Inspection on 25/06/10 for Lilburn Lodge and Riverview Care Centre

This inspection was carried out on 25th June 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 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lilburn Lodge and Riverview Care... 29/07/09

Lilburn Lodge and Riverview Care... 07/08/08

Lilburn Lodge and Riverview Care... 20/07/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Lilburn Lodge and Riverview Care Centre Lilburn Place Southwick Sunderland SR5 2AF     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: Karena Reed     Date: 2 5 0 6 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: Lilburn Lodge and Riverview Care Centre Lilburn Place Southwick Sunderland SR5 2AF 01915496331 01915480395 lilburnlodge@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare (Focus) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 68 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of users who can be accommodated is 68 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 - Code OP, maximum number of places, 40 Dementia - Code DE, maximum number of places 46 Date of last inspection Brief description of the care home Lilburn and Riverview Care Centre is a registered care home with nursing, situated near Sunderland s Queen Alexandra Bridge and close to the shopping centre of Southwick. The area is well served by public transport. Until recently it was two Care Homes for Older People Page 4 of 35 Over 65 0 40 46 0 Brief description of the care home separate services known as Lilburn Lodge and Riverview Lodge and both shared the same grounds and were run by the same provider. The services have now been amalgamated into one and it is now registered with CQC as Lilburn and Riverview Care Centre with one registered manager. The home provides permanent accommodation with personal care and support for up to a total of 68 older people, some of who may have dementia care and nursing care needs. Within this total, the home may also provide a service to a limited number of older people with a physical disability. Throughout the two buildings the accommodation is laid out over three floors of the purpose built property, served by a passenger lift. Each floor has a lounge, bathing areas, WCs and single en-suite bedrooms. Open plan kitchen/dining areas are situated on the first and second floors and there is an enclosed lawned area to the rear and car parking on site. The home publishes a regularly updated service user guide that is available in a range of accessible formats and this is available to service users and visitors along with a range of information leaflets including a monthly newsletter in the homes reception area. . 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: The quality rating for this home is 0 stars. This means that people who use the service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out. Before the visit we looked at information we have received since the last inspection,how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run. Care Homes for Older People Page 6 of 35 The Visit: An unannounced visit was made on June 25th 2010. The inspection was scheduled to be a random inspection but due to the severity of findings it was changed to a key inspection. During the visit we talked with people who use the service,relatives and staff. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept,checked that staff had the knowledge,skills and training to meet the needs of the people they care for,looked around the building to make sure it was clean,safe and comfortable and checked what improvements had been made since the last visit. We told the person in charge what we found. 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: Assessments carried out before a person moves into the home must include details of their social history,likes,dislikes and personal preferences. Life histories must be completed for all people living at the home, to provide staff with more information about them, for when they are unable to give this information themselves. The care plans for people living at the home must follow clinical guidelines showing how individual service users health and welfare needs are to be met. A system must be put in place to ensure that all service users care plans are reviewed at least monthly. Service user care plans must reflect their changing health and social care needs. Care plans must reflect the care necessary for the treatment of pressure areas. Care plans must include the social needs and aspirations of people living in the home. Effective arrangements must be put in place so staff are aware of individual service users skin conditions having particular regard to pressure damage. Effective arrangements must be put in place to ensure the advice and guidance provided by multi disciplinary professionals about care and treatment for service users is relayed to staff for them to follow. Care Homes for Older People Page 8 of 35 Challenging behaviour training and conflict resolution must be provided to all staff to help ensure individualised care and support is provided to people living at the home. Risk assessments must be reviewed and updated to reflect the changing health needs of individuals. All handwritten directions on the Medication Administration record must have two witness signatures. Medicine storage facilities must be reviewed in the home to ensure it is complying with best practice guidelines. Medicines must be stored safely and securely and at the correct temperature. Staff must be able to interact with people living at the home and engage in activities and provide meaningful interaction. Menus and other information should be available in large print and in other formats to offer people choices and involve them in decision making. Staff must receive the local authority multi-agency safeguarding training to inform them of procedures to protect vulnerable people. A programme of decoration and maintenance is required for the home. The appropriate beds and any other specialist equipment that may be required must be provided for people who live in the home. A programme for cleaning the building must be put in place. More effective odour control is required around the building. A programme of training must be provided including training already identified to ensure staff can meet the specialist needs of individuals. Carers must receive more in depth training about working with people with memory loss and dementia. This should help them understand the support needs of people with dementia and memory loss and help involve them in decision making in their daily lives. A manager must become registered with the Commission for the day to day running of the home. Any hazardous substances must be locked up for the health and safety of people living in the home. Care Homes for Older People Page 9 of 35 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 10 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 11 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited procedures in place to ensure that prospective service users coming to live at the home are making an informed choice about the home and that the home can meet all of their needs. Evidence: The sample of records examined for people who live at the home showed that when they were admitted an assessment of their care needs had been carried out, before their admission by a social worker or health professional. This assessment is forwarded to the home for the manager to look at to decide if the needs of the person can be met by staff at the home. The manager or senior staff carry out a preadmission assessment to ensure that the staff can meet each individuals needs. The person coming to live at the home and relevant people are involved in the assessment. These initial assessments are used to create care plans. The assessment form encourages staff to explore issues relating to equality and diversity.It looks at mood,speech,sexuality,behaviour,mental health,risks and living skills.There was little Care Homes for Older People Page 12 of 35 Evidence: or no information about the social history of the person or any information about their daily living preferences and likes and dislikes, especially if they were no longer able to communicate this information for themselves in order to ensure staff could meet all their needs. People who are interested in coming to live in the home or their relatives are encouraged to come and look around and meet staff. People have the opportunity to visit the home as often as they need in order to decide if they want to live there. 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. There are poor arrangements in place to ensure the health and personal care needs of people living at the home are met by staff. Evidence: We examined the care records of seven service users in detail and the specific aspects of individual care . Risk assessments were in place for pressure prevention, nutrition and hydration, falls, moving and assisting,dependency and dealing with challenging behaviours. Assessments contradicted information in the care plans and care plans did not always identify how individual service users health and welfare needs were to be met. Manual handling risk assessments had been completed on admission but then had not been updated to reflect service users changing needs.For example,independently mobile but was being nursed in bed,use safe moving technique but none was specified, and another recorded sleeps on mattress on floor. None of the risk assessments identified the type of hoist,sling,number of staff or the methods staff were to use to transfer service users safely. One service user was identified as having Care Homes for Older People Page 14 of 35 Evidence: a high risk of falls and was sleeping on a mattress on the floor but rolling around during the night. There was no evidence of what further action staff took to prevent injury and maintain comfort, safety and dignity for that person. Care plans for continence care did not specify the type of aid to be used for example,appropriate sized pads. Information from continence nurse specialists was not transfered into a plan of care for individual service users. One service user came out of hospital with an indwelling catheter.There was no care plan to evidence initial catheter care or how and when the catheter was removed. Care plans and information regarding service users nutritional care were contradictory with care plans not updated to show how service users needs had changed. One service user was identified at very high risk and had a very low body weight.The MUST tool was not completed in full and the nutritional care plan records has good appetite, soft moist diet Stage 1 fluids but the evaluations all referred to monthly evaluation of falls.This person was prescribed supplements, however there was no information in the care plan identifying when these were to be given. An assessment carried out by the Speech and Language Specialist (SALT) in December 2009 recommended a pureed diet and stage 2 thickened fluids.The care plan had not been updated to show the changes made placing the service user at risk of choking and aspiration. This service user had diabetes,however there was no care plan in place to evidence how this was being managed by staff. Another risk assessment for nutrition showed that a service user was at very high risk and dietetic advice should be sought.There was evidence of decreasing weight,however the risk assessment for weight loss and dehydration was written in August 2009 and had not been updated since.When this service user returned from hospital in January 2010 updated care plans were completed,although they did not record the advice to provide fortified foods,supplements and weekly weights. Another service user had a care plan in place identifying a need for pureed diet and normal fluids and prescribed supplements.The service user had a low body weight but the care plan did not specify extra high calorie snacks,fortified and high protein diet. Written information regarding the prevention of pressure damage gave little information when dressing were changed.For example,there was no information to show what action the nurse had taken and whether the wound was healing or otherwise. Another service user had skin damage. The plan of care was incomplete, records evidence change dressing using aseptic technique, alginate and Allevyn still discharging. There was no indication of how the damage occurred or the if the wounds were healing or otherwise. A care plan for a grade 2 pressure ulcer was still active although the evaluation recorded that the ulcer had healed. None of the care Care Homes for Older People Page 15 of 35 Evidence: plans showed evidence of wound mapping,photographs or ensuring the weight of the service user was taken into account when setting the air wave mattress. Short term care plans were not in place where service users experienced acute problems such as chest infections or wounds. There were no care plan instructions to help staff deal with and understand service users with dementia who exhibited difficult and challenging behaviours. The care plans did not identify and plan for every aspect of service users health and care needs, for example sensory impairment,communication,diabetes,social aspirations and goals. Care plans focused on the medical model of care by looking at clinical tasks rather than the person, especially on the Riverview Unit. Facilities for the storage of medicines on both units were poor and were located within the care and nurses offices which is not appropriate for the storage and preparation of medicines.Windows were open although gaining access would be difficult. On the Lilburn unit the windows were open although it would be difficult to access the room. Room temperatures were being monitored with recorded temperatures between 22 and 28 C.Drug fridge temperatures were not always monitored and some were recorded at 10 C . The room was generally messy and untidy and needed a good clean. There was a list of staff signatures authorised to administer medication. There were no gaps on the medicine administration records and a check of controlled drugs was satisfactory. Handwritten directions on the MAR did not have 2 signatures. On the Riverview unit the room was chocked open with no member of staff or qualified nurse in sight. The inspector stood in the room until a member of care staff came by and realised the door should be shut .The room was being used for all sorts, as nurses office and storage for staff coats,bags and personal items. The room was again messy with dirty ledges and floor. A check of Controlled Drugs found no discrepancies.A random check of Medicine Administration Records (MAR) found no gaps. Daily drug fridge temperatures were recorded at 5C and the room temperatures showed temperatures in excess of 25 C 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have limited opportunities to make choices about activities,daily routines and menus so that they may lead a lifestyle that matches their social care needs. Evidence: The care plans of people living at the home recorded very little or no information about their social and leisure needs,their likes,dislikes,personal history,things that are meaningful and of interest to the person. This information is essential to ensure all the needs of the person can be met by staff, their social as well as their health care needs. There was a programme of activities and an activities organiser is employed to work across the home. A weekly activities plan is available and includes:chair aerobics, listening to music,quizzes,gardening,reminiscence,arts and crafts,bowls,bingo,cookery,tv and videos, pamper sessions and cards. A bus is used for outings and some people have the opportunity to go to the shops,library and church. On the day of inspection there was no evidence of staff carrying out any activities or interacting with people living at the home in the parts of the home where the activities organiser was not working. There was little evidence of staff asking each person about their wishes,interests and Care Homes for Older People Page 17 of 35 Evidence: choices.This could be promoted if the staff team had some intensive training about memory loss and dementia care. This training should help ensure people are given some choice in order to keep some control in their lives. Staff support people to keep in touch with relatives. There were some relatives visiting at the time of inspection who had very mixed views about the service offered. Some people had positive comments and other people felt improvements could be made to the care and support offered to their relatives. People living at the home are asked what they want to eat. They are usually asked the day before to choose the following days meals. A menu was not available to display the choices available. Lunch on the day of inspection was fish,battered or poached, chips and peas or egg and chips followed by sponge and custard or ice cream and fruit. Care Homes for Older People Page 18 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. Complaints and safe guarding issues have not always been well managed and leave people at risk of harm. Evidence: There is a complaints procedure for people living at the home and their relatives to bring any matters to the attention of staff in the home.The procedure also refers to the agencies a person can bring refer a complaint to in case they felt uncomfortable bringing any complaints or concerns to the attention of staff within the home. The home keeps a record of complaints. Seven complaints have been reported and investigated since the last inspection. Some complaints were forwarded by complainants to CQC as they were not satisfied with the companys response. Some relatives spoken to at the time of inspection did not feel their complaints were addressed or taken seriously. As a result two people living at the home have chosen to leave and live elsewhere and another persons relative was in the process of looking for an alternative home because they felt their relative was receiving poor care. Four safeguarding incidents have been raised and investigated using the councils safeguarding strategy. Staff had not had training in the Mental Capacity Act and Deprivation of Liberty. They had not received up to date training about dementia care to help give them more insight into the needs of people who may not communicate verbally. Staff have Care Homes for Older People Page 19 of 35 Evidence: received some in house training about safeguarding vulnerable adults, but this was not the local authority multi-agency strategy training, which describes the procedures to be followed by staff when allegations of abuse are made about a person. There was no evidence that all staff had completed training in dealing with challenging behaviours and conflict resolution. Care Homes for Older People Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment needs to be better maintained so the home is more pleasant,comfortable and clean for the people who live there. Evidence: An inspection of the premises took place.Since the last inspection a leak to the roof has been mended, two windows have been replaced. The outside of the home requires decorating.Both units are in need of redecoration There is damage to walls and doors from trolleys,wheelchairs and hoists. The kitchen units at Lilburn are broken and discoloured and some of the cupboards do not close. A storage unit was unlocked in the kitchen that contained some cleaning materials. The floor covering by the dishwasher is black and rotting. The dining room floor is also sticky and difficult to walk on without sticking. Riverview was malodorous and both need a cleaning monitoring system in place, as ledges and furniture were dusty.Corridor carpets are looking worn and there has been a water leak in thegarden room in the Riverview Unit resulting in damage to the ceiling. Generally bedrooms are being maintained and redecorated by the maintenance person. One service user did not have a bed only a blue foam plastic mattress on the floor. The bottom sheet was nearly see through,the pillow lumpy and the only other covering was quilt. The walls were marked.The window ledge was dusty and the Care Homes for Older People Page 21 of 35 Evidence: radiator marked with unidentified detrius. The room was stark with no personalized items. Another service user was being nursed in bed and did have an appropriate nursing bed and equipment for his room but again there was damage to walls and doors. We were informed that the water boiler in the main kitchen had been broken for a month and had not been replaced .The seal on a fridge was broken,however we were told that there were enough fridges to use. Care Homes for Older People Page 22 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. There are not enough staff for the current occupancy levels of the home,more training is required to ensure they can provide personalised care and support to people living in the home and to ensure their health and safety. Evidence: The service has been registered as a care home with nursing dementia, 46 places and older persons 40 places. Total 68 beds. Riverview has always provided nursing care for service users who have a dementia. Ten people were living in this part of the home at the time of inspection. Lilburn Lodge had 9 service users who have a dementia but do not need nursing care and also one service user who had been admitted for respite care .They were also providing none nursing care for another 12 service users. Each unit was being staffed separately. Riverview, one qualified nurse and 2 carers during the day; one qualified nurse and one carer overnight. The qualified nurse on duty is not always a RMN. There was a lack of employed nursing staff .There was only one full time nurse on days and nights with the rest of the shifts being covered by agency and bank staff. There was an issue should anyone go to hospital overnight or if there were staffing problems overnight that the day staff senior and unit managers would be expected to come in regardless of what shift they had done or were to do the next day.Also there Care Homes for Older People Page 23 of 35 Evidence: were problems getting authorisation for agency staff for the weekend.Waiting to access qualified nurses to cover shifts at the last minute was not appropriate as should it be impossible to get cover, the employed nurse would have been expected to work, meaning a 70 hour week. In the Lilburn Unit staffing arrangements are, manager and 2 carers on DE Unit and 2 carers in general unit .Overnight 1 Senior carer and 2 carers. The administrator also did shifts as carer,when not rostered for administrative duties. Also on duty was a cook and kitchen assistant, domestic and laundry assistant.There were two maintenance staff, one was on annual leave. The two units were being managed and staffed separately despite there being a designated deputy manager. Staff training was not standardised across the home. Staff had received the necessary statutory training but very little recent developmental training to give them more insight into the specialist needs of the people they were caring for. Care staff had achieved or were studying for National Vocational Qualifications at levels 2 and 3. Care Homes for Older People Page 24 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. People live in a home that needs to be better run,to ensure their health and safety and to ensure the welfare of all is promoted. Evidence: Although the home is registered as one home,Lilburn and Riverview are operating as two separate establishments for the most part. The manager left 3 months ago and a new manager was appointed but she did not turn up to work at the home,therefore the home is wthout a manager. The deputy manager is to step down and a new deputy has been appointed and will commence once their CRB is cleared. The deputy has tried to oversee the running of the home at the same time working as the registered nurse providing care and support to service users. As there have been no supernumerary hours allocated to the deputy quality monitoring systems have not been kept up to date.Medication audits have been completed regularly,however other Care Homes for Older People Page 25 of 35 Evidence: audits and quality monitoring systems had fallen behind schedule. Regulation 26 ,monthly visits are being carried out by the manager of another home to report upon aspects of care provided by the home. The deputy manager had managed to start staff supervisions. Staff and relative meetings do take place but there have been none since January and February respectively. When a person does not keep control of their own money, the home is able to provide the facility to hold a small amount on behalf of the person for everyday living. The home has a suitable system for accounting any monies on behalf of a person living at the home. Some cleaning materials were left in an unlocked kitchen cupboard on one of the units and were in easy reach of any service user who may come into the serving area. Care Homes for Older People Page 26 of 35 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 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 4 14 The registered person must 31/08/2010 ensure that preadmission assessments include details about the social needs of the person and some life history information. This is to ensure the social and personal care needs of people can be met by staff. 2 7 15 The registered person must 19/08/2010 put in place effective arrangements to ensure that where appropriate,service user care plans are revised to reflect individual service users changing health and welfare needs after consultation with the service user or their representative. This is to ensure the health and personal care needs of people living at the home are met by staff. 3 7 15 The registered person must ensure effective 19/08/2010 Care Homes for Older People Page 28 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 arrangements are put in place to ensure that all service user care plans are reviewed at least monthly or sooner as dictated by changes in individual service user needs. This is to ensure the health and personal care needs of people living at the home are met by staff. 4 7 15 The registered person must ensure that all service users plans of care clearly identify how each individual service users health and welfare needs are to be met. This is to ensure the health and personal care needs of people are met by staff. 5 8 13 The registered person must ensure that individual service user risk assessments are reviewed and up dated to reflect their changing health needs. This is to ensure the health needs of people are being met by staff. 6 8 12 The registered person must 19/08/2010 put in place effective arrangements to ensure that guidance and instruction provided by the multi19/08/2010 19/08/2010 Care Homes for Older People Page 29 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 disciplinary professionals about the care and treatment of service users, in particular dieticians,speech and language therapists and challenging behaviour specialists is relayed to staff and followed at all times. This is to ensure that the health and personal care needs of people are being met. 7 8 12 The registered person must ensure a review is undertaken of the pressure area care provided to each individual service user ensuring all staff are aware of individual users skin conditions and implement any necessary changes. This is to ensure that pressure area care is provided to all service users according to their individual needs. 8 9 13 The registered person must 30/07/2010 ensure that medicine storage facilities on both units are reviewed and up dated in line with best guidance practice. Medicines must be stored safely and 19/08/2010 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 securely at the correct temperature. This is to ensure the health and safety of people living at the home. 9 12 16 The registered person must 19/08/2010 ensure that everyone living in the home has the opportunity to enjoy social activities as required ,which is then recorded in their plan of care. This is to ensure the social care needs of people living at the home are met by staff. 10 12 16 Assessments must include detailed information about the social aspects of a persons care to help ensure activities provided are meaningful and of interest to the person. This is to ensure the social and communication needs of the person are met. 11 12 16 Staff must be able to 27/07/2010 interact with people living at the home and engage in activities and provide meaningful interaction. 30/09/2010 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 This is to ensure the social needs of the people living at the home are met. 12 14 12 The registered person must ensure that people living at the home are properly assisted to make choices and decisions in daily living and how their care is planned and provided. This is to ensure that people are involved and have some control over decision making in their life. 13 18 13 The registered person must ensure that all grades of staff complete safeguarding training which links into the Local Authority procedural Framework. This is to ensure people living at the home are protected from abuse. 14 19 23 The registered person must provide a programme of maintenance and renewal of the fabric and decoration of the building. This is to ensure the health and well being of people living in the home. 27/08/2010 30/09/2010 30/07/2010 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 15 24 13 The registered person must 30/07/2010 provide appropriate beds for service users who require nursing care and are at risk. This is to ensure the health and safety of people living in the home. 16 26 23 The registered person must ensure that a cleaning programme is in place to maintain a hygienic environment and to eliminate odours. This is to ensure appropriate standards of hygiene are maintained. 30/07/2010 17 27 18 The registered person must ensure that staff are available in sufficient numbers to meet all the needs of people living in the home. This is to ensure the health and safety and well being of people living in the home. 30/08/2010 18 30 18 The registered person must 30/09/2010 ensure that all staff are provided with opportunities to receive training that is appropriate to the work they are to perform. Ensure as a minimum that each staff member receives up dated training in 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 Understanding Dementia,challenging behaviour,Mental Capacity Act and Deprivation of Liberties. This is to ensure people living at the home are protected and staff are able to deliver more personalized care. 19 38 13 The registered person must ensure that cupboards containing hazardous substances are locked to ensure the safety of people living at the home. This is to ensure the health and safety of people living in the home. 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 26/07/2010 1 15 Accessible menus should be displayed around the home or dining rooms to inform people of food and snacks available each day. A person must be be appointed for the day to day running of the home and become registered with CQC. 2 31 Care Homes for Older People Page 34 of 35 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. © 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. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!