Inspection on 28/01/09 for Kings Lodge

This inspection was carried out on 28th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kings Lodge Main Road Cutmill Chidham West Sussex PO18 8PP     The quality rating for this care home is:   zero star poor 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: Lesley Webb     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Kings Lodge Main Road Cutmill Chidham West Sussex PO18 8PP 01243573292 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): London Residential Healthcare Ltd Name of registered manager (if applicable) Mrs Michelle Shann Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 91. The registered person may provide the following category of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary needs on admission are within the following categories: Old age, not falling within any other category - (OP) Dementia - (DE) Date of last inspection Brief description of the care home Kings Lodge is a 91 bedded nursing home registered to provide accommodation to people of old age and dementia. The homes registered providers are London Residential Healthcare Limited. With Mr Ronald Alan Dixson registered as the Responsible Individual representing the company. Mrs Michelle Shann is the registered manager who oversees the day to day management of the establishment. Kings Lodge Care Homes for Older People Page 4 of 33 care home 91 Over 65 0 91 91 0 Brief description of the care home is situated in a quiet residential area of Chidham, West Sussex. The care home consists of two seperate buildings. One is a large, three-storey, purpose built establishment with the parking facilities to the front of the building and a garden area to the rear. There is a lift providing access between all the floors. There are large communal lounges and dining rooms along with seperate kitchen and laundry facilities. The second building is currently not being used to accomodate residents. The current fees for staying at the home range between three hundred and thiry seven pounds and seven hundred and fifty pounds per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the first key inspection we have undertaken at Kings Lodge since it was purchased by the present owners, London Residential Healthcare Limited. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The Registered Manager was present throughout the visit. During our visit we talked to five residents, four care staff and a nurse on duty. We also case tracked three residents care by examining their care records, looking at staff records and other documentation in the home. In addition to this we also looked at the care records of two other residents. We also looked around the home and indirectly observed interactions between residents and staff. Care Homes for Older People Page 6 of 33 Before our inspection the home sent us its Annual Quality Assurance Assessment (AQAA). At the time of writing this report we have received five residents surveys. Information from these is also included in this report. Information gathered from all of these sources was used when assessing if the home is meeting key National Minimum Standards, Regulations and outcomes for people living at the home. What the care home does well: What has improved since the last inspection? What they could do better: Management of this home is not meeting all the needs of residents safely in terms of care planning documentation, some medication practises, activities and staff training. Residents must have clear individual care plans describing the support that staff must give to meet identified needs. The registered person must be able to demonstrate through the homes records that residents receive where necessary, treatment, advice and other services from any required health care professional. A record must be maintained of all medication when it has been administered to residents. Sufficient stock of medication must be maintained in the home so that residents can have their medication as directed by the prescriber. Activities must be offered that are varied, flexible and meet the expectations and preferences of residents. The registered person must make arrangements, by training staff or by other measures, to prevent residents being harmed or being placed at risk of harm or abuse. The registered person must ensure suitable numbers of staff are trained in all mandatory and specialist areas associated with dementia and ensure that suitably qualified staff are on shift at all times. The registered person must establish and maintain a system for monitoring and improving the quality of care provided to residents. Care Homes for Older People Page 8 of 33 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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. In the main residents have their needs assessed so that staff understand what areas individuals require support. Evidence: Prior to our inspection the home sent us its Annual Quality Assurance Assessment (AQAA). With regard to assessment processes it states comprehensive individual assessment are undertaken both before and after a resident is admitted to the home to ensure we have all of the skills and equipment necessary to care for the resident competently. At our site visit we examined the care documentation of 3 of the newest residents to move into the home. One did not contain a pre-admission assessment. We were informed this was due to them moving from another home owned by the same company that owns Kings Lodge and that they moved to the home with a complete Care Homes for Older People Page 11 of 33 Evidence: care plan. The other 2 residents files contained assessment documentation that allows for recording in areas including personal care, health, medication, dietary requirements, daily living and religious needs. The amount of detail recorded in both assessments varied, with some sections giving a description of the assessed need, others one word answers and some areas with no information recorded at all. We noted that the assessment documentation was not maintained with the residents care plans. The registered manager informed us she has chosen not to leave pre admission assessments with care plans as she feels people would crib instead of assessing and finding out about people when they move into the home. We explained that staff should read this information before caring for a resident in order that they have a basis on which to provide care. 5 residents surveys were completed and sent to us before our inspection. All state they received enough information about the home before they moved in so they could decide if it was suitable for them. 2 state they always 2 they usually and 1 they sometimes receive the care and support they need. The registered manager informed us that the home does not provide intermediate care. Care Homes for Older People Page 12 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not in place for all identified needs and those in place do not always contain sufficient information. This means that the personal and health care needs of residents are not being met consistently and safely. Some medication practises do not offer sufficient safeguards to residents. Residents are treated with respect and their rights to privacy upheld. Evidence: With regard to health and personal care the homes AQAA states under what it does well each resident has an individual care plan and assessment, which is developed and implemented with the resident and their key worker. Assessments include all aspects of care including physical health checks as well as mental health and psychological wellbeing. Care plans also include the residents wishes regarding death and dying. All care plans are reviewed on a monthly basis or before if required, with the resident and/or their relative/advocate. During our inspection we looked at the care records of 5 residents and found none to Care Homes for Older People Page 13 of 33 Evidence: be completed in full or reviewed on a monthly basis as described in the homes AQAA. For example one residents file contained a blank social activity plan, a blank care plan review sheet, a blank evaluation sheet, a blank pressure ulcer sheet, a blank mental capacity assessment and a blank moving and handling assessment. Another residents file contained a pressure ulcer assessment that included information regarding weight, skin type, continence, mobility and age. The sections for recording special risk factors and the screening tool for malnutrition have not been completed. The same persons file contained a pain wound assessment that indicates they have a grade 1 pressure area. This includes information on the type of dressing required but does not state when the assessment should be reviewed or information on when the dressing is to be changed and cleaning of the area. As a result of looking at other records maintained in the home we asked to view the care records for a named resident. A care file was given to us that contained no completed care plans or risk assessment of any kind. We spoke to 3 members of staff about the care needs of the above resident. All explained that the individual has specific needs associated with dementia. For example one person explained, she will not let you wash, dress, change or do anything for her. The only way we get in room to get washing is if she comes out for a meal. She hoards food, papers, faeces around her, sometimes comes out of her room for lunch. We showed the registered manager the blank care file. She explained that a head of care is responsible for completing all care planning documentation. We spoke to the head of care regarding the lack of completed care planning documentation for this resident who stated, this is something we slipped up with, can assure you will be quickly rectified. We raised concerns with the registered manager regarding this situation as the resident moved to the home 02.12.08 and the lack of care documentation had not been identified through the homes monitoring systems. The home is currently using 2 forms of care planning documentation. We found one, as described above not being completed in full. For those residents who have had a care plan completed using the second system we found this gave greater detail about individuals. For example the daily living plan for one resident informs staff put water into sink, show X where her flannel, soap and towels are stored. Likes to get up at 8.30 am and will become distressed if carer not in her room at this time, also same for the evening. Care Homes for Older People Page 14 of 33 Evidence: Of the 5 residents surveys returned to us 2 state they always and 3 they usually receive the medical support they need. With regard to medication the the homes AQAA states under what it does well Medication, where appropriate, are held by residents to prolong independence as much as possible. Where this is not possible medication is administered to residents on an individual basis ensuring that privacy and dignity is considered. All staff involved in the giving of medication have received suitable training and are regularly supervised by senior staff. Its evidence for this is stated as medication records are accurate and complete. Medication records that we examined do not support this information. For example 3 residents medication administration records had not been signed each time when the medication was administered. 5 residents have not been administered medication as directed by the prescriber, with records stating out of stock Records indicate for one of these individuals they have not received a prescribed medication for 11 consecutive days. 2 residents medication administration records state to give a medication as directed. No information could be produced informing what as directed means. A medication fridge is in place. We found 3 different medications being stored (fortisips, eye drops and insulin). No record of fridge temperatures is currently maintained. Systems for the management of controlled drugs are in place, including a controlled drugs cabinent and register. Stock that we sampled accurately reflected records in place. No care plan was seen to be in place for one resident who is prescribed a controlled drug for the management of pain. Staff were observed speaking and assisting residents with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. Care Homes for Older People Page 15 of 33 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. Activities are offered but these are not varied and do not always meet the needs of all residents. Dietary needs are catered for with a balanced and varied selection of food available. Evidence: With regard to daily life and social activities the homes AQAA informs us Social activities are planned with residents and are designed to meet the needs of everyone at the home not just the people who can communicate well. These activities include outside entertainers as well as planned activities with the activities coordinator employed at the home. Residents relatives are welcome at anytime within the home and may be entertained in the residents own room, if the resident chooses. At our inspection we found little evidence to substantiate the above statement. We saw an activity board displaying an advert for a forthcoming St Valentines dance. It informs residents that they can join in with bingo, card games and crafts. Also that a hairdresser visits weekly and of church services. We noted that all the information displayed is printed in a light colour and italic font. We informed the registered manager of the possible difficulties people with dementia or with a sensory impairment Care Homes for Older People Page 16 of 33 Evidence: may have reading information produced in this format. The registered manager agreed to review this. We were shown an activity folder that is used to record events that individual residents have participated in. For the majority of residents records show 2 or 3 activities recorded in a 2 month period. For some these were recorded as hairdressing or a discussion with a member of staff. During our inspection we did observe a member of staff sitting reading a book to one resident, some residents watching television and a member of the clergy visiting the home. Of the 5 residents surveys returned to us 4 state activities are sometimes arranged by the home and 1 that they are usually. Additional comments were recorded of not always able to participate would like more activities to cater toward specific requirements, poor sight, handicapped not yet functioning and singing, playing cards. With regard to meals 2 of the residents surveys state they always 2 they usually and 1 they sometimes like the meals at the home. Additional comments were recorded more vegetable varieties perhaps love the cakes its not like home cooking. The homes AQAA states Menus are changed on a four weekly rolling rota and demonstrate a wide variety of choice at each meal. Fresh food is available for residents at each meal along with a good range of food items outside of meal times. Alcohol is available at all times. There is a open budget for food purchased in the home. During our inspection the chef informed us he is going to introduce food questionnaires for residents and families that will seek their views on preferences, sizes, special requirements and other areas relating to choice. He confirmed the comments recorded in the AQAA that there is no set budget for food, stating that residents can have what they want. We spoke to two residents regarding meals. One stated, lunch was very nice thank you and the other meals not too bad, quiet good sometimes, not so good others. During our inspection a member of staff was observed asking each resident what they wanted for lunch, offered choice of 2 hot meals. The member of staff explained to us that information regarding meal choices is given verbally so that people with dementia can make an informed choice. We also observed an afternoon tea trolley taken around the home. This contained an abundance of cakes and biscuits, which residents Care Homes for Older People Page 17 of 33 Evidence: appeared to enjoy. Care Homes for Older People Page 18 of 33 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. Some concerns raised by residents are not treated as complaints. People with dementia are currently disadvantaged by the management and monitoring of complaints. Safeguarding procedures are in place but staff do not have sufficient knowledge in this area to protect residents from harm. Evidence: Of the 5 residents surveys completed and returned to us all state they know how to make a complaint. 2 state they always 2 they usually and 1 they sometimes know who to speak to if they are not happy. The registered manager informed us that one complaint has been received by the home. We examined the records for this and found that they demonsrated that the registered manager has investigated and responded to the complainant appropriately. When looking at a quality monitoring folder maintained by the registered manager we saw a photocopied document dated 26.01.09 expressing dissatisfaction with a lunchtime meal. At the bottom of this document the registered manager had recorded that she had spoke to the chef. This complaint was not recorded (including actions and outcomes) in the homes complaints file. The registered manager confirmed she had not acted upon this as a formal complaint, informing us that the resident always puts notes up. The registered manager confirmed that the resident in question has Care Homes for Older People Page 19 of 33 Evidence: dementia. We discussed equality with the registered manager explaining that someone with dementia may not understand and be able to access the formal complaints procedure and that they might view writing a note as complaining. The registered manager agreed and said that she would ensure all complaints are recorded and acted upon equally in future. The registered manager informed us that the complaints procedure is included in the service user guide, a copy of which is kept in each residents bedroom. We asked how residents with dementia are supported to raise concerns and were informed Havant Good Neighbour Advocacy Scheme is in place and that families and staff act on behalf of residents. The registered manager informed us the advocacy information is not readily accessible and agreed to put this on display. We spoke to 3 members of staff, all of whom demonstrated understanding of supporting residents who are unhappy or wish to raise concerns. For example one person explained, we try and find out why unhappy in any way we can, we write it down or spend time with resident, take time to communicate. When talking to staff one informed us that 4 residents had approached her to make a complaint about the behaviour of another person living at the home. We discussed this with the registered manager who confirmed she was not aware of this situation, that she did not know if this had been investigated or if needed any safeguarding referral made. We asked 3 members of staff how they protect residents from abuse. None of the staff gave sufficient responses to this question. We were particularly concerned with a comment made by one member of staff. They said, X wants to go home, pushes people, i tell staff if you talk instead of shouting and make a story up to pacify. We informed the registered manager that the staff members comment indicates residents are being shouted at and the intervention decribed may not be the most appropriate. The homes training matrix informs us that 1 of the 9 nurses and 5 of the 18 care staff working at the home have received safeguarding adults training. Care Homes for Older People Page 20 of 33 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. Residents have a pleasant, clean and homely environment to live in. Evidence: The homes AQAA informs us We ensure that a homely environment is forthcoming for residents by making sure the home is clean and tidy, comfortable and well kept. The maintenance person in the home is full time and can address requests and issues quickly. The home boasts a team of trained housekeeping staff whose sole responsibility is to ensure that the home is clean and fresh and free from hazards. Residents have all of the nursing equipment that they need and any shortfalls noted are redressed quickly. Residents have a choice to whether they wish to share a room or have a single. Both of which can be furnished to the needs and wishes of the resident. The information contained within the AQAA was found to be accurate on the day of our inspection. We looked around some of the home and we were able to see communal areas such as dining rooms, lounges, bedrooms and bathrooms. Residents are encouraged to furnish their rooms with personal belongings such as furniture and pictures, to make it feel like home. The home was seen to be very clean throughout, with no malodour. Care Homes for Older People Page 21 of 33 Evidence: The registered manager informed us that the original building that has fourteen bedrooms in currently has no residents living there, that it is used for staff to live in. She confirmed no part of the original building is used for residents including laundry and kitchen facilities and that future plans may be to demolish and rebuild. We did not inspect this part of the building during this inspection, as it is technically dormant. We informed the registered manager that we must be informed in writing if this part of the home is used again for residents so we can take opportunity to visit if we wish. We also instructed that the homes statement of purpose must be updated to reflect this situation. The registered manager agreed to do this. All 5 residents survey state that the home is always fresh and clean. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels meet residents needs. Monitoring systems do not ensure sufficient numbers of staff are trained to care for residents and are on every shift. Recruitment practises offer safeguards to residents. Evidence: The staffing structure at the home consists of: manager, head of care, nurses, care assistants, kitchen staff, housekeeping and maintenance. The rota indicates that there are qualified nurses and care staff on duty throughout the day and night. In addition to this housekeeping and kitchen staff on duty 7 days a week. All five residents surveys that we received state staff listen and act on what they say. 2 state staff are always available when needed and 3 that they are usually available. We spoke with three care staff and a nurse on the day of our inspection and indirectly observed care practises. All indicated that they were aware of the needs of residents. However the amount of knowledge they demonstrated varied. We observed a member of staff sitting next to a resident. The member of staff informed us that they were of the same nationality as the resident. We said that this was positive as it she could converse with the resident in their language. The member of staff stated, no we have told him he lives in England now and must speak English language. We informed the Care Homes for Older People Page 23 of 33 Evidence: member of staff that sometimes people with dementia regress and that it might be easier for the resident to communicate in their original language. We examined this residents care documentation. It states their nationality. The sections for language, communication, cultural and spiritual needs were blank. When examining the staffing rotas we noted that hours that the registered manager works at the home are not included. The registered manager informed us she records this in her diary and that an electronic system is being installed at the home that will record everyones times and shifts. The training matrix in place at the home on the day of our inspection states 1 of the 7 nurses having received moving and handling training and 7 of the 18 care staff. It states all nurses and 14 care staff have undertaken fire training, 4 care staff food hygiene, 3 care staff health and safety, 5 care staff infection protection, 2 care staff hold a National Vocational Qualification (NVQ) at level 2 and 3 with 2 others in the process. With regard to specialist training relevant to meeting the needs of people living at the home it states 5 care staff have received dementia awareness training, 1 nurse and 3 care staff mental capacity training, 5 staff pressure care, 1 care communication, no staff person centred care plans, 1 nurse and 4 care staff challenging behaviour, 2 care staff Parkinsons, 1 nurse diabetes, no staff equality and diversity, 1 nurse and 5 care staff skin care, 1 care falls awareness and 2 care staff palliative care. When talking to 3 staff about equality and diversity, 2 said they did not know what this was and one gave examples only relating to staff. We asked the registered manager if a risk assessment has been completed with regard to first aid, the needs of residents and staff on duty. she said no. We directed her to the CSCI website where further information regarding this can be found. Also we asked the registered manager how she ensures suitable numbers of qualified staff are on duty each shift. The registered manager stated that as yet no system for monitoring this is in place and that a member of staff is a train the trainer in dementia, mental capacity act and abuse. She informed us just this week starting to get to grips and working with staff. We examined the recruitment records for 4 of the newest staff to commence working at the home. Records included application forms, references, contracts of employment, equal opportunities monitoring forms, job descriptions and forms of identification. In some instances evidence of satisfactory POVA first and/or Enhanced Criminal Records Care Homes for Older People Page 24 of 33 Evidence: Bureau (CRB) disclosures was not on file. However when we drew this to the registered managers attention she was able to produce evidence of these being obtained. None of the staff files that we viewed contained evidence that they received an induction when commencing work at the home. We discussed this with the registered manager who produced a blank induction pack explaining that staff had received an induction but that she would not be able to evidence this as the induction packs have not been completed. Care Homes for Older People Page 25 of 33 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. Management of this home is not meeting all the needs of residents safely in terms of care planning documentation, some medication practises, activities and staff training. Residents financial interests are not always safeguarded. Residents health, safety and welfare is not always promoted and protected by the homes monitoring systems. Evidence: The registered manager informed us that she is contracted to work 37.5 hours a week but undertakes additional hours when needed. Evidence gained at this inspection shows that improvements must be made to care planning documentation, medication, activities, staff training and monitoring systems. We discussed this with the registered manager, drawing her attention to her legal responsibilities as a registered person to comply with the Care Home Regulations 2001. Reports in line with Regulation 26 of the Care Home Regulations 2001 were viewed. These evidence that visits take place on a monthly basis and that discussions with Care Homes for Older People Page 26 of 33 Evidence: residents and staff take place. The registered manager informed us that questionnaires are kept at the entrance to the home for people to complete and that the home intends to send surveys to health care professionals. In addition to this a comments book is also maintained at the entrance to the home. This contained 3 compliments. 5 residents/relatives satisfaction surveys were viewed and found to contain praise for the home and also areas where improvements could be made. A record of action taken by the registered manager was seen to be in place in response to these. We asked the registered manager if the home looks after the personal finances of any residents. She informed us that no monies are held or managed by the home and that each resident has a lockable facility within their room. Whilst examining care and medication records we found that one residents personal inventory dated 25.01.09 states 33.83 locked in CD cupboard at families request. We viewed the controlled drugs cupboard and saw an envelope with the residents name and amount of money detailed within, signed by the nurse head of care. We informed the registered manager of this who stated she was not aware of this. When asked the registered manager informed us that no residents currently use bed rails. The head of care informed us that 2 residents currently use this equipment. Both residents care records confirm this but do not demonstrate why this equipment is needed. We asked the resident manager to produce any accident records for us to view. She informed us these are maintained in each residents file. We explained none had been seen in any of the files we sampled. Two accident books were produced, one for the ground floor and one for the nursing floor. The accident book for the nursing floor contained 19 recorded incidents from 6.12.08 to 27.01.09 and the accident book for the ground floor contained 8 recorded incidents from 25.08.08 to 19.01.09. We noted that an accident record dated 27.12.08 detailed a resident falling that resulted in being taken to hospital for an x-ray. We asked the registered manager if an Regulation 37 notification had been completed. She informed us the head of care is responsible for completing these. The head of care checked the homes records and confirmed a notification had not been completed for this incident. Regulation 37 notifications were seen to be in place for other notifiable events. We asked the registered manager how accidents are monitored. We were informed the head of care looks at weekly and reports back to her any further action needed or taken. We sampled a number of maintenance records, with these evidencing appropriate checks are being undertaken with regards to gas, electric, water and fire. Care Homes for Older People Page 27 of 33 Care Homes for Older People Page 28 of 33 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 29 of 33 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 Residents must have clear individual care plans describing the support that staff must give to meet identified needs. This must happen in order that residents needs are met safely and consistently. 31/03/2009 2 8 13 In line with Regulation 13(1)(b)The registered person must be able to demonstrate through the homes records that residents receive where necessary, treatment, advice and other services from any required health care professional. This must happen in order that residents health needs can be monitored safely. 31/03/2009 3 9 13 In line with Regulation 13(2) 08/03/2009 a record must be maintained of all medication when it has been administered to a resident. Page 30 of 33 Care Homes for Older People This must happen in order that medication records safeguard residents. 4 9 13 In line with Regulation 13(2) 08/03/2009 sufficient stock of medication must be maintained in the home. This must happen in order that residents can receive medication as per the prescribers instructions. 5 12 16 In line with Regulation 16(2)(m)(n) Activities must be offered that are varied, flexible and meet the expectations, preferences and expectations of residents. This must happen in order that residents social needs are met. 6 18 13 In line with Regulation 13(6) 31/03/2009 the registered person must make arrangements, by training staff or by other measures, to prevent residents being harmed or being placed at risk of harm or abuse. This must happen in order that staff have sufficient knowledge to protect residents from harm. 7 28 18 In line with Regulation 18(a)(c) the registered person must ensure suitable numbers of staff are trained in all mandatory and specialist areas associated 31/03/2009 31/03/2009 Care Homes for Older People Page 31 of 33 with dementia and ensure that suitably qualified staff are on shift at all times. This must happen to ensure all residents needs are met safely. 8 33 24 In line with Regulation 24(1) 30/04/2009 the registered person must establish and maintain a system for monitoring and improving the quality of care provided to residents. This must happen in order that residents needs are met consistently and safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 33 of 33 - 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!