Inspection on 01/09/09 for Keldgate Manor

This inspection was carried out on 1st September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Keldgate Manor 06/09/07

Keldgate Manor 17/02/06

Keldgate Manor 10/06/05

Keldgate Manor 25/06/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Keldgate Manor Keldgate Beverley East Yorkshire HU17 8HU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Wilkinson     Date: 0 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Keldgate Manor Keldgate Beverley East Yorkshire HU17 8HU 01482882418 01482882098 kme@mail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Keldgate Manor Estates Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Keldgate Manor is a care home that is operated by a privately owned family company. The home is an eighteenth century property that has been adapted and extended to provide accommodation and care for 35 older people, including those with dementia related conditions. It is situated in the market town of Beverley and is close to the town centre. The home stands in an acre of land that has mature trees, flowerbeds and a large ornamental pond. Accommodation is located over three floors - communal accommodation is provided in two quiet lounges, a large lounge and dining room/lounge - the two latter rooms overlook the large garden. Private accommodation is provided in 23 single rooms and six shared rooms. The home is close to public transport facilities and is easily accessed via car; car parking space is available at the rear of the property. Care Homes for Older People Page 4 of 34 Over 65 35 35 0 0 Brief description of the care home Information about the home is provided to people living at the home and others in the statement of purpose and Service Users guide. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 6th September 2007, including information gathered during a site visit to the home. The unannounced site visit was undertaken by two inspectors over one day. It began at 9.45 am and ended at 5.00 pm. On the day of the site visit the inspectors spoke on a one to one basis with residents, members of staff, the care manager and the registered manager/provider. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered person submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. As part of the inspection process we asked for surveys to be sent to people living at the home, staff and health and social care professionals but, due to an error by the Care Care Homes for Older People Page 6 of 34 Quality Commission, the surveys for people living at the home and staff were not sent out. No surveys had been returned by health and social care professionals at the time of writing this report. The registered manager told us that the current fee for residential care if from £362.04 to £410.02 per week. At the end of this site visit, feedback was given to the registered provider/manager and the care manager on our findings, including requirements and recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 34 A photograph is needed on care plans to aid new staff with identification and to assist the emergency services should someone go missing from the home. Bed rails must only be used following a written risk assessment following guidelines issued by the Medicines and Healthcare products regulatory agency (MHRA) to ensue that they are suitable for the persons needs and used safely. The Care Quality Commission must be notified of any accidents or incidents that require medical intervention. Some improvements are needed in the storage of medication to protect people from the risk of harm; fridges used for the storage of medication must be lockable or be kept in a locked cupboard or room, temperatures should be taken and recorded to ensure that medication is stored at the correct temperature and dedicated medication fridges should not contain foodstuffs. The medication trolley must always be locked when unattended. Any handwritten entries made on medication administration records should be signed by two staff to ensure accuracy. Controlled drugs must be recorded in a book that has numbered pages and there must be space to record the amount of medication received and administered, and a running total. A controlled drugs book is the preferred option. All care plans should include information about a persons previous lifestyle and their likes and dislikes so that they can continue to live their chosen lifestyle. Hand washing facilities for staff in the laundry room should be improved i.e. disinfecting hand gel and paper towels should be available to reduce the risk of cross infection. All cleaning materials and other substances that could be hazardous to health must be stored in a locked cupboard to protect people from the risk of harm. Staff must not commence work until there are satisfactory safety checks in place to evidence that they are safe to work with vulnerable people, and staff must have training on safeguarding adults from abuse. The quality assurance system should be expanded to include other stakeholders so that people have the opportunity to comment on the quality of the service provided and are able affect the way in which the home is operated. Some minor repairs need to be carried out and the carpet in the corridor from the conservatory to the office should be replaced. Managers should monitor the policies, procedures and practices in place to ensure that they are being followed consistently and to protect people from the risk of harm, including recruitment practices and medication policies and procedures. 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. Care Homes for Older People Page 9 of 34 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 3 and 4. People are only admitted to the home following a full care needs assessment that evidences that their needs can be met. Evidence: We examined the care records for three people on the day of the site visit. They all included a care needs assessment that had been completed prior to their admission to the home. The assessment is thorough and covers all aspects of a persons physical, emotional and social care needs; there is also a record of where the assessment has taken place, for example, at a hospital or at the persons own home. Risk assessments are completed at the time of a persons admission to the home and these include a general risk assessment as well as more individual risk assessments such as use of the stairs, chiropody (due to diabetes) and personal hygiene. This informs staff of a persons iindividual care needs from the time of their admission. We discussed the Care Homes for Older People Page 12 of 34 Evidence: admission process with the registered manager and the care manager and were told that they both go out to undertake an assessment for prospective service users and that they complete a care needs assessment and risk assessments during this visit. They told us that, on occasions, they do conclude that they are not able to meet a persons needs when they feel that admitting a person to the home would be detrimental to the other people living there. We noted that community care assessments and care plans are obtained from the local authority when they are commissioning the placement at the home. This, along with information obtained from relatives and others and information gathered at the time of the initial assessment, is used to develop an individual plan of care for the new resident. We noted in training and development records that staff undertake training on dementia care, mental health awareness and challenging behaviour; this equips them to meet the needs of the people living at the home. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 7, 8, 9 and 10 Care plans are in place to guide staff and make sure that peoples needs can be met. However, some aspects of a persons diverse needs had not been identified. A persons privacy and dignity is respected by staff. Medication practices are not sufficiently robust to ensure that people living at the home are protected from the risk of harm. Evidence: Individual care plans have been developed using information gathered at the time of the initial assessment, and wherever possible, have been agreed by the person concerned or a relative. Care plans set out in detail the action that needs to be taken by care staff to ensure that all aspects of the persons health, personal and social care needs are met. For example, care plans record detailed information about the assistance needed with bathing such as, to use a bath hoist and assistance from one member of staff, not to be left alone, bath mat to be used. Care Homes for Older People Page 14 of 34 Evidence: Each care plan is accompanied by a general risk assessment (that includes the risk of falls) and additional risk assessments that are individual to the person concerned, such as use of the stairs, eye sight and chiropody (for people with diabetes). Again, risk assessments include specific information about the person concerned, such as, staff to inform service user what food is on their plate. Care plans are reviewed by staff at the home once monthly and we noted that care plans and risk assessments had all been updated with the latest information. Some information in care plans had not been completed - we saw blank forms for residents likes/dislikes, resident profiles and self care checklists across the three care plans we examined. This results in staff not having a full picture of the care needed by the individuals concerned. In addition to this, there was no photograph of the person concerned attached to the care plans we examined. A photograph helps new staff with identification and assists the emergency services should someone go missing from the home. Information about a persons health care needs is included in care plans. These evidence that GPs, district nurses, chiropodists, dentists and opticians are contacted on behalf of people living at the home and that these contacts are recorded, including the reason for the contact or visit and the outcome. We saw information that had been received from the hospital following discharges to the home and appointments for people to attend for breast screening. There is a pressure area care checklist and a body map in use; some of these had been used and others had not, depending on the risk levels of the person concerned, and we saw that pressure care equipment is used. Nutritional screening takes place and there are fluid intake charts in place when this has been identified as a need; these included information such as 1 cup = quarter of a pint so that staff could record accurate information. We noted that some people had been provided with a bed rail to prevent them from falling out of bed; these were not supported by individual risk assessments to evidence the decision making process around the provision of bed rails. We noted that the registered provider was previously a registered mental health nurse and is now a member of the Alzheimers Society. He attends a weekly memory clinic and his experiences are passed on to staff at the home to enhance their knowledge of caring for people with dementia. When we arrived at the home we noted that the medication trolley was in use and had been left open whilst unattended; the medication trolley should be locked when unattended to protect people from the risk of harm. The medication cabinet in the Care Homes for Older People Page 15 of 34 Evidence: main office was locked at all times. We observed the administration of medication at lunchtime. The pharmacist supplies medication in blister packs, apart from as required (PRN) medication and liquids; blister packs are colour coded to indicate the time of day the medication should be administered. Recording on medication administration record (MAR) sheets was found to be accurate including when medication is refused or not required. However, we recommend that two staff should sign any handwritten entries on MAR sheets to ensure accuracy. We noted that homely remedies were included on the MAR sheet; this is good practice. Medication records include a photograph of each person living at the home along with information about the medication prescribed to that person. There is a sample signature for all staff that have undertaken medication training and have responsibility for the administration of medication; this enables medication records to be checked to ensure that only staff who have received appropriate training are administering medication. We checked the arrangements in place for controlled drugs. There are safe storage arrangements in place but the book used for recording administration does not comply with the Misuse of Drugs (Safe Custody) Regulations 1973. There is no space to record the amount of medication received or a running total of medication remaining, and pages are not numbered; we recommend that the home purchase a controlled drugs book. The manager told us that none of the current service users have been prescribed controlled drugs but arrangements need to be in place should this occur. There is a medications fridge in the main office but this does not lock and the office door is left unlocked throughout the day; this fridge also contained food stuffs. We did not see any records to evidence that the temperature of the fridge is checked and recorded on a daily basis. In addition to this, we observed that some food supplements prescribed by the GP are stored in the fridge in the dining room; again, this fridge does not lock. Medication should be stored in a lockable fridge to protect people from the risk of harm and fridge temperatures should be taken and recorded to evidence that medication is being stored at the correct temperature. We observed that staff respect the privacy and dignity of people living at the home and care plans record how assistance should be given with personal care in the least intrusive way. A persons preferred name is used by staff and it is evident that people always wear their own clothes. People have access to a telephone to keep in touch with family and friends. Most people have a single room so are able to see visitors and health care professionals in private, and people accommodated in shared rooms have been provided with a screen to promote privacy. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 12, 13, 13 and 14. People are able to choose how to spend their day and various activities are provided for people to participate in if they choose. Visitors are made welcome at the home and meal provision is good. Evidence: Most care plans (but not all) record details of a persons previous lifestyle, their hobbies and interests and their likes/dislikes. People are able to choose where to spend their day, where to take their meals and whether to take part in available activities; on the afternoon of the site visit a ball activity took place. Daily diary sheets record any activities that a person has participated in, any visitors seen and any trips out of the home. There are extensive gardens at the rear of the property with seating provided for people living at the home and their visitors. A small allotment area has been created to try to encourage people to take part in gardening activities and there are now chickens in the garden; the registered person recorded in the AQAA, this is for ambience and eggs! We saw that visitors were in and out of the home throughout the day and that they Care Homes for Older People Page 17 of 34 Evidence: were made welcome by staff. Most people have single rooms so are able to see visitors and care professionals in private, and there are also private areas of the home where people can meet with family and friends. We noted that people are able to bring small items of furniture, photographs, pictures and ornaments with them from their own home so that their bedrooms are personalised. We saw information in the home about Advocacy, Deprivation of Liberty, safeguarding adults and funding of residential care; this enables people to access this information without having to ask for advice and promotes privacy and independence. Meal provision at the home is good. A three course lunch is provided with a choice of main meal and dessert, and a choice of meal at tea-time; this is recorded on a daily menu that is displayed in the dining room. We were told that kitchen staff talk to people each morning about the choices on offer that day. We observed the serving of lunch and noted that lunch was presented in an attractive manner and that people were offered both a cold drink and a drink of tea. Food supplements (including Calogen and Ensure) are provided for some people as well as meals to suit people with diabetes. We observed that some people were served their meal on a plate that made eating easier and that people were given time to eat. We were told that key workers discuss the menu with people living at the home and that menus are adjusted accordingly. We were concerned to see that the drink served for afternoon tea was served from a very large teapot and that the tea already contained milk. This is institutionalised practice that does not promote choice for the people living at the home. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 16 and 18. People tell us that they know who to speak to if they have any concerns and there are policies and procedures in place on how to make a complaint. There is insufficient evidence that all staff have had training on safeguarding adults from abuse and staff have commenced work at the home prior to safety checks being in place to evidence that they are suitable to work with vulnerable people. Evidence: There is a complaints log in place and we noted that information is displayed in the home to inform people about the complaints procedure. The manager told us in the AQAA form that there have been no complaints made to the home in the last year and records at the home support this. People told us that they know who to speak to if they have any concerns. There are policies and procedures in place that are designed to protect people from the risk of harm, including safeguarding adults from abuse and whistle blowing. The home has made no safeguarding referrals to the local authority in the last year but one safeguarding alert was completed by hospital staff following a persons admission to hospital. This was investigated by the safeguarding team and it was found that there had been no bad practice by any carers or nurses. Care Homes for Older People Page 19 of 34 Evidence: The manager told us in the AQAA form that she is qualified to train staff on safeguarding adults from abuse. The training and development plan at the home and the individual records seen on the day of the site visit did not include any information about recent training for staff on safeguarding adults from abuse. However, the manager told us that staff have recently attended this training and they are waiting for their certificates; this information should be recorded on the training and development plan. We observed in staff records that two members of staff had started work at the home prior to a satisfactory Criminal Records Bureau (CRB) check being received and that no Protection of Vulnerable Adults (POVA) first check was received for either of these people. One of these members of staff had been in post for a year before their CRB clearance was received. This could leaving people living at the home at risk of harm by people being employed who are not suitable to work with vulnerable people. Monies held on behalf of people living at the home are held safely and securely. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 19 and 26. The home is generally well maintained and the gardens provide an attractive space for people to enjoy. The home is clean and hygienic but some improvements are needed to fully protect people from the risk of harm. Evidence: A handyman is employed at the home and he was present on the day of the site visit undertaking routine maintenance of the premises. The home was generally well maintained; a new shower unit has been provided and there is a walk-in shower room. Some corridor carpets have been replaced but the one in the corridor leading to the kitchen and staff room has not been replaced, as recommended in the last key inspection report. The manager told us in the AQAA that the outside of the premises has been redecorated and that all fire doors are in the process of being replaced; the handyman was working on these on the day of the site visit and we were told that there were only two left to complete. We identified some areas that needed to be improved: the parquet flooring in one area of the home needs to be repaired as it is creating a trip hazard, some plastic sheeting on a display cabinet close to the main office is broken and should be replaced to avoid the risk of someone cutting themselves and one window in a bedroom needs Care Homes for Older People Page 21 of 34 Evidence: to be fitted with an opening restrictor. We saw a copy of a letter from the Food Safety (Environmental Health) department of the local authority - they visited the home in March 2009 and had made some recommendations; the registered person told us that these had been actioned. CCTV cameras are restricted to the entrance areas of the home and are used for security purposes only. The grounds are extensive and are kept tidy, safe, attractive and accessible to people living at the home. We noted that radiators are not covered; the registered person told us that all radiators are thermostatically controlled so cannot get hot enough to cause anyone harm. The home was clean and hygienic on the day of the site visit and no unpleasant odours were detected. Laundry facilities are suitable for the needs of the people living at the home but we noted that hand washing facilites for staff were inadequate on the day of the site visit - the hand wash liquid had run out and the paper towel dispenser was empty and a hand towel was being used instead; this does not protect people from the risk of cross infection. Disinfecting hand gel is placed at entrances to home along with polite notices about precautions for swine flu and diarrhoea outbreaks; this is good practice. Records evidence that staff have training on the control of infection. The main cupboard used for storing cleaning materials is locked but we saw that some cleaning materials were stored in other areas of the home and these were not locked. All substances that may cause harm to people living at the home should be stored in a locked cupboard to meet the Control of Substances Hazardous to Health (COSHH) regulations. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at key standards 27, 28, 29 and 30. There are sufficient staff on duty to meet the needs of the people living at the home and NVQ achievement is good. Staff receive appropriate induction and on-going training but recruitment practices are not robust and this could result in people who are unsuitable to work with vulnerable people being employed and people being placed at the risk of harm. Evidence: We noted that the staff rota recorded the role of each person on shift each day and that the staff recorded were actually on duty. Domestic staff and catering staff are employed in addition to care staff; there are three full time cooks, three full time domestic assistants and one kitchen assistant. This allows care staff to concentrate on care duties and all other tasks are undertaken by ancillary staff, which helps to alleviate the risk of cross infection. Records evidence that there are enough staff on duty to meet the needs of the people living at the home and we noted that staff are well supported by the management team, who live on the premises. Nine care staff have achieved NVQ Level 2 in Care and some are now working towards NVQ Level 3 in Care. Managers are working towards NVQ Level 4 in Care and/or the team leaders award. In addition to this, domestic staff are doing NVQ Level 2 in Care Homes for Older People Page 23 of 34 Evidence: housekeeping and catering staff are doing NVQ 3 in Catering; this is good practice. We examined the recruitment records for two care staff. Both had completed application forms that recorded their employment history, their qualifications, the names of two referees and a criminal conviction declaration. Two written references had been obtained prior to them commencing work at the home. However, both had commenced work at the home prior to a satisfactory Criminal Records Bureau (CRB) check being received and in one instance the CRB check was not received until one year after the person started work. A Protection of Vulnerable Adults (POVA) first check had not been obtained for either employee. This leaves people living at the home at risk of harm, as someone not suitable to work with vulnerable people could be employed. Training records evidence that staff have induction training prior to commencing work unsupervised; this includes training on fire safety and hygiene and some shadowing shifts with experienced staff. The training and development plan evidences that staff have regular training opportunities and recent training has included diabetes awareness, COSHH, epilepsy, loss and bereavement, risk assessment, bladder and bowel care and moving and handling. Training planned up to March 2010 includes moving and handling, challenging behaviour, mental health awareness and falls prevention. However, as previously recorded, all staff should undertake training on safeguarding adults from abuse and this has not yet been achieved. Individual training records are also held and these record the training courses attended by staff at this home and in their previous employment. It would be good practice for the training and development plan to record the date that each person has attended a specific training course so that the need for refresher training could be easily identified. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 31, 33, 35 and 38 Some systems and practices are not being managed consistently and quality assurance systems need to be expanded to ensure that people have the opportunity to affect the way in which the home is operated. This could result in people not receiving the care they need. Evidence: The registered manager is a qualified nurse and has the skills, qualifications and experience to manage the home. The care manager is also experienced and skilled and is working towards NVQ Level 4 in Care. Staff and others tell us that they are clear about the roles of the registerd manager and the care manager. However, there have been some instances when managers have not monitored that policies and procedures are being adhered to, such as recruitment practices, quality assurance systems, health and safety systems and the administration of medication, and we are concerned that this is because several people are involved in carrying out Care Homes for Older People Page 25 of 34 Evidence: management tasks. The quality assurance systems in place at the home continue to be the same as when we last inspected the home. People living the home complete a survey prior to their annual review and this allows any concerns to be discussed at the time of the review. Other stakeholders such as staff, relatives/friends and health/social care professionals are not included in the quality monitoring process, although staff do have monthly meetings where they are able to express their views and make suggestions. The home has achieved QDS (the local authority quality award) parts 1 and 2. Most people are assisted by a family member to manage their financial affairs but monies are held on behalf of some people living at the home. A sample of these monies and associated records were checked and were found to be accurate. Monies are held safely and securely and we noted that receipts are obtained from the hairdresser or the chiropodist as proof of expenditure. Staff records evidence that staff have an annual appraisal and attend monthly staff meetings but they do not have regular one to one supervision with a manager so that they get the opportunity to discuss their practice or any concerns and training requirements they may have. Staff tell us that they talk to each other at shift handovers and that they get together to discuss any concerns. We examined some of the health and safety documentation at the home. Accident/incident forms had been completed appropriately but we saw several instances when accidents had resulted in attendance or admission to hospital and no Regulation 37 notification had been sent to the Care Quality Commission (CQC). The manager was advised that the CQC must be notified of any accident or incident where there has been medical intervention. We saw service certificates for gas safety, the fire alarm system, fire extinguishers, emergency lighting, portable appliances and the lift. There is an electrical installation certificate in place; this records that a test should take place again after five years and it is now due. The registered person told us that they had checked this and had been told that the test does not have to take place until 10 years after the original test. However, they informed us that they had arranged for the test to be done later in the month and they agreed to forward a copy of the service certificate to the CQC. This had not been received at the time of writing this report. All water outlets accessible to people living at the home in bathrooms, toilets and bedrooms have now been fitted with thermostats and this reduces the risk of scalding. Care Homes for Older People Page 26 of 34 Evidence: On the day of the site visit one wash basin in a toilet was found to have very hot water but this was rectified by the handyman on the day. There is a folder that records information about who should be contacted in case of an emergency such as an electrical or gas supply fault; this enables staff on duty to contact people quickly and is good practice. Risk assessments need to be undertaken in three areas: for any bed rails in use at the home following the Medicines and Healthcare products regulator agency (MHRA) guidance, for the use of portable heaters and for the use of steredent tablets; we saw that some people had steredent tablets in their bedrooms and were concerned that these could be consumed by people if they were mistaken for sweets. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Risk assessments must be undertaken for the use of bed rails, following the guidance issued by MRHA. This is needed to evidence that risks to people are kept to a minimum and people are kept safe from harm. 23/10/2009 2 9 13 Prescribed medication that 23/10/2009 requires storage at a cool temperature must be stored in a fridge that is lockable or in a locked cupboard or room. The medication trolley must be locked when unattended. This is needed to protect people from the risk of harm 3 9 13 Controlled drugs must be recorded appropriately, i.e. there must be a record of drugs received, drugs administered and a running total. A hardback book must be used and pages in the 23/10/2009 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action book must be numbered to evidence that all sheets in use have remained intact. This is needed to protect people from the risk of harm by incorrect medication being administered by staff. 4 18 19 All safety checks must be in place prior to staff commencing work at the home. This is to protect people from the risk of being abused if unsuitable staff were employed. 5 18 13 There must be evidence that 31/10/2009 all staff have had training on safeguarding adults from abuse. This is to ensure that all staff know what action to take should an incident occur or allegation be made. 6 26 13 All substances that could be 31/10/2009 hazardous to health must be stored in a locked cupboard. This is needed to protect people living at the home from the risk of harm. 7 29 19 People must not commence work at the home until a satisfactory CRB check has been received (or POVA first 31/10/2009 31/10/2009 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action check in exceptional circumstances). This is to ensure that only people who are considered safe to work with vulnerable people are employed. 8 38 37 The Care Quality 31/10/2009 Commission must be notified of any accidents or incidents involving people living at the home where there has been medical intervention. This is to enable the Care Quality Commission to check that the registered persons are obtaining appropriate medical intervention for people. 9 38 13 The health and safety of the 31/10/2009 people living at the home must be ensured by - the completion of risk assessments for any activity or equipment that may pose a risk, the maintenance of electrical systems and equipment, the regulation of water temperatures to control the risk of scalding, the provision and maintenance of window opening restrictors, the safe storage of chemicals and the provision of hand washing Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action facilities for staff to promote good infection control. This is to evidence that action has been taken to protect people from the risk of harm and that risks to people are kept to a minimum. 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 All relevant information about a person should be obtained and recorded so that staff have a full picture of the needs of the person concerned. There should be a photograph of the person concerned in each care plan to aid new staff with identification and to assist the emergency services should someone go missing from the home. The temperature of medication fridges should be checked and recorded daily to ensure that medication is stored at the correct temperature. Only medication should be stored in dedicated medication fridges. Any handwritten entries on medication administration records should be signed by two members of staff to ensure accuracy. All care plans should include information about a persons previous lifestyle and their likes/dislikes. Some areas in need of repair or replacement were identified i.e. parquet flooring in the quiet area and plastic sheeting in a display cabinet should be repaired and the carpet leading to the kitchen and staff room should be replaced. One window should be fitted with an opening restrictor. These are needed to protect people from the risk of harm. Page 32 of 34 2 7 3 9 4 9 5 6 12 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 26 Handwashing facilities for staff in the laundry room should be improved to promote good hygiene practices and control the risk of cross infection. It would be good practice for the training and development plan to record the date that training has been undertaken so that the need for refresher training can be easily identified. The manager should ensure that all policies, procedures and practices in place at the home are monitored to ensure that they are being followed consistently The results of quality questionnaires should be published and other stakeholders should be included in the quality monitoring process to ensure that people are able to comment on the care provided by the home. The Care Quality Commission should be notified of any accidents or incidents involving people living at the home where there has been medical intervention. 8 30 9 31 10 33 11 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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