Inspection on 13/05/10 for Inglemere House Residential Home

This inspection was carried out on 13th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Inglemere House Residential Home 05/11/09

Inglemere House Residential Home 15/05/08

Inglemere House Residential Home 22/05/07

Inglemere House Residential Home 28/09/06

Inglemere House Residential Home 01/09/05

Inglemere House Residential Home 05/05/05

Inglemere House Residential Home 16/12/04

Inglemere House Residential Home 07/09/04

Inglemere House Residential Home 05/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Inglemere House Residential Home Waterloo Road Crowthorne Berkshire RG45 7NW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 1 3 0 5 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 37 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 37 Information about the care home Name of care home: Address: Inglemere House Residential Home Waterloo Road Crowthorne Berkshire RG45 7NW 01344772120 01344772120 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Yuen Yuen Jackson Name of registered manager (if applicable) Mrs Yuen Yuen Jackson Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 14 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Inglemere House is situated in Crowthorne and is registered to provide personal care and support to up to 14 older people. Accommodation is provided in single rooms, distributed over three floors. All rooms have vanity basins and one room has en-suite facilities. The home has four dayrooms and one dining room. These communal areas provide space for receiving visitors, Care Homes for Older People Page 4 of 37 Over 65 14 0 Brief description of the care home socialising and participating in activities. A ramp is situated at the front door of the building to accommodate wheelchair users. There is a lift, which enables access to all floors of the home. Car parking facilities are provided at the front of the home. Fees at the home are £450 per week. This information was provided on 13 May 2010. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 13 May 2010 starting at 9.30am. The provider/manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the provider/manager and any information that CQC/CSCI has received about the service since the last key inspection on 15 May 2008. On 05 November 2009 we carried out an unannounced visit to the home following concerns raised with us relating to care plans, the identification and management of risks plus staff training. Following the visit we requested an improvement plan from the provider/manager, which we received on the 16 December 2009, some quotes from the improvement plan are used in this report. A copy of the report from that visit is available on our website: www.cqc.org.uk. Care Homes for Older People Page 6 of 37 People who live at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit six of the ten residents were involved in the inspection and information was gained from two on duty staff. Prior to the inspection, survey forms were sent to all residents and all members of staff employed at the home. Survey forms were returned by nine residents and five members of staff. The residents were all assisted to complete their survey forms by the provider/manager and other members of staff at the home. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Residents care plans, staff recruitment and training records, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? Following our random inspection of the home in November 2009, the provider/manager engaged the services of a number of external consultants who assisted and advised the provider/manager on how to meet the requirements made at that inspection. Those requirements have now been met: With the support and input from a care consultant a new care planning system has been introduced and all residents have had their needs re-assessed; care plans have been rewritten and comprehensive individual risk assessments have been carried out. Where risks were highlighted we saw that risk reduction care plans had been put in place. Where residents cannot manage their medicine, the home now supports them with it in a safe way. With the support and advice of the local pharmacist; the support of an independent care consultant and the services of an external training company, the procedures and practices for the handling of medicines at the home have been amended and staff have received updated training. Residents are now cared for by staff who have received the relevant training. With the support of an external training company a staff training plan has been produced and staff have been provided with the mandatory health and safety training updates. With the input of the local fire safety officer, the local environmental health officer, an independent health and safety consultant and an independent care consultant, full risk assessments of the homes environment and practices within the home were carried out. Where risks were highlighted we saw that the provider/manager had carried out the actions required by the local agencies and those recommended by the consultants. Care Homes for Older People Page 8 of 37 Following carrying out the initial work needed to meet the requirements from our November inspection, the provider/manager has told us that she will continue with the services of the external consultants for health and safety and staff training, and that the independent care consultant will: be supporting me in my management role to ensure compliance with current regulations and to develop objectives/agreed outcomes for the future of lnglemere and its residents. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 9 of 37 order line 0870 240 7535. Care Homes for Older People Page 10 of 37 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 11 of 37 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. Policies and procedures are now in place that, if followed in practice, will ensure that new residents will only be admitted to the home following a comprehensive needs assessment to make sure that the home can meet the residents identified needs. This home does not offer intermediate care. Evidence: At our random inspection in November 2009 we reported that: One person had recently moved to the home and their pre admission assessment was seen. This document was one double sided sheet and contained medical details and a series of tick boxes. Where needs had been identified there was no evidence that further details had been sought. A requirement was made. Following that visit the provider/manager obtained a new care planning system that includes comprehensive pre-admission assessment forms. Care Homes for Older People Page 12 of 37 Evidence: In their improvement plan the provider/manager stated: All residents to be assessed prior to admission or in an emergency admission scenario to be fully assessed within 24hrs of admission. Prior to admission either the proprietor or the care manager will visit the prospective resident to complete a pre admission assessment plan. All current residents have been re-assessed and their care plans are up to date. Three care plans were sampled during this visit and, although there have been no new admissions since our visit in November, it was seen that the provider/manager had re-assessed all current residents using the new care planning documentation. In discussion with the provider/manager we were advised that, at present, the provider/manager will carry out any new pre-admission assessments but that she would expect the new manager to take over once in post. The provider/manager also explained that during the pre-admission assessment visit she would carry out risk assessments and refer to hospital notes and information from other involved professionals. In the AQAA, to demonstrate improvements made, the provider/manager stated that: We have taken on more staff, plus an advisor who will ensure we keep up to date with current practice. Residents who returned survey forms all felt they had received enough information prior to moving to the home. Care Homes for Older People Page 13 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met. The home has a plan of care that the resident, or someone close to them, has been involved in making but the home must make sure that the care plans are kept up to date with any newly identified problems. If residents cannot manage their medicine, the home now supports them with it, in a safe way. Residents right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Evidence: At our random inspection in November 2009 we reported that: We sampled the care plans for three residents. All of the care plans we looked at had entries for each section, although the information was basic in detail and did not provide a person centred approach to care planning, for example residents likes, dislikes and preferences were not recorded. We also found concerns that, although individual risk assessments had been carried out for residents, there was no detailed record of the risks that had been identified. All three of the care plans sampled identified increased risks for all three residents in a number or areas, however there were no risk Care Homes for Older People Page 14 of 37 Evidence: reduction plans in place and no guidance for staff to follow to ensure that identified risks were minimised or eliminated and requirements were made. Following that visit the provider/manager obtained a new care planning system. This is a comprehensive system going from pre-admission assessment through to writing and reviewing the care plans. The system includes risk assessments and provides templates for all associated documentation. In their improvement plan the provider/manager stated: Care plans for the current residents have now been reviewed and updated according to requirements. All staff have been instructed in this new approach and understand the principles involved. During the last month all residents risk assessments have been reviewed and their care plans have been updated to provide additional care and support where required. All residents or their representatives have been consulted and their agreement has been sought. All care plans will be person centred and outcome led. All care plans will be reviewed and updated monthly or more often should residents needs change. Additional communication and nutritional, food handling and infection control training booked to take place ASAP. The three care plans sampled during this inspection had all been rewritten and transferred into the new care planning documentation. The care plans had been based on the new needs assessment and were seen to be extremely person centred including details of how the resident liked to be supported and how they wanted things done. The care plans included in depth risk assessments and it was seen that risk reduction care plans had been opened where risks had been identified. All care plans had been signed by the resident or their representative and it was seen that the care plans had been reviewed on a monthly basis. We were advised that, during the monthly care plan review, the staff sit with the resident and discuss their plan. Residents comments had been added at the end of each monthly review note in the care plans sampled. These actions meet the requirement relating to the assessment of risks. Daily notes made by staff evidenced that action is taken should new problems arise, although the problems are not added to the care plan if considered temporary. For example, in one file it was noted in the daily notes that the resident had developed a problem with one leg. The notes gave details of the GP being called, prescribing a course of antibiotics and leaving instructions for the leg to be elevated. This problem, and the GPs instructions, had not been transferred into the care plan and there was no further mention of the problem or any evidence that staff had followed the GPs instructions. There were no notes kept that evidenced that the problem was being Care Homes for Older People Page 15 of 37 Evidence: monitored although the provider/manager advised us that the problem had been resolved. It is important that care plans are kept up to date; that newly identified problems are promptly added to the care plans and that notes are kept to evidence that specific instructions are being followed. Most of the previous requirement relating to care plans has been met with the exception of keeping care plans up to date in the one example given above. A new requirement and recommendation has been made that relates only to those areas of care planning. In discussion with the provider/manager we were advised that she currently oversees the writing and review of the care plans but that she would expect the new manager to take over once in post. In the AQAA, to demonstrate improvements made, the provider/manager stated that they have: Introduced a new care planning system that is outcome focussed. We have taken on board criticism and put in place an improvement plan to eliminate our shortcomings. We have appointed a consultant to take us into the new year providing a higher level of care. At our random inspection in November 2009 we found concerns relating to the administration and handling of medicines and a requirement was made that has now been met. We were advised by the provider/manager that, following the inspection, she had consulted with the local pharmacist (from the chemist that supplies medicines to the home) and arranged for a medication audit to be carried out. In their improvement plan, the provider/manager stated: Pharmacy audit process agreed. Medication policy and procedure to be reviewed. Prescriptions to be brought up to date. Ordering and delivery systems to be tightened up. All above to then be reflected in care plans. In discussion with the provider/manager we were advised that the planned audit had taken place and the recommendations of the pharmacist had been actioned. We were also advised by the provider/manager that the medication policy and procedure had been updated and that the provider and her deputy had updated the ordering and audit system. The provider/manager plans to carry out a monthly review of medications and has now arranged for the pharmacist to carry out six monthly audits. During this inspection we sampled the medication administration records (MAR) and looked at some of the medication stored. All records were up to date and tallied with Care Homes for Older People Page 16 of 37 Evidence: the medications stored in the home. The method of storage was found to be secure with the person in charge of the shift holding the key. The provider/manager has purchased a lockable storage box for any medication requiring refrigerated storage, as recommended by the pharmacist. Care plans for individually prescribed as needed medication had been drawn up and are kept with the MAR sheets for easy access. At present no residents are prescribed controlled drugs, the provider/manager is aware that their current storage provision does not meet the law and is currently looking into purchasing a controlled drug cabinet that does. The home does not currently keep over the counter medication at the home. When asked, the provider/manager stated that she would call the GP if (for example) a resident had a headache if they were not prescribed as needed medication for pain. The provider/manager was not aware that it is allowed for care homes to keep some medicines for such circumstances and a recommendation has been made that the provider/manager obtain a copy of the guidance document published by The Royal Pharmaceutical Society of Great Britain (RPSGB): Handling of Medicines in Social Care, this guidance covers all areas of the administration and handling of medicines in a care home setting. Following this inspection the provider/manager contacted us via email with an update on action taken. In the email we were advised: I have contacted our pharmacist, have agreed a way forward and my understanding of medicines that can be held for minor treatments i.e. paracetamol antacids etc. and a new policy has been drawn up to cover this. It is positive to note that such prompt action was taken by the provider/manager but it remains recommended that the provider/manager obtains a copy of the RPSGB publication and makes sure that the advice she has been given is in line with the guidance given by the RPSGB. On the day of this visit staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. All residents spoken with felt that their privacy and dignity was always respected by the staff. Care Homes for Older People Page 17 of 37 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. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and gender. The home supports residents to follow personal interests and activities. At present contact with the local community is limited to people coming into the home and residents would benefit by having more opportunities to go out into the local community. Residents are able to keep in touch with family, friends and representatives. Meals are well balanced and varied with individual choices and preferences catered for. Evidence: This outcome group was not assessed at our random inspection in November 2009. The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with and all residents who returned survey forms confirmed that the home arranges activities that they can take part in if they want. In the residents files sampled, the staff had taken time to find out residents past interests and hobbies, and activities participated in at the home have been noted. In their AQAA the provider/manager told us that plans for improvement in the next Care Homes for Older People Page 18 of 37 Evidence: twelve months include having new activities suited to residents with cognitive impairment. Residents are able to choose which activities they attend or participate in and their individual rooms were all seen to contain many personal possessions which were arranged to suit their individual wishes. At present community involvement and contact is limited to people coming into the home (e.g. local clergy and students from a local college who come in once a week for an hour in term time). We were advised that the home do not have the staff or resources for community trips, although once a year all the staff come in and the residents have a day out to watch the Crowthorne Carnival parade and procession of floats. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining room was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. In the AQAA, to demonstrate what the home does well, the provider/manager stated that: The home offers three meals together with snacks and drinks each day. Special diets are catered for. Residents are able to make decisions on what they would like to see on the menu and activity programmes. Of the nine residents who returned survey forms, all said that they always liked the meals at the home. One resident commented on how much she had enjoyed the roast lamb at lunch time and another added the food is lovely, all the staff are very good cooks. Care Homes for Older People Page 19 of 37 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. If residents have concerns with their care, they or people close to them know how to complain. Safeguarding adults policies and procedures are in place, and staff have received training, but the policies, procedures and training have not been followed in practice and appropriate action has not been taken to follow up on an allegation. Evidence: This outcome group was not assessed at our random inspection in November 2009. The home has a complaints procedure in place that is available to all residents and their relatives and is provided to new residents when they move into the home. All residents who returned survey forms said that they always knew who to talk to if they were not happy and that they knew how to make a complaint, all staff who returned survey forms stated that they knew what to do if anyone raised concerns about the home. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Staff have recently attended training in safeguarding of vulnerable adults and the training records showed that the provider/manager attended a safeguarding for managers training day run by Bracknell Forest Borough Council in May last year. Care Homes for Older People Page 20 of 37 Evidence: However, during this visit we sampled records of complaints and saw a record of a safeguarding allegation made to the provider/manager. The provider/manager had not referred this allegation to the local safeguarding team for them to investigate, as required of the Berkshire procedure. The provider/manager had started her own investigation but had dropped it two days after the allegation was made, at the request of the resident and no further action was taken. The nature of the allegation, if proven, would mean that all residents were at risk, the incident was poorly managed and a satisfactory resolution was not reached. The local authority is responsible for coordinating a multi-agency response to alerts and, in line with CQC procedures, we passed the concern onto the local authority on the morning after our inspection. The local authority will now take the lead on ensuring the allegation is investigated and followed up. In the AQAA, to demonstrate what the home does well, the provider/manager stated that: All staff are trained in protection of vulnerable adults and safeguarding and work to these regulations. We thoroughly and quickly follow up any incidents. This statement is not supported by the evidence seen on the day of this inspection. Care Homes for Older People Page 21 of 37 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. Residents live in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. Their room feels like their own, it is comfortable and they feel safe when they use it. Overall there was a good standard of housekeeping apparent throughout the home but steps need to be taken to eradicate the strong smell in one room. Evidence: Some areas of the environment of the home were assessed at our random inspection in November 2009 and a number of requirements were made. As these areas related to health and safety, they are discussed under the Management and Administration section of this report. Accommodation is provided in single rooms, distributed over three floors. All rooms have vanity basins and one room has en-suite facilities. The home has four dayrooms and one dining room. These communal areas provide space for receiving visitors, socialising and participating in activities. On the day of this visit we were shown around all areas of the home and grounds. The communal areas were well furnished and provide a homely atmosphere and accommodation for the residents. Personal bedrooms were all seen to be personalised to the individual residents wishes and contained many personal items and mementos. Care Homes for Older People Page 22 of 37 Evidence: In the AQAA, to demonstrate what the home does well and improvements made in the last twelve months, the provider/manager stated: We have a variety of communal spaces, including a quiet area, lounge for activities and a separate dining room. Individual rooms can be decorated and furnished to the residents individual taste. The public areas have been redecorated recently. We have installed a disabled access shower. New carpet for ground floor corridor. Overall there was a good standard of housekeeping apparent throughout the home but in one bedroom there was a strong odour. The provider/manager told us that the carpet in this room is cleaned every week. However, on the day of this visit the smell was very strong and also noticeable in the corridor outside the room, even with the door closed. A requirement has been made. Laundry facilities are sited in a separate building in the garden, with a washing machine suitable for the needs of the residents at the home. Residents spoken with expressed their satisfaction with the accommodation provided at the home. One resident said how much she liked her room and another showed us, and spoke about, the stories behind the photographs around the room. Care Homes for Older People Page 23 of 37 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. The numbers and skill mix of the staff now meets residents needs. Residents are now cared for by staff who have received the relevant training. Current staff recruitment practices are placing residents at potential risk of harm and/or abuse as the required checks have not been done to make sure that they are suitable to work at the home. Evidence: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the residents at the home. The morning (8am - 2pm) shift is covered by two carers, two carers cover the afternoon/evening shift (2pm - 9pm) and the night staff consists of one waking carer and one sleeping on the premises and available if needed. The provider/manager told us that extra staff are brought in to work if needed. Of the nine residents who returned survey forms, all stated that staff are always available when needed with one person adding a comment: I am being looked after well by all carers and my needs are met. Of the seven carers, three hold a National Vocational Qualification (NVQ) level 2 or above in care, with another carer awaiting final assessment of her course and the issuing of a certificate. Care Homes for Older People Page 24 of 37 Evidence: During this visit the recruitment files of two carers were sampled. These were the files of all staff recruited, since our last key inspection in May 2008, who are still employed at the home. Both files had application forms, completed work histories, copies of the persons passports, two references and enhanced Criminal Record Bureau (CRB) certificates, with evidence that the Protection of Vulnerable Adult and Independent Safeguarding Authority lists had been checked. However, the provider/manager had not authenticated the references that had been obtained and told us that, as none of the referees were in the UK, she had asked the prospective staff members to arrange for the references to be sent to her. All references where addressed to To Whom it May Concern. The two references for one person were both typed on plain paper and we were advised that they had been delivered to the home by the prospective staff member. For the other person, the provider/manager had accepted two emailed references from people with popular email provider addresses, rather than professional email addresses that could be checked. For the second applicant, neither of the references had come from the persons last employer where the applicant had been working with children and vulnerable adults. It was also noted that, although the homes application form states that one referee must be your last employer if you have worked in the last five years, the applicant had not given the name of that employer as a referee and there was no evidence that the provider/manager had questioned this or sought to obtain a reference from that employer. In neither file was there written verification of the reason the applicant had ceased to work in previous positions which involved contact with children or vulnerable adults. The provider/manager was not aware of the requirements of The Care Homes Regulations 2001 or the associated schedule 2, relating to staff recruitment, and was not aware of the pre-employment checks that have to be carried out before allowing a person to work at the home. We reviewed the requirements of the recruitment regulation and the associated schedule 2 with the provider/manager before we left the home. At our inspection in November 2009 we had also discussed the importance of working to the Care Homes Regulations 2001 and advised the provider/manager on how to obtain an up to date copy from the CQC website. One of the new employees had been recruited since that inspection. In the AQAA the provider/manager stated that all people who had started work in the home in the last 12 months had satisfactory pre-employment checks. This statement was not supported by the findings on the day of this inspection. Care Homes for Older People Page 25 of 37 Evidence: Following this inspection the provider/manager contacted us via email with an update on action taken. In the email we were advised: All references have been reviewed and where it is unclear as you pointed out that they are from an official source those referees have now been written to and I anticipate formal replies in the next week or so. It is positive to note that the provider/manager took prompt action once we had identified the omissions, but it is concerning that the provider/manager was unaware of the legal requirements until we highlighted the concern. In line with our enforcement policy a management review meeting will be held and decisions will be made about the action CQC will take. This action may include enforcement action. At our random inspection in November 2009, a number of concerns were identified relating to staff induction and staff training and we found that there was no structured staff training and development programme in place and there was no method of monitoring, recording, or documenting training provided to staff apart from keeping certificates together in a folder. There was also no system in place for the provider/manager to identify and book mandatory safe working practice training and updates and the provider/manager was not aware of who, in her staff team, had received which training, or if anyone was due for updates. During that random inspection we also found that only one person working at the home had an up to date first aid certificate. Requirements were made relating to staff training. Following that visit, the provider/manager advised us that she had appointed a training company on the 6th December. In their improvement plan the provider/manager stated: A revised induction package is in the process of being introduced. Annual updates booked for all staff. During this inspection the training records were sampled. These records showed that the majority of staff, with the exception of the staff member still on induction, had been provided with the required health and safety training, including first aid, meeting the requirements made in November. There were no records to show that staff had been assessed as competent following their training, however, we were advised in the homes improvement plan that: the assessment of training/competency is to be implemented by the homes new independent assessor and where required by an NVQ/CQF assessor in the future. In discussion with the provider/manager we were advised that they will continue to Care Homes for Older People Page 26 of 37 Evidence: use the same training company and that the independent training assessor will monitor the training in future. In the AQAA, to demonstrate improvements made, the provider/manager stated that they have: appointed a new training provider. and to demonstrate plans for improvements in the next twelve months the provider/manager stated: To develop the quality audit and our expertise in dementia care training planned to enable us to provide a better service to those residents who require our support. Of the nine residents who returned survey forms, all said that the staff always listened and acted on what they said. Additional comments made included: Excellent care and attention and my needs are met and more. Residents we spoke with on the day of our inspection were complimentary about the provider/manager and all staff. They told us they were happy living at the home and one resident, commenting on the provider/manager told us: She is a wonderful lady, we are very lucky to have her, she is exceptionally kind. Of the five staff members who returned survey forms, all said that they receive training which is relevant to their role; helps them understand and meet the individual needs of residents and keeps them up to date with new ways of working. One member of staff spoken with told us that they were happy with the training they have recently received and that there had been many training sessions since our last visit in November. Care Homes for Older People Page 27 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With the assistance of external consultants the day to day management and administration has improved, but the provider/manager continues to rely on concerns being identified by people external to the home before taking action. Residents feel they are listened to and that their opinions are sought and acted upon. Residents, or someone close to them control their own money and choose how they spend it. The environment is safe for residents and staff because appropriate health and safety practices are now carried out. Evidence: At our random inspection in November 2009 we found that the health, safety and welfare of residents was not being protected; that the home was not being effectively managed and a number of requirements were made relating to those concerns. Shortly after that inspection we held a meeting with the provider/manager to discuss our concerns relating to the management of the home and the safety of the people at the home. At that meeting the provider/manager voluntarily agreed that she would Care Homes for Older People Page 28 of 37 Evidence: admit no new residents until a competent manager was recruited and had taken over the day to day operation of the home. At our random inspection in November we found that the provider/manager was not aware of her full responsibilities under legislation that directly relates to the safety of people living, visiting and working at the home, especially fire safety and health and safety. Such were our concerns that we contacted the local fire safety inspecting officer on the day of the inspection and we asked the provider/manager to contact the local environmental health officer as soon as possible, to seek advice on specific concerns we identified. Both agencies have subsequently carried out their own inspections and identified a number of concerns in their reports. Reports from follow up compliance visits from those agencies showed that the provider/manager had taken the action recommended by them and had addressed the immediate concerns. Health and safety monitoring check sheets were sampled during this inspection and found to be up to date. All staff have now received required safe working practice training and updates. Staff were observed to be following appropriate health and safety practices as they went about their work. In their improvement plan the provider/manager told us that an independent fire inspection had been carried out, that she had agreed a pharmacy audit process with the local pharmacist and that she had appointed a health and safety consultancy company, a training company and an independent care consultant. In a further letter at the end of December from the provider/manager, updating us on work done to meet the requirements we had made, the provider/manager told us that the health and safety consultants will: also visit Inglemere House on a two monthly basis to ensure the house is compliant with health and safety regulations and legislation. In this letter we were also told that: A new training company has been appointed to carry out all future training to ensure we are all kept up to date. In discussion with the manager on the day of this inspection, the provider/manager explained that the independent assessor from the training company will oversee the development and implementation of the staff training plan and that the local pharmacist will monitor the homes practices in relation to medication on a six monthly basis. During this discussion we also clarified areas of the AQAA dataset, provided by the provider/manager, that were inconsistent with other evidence, for example, the dates of the last review of specific policies (given as May 2009 for all policies). The provider/manager told us that most policies had been reviewed since Care Homes for Older People Page 29 of 37 Evidence: our inspection in November; that some new policies had been introduced and that the dates given in the AQAA were incorrect. The inconsistency relating to staff recruitment checks has been discussed in the previous section of this report. Also at our random inspection in November 2009, we found that the provider/manager was not aware of her full responsibilities under the Care Homes Regulations 2001. At that inspection we asked the provider/manager if she had a copy of the regulations. The manager advised us that she thought she had an old copy but wasnt sure where it was located and that she did not refer to the regulations when managing the home. The manager was advised at that time that copies of up to date regulations could be downloaded from the CQC website. At that inspection we made requirements relating to records that have to be kept and the notification of certain incidents to us. In their improvement plan the provider/manager told us that the independent care consultant had reviewed all the records that have to be kept in the home, as listed in the regulations, and that they were all now in place. We have also, since our inspection, been receiving notifications from the provider/manager of reportable incidents at the home. In the improvement plan the provider/manager told us that she has arranged that the continued compliance on record keeping, notifications and work towards carrying out the homes improvement plan will all be monitored by the independent care consultant by him visiting the home every month and carrying out a review. We were advised by the provider/manager in December that the independent care consultant will: be supporting me in my management role to ensure compliance with current regulations and to develop objectives/agreed outcomes for the future of lnglemere and its residents. As evidenced in this report, the provider/manager has taken steps, by employing external consultants and advisors, to address the concerns we identified at our inspection in November plus deficiencies and concerns identified by the local fire safety and environmental health officers relating to fire safety and health and safety following our inspection. However, despite the ongoing support and involvement of the external consultants, new areas of non compliance with the Care Homes Regulations, relating to the protection and safeguarding of residents, have been identified by us at this inspection. The provider/manager remains unaware of her full responsibilities under the Care Homes Regulations 2001 and continues to rely on concerns being identified by people external to the home before taking action. Shortly after our inspection the provider/manager contacted us by email to update us on actions taken to address the concerns we identified. This email has been quoted in previous sections of this report. Care Homes for Older People Page 30 of 37 Evidence: Following this inspection, and in line with our procedures, we held an internal CQC management review meeting. During that meeting we discussed our ongoing concerns with the management of the home in relation to the rating of this outcome group, i.e. the management and administration of the home. Whilst the evidence of this and the last inspection demonstrates that the provider/managers knowledge and competence as a manager is poor, it was agreed that her actions in accepting this and employing external consultants was a positive action to take in her role as the registered provider. We also took into account the provider/managers assurance that she will continue to employ the external consultants to oversee and monitor the homes compliance until she has a competent manager in post. For those reasons, and in line with our methodology, the management and administration of the home at this time has been assessed as adequate. However, it must be noted that new concerns have been identified at this inspection that would not have occurred if the home had a manager in place who was fully aware of his/her responsibilities under legislation and who had developed and implemented an effective and ongoing quality assurance system. Following our inspection in November the provider/manager decided she would advertise for a manager for the home. In discussion with the provider/manager during this inspection the manager updated us on the current situation. In December a new manager was interviewed and offered the position. That person was due to start work at the beginning of April but contacted the provider/manager at the end of March to say that, due to personal reasons, would have to delay. The provider/manager does not have a start date for the new manager as of the day of this inspection. In the AQAA, to demonstrate how they make sure that the views of the residents are promoted and incorporated into what they do, the provider/manager stated: We hold resident and relatives/representatives meetings. Regular surveys, residents forums and relatives comments. In the AQAA, to demonstrate changes made as a result of listening to the residents, the provider/manager stated: A regular review of our activity programme, individual support for specific requests and the involvement of residents in day to day activity. Plans for improvement over the next twelve months as a result of listening to residents include: Extending our key worker programme. To continue engaging outside entertainers at residents choice. Policies and procedures are in place to protect residents financial interests. The provider/manager stated that the home does not handle the financial affairs for Care Homes for Older People Page 31 of 37 Evidence: residents. All interactions observed between the staff and residents were inclusive, caring and respectful. A total of five care staff survey forms were returned to us. From observations made on the day of this inspection and from comments made on the staff survey forms it is clear that the home have a close and happy staff team. Staff comments on the survey forms returned included: I enjoy working at Inglemere House, Im happy working here at Inglemere House and Im happy with my colleagues as well and Inglemere House has staff that work closely together to make sure residents are cared for according to their individual needs, all the staff know how each resident likes or prefers to do each daily task. Care Homes for Older People Page 32 of 37 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 33 of 37 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 The registered person must 13/06/2010 ensure that care plans are kept up to date and that any newly identified problems are promptly added to the care plan. So that residents can be confident that any staff supporting them have access to up to date information and so that residents can be confident that any new problems they have will be closely monitored. 2 18 13 The registered person must make arrangements, by training staff or by other methods, to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse and make sure that training provided, and policies and procedures in 13/06/2010 Care Homes for Older People Page 34 of 37 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 place, are followed in practice. So that residents can be confident that the home safeguards them from abuse and takes appropriate action on any allegations. 3 26 16 The registered person must keep the home free from offensive odours, this requirement relates specifically, but not exclusively, to the bedroom identified to the provider/manager on the day of this inspection. So that all residents can be confident that they live in a home that is kept clean, pleasant, hygienic and free from offensive odours. 4 29 19 The registered person must ensure that no person is employed to work at the home without first making sure that all the required checks and documents have been obtained, as required of the Care Homes Regulations 2001, the associated Schedule 2 and related amendments to the regulations. So that residents and their 21/06/2010 13/07/2010 Care Homes for Older People Page 35 of 37 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 relatives or representatives can be confident that all required checks have been done on the staff to make sure that they are suitable to work with them. 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 7 It is recommended that staff relate their daily notes more closely to the residents identified needs and care plans, to evidence that they are working towards meeting the persons agreed goals and monitoring the status of all identified concerns. It is recommended that the provider/manager obtain a copy of The Royal Pharmaceutical Society of Great Britains guidance document: Handling of Medicines in Social Care and ensures that practices at the home, in relation to all areas of the handling of medicines, are in line with this guidance. 2 9 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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