Inspection on 11/03/10 for Leycroft Care Centre

This inspection was carried out on 11th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Leycroft Care Centre Leycroft Care Centre Roman Road Taunton Somerset TA1 2BB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Philpott     Date: 1 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Leycroft Care Centre Leycroft Care Centre Roman Road Taunton Somerset TA1 2BB 01823279151 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): care@schealthcare.co.uk Southern Cross (Taunton) Opco Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 69 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: A suitably qualified and experienced clinical lead must be in place whilst Linda Knowles is the registered manager for this service The maximum number of service users who can be accommodated is 69 The registered person may provide the following category of service only Care home with nursing Code N to service users of either gender whose primary care needs on admission to the home are within the following categories Old age not falling within any other category Code OP Dementia Code DE Date of last inspection Brief description of the care home Leycroft is a new purpose built home near to Taunton town centre. The home is registered with the Care Quality Commission (CQC) to provide a service for up to 69 Care Homes for Older People Page 4 of 33 Over 65 0 69 69 0 Brief description of the care home people with dementia care needs to include personal and nursing care. A passenger lift serves all floors. The ground floor has 34 bedrooms, dining room, 2 lounges, and an activity lounge. The first floor has 35 bedrooms with dining facilities, lounge areas, and a hair salon. All bedrooms have ensuite toilets and showers. In addition each floor has two bathrooms. The home has a internal courtyard garden and side garden. The registered provider is Southern Cross. The home does not currently have a registered manager. The current fee range (from 1st April 2010) is from £547.63 to £750.00. Continuing healthcare funding (CHC) will be discussed on an individual basis. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Leycroft Care Centre was registered with the Commission in September 2009. As the home is registered with the Commission as a new service, all of the National Minimum Standards were assessed at this inspection. This was an unannounced inspection which was carried out by two inspectors over a total of 13 inspection hours on 11th March 2010. Throughout the report the term we will be used as it is written on behalf of the Commission. On the day of inspection, five residents were living in the home. One person was receiving nursing care, four people were receiving personal care only. A sixth person was moving into the home for planned respite on the day of the inspection. As part of this inspection we received three completed surveys from people who have lived in the home. During the inspection we spoke with people who live at the home Care Homes for Older People Page 6 of 33 and staff. Some people who live at the home were unable to fully express their opinions, therefore we also observed care practice and interactions. We viewed parts of the accommodation. We looked at three individual care plans, and looked at records relating to medication, finance and health & safety. The home did not have a manager on the day of the inspection. The Clinical Lead Nurse was in charge of the home and was available throughout the inspection. The inspectors would like to thank people who live at the home and staff for their assistance on the day of inspection. The focus of this inspection visit was to inspect the relevant key standards under the Inspecting for Better Lives 2 framework. This focuses on outcomes for residents living at the home. The quality of the service is measured under four ratings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The homes Statement of Purpose and Service Users Guide does not contain current information. These documents must be updated, so that people have the up to date information about the management structure at the home. Care plans need to contain clear records, in particular this refers to what people have eaten or had to drink; incidents of challenging behaviour and aggression. There needs to be evidence of how care needs are being monitored and when action needs to be taken. The registered provider needs to ensure that staff are given detailed guidance on how to meet peoples needs, and that staff follow the guidance in the care plan. This is to ensure that people receive appropriate care and the effectiveness of care plans can be evaluated. Staff at the home are currently trying to carry out nursing and care duties whilst also providing activities for the people who live in home. The home told us that they are getting an activities worker. The mealtime experience could be improved to ensure that people are able to enjoy their food and mealtime in more settled and sociable setting. We observed limited communication between a care assistant and a person who lives in the home. Whilst people were eating their lunch, staff were vacuuming the carpet outside the dining room. There have been several incidents where people who live in the home have been placed at risk of harm or have been harmed. The registered provider needs to ensure that staff are given detailed guidance on how to meet peoples needs, and that staff follow the guidance in the care plan. Care Homes for Older People Page 8 of 33 There was no signage on bedroom doors. Some of the people with dementia may find this very disorientating. The registered provider must ensure that there is adequate signage and points of reference around the home. This will enable people to move easily around the home and maintain independence. Recruitment files were generally well organised. However, one employment reference was not signed or dated to evidence who had written it. One member of staff did not have a full employment history. The home must ensure all the required information is obtained to protect people from risk of harm. We found a number of shortfalls in staff training. There were gaps where staff have not completed training in the following areas; induction; fire safety; health & safety; abuse and protection of vulnerable adults; infection control; challenging behaviour; and dementia awareness. The home must ensure that staff complete training in these areas. This is to ensure that staff have the specialist skills and knowledge to meet the needs of the people who live in the home. It is also to ensure that people who live in the the home and staff are protected from the risk of harm. The home does not have a Registered Manager. The home needs a Registered Manager so that there is clear leadership and direction to the home and to ensure that care and support is of a high standard and appropriate to the needs of people living there. The home told us that a new manager is starting work at the home on 15th March 2010. The home has not kept us informed about what has happened there in a timely manner. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes statement of purpose contains detailed information about the service but has not been updated to reflect the current management structure. Each person living at the home has a written contract and terms and conditions. The home completes a pre admission assessment prior to admission. The home does not ensure that systems are in place to keep people safe after admission. People with specialist needs who live in the service may receive poor quality care due to the lack of trained, knowledgeable staff. People are offered the opportunity to visit the home. Evidence: We looked at the homes Statement of Purpose and Service Users Guide. These Care Homes for Older People Page 11 of 33 Evidence: documents contained a good level of detail about the home. The documents need to be updated to reflect the management arrangements at the home. One person told us that they received sufficient information to enable them to choose to live in the home. The home told us each person has a contract and terms and conditions. We looked at one contract. This contained all of the required information. We looked at three pre-admission assessments that had been carried out prior to people moving into the home. The home had also obtained assessments from other agencies. These contained detailed information about the individuals needs. Two of the people had been involved in incidents within three days after their admission including a fall that led to harm, one person exiting the home on two occasions, and a staff member being hit. One member of staff was providing one to one support to a person who lives in the home. The person has one to one support in place due to their care needs, dementia and challenging behaviour. We spoke with the member of staff and found that they had not worked with people with dementia care needs before starting work at the home, neither had they completed an induction, or training in dementia or challenging behaviour. Five out of the six people who were living at the home on the day of the inspection have dementia care needs and some of these people present with challenging behaviour. The home currently employs nine care staff. We found that four out of the nine staff have completed training in challenging behaviour; six out of the nine staff have completed training in dementia awareness. This potentially places people living in the home and staff at risk of harm. The home told us on the AQAA we recommend all potential service users, relatives or friends visit our home to assess our facilities and their suitability. One person who who lives in the home told us their relative visited the home on their behalf to look around. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place but do not always provide a clear record. Staff do not consistently follow the guidance provided which places people at risk of harm. People have access to health care services. There are safe medication administration procedures in place. Peoples privacy and dignity are generally respected. The lack of interaction of one staff member when carrying out a task is disrespectful to people living at the home. The home has information in place relating to dying and death to ensure that peoples wishes are met. Evidence: The home told us on the AQAA a pre-admission assessment and comprehensive care plan is formulated to ensure that the care needs for the residents in our care are fully met. Care Homes for Older People Page 13 of 33 Evidence: We looked at three care plans. These contained an assessment of individuals needs and information on how these needs were to be met. One person who lives at the home was identified as needing constant supervision and observation prior to moving in. On the day after they moved into the home, they were left unattended in the lounge and fell. This shows us that staff had not followed the assessment information. It wasnt until after this incident that the home arranged one to one care for the person. The care plan written after this incident stated unable to maintain a safe environment and needs close observation continually and ensure staff always around. The home told us on the AQAA the local GP visits the care home once every week. The home had discussed one persons weight loss with the GP. The GP advised the home to give the person supplements and more snacks between meals. We looked at the nutritional intake chart. It was very difficult to ascertain what had been given. There was no evidence that snacks were being offered between meals. There was no information relating to this in the care plan and no information on how to increase the calorific value of foods. We looked at fluid intake records for two people. For one person, fluid intake had not been totalled and the amount taken was not consistently recorded. Therefore it was difficult to evidence what the person had actually received and how this was being monitored. The second persons care plan stated encourage at least 1500mls fluids a day. This had not been achieved on any day over the past eight days. There was no evidence how this was being monitored or followed up. Two of the peoples care plans referred to challenging behaviour and aggression. There was no information on what may trigger this. Incidents were being recorded in daily records, a separate diary for one person, and on incident forms. There were instructions for staff to keep a distance; document inappropriate behaviour and use distraction/de-escalation techniques. One persons care plan stated all challenging behaviour incidents and falls need to be recorded in challenging behaviour record and in daily notes. The challenging behaviour record was blank. There was no consistent way of recording incidents and it was not clear how the home was monitoring and reviewing these. There was no further information on what these techniques were and not all staff have received training in dealing with challenging behaviour. We looked at the medication records and medicines. The home uses a monitored dosage system. The Medication Administration Record Sheets were fully completed. Care Homes for Older People Page 14 of 33 Evidence: Where entries had been hand written on the sheets these had been checked by two staff. Where variable doses had been prescribed, the amount given had been recorded. One person was prescribed controlled drugs. These were checked and the balance was found to be correct. The temperatures of the fridge and room where medication is stored were recorded daily to ensure that medicines are stored at the correct temperature. Registered Nurses administer the medication. Training records show that all of the Nurses have completed training in the safe handling of medication and a medication update. We observed staff respecting peoples privacy and dignity by knocking on bedroom doors, and closing doors when carrying out personal care. The lack of interaction between one staff member and a person who lives at the home indicated a lack of respect. On checking the training records, the member of staff had not completed their induction training which includes communication and respect. The home has information and wishes relating to dying and death in individual care plans. The home told us that they have links with the local hospice. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As there is currently no activities worker at the home, activities are limited. Visitors to the home are made to feel welcome. People are offered choices. The food at the home is balanced and nutritious. Lunchtime did not provide an enjoyable social event for people who live in the home. Evidence: Staff told us that the activity worker has left the home. Care staff are currently doing the activities. We looked at an activity planner on the wall. When we asked what was happening on the day of the inspection, staff told us I will have to look at the board and see what I can do. During the inspection, we observed the nurse on duty playing ball games with people and later reading poems to an individual, in addition to her duties. Several people were wandering up and down the corridor. Staff told us that an activity worker is being recruited. The home told us that one person who lives at the home had requested a visit from a Care Homes for Older People Page 16 of 33 Evidence: minister. This had been arranged and had taken place. One person who lives at the home told us their visitors are made to feel welcome and staff always offer them a hot drink. They also told us that they are able to choose how to spend their time during the day. Although the home is registered to provide specialist care for people who have a dementia, we did not observe any objects around for people touch, pick up or interact with. We observed nice interactions at breakfast between a care assistant and people who live in the home. We observed that the menu was displayed on a white board in the corridor. The home had also left the menu from the day before on the board. This may be confusing for some of the people who live in the home. The home told us on the AQAA mealtimes are important for social interaction and service users are encouraged to come to the dining room. We provide a varied and appealing menu and a positive dining experience for all residents. The dining room tables were laid for lunch by a care assistant. The home should consider involving people who live at the home in carrying out daily living activities, where appropriate. People were offered a choice of juices at lunchtime. The cook brought the hot trolley into the dining room. People were offered a choice of meals. A care assistant brought one person into the dining room and assisted them to sit down. They did not explain to the person why they were there and there was very limited communication. The person did not eat their lunch and the care assistant did not look for ways to encourage the person to eat. As people began to eat their lunch, housekeeping staff started to vacuum the carpet outside the dining room. This continued on and off for over ten minutes, taking away from the social experience of lunch. One person who lives in the home told us that the food is very good. They told us that their special diet is well catered for, alternative dishes are available if you dont like something and sandwiches are provided so they can take their medication in the evening. We spoke with the cooks who told us that they talk to the nurses about peoples diets. They were booked to attend a training course in nutrition. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure. People rights to vote are upheld. A number of staff have not received training in abuse awareness. The home does not have always have systems in place to ensure that people are protected from risk of harm. Evidence: The home has a complaints procedure in place. The home told us that they have not received any complaints since they opened. The home told us that they had offered people the right to vote where appropriate. We saw that voting forms were in place if anyone should wish to vote. The home does not currently have information about advocacy services in place. They told us that they are planning to obtain this information. 7 of the 22 staff who work at the home have not completed training in abuse or protection of vulnerable adults. Staff spoken with on the day of the inspection knew what to do if they suspected or witnessed abuse. The company that owns the home Care Homes for Older People Page 18 of 33 Evidence: have a whistleblowing service that staff can telephone to raise concerns. As a result of the incident at the home where a vulnerable person who was identified as needing constant supervision was left unattended and fell causing harm, a safeguarding meeting was held. This was attended by Local Authority, the Commission, other agencies and the home, as there were concerns about peoples safety at the home. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is well maintained, well furnished and provides pleasant surroundings. The home does not have signage in all areas to help orientate people who have dementia. The environment was clean and fresh throughout. Evidence: Leycroft is a new purpose built home. A passenger lift serves all floors. The home told us on the AQAA all rooms and facilities are at the highest specifications including top of the range furnishings and Freeview TV as standard. The ground floor has 34 bedrooms, dining room, 2 lounges, and an activity lounge. The first floor has 35 bedrooms with dining facilities, lounge areas, and a hair salon. This floor is currently unoccupied. We looked at the bedrooms that are currently occupied. Peoples rooms were personalised with their own possessions, including furniture, photos, and pictures. One person told us they were pleased that they could bring their chair with them. Care Homes for Older People Page 20 of 33 Evidence: There was some signage within the home to help orientate people. There was no signage on bedroom doors. Some of the people with dementia may find this very disorientating. The home has a call bell system in place. This system can be linked to room sensors to monitor people moving about at night. We observed that people living in the home had access to call bells in their bedrooms. All bedrooms have ensuite toilets and showers. In addition each floor has two bathrooms. A hoist can be used for access. The home has hoists and stand aids on each floor. The home has a internal courtyard garden and side garden. On the day of the inspection, the home was warm throughout. The home was well lit, with some areas benefiting from natural light. The areas of the home we viewed, were clean and fresh throughout. The laundry is situated on the third floor of the home. Commercial style washing machines and tumble dryers are provided. The home employs laundry staff. Staff were observed wearing gloves within the home. Hand washing facilities are available throughout the home. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There appeared to be sufficient staff on duty to meet peoples physical needs but the level of staffing restricted the provision of activities. A number of staff do not have the necessary skills and knowledge to meet the assessed needs of people who live in the home. Recruitment records are generally well managed but improvements could be made. Evidence: On the day of the inspection, the following staff were on duty; one Registered Nurse, two care assistants; two cooks; two housekeeper; and a laundry assistant. One of the care assistants was providing one to one care. Care staff told us that they are managing with two care assistants on duty as only one person currently needs two staff to assist them. Care staff were also providing some activities. We looked at the rotas and found that one member of staff had worked 72 hours over a seven day period. The staff member worked 48 hours of this at Leycroft and 24 hours at one of the companys other homes. On checking the training records and speaking with the staff member, we found that they had not completed an induction or training in challenging behaviour or dementia awareness. This potentially places Care Homes for Older People Page 22 of 33 Evidence: people who live in both homes and the staff at risk of harm. The home told us on the AQAA we strive to maintain a good skill mix for staff who are adequately trained and all staff have attended mandatory induction training for all levels and an on-going training programme is in place. We found a number of gaps in the homes training matrix. Staff told us that planned induction training which was booked for 12th February 2010 did not take place as the manager left on 5th February 2010. The home employs 22 staff. 4 staff have not completed fire safety training; 7 staff have not completed abuse and protection of vulnerable adult training; 7 staff have not completed training in infection control; (see also dementia awareness training and challenging behaviour training in Choice of Home section). Four of the nine care staff (44 ) have completed an NVQ at level 2 or above. The home told us that more NVQ training is planned. We looked at three staff files. One staff recruitment file contained all of the required information. The second file contained a reference that was not signed or dated. The application form in the third file contained an employment history that started from 2007. Care Homes for Older People Page 23 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have a registered manager. It currently lacks leadership and direction. Quality assurance systems are being developed. Policies and procedures safeguard peoples monies. The health, safety and welfare of people who live in the home and staff are not fully promoted and protected. Evidence: On the day of the inspection, the home did not have a manager. We attended a safeguarding meeting on 4th March 2010, where the project manager for the company who owns the home was present. At the meeting we found out the manager designate who was due to register with the Commission had left employment at the home on 5th February 2010. The Commission had not been notified that the manager had left. We Care Homes for Older People Page 24 of 33 Evidence: were told that a new manager will be starting work at the home on 15th March 2010. The project manager told us that she was providing two and a half days management cover per week at the home in the meantime. On the day of the inspection the clinical lead nurse was in charge of the home. It is evident from our findings that the home is currently lacking leadership and direction. This includes the inappropriate supervision of a new resident which led to an incident and safeguarding investigation; inconsistent record keeping; the lunchtime experience; gaps in staff training; and lack of communication with the Commission of what has been happening at the home. Staff told us they are happy. One person told us they feel well supported as the project manager and operations manager are available on the telephone. We looked at records of Regulation 26 visits carried out by the company that owns the home. These records were detailed. The manager designate had carried out a monthly audit up until January 2010 to monitor quality. The home told us that they have not yet carried out any surveys and that this was planned. The home has a certificate of insurance cover on display in the entrance hall. The home told us on the AQAA the individual budget for the home is broken down and cost analysed each 4 weekly period. The home stores small amounts of monies for some of the people who live in the home. We checked the monies for two people. The balances were found to be correct. Records are maintained on a computer spreadsheet. Monies are stored securely and individually. Two signatures are obtained to evidence transactions. Receipts were available for auditing purposes. Staff told us that they have received supervision on a regular basis. We saw records that indicated that supervision took place in November 2009 and January 2010. Records were stored securely in accordance with the Data Protection Act 1998. The home has submitted Regulation 37 reports to let us know what has happened at the home. Two reports of incidents that took place in December 2009 were not forwarded to us until February 2010. The home must ensure that Regulation 37 reports are submitted to the Commission in a timely manner. Care Homes for Older People Page 25 of 33 Evidence: The training matrix shows that a number of staff have not undertaken training in safe working practices including fire safety and infection control (see staffing section) We looked at the fire safety book. The fire alarms had been serviced on 15th January 2010. The home had carried out regular checks to ensure that the fire alarm system and emergency lighting was working. Three staff fire drills had been carried out between September and November 2009. The home told us on the AQAA that the following equipment had been maintained and serviced as appropriate; electrical installation, portable appliance testing, lifts, hoists, call bell system, and gas appliances. We looked at records that evidence that the home tests water temperatures on a weekly basis to ensure that a safe temperature is maintained. Cleaning chemicals were stored securely. We viewed a number of incidents written in daily records where staff had been hit or experienced aggression. The home told us that these not recorded on incident forms. It is not clear how the home is monitoring and following up incidents that involve staff. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 The registered provider must ensure that the Statement of Purpose and Service User Guide contain up to date information. This is to ensure that people have the correct information about the management structure at the home. 31/05/2010 2 4 18 The registered provider must ensure that staff receive training in dementia awareness and challenging behaviour. This is to ensure that staff have the specialist skills and knowledge to meet the needs of the people who live in the home. It is also to ensure that people who live in the the home and staff are protected from the risk of harm. 31/05/2010 3 7 12 The registered person must ensure that staff are given 30/04/2010 Care Homes for Older People Page 28 of 33 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 detailed guidance on how to meet peoples needs, and that staff follow the guidance in the care plan. This includes guidance relating to physical and mental healthcare needs. To ensure that people receive appropriate care and the effectiveness of care plans can be evaluated. 4 12 16 The registered manager is 31/05/2010 required to ensure that social interaction and activity is provided and available for all people using the service. This is to ensure that individuals social needs and preferences are met. 5 22 23 The registered provider 31/05/2010 must ensure that there is adequate signage and points of reference around the home. To enable people to move easily around the home and maintain independence. 6 29 19 The registered person must ensure that employment references are signed and dated. This refers to one identified reference. 31/03/2010 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To evidence who has written the reference and to protect people from the risk of harm. 7 30 18 The registered provider 31/05/2010 must ensure that new staff undertake induction training. This is to ensure that staff have the skills and knowledge to meet the requirements of the job and peoples needs. The registered person is 30/04/2010 required to ensure that care provided at the home is monitored and audited to ensure good practice is maintained. This is required for the health, safety and well being of people using the service and staff. The registered provider 31/05/2010 must ensure they register a manager. To give clear leadership and direction to the home and ensure that care and support is of a high standard and appropriate to the needs of people living there. 8 31 12 9 31 8 Care Homes for Older People Page 30 of 33 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 10 38 37 The registered person must ensure that Regulation 37 reports are submitted to the Commission in a timely manner. This is so that we know what is happening at the home. 31/03/2010 11 38 13 The registered person must ensure that staff complete training in safe working practices. This is to promote and protect the health, safety and welfare of people who live in the home and staff. 30/04/2010 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 10 Support should be given in a way that shows respect for the person. This refers to the lack of interaction between a staff member and a person who lives in the home. The registered person should explore ways to make the menu more accessible to people who live in the home. The home should review the manner in which people are assisted with preparations for lunch and the service of food to ensure that people are able to enjoy their food and mealtime in a more settled and sociable setting. 2 15 3 4 29 30 The home should obtain a ten year employment history for staff who work in the home. The home should provide a separate column in its training matrix to evidence the date that individuals staff induction was completed. Page 31 of 33 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 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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