Inspection on 16/09/09 for Lily House

This inspection was carried out on 16th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lily House 17/11/09

Lily House 19/08/08

Lily House 30/08/07

Lily House 22/08/06

Lily House 05/10/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Key inspection report Care homes for older people Name: Address: Lily House 143 Lynn Road Ely Cambridgeshire CB6 1DG     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: Elaine Boismier     Date: 1 6 0 9 2 0 0 9 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 37 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Lily House 143 Lynn Road Ely Cambridgeshire CB6 1DG 01353666444 01353666445 lily.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne Boss Limited care home 44 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 44 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 Dementia Code DE Date of last inspection Brief description of the care home Lily House is situated on Lynn Road approximately one mile from the centre of Ely. It is a purpose built home that offers care for up to 44 older people, some of whom have dementia. Accommodation is provided on two floors and consists of 44 single bedrooms of which 43 of these have en-suite facilities. There are five bathrooms, one shower room and eleven additional WCs. There are lounge and dining rooms in the home and two quiet rooms. Enclosed gardens surround the home for people to visit Care Homes for Older People Page 4 of 37 Over 65 21 44 0 0 Brief description of the care home and sit. Local amenities include shops, cafes pubs, restaurants and a cinema. Information about current fees, including any additional costs, can be obtained from the home. A vacancy has arisen for a registered home manager. A copy of the inspection report is available at the home or via the CQC website at www. cqc.org.uk Care Homes for Older People Page 5 of 37 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, The Care Quality Commission (CQC),carried out this unannounced key inspection (KI), by three Inspectors, between 10:00 and 17:00 taking 7 hours to complete. Before the inspection we carried out an Annual Service Review (ASR) on the 27th July 2009. This is a review of the information that we have received about the home since our last inspection of the 19th August 2008, when we had assessed the home to provide excellent quality outcomes for the people living at the home. For our ASR we received surveys from seven of the residents and from four of the staff. We also received a survey from one health care professional. The home sent us, as requested, an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We concluded from our ASR that we might bring the next KI forward which we carried Care Homes for Older People Page 6 of 37 out on the 16th September 2009. Between our ASR and this KI we received two more surveys from residents. During this inspection we looked around the premises and looked at some of the documentation. We case tracked four of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager and a visitor to the home. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be followed by the staff so that the assessed needs of the people are met in a safe way. The people must be actively consulted about their care plans, so that the care provided is done with consent from the resident. Care plans must be made available for any person who has pain and is being treated for this condition. This will enable the staff to monitor and review the residents experience of pain and to ensure that they are receiving relief from their pain. The management of the home must ensure that the staff read the care plans and transfer this guidance in to their care practices. These issues about care plans must be actioned by the home to ensure Care Homes for Older People Page 8 of 37 people are protected by accurate records and that the staff follow the guidance within the care plan. Any person assessed to have a swallowing difficulty must have the appropriate food and drink given to them, to reduce the risk of choking. We have made a requirement about this. Any referral made to a health care professional should be followed up, if the home has had no response to such a referral. This is to ensure that the residents receive timely assessment, advice and treatment to reduce any identified health risks. Practices and procedures for the safe handling, storage and recording of medicines must be improved to protect people and demonstrate that they receive their medicines as prescribed. When medicines are prescribed on a when required basis there must be clear guidelines for their use to ensure people receive treatment that is appropriate and consistent. All staff authorised to administer medicines must have up to date training and an up to date assessment that they are competent to do so. This is to ensure that people are receiving safe care from the staff. Peoples privacy and dignity must be valued and respected to include the standard of personal care and how sensitive information is kept confidential. The record of complaints must provide evidence that the complaints have been actioned and resolved within the 28- day required time period. This is to make sure people are being listened to and complaints and concerns are valued as part of the homes quality assurance. Staff must be able to follow correct and timely safeguarding reporting procedures. We have made a requirement about this to ensure that people are protected from the risk of reoccurring harm. There should be no restriction imposed, unless based on a risk assessment, for people to go in to the garden area, if they so wish. The garden fence should be made stronger to reduce the risk of injury to any person coming into contact with it. The use of general toiletries, such as hand and body lotion, poses a risk of the spread of infection. This practice must cease. The overall competencies of the staff must improve with regards to areas such as care planning; understanding and appropriately responding to the special and unique needs of the residents and to be competent in responding to safeguarding alerts. This is to ensure that people are protected from any risk of harm and that they receive safe care (see also above regarding medication training for staff). We have assessed that the home provides poor quality outcomes for people and this is due to the current standard of the management of the home. This must improve to ensure that peoples health, welfare and safety are protected. Care Homes for Older People Page 9 of 37 The overall management of the home must improve to ensure that the home is safely managed and in line with current health and safety legislation such as staff training in first aid: to this we have made a requirement. We found two of the kitchen doors were not completely shutting. All fire doors must completely close against the tumescent strip. This will ensure that the risk of spread of fire is reduced. 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 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information to help them with their decision on where to live prior to moving into the home. The assessment undertaken prior to admission ensures the home can meet the needs of prospective residents. Evidence: Within the main foyer the certificate of registration was on display. This had the details about the home including the name of a former responsible individual. The Statement of Purpose was also available in this area of the home and had been updated to include the name of the current Manager although the document needs a minor amendment to include the name of the current responsible individual. This is so that people will know who to speak to if they so wished. Within the care plans, that we saw, we noted that the person had a full assessment of their needs, by, for example, a community psychiatric nurse and by the former home manager: these assessments were carried out before the person moved into the Care Homes for Older People Page 12 of 37 Evidence: home. The assessed needs included the persons ability to communicate; their ability to look after their personal care and how any conditions, such as difficulties with their memory, influenced their day to day living. All of the nine surveys received from residents told us that the person had received enough information about the home to help them in their decision where to live. A visitor to the home told us that they and another family member had visited the home, on behalf of their relative, and, from the information they had received, decided it was a suitable place for their relative to move into. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot consistently be confident that their care needs will be met in a safe and dignified way due to the standards of some of the records and the manner in which care is provided. Evidence: We found at our last KU that the care plans were not meeting the standard and we expected the home to take action to improve this. Since this last inspection we have received information that the care plans were subjected to scrutiny as part of the safeguarding investigations that first commenced in November 2008. Agreed actions were made, between the home and the safeguarding team, that there would be an improvement in the standard of care plans to include details such as how staff were to manage some of the peoples challenging behaviours. The AQAA told us that staff have attended training in care planning. As part of our case tracking we looked at four care plans and we found that there was information about peoples mental health needs and how the staff were to meet these needs such as talking to them about their family and how to manage people safely Care Homes for Older People Page 14 of 37 Evidence: when they presented with challenging behaviours. There was also information about the persons life histories such as where they were born, what they did for a living and about their significant relationships such as marriages and children. This information indicated that the person was valued as a unique individual. We saw that risk assessments were actively evaluated: falls risk assessments, for example, took into account if the person had any incidents of a fall, or not, within the last twelve months. This twelve month history was reflected in the ongoing evaluation of the risk assessments. We noted, however, from speaking with the staff that the care plans are not always referred to. For example, when speaking with a member of the staff, we were told that a person had a diagnosis of irritable bowel syndrome (IBS). We could find no record of this diagnosis of IBS although the person had a different diagnosis recorded in their pre-admission assessment information. We saw the person was distressed and they told us that they had pain. We could find no care plan or a pain monitoring tool for this person although they were prescribed pain killers. We noted that this person was distressed and communicated this in a manner that suggested they wanted to go to the toilet as a matter of urgency. The persons records indicated that on the 30th March 2009 they were seen by a community psychiatric nurse for increased agitation and it was found the person had a urine infection: this was subsequently treated by their doctor in April 2009. It was unclear if the staff had taken this past medical history into account: we were told that the person was often anxious and distressed although there was no indication from our observations that the staff had tried to understand if there was a reason for the persons current distress. This suggested that the staff might not be reading the information provided in the persons care plan. We found other evidence that the staff do not use the care plans to help them meet the needs of the people. As part of our case tracking we saw a person had a care plan, dated 11th August 2008, that said (They) have been diagnosed with minor swallowing problems due to stroke complications and they were to have soft food which was to be cut up into small pieces. The care plan had been evaluated each month and the care plan remained unchanged. The evaluation of the care plan, dated the 26th February 2009, for example, said, Staff must cut (their) food into small pieces for (them). When we visited the person in their room, they were sitting upright in a chair (this is a better position for a person than in bed if they do have problems with swallowing). Although they were sitting in such a position we saw that they had some difficulty with swallowing their saliva. At lunch time we asked a member of the staff Care Homes for Older People Page 15 of 37 Evidence: what this person was given for their lunch; we were told that the person had the pork and apple casserole and vegetables that included brussel sprouts. We saw the person eating their lunch, in the main dining room, and saw a whole brussel sprout on their plate. We asked the member of staff if they had seen the persons care plan about eating and we were informed that they had not. This placed the person at an unacceptable risk of choking. We spoke with the Manager about this and required immediate action to take place to reduce such risks to this person. When speaking with one of the residents we were told that they had not been consulted about their care plan. We could find no recorded evidence that people, wherever possible, had actively been consulted about their care plan. The records therefore did not provide robust enough evidence that people are actively consulted about their wishes and choices (such as how and when they would like to smoke). All of the nine residents surveys said that the person received the care, including medical care, and support that they needed. People were well dressed and clean although we noted, at lunch time, one person, who we case tracked, was unshaven. For another person, who was not part of our case tracking, they told us that they had a wash most days and had had a wash that morning. We noted, however, that the person had a body odour. We informed the Manager about these issues for action to be taken to ensure that the personal care provided for these two individuals was carried out to a standard that respected their dignity. As part of our case tracking we spoke with a visitor to the home: they said that they would Highly recommend Lily House to any person interested in moving in as they considered the care provided, to their relative, was Excellent. Whilst we were at the home some of the people were being treated by a visiting chiropodist and some of the people were having their hair done by a visiting hairdresser. For one person, who we case tracked, we saw that there was a monthly record of their weight and the malnutrition universal screening tool (MUST) was in use. The person had been assessed as being at a medium risk of malnutrition and a referral to the dietician, dated the 1st June 2009, was in the persons care file. We were unable to find a record of the dieticians response to this referral and we could not find any record to indicate that the home had pursued this referral. We noted that the person was continuing to lose weight. We spoke with the Manager about this and we were Care Homes for Older People Page 16 of 37 Evidence: informed that she was not aware that the person was losing this unintentional weight. Most medicines are stored securely for the protection of residents. The temperatures of the medicines storage rooms are monitored and recorded regularly but the entries are all identical and have not varied, so we suspect that the readings are taken from the controllers of the air conditioning units rather than being the actual temperatures of the storage rooms. Similarly the fridge temperatures are recorded from the settings on the fridge thermometers rather than being actual readings. To store medicines outside the recommended temperatures could result in people receiving medicines that are ineffective. We expect this to be managed by the home. In one of the shared bathrooms we found some medication labelled for a resident which was not locked away and therefore could be used by people it is not prescribed for. We watched medicines being given to some people during the morning and at lunchtime and while this was done with respect to the peoples dignity and personal choice, the medicines trolley was left open and there were medicines on top of the trolley in open accessible areas, such as corridors and in a position where the member of staff would not be able to intervene should medicine be accessed by other people. This is an unacceptable risk and a requirement has been made about this. We looked at the medication and medication records for several people in the home. We looked at records made when medicines are received into the home and when they are disposed of and in general they were reasonably good, providing an account of medicines in use. However, there were some worrying discrepancies in the records made when medicines are given to people: we found discrepancies in some of the stock balances of medicines which might indicate the records made when people are given their medicines are inaccurate, when medicines are given at a time different to the time printed on the medication record then the actual time the medication is given is not recorded and this could result in people being given their medicines too close together. We also found that some hand-written records did not clearly indicate the date that medication was given. We have made a requirement to ensure that medication records are completed accurately. When people are prescribed medicines on a when required basis e.g. for pain control we could find no guidance for their use to ensure they are used properly. But there were good care plans for people who take medicines to control the risk of bleeding and good risk assessments in place for these people. Most staff who are authorised to administer medicines have been trained and assessed that they are competent to do so, but in most cases this training was over a year ago. Care Homes for Older People Page 17 of 37 Evidence: An action plan received from the home, in response to other concerns, for all staff to attend a refresher training course on the safe handling and administration of medicines by the 9th September 2009 has not been achieved. A requirement has been made about this. We saw that the staff were interacting with the residents in a kind and caring manner. On the first floor we saw that there were plastic wallets that had some of the residents unopened letters: a member of the staff told us that these were for the residents families to collect to deal with, such as private telephone bills. We were told that other residents had their mail delivered to their rooms to open themselves. We noted that a resident was being attended to by their doctor, in their room, with a member of staff in attendance. We overheard the confidential conversation (about the residents bowels) between the doctor and the resident, as the door was open. We suggested that the door was to be closed during this private time and this was done. We expect the home to take action to remind the staff about respecting peoples privacy and valuing their dignity at all times. Care Homes for Older People Page 18 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunities to live generally a good social life with a wide range of activities available to stimulate their interests. Evidence: All of the nine residents surveys said that the home provided suitable activities that the person could take part in. One of these surveys added Activities are very good. According to the AQAA there is A wide variety of stimulating activities take place, based on individual requests from having a hand massage to surfing the internet. Photographs of events for 2009 were seen as we looked around the premises: these included a visit to Sandringam House, the homes summer fete and a visit to a local fish and chip shop. We visited one person (who was not part of our case tracking) in their room: they were knitting and had read the days newspaper. Although they had engaged in these activities they said that the day was long as they were bored. People who we spoke with said that they could get up when they wanted to and go to bed when they liked. The majority of the bedrooms had pictures and photographs. We saw people receiving their guests. Residents who we spoke with said that they had Care Homes for Older People Page 19 of 37 Evidence: contact with their families and this information was also recorded in the peoples care records. All of the nine residents surveys said that they always or usually liked their meals. All of the four staff surveys indicated that the quality and choice of food for the residents is restricted due to budgetary constraints: Catering has a budget of 2-3 years ago and the home could do better with the Budgets for food. Another of these staff surveys said that people could Have more selections at meal times. We have received other information, from members of a social care team, that the standard of food provided was considered poor. This was discussed with represenatatives of Southern Cross and we were later informed that action was taken to improve the standard of food provided. We visited the main kitchen to ask the staff what action had been taken to improve the standard of the food. We were told that the staff, and care staff, had asked people for their views about the food and that there were no issues found. The people we spoke with said that the food was good to ok and that there was a choice. One of the three Inspectors had lunch to test the quality and taste of the food and considered it to be adequate i.e neither good or poor. The menus were seen and the information provided on the days menu was the same range of food provided. Following the pork and apple casserole people were eating bananas in home made custard. As part of the action plan a member of staff was to have a meal with the residents and any views were to be entered in the new comments book. On the ground floor we found a comments book, in one of the small dining areas, and this told us that a representative of the registered provider had visited and had a meal on the 10th September 2009. The persons views were recorded, within the comment book, that said I would like to congratulate the home for an excellent lunch time experience. The kitchen staff said that a cooked breakfast is available on a Saturday and this was indicated on the menus. We saw that, for other days, there was a choice of cereal, toast, egg and fruit juice. For lunch there was an alternative of omelette or salad and most days there were two hot options. For supper there was soup, sandwiches and a choice of dessert such as yogurt, cake or ice cream. We found no clear evidence to suggest that people are not having a satisfactory diet and choice due to alleged budgetary constraints. We were told that people are asked the day before what they would like to eat: for Care Homes for Older People Page 20 of 37 Evidence: people who have problems with remembering, this system is not appropriate to their needs. We discussed this with the Manager to consider how this could improve. Care Homes for Older People Page 21 of 37 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. People cannot be fully confident that action will be taken to resolve their complaints in a timely manner and they cannot be fully confident that the staff are competent in following correct safeguarding procedures. Evidence: All of the nine residents surveys said that the staff listened to the person and acted on what was said to them. All of these nine surveys said that the person always or usually knew who to speak to if they were unhappy about something and would know how to make a formal complaint if they wanted to do so. The people we spoke with, including a visitor to the home, said that they would speak with the Manager if they were unhappy about something or wanted to make a complaint. Information about the homes complaints procedure was available in the main foyer and on both floors of the home: this needs to be amended due to the CQCs change of contact details. As good practice it should also contain the telephone number of the local authority as they have a statutory duty to investigate complaints. The AQAA told us that within the last twelve months the home had received seven complaints, six of which had been resolved within the required 28-day time period and five of these had been substantiated. We looked at the record of complaints and found that all but two of the complaints had written responses. From our examination of the record of complaints and from discussion with the Manager, we were unable to find Care Homes for Older People Page 22 of 37 Evidence: evidence how these two complaints were resolved, if at all. The AQAA told us that there has been four safeguarding referrals made, all of which had been subjected to safeguarding investigations. In November 2008 there was a delay, by the home in reporting allegations of abuse of residents and this failing to report an injury to a resident, by another resident, was repeated in July 2009. We were informed by a member of the local safeguarding team, in June 2009, that the home had not followed correct safeguarding reporting procedures and this posed a risk of delay in action being taken in a timely manner for people to be protected from any recurrence of similar abuse. In August 2009 we were asked, by a member of the public, to speak with a member of the staff, about concerns they had about the home, which we did, and found evidence that there was a reluctance for the person to blow the whistle. The staff we spoke with, during this inspection, said that they knew how to follow the homes whistle blowing policy and copies of the Department of Healths No Secrets guidance was available on both floors of the home. We found action had been carried out to improve the availability of information, for staff, residents and visitors, about what to do if abuse against any of the residents was witnessed or suspected. We asked the staff what they would do in such an event and we had a mixed response. One of the members of the staff knew what to do, including contacting outside agencies, such as the local authority whereas other members of the staff were not able to say what they would do other than reporting such allegations internally within the management tier system of the registered provider. This indicated that the management of staff in raising their awareness about safeguarding reporting has not been wholly effective. Examination of the staff training records indicated that, within the last thirteen months, thirty-two of the staff have attended safe guarding awareness. We understood, from the Manager, that arrangements are in place for refresher training in safeguarding for staff to attend. Currently, until all of the staff have attended up to date training and their knowledge has been assessed, people at the home are placed at some risk, due to the current confidence and competency of the staff in having full working knowledge of safeguarding procedures. We have made a requirement about this. The AQAA told us that all of the staff have attended training in applications of the Care Homes for Older People Page 23 of 37 Evidence: Mental Capacity Act 2005 Deprivation of Liberty Safeguards and one of the staff we spoke with said that they had attended this training in March 2009. Care Homes for Older People Page 24 of 37 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. People can be confident that they live in a comfortable and clean home but cannot be totally confident that it is completely safe. Evidence: The home is a purpose built two-storey building and has an enclosed garden to the rear. The premises were well-maintained, clean and well decorated. Outside we noted that a panel of garden fencing was missing and other panels of this fence were in need of attention. Striped garden furniture and tubs of plants were seen in the rear garden and access to this area is via alarmed doors from two lounge areas of the ground floor. We noted that these doors were locked and therefore people were restricted from being allowed to walk freely in and out of the home, to the garden area, if they wanted to do. Records for temperatures for hot water were seen and these were satisfactory as no temperatures were recorded above the safe level of 43 degrees centigrade. Infection control measures were available for people to clean their hands before and after entering each of the two units. We noted that there were communal toiletries in two of the bathrooms that we visited. These included body and hand creams: the use of such items for general purposes Care Homes for Older People Page 25 of 37 Evidence: poses a risk of cross infection and we asked the Manager to remove these. The staff told us that they have received training in managing infection control. A member of the laundry staff told us if any of the residents had an acquired infection the care staff would inform them of this so that laundry would be dealt with in a way to reduce the spread of infection. All of the nine residents surveys said the home was always clean and fresh and we found that this was the case. Care Homes for Older People Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are cared for by well-recruited staff although they cannot be wholly confident that the staff are able to always provide their care in a safe and competent manner due to a lack of understanding and underpinning knowledge. Evidence: Comments in the residents surveys said that the Bells are answered quickly and Staff are quick to respond indicating that the residents felt they did not have to wait for the staff to attend to their needs. The majority (3) of the surveys from the staff said that there was always or usually enough staff on duty to meet the needs of the residents. We received these surveys in time for our ASR that we carried out on the 27th July 2009. We received a notification from the home to tell us that, on the night of the 17th August 2009, the home was without two members of the staff, who should have been working that night. The notification informed us what action was taken to support the residents and the staff during this time. On the 21st August 2009 we received verbal concerns, from two members of the public, over the telephone about the low staffing numbers of the home. We were told that some of the residents were not getting the care, including drinks, that they needed. We shared this information with the local safeguarding team who visited the Care Homes for Older People Page 27 of 37 Evidence: home and found the information to be correct. Information provided from our examination of the staff roster, for August and September 2009, and from our discussions with the staff, including the Manager, told us that the home has five permanent members of staff who are on leave, some of which is unplanned. Agency staff are currently used, to fill these gaps in staffing numbers and we spoke with one of these staff. They told us that it was their first time working at the home but found that, although busy, felt there was a sufficient number of staff on duty that morning. We timed the staffs response to ringing call bells and we found that these were answered within less than one minute. The atmosphere throughout the home was calm and we saw that the people were getting their drinks and lunch on time. One of the staff surveys indicated that the staff morale was low through no fault of (our) own because equipment does not always deliver. We found no evidence, from speaking with a permanent member of the staff, that equipment was not available but said that the staff morale was low. The AQAA told us that 17 of the 25 care staff of care staff have a National Vocational Qualification level 2, or equivalent, in care (i.e. 68 ). We examined three of the staff files and we found that all the required information was made available to tell us that the home has recruitment procedures to ensure that people are cared for by suitable staff. All of the four staff surveys said that they were satisfied with their induction training that had prepared them to do their job. One newly recruited member of staff said that, as part of their induction training, they were shown how to provide personal care to residents, were shown where the fire exits were and had attended training in safe moving and handling and fire safety before starting to care for the residents. The AQAA told us that staff have attended training in dementia care awareness, the management of medicines, infection control (32) and how to provide the care to any person who has difficulties maintaining their continence and nutrition.The AQAA also told us that 25 of the staff have attended training in how to help people with eating. This indicates that the residents should be safely cared for by well trained staff. However we have indicated throughout this inspection report (for example Standards 7 to 10 and Standard 18) that although staff may have attended training this should be re-considered to ensure that the staff have up-to-date knowledge and that this is Care Homes for Older People Page 28 of 37 Evidence: competently embedded into their care practices. Care Homes for Older People Page 29 of 37 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 cannot be confident that they live in a safely managed home. Evidence: In July 2009 we were informed that there was a change of home Manager. She started working in her new post on the 15th June 2009. We examined her employment history and she has worked with people with a learning disability and people with an acquired brain injury. She has also had experience managing teams of staff. The staff told us that she was approachable and listening but, as she had no previous experience of working with older people and managing teams of staff working with this client group, they had little confidence in the Managers leadership abilities. We have received some, but not all, of the required information, such as untoward incidents (see under Standard 18 of this report) from the home until we reminded the home of this. We have also reported, under Standard 18, that the Manager did not always follow correct safeguarding reporting procedures. Care Homes for Older People Page 30 of 37 Evidence: In August 2008 we assessed Lily House to have excellent outcomes for people living there. Since then the home has allowed people to be placed at risks to their health, welfare and safety (e.g. Standards 7-10, 30 and 38) and this, we consider, is due to the current management arrangements of the home. The AQAA was completed to a satisfactory standard and identified areas where the home did well in (as quoted in this inspection report). We saw surveys (all but one undated-which was stamped with a date of the 11th September 2009) from relatives and the results of these have yet to be collated by the home. Reports of visits made by a representative of the registered provider were seen for 3rd June and 11th September 2009 and these were audits of areas such as care plans and peoples personal finances. Any action to be taken was recorded, such as making changes within the peoples care plans. Although there were some quality assurance systems in place we found evidence, and recorded in this report, that the quality assurance systems were not robust enough to maintain the previous quality rating of Excellent. We were not able to fully assess how the home safeguards any peoples monies for safe-keeping as no members of staff on duty were able to access this information. One person who we spoke with said that they had asked the staff to safeguard some money for them although, without access to this information, we were unable to tell how this was managed. The person had a lockable drawer in their room but had no key to lock the drawer. The Manager said she would look into this. The reports of the visits made for 3rd June and 11th September 2009, made by a representative of the registered provider, had checked the way the home manages peoples personal monies and considered that systems were in place to ensure that their money was safe: these reports said, for clients finances, No issues, spread sheets checked, no deficits and These are checked frequently and weekly balance sheets are sent to the regional administrator for checking and monitoring. The AQAA told us that the home is a safe place as the safety and service checks for portable electrical equipment, fire detection, fire alarms and fire fighting equipment are in date. We looked at the records for tests on fire alarms and emergency lights and these were satisfactory. The majority of the staff have attended fire safety training: the evidence for this was Care Homes for Older People Page 31 of 37 Evidence: provided by information from the staff and from the staff training records. Two of the staff have out of date fire safety training. We looked at the staff roster and found that these two members of the staff were currently working on night duty. We expect the home to take action to ensure that all of the staff have attended up to date fire safety training. We saw, from the staff training records, that 26 of the care staff have out of date moving and handling training. Arrangements were in place for staff to attend this training the day after our inspection. We also noted that, from the staff training records, that three of the staff have an in date first aid certificate (one of these members of staff worked office hours). We saw there was a list of staff names to be put forward for first aid training although we found no evidence that arrangements were in place for this training to be attended. We have made a requirement. The main kitchen was inspected by the environmental health officer, on the 4th February 2009, and there were no requirements made following their inspection. In August 2009, a member of the public, told us, over the telephone, that there was a problem with the homes heating system (we understood later that this was not a current issue). At our inspection we asked to see evidence that the boiler and heating system had since been serviced. We saw an email confirmation, received from the Southern Cross head office, that this service was last carried out on the 7th September 2009 and the home was waiting for the certificate. The fire door of the servery on the first floor, opposite the main dining area, and one of the fire doors to the main kitchen were not fully closing against the tumescent strip. We pointed this out to the Manager for action to be taken to ensure the home was safe from the risk of spread of fire. Care Homes for Older People Page 32 of 37 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 33 of 37 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 8 13 Any person assessed to have difficulties with their swallowing must be given the right food and drink. This is to ensure that people with this difficulty are not placed at any risk of choking. 18/09/2009 2 9 18 All staff authorised to 30/09/2009 administer medicines must have up to date training and an up to date assessment that they are competent to do so. This will protect people from harm. 3 9 14 When medicines are prescribed on a when required basis there must be clear guidelines for their use. This is so that people receive treatement that is appropriate and consistent. 15/10/2009 Care Homes for Older People Page 34 of 37 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 4 9 13 All medicine must be locked away when not in use. This will protect people from harm and ensure they are not accessible to unauthorised people or those they are not prescribed for. 30/09/2009 5 9 13 Records made when 30/09/2009 medicines are given to people must be accurate and complete. This will demonstrate that people receive the medicines prescribed for them. 6 18 13 All of the staff must be trained and competent in reporting allegations of abuse in a timely manner. This is to ensure that the people are protected from the risk of harm reoccurring. 31/10/2009 7 38 13 Staff must receive training in first aid and to ensure that there is a certified first aider on duty at any time of the day or night. This is to make sure that any person affected by a sudden change in their condition, receives prompt assessment, treatment where possible and timely 31/10/2009 Care Homes for Older People Page 35 of 37 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 referral, if required, to external health care professionals. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 36 of 37 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. Care Homes for Older People Page 37 of 37 - 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!