Inspection on 18/11/08 for Kimblesworth Care Home

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Adequate 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

Kimblesworth Care Home 24/01/07

Kimblesworth Care Home 27/01/06

Kimblesworth Care Home 29/07/05

Kimblesworth Care Home 08/12/04

Kimblesworth Care Home 21/07/04

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: Kimblesworth Care Home Elm Crescent Kimblesworth Chester le Street County Durham DH2 3QJ     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: Kathy Bell     Date: 1 8 1 1 2 0 0 8 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (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 30 Information about the care home Name of care home: Address: Kimblesworth Care Home Elm Crescent Kimblesworth Chester le Street County Durham DH2 3QJ 01913712259 01913712489 kimblesworth@mentalhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mental Health Care Name of registered manager (if applicable) Paul Satterthwaite Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Kimblesworth Care Home is a converted school in a small village on the outskirts of Durham. It is run by a registered charity Mental Health CARE. The home provides 24hour personal care (with nursing) for up to twenty service users with mental health needs and most are over sixty-five years of age. Accommodation is provided on two levels, with a choice of lounges and dining room and other quiet areas for use by the service users. The home has six double bedrooms and eight single bedrooms. The home employs registered nurses, care staff, domestic staff and kitchen staff. 20 Over 65 20 care home 20 Care Homes for Older People Page 4 of 30 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: This inspection took place during one day in November 2008. It was the key, unannounced inspection planned for this year: the last inspection took place on 27 January 2007. For part of the day, an expert by experience visited the home as well. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits the service with an inspector to help them get a picture of what it is like to live in or use the service. The manager completed and returned an Annual Quality Assurance Assessment (AQAA). The AQAA is the services self-assessment of how they think they are meeting the National Minimum Standards. This information was received before the inspection and was used as part of the inspection process. During the inspection, we looked around the building (although not in every room), Care Homes for Older People Page 5 of 30 looked at records and spoke with five people who use the service and three staff. After the inspection we spoke with two care managers who were responsible for some of the people who live in the home. 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 the service are not being put at risk of harm. In future, if the requirement is repeated, it is likely that enforcement action will be taken. The weekly fees are 411 Pounds, which covers personal care and accommodation. 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. 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 –03000 616161. Care Homes for Older People Page 7 of 30 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 8 of 30 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 home obtains information about possible new people so it can make sure it will be able to meet their needs. Everyone has a contract which sets out how much their care costs. Evidence: The records of the last person to be admitted showed that the home had obtained an assessment by a care manager and information from a hospital. In the AQAA, the manager said that the home also completes its own comprehensive assessment before anyone is admitted. There was an up-to-date contract, setting out how much had to be paid and what was included in this, in the file of this person. The manager said that everyone has a contract now. Care Homes for Older People Page 9 of 30 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. Each person has a care plan which describes in detail the care they need and what staff must do for them. The record showed monthly reviews but staff had not always actually updated these, just seemed to do so. This meant that the monthly summary included wrong information. But the home has other systems to share information between staff, to keep them up-to-date. Healthcare needs are well met and the home generally looks after medication in a safe way. Staff showed that they understand the need to respect peoples privacy and dignity. There are still four shared rooms,which reduce privacy and dignity, but residents said they did not mind. Evidence: We looked at the care plans of four of the people who live in the home. These included details of each persons needs and what staff needed to do to meet these needs. They covered the help each person needed with healthcare and personal care, including if particular care was needed to avoid pressure sores, and if they had special dietary needs. There were guidelines for helping a resident who had Type 2 diabetes, and needed care with his diet and monitoring. Where people needed help to move around Care Homes for Older People Page 10 of 30 Evidence: or to get in the bath, there were moving and handling assessments which set out what help was needed and what equipment must be used. There was also an assessment of whether someone could smoke without supervision. Care plans also considered peoples needs for activities. These would be better if they included records of discussions with each person about what they wanted to do and details of whether the home had helped them do what they wanted. The care plans are kept on a computer system and each month, one of the nursing staff completes an updated summary of how the home is meeting that persons needs and what further action is needed. But in three of the files, the monthly evaluation was just a copy of the previous months. Checking with the daily records showed that there had been changes and the previous evaluation was no longer correct. An example was that the evaluation seen on this visit in November said someone had enjoyed a trip to Durham when their last visit had been at the end of August. For another person, the evaluation talked of a system of rewards for carrying out his own personal care but the manager confirmed that this had not been correct for several months. This is bad practice because it gives the appearance that care plans have been properly reviewed and updated when it has not actually happened. Staff described systems in the home which made sure that staff were always kept up-to-date with any changes, but care plans are a legal requirement and as such must be kept up-to-date and accurate. During the visit, we saw one lady who seemed quite agitated. The staff who were asked, all knew what was upsetting her. But this information was not in the care plan. As well as a list of tasks which staff need to carry out to support people, care plans should also include information about each person, their lives and wishes and what is important to them. In the surveys, when we asked people who live in the home, Do you receive the care and support you need?, two said always and one said usually. All those who replied said that they always received the medical support they needed. One person said that he was not looked after too bad. He said that staff always leave the call system buzzer within his reach and they can come to help him reasonably quickly when he buzzes. He said that they know his preferences, for example, that he likes a bath not a shower. Another resident confirmed that he is looked after and staff pay attention to his health. A care manager who had recently reviewed a resident, with him and his relative, said that both were happy with the care he received. Staff keep clear records of any medical attention, which doctor was seen and the advice or treatment given. Records show that staff take particular care in maintaining healthy skin. In the medication room, staff keep a list to remind them when people need regular blood tests. Although the responsibility for arranging blood tests lies with Care Homes for Older People Page 11 of 30 Evidence: the prescribing doctor, it is right that staff make sure people receive the regular monitoring they need. The home seems to have a generally safe system for storing, giving out and recording medication. But when staff wrote out the sheets they used to record medication given, they were changing the instructions for administration of medication from the English used on the pharmacy label into Latin. The nurse I spoke to did not think this would be a problem and was sure that any nurses would know what the Latin terms meant. The only other thing wrong was that staff had not always recorded when creams or eye drops were opened, so they could discard them when they were out of date. One person who lives in the home looks after their own medication. This shows that staff do consider whether people can take responsibility for their medication themselves, to be more independent. The manager said that the Health Authority pharmacist had recently inspected their medication systems and found them satisfactory. Discussions with staff showed a good understanding of the need to respect peoples feelings and dignity. A care worker explained how they had looked at the help someone needed to eat, and accepted he did not want to use a special feeder cup. One member of staff also showed she appreciated people living in the home were individuals, with distinct needs and personal qualities. The home still has four double rooms. Sharing a bedroom limits privacy and dignity. But some people who shared said to the Expert by Experience that they did not mind sharing, its company. There were six double rooms in the past, but as people have moved on, two have been changed into single rooms. Care Homes for Older People Page 12 of 30 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. People who use this service take part in different activities according to their interests, with staff arranging activities inside the home and trips out. But the home must do more to clearly identify individuals wishes for social activities and monitor whether they are successful in meeting these wishes. People have been able to maintain family relationships and have friends outside the home. Some people who use the home seem to be able to make decisions about their daily lives, but others are less able to do this. Staff have not always recognised when they are restricting someones liberties and the legal safeguards they should consider when doing so. The meals are appreciated by residents and special diets are catered for, but healthier choices should be available. Evidence: Some people who use the service can go out independently. Some go to local church services, or shopping or to meet friends. One was planning a trip to Edinburgh. Some people have been able to take part in short holidays in the Lake District. People told the Expert by Experience about planned trips to Chester-le-Street and the Metrocentre for Christmas shopping. There was a board in a room used partly as a staff room which showed regular, at least monthly, events for special occasions, such as bonfire night Care Homes for Older People Page 13 of 30 Evidence: and Halloween. Information about events should be shown where all residents will see it. It was difficult to judge how well the home provides activities on the day because a training session had been arranged for that afternoon for staff, taking up their time and one lounge. Two people mentioned occasional karaoke evenings with wine but, in general, the Expert by Experience did not get the impression from residents that there were a lot of day-to-day activities within the home. Records kept in the home for one resident recorded that in the month of September he took part in games, cards, drawing, karaoke, social nights, a birthday party and informal games of cricket outside a few times. Staff said that they can take people out when they ask to be taken somewhere. Some older, less mobile residents prefer to spend their time in their rooms with TV and videos. One lady spends time in her own small sitting room. One care plan did say that staff should try and find out what activities that resident would like. But there wasnt a clear way of recording what each person liked to do, and if they had been able to do it. In the surveys, when asked, Are there activities arranged by the home that you can take part in?, three said always and two said usually, one mentioned social evening, bingo, karaoke. Residents can have visits from family members and some can maintain friendships with people from outside the home. When this care home opened, it provided care for a group of people who had previously been residents in longstay hospitals. Their experience of day-to-day life in a hospital setting means it is likely that they were accustomed to having their choices limited by routines. Now Kimblesworth is also home to people who have been used to living in the community and have different expectations, but records showed that staff know they need to continue to encourage people to express their wishes. The Expert by Experience noticed that all the residents who smoked went for a smoking break at the same time. This looked institutional, but the manager explained that residents need to limit how many cigarettes they smoke so they will not run out, and there are risk assessments explaining why people need supervision while they smoke. It would be impractical for staff to try and monitor when each person last had a cigarette and would mean each resident had to go to the office to collect a cigarette. If everyone smoked at different times and needed staff with them, it would also expose staff to passive smoking in the smoking room more often which is not unacceptable. It would be good practice to review again whether each person needs this level of supervision, because if fewer residents needed supervision, a more flexible and dignified system might be possible. Residents can take part in community meetings in the home and some said to the Expert by Experience that they thought they contributed to decisionmaking in these meetings, although they could not think of examples of what had changed. In the surveys, three out of five people said they could choose what they wanted to do in the day or at weekends but two said they could not. One person put in Care Homes for Older People Page 14 of 30 Evidence: the survey that he would like to go to Durham on his own. He repeated this to the Inspector during this visit. The manager said that they needed to assess if he could do this safely but the resident had refused to go when staff had offered to take him. But there were no clear records to show how often staff had offered this and how he had responded, so that staff could consider what to try next to meet his wishes. A record showed that on one occasion, staff had brought him back to the home because they believed he would be in danger on a busy road. When staff in a home feel that it is in someones best interests to have their liberties restricted, to keep them safe, they should, with the involvement of the care manager and anyone else who can represent the interests of the resident, an independent advocate if appropriate, look at the persons capacity to make the decision. If they do not have the capacity to make the decision, staff should look at the least restrictive option, which meets the persons wishes as far as possible. The home does have a formal policy (Privacy and Dignity guidelines) which states that Where the independence of the service user is restricted for whatever reason, a full explanation will be given, all actions documented and regularly reviewed. As far as practicable individuals are free to come and go as they please. In this case, the home does not appear to have followed these guidelines. In the surveys, four people said they always liked the meals and one said they usually did. The Expert by Experience talked to residents about the food and said they greatly appreciated it. One said , The chefs are good and we get to choose what we have to eat. There is a good choice (variety) and breakfasts are a mixture of cooked or cold, whatever we want. People said that the portions are generous. Care plans show that staff consider when people have special dietary needs. But the records of meals actually provided showed that the cooks often did not follow the planned menus but provided meals which were more likely to include chips and less likely to include green vegetables and more healthy options. Following the inspection, the manager has explained that staff had not been recording the vegetables provided. Care Homes for Older People Page 15 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has satisfactory procedures so that people can complain and are protected from abuse. But staff need to do more make people aware of the procedure and to treat some comments as complaints even if a resident cannot describe their dissatisfaction as a complaint. Evidence: The information on complaints included in the pack given to people who use this home is the complaints procedure provided for staff, not people who live in the home. The manager produced some leaflets which were well-written and explained to residents how they could complain and how complaints would be responded to. He thought that these had been given out two or three years ago but they were not left out in an area of the home where everybody would see them. In the surveys, most people knew how to complain and who to speak to if they were not happy. But when staff had helped one person living in the home complete a survey, they had written down for him comments which clearly showed he was unhappy about an aspect of his care. They should have treated this as a complaint, bearing in mind that not everyone is able to say if they are unhappy about something in a formal way. The home has proper procedures to respond to any suspicions of abuse of residents and staff were having refresher training on how to recognise abuse and what they should do, on the day of inspection. An ex member of staff made allegations of poor treatment of residents nearly 2 years ago. Social services and health care Care Homes for Older People Page 16 of 30 Evidence: professionals investigated these concerns and were satisfied with the care provided. Another staff member alleged abuse by this ex member of staff and the manager recognises that he failed to refer these concerns to the relevant authorities as promptly as he should have. The home protects people by carrying out checks on new employees, to make sure there is nothing in their history which would make them a risk to vulnerable people. There is not a policy about residents who may wish to have sexual relationships. Staff need to have guidance in this area so that they can respect peoples rights but also be aware of the need to protect more vulnerable residents. Care Homes for Older People Page 17 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable, clean and safe place to live, which meets peoples needs in most ways. The only drawback is that there are still four double rooms. Evidence: The home is a converted building at the edge of a small village, surrounded by a large garden. Downstairs, the home has one large lounge and two smaller seating areas, and the dining room. There are four double bedrooms and the rest are singles. Some of the singles are large rooms, because they used to be doubles, but others are much smaller. The manager said that the company is committed to reducing the number of doubles in use but this only happens when someone leaves the home. Toilets and bathrooms are provided around the building and adaptations and equipment are available for less mobile people. People who live in the home can use their own possessions to make their room personal and those who are less mobile have chosen to have large TVs in their rooms. The home has made available a small lounge for a lady who has a lot of ornaments and other possessions, because otherwise she could not fit them into her half of a shared room. The building is decorated and furnished in a satisfactory, domestic style. The owners Care Homes for Older People Page 18 of 30 Evidence: have carried out maintenance as necessary, replacing the kitchen flooring in the last 12 months and responding to the requirements made in a recent inspection by the fire officer. In the surveys, four residents said the home was always fresh and clean and one said it usually was. Care Homes for Older People Page 19 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from a trained and experienced group of staff. Staffing levels seem satisfactory but need to be reviewed as the needs of people who use the service change and as social needs are identified. The home recruits people carefully to avoid employing unsuitable people. There is a training programme but not all the staff had completed all essential training. Evidence: The staffing rota showed that the home provides a nurse qualified in mental health on duty at all times, as it is required to do. Also, there are three care staff on the morning to mid-afternoon shift, two on the mid-afternoon to bedtime shift and two on duty at night. Many of the residents do not need help with personal care but may still need prompts and guidance, according to the manager. As time has passed, some of the original residents have grown older and need more care and support. One of these did confirm that the staff were able to come promptly when he used the call system to buzz for help. The staff we spoke to felt that they did have enough time to look after residents. One said that they were able to respond to requests from residents for a member of staff to go out with them within a few days at most. But staffing levels will need to be reviewed once staff have a clear picture of individual needs for social activities. They also need to be kept under review as residents needs change. Care Homes for Older People Page 20 of 30 Evidence: Residents have praised the staff-one told us that the staff were good, kind, and they told the Expert by Experience that staff were really nice and helpful. In a survey the home carried out in 2007 one comment was that the staff were friendly and patient. Care homes are meant to have at least half of their care staff qualified to the National Vocational Qualification in care at level 2, which is the recognised qualification for care workers. Kimblesworth has done much better than that because some staff have already completed level 3 and only one now needs to achieve level 2. We looked at the records of the recruitment of two staff. Both showed that the company had carried out the necessary checks, including obtaining two references and a Criminal Records Bureau/Protection of Vulnerable Adults List check before they started work. The home has a training programme so that people receive the training they need to work safely. This includes first aid, moving and handling, food hygiene, health and safety and fire safety. But not all the staff have completed all essential training. In the AQAA, the manager confirmed that 14 of the care staff, as well as catering staff had had training in safe food handling. We saw the records of the induction for new workers. Staff were receiving refresher training in the protection of vulnerable adults on the day of inspection. Care Homes for Older People Page 21 of 30 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 manager is experienced and qualified but does not seem to have enough hours available for his job. There are systems to review the quality of care, including finding out the views of residents, but these need to be improved. More care is needed to make sure the home is a safe place to live and work. Proper records are kept of money handled for residents. Evidence: The manager is a nurse who has specialised in mental health and has also obtained management qualifications so that he has the necessary skills and knowledge to run the home. He has run the home for about five years. But each week, for most of his working week he is the single nurse on duty on that shift. For only 7 1/2 hours a week he has hours set aside for his job as manager. He said that he is often not able to have these 7 1/2 hours. We would normally expect the manager of the home this size to have full-time hours devoted to their job as manager. The manager explained that one of the other nurses has taken on some of the duties of running the home, such as Care Homes for Older People Page 22 of 30 Evidence: making sure care plans are satisfactory, and also organising training. But this means that on some shifts, when she is the nurse on duty, she is taken away from work with residents to do these management tasks. In the AQAA, the manager identified some tasks which needed to be done, such as improving awareness of the complaints procedure. But by the time of the inspection, he had not had time to take action on this. He had not been aware that nursing staff had been failing to properly review care plans, but giving the impression they had on the records. He had not made sure that essential safety checks were carried out. Taken together, these things suggest that the manager does need more time to manage the home. The company might consider whether some administrative support would help. The home does have a quality assurance system with surveys of residents and relatives views. The last survey was carried out in the summer of 2007 so another is due. The home should also seek the views of care managers and other people responsible for the care of residents. The surveys should help the home produce an annual development plan which would describe any improvements they need to make. The manager confirmed in the AQAA that he knew they needed to work on a development plan. But the company does not seem to have had sufficient oversight of the home because the false reviews of the care plans were not noticed. The company carries out a three-monthly health and safety audit in the home. In the AQAA the manager confirmed that equipment is regularly serviced and maintained. There is a fire safety risk assessment, so the home has considered how fires could start and what action they need to take. The record of fire drills showed that not all of the staff had taken part in a fire drill within a six-month period, as they should do. We looked at the records of the fire safety checks which should be done weekly. The record of recent checks showed that they had been done on 11th August, 1st September, 9th and 20th October. Also the record did not show clearly that when the fire alarms were set off, the person checking them also checked whether fire doors shut correctly. During this visit we found that two of the bedroom doors did not close correctly (probably because of recent work on the doors). The temperature of hot water at taps used by residents was checked every month but the record showed in some cases the temperature was rising, with no indication of what action had been taken about this. The manager explained that these checks are now carried out by a maintenance team used by the company. We saw the records kept of any money handled for residents, which included keeping receipts to account for money used. This system was satisfactory. Care Homes for Older People Page 23 of 30 Care Homes for Older People Page 24 of 30 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 25 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be kept up- 08/02/2009 to-date. Care plans must be up-todate so that staff have the correct information they need to look after people. 2 12 16 Staff must identify and record each persons needs and wishes for recreation and social activities and record if they are meeting them. Staff need to know what each person needs and wants to be sure they are meeting their needs and wishes. 09/03/2009 3 14 12 Staff should identify when 09/02/2009 they are restricting anyones freedom and, if appropriate, take action in accordance with the Mental Capacity Act Deprivation of Liberty Safeguards Regulations. This will enable the home to Care Homes for Older People Page 26 of 30 respect peoples human rights and ensure they have advocacy services if necessary. 4 15 16 Staff must provide more healthy options at mealtimes. This will help residents have a nutritious diet. 5 16 22 The home must make sure 09/02/2009 that people who live there are aware of their rights to complain and how complaints will be responded to. Copies of the complaints leaflet should be given to the relatives of anyone who would not be able to make use of the complaints procedure by themselves. Staff must treat it as a complaint when someone is saying they are not happy about something, even if they do not actually call it a complaint. People living in the home need to be aware of their rights to complain. Some people may not be able to express their dissatisfaction as a formal complaints. 6 19 12 When one person moves permanently out of a double room, the owners must convert the double to a single. This is essential to promote the privacy and dignity of people who live in the home. 14/01/2010 09/02/2009 Care Homes for Older People Page 27 of 30 7 31 8 The owners of the home 14/03/2009 must make sure the manager has enough time to do his job properly. For the home to be well-run, the manager must have enough time to do his job. 8 33 24 The owners of the home 14/03/2009 must consider the results of surveys and develop a formal review of the quality of the care they provide. This should include a plan to make any improvements seen to be necessary The home must review the quality of care to make sure it is providing the service people expect. 9 38 13 Regular checks of the fire 30/01/2009 safety system and hot water temperatures must be carried out, and appropriate action taken and recorded when necessary. All staff must take part in regular fire drills. To reduce the chance of any accidents to residents. Staff must take part in fire drills so they are familiar with what to do if a fire starts 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 Care plans should include information about individuals, Page 28 of 30 Care Homes for Older People their lives and what is important to them. 2 27 Staffing levels should be reviewed as peoples needs for leisure and social activities are reviewed, and as people grow older and more frail. Care Homes for Older People Page 29 of 30 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!