Inspection on 26/03/09 for Ingleby Care Home

This inspection was carried out on 26th March 2009.

CSCI found this care home to be providing an Poor 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ingleby Care Home 22/09/09

Ingleby Care Home 25/03/08

Ingleby Care Home 18/05/07

Ingleby Care Home 17/05/06

Ingleby Care Home 19/09/05

Ingleby Care Home 16/05/05

Ingleby Care Home 22/09/04

Ingleby Care Home 15/06/04

Ingleby Care Home 27/02/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ingleby Care Home Lamb Lane Ingleby Barwick Stockton-on-Tees TS17 0UP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jacqueline Herring     Date: 3 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Ingleby Care Home Lamb Lane Ingleby Barwick Stockton-on-Tees TS17 0UP 01642750909 01642750966 noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: T L Care Ltd care home 56 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 who can be accommodated is: 56 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 56 Date of last inspection Brief description of the care home Ingleby Care Home is a 56 bedded purpose built care home, which provide personal care to older people. All 56 rooms are single rooms with ensuite facilities and there is the required number of bathing facilities and communal space. Ingleby is owned by TL Care who also operate a further four homes in the Teesside area. Ingleby Care Home is close to the centre of Ingleby Barwick, being in easy reach of the local church, supermarket and parade of shops. The fees for Ingleby Care Home still need to be Care Homes for Older People Page 4 of 34 Over 65 56 0 Brief description of the care home confirmed. 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 quality rating for this service is no stars. This means the people who use this service experience poor quality outcomes. This Key Inspection was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted by two inspectors in one inspection day. During the inspection, a number of records were looked at, including records of people who use the service, along with staff recruitment and training records. The medication systems was also looked at and discussed at length. Discussion also took place with the interim manager of the service, a manager who Care Homes for Older People Page 6 of 34 was tranfering from one of the other services and a number of staff. Discussion also took place with people living at Ingleby Care Home and with relatives. The Operations Manager has completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards. This was received prior to the inspection and some of information has been reflected within the report to support the judgements made. We have reviewed our practice when making requirement to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 34 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before moving to the home, which ensures their needs can be met. Evidence: The AQAA contained the following information about the admission procedure, Provide a pre-admission assessment prior to admission. This is compiled for our long term and short term residents. A thorough system is in place regarding admissions to the care home. The care files of three people currently living at the home were looked at, one of which was for a person recently admitted to the home. There was also a separate file that contained care managers assessment. The actual documentation is currently under review, previous information had been removed from the care files, as such, the pre admission assessment documentation Care Homes for Older People Page 11 of 34 Evidence: was not viewed, so it was not clear how detailed this information was. Some information looked at though did show that it in further needs of development. Care was also needed with the record keeping as one person had their weight recorded prior to them being admitted to the home. 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. People receiving the service are happy with the way in which care is delivered by staff. However records detailing how health and personal care is to be delivered and associated risks is insufficient. The way in which medication is managed is inadequate and could put people using the service at risk. Evidence: Requirements had been made at the last inspection about the need to continue to develop the care needs assessments, care plans and risk assessment. Little progress has been made. In the few days leading up to the inspection, managers from other TL Care homes had started to review to care plans, however very little had been achieved. The care records of three people living at the home were looked at in detail and a further three sampled for more specific information. One of the care records was for a person recently admitted to the home. The assessment of need contained sufficient detail and there were a range of care plans in place with sufficient information detailing how to meet their needs. This person however has two care plans in place for Care Homes for Older People Page 13 of 34 Evidence: management of pain. They did not contain sufficient detail, more was needed in the interventions and about monitoring the effectiveness of pain control. This became more evident when linked to the daily records, where this persons pain control medication had been reduced, however within days of this the these records contained details of the person being weepy and complaining of pain and there was no information to demonstrate how this was dealt with. Care is also needed with the daily records as there were days when there had been no entries, for example no entries since 18 March 2009 until 23 March 2009. One of the other care records looked at was for someone who had lived at the home for a number of years. Some of these records has been updated but did not have the corresponding care plans in place. As such, it was unclear what care and support they were receiving. From looking at the assessment of need and supporting care information, there should have been a number of care plans in place, which were not. This included, no care plan for pain management, no care plan for challenging behaviour and no care plan for continence management. The three care plans that were in place, two were not up to date and the third had not been fully cross referenced with the other information about this persons needs and healthcare needs. For example, this person is tablet controlled diabetic, they had been seen by the GP who had changed their medication but the care plan had not been updated to reflect this and it was not included within the evaluation of care. There were also other examples of this as discussed with the interim manager. This person has also lost some weight, however the mobility assessment stated, Has gained weight due to lack of mobility. This again shows that staff are not cross referencing information. A further set of care records were to look, one for someone where the new documentation that was being introduced. The content of this care record was better and contained more detail, however there were still areas where more information was needed. A further three records were looked at to see how up to date the information was, how it was being cross referenced and whether the appropriate information was in place. These records were also looked at for specific information, such as record of peoples weight. It was clear that staff were not cross referencing this information with the assessments and care plans and were not identifying any concerns or issues, for example weight loss or that there could be a problem with the actual scales. Care Homes for Older People Page 14 of 34 Evidence: There is also the need to ensure that appropriate risk assessment are completed. For example the file of a person who had had a number of falls was looked at, there was no up to date risk assessment or care plan. A number of other risk assessments needed to be looked at and further staff training was needed, particularly in respect of nutrition and skin integrity. Nutritional risk assessment were not being updated even where risk had been identified. The current tool used to assess people at risk of pressure damage was not being fully completed and staff were not noticing when only a proportion of it was being completed, which again raises concerns about the knowledge and understanding of staff who have completed them. The evaluations of care are also in need of further development as currently they are not value based evaluation and do not show if the care interventions are being effective or not. Currently they include comments such as Care as planned. In one of the care files looked at, this person had a care plan as they suffered from urine infections. They had recently been seen the GP and prescribed antibiotics, however the evaluation of a care did not contain this information. There is clear evidence of the involvement of GPs, District Nurses and other health care professional; such as chiropodists. People living at the home confirmed that if they were feeling unwell, the GP would be called. One person said, They get the GP straight away if you are poorly. When asked about their care and support that is provided, one person said, It has been fine, always there for me and they understand my needs. Another person said, I cant fault the care. Other people said, Nurses are nice, do anything for you, only have to ask. They always knock on the door, Their attitude and manner is good, and they show respect. The way in which medication is managed was looked at, including storage, ordering and administration. Serious concerns were identified about how the staff managed peoples pain control and their associated medication, this primarily related to the management and administration of Controlled Drugs of a pain control nature. People were not always receiving their medication at the prescribed times, on occasions having it too soon and at other times well beyond the date and time they should have. The medication administration records do not contain details of some of the Care Homes for Older People Page 15 of 34 Evidence: medication being administered. Handwritten entries on the medication administration records are not being witnessed and double signed. Audits have been taking place, however, from the above findings, it is again clear that further training in needed to ensure that audits of these systems are effective. The medication procedure is currently under review, however this has not been completed. As a result of identifying these issues, safeguarding referrals were made and a request from the local Primary Care Trust to conduct an audit, to then support the home to ensure they had robust procedures and a clear understanding of medication management. This outcome group causes serious concerns as feedback to the interim manager and Operations Manager. Despite being informed that staff have been trained in assessing peoples needs and care planning and safe handling of medicines, it is clear that they do not fully understand the systems and what is required of them, as such, people are potentially at risk. The AQAA detailed that audit take place in regard to care plans, risk assessment and medication. It is recommended that further training is carried out for these audits, as they have not identified areas of concern. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated with respect and there are opportunities for social and recreational activities. Meals are provided to a reasonably good standard, although the new menu will offer more choice. Evidence: The AQAA detailed thaat there was an entertainments and social committee from the local church who run the coffee mornings and bingo evenings every week. It also detailed that there are visits and outings to show and other venues and garden parties that families and the local community can join in with. During discussion with staff they said that a new activities person had recently commenced employment and that they were doing alot of craft activities with people living at the home. In the care files looked at there was limited information about peoples social and recreational interests. People spoken to said that they thought the activities were beginning to improve, although one person said, Not a lot going on, Im bored, I have too much time on my hands. Care Homes for Older People Page 17 of 34 Evidence: The AQAA states that people can continue with their religous beliefs and a monthly church service is held at the home as well as communion every week. People are able to have visitors when the want and also have contact via the telephone. Visitors were seen coming and going during the two inspection days. At the last inspection, there were a number of concerns about the meals and choice of meals. The current menu in use does not offer choice, but alternatives are available. A new menu has been developed although not introduced as yet, this has been checked by the hospital dietician, who has confirm it as a balanced menu. There have been some difficulties with catering due to staffing, the intermin manager is hopeful that this will soon be resolved. People are able to have their meals in one of the three dining rooms or in their rooms. People who live at the home were spoken to about the meals, they said, The food it alright, I am satisfied with it and a tea-time you can have what you want. Another person, who had particlars likes, dislikes and preferences thought that there nutritional needs could be better. Another person was aware of the staffing difficulties in the kitchen and thought that there was no-one taking charge of the tea meal and that anyone who was available would see to the teas, which is not satisfactory. Staff said that there wasnt any actual choice but that there were alternatives available. One member of staff said that the breakfasts and tea meal were repetative. They said that whilst a cooked breakfast was available, it was the same everyday, bacon, egg and toast, but no sausage or tomatoes and tea tends to be sandwiches. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place if people want to raise concerns or complaints. Adult protection procedures are in place, which helps to protect people that use the service from abuse. Evidence: The AQAA detailed information in regard to complaints, it was stated that the service, Address complaints immediately. It also detailed that the complaints procedure and contact details are on display in the home. It also details that all staff are updated with regard to No Secrets training. It detailed that there had been three complaints since the last inspection, one of which was upheld. The records kept within the home detailed that there had been five complaints since the last inspection, these were all fully detailed and recorded. People spoken to said that they would raise concerns if necessary. One person said, I have no complaints about the home or the staff, I never have but I would speak to key staff if I needed to. The staff training matrix shows that staff have been given Protection of Vulnerable Adults and No Secrets training. Staff spoken to during the inspection confirmed that they had received this training and were fully aware of the action to take should it be required. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, reasonably homely and maintained environment, which meets their needs. Evidence: The environment at Ingleby is reasonably homely and was clean on both of the inspection days. There was however a malodour problems along one of the corridors. Improvements had been made to the environment prior to the last inspection and since then, more new carpets have been laid in bedrooms. People living at the home are able to personalise their bedrooms and there was much evidence of this in the rooms visited. This included photographs, paintings, own TV, telephones as well some people having their own furniture. There are still however some areas that would benefit from further refurbishment. This continues to include the need to replace some of the bedroom furniture. Although the furniture is sturdy, some of it is now beyound reasonable repair. It is also difficult for people to access their belongings due to the layout of the rooms and where the fitted robes are located as well as the top box being too high for people to reach. The doors on some of this furniture do not remain shut and some of the attached tables are split. There is no accessible lockable facility for peoples belongings and the current Care Homes for Older People Page 20 of 34 Evidence: arrangement of using a hasp and padlock is no longer acceptable. One person said, I dont like the wardrobes I cant get in to choose my own clothes and there are no locked facilities. As discussed with the interim manager, some of the corridor lighting could be improved as one corrider in particular was dim. There was a shower out of use, this was in the process of being attended to. The corridor carpets were showing signs of wear and consideration should be given to replacing these The light fittings in the ensuites had no covers. It was also recommended that shelves or cabinets be fitted as people had nowhere to put their toiletries. The interim manager said that the dining rooms were in the process of being improved and that some new furniture had been ordered. There was a skip in the rear carpark, which was over flowing. The interim manager said that they were waiting for it to be collected and agreed to follow this up. A relative spoken to also raised concern about the parking facility. They also raised concerns in regard to the telephone system, as they said that the phone does not ring throughout the home and as such it often does not get answered. They said that they often gave up telephoning and called in instead. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are generally protected by the recruitment systems although care is needed to ensure that the information detailed on application forms is correct. Evidence: The files of four staff were looked at during this inspection, one of which was a fairly recent appointment. In the main, they contained all of the information needed to show that good recruitment practice takes place. This included completed application form, references and Criminal Bureau Checks, which are completed prior to commencement of employment. Care is however needed with fully checking the information on the application form against references received as we found conflicting information. The duty rota was looked at, it was not detailed enough and was not an accurate record of staff on duty. It was a laminated rota and the rota was on week two. The actual dates are not specified and the staff listed to not correspond to the staff on duty. A new sample rota was made available and it was confirmed by the interim manager that this new rota would be introduced. Staff spoken to said that there was sufficient staff on duty to meet the current needs of the people living at Ingleby. Another member of staff said, Staffing levels are OK, as far as I am aware, peoples needs are being met but it is not being staffed for Care Homes for Older People Page 22 of 34 Evidence: quality and for time to take people out. Another member of staff said, We can generally manage if we all pull together. There are times when the floor is not covered. People who live at Ingleby were also spoken to about sufficiency of staff and there were mixed views about this. One person said, whilst they thought the actual numbers were sufficient, they felt that there was no continuity, due a number of staff being on holiday and care staff being brought into the home from other homes within the organisation. Other people however did not think there was enough staff on duty. One person said, They are run off their feet, there is not enough staff. Another person said, Definately a shortage of staff, they appear to be chasing their tails to get things done, There is no time to spend with you. A further pseson said, They are pushed, rushing to get the job done, the cleaners and girls in the laundry are helping out due to staff shortages. Another person spoke of the skill mix and said, They provide care but they are not nurses, I sometimes feel that we could do with a proper nurse. People were however positive about the staff, they said, The staff are friendly and approachable, you can talk to them. Records were looked at for staff training. A matrix was made available and it showed that mandatory training such as fire and moving and handling takes place on a regular basis. A seperate training file is kept for each of the staff, this contained copies of their certificates for qualifications and courses. Staff confirmed that there was a rolling programme for this. Other training such as dementia care and knowledge of diabetes has also taken place but one member of staff said that it would be beneficial to have more of this training. The AQAA details that 17 of the 18 permanent care workers employed are qualified to NVQ Level 2 or above. Despite being identified at the previous inspection, the interim manager said that they are not currently using the Skills for Care induction. Care Homes for Older People Page 23 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. People who live at Ingleby do not benefit from a home that is well managed. There is the need to appoint a manager who will provide the leadership necessary and ensure that the home is run in the best interests of people living there and ensure that effective systems are in place. Evidence: There is currently no registered manager at Ingleby Care Home and has not been for some time. Presently the home has an interim manager and also some management cover from other homes within the organisation. A manager is in the process of being transferred from one of the other homes and we were informed that they would be appointed into the post. Across the two inspection days, from records looked at, through discussions and observation, it is clear that Ingleby Care Home is in need of a manager who will give the leadership and direction that is needed and ensure that effective management systems are in place. Care Homes for Older People Page 24 of 34 Evidence: One member of staff said of what could be improved, We need leadership from someone who is not frightened to confront, at the moment there are too many chiefs and everyone blames each other. One of the people living at the home was also very aware of the current situation. They said, It is lacking leadership, there are carers who are unhappy and they are all blaming each other. The way in which peoples personal allowances were looked at, these were generally being well managed and recorded. A sample of records were looked at along with their corresponding monies, there were double signatures in place and each of those looked at balanced. It was recommended that these systems could be strengthened further, as currently there are no receipts from the hairdresser or chiropodist. The interim manager was also asked to look at some substantial expenditure for one person, as all of the receipts were not available. There was audit taking place in respect of peoples personal allowances. Quality assurance was detailed in the AQAA, it stated, Quality assurance and monitoring for all care, food, activites, medication and the care home. Food and menu audits are taking place as well as Health and Safety audits being conducted from an external agency. There were surveys in place from people who live at the home, however there was no summary report detailing the outcome. Surveys had been completed by relatives and there was a summary in place for this. The policies and procedures continue to be in need of further review as identified at the last inspection. They continue to be generic and do not give the staff the guidance needed. The accident records were looked at and there was questions raised about the accuracy and robustness of recording of accidents, as there were so few. After discussion with the future manager, it was thought that only accidents where people had sustained injuries were being recorded. It was agreed that there would be a change to accident recording. A sample of service and maintenance records were looked at. There was a plan in place, showeing when the maintenance of equipment is next due. Generally the maintenance records were in order, however the weekly fire check needs more information as it does not detail which zone had been used for the check. There was also no evidence of recent fire drills. The folder containing all of the information in Care Homes for Older People Page 25 of 34 Evidence: regard to fire needs to be sorted as there was a lot of out of date information, which could lead to confusion by staff. Water temperatures had been checked weekly up until 4 March 2009, however they had not been done since. Care Homes for Older People Page 26 of 34 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 7 14, 15 The work that has 01/08/2008 commenced on improving the care needs assessments and care plans must continue and staff must receive further training. There must be evidence of residents or representatives involvement with individual assessments and plans of care. This should ensure that residents needs are assessed with appropriately plans in place and needs met. The health care assessment 01/06/2008 tools must be accurately and regularly completed and staff must have an understanding of the need to crossreference the information with assessment of needs and care plans. This should ensure that care needs are fully assessed and appropriate plans of care are in place. There medication policy and 01/05/2008 procedures must be reflective of the systems in place within the home, which are relevant to the service to ensure that staff have the correct information and guidance for the safe Page 27 of 34 2 8 14 3 9 13 Care Homes for Older People 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 handling of medication The risk assessment and supporting records for people who want to self-medicate must be reviewed and people must be provided with an appropriate locking facility. This will ensure that good systems are in place and people are protected. 4 24 16 Lockable facilities must be available with peoples room that are accessible for their use. 02/04/2008 5 38 13 The new policies and 30/09/2008 procedures must be amended so that they are reflective of the service and give the staff the information and must provide staff, residents and relatives with the information they need to ensure safety, wellbeing and protection. These must be easily accessible to staff. 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 Care plans must be 30/04/2009 developed that are reflective of the individual needs identified. The interventions must be specific and achievable.The evaluations of care should be relevant to the care plan and should give information about the effectiveness of the planned care. This will ensure that staff have up to date information about peoples needs and how their needs are to be met. 2 8 13 Risk assessments must be developed for more individual specific risks. This will ensure that all risks are considered and care plans developed where needed to manage these risks. 29/05/2009 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 It will also ensure that information is in place for the safety and wellbeing of people. 3 9 13 Medication must be given as 30/04/2009 prescribed and a record must be made at the time that it is given. Accurate records must be kept for all medicines including controlled drugs. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 4 24 16 Lockable facilities must be available within all of the bedrooms. This will ensure that people are able to lock their valuables away should they want to. 5 30 18 New care staff who are not qualified to NVQ Level 2 or above must complete the Skills for Care Induction. This will ensure that new staff have the underpinning knowledge to support them 30/04/2010 29/05/2009 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 in their care role and in meeting peoples needs. 6 31 8 A manager must be 01/06/2009 appointed and provide the leadership necessary for the effective management of the home. This will ensure that people benefit from a well run home, that has effective systems. This will ensure the health, safety and wellbeing of people who live at the home. 7 38 12 The policies and procedures 01/06/2009 must be reviewed and updated. They must be reflective of the service and must provide people with the information they need to ensure safety, wellbeing and protection. These must be easily accessible to staff. This will ensure that staff have the information needed to keep people safe. 8 38 24 Fire drills and checking of 11/05/2009 water temperatures must take place on a regular basis in line with the fire regulations and the weekly checks that are conducted must be fully detailed. 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 This will ensure the safety of people living and working in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 9 A daily statement of care should be written for all of the people who are living at Ingleby Care Home. Handwritten entries and changes to MAR charts should must be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The medicine policy should be updated in line with current guidance so that staff understand how to handle and administer medicines safely. The social and recreational activities should continue to be developed and should take account of peoples own interests. The new menu that has been produced should be introduced, which will give people living at the home more choice. Consideration should be given to replacing a number of corridor carpets. The lighting in one of the corridors should be improved. 3 9 4 12 5 15 6 19 7 24 The bedroom furniture should be replaced and this furniture should be accessible to people living at the home. Consideration should be given to fitting shelves or cabinets in the ensuites so that people could store their toiletries appropriately. 8 27 The staffing levels should remain under review to ensure that there are sufficient staff on duty to meet peoples needs. Page 32 of 34 Care Homes for Older People 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 The staffing rota should be dated and should be an accurate record of the staff on duty. 9 29 The manager should ensure that the information detailed on the application form is correct and corresponds to references. Work should continue in regard to developing quality assurance systems and staff who conduct audits and other quality assurance should be trained to do so. The way in which personal allowances is managed should be strengthened further to include all receipts. The record keeping for accidents should be reviewed and all accidents should be recorded. 10 33 11 12 35 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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