Inspection on 05/11/09 for Inglemere House Residential Home

This inspection was carried out on 5th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Inglemere House Residential Home 13/05/10

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

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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 16/02/2010.

Random inspection report Care homes for older people Name: Address: The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Denise Debieux Date: 0 5 1 1 2 0 0 9 two star good service Information about the care home Name of care home: Address: Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Conditions of registration: Date of last inspection Brief description of the care home Over 65 care home Care Homes for Older People Page 2 of 17 What we found: The purpose of this random inspection visit was to follow up on concerns identified to us which specifically related to care plans, the identification and management of risks to the service users and staff, plus staff training provided at the home. The registered provider for this home is also the registered manager and was present throughout the inspection. During this unannounced inspection, service users care plans and associated risk assessments, health and safety risk assessments, staff training records, accident and incident forms and medication practices and records were all sampled. We were shown round all areas of the home and information was also obtained from additional records provided by the manager and from discussions with the manager, service users and members of staff on duty on the day of our visit. NEEDS ASSESSMENTS AND CARE PLANNING: We sampled the care plans for three service users. 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. This could mean that people are being offered accommodation at the home without the home being sure that they can fully meet the persons needs. The manager has very recently introduced a new system of care planning. This is a commercial system purchased by the home and contains a comprehensive range of documentation that has to be completed in full by the staff. The system includes a needs assessment, care plan and risk assessments. The documents cover all aspects of daily living and include a section for life history, personality/personal circumstances, wishes regarding death, financial issues, social activities, interests and hobbies, religious activities, current medication and physical health. 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 service users likes, dislikes and preferences were not recorded. The care plans should be further developed to ensure clarity as to all aspects of the service users care needs and to ensure that service users preferences are documented and a requirement has been made. INDIVIDUAL RISK ASSESSMENTS Areas of risk covered in the new care planning system included risks associated with: Mental health e.g. memory impairment, wandering, depression; Physical health e.g. mobility, diet, continence; Personal e.g. getting up, bathing/showering, communication, use of equipment, going out; Behaviour; Pressure sores; Nutrition; Falls. Some work had been undertaken to identify some of the risks to service users but 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 service users in a number or areas, however there were no risk reduction plans in place and no guidance for staff to follow to ensure that identified risks were minimised or eliminated. In one file it was seen that the person had fallen twice in the past four months and had sustained a minor injury on one occasion. The falls risk assessment had not been updated and a recent review assessed that the person remained a low risk of falling. In another care Care Homes for Older People Page 3 of 17 plan it was seen that the persons risk of developing pressure sores had increased but there was no care plan introduced to monitor or reduce the risk identified. The lack of robust risk management practices at the home is placing service users at risk of harm and/or injury and a requirement has been made. Each part of the care plan had been signed by the member of staff who had filled it in, however there was no evidence to show that the service users had been consulted on their plans. The manager told us that in the past she had asked service users to sign their plan but they had not been asked to sign the new plans. All of the plans looked at had been reviewed on a monthly basis with any changes recorded and signed by the staff member undertaking the review, the manager had then countersigned the plans and reviews. MEDICATION: The safe handling of medicines was assessed by a CQC specialist pharmacist inspector. We looked at the medication records and medicine supplies for eight people, the care plans for one person, watched some medicines being given to people by a carer and talked to the care staff and the manager. Medicines were not kept securely for the protection of people who live in the home as the key to the medicines cabinet was not kept securely. Items requiring cool storage were kept in a food fridge and were not in a locked container. The home does not have a cabinet that meets the standard of the Misuse of Drugs (Safe Custody) Regulations 1973. Whilst no one living in the service is currently prescribed any Controlled Drugs they may be prescribed at any time in the future and so it is recommended that the provider obtains a cabinet that meets the legal standard for the storage of Controlled Drugs. Clear records were kept of all medicines received into the home. When medicines are given to people a record is kept on a medication administration record chart by the carer giving the medicine. The records were not able to show us that people always get their medicines as prescribed. For example: One medicine, that is prescribed to be given every day, had not been recorded as given for the last eleven days. When we looked at the medicine supplies we found that the medicine had gone from stock for these days, indicating that it may have been given. Two people prescribed medicines to be given four times daily were only being given these medicines three times each day. There was no record to show that the medicines were offered more regularly. When we asked the manager why this was she said that it was peoples choice to have their medicines like this. She acknowledged that this was not recorded anywhere in their care plans. Three people were prescribed medicines to be given only when needed. None of these people had a care plan describing to staff when these medicines should be given. All of these medicines were being given to people regularly every day and not only when needed. This could mean that people are being given medicines that they dont need. One person had not been given one of their prescribed medicines for three days whilst the service obtained a new supply of their medicine. This could have adversely affected this persons health and welfare. We watched one carer giving people some of their medicine. They followed appropriate safe practices and treated people respectfully. Staff have received training in the safe handling of medicines. However the most recent training had been delivered over two years ago and one carers certificate dated from 2005. STAFF TRAINING: The staff team at the home consists of the manager plus eight care Care Homes for Older People Page 4 of 17 staff. The induction training file for a member of staff, recruited earlier this year, was sampled. It was seen that the induction booklet covered all topics required of the mandatory Skills for Care induction standards. The member of staff had completed question and answer sheets for all sections of the booklet. On the front of the booklet there was a date of May 09, which the manager said was the date the person had completed their induction. There were no other notes or documentation in the file although the manager said she had worked through the booklet with the member of staff. The manager was not aware that she is required to assess and verify that the staff member has attained the expected outcomes for each topic and that she should be signing a record as confirmation. A certificate was seen that this member of staff had attended manual handling training on the 2nd November 2009. When asked, the manager confirmed that this was the first manual handling training the person had received even though this topic should have been included in the persons induction training. There is no structured staff training and development programme in place. In discussion with the manager, we were also told that there is no method of monitoring, recording, or documenting training provided to or undertaken by staff apart from keeping certificates together in a folder. There is also no system in place for the manager to identify and book safe working practice training and updates that are required and the manager was not aware of who, in her staff team, had received which training, or if anyone was due for update. The manager told us that she provides all staff training herself including skin care, manual handling, risk assessment, fire safety, infection control and dementia training. When asked for further details the manager explained that she has a collection of commercial training DVDs and workbooks that staff are expected to watch or work through. We were told that the staff then answer question sheets which are sent off to the companies for marking and return with completion certificates. The manager said she only provides the dementia training herself, although this training is not formal or documented. The manager, when asked, said she had no formal qualifications in education and, apart from a manual handling train the trainer course three years ago, had not received any training herself in providing training to others. It was noted that the manual handling train the trainer certificate was only valid until January 2007 and had expired. The home has no system for assessing that staff have understood their training, or for assessing that they are competent and safe to carry out the work they are expected to perform. The manager told us that, to keep herself up to date with current best practice she subscribes to a professional, monthly magazine, looks on the Skills for Care website and looks on the internet. Concerns were raised with the home in early October relating to moving and handling practices at the home. It was noted at that time that service users who were not able to weight bear were being lifted by staff without the aid of appropriate equipment. At that time the home did not have a hoist although there were a number of service users who were not able to transfer themselves. Following the raising of those concerns the manager purchased a hoist and arranged for an external training company to come to the home and provide manual handling training to the staff. Certificates were seen at this inspection that confirmed that manual handling hoists training was provided in early November. On the day of this inspection the hoist was not in use as the manager was waiting for the correct sling attachments to be delivered. There are at least three service Care Homes for Older People Page 5 of 17 users currently living at the home who have now been professionally assessed by the local occupational therapist as needing hoist transfers. It is not clear how the training company was able to deliver hoist training when there were no sling attachments available and, as yet, no staff have been practically assessed for competence in transferring service users. Of the staff currently working at the home there was evidence that two people had received first aid training, although only one of the certificates was still within the validity date. The manager showed us the infection control training workbook she had purchased and that we were advised all staff had worked through, although there was no record of this. However, there was some evidence seen that the home has not followed through on the training and made sure that safe infection control practices are put into place and followed. Contrary to safe hand washing instructions there was only a cloth towel in the staff toilet. A bed rail on one service users bed was dirty, having old food debris and other substances stuck on it, the commode in this room was also dirty with used toilet paper stuck on the seat, although the manager said the commode had already been cleaned that day. A member of staff was spoken with and confirmed that training is usually carried out by the manager. The staff member advised that she had received manual handling training a few years ago and had recently had hoist training. The person also advised that she had had fire safety training not that long ago. The current staff training practices and the lack of staff competency assessments at the home are not ensuring that service users are in safe hands at all times or that they are supported by staff that have received the relevant training. Requirements have been made. RECORD KEEPING As described earlier in this report, there are a number of records that are not maintained at the home and are not kept up to date or accurate e.g. care plans, medication records and staff training records. A requirement has been made. SAFE WORKING PRACTICES We were shown around all areas of the home by the manager. During our tour a number of concerns were identified that related directly to the safety of service users and staff. These concerns included fire safety concerns: there was a pile of building rubbish directly outside one fire exit door and there was carpet blocking access to the door; another fire exit had a scatter mat in front of it creating a trip hazard; one internal fire door was not functional and others needed attention; in one service user bedroom their bed had been positioned so that the door was prevented from closing; throughout the home numerous bedroom and communal room fire doors were being held open with bins, chairs, ornaments; cupboard doors that were marked in one hallway to be kept locked at all times were found to be open and the manager advised that they are not usually kept locked, despite the instructions on the signs. Due to the number of concerns, a referral was made to the local fire safety inspecting officer, who visited the home on the afternoon of this inspection and identified a number of fire safety deficiencies. We were advised that he had found that good records were kept of fire alarm tests and that all fire extinguishers were in date. The fire safety officer will follow up with the home and monitor for compliance of the deficiency notice. The manager was not able to locate the annual fire risk assessment for the home, although she assured us it had been carried out. During our tour other health and safety hazards were noted and pointed out to the manager (in addition to infection control concerns that have been mentioned earlier in Care Homes for Older People Page 6 of 17 this report): there were a number of loose mats that presented trip hazards, although the manager told us she was aware that they should not be used; the cupboard used to store substances hazardous to health (COSHH) was in the main hall and unlocked, the manager told us that she was aware this should be kept locked. Although it took some time to locate the key, this was eventually found and the cupboard was locked. We asked the manager for copies of the required health and safety risk assessments for the home. We were told that these have not been carried out. The manager showed us a quality assurance package she had purchased in February this year. This package contained many health and safety risk assessment forms to be completed but to date these have not been put into practice. Requirements have been made relating to these concerns. The manager was also left a requirement to contact the local environmental health officer within 7 days for advice and guidance in meeting her legal responsibilities for health and safety. We made a referral to the local environmental health officer on the day following our inspection and were advised that the manager had already made contact. Concerns relating to the health and safety at work practices at the home will be followed up and monitored by the local environmental health office. NOTIFIABLE INCIDENTS Incidents brought to our attention prior to the day of this inspection had not been notified to us as required by the manager and a requirement has been made. During our visit we sampled the homes incident records and found that there were five incidents recorded that should have been notified to us without delay. In discussion with the manager she told us that she was not aware that she had to notify us of events and asked for clarification. We explained that the events were set out in the Care Homes Regulations and asked the manager if she had a copy. 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 that copies of up to date regulations can be downloaded from the CQC website. MANAGEMENT AND ADMINISTRATION A number of concerns identified during this inspection also relate specifically to the management and administration of the home. As described above, the manager was not fully aware of her legal responsibilities, e.g., amongst others, responsibilities under the Care Homes Regulations and responsibilities relating to fire safety and health and safety. There are no effective systems in place to identify and deal with risks to service users, staff or visitors, and risks, when identified, are not effectively addressed or monitored. The lack of a structured and effective system for staff induction and ongoing training and the lack of a system to monitor staff practices and assess that staff understand and are competent in skills needed to carry out their work, are also placing service users and staff at risk. Requirements have been made relating to the overall management of the home. What the care home does well: On arrival at the home we were introduced to one service user who sat and chatted with us for a while. During our conversation he expressed his satisfaction with the home, the accommodation and the care and support he receives. He was very complimentary about all the staff and told us that the manager is a kind, caring and loving person. Other service users spoken with were all also happy at the home. Comments made to us by service users included: we are like one big family, this is our home, the girls are all so cheerful and helpful, nothing is too much trouble, the food is lovely and I am lucky my family found this home for me. One relative was visiting the home while we were there Care Homes for Older People Page 7 of 17 and made the time to speak with us, the relative told us how happy she was with the service provided by the home, how grateful they were to the manager and all the staff and how happy they were with the care and support provided to their relative. Local social and health care professionals consistently report that the service users they visit at the home are all very happy to be there and are complimentary about the staff and the care they receive, as are their relatives. On the day of this inspection all interactions observed between the staff and service users were caring and respectful, there was a happy, family atmosphere and service users were treated with dignity and seen to be included in the everyday decisions that were being made. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 17 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, 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, 05/01/2010 after consultation with the service user or their representative, prepare a written care plan as to how the service users needs in respect of their health and welfare are to be met. The registered person must ensure that care plans are sufficiently detailed in order that staff are aware of the actions to be taken to ensure that all aspects of the service users health, personal and social care needs and preferences are fully met and must ensure that the care plan is signed by the service user, or their representative, in order to indicate that they are in agreement with the plan. The care plan must be kept under review and updated whenever the service users needs change and/or new problems arise. So that service users can be confident that their health, personal and social care Care Homes for Older People Page 10 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 needs will be met and that the home has a plan of care that the service user, or someone close to them, has been involved in making. 2 7 14 The registered person must 05/12/2009 not provide accommodation to a service user unless the needs of the service user have been fully assessed by a suitably qualified or suitably trained person and the registered person has ascertained that the home is suitable, and continues to be suitable, for the purpose of meeting the service users assessed and changing needs. The assessment of the service users needs must be kept under review and revised whenever the service users needs change and/or new problems arise. So that service users can be confident that their current and changing needs will be met. 3 8 13 The registered person must 05/12/2009 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. All risks to the health and safety of service users must be clearly detailed in their care plan and documented risk assessments carried out. The assessed risks must have corresponding action plans in Page 11 of 17 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 that will provide staff with clear guidance as to how the identified risks are to be minimised or eliminated. The registered person must ensure that the risk assessments are reviewed and updated following any change to the service users health which may impact on their health and safety. This requirement relates specifically, but not exclusively, to risks related to falls, mobility, moving and handling, nutrition, skin breakdown and cognitive impairment. So that service users can be confident that all possible steps are taken to identify and minimise any risks relating to their individual health and safety. 4 9 13 People must receive their 05/12/2009 medication as prescribed. Particular attention must be paid to: ensuring that people do not run out of their medication; keeping complete and accurate records of all medicines given to people; ensuring that people are given their medicines at the prescribed dose and frequency; providing care plans that include detailed information and instructions to staff on when to give medicines Page 12 of 17 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 prescribed to be given only on an as and when required basis and ensuring that all medicines are stored securely at all times. So that service users are given their medicines at the dose and frequency prescribed in a clear and consistent way that meets their needs; so that service users have their medicines available when they need them and are not left without treatment and so that the safety of service users is protected. 5 27 18 The registered person must 05/12/2009 ensure that at all times suitably qualified, competent and experienced persons are working at the home, in such numbers, as are appropriate for the health and welfare of the service users. So that service users can be confident that there are enough competent staff on duty at all times. 6 30 18 The registered person must 05/02/2010 ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform, including structured induction training, and that the staff understand and follow the training they have received. The training Page 13 of 17 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 and subsequent competency assessments must be provided and carried out by suitably experienced and qualified persons. So that service users can be confident that they receive safe and appropriate support from staff who get the relevant training and who have been assessed as competent for their role. 7 37 17 The registered person must 05/01/2010 ensure that all records specified in Schedules 3 and 4 of The Care Homes Regulations 2001 are maintained in the home, kept up to date and are at all times available for inspection. So that service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. 8 38 24A The registered person must produce a plan setting out the methods by which, and the timetable to which, the registered person intends to improve the services in the care home. So that the service users and staff can be confident that their health, safety and welfare is promoted and protected. Care Homes for Older People Page 14 of 17 19/12/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 9 38 37 The registered person must 30/11/2009 notify the Commission, without delay, of the occurrence of any incident detailed in Regulation 37 of The Care Homes Regulations 2001. So that service users rights and best interests are safeguarded by the homes record keeping and reporting procedures. 10 38 23 The registered person must consult with the local fire authority in order to ascertain that the fire safety arrangements at the home comply with current fire safety legislation. So that the service users and staff can be confident that their health, safety and welfare is promoted and protected. 05/12/2009 11 38 13 The registered person must 05/12/2009 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety and ensure that unnecessary risks to the health or safety of service users and staff are identified and so far as possible eliminated. So that the service users and staff can be confident that their health, safety and welfare is promoted and Care Homes for Older People Page 15 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 protected. 12 38 13 The registered person must 05/12/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. So that the service users and staff can be confident that their health, safety and welfare is promoted and protected. 13 38 13 The registered person must 05/01/2010 make suitable arrangements for the training of the staff in first aid and make sure that a qualified first aider is available at all times. So that the service users and staff can be confident that their health, safety and welfare is promoted and protected. 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 9 A cabinet that meets the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973 should be obtained so that any Controlled Drugs that are prescribed in the future can be stored in a way that meets the law. Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 17 of 17 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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