Inspection on 18/08/09 for Knightsbridge Lodge

This inspection was carried out on 18th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Knightsbridge Lodge 17/09/07

Knightsbridge Lodge 08/11/06

Knightsbridge Lodge 21/02/06

Knightsbridge Lodge 17/02/05

Knightsbridge Lodge 18/08/04

Knightsbridge Lodge 27/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Knightsbridge Lodge Knightsbridge Lodge Knightsbridge Green Cheltenham Glos GL51 9TA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janice Patrick     Date: 1 8 0 8 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 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Knightsbridge Lodge Knightsbridge Lodge Knightsbridge Green Cheltenham Glos GL51 9TA 01242680168 Telephone number: Fax number: Email address: Provider web address: Knightsbridge.lodge@btinternet.com Name of registered provider(s): Mr David Easdown,Mrs Ann Dorothy Easdown care home 22 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 22 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Knightsbridge Lodge is situated adjacent to the main Tewkesbury Road near the hamlet of Knightsbridge. The home is conveniently positioned about six miles between Gloucester and Cheltenham. 0 Over 65 22 Care Homes for Older People Page 4 of 34 Brief description of the care home The house was originally a Victorian Toll House and has been sympathetically extended to provide accommodation for 22 older people. Bedrooms are positioned on the ground and first floor; a shaft lift provides access to the first floor. All bedrooms have wash hand basins and three rooms have en-suite facilities. All the rooms are single occupancy. Well-equipped bathrooms are provided on each floor with a shower room on the ground floor. Toilets are provided within close proximity of all bedrooms and communal areas. On the ground floor there are two lounges and one dining room. The attractive gardens are well maintained and fully accessible to all people who live in the home. The provider supplies information about the home, including the Commissions most recent report to anyone who has expressed an interest. The details are maintained in a file, which is displayed in the front hall of the home. Current fees range from three hundred and eighty one pounds and twenty pence to five hundred and nine pounds. Hairdressing, chiropody and any personal purchases are charged extra; the individual prices are available on request. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We looked at the previous report and any requirements that had been made. We also considered all of the information we have gathered about the service since the last inspection. This included any complaints or concerns and notifications from the service. A notification is information that the home has to send us in the event of any untoward event that affects the people who live in the home including letting us know of a death. We read the services current Annual Quality Assurance Assessment (AQAA) this is their assessment of the current quality of the service, what they have already improved and any plans they have for the next twelve months. It also gives us a Dataset of required information. Prior to our site visit we forwarded questionnaires to the people living in the home to seek their views on the service. We received six back. Care Homes for Older People Page 6 of 34 One Inspector then visited the home on one day between the hours of 10.30am and 8pm. We spoke to some of the people who live in the home and some of the staff. We inspected a selection of care records; including medicine records. We inspected the arrangements in place to safeguard people from harm and abuse. We inspected all records pertaining to staff recruitment and staff training. We also discussed the arrangements for providing staff with adequate supervision. We looked at all aspects of health and safety which included the current arrangements for fire safety and safe evacuation in the event of a fire. We considered the overall management structure and its effectiveness. What the care home does well: What has improved since the last inspection? What they could do better: Maintenance of the care documentation and the content of the care plans needs to improve. Each personal care need and health care need should have a care plan which gives staff clear guidance on how these needs should be met. This is not the current situation. All assessments that relate to the safety of an individual such as safe moving and handling and general risk management need to be reviewed and correctly considered and completed. This is not currently in place. Arrangements for the storage of some medicines need consideration and altering. The arrangements for the Safeguarding of Vulnerable Adults are weak. Although we believe it is not the intention of the service to put people at risk of harm or abuse, the current level of the services understanding and practices (such as staff recruitment) do not provide people with adequate protection. The arrangements for storing peoples personal monies and the recording of how this is spent need to be more robust. The service cannot currently demonstrate that all staff are receiving adequate supervision and additional trainings. Advice needs to be taken from the Fire Services regarding the current guidance being given to staff on how to evacuate people from a fire who are not confidently mobile. The service must produce a fire risk assessment and have this easily to hand for staff reference. The service needs to be managed in a manner that enables it to be up to date with what is required to meet the current Care Home Regulations 2001 and in order to prepare it for registration in 2010 under the Health and Social Care Act 2008. Care Homes for Older People Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –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 good 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 and considered before they are admitted to the home so that the home can be sure it can meet these needs. Evidence: The service assess peoples care needs prior to them moving into the care home and we saw two examples of these assessments. Additional information is also taken into consideration from the persons representative and other health care professionals that maybe involved. If the person is receiving support with the cost of their care the home will also be in receipt of the funding authoritys assessment of needs. The AQAA tells us that the service has introduced a trial period of admission before people become permanent residents. This service does not provide designated rehabilitation support. Care Homes for Older People Page 11 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 clearly feel they are well cared for but the homes care documentation is weak and they are not always able to demonstrate that the required action is being taken or that staff are always getting the guidance they need. This potentially puts people at risk. Evidence: We received questionnaires back from six people who live in the home. All were very complimentary about the care and support they receive and all confirmed that they also receive medical attention when needed. These views were reiterated to us during our site visit with everyone spoken to be being happy to be living in the home. We spoke to a Community Nurse who visits regularly and she confirmed that staff call her appropriately when nursing skills are required. She also confirmed that staff follow any instruction she gives. We inspected a selection of care records and it was explained at the time that the service was changing the care planning format. The AQAA however tells us that care plans are devised for each need. We were not concerned about the different formats Care Homes for Older People Page 12 of 34 Evidence: as long as the care plans gave clear guidance to staff on how a persons needs are to be met and in several examples this was not the case. There were also examples of health care needs where care staff are involved on a day to day basis, such as prevention of pressure sores, diabetes, management of epilepsy and memory loss which had no associated care planning. We discussed this with the Registered Provider who was aware that the content of the care plans was not satisfactory. She explained that she was currently supporting the staff that were responsible for writing these. There is a key worker system and the AQAA tells us that the service plan to involve the key worker in the care planning. The AQAA also tells us that they plan to involve the person who is receiving the care. The risk assessments seen for safe moving and handling and for demonstrating what was being done to prevent other potential risks, such as trips and falls were incomplete in some cases. In others it failed to identify the level of risk and the guidance needed by staff to manage this. One person had previously fallen and suffered an injury that necessitated hospital treatment. This person was still at risk of injury, particularly at night, but still the risk management records and the care plans did not tell us what the service were doing to manage this and protect the person. Prior to our inspection we had received an anonymous complaint regarding safe moving and handling practices and a reference to a lack of equipment being available in the home to achieve this. We forwarded this to the Registered Provider to investigate under the services complaints procedure. This was done and a response returned to us which pointed out that there has always been a hoist available in the home to safely move people if needed. We also evidenced that the Primary Health Care Trust have provided specialised equipment when it has been needed. We are also aware that there has been some reluctance at times for a hoist to be used. Coupled with poor guidance in the care documentation it is easy to see that at times there may have been a lack of clarity on what should be happening. In one care file a member of staff had recorded an observation about someones skin. This indicated that it was prone to developing into a pressure sore if not monitored. We noted there was no follow up to this in the care record but we were reassured that this person did not currently have a pressure sore. We later saw this person using a pressure relief mattress which had been organised by the Community Nursing Team. In contrast to the above shortfalls, there was a very good care plan, which highlighted the triggers to someones agitation and gave guidance to staff as to what things should be avoided. Care Homes for Older People Page 13 of 34 Evidence: All of the above shortfalls require attention so that staff are provided with clear guidance. Staff also clearly need training in writing care plans and associated assessments. We did suggest that the home contact the Care Home Support Team for guidance in the care planning and assessment of the one specific person we felt was potentially still at risk. We inspected the arrangements for the safe storage of medicines. Two areas of storage were unsatisfactory and two met current guidance. We explained why one particular area of storage was not suitable and advised that alternative arrangements be made. We looked at the records kept for administration of medicines and on the whole these were well maintained with very few gaps. There were a few areas that needed clarification such as why staff were signing for one medication that effectively the person was self medicating. Good care planning for this situation would clarify what needs to be done by whom. Another person was having a medication which is sedating and which was prescribed to be taken when required. Its use is therefore potentially open to abuse. There should be a care plan which clearly states when this medication should be used and staff should record their reasons for using it. They should also record what other interventions were tried before a decision was taken to use the medication. We witnessed one carer take someone their medication and go to leave before making sure the person had taken this. This appeared to be a one off observation but it is not good or safe practice. The times for medication administration have been thought out to suit the type of medication being given and reflect individual peoples routines, rather than being administered at breakfast, lunch, tea and bedtime. All eye drops had been dated on opening and controlled medicines inspected corresponded with the records being kept. We could see from training records that five staff have completed training in the safe handling of medicines. At no time did we observe anyones privacy and dignity being compromised. Care Homes for Older People Page 14 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home where staff recognise the importance of choice, social interaction and activities, which enables people to have a better quality of life. Evidence: People in the home are able to make their own choices about how they spend their day, the only constraint would be a health related problem. One example of this was a person who currently needed to spend a proportion of the day on their bed, which had a pressure relief mattress. This person however understood why this was necessary and was happy with the arrangement. A group of people told us what they do for social contact and activities. During our inspection an activities meeting was held and ideas were discussed for the coming week. The AQAA tells us there is a new activities coordinator and we spoke to the care assistant who has taken on this role. Some longer term plans were also being discussed for trips out. People told us of some of their favorite such as joining staff on a shopping trip to the local supermarket and having a cup of coffee afterward, a mystery drive around the countryside was another favorite and clothes shopping. Some people said they would like to see the Christmas lights. At the end of this planning an activities programme is put up to remind people what is on during the Care Homes for Older People Page 15 of 34 Evidence: week. This group of people seemed to be well motivated and one questionnaire returned to us said we could always do with more activities. The AQAA tells us that the service plan to allocate an activities budget. We were told that outside entertainers come in each month. This includes one person who organises exercises to music and another who plays the organ. When we arrived people were sitting outside enjoying the garden and the warm weather. The homes annual fete was due to take place in three weeks time and the gardens were looking very well tended. There were several very positive comments during the day about how well the gardener has done with some of the flower beds; it is clearly very much appreciated. Most people said the food was very enjoyable and that alternatives can be ordered if someone really did not like the days meal. We spoke to one member of staff who cooks and she explained that the staff know peoples individual likes and dislikes very well. One comment in one of the questionnaires returned said that the menus need changing more frequently and that there were too many casserole type dishes. Peoples differing Faiths are respected and arrangements are made for pastoral support if it is wanted. An open denomination Communion is held every two weeks. The home welcomes visitors at anytime and people are free to go out with family and friends as their health dictates. Information about how to contact an Advocacy service was on the notice board. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are arrangements in place for complaints to be received and acknowledged, but the arrangements for safeguarding adults requires improvement if people are to be adequately Evidence: The service has a complaints policy with procedures, which people are aware of. Everyone that returned a questionnaire to us knew how to make a complaint if needed. We saw records pertaining to one complaint that the service had received. Included was a copy of the services acknowledgment letter, a staff members statement of events and the outcome letter sent to the complainant. The anonymous complaint that we received and forwarded to the service (as referenced in the Health and Personal Care outcome of this report) was responded to by the Registered Provider, but we did ascertain during this inspection that part of this complaint was not correctly responded to as there are people employed by the service without appropriate Criminal Record Bureau (CRB) clearances. The AQAA tells us that the home has guidance for staff on safeguarding adults from abuse. We were shown a document called Guidance on Abuse and we were told that all staff had read this. This described the different forms of abuse as referenced in the Department of Healths document No Secrets. It gave staff guidance on what to do in Care Homes for Older People Page 17 of 34 Evidence: the event of an actual incident of abuse, alleged or suspected abuse. It named external parties that should be contacted but did not provide telephone numbers for these. These need to be added. We asked a senior carer whether she was aware of the document and its contents; she told us she was not. The AQAA also tells us that all staff have attended the alerters training (training provided by the local County Council which gives staff an awareness of how to identify and respond to abuse and an awareness of the local Countys protocols). We asked to see a record of who had completed this training and the service was only sure of four names. We were told that more staff had received this training but this could not be demonstrated via the training records. We strongly recommended that the home makes sure that all staff attend training on this and that they read and understand the homes own guidance document. Staff who are in charge of the home at any given time should ideally attend a more enhanced training on as should all night staff as they work predominantly alone. Another area of practice which is designed to help protect people from harm and abuse is recruitment (see Staffing outcome in this report). We do not believe the service are intentionally wanting to put people at risk but, systems that should be in place and adhered to are not and this puts people at risk. All questionnaires returned to us indicated that people knew who they would talk to if they were not happy about something and there were comments describing staff as cheerful and helpful. Care Homes for Older People Page 18 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 good 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 home that is kept attractive and clean, helping to make it a pleasant place to live. Evidence: The internal and external presentation of the home is of a high standard. This is maintained by an ongoing programme of redecoration and refurbishment. Inside it is welcoming and domestic in character and an example of this is seen in the main lounge where the seating is arranged so that groups of people can sit together rather than being arranged around the walls. This room also has all the comforts of a domestic home with television, music centre, pictures and ornaments. Most of the bedrooms have been personalised with peoples own possessions. We noticed that the corridors are quite narrow making it not an ideal place if alot of larger pieces of moving and handling equipment were required and this was also an observation of the Community Nurse. However, currently most people are either mobile or able to transfer into a wheelchair. The one hoist, seen in a bedroom, was in a room that looked slightly larger than others seen in the home. The home appeared very clean and their were no offensive odours. Care Homes for Older People Page 19 of 34 Evidence: Protective aprons and gloves were seen available for staff. The laundry has a specialised system that helps to rid soiled items of any bacteria during a wash cycle. Waste is disposed of correctly and the Community Nursing team have their own arrangements in place to dispose of any contaminated dressings or equipment. Some staff have completed Infection Control training. Care Homes for Older People Page 20 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. Poor recruitment practice and a lack of review and adjustment to staff numbers when peoples needs increase are placing people at risk. Evidence: The AQAA explained a period of high staff turn over and alot of staff absenteeism. There has therefore been a need for recruitment and rebuilding of the staff team competencies. There are however several staff who hold the National Vocational Qualification (NVQ) in care at levels 2 and 3. We were told that new staff have to complete an induction training, which is signed off in an induction book by the Registered Provider or acting manager when the staff member is thought to be fully competent. There were no induction books to see during this inspection. Various trainings are booked for staff to attend and most are viewed by the service as being mandatory. These would include trainings such as Fire Safety, First Aid, Food Hygiene, Health and Safety, Safe Moving and Handling, Safeguarding Adults and Infection Control. Training records are kept electronically and these showed that many staff were updated or initially trained in safe moving and handling, health and safety and first aid. Some staff were behind with various updates but there was usually a specific reason for this; such as sick leave. It was difficult to fully ascertain who was trained or Care Homes for Older People Page 21 of 34 Evidence: updated in the Protection of Vulnerable Adults and the same went for Infection Control training. The service need to resolve this shortfall in their record keeping and be able to clearly show Inspectors who has completed what, through their electronic records. These should then be supported with certificates in the staff members file. Although some staff hold NVQs there seemed to be an overall lack of any additional training to supplement the mandatory training. Some records demonstrated training in dementia awareness, Parkinsons disease and continence care for example, but not many. The AQAA tells us that the service plan to access more additional training courses. The acting manager has completed training to be the Dementia Link person for the service. This means that she will liaise with external health care professionals via the Partnerships for Older People Projects (POPPS), which is a Department of Health initiative designed to improve outcomes for older people in care homes; in this case dementia related needs. Another member of staff is also going to take on this role. Staff rosters are devised and coordinated by the Registered Provider who staffs the home on a daily basis usually with two care assistants and the acting manager up until 4pm and then there are two care staff on duty until the night staff arrive. This is usually complimented by one or two general assistants who we understands help those who live in the home with many other things other than personal care. The general assistant will also clean the home. After speaking to various people during this inspection and taking into consideration the views of some who live in the home, there has obviously been a period where there has not been enough staff either on duty or to deploy in a way that meets the services needs. There is no current evidence to suggest that peoples personal care needs overall are not being met. The AQAA however tells us that all twenty two people in the home require personal care support to wash, we are aware of the increased needs of one person that have been evident now for sometime and the acting manager has needed to spend a good proportion of her time in a hands on caring role. We were told that if the acting manager wants a supernumerary day for paperwork and other managerial tasks, she must be able to cover her care shift. Some care shifts are also covered by one of the general assistants (we did specifically note that this person is updated in safe moving and handling and first aid). Taking into account the shortfalls evidenced during this inspection and the few comments received from people who live in the home such as staff are pressurised and over worked, I wish staff had more time to sit and talk to us, I often feel guilty Care Homes for Older People Page 22 of 34 Evidence: to ask them to do something for me; we consider that there is obviously a need for the staffing numbers to be adjusted and for the acting managers role to be defined. We were told that it is the services plan, now, following a fairly successful recruitment drive, to have three care assistants on duty and to free up the acting manager for a proportion of her time to be able to carry out managerial tasks. We also noted that the staffing drops to two care assistants at 4pm. Although the Registered Provider explained that there is not much to do between 4pm and when the night staff come on duty these staff are responsible for preparing tea for currently twenty two people, serving it, any care needs that arise including specific supervision needs and administering some peoples medication at 6pm. We consider this to be minimum staffing as we also do the current night staffing numbers (one carer awake and the other asleep from late evening until 6am. We were particularly concerned about these times of minimum staffing and even more so because they appear not to have been adjusted despite the increase supervision needs of one particular person. We recommended that the service seek a review of this persons needs and that they consider adjusting the current staffing levels to reflect the current needs. We inspected the recruitment files of three care staff and looked at the arrangements for completing Criminal Record Bureau (CRB) checks on all people employed by the service. We also did the same for checks against the Protection of Vulnerable Adults List (POVA). The overall standard of practice was poor. This is because in several cases people had not been correctly checked via the CRB or POVA list. The Registered Provider was reminded that CRBs are not potable. We were told that there were no employment risk assessments in place, either for the staff without correct CRB clearances or for the volunteers who visited the home, also without CRBs. There is one person working in the home where no recruitment practice has taken place at all. It is irrelevant that this person is known to the Registered Providers family or that they work part-time in a domestic capacity. They still have access to vulnerable people as is the case with all the above. The fact that poor recruitment practice is coupled with how the home is currently staffed and the fact that there has been no adjustment to this during a period of increased needs; has influenced the overall rating of this outcome. Care Homes for Older People Page 23 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are significant shortfalls in the management of the service. These do not however seem to be compromising peoples personal care and the positive way people feel about living in the home, but they are however putting people at risk. Evidence: During this inspection we were told by the Registered Provider that the Registered Manager had left the home just over a year ago and that the then senior carer has been acting manager ever since. We were told that the Commission were informed at the time. The Registered Provider went onto explain that it has been the intention to put an application forward to the Commission for the current acting manager to be the Registered Manager. Other things that the service have had to consider over the last year in respect of this were discussed with the Inspector and these have been noted. The Registered Provider has been informed that the service has been without a Registered Manager for too long and an application will have to be submitted as soon as possible. Guidance can be found on the Commissions website www.cqc.co.uk regarding the absence of a Registered Manager. Care Homes for Older People Page 24 of 34 Evidence: The acting manager has completed the National Vocational Qualification in care at Level 4. She has also completed training in the Mental Capacity Act 2005 and the Implementation of the Deprivation of Liberty Guidelines (DOLs), along with one other member of staff. She has also completed accredited training in the safe handling of medicines. The acting manager has the support of the general manager who is responsible for the majority of the services needs other than personal care related issues. The Registered Provider is involved in all aspects of the services management. This should leave the acting manager able to concentrate on taking a lead in care delivery, its documentation and planning, including some staff training and supervision and auditing. We have been told that staff supervision is taking place but has not predominantly been recorded. There are several areas of significant shortfall in the management of the home which is resulting in non compliance with some Care Home Regulations. This has to be addresses and the Commission will be seeking compliance through an Improvement Plan which will be issued as part of this inspection process. The service do seek the views of those who live there, but not relatives, although, we were told that the home operates an open door policy and relatives know that they can raise any issues whenever they wish to. The service last sought the views of the people who live in the home, on the quality of the service provided, in October 2008. Various other audits are completed and include a general quality monitoring tool, a staff practice audit as well as audits on the medication system and associated records and care planning. These were not inspected in detail but discussed. Health and safety audits are more specific and done every six months, to include fire safety arrangements and Legionella prevention. Fire safety training is carried out by the general manager and we have been informed by the service that this is an ongoing cycle of updating staff via the use of a video and setting scenarios within the home. We noted that there was no specific evacuation equipment around the home. We saw guidance to staff about how to evacuate a person in the event of a fire that caused us concern. We also requested to see the services current Fire Risk Assessment, which we were told had been written but could not be found during this inspection. We recommended that the service contact the Fire Safety Officer following this inspection and seek advice on safe evacuation arrangements. We contacted the Fire Safety Officer following this inspection and we understand a Fire Audit was carried out in 2008. The Fire Officer was informed that a Fire Risk Assessment had been carried out but not written out. The Fire Service confirmed in 2008 that the premises were satisfactory. Care Homes for Older People Page 25 of 34 Evidence: We inspected the arrangements for keeping peoples personal monies safe and although all amounts being kept corresponded with the records the way it was stored was unsatisfactory. Various items are brought for people when the service does its shopping but, although the main receipt is kept, because of a lack of precise records; what was brought for the actual person is not recorded so over a period of time an audit of what the money was spent on would be impossible to demonstrate. There was also no indication that the person received the goods. These arrangements in need a review to protect both the people whos money it is and those who are spending it on their behalf. We were informed that the acting manager and a couple of other staff have attended training on the Mental Health Act 2005 and the Deprivation of Liberty Guidelines. This has yet to seen, as considered within the services care planning. Care Homes for Older People Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 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 7 15 People must have care plans 30/11/2009 devised for all their needs. These must clearly state what the need is and how the staff are to meet these needs. These must be reviewed either on a regular basis or as needs alter. Care planning must include participation by either the service user or their representative if appropriate and possible. This so that staff know what the problem is and are given clear guidance on how to address it. It is so that care is delivered in a consistent manner and in a why that is current and relevant. It is so that the care is delivered in a why that has been agreed or, which recognises peoples personal preferences. 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 It is so that the service can demonstrate an audit trail of review and care delivery. 2 8 13 Staff must be given clear 09/11/2009 guidance on how unnecessary risks to peoples health or safety are to be reduced or eliminated. This is with particular reference to potential pressure sores, acute or chronic illness, falls and injuries. This so that people are protected from unnecessary risks through the implementation of good assessment and risk management. This is so the service is able to demonstrate what action it took to prevent actual and potential risks to service users. 3 9 13 When any medicines are 09/11/2009 prescribed to be administered as, when required, make sure that there is clear and specific written guidance to staff on how to reach decisions so as to consistently administer each particular medicine in accordance with that persons needs. 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 This will help to make sure people receive the correct levels of medication in accordance with their needs and planned actions. 4 18 13 The Registered Provider 09/11/2009 must make arrangements by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse This so that people in the home are protected from any form of abuse or harm by staff or those that regularly visit the home. 5 27 12 The Registered Provider must staff the home in a manner that best suits peoples every day needs and which meets specific health, welfare and supervision needs. This will ensure there are enough staff on duty to provide the additional support to the person whos needs have increased and at the same time ensure other peoples needs are equally fully met. 09/11/2009 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 27 18 The service must be able to 30/11/2009 demonstrate that all staff are trained and up dated in the tasks they need to safely and competently carry out as part of their role. This is so that the people in the home are having their needs met by staff that are fully competent and that people in the home are provided with as much protection as possible. 7 29 19 Staff must only be employed 09/11/2009 when the service is happy that all recruitment criteria has been completed and is satisfactory. This includes satisfactory CRB and POVA clearances for anyone else who visits the home on a regular basis in a volunteer capacity. This is so that the home is doing everything possible to help protect people from people who may want to harm or abuse them. 8 31 8 An application for a competent and appropriate person must be received by the Commission in regard to the post of Registered Manager. 07/12/2009 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 This is so that the home can comply with the Care Home Regulations 2001 and the Care Standards Act 2000. 9 35 16 Appropriate arrangements 09/11/2009 must be made for the safe keeping of any service users personal monies. This is so that people do not have any of their money lost whilst being looked after by the service. 10 38 23 The Registered Provider must take advice from the Fire Officer in relation to appropriate arrangements and guidance for the safe evacuation of service users in the event of a fire. The Registered Provider must ensure that all requirements and requests made by the Fire Safety Officer are put into action. This is so that service users can be correctly and safely evacuated. This is so that the home can demonstrate that all necessary actions have been considered in order to keep people safe from fire or during a fire. 09/11/2009 Care Homes for Older People Page 32 of 34 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 35 Clear records (itemised) and receipts should be kept of all monies spent on behalf of a service users. Service users should also sign or in the absence of them being able to do this, two staff, for the withdrawal of the money to be used and the receiving of the purchased items. All supervision sessions with a member of staff should be recorded in the staff members file. There should be a minimum of six sessions per year with each member of staff. 2 36 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - 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!