Inspection on 25/06/09 for Lea Green Court

This inspection was carried out on 25th June 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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lea Green Court 23/02/09

Lea Green Court 29/10/08

Lea Green Court 01/07/08

Lea Green Court 17/07/07

Lea Green Court 10/07/06

Lea Green Court 24/10/05

Lea Green Court 13/06/05

Lea Green Court 23/09/04

Lea Green Court 10/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lea Green Court Kenton Road Gosforth Newcastle Upon Tyne NE3 3UW     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: Elaine Charlton     Date: 2 5 0 6 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: Lea Green Court Kenton Road Gosforth Newcastle Upon Tyne NE3 3UW 01912851720 01912851960 lea_green.court@fshc.co.uk www.fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Lynne Lilian Doyle Type of registration: Number of places registered: Tamaris Healthcare (England) Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Dementia Code DE, maximum number of places 45 Date of last inspection Brief description of the care home Lea Green Court care home provides nursing care for older people with enduring mental health problems. Care in the home is provided by Registered Mental Nurses supported by care staff. The home is owned and managed by Four Seasons Healthcare Limited a large provider of care services to vulnerable client groups. It is situated in Care Homes for Older People Page 4 of 34 Over 65 0 45 2 9 1 0 2 0 0 8 Brief description of the care home Gosforth on the outskirts of Newcastle upon Tyne close to local shops and good public transport links. There are 45 single bedrooms located at ground or first floor levels, and there is a passenger lift to help people who may have difficulty with stairs. Most bedrooms have en-suite facilities, those that do not have a wash hand basin and are close to bathroom, toilet and shower facilities. On each floor there are separate lounge and dining room areas, and a number of toilets and bathrooms. The home also has its own kitchen and laundry facilities. Fees in the home are between £454 - £616 per week. They are dependent on they type of service provided and whether the placement is privately funded or not. The home has a statement of purpose and service user guide that gives people information about the type of care and support they can expect to receive in the home. Copies of the Commissions reports are made available for people to read. 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: The quality rating for this service is one star, this means that the people who use this service experience adequate quality outcomes. An unannounced visit was made on the 25 June 2009, followed by a pharmacy inspection on the 29 June 2009. A total of 10 hours were spent in the service. The manager was present throughout the inspection. This inspection was carried out following the service of a Code B Notice using our statutory powers in Part II of the Care Standards Act 2000, and paragraph 6.7 of the Police and Criminal Evidence Act 1984 (Code of Practice for the Searching of Premises and the Seizure of Property Found on Persons or Premises). The organisations representatives co-operated fully with us and there was no need to copy or seize documents or property to support the outcome of our inspection. Care Homes for Older People Page 6 of 34 Before the visit we looked at Information we have received since the last visit on the 23 February 2009. The Annual Quality Assurance Assessment (AQAA) that gives CQC evidence to support what the service says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. How the service has dealt with any complaints and concerns since our last visit. The providers view of how well they care for people, and the views of people who use the service, their relatives, staff and other professionals who visit the service. We have also reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since our last visit. We told the manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Make sure that assessment information is used to prepare care plans and that any changes are properly recorded. Make sure that staff follow the organisations policies and procedures on the safe handling of medication and good practice guidance to support the safe administration of medication. Care Homes for Older People Page 8 of 34 Make sure that the personal care and well being of people living in the home is promoted through the proper and regular use of food and fluid charts, turn charts, guidance on behavioural issues and properly record the intervention of healthcare professionals. Carry out the minor repairs and replacements identified as part of the inspection for the comfort and safety of people who live in the home. Continue to provide staff with training and supervision so that they are properly equipped to carry out their job keeping everyone safe and well. When asked what the home could do better people said: Perhaps more in the way of activities or outings although this could be difficult in residents like my relative with alzheimers. I think various experiments with different forms of therapy are now being tried out; Big television in big lounge. Carers sit with residents at least one or more at any time. Small quiet lounge - sometimes about 4-6-8 residents can be sitting with no carer supervision for up to two hours; Clothing often gets mixed up with other residents; Cleanliness - although this has recently been addressed (mainly in bedrooms). Food is much better now due to change of staff, it had recently been of poor standard but now its lovely (at last). Would be nice if it was kept to this standard. Too many staff at one time outside smoking leaving residents with little supervision; 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. People who wish to move into the home, and their relatives, are given good information to help them decide about moving into the home and their diverse needs and wishes are fully assessed so that everyone is sure they can be met. Evidence: The company has its own assessment tool called the Care and Health Assessment Profile (CHAP). This is completed as part of the homes assessment of its own ability to meet the needs of people who may want to move into the home. All staff do not make good use of the document. Relatives who had completed questionniares on behalf of residents told us that they had been given enough information to help them decide whether it was the right home for them. We saw assessments from local authority, healthcare professionals and hospital based Care Homes for Older People Page 11 of 34 Evidence: staff that had been obtained before a person moved into the home. We looked at the records for two people recently admitted to the home. The CHAP document had been completed for both but only the scoring sections had been used and little additional information had been detailed about the persons needs. In one assessment information was recorded about where staff could get additional support when caring for a person who had had a laryngectomy. Although the names and telephone numbers were noted there was nothing to say what role the people who would be providing the help held. Professionally recognised assessment tools are regularly used to record what level of support people moving into the home might need with pressure area care, continence, nutrition and any deteriorating or enduring mental health issues. Not all the information collected through the assessment process is used in the care planning process. The home does not provide intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are asked how they wish their personal care to be provided and by whom but some records that contain this information are not always legible or complete which could place people at risk. Evidence: We sent Have your Say questionnaires to the home for staff, relatives and healthcare professionals to complete. Five relatives sent questionnaires back on behalf of residents. All said that the care and support needed was always or usually available. We were also told that staff are available who listen to what residents say and act on their wishes. We looked at the records for six other people who live in the home. Records are kept in a standard way with information being found in the same place in each file. Care plan evaluations have improved but some handwriting is still not legible making it difficult for anyone reading the records to be sure what care and support Care Homes for Older People Page 13 of 34 Evidence: should be provided. Staff do not consistently record visits from healthcare professionals in the same place and it was not always possible to see whether comments made in the daily records had been followed up. We saw some nice, sensitive recordings that would help staff make sure the person was cared for and dressed in a way they would have chosen for themself. An example of this was X prefers to wear a blouse and skirt during the day. Body maps did not always clearly record the size of areas of brusing or skin flaps, or the treatment being provided. There was also sometimes a difference between these recordings and what was included in accident and incident reports. For one person whose care plan showed they may display signs of aggitation when receiving personal care, and may punch staff, there was limited guidance about how staff should approach this area of care and the only distraction techniques noted were to offer sweets or a drink. Food and fluid intake charts as well as turn charts were not being regularly or consistently completed so it was not always possible to see whether a person had received the amount of fluid noted in their care plan, or the pressure area care needed. Another record indicated that staff should use minimal restraint on intervention when changing X, eg., holding hands. With this guidance was information about different levels of restraint. There had been no multi-disciplinary meeting held to establish whether this was an appropriate course of action or not. For the same person there was a note in the daily records that said to be referred to GP as they had lost 3.2kg over the previous month. We could not establish whether a referral had been made or not. The next GP visit that was recorded in the persons file was 21 days after the first recording. An assessment for a female resident stated that she was not at risk of abuse to herself or others. However, there was a care plan in place headed allegations that recorded a very serious complaint had previously been made by the person against another resident. The care plans and assessments for a lady who had just returned from hospital had Care Homes for Older People Page 14 of 34 Evidence: been immediately updated to take account of changes in the care she needed. We saw Deprivation of Liberty tools being completed but for one person part of the assessment was missing. A relative told us that they had reported a resident had lost their glasses and was having to wear reading glasses instead. It did not appear that anything had been done about this so the family were making arrangements for them to be replaced. Staff were seen talking to residents, helping them move around the home and enjoy their meals in a sensitive, quite but professional way. A pharmacy inspector from CQC carried out an inspection of medication systems and practice in the home on the 29 June 2009. The following are the findings from that inspection: There is a good set of Four Seasons Medication policies covering all aspects of medicine management. Records were kept of prescriptions ordered and received into the home and of medicines destroyed or returned. On the day of the inspection some medication administration was observed on the ground floor. The trolley was left open and unattended whilst medicine administration was taking place. Later the medication trolley was locked but blister packaged medicine was left on top of the trolley. On the first floor the medication room was left open and unattended at various times during the morning. Some medication on the medicine trolleys were not marked with the date of opening and there were medicines in use which were out of date. The upstairs medication room was warm and there were no daily records kept of temperature. The ground floor room was warm but has an air-conditioning unit to be used when hot, the temperature is difficult to judge as the thermometer is in front of open an window. Refrigerator and room temperatures are kept daily however fridge temperature records show a maximum temperature of 24 degrees centigrade since 18 June 2009. Care Homes for Older People Page 15 of 34 Evidence: The nurse on duty on the day of the inspection was recording the temperature but did not know how to reset the minimum/maximum reading. Some medicines which should be stored at room temperature were stored in the fridge and medicines which should be stored in the fridge were stored on the medication trolley at room temperature. There was a large quantity of unlabelled nutrtritional supplements in use. Some were out of date and others were labelled with the names of people no longer living in the home. The cupboard used to store controlled drugs appeared to meet regulations. Records were neat and kept in a bound book. All records and stock balanced on day of visit. The signature list in front of Medication Administration Record (MAR) folder was up to date and included all nurses who have signed MAR charts. All MAR charts have a divider that includes a recent photograph and a list of allergies for each resident. There were gaps on MAR charts on both floors and some medicines audited on the day did not balance with the stock available in the home. Discontinued medicines had a record of the date they were discontinued and handwritten entries were signed and dated. Care plans for two people on when required medication for aggitation were seen. One contained the appropriate protocols and risk assessments the other did not. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to use all areas of the home as they wish and relatives are encouraged to visit and join in events. Activities and social opportunities are still limited but planned changes should mean that people live more interesting and stimulating lives. Evidence: The new activities co-ordinator who is now called a PAL (Personal Activities Leader) told us that she was trying to make contact with schools and churches in the local community and to see which residents might like to go out to events. Monthy PAL meetings are held and these rotate around the different homes in the group so that PALs can share good practice and new ideas. An experienced PAL leads these meetings and is reponsible for producing minutes. We saw some nice social activities progress reports that were very individual and recorded what a person had been doing, and whether this was a communal event or carried out on a one to one basis. Events and activities included crosswords, wordsearch, manicures, and one to one sessions where time was taken to look at family photographs and reminisce. Entertainers had also been into the home. Care Homes for Older People Page 17 of 34 Evidence: People who sent back questionnaires said they always or usually liked the meals. A four weekly menu was in place but it was very repetitive. The operations manager immediately provided chef with the organisations comprehensive menu plan. Most of the food provided at meal times is home cooked/baked and good use is made of fresh produce. When we arrived at the home some residents were still enjoying their breakfast. There is always a cooked choice as well as cereals, toast or a resident can request something different. Sandwiches, home made soup and other items are available over night if someone wants something to eat. Residents were seen moving around the home as they wished and spending time in private or with a visitor. Visitors told us that they were happy with the care and support being given. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected from harm through policies, procedures and staff training in complaints and safeguarding adults. They know who to speak to if they are unhappy or wish to make a complaint and can be confident that issues will be properly dealt with. Evidence: Everyone who returned our questionnaires said that they knew how to make a complaint and who to speak to. The organisation has policies and procedures in place to promote the acceptance, recording and investigation of complaints, concerns and allegations. Monthly summaries of complaint and compliments are sent to the Regional Manager. These are also checked as part of the providers Regulation 26 visits. Staff are still working on the organisations Protection of Vulnerable Adults (POVA) workbook to keep them up to date with good practice, and increase their understanding of abuse and poor practice. There is also a whistle blowing policy that encourages staff to disclose any poor practice that they may witness. The home had received one complaint since last inspection, this had been reported to Care Homes for Older People Page 19 of 34 Evidence: CQC. Staff are required to have a Criminal Records Bureau (CRB) check carried out at an enhanced level before they are able to work in the home, and managment are aware of the need to report people who may be considered unsuitable to work with vulnerable people to the register. Regular checks are carried out to make sure that nurses working in the home have current registration. Care Homes for Older People Page 20 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 live in a home that is warm, comfortable and clean, where they can spend time in private or with other people and move about safely both inside and in the enclosed garden. Evidence: During the inspection we walked around the home. We also looked in a selection of bedrooms to make sure they were clean, tidy and safe for people who live in the home. People who live in the home have access to both communal and private areas where they can choose to spend their time. Everyone has a private bedroom, most of which also have en-suite facilities. We saw an increase in the number of profile beds and/or hospital style beds being used for the comfort and protection of residents. We identified the following issues that need attention. Lighting throughout the home needs to be checked to make sure that it meets the required lux levels. Some areas were dark which may be a result of light bulbs being replaced with environmentally friendly ones. Care Homes for Older People Page 21 of 34 Evidence: Minor repairs to furnishings were pointed out to the manager. The operations manager told us that new bedroom furniture and other items had already been ordered to improve the environment. An emergency pull cord in the upstairs lounge had snapped and could not be reached by anyone needing to summon help. We tested the nurse call system from a bedroom on the first floor. A sluice and domestic cupboard on the first floor were in need of cleaning, and no one could get into the linen store as bedding, duvets and other items were stacked from the floor, waist high, from the back to the front of the cupboard. The manager made arrangements for this store to be cleaned out immediately. Several plugs to sinks and baths were seen to be loose, and a tap was dripping in an assisted bathroom/toilet on the ground floor. We were told that a new bath is being fitted but the date for this was not yet known. Handrails throughout the home were sticky. The operations manager told us that they had been experiencing problems with some of the cleaning products being used and this was currently under review. En-suite facilities were seen to provide residents with limited storage facilities for their toiletries. People who sent back questionnaires said that the home was usually fresh and clean. Corridors have been re-decorated and were much brighter. New pictures, posters and other items were being introduced. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People working in the home are properly recruited and the residents know that their staff receive training to help them provide the care and support they need, although some training is still in need of updating. Evidence: The company has policies and procedures in place to support the proper recruitment and selection of staff. We looked at the records for three people most recently recruited to work in the home. Two nurses and six care assistants are on duty between the hours of 08:00 and 20:00 each day. Overnight there are two nurses and two care assistants. The care team is supported by the manager, administrator, PAL, chef, kitchen, laundry and domestic assistants, and a handyman. Each person had completed an application form, provided references from current/past employers as well as evidence of their identification. Interview sheets were not consistently completed, and for one person who had made a disclosure about a criminal offence, there was no dated/signed statement about the events that had taken place leading up to the caution. Care Homes for Older People Page 23 of 34 Evidence: All staff are issued with a statement of terms and conditions, and the organisations staff handbook. Care workers are employed in accordance with the General Social Care Council (GSCC) code of conduct and nurses have professional responsiblities linked to their registration with the Nursing and Midwifery Council (NMC). We saw an induction workbook that had been completed by a new member of staff. Only 24 of care staff have obtained a National Vocational Qualification (NVQ) at a minimum of level 2. We were told that seven other members of the care team were to start this training on the 1 July, and when this is completed will mean the home has achieved the 50 level required by the National Training Organisation. Mandatory training is not up to date but arrangements were being made to correct this. All qualified staff have completed medication administration training and three have updated their venapuncture/catheterisation practice. They have also done training on deprivation of liberty legislation and care planning. Ten care assistants have done tissue viability training. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that is being run in an open and inclusive way, promoting their best interests, safety and well being. Evidence: The manager provided CQC with a copy of the Annual Quality Assurance Assessment (AQAA) when we asked for it. We saw accident records that did not always properly reflect incidents and regulation 37 notifications had not been sent to the Commission to notify those events that had seriously affected the health and well being of a resident. We saw the fire log for the home that showed checks had been regularly carried out and recorded. Supervision is taking place but the record of these sessions are limited. Supervision notes were not locked up, but were being kept on an open shelf in the managers Care Homes for Older People Page 25 of 34 Evidence: office. Staff and health and safety meetings are not held regularly. There had only been two meetings for qualified staff, one for care staff and two health and safety meetings since the beginning of 2009. The home has an up to date certificate of insurance. Maintenance and servicing contracts were seen. An incident that involved a resident who had grabbed and shaken the wife of another resident had not been reported to the relevant professionals for investigation. When asked what the home does well people who sent back questionnaires said: Keeps relatives informed of residents health conditions etc; Staff are very approachable and helpful. Mum is always clean and presentable; Try their best. Present manager making slow progress in changing things for the better; Cares for my relative - assists her in personal care and keeps her safe, sees that she has all the clothing she requires. The home keeps me closely informed about my relative at all times. When asked what the home could do better people said: Perhaps more in the way of activities or outings although this could be difficult in residents like my relative with alzheimers. I think various experiments with different forms of therapy are now being tried out; Big television in big lounge. Carers sit with residents at least one or more at any time. Small quiet lounge - sometimes about 4-6-8 residents can be sitting with no carer supervision for up to two hours; Clothing often gets mixed up with other residents; Cleanliness - although this has recently been addressed (mainly in bedrooms). Food is much better now due to change of staff, it had recently been of poor standard but now its lovely (at last). Would be nice if it was kept to this standard. Other comments made included: We are very satisfied with the care my relative receives and I have found the staff and management approachable, co-operative and friendly; Too many staff at one time outside smoking leaving residents with little supervision; Staff are always very friendly and helpful. Always speak very nicely of my relative. 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 12 All the information obtained during the assessment process must be used to create care plans. This will mean that staff have all the information they need and know how to support people living in the home. 25/11/2009 2 8 12 Food and fluid charts must be properly and reguarly completed so that checks can be carried out to make sure that people are getting enough to eat and drink. This will help to keep people who live in the home safe and well. 25/08/2009 3 8 12 Body maps must be properly 25/08/2009 and fully completed detailing the size of injuries or pressure areas and the treatment being provided. 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 This will help to keep people who live in the home safe and well. 4 8 12 Clear guidance must be provided for staff who are supporting people who display behaviours that may challenge daily routines. This will help to keep people who live in the home and staff safe and well. 5 8 12 Staff must follow up and record the intervention of healthcare professionals. This will mean that residents get to see healthcare professionals when they need helping to keep them safe and well. 6 9 13 Medication must be given as 25/07/2009 prescribed and a record must be made at the time that it is given. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 7 9 13 Medication must be stored safely and securely and a system must be in place to 25/07/2009 25/08/2009 25/08/2009 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 check expiry dates of medicines and to add the dates of opening when necessary. This makes sure that medication is safe to administer. 8 12 13 The home must continue to promote an increase in opportunities for people to take part in activities and social events. This will mean that residents live more interesting and stimulating lives. 9 13 13 The home must continue to promote increased contact with the local community. This will mean that residents live more interesting and stimulating lives and keep in touch with events that are taking place. 10 15 13 A more vaired and interesting menu choice must be made available to people living in the home. This will promote variety and choice at mealtimes for people who live in the home. 25/08/2009 25/11/2009 25/11/2009 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 11 19 13 Lighting levels in the home must be reviewed to make sure they meet the required lux levels. This will mean that sufficient light is provided so that people can be safe. 25/08/2009 12 19 13 Minor repairs and replacements must be carried out. This will mean that people live in a safe and comfortable environment. 25/08/2009 13 28 19 The home must promote training so that 50 of care staff have an NVQ at a minimum of level 2. This will mean that people are properly trained to do their job. 25/11/2009 14 30 19 A programme of training must be completed to make sure that all mandatory training is up to date. This will help to keep people in the home safe and well. 25/11/2009 15 36 13 Staff supervision and support must be carried out at regular intervals and properly recorded. This will mean that staff get the support they need to do 25/11/2009 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 their job and their is a clear aduit trail in the event of capability or disciplinary issues being raised. 16 36 13 Staff meetings must be held regularly so that staff have access to the most recent, and up to date information. This will mean that staff have all the information they need to do their job and the opportunity to raise any issues of concern. 17 37 17 All records must be kept up to date and be legible. This will mean that people using the records can easily read the information provided. 18 37 37 All events and incidents that affect the well being of residents must be reported to CQC. This will help to keep people who live in the home safe and well. 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 25/11/2009 25/11/2009 25/07/2009 1 3 Staff should make full use of the CHAP document when carrying out assessments, recording as much information Page 32 of 34 Care Homes for Older People 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 as possible, to help and support staff to provide the right care and support that people need. 2 9 The temperature of the medication room and fridge should be regularly monitored. This makes sure that medicines are being stored at the temperature recommended by the manufacturers. 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. 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