Inspection on 09/02/10 for Lickhill Manor Nursing Home

This inspection was carried out on 9th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lickhill Manor Nursing Home 14/06/10

Lickhill Manor Nursing Home 07/04/09

Lickhill Manor Nursing Home 07/10/08

Lickhill Manor Nursing Home 25/01/08

Lickhill Manor Nursing Home 04/05/07

Lickhill Manor Nursing Home 25/01/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL     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: Christine Potter     Date: 0 9 0 2 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 35 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 35 Information about the care home Name of care home: Address: Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL 01299827789 01299878065 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Gentle Care Services Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to accommodated is 40 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 categories: Old age not falling within any other category (OP) 40 Physical Disability (PD) 40 Date of last inspection Brief description of the care home Lickhill Manor Nursing Home is a large grade II listed building, which has been extended to provide nursing and personal care for 40 people. The majority of people in the home are elderly people, but the home accommodates some younger people with debilitating illnesses, for example multiple sclerosis. The home is located on the outskirts of Stourport-on-Severn next to Lickhill caravan park. It is situated in over an acre of landscaped gardens providing pleasant views from the rooms. The home is difficult to access on public transport but is within short Care Homes for Older People Page 4 of 35 0 40 Over 65 40 0 Brief description of the care home distance of the town with the shops and the river Severn. The home provides plenty of car parking for visitors within the grounds. Accommodation is provided on three floors in both single and shared rooms. The home provides a range of aids and equipment to assist them in meeting the needs of people using the service. A passenger lift is available to assist people using the service to access all three floors of the home. Communal areas are available with three lounges and a separate dining area, so that people have a choice of where they wish to spend their day. The home is owned by Gentle care services limited. The registered manager for the home is Lyn Mason who is a first level registered nurse with many years experience, having worked at the home for 16 years. Lyn is responsible for the day to day running of the home. Information regarding the home can be obtained from the Statement of Purpose and the Service Users Guide which are available from the home. Information regarding fees for the Home should be requested direct from the manager or from the owners. Copies of the most recent Care Quality Commission inspection report are readily available within the Home and on request. Care Homes for Older People Page 5 of 35 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: We carried out this key inspection without prewarning the home we were going. During the inspection we looked at aspects of the service that are important to people using it and checked the quality of the support provided. The inspection was carried out early to follow up concerns and monitor the health and safety of the people living in the home. The Annual Quality Assurance Assessment was not received from the home prior to the key inspection. We also took into account information in surveys that were returned to us by three people who live in the Home (some of these were filled in for them by relatives), and four staff members. During the inspection we spoke to people who live in the Home and to relatives. We also spoke with the manager, administrator, deputy manager and nurses and care Care Homes for Older People Page 6 of 35 staff. We inspected parts of the premises and looked at various records such as care records and staff files. During the inspection we issued code B notices (these are statutory notices for seizing information) and copied information as evidence that the home had not serviced the boiler and the lifting hoists in the home. The provision of staff covering the 24 hour day, appeared insufficient for the size of the home and the needs of the people. The latest regulation 26 reports, was a requirement at the last key inspection and had not been complied with. An immediate requirement was made for the home to provide risk assessments for the portable heaters in use in the home. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: The main areas of concern were around health and safety issues in the home. The registered provider must ensure that maintenance and servicing of all systems and equipment is completed to ensure the safety of people living in the home and for staff working there. Issues around medication were found during the inspection. The home must ensure that people receive their prescribed medication correctly. Staffing arrangements need to be reviewed to ensure that staff are always deployed effectively and in sufficient numbers so that people in the home have the individual care and attention they need. The home needs to work on improving the quality of written plans describing peoples care needs to make sure the plans give clear information and guidance to staff and reflect each persons needs and wishes. The health and social care needs of the people who use the service need to be promoted and staff need to act upon outcomes of assessments and instructions from health professionals to ensure people are not placed at risk of harm through neglect of care. If the Home is going to continue to accommodate people with dementia type illnesses they need to find out more about recognised best practice in this area of care, including care practice, communication, training and how the environment can be used to help people. To further protect people living in the home, all accidents should be reviewed and investigated, while significant events should be reported to the Care Quality Commission under regulation 37. The hours allocated for cleaning should be reviewed to ensure that the staff have Care Homes for Older People Page 8 of 35 sufficient time to clean and maintain a good standard for the people living in the home. To further protect people living in the home all staff recruited should follow the correct procedure and safety checks. The home should ensure that policies and procedures are in place, and staff are aware of them to ensure best practice for the people living in the home. To ensure that people feel listened to, the complaints procedure should be reviewed. 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 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with sufficient information about the home before moving in, so that they know what they can expect. Failing to assess peoples health and psychological needs accurately may affect the care delivered by not meeting the individuals assessed needs. Evidence: The last key inspection rated these standards as adequate, and recommended that the home review its admission procedure, to make it more person centred for the individual. We received three completed surveys from people using the service. These confirmed that people had received sufficient information about Lickhill Manor. To assist them to make their mind up about moving into the home. Comments received included: the home is a friendly home, which is important for those that stay and also for their relatives, but there is always room for improvement Care Homes for Older People Page 11 of 35 Evidence: We asked to look at the Statement of Purpose and Service Users Guide. We were provided with a copy which had been printed off the computer, which was not clear to read. These showed that the information had not been reviewed since 2008. The details were not accurate about the home. Copies of the documents were not seen for people to look at in the home. There was no previous inspection report available for people to read and we were told that the manager would have to send a copy out in the post if anyone requested to see this. We asked to look at the contracts for people moving into the home. We were told that they were still using old ones from the previous provider. Staff had not been provided with accurate contracts to give people being admitted to Lickhill Manor. The people we case tracked had not been provided with a contract providing them with the homes terms and conditions. We looked at the care files for four people. This was to assist us in understanding why the individual had been admitted to Lickhill Manor and the level of information included in the pre admission assessments. This is an overview of the person to ensure that the home is able to meet the individuals health and personal care needs fully. We were informed by the deputy manager that it is normally the manager who would assess peoples needs before they were admitted. It was found that a pre admission assessment had not been completed for two of the four individuals prior to them being admitted to the home. The reason for this was they were emergency admissions and the manager took information over the telephone. To ensure that the home only accepts people whose health and personal care can be met some assessment should be completed. This helps the home to ensure that they have the correct number of staff with the appropriate skills to meet the individuals health and psychological needs. One pre admission assessment gave directions for staff to encourage fluids, x likes to have a drink with them at all times. However the care plan did not clearly show how this was being managed. It stated to provide the person with a beaker of fluids within reach at all times, this was not happening at the time of the inspection. The person was admitted to the home in July 2009, and some basic assessments had not been developed until November 2009. Where pre admission assessments were completed they did not provide sufficient information, and failed to include a proper risk assessment for the persons potential development of pressure sores or nutritional risk prior to admission. The information Care Homes for Older People Page 12 of 35 Evidence: also failed to provide information about the persons psychological needs and any issues for them about independence and moving into a nursing home. Nurses and carers told us that they were not always provided with all the information about new people when they moved into the home. Care Homes for Older People Page 13 of 35 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 do not provide sufficient information for staff to assist people to meet individual needs. The management of medication does not ensure that people receive their medication as prescribed. Evidence: The last key inspection rated these standards as adequate, and made two recommendations. For the service to ensure that people have care plans completed in a timely way when they are admitted to the home.The second that the care plans should provide personalised information so staff are aware of how to support the individual and meet their personal preferences. These recommendations had not been addressed at this inspection. We looked at the care records for four people who were using the service. We found some poor outcomes of care for these people from the poor quality of record keeping. Each person has an individual care plan. The care plan consisted of information about the persons health and very basic risk assessments. These had not been completed in Care Homes for Older People Page 14 of 35 Evidence: sufficient detail for staff to follow and there was a general lack of consistency with the care plans which we looked at. The pre admission assessment provided little information about the individual and lacked guidance about specialist equipment and aids needed, to ensure the individuals health is not compromised. The pre admission assessment for two people had not been completed. We were told this was because they were an emergency admission. In one care plan there had been a long delay from the person being admitted to the home for the development of care plans and risk assessments to be completed. The person was admitted early August 2009 and some of the assessments and care plans were dated November 2009. The care records failed to provide sufficient information about individual personal preferences, which assist staff in getting to know the individual and understanding them. Information about food preferences, life history, and social and leisure preferences were not consistently in place. For one person, there was a history of falls recorded on the pre admission assessment. The home had not completed a fall risk assessment for three months of them being admitted to the home. The accident records showed that the person was having falls in the home. For another person the care plan told us of that the skin integrity recorded broken areas. There was no clear intervention recorded about what equipment was being used, the skin risk assessment had not been updated, and no actual measurements had been documented. This assists in monitoring the progress of skin damage. The third record showed that the person was losing weight and the assessment stated to weigh the person weekly, however this was not being followed. It was a significant weight loss which appeared not to have been addressed. We spoke to the nursing staff who told us that because of the poor staffing levels they did not have sufficient time to complete the care records, but were aware of the importance of maintaining accurate records. We asked how the staffing levels are being calculated and were informed by the use of Dependency assessments. However in the records we looked at, these had not been completed or reviewed. Comments received from people using the service included: they are all very caring. Care Homes for Older People Page 15 of 35 Evidence: Comments from staff working at the home included: person centred care plans need to be practical throughout the day, not just on paper. An assessment for mental health should be given the same importance as physical problems. Care plans should be available to all staff. Family should be encouraged to participate with these plans. Hand overs should be seen as a valuable communication system. All staff should have designated roles with all staff aware of their responsibilities. Being short staffed means that sometimes individuals needs are not met fully. We looked at how the home managed peoples medication. Nurses told us that because of the staffing levels, the prescribed medication was being administered late to people. We saw medication left in a medicine container (tot) on a table with one person. This does not ensure the safety of people who may be wandering around the home or may be confused due to their dementia. On the Medication Administration Records (MAR) we found that there were several gaps where medications had not been signed for. There was no system in place for auditing the medication management to identify if the medication had been administered. A nurse spoken to had not been shown the homes medication policy. We spoke to staff who had recently been appointed to the home, and they told us that they had not received induction training, or shown any of the homes policies and procedures. This places people using the service at potential risk. We saw toiletries in the bathrooms with no name, and large tubs of barrier cream with no name and no date of opening. Protective clothing was available in the home for staff to use. However in some areas protective gloves, and hand gel were missing. A system should be in place for checking that protective products are available to reduce the risk of cross infection in the home. On looking at the accident records we noted an increase over the last three months, and some involved lifting equipment, which appeared not to have been followed up. On checking the hoists in the home these had not been serviced since January 2009. Staff confirmed that they were using the hoists. New staff told us that they had not received manual handling training when they commenced, and were operating the lifting equipment. Information was copied and taken from the home using code B notices. Care Homes for Older People Page 16 of 35 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. The social and nutritional care is not person centred to ensure all people receive the stimulation and nutrition they require in order to meet their needs. Evidence: The last key inspection rated these standards as good. Since the last key inspection we have received two complaints making allegations about the poor quality of food provided in the home. These complaints have been investigated and were not upheld. The last key inspection recommended that the home review more suitable activities for people with more complex needs. Comments received from people using the service and staff, stated that the home could provide more stimulating activities for some of the people living there. The activities organiser works at the home for 21 hours a week spread over four or five days. Given the layout of the home and the dependency of some individuals the activities are not meeting everyones needs. Those people participating were complimentary about the staff memeber and the events arranged for them. We were told that the home does not provide a budget for activities, this is raised by fund raising events. We spoke to the activities co ordinator, we were told that she Care Homes for Older People Page 17 of 35 Evidence: visits everyone in their room for a chat at least once a week. In addition to this she organises some group and individual activities. Some of the outings had stopped, it was felt the same people going out all the time. Examples of activities include: music, visiting entertainers, exercise for hands, bingo, art, quizzes, craft clubs, film clubs, relaxation and massage, reminiscence, walks and church services. There is a board displayed in the entrance to the home advising of the forthcoming activities. We saw visitors throughout the day, and they were made welcome by staff. Visitors can visit the home at any time, and can request a meal to have at the home. During the inspection we saw people in the lounges watching the television. The picture on the television in the first floor lounge was blurred, making it difficult for people to watch. We asked staff if peoples wishes were respected about what time they get up and go to bed. Staff told us that given the staffing levels they were not sure that everyones choice was being met. We spoke to the cook who was on duty at the time of the inspection. We were told that they are responsible for ordering the food, and where the food is supplied from. The owner brings the tinned foods, fresh fruit and vegetables into the home. The only fresh fruit and vegetables in the home were seven bananas and eight pears. The lunch on the day of the inspection was chicken stew, potatos and cabbage. The pudding was teacakes with jam and custard on the top. This was left standing on side uncovered and not very hot. We saw two people having different lunch choices. Comments from people about the food was variable. It is very good, it is very nice, we have no choice you just take it or leave it and the food is very salty. We were told that people are not asked daily what they would like for lunch as catering staff know individuals preferences. For people who need additional supplements we were told that they add cream to the rice puddings etc. We looked in the fridges and freezers which were full. The cook told us that they are using frozen vegetables. The home has a four weekly menu in place which does not show much variation between the weeks. The cook was completing the appropriate health and safety checks in the kitchen and the records of these were shown to us at the inspection. There did not appear to be an effective system in place for monitoring diet and fluid intake for people nutritionally at risk. Charts in peoples bedrooms were not being Care Homes for Older People Page 18 of 35 Evidence: completed consistently. Care charts showing weight loss were not being followed up or referred for specialist advice. Care Homes for Older People Page 19 of 35 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. If people have concerns with their care, they or people close to them know how to complain. Outcomes of complaints are not being recorded so people cannot be confident they are fully addressed by the home. Staff need training about safeguarding people and procedures to follow when incidences of abuse occur in the home to ensure people are being protected from harm and neglect. Evidence: We received three anonymous complaints since the last inspection, two of these were referred to the safeguarding multi agency team for investigation. Two complaints were about the homes financial status, and how this is impacting on the home. The results of these is not yet known. One complaint was about the central heating and hot water not working for a long period, this was substantiated. We looked at the homes complaints records, there was nothing recorded in these since the last key inspection. The complaints policy is not displayed in the home, and we were told that this has not been updated since 2007. We looked at the accident/ incident records and found several events to residents where they have received injuries which had not been followed up. An example of this was bruising to xs left foot, which had not been followed up. The home had not informed the commission of these which they are required to do so, known as a regulation 37 notice. Staff were unaware if accident audits were being completed to Care Homes for Older People Page 20 of 35 Evidence: assist in monitoring the number and type of injuries sustained to people and build up a clear picture. This assists management in ensuring that staffing levels are effectively deployed in the home. It also assists in establishing if the falls risk assessment is accurate for the person. From reviewing the accident records there appeared to be an increase in the amount of accidents during the night and afternoons. This may be a result of insufficient staff on duty at these times. Copies of the accident/incident forms were seized using a code B notice. The updated training for the protection of vulnerable adults was canceled because there were not enough staff on duty for them to attend. We spoke to the nurse and carers during the inspection some staff had not received training about safeguarding and had not seen the homes whistle blowing policy. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to keep the maintenance for the systems and equipment up to date to make it a safe environment for the staff and people who use the service. Evidence: The last key inspection report rated these standards as good. This inspection was brought forward following the recent complaints, including recent breakdown of the homes central heating system. On entering the home, we saw portable heaters in use around the home. We were told that this was because of the cool temperature in the home. We asked for risk assessments for the portable heaters and were informed that these had not been undertaken. An immediate notice was issued for the home to complete risk assessments within the next 24 hours. This was received by the Commission on the 10th February 2010. The temperature of the home was cool throughout the day of the inspection, we spoke to the registered provider and were informed that he would get the engineer out to look at the boiler. We checked the maintenance certificate for the boiler and this was dated 20/05/2008. We requested that the most recent service report be forwarded to us, and temperature of the home monitored by placing thermometers in various parts of the home. We were told that when the heating is off the home is without hot water, we could see Care Homes for Older People Page 22 of 35 Evidence: no bath thermometers in the bathrooms for staff to check the temperature of the water before bathing people. We looked at the maintenance records, these were not well organised. We were given an A4 ring binder of paperwork. Many of the records referred to 2006/2007. We did not see the servicing records for the passenger lift, nurse call system, pressure relieving equipment and water safety checks. The service records for the specialist lifting equipment stated that they were overdue their service. We were told that the company was refusing to come into the home unless they were paid first. Copies of this information was copied using a code B notice. The house is a large grade two listed building, which has recently been extended to provide some modern bedrooms with en suite facilities. The home has over an acre of land. The home is built on three floors all of which accommodate residents. A passenger lift is available to assist people with mobility problems to access all areas of the home. There are three lounges and a separate dining area, so people can have a choice of where they spend their day. We looked around the home and saw that some of the bedrooms are personalised for the person using the room, and this gives a more homely appearance. It was recommended that the home complete risk assessments for all external doors leading from ground floor bedrooms. To assist in protecting the person in that room. Some damage was observed whilst walking around the home, and the home should have a system in place for reporting and attending to damaged items. These items included beds in use with no headrest. Broken light fittings, damage to bath enamel and exposed pipes around sinks. It is recommended that the provider complete an audit of all areas of the home and develop an action plan for repairs. Some building work was being undertaken at the time of our visit. We were told this was, for damage to the bathroom in the new extension. A storage area was being developed for the storage of wheelchairs. At the moment the Home does not have a strategy for helping people with dementia illnesses to find their way around the building. If the Home plans to continue to provide a service for people with dementia illnesses, this is something they need to develop with reference to available best practice guidelines. At the time of the visit the hand cleanser bottles were empty in some toilets, and the boxes of protective gloves were empty. A system for ensuring these are refilled should Care Homes for Older People Page 23 of 35 Evidence: be in place to assist in reducing the risk of cross infection in the home. Given the high dependency of some of the people living in the home it is recommended that the beds are reviewed to ensure that they are suitable for using with specialist equipment. This assists staff in ensuring that people are assisted safely with the correct equipment. Some bedrooms were odourous at the time of the inspection it is recommended that the domestic hours are reviewed to provide seven day cover to the home, and assist in providing a clean home for people to live in. Care Homes for Older People Page 24 of 35 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. By not having sufficient staff to meet the health and social care needs of the people who use the service places them at risk of harm through neglect. Recruitment practices need to be more thorough to ensure people can be confident staff are suitable to care for them. Some staff training is required to ensure that they have the knowledge and skills to meet peoples needs effectively. Evidence: The last key inspection rated these standards as adequate. It was recommended that the staffing levels and skill mix are closely monitored, to ensure there are always sufficient staff to meet the dependency levels of the residents. Since the last key inspection some of the homes permanent staff have left. Agency staff are covering some shifts and permanent staff are working additional hours. We were told that staff moral was really low, they told us that they were doing there best to care for the residents. They said this could be improved with additional staff. We were told that people were not having their preferences respected in what time they chose to get up and go to bed. Delays in responding to call bells, resulting in people having to wait for attention. Peoples prescribed medication being administered late which could have an adverse effect on their health. Staff not having time to sit and chat with people. Surveys received from people who use the service told us: to improve the home we need more staff, they are always short, and use lot of bank people. Surveys from Care Homes for Older People Page 25 of 35 Evidence: staff told us: The care staff try their best with the staffing levels, but they need more staff to be able to cope more with the residents changing needs. Need to employ the right number of staff in line with the needs and the number of residents and their state of dependence . We could do with more staff, so we can meet the individuals care needs more effectively. More training to provide better care and keep staff updated. The carers and matron are very dedicated. We looked at the duty rotas from December 2009 to January 2010 December these showed that some shifts were down to two or three staff members. The manager and deputy were on shift with no support from an additional nurse. A nurse recently appointed told us she had a week shadowing, and was then left in charge, and she was not aware of the homes policies and procedures. We looked at the accident records which have increased over the last three months particularly on nights and afternoons. The reason people were falling stated that they were trying to go to the toilet unaided. Copies of the accident records and duty rotas were copied and taken from the home using a code B statutory notice. We asked for the staff training matrix the administrator told us that she had been unable to complete this as training was cancelled at short notice due to the staffing levels. Nine staff had attended moving and handling training on the 27/10/2009, and thirteen staff received fire training on the 27/10/2009. Health and safety, infection control and first aid training all dated September to October 2008. We spoke to a member of staff who had worked at the home for 12 weeks, we were told that they had not done any mandatory training with the home. When asked about fire procedures they had been informed to diall 999. We looked at the staff files for three staff that had been recently recruited. These showed that the home were not following all the safety checks to protect the people living in the home. For one member of staff we could not find a start date, the record showed December 2009. We could not see this persons name on the off duty which we had copied. The CRB clearance was dated January 2010, so we are unable to identify what assessments were put in place for this person to be safely monitored. The persons induction commenced 13/12/2009 however this was incomplete. The second file we looked at was on the off duty, but they had done no formal induction training in the home they confirmed this with us at the time of the inspection. There was no CRB for this person, and they were being left in charge of the home. To ensure that people living in the home are protected the home must recruit people properly and ensure that the appropriate safety checks have been completed. Care Homes for Older People Page 26 of 35 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 organisation of the home does not ensure that it is run in peoples best interests. Evidence: The last key inspection rated these standards as adequate. A requirement was given for the registered provider to complete a monthly written report of the home to assist in monitoring the service. This is known as a regulation 26 report. This requirement had not been complied with, information was seized from the home using a statutory code B notice. The commission may take enforcement action for the home failing to comply with this requirement. We looked at the records of servicing, tests and maintenance in respect of health and safety for utilities, appliances and equipment such as electricity, fire; emergency lighting and hoists are in need of reorganisation. Many of the records were relating back to 2007, and some records could not be found. We were concerned to see that the lifting equipment in use in the home had not been serviced this was due in July 2009. Staff confirmed that this equipment was being used daily. Care Homes for Older People Page 27 of 35 Evidence: We looked at the fire records which are kept in A4 ring binder. The last fire drill for the home was 17/06/2009 and attended by 15 staff, a copy of this was seized using a code B statutory notice. The maintenance person was testing and signing for the weekly fire checks. Theses checks were up to date. The fire risk assessment had not been reviewed since 2007. Staff told us that there were no policies and procedures to refer to in the home. This is concerning given the home is using agency staff, and new staff. Policies and procedures provide the basic guidance for all staff, and a way of monitoring staff performance. We were told that because of the staffing levels no staff supervision had been completed. The staff minutes from the most recent meeting discussed cutbacks being introduced to save money. The service do some quality audit with people, but do not act on the responses from people in a positive manner, for example staffing levels and having to wait for long periods to go to the toilet. Comments received from staff and people using the service included: There are no policies available and procedures for example, new admission, death, fire drills and we need this advice. There seems to be problems with unqualified staff having concerns about qualified staff and how this is managed by the manager. Staff are expressing that concerns that are not being acted upon.For the owner to understand what care needs all individuals requireBills should be paid so that we do not have calls from suppliers Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 Regulation 12 The registered person must 07/07/2009 (1)(a)(b) ensure that there is a system in place to monitor staff training and development. The service must be able to demonstrate mandatory training, training in the protection of vulnerable adults and specialist training is being planned for and provided to staff. This will ensure staff fulfil the aims of the home and meet the changing needs of people using the service. 2 33 Regulation 26 The provider of the service or 07/07/2009 their appropriate representative must visit the service at least once a month, and prepare a written report on the conduct of the service. This ensures that the quality of the service is being monitored for the benefit of people using the service. Care Homes for Older People Page 29 of 35 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 3 14 Reg 14 1 c d e 08/03/2010 The home must ensure that a full needs assessment is completed, prior to a person being admitted to the home. To ensure that they have the appropriate equipment and suitably qualified staff and numbers to meet their health and welfare needs. 2 7 15 Reg 15 1 2 b All people living in the home should have a care plan which accurately reflects their health and welfare needs and provides clear guidance for the staff to follow. This should be reviewed and updated to reflect any changes or at least monthly. So that people can be confident that staff have clear guidance and understanding in ensuring 31/03/2010 Care Homes for Older People Page 30 of 35 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 that there health and personal care needs are met. 3 8 12 The home should ensure 19/03/2010 that appropriate risk assessments have been completed, and any potential risks are dealt with to ensure that the persons health and welfare is not being compromised. This includes referring to other professionals for advice and treatment for people where it is required. To ensure peoples health and welfare needs are met. 4 9 13 The service must make 31/03/2010 arrangements to ensure that medication administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry on the medication administration record; that the meaning of any codes are clearly explained on each record; and that the person administering the medication completes the medication administartion record in respect of each person at the time of administration. This is to Care Homes for Older People Page 31 of 35 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 ensure that people who live in the service are protected from harm. People have their prescribed medication correctly. 5 9 13 The service must make 31/03/2010 arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of to ensure that accurate checks can be made on peoples medication. To ensure that they can account for peoples prescribed medication at all times. 6 15 12 Reg 12 1 The home should ensure that peoples dietary needs are being met, which can be reviewed and acted upon. To ensure people are receiving sufficient diet and fluids 7 16 22 Reg 22 1 The home must have a complaints procudure for people who may wish to complain about any provision. 31/03/2010 31/03/2010 Care Homes for Older People Page 32 of 35 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 protect people and show that the service is responding to peoples concerns. 8 19 12 Reg 12 1 a ensure that all the systems and equipment are serviced to ensure that they are wirking correctly. To keep people warm, have hot water and are safe from harm. 9 19 16 To ensure that people living 31/03/2010 in the home have damage to furnishings and fittings repaired in a timely manner. To assist in protecting the person from harm. 10 27 18 To demonstrate that their are sufficeint staff on shift. To ensure that health and welfare needs of people are safely met. 11 29 18 The home must ensure that 31/03/2010 all staff working at the home have been recruited following the correct procedure To protect the people living in the home. 31/03/2010 31/03/2010 Care Homes for Older People Page 33 of 35 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 12 37 37 The home should notify the 17/03/2010 CQC about any event in the home which affectys the well being or safety of anyone. To protect people living in the home. 13 38 25 Reg 25 The registered provider to produce his buisness plan for the next five yeras to show that the home is financially viable. To protect the people living in the home 03/04/2010 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 1 The home should ensure that the Statement of Purpose and Service Users Guide are reviewed and updated in a format suited for peoples needs. To ensure people have accurate information to assist them with their selection. The home should ensure that people have a contract of terms and conditions when they are admitted, so that their rights are protected. To assist residents with more complex needs the home should review more suitable activities / therapies. All staff working at the home should have training to assist in protecting people who live in the home, and be aware of the whistle blowing policy to protect them. Tp provide people with a pleasant environment to live, keep all parts of the home clean and free from odours. Page 34 of 35 2 2 3 12 4 18 5 26 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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