Inspection on 23/03/10 for Huyton Hey Manor Residential Care Home

This inspection was carried out on 23rd March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Huyton Hey Manor Residential... 17/06/10

Huyton Hey Manor Residential... 13/10/08

Huyton Hey Manor Residential... 28/07/06

Huyton Hey Manor Residential... 12/12/05

Huyton Hey Manor Residential... 20/05/05

Huyton Hey Manor Residential... 13/12/04

Huyton Hey Manor Residential... 21/05/04

Similar services:

Dystlegh Grange

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Huyton Hey Manor Residential Care Home Huyton Hey Road Huyton Knowsley Merseyside L36 5RZ     The quality rating for this care home is:   zero star poor 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: Julie Garrity     Date: 2 4 0 3 2 0 1 0 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 34 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Huyton Hey Manor Residential Care Home Huyton Hey Road Huyton Knowsley Merseyside L36 5RZ 01514893636 01514266415 angharad-huytonhey1@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cranford Care Homes Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Service users to include up to 30 OP and 30 PD(E) The service may admit one named service user under pensionable age. The service should employ a suitably qualified and experienced manager who is registered with the CSCI Date of last inspection Brief description of the care home Huyton Hey Manor is a care home registered to provide placements for 30 persons of the category old age. The home is situated in pleasant grounds in a residential area close to local amenities and Huyton Village centre. Accommodation is provided on three floors and there is a passenger lift to all levels. The home has a variety of aids and adaptations in place around the home to assist residents with mobility. Twentyfour of the bedrooms are single, three are double and none of the bedrooms have en suite facility. There are two communal toilets to the ground floor plus two bathrooms Care Homes for Older People Page 4 of 34 Over 65 30 30 0 0 1 3 1 0 2 0 0 8 Brief description of the care home and toilet combined. There are two communal toilets to the first floor plus one shower and toilet combined and two communal toilets and one bathroom to the second floor. Care Homes for Older People Page 5 of 34 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: The visit to the home started at 10.00 on the first day and finished at 22:00 on the second day . We spoke with a total of nine people who live in the home, seven members of staff, three relatives and the manager. The home completed a document known as an Annual Quality Assurance Assessment(AQAA). This documented is completed and sent to us by the home before we visit. All AQAAs are considered to be remaining in dates if less than nine months old. As such we use the AQAA submitted to us by the home in October 2009. The AQAA tells us what the home does well and what their plans are ,if any to increase the quality of the home. We sent surveys to people living in the home, none were returned. When we visited the home we looked at many of the records these included care records, staff records, medications, policies and procedures, menus, duty rota, staff training and activities records. We received information from the Primary Care Trust with serious concerns regarding Care Homes for Older People Page 6 of 34 medications. As a result a specialist pharmacy inspector was included in this visit. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The service has not developed any active plans that look at the quality of the support provided. The service will find it difficult to maintain or increase the quality without making sure that the manager is aware of the areas that need to be improved. The management of health and welfare including medications is not sufficient to meet the needs of the people living in the home. In particular the management of medications place people living in the service a significant risk of harm. Staff had not received updated training, not been tested that they were competent to give out medications, had out of date policies and procedures to support them in this task and audits on medication and had not taken place. Without these aspects the manager was unable to make sure the people living in the service received a medications as they should. We also noted that care plans which direct staff on how to look after the people living in the home row to date, inaccurate, did not identify significant risk and did not support the staff to monitor the condition of people living in the home. This therefore meant that changes in peoples needs had not been recognised or responded to correctly. This would have a detrimental effect on the health and welfare of some of the people living in the service. Policies and procedures available to the staff team are out of date and do not reflect the correct guidance that staff need not. Other documentation such as information to people wishing to move into the home is out of date. Training for the staff is in need of further development and there is no evidence that staff members that have had training to keep them up to date. Not all the staff are fully checked before they start working in the service and this places individuals at risk. There is no determination by the manager that staff are competent to undertake the activities they do. During the visit we witnessed two incidences that placed the people living in the home at risk. The daily routine of the service is not in keeping with individuals, choices preferences Care Homes for Older People Page 8 of 34 or needs. Information that will inform them of the choices available was not in formats to meet the needs of all the people living in the home. 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 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available in the home and assessments by the manager are available. Neither of these were in sufficient detail or in a format that supports people wishing to move into the home to make an informed decision. Evidence: We looked at how the service assessed (a review of peoples needs), before they moved into the home. To do this we spoke to the manager who told us that she usually assess people before they move in to see if the service can meet the persons individual needs. The AQAA submitted by the manager stated, Prior to admission without fail a full preadmission assessment is carried out with the prospective service user in their own environment. We looked at five peoples care records two of the people had recently moved into Huyton Hey. One person had, had significant periods of respite before moving in there records did not show that they were assessed each time they returned to the home. We noticed that records were unclear for two people whose assessment had not been signed or dated. As such it was not possible to Care Homes for Older People Page 11 of 34 Evidence: determine when the assessment was done or whether the member of staff completing them was qualified to do so. Of the assessments viewed only one had evidence that at some point it had been updated. It is essential that good assessments are in place for all people wishing to move in or living in the home and that these are updated. This needs to be done in order for the staff to make sure that they are aware of peoples needs and are able to plan how to meet their needs. Although the assessments contained clear information about peoples individual needs the majority of sections concentrated on physical needs with only two sections out of twelve discussing peoples personal preferences or daily activities. The assessments did not take into account changes in legislation such as mental capacity. None of the assessments viewed were signed by the person wanting to move into the home or their representative. We spoke to people living in the home about the information that they received before they moved into the home. We looked around the service and noticed that people living there did not have a copy of the information know as the service users guide in formats that met their assessed needs. When we reviewed this information we noticed it had not been updated and several sections were unclear. The information needed an explanation for the circumstances that a person can be admitted to the service and the arrangements for emergency admissions. People spoken with had told us that they had been given the opportunity to look around the service before moving in without an appointment. Care Homes for Older People Page 12 of 34 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. The people living in the service do not have their health and welfare needs met. Evidence: We looked at how Huyton Hey Manor met peoples health and welfare need. To do this we looked at five different peoples care records. We paid particular attention to the care plans which tells staff how to look after the people living in the service. Of the five care plans we looked at, two were undated and unsigned and as such it was not possible to determine when they had been written or who had written them. The other three care plans viewed were dated up to four years ago. When we looked at how the people living in the service we noticed that four plans were not signed by the person that they were written for. Two plans were signed for by the persons relative despite having an assessment that showed they were able to communicate and were full able to make decisions. The plans were signed when they were written and there was no evidence that the person had been consulted about their care plans as they were reviewed. As the support is decided on is for the people living in the service they need to be included in order that they can make an informed decision. Care Homes for Older People Page 13 of 34 Evidence: Records viewed showed that staff had done a monthly review of people living in the service. When we looked at these we noticed that staff had reviewed the person in the last month but not how effective the care plan was. Staff had written no changed to plan it was evident the monthly evaluations showed that a persons needs had changed but the care plans were not updated. This meant that care plans available were out of date, inaccurate and gave no relevant instructions to staff on how to meet peoples needs. This had resulted in people living in the home not receiving support to meet their needs. Examples of this included two people who told us that they were in pain. When we looked in their care plans we could not find information that instructed staff on how to assist people in reducing their pain. We looked at how peoples pain relief was managed and noticed that some people living in the home had not received their pain relief medication correctly. The lack of management for pain relief had resulted in the service not meeting the needs of the people living in the home and placing them at risk of harm. We looked at how the service assessed what risks people had regarding their health and welfare. We could not find evidence that peoples nutritional needs had been looked at. There were no nutritional needs risk assessment available, this included for people who have been identified as having lost weight or were receiving supplementary foods. One person had lost a significant amount of weight in one month this had not been identified in the person care plan. The person had not been weight again in the last few months. Another person was identified on admission that they had lost a significant amount of weight. We could find no records that showed that their weight was monitored in the last nine months. Care plans did not contained information about who need supplementary foods, when they were to have this and how to monitor to make sure that they did not lose weight. We also looked at how the service determined whether someone is at risk of developing pressure ulcers. We noticed that three people had a Waterlow score (an assessment of the risk of developing pressure ulcers). One persons score was incorrectly calculated her medical condition which would have increased the risk had not been taken into account. Two other people had been determined as at risk by a Waterlow score, this information had not been included in their care plans. In both cases neither had another assessment for four years. People who are at risk of developing pressure ulcers should be monitored in order to maintain their health and welfare needs. The lack of guidance to staff regarding how to prevent pressure ulcers place people at significant risk of harm. A specialist pharmacist inspector was included at this visit. This was as we had received information from the primary care trust (PCT) detailing that medication management was not sufficient to maintain the health and welfare of people living in the service. We asked the manager whether she had been aware of this report from Care Homes for Older People Page 14 of 34 Evidence: the PCT she informed us that she had seen the report. We asked her what actions to taken to met the recommendations from this report. She informed us that as yet had taken no action as she had been too busy. When we looked at the medications we noted that several people had not been given their medications correctly. Records regarding controlled drugs were unclear and showed that people receiving controlled drugs were not getting these correctly. Two people on patches for pain relief meant to be given weekly had on occasions had to wait up to an extra seven days before they receive this. Staff had not always had two people to witness that the strong medicines (controlled drugs) had given correctly and had often failed to write a medication name, dose and the name of the person down in the record. We looked at how the service ordered these medications and found at times there was a significant delay before the medications where available in the home. This had resulted in some people not receiving their pain relief correctly. Medication administration records (MARRs) where looked at. These showed that at times staff had signed for medications but not given them. This is particularly noticeable on courses of antibiotics where more tablets had been signed for as given than had been received by the home. One person was to receive an injection which should be given no more than twelve to thirteen weeks between intervals. The records viewed showed that on occasions this had been up to seventeen weeks before it was given. We could find no record for the injection that was last due. This injection is vital to the health and welfare of the individual and must be given at the correct intervals. The lack of appropriate management of medications has place people at significant risk of harm. We looked at how the service managed per required need medications, creams and supplementary foods. We could not find any instructions available to staff on how to make the decision as to whether these items were to be used, how they were to be used or how to monitor the effects of their usage. Without clear and proper instructions staff will be unable to decide when to give these medications appropriately. One person frequently left the service for leave. There were no arrangements in place to make sure that their medications were safely managed. We also noticed that at least one person managed some of their own medications such as creams. There were no risk assessments in place that helped them to do this safely. Records available showed us that staff frequently contacted external professionals such as doctors and consultants. The instructions from these visits were not always Care Homes for Older People Page 15 of 34 Evidence: clear and staff had not always followed the instructions received from the external professional. One person was to have their medication is reduced slowly staff had not to followed this instruction and stopped the medication suddenly. Records showed that the person became increasingly agitated during this period of time. Clear external professional records need to be kept and used to update care plans in order that staff can provide the correct support. Care Homes for Older People Page 16 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service are not offered daily life and social activities that meet their individual choices, preferences and needs. Evidence: People in the home are asked on admission about some of their preferences and choices, social activities are not always looked at. This information is recorded on their assessment and is not updated. We discussed with the manager how activities and menus were decided on and we were told by the manager and staff we know them. The AQAA for the service did not describe to us the means by which the service makes sure that the people living in the home were offered a choice of meals. There was no information on the AQAA about what the service did to maintain peoples nutrition. None of the people moving into the home have their nutritional needs looked at. Peoples weight was not monitored to make sure that they had not lost or gained too much weight. One person had lost weight and this had not been recognised, dealt with all monitored. When we observed staff over the lunchtime. All the meals given where the same. We were told by people living in the home that they were not aware of what choices there Care Homes for Older People Page 17 of 34 Evidence: were or if there were any. The menu did not show alternative diets such as a diabetic or a choice of meals at lunchtime. Assessments for the people living in the home showed that some of the people had special diets as part of their assessed needs. this information was not included on the menus and as such people living in the home were not assisted to make appropriate choices in independent manner . Staff spoken with told us that breakfast and supper is available. This information was not available in any format to people living in the home to meet their needs. The menus in the service do not show a choice of food and do not provide people living in the service with the opportunity to make a choice in a manner that maintains their independence The staff told us that they ask people what they would like to eat. People living in the service told us, no there is no choice, if you dont like it theres nothing else, we never know whats for lunch until it arrives, The food is generally tasty, can be a bit boring, I like it most of the time and I dont really have that many problems with it. The service did not keep up to date records of what peoples choices are that would help them decide on future menus. Over lunchtime we noticed that one lady told us she did not like what was available, she was given a meal available and was not offered a choice. She gave the main parts of her dinner away to the lady sitting next to her. We discussed with the manager and the kitchen staff what this lady had told us in one we had observed. We were informed that they had not realised that she did not like this meal as her plate always came back empty. The manager told us that the menus were generated from herself and kitchen staff and this was done on the basis of what they knew about the people living in the home. The service did not keep up to date records about peoples choices and preferences, nor had the opportunity been taken to fully explore peoples individual choices and preferences and to keep that information up to date. Staff need to be fully aware of what peoples personal preferences and choices are in order to support them to make an informed decision. After lunch several people remain seated in the dining room. One lady got up to go to her bedroom. She was called back by the member of staff giving out medications and told to wait in the dining room until she had received her medications. Other people sitting in the dining room were also waiting for their medications. Several of them waited for over 15 minutes before they receive the medications. We discussed with the manager why this arrangement was in place and we could find no reasonable explanation. The restriction on people living in the home not being allowed to leave the dining room until they receive their medications is not in keeping with supporting them to live their lives as they choose. Next to the lift is a notice board which lists the activities generally available. This list is Care Homes for Older People Page 18 of 34 Evidence: at shoulder height for a standing person and therefore cannot be seen clearly by anybody in a wheelchair. We noticed that this was the only copy available and it was not available in large print for people who may have slight issues. We discussed with the manager how the activities available had been decided on We were informed that they were decided on by the manager and the people living in the home. We asked for activities records that demonstrated what peoples personal preferences and choices were. We noted that the activities records listed the activities the people have done but made no mention of their personal preferences and choices. Some information regarding preferences and choices is included on the initial assessments when the person is admitted. The assessments viewed had not been updated in some cases for over four years. We spoke to people living in the home about the activities available and they told us nothing I want to do, what activities, I can get very bored, I like some of the things that we do and we coloured in Easter eggs. It was a bit childish it was okay. There were minutes available for one meeting in which some activities and food preferences have been discussed. This is used with people who are in a position to verbalise their points of view. We found no evidence of how staff determined the choices of people less able to say what their choices were. Staff frequently told us we know what they like. Care Homes for Older People Page 19 of 34 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. People living in the service field that their concerns are less than. Concerns and complaints are not always recognised and acted promptly. Evidence: We looked at how the service dealt with concerns. The manager informed us that the service had not received any complaints or concerns. This did not tally with the information in the aquaculture told us that one person had made a complaint and that this had been addressed within 28 days. Records of this complaint of how it was investigated were not made available for all is to view. We discussed with her the gentleman who requested his medications changing from one time to another as it did not suit his needs. He had discussed this with the manager on a number of occasions that he was not happy those medications times did not change. We explained to the manager that the gentleman had in fact complained. All complaints no matter how informal need to be recognised and addressed in order to maintain the safety of people living in the service. There is a copy of the complaints policy readily available to people living in the service. In discussion with people who live in the home, their relatives and staff all were confident that concerns if raised with the management would be addressed. We looked at the training of staff received in the last 12 months with regards to the protection of vulnerable adults. Records show that staff had not received this training Care Homes for Older People Page 20 of 34 Evidence: since September of 2008. On the day of our visit information regarding the welfare of one person who lived in the home indicated that this needed to be reported as a potential neglect to social services. We asked the manager to do this in accordance with their own policy and procedure. On further examination we noticed that the service did not have its own policy and procedure for safeguarding vulnerable adults. The manager did have a copy of Knowsley social services safeguarding procedure who are the authority that takes the lead in all potential safeguarding concerns. The manager informed us that the social services policy was out of date as the telephone number listed was inactive she was able to contact a social worker to report her concerns. We spoke to staff working in the home the majority were aware of how to recognise serious concerns and what actions would be taken to maintain the safety of people working in the service. Care Homes for Older People Page 21 of 34 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. Huyton Hey Manor presented as a warm and welcoming place for people to live. There were not sufficient arrangements in place to maintain the safety of the people living in the service including the prevention of the spread of fire and potential infections. Evidence: We toured the service to look at the environment. There is a dining room which is large enough to accommodate everyone at mealtimes should they wish to eat in the dining room. There is a separate lounge which is well used by the people living in the service. A separate conservatory is also available at the side of the building. These areas had comfortable chairs available for people to sit in. There is also a smoking area available for people living in the home. The washing and hand drying facilities were not suitable. In one bathroom there was no facility to wash and dry hands safely. As there was no hand towels and only hard soap. In another bathroom there was no disposable towels and hard soap only. These presented a significant risk to infections being passed on. noticed that plastic aprons and gloves were available in the home and these are used appropriately by staff during the day. One of the shower rooms was being used as a storeroom and therefore is no longer accessible to be used by people living in the home. The items stored in the shower Care Homes for Older People Page 22 of 34 Evidence: room with supplementary foods which need to be stored at a certain temperature. There is no monitoring the shower room was suitable to store these items in. We looked at peoples bedrooms with their permission. The majority contained personal items that made the bedrooms very much the persons own space. People living in the service told us that they liked their bedrooms, its a very nice place to live and its a nice home. Several bedroom doors were wedged open during the day. We noticed that some of the bedroom doors and other fire doors did not correctly close against the door frame leaving a gap. In the event of a fire this would mean that the fire doors would not be able to protect people fully. People living in the service told us that they thought that Huyton Hey Manor was clean and tidy. We looked around the service and noted that it was very clean and tidy. That was clear evidence that the majority of areas in the service were maintained to a reasonable standard. Care Homes for Older People Page 23 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have the training or skills make sure that they support people living in the home in a manner that maintains their safety. Evidence: We looked at the staff files to see how staff were recruited. Of the four staff files we asked for one had full checks in place. One staff member did not have a file in the home at all as they worked for other homes in the group as well. As such the manager was all able to determine the staff member was fit to work in a care home. Another staff member had a police check but this was for another service and only had one reference. Gaps in the working history of staff had not been explored. Staff working within the service need to be fully checked in order to make sure that they are suitable to work with the people living in the home. We asked to see the training of the staff . The AQAA for the service made no mention of the training in place of staff. Plans for the future where to continue as we are . when we looked at the training records available with could find no training more recent than 18 months ago. During the day they witnessed staff giving medication out incorrectly. Staff members not utilising the proper moving and handling techniques and placing people at risk. This information was disclosed that the manager who told us that staff received moving and handling training every two years. Good practice Care Homes for Older People Page 24 of 34 Evidence: would indicate that staff received a practical moving and handling training on a yearly basis to keep them up-to-date. The moving and handling training as with all other training records showed that these were video and questions. We were unable to see who had marked the questions on whether they were qualified to determine whether the person had answered correctly. The manager told us that she had not undertaken any competency assessments staff in particular those undertaking medication handling. Care Homes for Older People Page 25 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangments in place have not made sure that a quality service is maintained. Evidence: The manager has worked within the care home are a number of years. She informed us that up until recently she had had a deputy manager available. The deputy had recently left Huyton Hey Manor and the manager told us that she felt that this may have impacted on her ability to respond to the issues raised from the PCT regarding medications. We looked at the training and the manager to received and noticed that she has not received updated training in the last 18 months. The training and the manager had taken was the same as the care staff. The manager had not taken any additional training in areas such as management, mental capacity and deprivation of liberty. The manager undertook the registered managers award (training specific for care home managers) in 2006.Since then they have not undertaken overmanned training to develop their skills and role. We discuss with her the arrangements of supervision by her line manager who is the owner of the home. She informed us that Care Homes for Older People Page 26 of 34 Evidence: he visited regularly but she had not received a formal supervision that would help are identified her training needs. We looked at how all the staff had supervision and noted that staff did not receive this on a three monthly basis. There were supervision records in place staff that had identified training such as food hygiene but there was no evidence that this requested training has been carried out. As part of our review of the service request the managers complaint document known as an AQAA. Any AQAA submitted within the last nine months is considered to be current. The AQAA submitted and received from Huyton hey was dated 16/10/09 and was therefore still current at the time on our site visits. The AQAA submitted to us firm plans as how the service was going to develop an increase the quality. Some sections were incomplete as an example date given the maintenance checks such as electricity and gas. Information within the AQAA was unclear and some information was not the same as they were told by the manager at this visit. We review policies and procedures within the home. These are written to provide staff with guidance. We noticed that none of the policies and procedures were up to date and there was no evidence that they have been updated to some considerable time. Where policies and procedures where available such as people living in the home managing their own medications this had not been followed. We looked at what arrangements were in place to recognise an increase the quality of the service. The manager informed us that there were no audits (checks) within the home on areas such as medications, care plans, staff recruitment, staff training or accidents. All services need to check the practice in order that can recognise areas that need developments and recognise potential risks to people living in the home and take appropriate action. When we looked at the accident records we noted that there had been 52 accidents in the home since 18/10/09. Six people had had three or four is in that time period but no risk assessment to determine what actions could be taken to reduce the risk of falling had been put into place. Risk assessments available within peoples care files were even not available, out of date or inaccurate. We looked at how people managed individuals personal allowances. Records where available that showed what people had spent their funds on. These funds are not accessible by anyone other than the manager. This means that if someone living in the home wanted some of their own money they would have to wait for the manager to be on duty. This does not support their individual needs. Care Homes for Older People Page 27 of 34 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 34 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 All care plans need to be up 17/05/2010 to date, specific to the individual and accurately reflect how the staff are to meet peoples individual needs. All changes to the persons needs and condition need to update the care plan rapidly. Without clear records staff will be all able to meet peoplesneeds. 2 8 12 The service needs to identify 17/05/2010 the health and welfare needs of individuals living in the home and take action to make sure that they meet those needs. Where instructions are received by external professionals these must be actioned as per the directions of the professional. Care Homes for Older People Page 29 of 34 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 Not meeting peoples health and welfare needs places them at significant risk. 3 9 13 Records of receipt, administration and disposal of controlled drugs need to be completed accurate and signed for by two people. In order to make sure that people receive these strong medicines correctly 4 9 13 All records about medication 17/05/2010 must be clear and accurate. To show that medication is given properly and can be accounted for. you 5 9 13 People living in the home 17/05/2010 must be given medication as prescribed at all times and special directions must be fully followed. To make sure that peoples health is not at risk. all 6 9 13 A record must be made of any drugs that leave arrive in the home or are disposed of. In order that a clear audit trail is available of all medication that enters the home 17/05/2010 17/05/2010 Care Homes for Older People Page 30 of 34 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 7 12 12 People living in the service need to be supported to make decisions with respect to the care they are to receive and their health and welfare. The people living in the service need to have so far as practicable their wishes and feelings determined and take into account in all matters to deal with their health and welfare. In order to support the people living in Huyton Hey Manor make informed choices about their health and welfare needs. 30/07/2010 8 15 16 All people moving into the 26/04/2010 home need to have their nutritional needs determined and were risks our identifies a plan that needs to be available that informs staff on how to support them appropriately. In order to prevent people from not having their nutritional needs met. 9 18 22 Service needs to update its 27/05/2010 own policy and procedure on safeguarding people living in the home. This should include how to report concerns, training and staff Care Homes for Older People Page 31 of 34 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 need and how to record any concerns of this nature. This is done in order to help safeguard the people living in the home 10 27 18 Staff need to be have 17/05/2010 effective checks in place that determine their competency to undertake their job role. In order that the provide the correct support to people living in the service in a safe manner 11 29 19 All staff must be subject to full checks, two valid working references, a police check and past working history,. In order to make sure that staff working in the service are fit to do so. 12 33 13 The service needs to put into place effective arrangements to audit the management of medications. To make sure that people receive their medications safely. 17/05/2010 18/05/2010 Care Homes for Older People Page 32 of 34 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 1 Information given to people about the services that the home provides should be available in formats that meets the needs of people wishing to move into the home. The statement of purpose needs to be updated to include a criteria for admission, arrangements for emergency admissions and respite support. All assessments need to be dated as to when they were done and signed by the assessor. The assessment process would benefit from making sure that it fully explored peoples needs and included aspects of good practice such as mental capacity. Assessments need to be updated as needs peoples needs change. The service need to review the process by which it determines peoples personal preferences and choices. Information about peoples choices and preferences needs to be kept up-to-date and is used to influence the daily living routine of people living in the home. Check that all fire doors fit correctly and are not wedged open. Contact the Fire Authority for advice and guidance. Update the fire risk assessment which should be done yearly. Review the arrangements for the prevention of the spread of infection.Put into place a plan that assists staff including what training they need. All staff need to receive an induction that covers all areas of the service and includes training necessary to their role. Staff training that is essential to health and safety needs to be updated yearly. Staff need to have training that helps them meet the determined needs of people living in the home. Review the quality assurance arrangements through out the service in order to make sure that the quality of the service is recognised and actions put into place to maintain the quality of the service. 2 3 3 12 4 19 5 26 6 7 28 30 8 33 Care Homes for Older People Page 33 of 34 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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