Inspection on 07/01/10 for Kingfisher Residential Care Home

This inspection was carried out on 7th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingfisher Residential Care Home 02/06/10

Kingfisher Residential Care Home 01/04/10

Kingfisher Residential Care Home 10/03/09

Kingfisher Residential Care Home 06/11/07

Kingfisher Residential Care Home 01/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Kingfisher Residential Care Home 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Catherine Perrins     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Kingfisher Residential Care Home 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET 01933623028 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): kingfisher.r.h@hotmail.co.uk Kingfisher Residential Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: No one falling within category DE(E) should be admitted to The Ferns Care Home where there are 27 persons within the category of DE(E) already accommodated The 5 persons identified in correspondence dated 2nd December 2004 who fall within the category of OP may continue to be accommodated at The Ferns Date of last inspection Brief description of the care home Kingfisher Care Home is registered to provide personal care to 27 older people, most of who have needs relating to dementia. The home is privately owned and is situated in the market town of Raunds, Northamptonshire, close to a range of local amenities. The home is on two floors and has a passenger lift and a stair lift. Single bedrooms and double rooms are provided, and there are four separate lounge/dining rooms. All of the roome are of domestic size. Care Homes for Older People Page 4 of 34 Over 65 27 0 1 0 0 3 2 0 0 9 Brief description of the care home The homes statement of purpose and service user guide (which provides information on the range of facilities and services available at the home) is made available to prospective residents and their representatives. The range of fees as from 1st April 2009 is £355 to £381 per week. The actual fee is dependent on the persons assessed needs and the type of room occupied. Additional costs would include external services such as chiropody and hairdressing. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero stars. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for people using the service. As part of the preparation for this inspection a period of four hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection. This included: The previous key inspection and the results of any other visits that we have made to Care Homes for Older People Page 6 of 34 the service in the last 12 months Information we have about how the service has managed any complaints. Details of a serious incident which occurred at the home in December 2009 and lead to a safeguarding adults investigation led by the Local Authority and the Police. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Relevant information from other organisations. The inspection visit lasted for 15 hours and was conducted over two weekday morning and afternoons. Two inspectors carried out the inspection. During the inspection two people were case tracked. This involves looking in detail at all aspects of their care and experiences at Kingfisher, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with dementia are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. During the second day of inspection as we felt that there had been a possible breach in the Care Home regulations relating to the recruitment of staff who work in the home we served a Code B notice to the registered provider. This notice is issued in accordance with the Police and Criminal Evidence Act 1984 and explains our powers and rights. Records were copied and seized during the inspection and this evidence considered in relation to possible enforcement action. Following the inspection we issued a statutory requirement notice to the home in relation to the breaches identified. The acting manager was present for some of the first day of inspection and all of the second day. The registered owner was present for the second day of the inspection at the request of the inspectors. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The home does not have a registered manager. The current acting manager told us that she is intending to register with the Care Quality Commission as the manager for the home. Some of the staff working in the home had not had the necessary pre recruitment checks prior to working in the home. This issue had been raised with the home prior to Care Homes for Older People Page 8 of 34 the inspection but action was not taken to ensure that the required checks were carried out. Some of the information in the Statement Purpose is not accurate, for example it states that most staff have received training in person centrered dementia care. Training records seen showed that less than half of the staff have had training in dementia care. Where people have pressure areas / sores records do not show when these healed. Advice from medical practitioners is not consistently included in peoples care plans. Assessments and care plans for people who are at risk of falling do not give specific advice to staff on how to reduce the risk of them falling. Staff have not received training in key areas of work that they need in order to care for people safely and in a way that meets their needs. One person who lives at the home told us that the home I dont think there is enough staff for a dementia home. they went on to say that staff dont always come straight away when the emergency cord is pulled. Records show that the home is not consistently sending details to the Care Quality Commission of notifiable incidents as specified in the Care Homes Regulations 2001. The homes Annual Quality Assurance Assessment (AQAA) was returned to the Care Quality Commission late. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move to Kingfisher but some of the information that they are given about the home is inaccurate which could mean that people move to the home without full knowledge of the service and facilities provided. Evidence: The home has a statement of purpose and service user guide which give people information about the home and the services it offers. These are used in the admission process, to give information to prospective people coming into the home. Some of the information in the Statement Purpose is not accurate, for example it states that most staff have received training in person centrered dementia care. Training records seen showed that less than half of the staff have had training in dementia care. Records show that peoples needs are assessed before they move to Kingfisher to make sure that the home is right for them. People had copies of their contract in their Care Homes for Older People Page 11 of 34 Evidence: individual files but the two that were seen had not been signed by the person or the home. The manager explained that people are able to visit the home before they move in to help them decide if it is the right move for them. One person told us that her family visited on her behalf before she moved in. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who generally have a good understanding of their needs but care plans and assessments are not consistently detailed to ensure that staff have all of the information that they require to care for Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to care for people in the right way. Care plans seen covered areas such as communication, eating and drinking, personal care, mobility, health and continence. One person told us that staff talked to her and asked her questions to get information to include in her care plan. Care plans seen reminded staff of the need to treat people with respect and dignity. As well as their care plans people have morning and evening routines in their individual plan of care file. These are detailed and give information such as what time people liked to get up and go to bed, whether they want a drink before they went to bed and how many pillows they like at night. Records also include a living history these contain information about their families, hobbies and interests, religion and likes and dislikes. Care Homes for Older People Page 13 of 34 Evidence: One person told us I like it here. Its good, I am well looked after. Records show that people have been assessed to find out if they are at risk of developing pressure sores. Where it was identified that there was a risk the home seeks advice from the district nurses and there is evidence of measures being put in place to reduce the risk such as provision of specialist equipment, and helping people to change position regularly. One person was observed to be wearing a protective bandage but their care plan did not detail how staff should be caring for them to reduce the risk of pressure sores. Records for one person who had a pressure sore, which the acting manager stated had healed, did not detail when the sore healed. The home uses body charts to record when and where people develop any sores, bruises or other marks. Entries for several different dates are made on the same body chart which makes it difficult to see if the sores or marks have healed or deteriorated. A recommendation regarding this was made following our last key inspection which has not been met. Records show that advice given by health proffessionals is not consistently included in peoples care plans. For example the record of a consultation one person had with their general practitioner detailed that the person was advised to sit with their feet elevated on a stool. Observation of person showed that this advice was being acted on but, their was no reference to this advice in the persons care plan. A requirement was made regarding this following our last key inspection and, although there is some evidence of improvement the requirement has not been fully complied with. Records show that assessments and screening tools are used to assess people for the risk of falls, moving and handling and nutrition. The assessments and care plan for two people who have been identified by the home as being at risk of falls, and who have had previous falls, did not detail what staff should do to reduce the risk of them falling. The risk assessment for one person using the stairs states staff are aware of safety when mobilising on the stairs. but does not detail what staff need to do to ensure the person is safe on the stairs. Relying on staff solely on knowledge could cause difficulties for new staff or staff with less experience and could lead to unsafe practice. Accident records detailing two occasions where one person had fallen stated that the person vomited after one fall and became a bit sleepy after another fall. Records show that staff continued to check on the person on a regular basis but there was no record of medical advice being sought despite vomiting and appearing sleepy being possible indications of concussion. Staff training records show that only three Care Homes for Older People Page 14 of 34 Evidence: members of staff have up to date training in first aid. The care plan for one person who has dementia advised staff that they should offer reassurance but did not give further details of how to support the person in relation to their dementia. This is important because the home is registered to take people with dementia but less than half of the staff have received training on how to care for people with dementia. The administration of medication is generally well managed with all entries on the medication record being signed to show that people are receiving their medication as prescribed. Records show that medication is entered onto the medication administration records when it arrives at the home and there is a clear audit trail to ensure that all medication is accounted for. Where people are prescribed to take their medication as required there are guidelines in their care plan to inform staff how and under which circumstances this medication should be taken. Prescribed creams had not been dated when opened which is necessary to ensure that they are used within the time specified by the manufacturer. During the inspection one person who lives at the home indicated that they were in pain. Staff responded promptly, showing care and sensitivity by offering the person reassurance, pain relieving medication and by helping them move to a more comfortable chair. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A limited range of activities within the home and community mean that people do not have regular opportunities to participate in stimulating and motivating activities. Evidence: Lunch was observed during the inspection. Staff were seen assisting people in sensitive manner, talking to them and explaining what the food was. People gave us mixed feedback on the food, two people told us that the food is good. Another person said that it was not always very good. The cook explained that their is generally one choice of main meal but that people can have something else if they do not like what is on the menu. During the inspection one person told the staff that she did not like the food that she was served. The staff member immediately offered the person an alternative meal. Activity records show people talking, reading, having visitors, and seeing the hairdresser. The home employs an activity co-ordinator to work in the afternoons. The activity co-ordinator was not in work at the time of the inspection. Staff told us that they found it difficult to do activities because of their other responsibilities to ensure that people receive the care they require. During the inspection people were observed watching the television and reading. No organised activities were observed. The home Care Homes for Older People Page 16 of 34 Evidence: has an activities room which had some handmade Christmas cards and other craft items on display. The manager explained that one person had now been taken off the staff rota to enable her to spend time going out with the people who live in the home. Staff explained that they held a raffle at Christmas and had a jar to save money to take people out on a day trip in the summer. Care Homes for Older People Page 17 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Unsafe recruitment practice and limited staff training mean that people are not adequately safeguarded. Evidence: Staff files show that not all staff had the necessary pre recruitment checks before they start working in the home. This puts the people who live there at risk as the home could be employing staff who are not suitable to work with older people. More details about this are recorded in the staffing section of this report. The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. A copy of the complaints procedure is displayed on the notice board in the hall. The manager said that the home has received five complaints since the last inspection. Records show that these were investigated by the home using their complaints procedure and resolved within the specified timescales. Two alerts have been made about the home to the Local Authority under the locally agreed safeguarding adults procedure. One alert was made by the home and concerned one of the residents losing a personal possession. The other investigation concerned a serious incident that occurred in December 2009 at the home. This incident was investigated by the Local Authority and the Police. Care Homes for Older People Page 18 of 34 Evidence: Staff spoken to were aware of how to raise any concerns that they may have. Peoples individual plans of care contained an assessment of their mental capacity.These assessments did not state the decisions that the person was being assessed for or detail how the assessment had been carried out. The Mental Capacity Act 2005 sets out how peoples capacity should be assessed and states that any assessment of a persons capacity must relate to a specific decision. Records for one person who lives at the home state that a relative has power of attorney. It does not state whether this is for financial or health and welfare matters which could result in the wishes of the person not being respected. The home has not made any applications to the Local Authority under the deprivation of liberty safeguards and observations made during the inspection suggest that people are able to move around the home freely and do not have any restrictions placed on them. Care Homes for Older People Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a homely environment. Evidence: Kingfisher consists of two former terraced properties which have been converted into one home. The downstairs of the property is divided in two by a covered driveway, with two of the lounges, a communal bathroom, the activity room, kitchen and office on one side and two bedrooms, a lounge and the laundry room on the other side. The majority of people use one of the two lounges in the main part of the building. There is a fourth lounge on the first floor. Each of the lounges has a small dining area. The lounge areas have been made homely with pictures, ornaments and plants and are domestic in size. The upstairs lounge area and the lounge away from the main part of the building have call bells so that people can call for staff if they need them. There are no call bells in the lounges in the main part of the building which mean that if staff are in another part of the building people sitting in the lounges are unable to call staff should they require assistance. The home is showing some signs of wear and tear with some chips in the paint work, tears in the wall paper and stains on the carpets. A number of repairs required were noted in the homes staff communication book. Staff told us that the majority of these had been carried out and that repair work happened more quickly since the current Care Homes for Older People Page 20 of 34 Evidence: acting manager took up her post. The first floor of the property is accessed by a passenger lift, stair lift or stairs. The home currently has one double bedroom with the other bedrooms all being single occupancy. All of the bedrooms have a hand basin and six have en suite facilities. People told us that they were able to bring in photographs, ornaments and other items to make their bedrooms feel more personal. Some of the radiators in the home did not have covers and there was no record of the risks to people burning themselves from the uncovered radiators having been formally assessed. The hot water in the downstairs bathroom was noted to be very hot. Staff said that the checked the water temperature by hand not a thermometer when people bathe. The acting manager stated that there was not a device fitted to that bath to regulate the hot water temperature as there is in the other bathrooms. There was no record of the risks of people scalding themselves having been assessed or of any instruction to staff about how to ensure that people are bathed safely. The acting manager stated that the home did have a thermometer which would be used in future to check the temperature of the bath water. Care Homes for Older People Page 21 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having a committed and caring staff team but unsafe recruitment practice and limited staff training put peoples safety at risk. Evidence: Records show that not all staff had the necessary pre recruitment checks, such as references from their previous employers and Criminal Records Bureau checks, before they start working in the home. We looked at staff recruitment records for three staff members and the acting manager to see how their suitability to work with vulnerable people had been assessed. The Care Homes Regulations 2001 requires that certain checks are carried out to help determine this. The checks include obtaining written reasons for leaving any post involving work with Children or vulnerable Adults, checks against the Protection of Vulnerable Adults (POVA) register, or with the Independent Safeguarding Authority (ISA) who have taken on the responsibility of managing the list of people found to be unsuitable to work with vulnerable adults. A criminal record bureau disclosure check and references from previous employers are also required. We found that staff had been employed and were working with vulnerable people without all of these necessary checks having been carried out. Following a previous inspection a requirement had been made regarding pre recruitment checks, so due to this continued breach of regulations, we issued a statutory requirement notice to the home following this visit. We issue a statutory requirement notice if there is no acceptable response to a previous requirement or if there is serious risk to people who Care Homes for Older People Page 22 of 34 Evidence: use the service. The registered owner told us that not all of the people who work in the home have a written job description to tell them what their main duties are. Staff training records show that staff have not received all of the training that they need to do their jobs safely and correctly. For example the latest training record shows that none of the staff have completed training in health and safety, only three staff have up to date first aid training, less than half of the staff have had training on infection control and less than half of the staff have had training on dementia. The majority of staff have had training on moving and handling and using a hoist. During the inspection staff told us that two staff members were helping people sit in chairs in the lounge. The training record for one of the two staff showed that they had not been trained in moving and handling or using a hoist. This puts the people being hoisted or moved and the staff member at risk of being injured. One person who lives at the home told us that the home I dont think there is enough staff for a dementia home. they went on to say that staff dont always come straight away when the emergency cord is pulled. In a survey completed by the home in March 2009 one staff member commented due to staff cut backs we are trying our hardest to give all our full care to residents. A relative commented There are times, especially at weekends that there are insufficient staff to meet the residents needs. Staff rotas show that there are two care staff working during the day and at night. At the time of inspection there were twelve people living in the home. Staff explained that three of the people living in the home need two staff to help them at certain times. The layout of the home means that people are on two different floors with the downstairs being divided into two separate buildings. Staff told us that they regularly check the people who chose to stay in their bedrooms or the lounge on the first floor and the people in the part of the ground floor away from the main building. Following a serious incident at the home in December 2009 the acting manager introduced new guidelines for staff handovers between the staff going off duty and the staff coming on duty. Observation of the staff handover showed that staff followed these new guidelines and passed on relevant information about each of the people who live in the home. Discussions with staff, and observations of how they interacted with the people living Care Homes for Older People Page 23 of 34 Evidence: in the home, demonstrated a commitment to the people who live in the home and a considerate approach to their care. Several of the staff have worked at the home for many years which provides consistency for people who use the service. The commitment of the staff team was demonstrated on the first day of inspection when it was noted that two staff members who were not on duty came in to work at short notice to cover shortfalls in the staff rota. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in management mean that the health, safety and welfare of people living in the home is compromised. Evidence: Kingfisher does not currently have a registered manager. The current acting manager has been in post since November 2009 and has stated that she will be registering with the Care Quality Commission. We discussed with the acting manager the registration requirements for all health and social care services for the new Health and Social Care Act 2008, coming into force next year. This further highlights the importance of the service having a Registered Manager. As detailed in the staffing section of this report we had concerns about poor recruitment practices of staff, which included the recruitment of the manager, who holds a very responsible position in the home. This demonstrates a lack of management and oversight of the care home. We have found it necessary to make requirements previously about staff recruitment and have also given reminders about Care Homes for Older People Page 25 of 34 Evidence: the expectations, during safeguarding vulnerable adults meetings. As a result of our concerns about recruitment practices and the risks this poses to people using the service, we seized evidence during the inspection, with a view to considering enforcement action. The home did not return their annual quality assurance assessment (AQAA) to the Care Quality Commission by the required time. The information provided by the home in the AQAA is brief and in places factually inaccurate. For example the AQAA states that all staff employed in the home have satisfactory pre recruitment checks when this is not the case. It also states that staff receive all statutory training and specific training as required. when records show that staff have not received all the necessary training. Staff told us that the acting manager had made changes and improvements since she started working at the home. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. Hoists and lifting equipment has been serviced as per manufacturers recommendations. Records show that the passenger lift had been out of use following a fault in September. There was no record to say that this fault had been repaired. Discussions with staff confirmed that the lift had been repaired within twenty-four hours of the fault and that any disruption to the people living in the home had been minimised. The acting manager told us that she was in the process of revising the current fire risk assessment and evacuation plan. Records show that the home carries out a satisfaction survey once a year. The results were viewed and were generally positive. One relative commented the atmosphere is more like someones home than clinical or institutional. Records show that the home is not consistently sending details to the Care Quality Commission of notifiable incidents as specified in the Care Homes Regulations 2001. Kingfisher was operating on low occupancy levels at out last key inspection and continues to do so. The Responsible Individual gave verbal reassurances during the inspection that the care home continues to be financially viable. Care Homes for Older People Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 19 (1) (i) paragraph 1 to 7 of schedule 2 The employment of a member of staff prior to receiving the CRB clearance must be only under exceptional circumstances and must be subject to the induction and supervisory arrangements stipulated in the Care Standards Act 2000. 30/11/2007 Care Homes for Older People Page 27 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 The registered person must 28/02/2010 notify the Care Quality Commission of any incidents or occurrences as specified in regulation 37 of the Care Homes Regulations 2001. To ensure that notifiable incidents are monitored. 2 12 Medical advice must be sought when people show symptoms of potentially serious injuries or conditions. To ensure the health, safety and welfare of all. 31/01/2010 3 12 Where people have dementia their care plans must detail how staff should care for them to meet their needs in relation to dementia. To ensure that people receive the appropriate care. 31/03/2010 Care Homes for Older People Page 28 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 12 Where people have been 31/03/2010 identified as being at risk of falling care plans must detail what staff should do to minimise this risk. To ensure that people receive the right care to reduce their risk of falling. 5 12 Where people are identified as being at risk of developing pressure sores their care plans must detail the actions that staff must take to reduce the risks of pressure sores developing. To ensure that people receive the appropriate care. 31/03/2010 6 1 4 The information in the homes statement of purpose must be accurate and reflect the services and facilities offered by the home. To ensure that people receive the correct information about the home. 30/04/2010 7 12 16 The home must provide a 31/03/2010 range of stimulating activities that reflect the interests and expectations of people living in the home. Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that people have opportunities for meaningful occupation. 8 17 12 Assessments of peoples 31/03/2010 capacity to make decisions must be completed in line with the Mental Capacity Act 2005 and accompanying code of practice. To ensure that people have their right protected. 9 27 18 The registered person must ensure that there are adequate numbers of staff on duty at all times to meet the needs of the people living in the home, taking account of the layout of the building. To ensure the health, safety and well being of all. 10 29 19 The registered person must 15/03/2010 put in place arrangements to ensure that, in cases where they are satisfied that persons can commence work at the home having received a satisfactory POVA First check or ISA Adult First check but, pending receipt of a satisfactory enhanced CRB Certificate, are subject to appropriate supervision and in particular that they 28/02/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action do not at any time during such period escort service users away from the care home unless accompanied by their nominated supervisor. To ensure that people living at the home are safeguarded. 11 29 19 The registered person must 15/03/2010 obtain in respect of all persons employed at the home all the relevant information and documents as required by Regulation 19 (1) (b) and paragraphs 1 to 9 inclusive of Schedule 2 of the Care Homes Regulations 2001 prior to them commencing employment. To ensure that all people working in the home are suitable to do so. 12 29 19 The registered person must 15/03/2010 put in place arrangements at the home to ensure that persons are not employed to work at the home until such time as all the relevant information and documents have been obtained as required by Regulation 19 (1) (b) and paragraphs 1 to 9 inclusive of Schedule 2 of Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the Care Homes Regulations 2001. To ensure that all people working in the home are suitable to do so. 13 30 13 Staff must receive appropriate training before being involved in moving and handling of people who live in the home. To ensure the safety of all. 14 30 18 Staff must receive the appropriate training to ensure that they have the skills and knowledge to care for people safely and in a way that promotes their health and well being. This should include health and safety, dementia, first aid and infection control. To ensure the health, safety and well being of all. 15 38 13 A risk assessment must be 28/02/2010 completed and appropriate action taken to minimise the risk of people being scalded from the hot water whilst using the bathing facilities. To ensure the health and safety of all. 31/07/2010 28/02/2010 Care Homes for Older People Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 16 38 13 A risk assessment must be 31/03/2010 completed and appropriate action taken to minimise the risk of people being burnt from hot radiators. To ensure the health and safety of all. 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 2 Each person who lives at the home should have a contract, signed by themselves or their representative, detailing the terms and conditions of their stay. Where someone is known to be at risk of falling the home should consider contacting the falls co-ordinator from the Primary Care Trust for advice. Creams, lotions and ointments should be dated when they are opened to ensure that they are used within the time specified by the manufacturer. Where people have given someone power of attorney records should state whether this relates to financial affairs and / or health and welfare decisions and should note any restrictions on the power. The call bell system should be assessed and action taken to ensure that it is accessible and adequate for purpose. A full assessment of the environment should be undertaken and a maintenance and cleaning plan drawn up to ensure that the home is well maintained and hygienic. 2 8 3 9 4 17 5 6 22 26 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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