Inspection on 08/03/09 for Kent Lodge

This inspection was carried out on 8th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kent Lodge 28/04/08

Kent Lodge 30/04/07

Kent Lodge 29/11/06

Similar services:

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kent Lodge 1 Pitshanger Lane Ealing London W5 1RH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Collisson     Date: 1 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Kent Lodge 1 Pitshanger Lane Ealing London W5 1RH 02089982412 02089912658 kent-lodge@shaw.co.uk 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) : Shaw Healthcare (Group) Limited care home 38 Number of places (if applicable): Under 65 Over 65 0 18 dementia old age, not falling within any other category Additional conditions: 20 0 The Registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (Maximum number of places: 18) Dementia - Code DE (Maximum number of places: 20) The maximum number of service users who can be accommodated is: 38 Date of last inspection Brief description of the care home Kent Lodge is a purpose built care home registered for thirty eight older people. It includes a first floor dementia unit for twenty people, which was opened in 2007. Both permanent and respite care are provided. The home is owned and managed by Shaw Healthcare (Homes) Ltd. This is a private organisation that manages residential homes nationwide. The home is located close to transport links and main roads. It is situated on the corner of two busy roads, with local shops and facilities nearby, including a small library, cafes and churches. The facilities of Ealing Broadway can be reached by bus. Although there is limited parking at the home, there is nearby street parking. Care Homes for Older People Page 4 of 36 Brief description of the care home Most areas of the home are accessible, with a passenger lift between the ground and first floors. There are thirty eight single bedrooms. Twenty people are accommodated on the first floor and eighteen on the ground floor. None of the rooms are en suite but each has a wash hand basin. Each floor has communal lounges, a dining room, bathrooms and toilet facilities. There are lounges for people who smoke on each floor. A courtyard garden is available and there are balconies on the first floor, with seating. The staff team consists of a Registered Manager, Deputy Manager, Team Leaders, and a team of day and night support workers. There is an administrative officer, catering, laundry, domestic and maintenance staff. The current weekly fees are from £490 to £572 for the dementia unit. Care Homes for Older People Page 5 of 36 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: We commenced this unannounced inspection on the 8th March 2009 from 10.30am to 4.30pm. We continued on the 9th March when we were joined by an Expert by Experience. A further visit was made on 12th March 2009 to complete the inspection and the inspection process took a total of fifteen hours. The Registered Manager was present on the second and third day. The home had ten vacant beds and there were fourteen people in each unit. One person was on respite stay. The Area Manager was in the home on the second day of the inspection and we were able to discuss what we had found. The Commission for Social Care Inspection is trying to improve the way it engages with people who use services so as to gain a real understanding of their views and Care Homes for Older People Page 6 of 36 experiences of social care services. It now uses Experts by Experience who are an important part of the inspection team and help Inspectors get a picture of what it is like to use a social care service. The term Expert by Experience used in this report describes a person whose knowledge about social care services comes directly from their experience of them. We toured the home and met the majority of the people living there. We also met the relatives and friends of three people. We saw that a number of people choose to remain in their bedrooms through the day. Other people regularly use the lounges and some were watching television. An Activities Organiser was recruited during 2008 and a game of bingo was being held with approximately a quarter of the residents taking part. An entertainer was in the home on the third day of the inspection and plans had been made for two more entertainments in the following two weeks. We examined a range of documentation, including care plans, medication records, maintenance, finance records, staff and training records. All of the key National Minimum Standards were examined on this inspection. We also sent surveys to the residents and the staff. We received twenty five from people in the home, some completed by relatives or staff. Ten staff completed the surveys. We will refer to the comments in the body of the report. We found that the Registered Manager has tried to build on the improvements we found last year, but shortfalls remain in a number of areas which need to be addressed. In particular, we were disappointed with the lack of stimulation, activity and staff interaction in the dementia unit. The malodour of urine on the first floor unit was noticed on each visit and has been remarked upon by visitors, including the ambulance service who reported this on a visit in late 2008. Agreement was made for new carpet to be provided in this unit during the inspection. There are a number of areas where redecoration is required and lighting is in need of improvement. There was a lack of cleanliness in some areas, particularly the laundry room which is in need of refurbishment. The exterior windowsills to many windows are in need of repair or replacement. We saw two lunches being served and people were generally satisfied with the meals. However, there is a limited vegetarian menu and the alternative meals for people from ethnic minorities were not as shown on the menu. The home has a total of fifteen requirements made at this inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 36 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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. The service has information, including a Statement of Purpose and Service Users Guide, which sets out the aims and objectives of the home, and includes and provides basic information about the service. There is evidence that prospective residents have a needs assessment before they go to live at the home. The home has received copies of the summary and care plans from the assessments carried out through care management arrangements. Staff have training in dementia care but good practice is not always in evidence. Evidence: We found that the Statement of Purpose had been updated since the last inspection to include information about the dementia unit. Although the information has details of how good dementia care should be achieved, we did not find that staff are necessarily putting this into practice. Care Homes for Older People Page 11 of 36 Evidence: The home has also catered for people with mental health needs. One person was to leave the home shortly so that their needs could be met more appropriately in another home. A Community Psychiatric Nurse had been involved in their care. It has been a requirement at the last two inspections that the terms and conditions were issued to each person. We saw some samples in the files we examined and the Manager confirmed they had all been completed. We saw that people referred by Local Authorities had assessments completed and that the home had also carried out a pre-admission assessment for each person whose file we examined. In order to meet the specialist needs of the people moving in the dementia unit, twelve staff have advanced dementia training and all of the staff have had some dementia awareness training. However, we did not find that staff were necessarily applying this training appropriately in the dementia unit. On a number of occasions, no staff were in the main lounge. At other times, they were writing their notes so were not fully engaged with the residents. The Expert by Experience wrote, Having spent some time on this unit, it would be fair to say that the interaction between the staff and the residents was negligible and those that were asleep in the lounge were ignored completely as I did not witness any member of staff going into check on them. We discussed with the Manager that the unit is in need of supervisory staff who can encourage and motivate staff to use the specialist training to help improve the quality of life for the residents. The home does not provide Intermediate Care, therefore this standard could not be assessed. Care Homes for Older People Page 12 of 36 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. People have detailed care plans, but they do not always provide information on the support that people require to improve their quality of life. The length of the care plans would not assist new staff, or agency staff, to understand the care needs of the person and the proposed outcome of their support plans. Care plans are not focussed on good outcomes, particularly in the dementia unit. Health needs are met by community services. Medication administration would benefit from regular auditing. Evidence: We examined six care plans, from each unit, in detail. We found that there is a good deal of information, including a variety of assessments for nutrition, skin integrity and daily living activities. We did not find that the care plans were always informative about the person to whom they referred. Most were up-to-date and had a monthly update completed. Some were unrealistic, such as recording that staff need to provide continual supervision for a person who smokes, when they are deemed to be quite independent. The staffing levels would not support this supervision. We did not find that the care plans would be helpful in assisting new staff or agency staff to fully Care Homes for Older People Page 13 of 36 Evidence: support someone with their social and personal care needs. We discussed with the Manager that a short digest of the persons needs would be helpful for new staff and agency staff to be aware of the support required. Wherever possible this should be seen to be discussed with the person or their representatives. One staff mentioned to us that male staff sometimes provide personal care to female residents, although they would prefer female staff. On one shift there were two male staff in the dementia unit. It was seen in some care plans that no preference is recorded. To support a persons privacy and dignity, and with the incidence of dementia among the residents, it should be clear that this is discussed with the persons representative where people cannot make this decision for themselves. The health needs of the people in the home are met by community services. We saw information about the visits by general practitioners, opticians, chiropodists and other health care staff. The Manager informed us that none of the residents have pressure sores. None of the residents require insulin or other injections and the district nurses visit currently only when dressings are required. The Manager said that one of the general practitioners specialises in dementia care and attends the unit. We checked the medication on the first visit. While most of the medication was in order, we found that one medication had not been signed for. Although a check had been carried out, and signed by the Team Leaders at the handover of shifts, the error was not found. The resident had the medication in an unlocked drawer in the bedroom which could have been accessible to other residents. The Team Leaders must ensure that health and safety is observed when they are in charge of a shift. It had been a previous requirement that an auditing system was put in place. A 28-day blister pack system is used, with a limited amount of medication being kept in separate packages. We found that, apart from a running total being kept of non-blister pack medication, that no regular audits were carried out. The Manager devised an audit form during this inspection so that spot checks could be made and recorded. Care Homes for Older People Page 14 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people say the meals are good and they enjoy them. The food in the home is of satisfactory quality and well presented. Those with specialist dietary or cultural requirements have little opportunity for variety or choice. Activities are provided but are limited when the Activities Organiser is not on duty. Evidence: The home has recruited an Activities Organiser and she has been in post since the middle of 2008. There was a programme of activities in small print on one wall near the dining room. On one of the days, music was being played in the dementia unit and some of the residents enjoyed dancing with the staff. Apart from the bingo session being held for a small group, and the entertainer on the last day, we observed few individual activities during the three days. The Manager said that two futher entertainments were planned in the near future, one for a leaving party and one for St Patricks Day. There was a lack of interaction between the staff and the residents. The Expert by Experience said The staff seemed to be unable or unwilling to interact in any way with the residents and therefore there was little in the way of stimulation. Care Homes for Older People Page 15 of 36 Evidence: The Expert by Experience wrote, I learnt that the activities coordinator is currently trying all sorts of different activities to stimulate the residents of both units but finds it very difficult as she has a poor response. She does, however, work with some residents on a one to one basis and takes them out to the local shops but this doesnt happen very often due to the time commitment involved. I did, however, feel that she was working hard to try and meet the needs of the residents and provide activities that would suit their needs both individually and as a group. There is also some involvement from a local school that visits occasionally and sings to the residents. Three people replying to our surveys said that they did not wish to join in with the activities, but one said they were never called to join in. There are items placed around the dementia unit, such as photographs, books, objects from the past, and crafts such as knitting. We were aware, however, that the people in the unit need encouragement to use these items and staff need to support them to do this. A number of people walk around the unit all day and need staff to ensure that they engage with them, whenever possible. We observed staff not taking notice of someone who was upset. The Activities Organiser had not yet been on an activities course for people with dementia and it is recommended that this is sourced as soon as possible. All staff who work on the unit need to be aware of how they can help to stimulate people to enjoy a range of activities or one-to-one interactions. We found as last year that the staff who work on the unit do not necessarily do so by choice and some indicated they would prefer to work in the ground floor unit. We discussed this again with the Manager who said that she needed to have a permanent staff team to do this but would try to consult when this was achieved. There are people under 65 in the dementia unit whose interests, musical tastes and other needs may be different to older people. We did observe not that many of their needs are being met. If the home admits people from a variety of age groups the activities need to be appropriate and the opportunity for outings needs to be available for everyone. Although some people obviously choose to spend their time in their rooms, particularly in the ground floor unit, we found that some people in the dementia unit appeared to spend all their time in their rooms. This was confirmed by a regular visitor. We could not see that they were encouraged to leave their rooms for exercise or activities. People told us that they did not always have the chance to go out. One person in the ground floor unit said that it had been a long time since they had been taken out, Care Homes for Older People Page 16 of 36 Evidence: although they were willing to do so in winter. Although there are local shops and cafes nearby, we saw little indication that people did go out regularly. People in the dementia unit have two balconies only where they may get fresh air. Otherwise they would need to be taken to the small garden by staff. Neither area was safe for everyone to walk unaccompanied. The home has had since the last inspection the use of a shared minibus with other Shaw homes but had not made use of this. We found that people we spoke to were generally happy with the meals. 75 said they always like the meals the remainder saying usually or sometimes. The Expert by Experience said, I was advised that residents could choose what they wanted to eat and if they preferred something that was not on the menu this would be made available for them. I sat in the dining room during lunch and the food did look quite appetising. I also saw some clients being fed and this was done in a respectful, unhurried way. She also wrote, I did notice that, although this was a dementia unit the menus were in very small print and there were no pictures to assist residents which might empower them to make their own choices if this was within their capabilities. I raised this point with one of the staff and was advised that they just knew what people liked. I did ask how this was possible if they could not communicate their choices but was told again that we just know. The meal on the first day of the inspection was roast pork or salmon with potatoes, carrots and sprouts. The dessert was apple strudel and custard or ice cream. The cook said that yoghurts were available for the people with diabetes. However, these were not of a low sugar variety. One staff member serving said that the custard had sugar in it while the cook said that it is made with a small amount of sweetener and people could add sugar if they wished. There needs to be clarity about the food being served. The following day there was a hot pot or fish and tomato bake. The dessert was apple pie and custard. The choice available on all three days for the alternative meal, for people from ethnic minorities, was not as shown on the menu but was rice and peas or rice and vegetables. The menu showed a variety of other dishes such as spicy fish. We found last year that there was no specific vegetarian meal available but the printed menu states a vegetarian option is available. A printed list of vegetarian options is now placed in the dining rooms but consisted of plain or cheese omelette, jacket potato with cheese or tuna, and tuna or cheese salad. We saw the salad consisted only of tomato and cucumber. A more varied vegetarian menu, which includes a more balanced diet is needed. If this was made available on the menu, as the third option, a better choice could be available to everyone. The cook said that the meat and vegetables are sourced locally. We saw only a limited amount of fruit available. We saw that one person in the dementia unit did not eat any Care Homes for Older People Page 17 of 36 Evidence: of the meal provided and we could not see from the notes that any alternative had been offered. A record is kept of food and drink, but staff said that night staff do not always record the drinks taken in the early morning, so the charts are not necessarily of use in ascertaining whether people are drinking well or not. The Team Leaders must ensure that, where monitoring is deemed necessary, the charts are completed correctly. The Expert by Experience wrote, about the kitchen, We noted that there was not a list of residents likes and dislikes on the wall. One lady said that she doesnt like peas but always gets them. This could be prevented if a food preferences list was displayed. We found that the kitchen was clean and the cook said that all of the equipment was in working order. Care Homes for Older People Page 18 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is in place and most people say they know how to make a complaint. Safe are trained in safeguarding procedures to help protect people. Evidence: We found that there were two complaints recorded since the last inspection. Both had resulted in safeguarding meetings held by the London Borough of Ealing. One of these was in response to a report from the London Ambulance Service about poor practice and odour in the home when called to an emergency. The second issue was about the behaviour of a resident towards another resident. This was being dealt with at the time of the inspection and was resulting in a move to another home for one of the people concerned. When we asked people whether staff listened to them and acted upon what they said, twenty of the twenty five people said that they did. However, one said No, because some of them are so busy. Although seventeen of the twenty five people replying to our surveys said that they knew who to complain to if they were not happy, we found that most people, because of dementia or other causes, were not able to say when asked them. One person did say they would go to the office We found that one persons representatives had a number of complaints but had not formally made them to the home. One of these was about the overwhelming odour Care Homes for Older People Page 19 of 36 Evidence: of urine on the first floor and the lack of stimulation for some of the residents. The last meeting of the residents and their friends and families was held in May 2008. The Manager said that these are valuable but we did not think they are held regularly enough to be of use. Because of the amount of dementia in the home, it is essential that people have their advocates involved if any concerns are to be dealt with. It is recommended that a more regular programme of meetings is planned. This would give people the opportunity to voice their concerns. Care Homes for Older People Page 20 of 36 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. Efforts are made to make the environment homely. Areas of the home would benefit from better lighting. The laundry is in need of refurbishment and cleaning. Maintenance is not always carried out speedily. The outside areas are not welcoming or always safe to walk. Evidence: We looked at all areas of the home, and found that there are improvements still to be made. The Expert by Experience said, I noticed that the entrance hall was dark unwelcoming and quite shabby and that there were areas of the carpet in this entrance hall that presented tripping hazards. The windows of the entrance doors were very dirty and I noticed that the curtains surrounding these doors appeared to be held to the wall with white masking tape. We found the lighting in the corridors to be low. There had been concerns with the heating system at the 2007 inspection but the system was working satisfactorily at the last inspection. However, we saw, in the the maintenance file, that two radiators were reported in not to be working and could not be repaired until the summer when the system could be drained. The people concerned had been moved to other bedrooms. At the present time, there are a number of unoccupied rooms so this is possible. However, it is not good practice to move people, particularly with dementia, and the Registered Providers must ensure Care Homes for Older People Page 21 of 36 Evidence: that everything is done to keep the equipment in good order. The Manager has tried to improve the look of the home by introducing plants, ornaments and pictures. However, in some areas, such as the bathrooms, this may be counterproductive as the amount of items makes cleaning more difficult. We found areas which were quite dusty. The lounge in the dementia unit has only sufficient seating for twelve people. There are two smaller rooms one which would hold up to three people for meetings or as a quiet area, but one is a smoking room so has limited use. Should the dementia unit be fully occupied, there would insufficient space for people to sit comfortably with visitors or staff unless they go to their bedrooms. As all of the bedrooms on this floor are around 9 sq. metres, there is limited space for visitors in the bedrooms. There are two lounges and a smoking room on the ground floor which provides a better choice of communal areas. Both dining areas are pleasant and the larger ground floor dining room is used for communal activities. We found that people in the dementia unit are not able to access open spaces and fresh air by themselves. Both doors to the balconies were very difficult to open. The Manager said that they had warped in the wet weather. The Expert by Experience said, The balconies are accessed from this level via the kitchen and lounge and I noticed that the doors and window frames on the outside of the property were rotting. The step out of the lounge onto the balcony is too high and there are no grab rails around the door to facilitate access to this area. There were loose paving stones on the balcony outside the lounge and some areas on both balconies were covered in green moss. Although there were one or two chairs on the balconies they both looked unkempt and uninviting. We found that the staff had made efforts with plants to improve the areas but more major work is needed to make them inviting and safe. She also said, The dementia unit was quite a depressing area with badly lit corridors and quite small bedrooms. In some bedrooms the curtains were falling off their rails and the vast majority were in need of some redecoration and general maintenance and some radiator covers were very loose. We found that one of the sliding doors in a toilet did not close and door handles were loose. The companys handy person covers several homes and is not always available. The company needs to ensure that maintenance work can be carried out within a reasonable time. In the dementia unit memory boxes have been placed outside bedrooms doors in the last year to aid recognition of the room. However, we found that these were not all relevant to the person in the room. One had the name of another person and the items they contained did not appear to be particularly relevant. Care Homes for Older People Page 22 of 36 Evidence: One bathroom is being used for storage but there were sufficient to meet the National Minimum Standards for the twenty eight people in the home. The laundry is in need of redecorating and, preferably, refurbishing. The Expert by Experience said, I visited the laundry and was advised that they would hand wash items if it was necessary. However this area seemed quite unclean and it was possible to scrape the dirt off of the wall at the back of the sink with my fingernail. This work has been outstanding for some time and needs to be completed. We found the sink was particularly grubby, as was the staff toilet wash basin. Although staff are trained in infection control, we did not find that these examples showed a good awareness. The first floor unit was found to have a strong smell of urine at each of our visits. A regular visitor reported that the smell is overpowering. Although the carpets have been shampooed with an industrial-style machine, this did not solve the problem. We were informed during the inspection that the Manager had permission to have new carpets for this area. Just prior to the inspection, an intruder was found in the home at night. The home is protected with key pads. The Manager said that additional precautions has been put in place to carry out more security checks each day. Care Homes for Older People Page 23 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are able to express themselves say they are generally satisfied with the support. Although adequate staff may be on duty their deployment is not used to its best advantage. Staff are delegated tasks but do not always have an awareness of their responsibilities. Good induction and training opportunities are available for the staff. People are generally protected by the recruitment procedures but some improvements are needed in record keeping. Evidence: Because of the number of vacant beds in the home, the Manager has not been offering permanent contracts to the staff. Supervison on each shift is provided by a Team Leader, and there were seven employed. Bank staff were being recruited and there are also agency staff working. The Manager was hoping to fill vacancies and had a file of applicants for the care and domestic vacant posts. The number of staff on the first day of the inspection, which was a Sunday, was seven including the Team Leader. One of the staff had just commenced and was on induction. The rota showed, on some days, there are only two staff on the dementia unit for, at times, for fourteen people although the agreed establishment is three. The Manager said that agency staff had worked but the Team Leaders had not added their names to the rota. The Manager was reminded that the rota must be accurate and reflect the actual staff working. Care Homes for Older People Page 24 of 36 Evidence: Staff continue to work double shifts of twelve hours on a regular basis. The Manager said that she tries to ensure they have the day off following a long shift. Staff working the long shifts have a total of one hours break during the day, so there are times during the day when there are fewer staff on duty than those shown on the rota. Although the Manager said that the management staff try to cover when these when breaks take place, this does not appear to be a practical solution, particularly when there is no Deputy Manager. A number of staff told us that there are insufficient staff on duty and two also said that they need people with more relevant experience. We found, however, that it is the supervision of the staff team that is needed to ensure that they are interacting and stimulating people, particularly in the dementia unit. One persons visitor spoke to us about the lack of attention some of the residents receive in this unit and we noted ourselves that staff were not being attentive to the residents. As we have discussed elsewhere in this report, and with the Manager, the practice of rotating staff between the different units is quite unpopular and does not enhance the support of the people living in the dementia unit. We found, for the second year, that action is needed to address the roles and responsibilities of the Team Leaders. We found that, although there is a system in place for checking the Medication Administration Record sheets, a mistake was not noticed. Supervision has not taken place regularly for all the staff, which should be carried out by the Team Leaders. They have been reminded by the Manager and we saw a number of reminders given to Team Leaders about keeping their work up-to-date. Although we found care plans have been monitored monthly, we did not find that the information was particularly useful. Staff said that one person had become more dependent but this was not reflected in the care plan and monthly notes. Recruitment is carried out by the homes staff and checked by their Human Resources department. The files were in need of urgent reorganising last year. There was an improvement this year but it was limited and this is still a requirement. The Registered Providers need to ensure that the Manager has sufficient assistance to get the files into good order. The organisation keeps the basic information on the computer, including information on Criminal Records Bureau disclosures. If the main files are to be kept confidentially, the basic information needs to be available for inspection at all times. We saw from the agency staff files that not all of the information has been obtained for the staff working recently. The Criminal Records Bureau disclosures were available but there was little or Care Homes for Older People Page 25 of 36 Evidence: no information on training. In some cases, there was a list of information but no dates of when the training had been carried out. The Manager was reminded that the home needs to ensure that they have the same information on agency staff as they have for their own permanent and bank staff. The Manager provided us with the matrix of staff training from the computerised records. The majority of staff had up-to-date basic training and bookings had been made for those who require the 4 day induction programme and refresher training. This includes moving and handling, first aid, food hygiene, fire awareness, COSHH, infection control and safeguarding adults. We found that staff were positive about the training on offer. We saw that the home has thirteen staff with National Vocational Qualifications training at Level 2. Although this is more than 50 of the permanent staff, it is not more than 50 of the staff working as many are bank or agency staff. Twelve of the staff have finished a course on dementia care and others have had dementia awareness training. Each member of staff undertakes an annual one-day update of the basic training courses, including manual handling. One of the staff is a manual handling trainer and is able to help train new staff before they attend the induction course. Care Homes for Older People Page 26 of 36 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. The home would benefit by having additional management staff in the dementia unit and a stronger senior team. Systems are in place for trying to ensure that people are kept safe and their health maintained but in some areas, these are not sufficiently monitored. Evidence: The Manager has been in post for two years and has previous experience of home management. She has been registered with the Commission for Social Care Inspection. She has a nursing qualification and the National Vocational Qualification Level 4. We found that the improvements we found at the April 2008 inspection have not been sustained in all areas. Since that inspection the Deputy Manager has moved to another home. The home had another Deputy Manager for a short period but at the time of this inspection there was no-one in the post. As the role includes overseeing the Care Homes for Older People Page 27 of 36 Evidence: dementia unit, we felt that the lack of a Deputy Manager has been instrumental in the shortfalls we found in the dementia unit. We did not find that the Team Leaders were always carrying out the tasks which the Manager had delegated to them, such as supervision. Some staff continue to be unhappy about working in the dementia unit and this does not help to enhance the support of the residents in the unit. We discussed with the Manager the importance of having a team of staff who wish to work in the unit and will work to provide a good quality of life for the residents. Because of the bed vacancies, the home has several bank staff and has not given permanent contracts. This was one of the reasons for not having a more permanent staff team in the dementia unit and this needs to be addressed. The last Residents meeting was held in May 2008. The Manager said that meetings with the residents and their families is useful but these need to be held more frequently to be effective. Staff meetings have been held but not very regularly. The home has a new administrator who had been in post for only a few weeks. We checked with her that the residents finances were still being kept in the same way as previously and she showed us a sample of the records. Two staff have to sign for withdrawals and we saw a record of this. Only a limited amount of money is kept for each person and this is for expenditure such as hairdressing, newspapers and toiletries. The money is paid through Shaw homes or brought in by residents families. Four people have their finances managed by the company and these are held in a joint account. We checked a sample of maintenance and servicing records. We found that there had been a check on the gas systems in March 2009, the boiler systems in October 2008, the extinguishers were checked in November 2008 and the water in March 2009. We saw that the homes insurance certificate is valid until the end of March 2009. The fire risk assessment was dated January 2008 and has not been reviewed. The information regarding the people living in the home and their capabilities had not been updated to take account of the changes in the home. This needs to be regularly updated. The Manager has not had training to compile a fire risk assessment which needs to be completed in accordance with current fire legislation, the Regulatory Reform (Fire Safety) Order 2005. We saw that the fire records are maintained satisfactorily and the battery operated devices which are fitted to all rooms are checked weekly. However, we saw that two bedrooms doors were being propped open with arm chairs which means they would not close in the event of a fire. The devices were working so there was no need for this. This was brought to the attention of the Care Homes for Older People Page 28 of 36 Evidence: Manager. We found on the first day of the inspection that the COSHH cupboard, containing potentially hazardous cleaning materials, was left unlocked in the dementia unit. This was brought to the attention of the staff on duty. Although we saw a large file of accident and incident reports, not all had been reported through Regulation 37. We discussed with the Manager that the staff need to be aware of when they must report to the Commission for Social Care Inspection. It was also noted that no analysis of the accidents had been carried out although some information is kept in individual files. A number of falls have been recorded for some people and it needs to be seen clear records are kept and action is taken to try and prevent these. One staff said that the falls could be prevented by having additional staff on duty. Care Homes for Older People Page 29 of 36 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 30 of 36 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 4 12 The Registered Manager 31/05/2009 must ensure that the specialist needs of the people living in the home are being met by appropriate staff supervision and monitoring. That the outcomes for people with dementia, and other specialist needs, ensure a good quality of life is maintained. 2 7 15 The Registered Manager 31/05/2009 must ensure that care plans fully reflect the way in which the health and welfare of the person are being met. That the care plans are realistic and reflect the way in which the support is provided. 3 9 13 The Registered Manager 30/04/2009 must ensure that medication is stored safety and that people are not put as risk. Care Homes for Older People Page 31 of 36 To ensure the safety of people living in the home and raise staff awareness of safe storage. 4 9 13 The Registered Manager 30/04/2009 must ensure that medication monitoring systems are maintained. To ensure peoples medication has been given and the monitoring systems are robust. 5 12 16 The Registered Manager 31/05/2009 must ensure that people have the opportunity to go out of the home on a regular basis where they wish to do so. That people have the opportunity to go out of the home regularly. 6 15 16 The Registered Manager must ensure that the meals provided are varied and meet cultural and dietary needs. That everyone has the opportunity to have a good choice of meals with varied and suitable alternatives. 7 19 23 The Registered Providers 31/05/2009 must ensure that the where the smell of urine cannot be eradicated, the carpets must be replaced. To ensure people live in a pleasant environment. 31/05/2009 Care Homes for Older People Page 32 of 36 8 19 23 The Registered Providers must ensure that maintenance work is carried out as required on the radiator covers, doors and paving slabs. To ensure that people live in a safe environment. 31/05/2009 9 25 23 The Registered Providers must ensure that each room has a satisfactory heating system. To ensure that people have appropriate heating in the bedrooms. 31/05/2009 10 26 23 The Registered Providers must ensure that the laundry room can be maintained in a hygenic condition and is refurbished as required. To ensure that good infection control can be maintained in the laundry. 30/06/2009 11 27 17 The Registered Manager must ensure that the rota is maintained accurately and shows the staff actually working. That an accurate assessment can be made of the staffing levels. 30/04/2009 12 29 17 The Registered Manager must ensure that all of the recruitment records for permanent and agency staff are maintained in accordance with the Care Homes Regulations 2001. 30/04/2009 Care Homes for Older People Page 33 of 36 So that people are protected by good recruitment and employment procedures. 13 36 18 The Registered Manager must ensure that all staff have the opportunity for regular supervision with their managers and that systems are in place to monitor that this happens. To ensure that staff are supported. 14 38 13 The Registered Manager must ensure that staff are aware of their health and safety responsiilities and take action when people are put at risk. To ensure that people living and working in the home are kept safe by good health and safety practices. 15 38 23 The Registered Manager 31/05/2009 must ensure that the fire risk assessment is uop-todate and regularly reviewed, taking into account the needs of the people currently living in the home. To ensure people are protected by the fire precautions. 30/04/2009 31/05/2009 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 Care Homes for Older People Page 34 of 36 1 16 That the meetings for people living in the home, and their representatives, are held more regularly to ensure that people have the opportunity to raise their concerns. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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