty-nine service users requiring nursing input. The building has been attractively arranged to provide a pleasant environment for the people living there, with good quality furnishing and fittings. Nine of the bedrooms are Care Homes for Older People Page 4 of 30 0 Over 65 49 Brief description of the care home shared rooms for two people. The majority of bedrooms have en suite facilities and all but two rooms are fully wheelchair accessible. There are three lounge areas, a large conservatory and a quiet area by the main entrance. The grounds are well maintained with a patio area and backs onto farmland. There are no public transport links and shops are some distance away. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took five days and included two days in the home, the first of which was unannounced. The key standards for older peoples services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager was not asked to complete an annual quality assurance self-assessment as this had been undertaken earlier in the year for the previous inspection undertaken on 23 January 2009. Residents and families were spoken to on the days of the unannounced visit. Discussions took place with the operational manager, interim home manager, nursing, care and ancillary staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Residents care needs must be agreed with them and be recorded in a care plan which is updated regularly. Protocols should be agreed to guide staff as to when residents should have medication that is prescribed as required, to ensure that residents receive this consistently when needed. Medication management must be improved to ensure that it is possible to track whether medication has been administered by keeping records of medicines returned to the pharmacy. This is to ensure that medication is administered reliably and that people always receive the medication that they are prescribed. The home should ensure that staff have the necessary skills and knowledge to care for people needing care at the end of their life, if they accept people specifically for end of life care. Residents should be given the opportunity to influence the new menus which should be implemented consistently if residents are to receive a varied, appealing and balanced diet. Care Homes for Older People Page 7 of 30 A record must be kept if the meals offered are different from the published menus, to ensure that residents diets are varied and nutritionally sound. Complaints must be managed better and complainants must receive a response in a timely way. An up to date record of all complaints must be kept in the home, to show that peoples concerns are recognised and addressed. All staff must have safeguarding training to ensure that staff are knowledgeable about how to protect older people from harm and to be sure that they understand what they should do if they have concerns. The lifts should be maintained in good working order if the first floor is to be accessible to residents with disabilities. The infection control procedures should be improved if residents are to be fully protected from potential cross infection in the home and the action plan described after the recent Health Protection Agency audit must be implemented in full. All staff must have an induction programme to ensure that they have the skills and knowledge to meet peoples needs. All staff must have up to date training in safe working practices including moving and handling and safeguarding older people. The new manager must apply for registration with us to comply with the requirements of the Section 11 (1)a of the care Standards Act 2000. The defects in the electrical installation system must be addressed to ensure that it is safe and does not pose a risk to residents or staff. The company must ensure that the findings of its quality assurance audits are addressed to ensure that there are ongoing improvements in care for residents. There are three outstanding requirements from the previous inspection. We will be considering taking further action about these. The requirements of this report must be met within the timescales set. We should be told when they have been implemented in full and should be told if there is any reason why they cannot be met. When this report is finalised the company must send an improvement plan detailing how the requirements will be met and the timescale within which they will be met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available and opportunity to visit the home to help people decide whether they wish to move to home. Peoples needs are are assessed before they move to the home to identify with them the care and support they need. Evidence: There is information available to residents in the form of a statement of purpose and coloured brochures. Prospective residents and their families are welcome to visit the home at any time. There have been three new residents since the last inspection, all of whom had comprehensive pre assessments to identify with them their needs and wishes for care. The assessment documentation prompts staff to take note of peoples faith and cultural wishes as well as their health and social care needs. Care Homes for Older People Page 10 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples healthcare and medication needs are not met in full. The care records are not an accurate record of the care people need and have agreed with the home, potentially leading to residents care needs being unrecognised and not being addressed. The staff team do not as yet have the skills to meet the needs of residents who have specialist end of life care needs. Evidence: The care of three residents was case tracked and the care plans of three further residents were checked. New care plan documentation has been introduced since the last inspection and was being piloted in the home. All residents had a care plan although they varied in completeness and the frequency with which they had been updated. Not all entries were signed and dated. It was clear in some that the resident or their family had been involved in drawing up the care plan but not in others. Some lacked key information. One gentleman had only one lung and used a nebulizer. The care plan section related to breathing was blank although staff, when spoken to, were aware of his needs. One gentleman was recorded as having a catheter although in another section of the care plan it was recorded as having been removed. One Care Homes for Older People Page 11 of 30 Evidence: resident who is partially sighted had no entries related to her communication needs. Although new care plans are in place they are not yet a complete record of the care agreed with the resident nor the care given. Residents are assessed as to their risk of developing pressure damage. Three residents had pressure damage at the time of the unannounced visit. They had care plans and their wound had been evaluated regularly. They were all healing. They had the appropriate mattress and their records showed that they had been helped to move regularly where they were unable to move themselves. The care plans did not state which mattress should be used depending on the level of risk to the resident and the records of wound healing were inconsistent. One residents dressing was not changed at the intervals stated in the care plan although the pressure damage was healing. Photographs of the wound were only taken at some dressing changes. One resident had several photographs which were not dated and labelled and it was not possible to identify which wound the photograph applied to. The were no written guidelines for staff on the prevention and management of pressure damage in the home on the day of the unannounced visit. This should be addressed. Care records relating to pressure damage must be clear and consistently applied. Residents are assessed as to their nutritional risk. The home uses two recognised methods of undertaking this although they appeared to give conflicting results. One person was noted to be high risk using one method and low risk using the other. This should be addressed as there is a risk of confusion. The chef has a list of special diets needed by residents and whether their meals need to be pureed or not. He also has information about whether people need a high calorie diet because of weight loss although this information had not been updated since March 2009. There was a soft and pureed diet option available at lunch time but only a pureed meal at supper. There is a four week menu plan although the lunches served on both days of the unannounced visit were not those stated in the menu plan. It was not possible to say whether residents are offered a varied diet as records of the food actually served have not been kept. The home is supported by a local general practice. One gentleman has moved to the home for the last stages of his life. Although the home is able to meet his needs at the moment staff have not had training in end of life care or specialist techniques for pain relief. The home also had to call out the community team to change his catheter when it blocked. The interim manager said she would seek training in both these topics for the registered nurses as soon as possible. Residents had been supported to maintain their personal hygiene and those seen and spoken to were happy with the care that they received. One said the staff are very kind. Care is given in residents rooms and staff were observed to speak to residents Care Homes for Older People Page 12 of 30 Evidence: with respect and to respond to the call bells promptly. There are medication management policies and procedures in place and the staff spoken to were aware of these. Storage facilities are satisfactory. Records are kept of medication delivered to the home, although the nurse spoken to on the day of the unannounced visit was unclear as to whether a record was kept of medication that was returned to the pharmacy. A contract is held for the disposal of unused medication. The registered nurses spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make the decision, the doctor and family would be informed and a way forward agreed. None of the residents in the home managed their own medication at present although there is a policy to facilitate this if a resident wishes. A number of residents were taking medication when required and not regularly. Some but not all had individual protocols in place to guide staff as to when required medication should given. There were a number of handwritten entries on medication records which had not been signed. This should be addressed. The controlled drug records were checked and found to be correct. Residents spoken to said that they received their medication regularly and were happy for the home to manage this. There is information about the safe management of residents medication on our website www.cqc.org .uk and from the Royal Pharmaceutical Society on www.rpsgb.org.uk. Care Homes for Older People Page 13 of 30 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. Residents are treated with respect and there is a programme of activities to bring interest and diversion to the day. Residents should be given the opportunity to influence the new menus which should be implemented consistently if residents are to receive a varied, appealing and balanced diet. Evidence: There is an activities coordinator in place. She arranges a programme of in house activities including coffee mornings, bring and buy sales, mobile shop, singalong and bingo and crossword sessions. Residents said that they can choose whether to attend or not. Families spoken to on the day said that they could visit at any time. Staff were observed to treat residents with respect. Care is given in residents rooms and their privacy and dignity is respected. One member of staff was seen to support a resident who was anxious when her family member left and to reasssure her. Residents were mixed in their views about the standard of the meals. One said that it varied and sometimes was good and at other times less appetising. One resident said Sunday roast was usually very good. There is a four week menu plan although this was not being followed. The meals were different on both days of the visits. The chef Care Homes for Older People Page 14 of 30 Evidence: said this was due to delivery problems after the bank holiday. The manager said that the menus had been revised although new menus had not yet been implemented. There was no evidence that residents had been consulted about the content of the new menus. On the first day of the unannounced visits the main meal was casserole, with vegetables and potatoes, with an alternative of sausages and mashed potato. On the second day it was fish cakes with an alternative of poached coley fish with vegetables and potatoes. It was not possible to ascertain whether residents received a balanced diet as the revised menus were not in place and the current menus were not being followed. Records of food actually provided for residents were not being kept. This was a requirement of the previous report which has not yet been met. Five residents were sitting at dining tables although most were eating in their rooms or at small tables in front of their chairs in the lounge. Staff were seen to help those who needed help discretely, sitting alongside reisdents and engaging with them. Care Homes for Older People Page 15 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are not managed consistently and peoples concerns are not always responded to. Residents are safeguarded in that the home is aware of and has cooperated with the local authority in its safeguarding investigation. The company has not however been proactive in telling the local agencies who have worked closely with them about significant changes in management, undermining confidence that the quality of care is improving and that residents are protected from harm in the home. Evidence: There are complaints policies and procedures in place. Information is posted in the entrance hall for residents and relatives as to how to raise a concern. There are also leaflets giving details of local advocacy organisations. Two residents spoken to said that they knew how to make a complaint and that small issues were dealt with promptly. The acting manager could not find a complaints file in the home and it was not possible to ascertain how many complaints had been received since the last inspection. She said that to her knowledge four complaints had been received. The correspondence available relating to these showed that one had been dealt within the timescales described in the companys policy and that the residents family was satisfied with the outcome and thanked the interim manager for her help. Two had been resolved with the support of the local authority care management team. One had received an unsatisfactory response. A family member had written to manager on 22 February 2009 expressing concerns about her mothers oral hygiene, the fact that her address was incorrect and the fee increases that she had been notified of. The acting Care Homes for Older People Page 16 of 30 Evidence: manager replied on the 23rd March 2009. The complainant then wrote to the operational manager and the Chief Executive on the 23 March 2009 with further concerns about her mothers care. She wrote again on 9th April 2009 expressing concerns that she had not received an acknowledgement or a reply. There was no evidence in the home that these concerns had been responded to. The company must ensure that a record is kept in the home of all complaints and that they are investigated and responded to in a timely way. The home has been the subject of a safeguarding review following concerns identified in the last three months of 2008. The company agreed to voluntarily stop accepting new residents until they could be sure that the quality of care had been improved. A full inspection was undertaken by us in January 2009 when it was found that the outcomes for residents were adequate. The home has information about the local multi agency procedures to safeguard older people . The training records showed that at March 2009 45 of staff had updated safeguarding training. Additional training was planned in June 2009 for those who had not yet had or updated their training. Care Homes for Older People Page 17 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and homely environment for residents. The lifts should be maintained in good working order if the first floor is to be accessible to residents with disabilities. The infection control procedures should be improved if residents are to be fully protected from potential cross infection in the home. Evidence: The home is situated in a quiet country village on the outskirts of Aylesbury. It is an older building with a ground floor extension. There are pleasant gardens and some ground floor rooms have patio doors opening onto the garden or a courtyard. Residents are encouraged to personalise their rooms and many had chosen to do so. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. A new call bell system has been installed. The manager said that call response times could now be monitored. The ground floor is accessible to people with disabilities. On the day of the unannounced visit the lift to one part of the first floor was not working. Staff said that it had not been working for a week. The manager said that a new part for the control panel was on order and it would be repaired as soon as that was received. The requirements made at the last inspection about the environment have been addressed. A recommendation was made that the shower be repaired in room 30 and that the defects noted at the lift inspection in November 2008 be addressed. These recommendations have not been addressed. Care Homes for Older People Page 18 of 30 Evidence: There are infection control policies and procedures in place. The training records showed that seventy per cent of staff had received training in infection control. Residents had individual sliding sheets if they needed help moving in bed although staff said that residents still shared hoist slings. Hoist slings were observed to be stored with the hoists in the corridors and not in individual residents rooms. This is not in line with the Department of Health guidelines on infection control. Soap and hand towels were not available in all rooms for the use of staff or visiting professionals. The alcohol hand sanitizers were empty in several of the rooms seen, although this may have been to protect residents who may attempt to put it in their mouth. The latest guidance from the department of Health states that hand hygiene must be performed before each and every episode of care and that alcohol hand rubs should be used at the point of care. A risk assessment should be undertaken if the alcohol hand sanitizers are to be empty. The company should review the infection control policies and procedures and ensure they are implemented consistently in the home to protect residents from acquired infection. The interim manager has produced an action plan in response to a recent infection control audit of the home by the local Health Protection Agency. She was unsure whether all the actions described had been achieved by the timescales set and agreed to review the plan to ensure it was fully implemented. At the time of the visits an outbreak plan for infectious disease was not available and the clinical waste bins at the front of the home were unlocked, both of which were actions that should have been achieved. Care Homes for Older People Page 19 of 30 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 said that staff were kind and caring. There are however insufficient permanent qualified nurses in post to ensure continuity of care for residents. Staff training is inadequate to ensure that all staff have the necessary skills and knowledge to meet peoples needs safely and effectively. Evidence: There is a staff rota which show that the home aims to have two registered nurses on duty throughout the day and one at night. They are supported by a team of carers. The acting manager said that she aimed to have seven carers on during the morning, five in the evening and three at night. The rotas showed that at the time of the unannounced visit there were seven permanent qualified nurses and five agency nurses who were working a variety of shifts. The local general practitioner had expressed concerns on one of his visits that he was met by an agency nurse who was not aware of the residents medical problems. The rota showed that this was the case on that day but that a permanent member of staff was on duty on twenty of the twenty eight days on the rota. The planned rotas seen for the 16th May until the 5th June show that there is one Registered Nurse on each shift but that the home will have to rely on agency nurses to meet the target that two Registered Nurses should be on duty during the day. The home said that they endeavoured to use the same agency nurses to ensure continuity of care for residents. At the last inspection the then registered manager and operational manager for the home said that they would Care Homes for Older People Page 20 of 30 Evidence: undertake dependency assessments when they began to take people into the home again to ensure that they had sufficient staff to meet people needs. The weekly returns show that dependency levels have been reported to the companys head office although the baseline data could not be found. We were told that this may be at the companiys head office. Three of the five residents spoken to said that staff were available to help them although two said that they often had to wait when they rang the bell. All said that staff were kind and caring. The training records were not available and were not up to date on the day of the unannounced visit to the home. The acting manager said that the regional training manager was visiting the home the following day and agreed to make the updated records available. When received they showed that not all staff had had basic mandatory training, for example only 45 of staff had up to date moving and handling training and only 45 safeguarding training and no staff had received training in specialist topics such as catheterisation and End of Life Care. 33 percent of care staff hold the National Vocational Qualifications in care at level 2. The home does not meet the standard that 50 percent of care staff hold this qualification. The information received showed that at least 6 members of staff had to complete the induction programme. Two of the staff spoken to said that they had been shown around the home but had not had a formal induction. Two requirements were made at the last inspection that all staff must have the basic mandatory training in safe working practices and that all staff must have an induction programme. These requirements have not been met and will be identified as outstanding in this report. The home has recently accepted people for care at the end of their lives. None of the staff have had end of life care. At the time of the unannounced inspection only two of the qualified nurses had had training to enable them to undertake blood tests and none had had training in male catheterisation. The recruitment files of three members of staff who have been appointed since the last inspection were examined. All had evidence to show that checks had been made as to suitability of prospective staff to work with the frail elderly. Criminal Records Bureau disclosures and two references had been sought before the staff member started work. Their identity was checked and work permits were in place where necessary. Care Homes for Older People Page 21 of 30 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. Whilst an interim manager has been appointed, the management arrangements lack continuity. Records are not up to date and actions agreed by the previous management teams are not carried through and the quality of care for residents cannot be shown to be improving in a consistent and reliable way. Evidence: The previous manager left the company in April 2009. An interim manager has been appointed who states that she will remain in post until a new manager who has been appointed starts in June 2009. The previous manager did not register with us and the company has not registered a manager with us since they acquired the home in 2006. The requirement made at the last report that the manager registers with us has not been met and will remain outstanding in this report. Residents spoken to were happy with the interim manager and said that she listened to their concerns and had addressed them. We had been notified that the operational manager covering home had changed but Care Homes for Older People Page 22 of 30 Evidence: not whether she was to become the registered responsible individual. This was raised during the inspection and an application to change the registered person was made shortly after the unannounced visit. The new operational manager has undertaken the quality assurance visits required by Regulation 26 of the Care Homes Regulations. The company has a quality assurance programme to improve the care for residents. The outcome of the last audit was not available in the home on the day of the unannounced visit and the interim manager was unaware of the findings. It was provided after the visit and had been undertaken on the 9th March 2009. The audit showed 61 compliance with the companys standards which was adequate in their view. A number of issues, which have been identified in this inspection, were also noted at this audit, including inadequate training of staff , poor control of infection standards, poor collation of wound photographs and medication management. Although the auditor had described the actions that should be taken in response to the audit there was no evidence that this action plan had been implemented. There are regular family and resident meetings where people can express their views and the company can tell people of their latest plans. The home does not manage residents money on their behalf. Any items of expenditure are invoiced to the resident or their family as part of the billing system. The home has not kept individual and home records up to date in that individual care plans were not an accurate record of peoples healthcare needs, complaints records were not available in the home and training records were not up to date to show that staff had had the necessary training to give them the knowledge and skills to care for older people safely. The maintenance schedules and safety checks were examined. These have been kept up to date by the new maintenance officer. There was no current electrical safety certificate in the home. This was sought from the company. The electrical installation was tested on the 22 January 2009 and the report states that the general condition of the installation is unsatisfactory and that attention should be paid to the points raised in the report. This must be addressed by the company. The records show that not all staff have had training in safeworking practices including moving and handling and food hygiene. There are three outstanding requirements from the previous report. We will be considering taking further action about these. The requirements of this report must be met within the timescales described. We should be told when they have been met in Care Homes for Older People Page 23 of 30 Evidence: full and should be told if there is any reason why they cannot be met in full. When this report is finalised the company must send an improvement plan detailing how the requirements will be met and the timescale within which they will be met. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 All staff must have an induction programme. To ensure that they are knowledgeable about the care needs of residents and the way in which these should be met in the home. 27/02/2009 2 30 18 All staff must have up to date mandatory training in safe working practices. To protect residents and staff from potential harm arising from their care. 27/03/2009 3 31 8 The manager must register with us. To comply with the requirements of Section 11(1) a of the Care Standards Act 2000. 31/03/2009 Care Homes for Older People Page 25 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents care needs must be agreed with them and be recorded in a care plan which is updated regularly. To ensure that residents health and personal care needs are identified and addressed. 30/06/2009 2 9 13 Medication management must be improved to ensure that it is possible to track whether medication has been administered by keeping records of medicines returned to the pharmacy. To ensure residents receive their medication regularly. 30/06/2009 3 9 13 Protocols should be agreed 30/06/2009 to guide staff as when residents should have medication that is prescribed as required. Care Homes for Older People Page 26 of 30 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 To ensure residents receive their medication when appropriate. 4 16 22 All complaints must be fully 30/06/2009 investigated and the complainant sent a response within the timescales set in the companys complaints policy. To ensure that peoples concerns are listened to and addressed where possible. 5 18 13 All staff must have safeguarding training To ensure that staff are knowledgeable about how to protect older people from harm and to be sure that they understand what they should do if they have concerns. 6 19 23 The lifts should be maintained in good working order. For the first floor to be accessible to residents with disabilities. 7 19 13 The action plan agreed after the recent Health Protection Agency infection control audit must be implemented in full. 31/07/2009 31/07/2009 30/06/2009 Care Homes for Older People Page 27 of 30 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 To ensure that residents are protected form potential cross infection. 8 31 8 The company must ensure that the new manager applies for registration with us. To comply with the requirements of the Section 11 (1)a of the care Standards Act 2000. 9 33 24 The company must ensure that the findings of its own quality assurance audits are addressed. To ensure that residents quality of care improves on an ongoing basis. 10 37 17 The home must ensure that the records described in schedule 4 of the Care Homes Regulations 2001 are maintained, up to date and accurate. These include complaints records and records of the food actually provided. To ensure that the records needed to protect service users and for the effective running of the home are in place. 31/07/2009 31/07/2009 31/07/2009 Care Homes for Older People Page 28 of 30 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 11 38 23 The defects in the electrical installation system must be addressed. To ensure that it is safe and does not pose a risk to residents or staff 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 4 The home should ensure when they assess and accept people that staff have the necessary specialist skills and ability to care for individuals. The home should ensure that staff have the necessary skills and knowledge to care for people needing palliative care at the end of their life, if they accept people specifically for end of life care. The menus should be agreed with residents, to ensure that they receive a well balanced diet which they will enjoy. The company should tell the local agencies with which it has been working closely over safeguarding issues, about major changes in the homes management and oversight. 2 11 3 4 15 18 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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