Inspection on 10/02/09 for Linwood

This inspection was carried out on 10th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linwood 06/07/09

Linwood 29/08/08

Linwood 31/08/07

Linwood 04/05/06

Linwood 19/04/05

Linwood 01/12/04

Linwood 19/07/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vera Bulbeck     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS 02083356800 02083393485 lorraine.hillsavery@anchor.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anchor Trust The registered provider is responsible for running the service care home 66 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 66 0 dementia old age, not falling within any other category physical disability Additional conditions: 66 0 66 The maximum number of service users to be accommodated is 66 The registered person may provide the following categories of service: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within`any other category (OP) Dementia (DE) Physical disabilty (PD) Date of last inspection Brief description of the care home Linwood is a purpose built care home that has been operating since April 2004. Service provision is for personal care for up to sixty-six older people, some of whom may have moderate dementia or mental health needs and/or physical and sensory disabilities. Care Homes for Older People Page 4 of 35 0 1 0 9 2 0 0 8 Brief description of the care home The home is owned and managed by Anchor Homes who are the registered providers. Linwood is located in a residential area within walking distance of Thames Ditton village where there are a small number of shops and other community amenities. A GP practice is nearby. There are car-parking facilities to the front of the building and further parking spaces and an enclosed garden to the rear. The accommodation is divided into six named living units over three floors. Upper floors are accessible by one passenger lift and stairs. The home is wheelchair accessible throughout, however wheelchair users are restricted to two per unit other than on the ground floor, for health and safety reasons. There are eighteen single bedrooms on the ground floor, all with fully functioning ensuite shower rooms. There are forty-eight single bedrooms over the first and second floors. These are all fitted with en-suite shower rooms for which a single charge applies for showers to be made functional. Communal facilities are arranged on each floor comprising of small kitchens, dining rooms, lounges, toilets and assisted bathing facilities. 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 service is 0 star. This means the people who use this service experience poor quality outcomes. The Commission has developed the way it undertakes its inspection of care services by the introduction of Inspecting for Better Lives. This unannounced visit formed part of a key inspection and was carried out by Vera Bulbeck, Regulation Inspector on 10th February 2009. An Expert by Experience was also present for the inspection. The Manager was present as the representative for the establishment and another manager from another service was also present. The inspection process took into account detailed information provided by the manager and any information that CSCI has received about the service since the last inspection. A tour of the premises took place. On the day of this visit the inspector spoke with a number of service users, relatives and staff on-duty. Prior to the inspection, survey Care Homes for Older People Page 6 of 35 forms were sent to service users, to staff employed at the home and health professionals. Survey forms were returned by seven members of staff and nine service users, four G.Ps also completed a survey. Some of the comments made to the inspector and made on the survey forms are quoted in this report. The home had completed an annual quality assurance assessment (AQAA) and service users care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector would like to thank the service users and staff for their time, assistance and hospitality during this visit and the service users, staff and G.Ps who participated in the surveys. The weekly fees range from 520 pounds to 770 pounds per week these fees do not include personal items. The date of the last key inspection was 1st September 2008. What the care home does well: What has improved since the last inspection? What they could do better: There are a number of requirements made in this report and these need to be addressed. An improvement plan needs to be implemented with dates and time scales required and should be sent to the CSCI. A number of areas that require to be attended to as a matter of urgency, these are service users health care needs, some service users need to be reviewed to ensure the home can meet their needs. Staff administering medication need further training. The home needs to produce a programme of activities and these should be individualised to meet the needs of the service users. There are some areas in the home that have a malodour for example the entrance hall and two service users bedrooms. The hoists stored on each floor one for example had crumbs on the foot plate and generally needed cleaning. The complaints received in the home need to contain more detail of the type of investigation and the outcome. Some staff training has been completed and some booked to be undertaken. The training records did not indicate staff had undertaken some mandatory training, particularly up dates to training. Staff competence requires more specialist training and supervision. All records must be maintained to ensure the health and safety of service users and staff including fire records, which were found to be out of date. Care Homes for Older People Page 8 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user is only admitted to the home following a comprehensive needs assessment to ensure that the home can meet the service users identified needs. This home does not offer intermediate care. Evidence: The statement of purpose and service users guide for the home is kept up to date and all service users are provided with a copy, which was seen in service users bedrooms. The documents are informative and provide the relevant information regarding the care home and the services provided. However, a service user stated I dont know what its here for no one ever reads it. The statement of purpose is also available in the main entrance to the home, as well as the complaints procedure and compliments. The inspector could not locate a copy of the last inspection report in the main entrance for any relatives or visitors to read. Care Homes for Older People Page 11 of 35 Evidence: The manager stated that pre assessments are undertaken by the deputy managers, team leaders or the manager. This is to ensure service users admitted to the home are within the homes category of registration, and to ensure the home is able to meet the needs of the service users. The pre assessment document was seen on file within the three service users care plans sampled. The home does not offer intermediate care. In the AQAA it states pre admission assessment visits are undertaken in different settings and at the home when possible, to establish care needs can be met. This enables prospective service users to meet others and decide if they want to live in the home. The Statement of purpose demonstrates what Anchor Homes and Linwood do to commit to providing high quality housing and care for older people. Care Homes for Older People Page 12 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. Personal care and health care support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. However the health care needs of some service users was not being met and reviews are being undertaken to ensure the home can meet the needs of the service user. The administration of medication needs to be reviewed to ensure the safe administration of medication. Staff who administer medication need to undertake further training. Evidence: The care plans have been up dated and contain comprehensive information to ensure the staff have sufficient knowledge regarding the service user to meet their needs. The care plans sampled have been signed and dated by service users or their relative. On the three care plans sampled there were details on end of life arrangements. The G.P practice next door to the the home provides the health care needs of the service users. Some service users are taken to the surgery for consultation, and the doctors visit the home whenever necessary. However the surveys from the practice Care Homes for Older People Page 13 of 35 Evidence: very clearly states that the home is not meeting the health care needs of some of the service users. It was felt that staff are not experienced or qualified to manage service users with higher needs. The inspector observed one service user in bed, staff confirmed that the service user is permanently in bed, and a pressure mattress has been supplied for the service user. When the inspector asked a member of staff how often this person was turned she did not know but stated she knows any one in bed needs to be turned every three hours. The staff member said this happens after lunch and supper time, and whenever the person is changed. There was no recorded information in the care plan regarding the turning process of this person. The inspector advised the management to contact the persons care manager for a review. The care plan states the person is very depressed and sleeps most of the time. Two service users have already been reviewed and transferred to a nursing home. The comments from the surgery practice were, there is a lack of communication between the staff, and staff speak in their own language and totally disregard the service users. One survey comment stated on one occasion a member of staff took a service user to the surgery, the member of staff did not know the service users name, and was unaware of what the problem was. While the doctor was examining the service user the member of staff fell asleep, the doctor had to wake up the member of staff to tell her to take the service user back to the home. On another occasion a member of staff took a service user to the surgery and took the service user to the toilet, left the door wide open and went back to the waiting room. The service user managed to get off the toilet on her own and make her way back to the waiting room. These comments have been fed back to management who was horrified and immediately took some action and produced a new protocol. The manager will be meeting with the G.Ps to ensure the comments shared will never happen again. The medication administration was seen to be followed, there were no signature gaps and records had been made of medication received by service user. However it was noted that blister packs were not being used systematically, tablets were not being administered on a running date order basis. The G.P surgery also commented that staff give medication on a regular basis, for example, anti histamine even if the medication is prescribed as and when necessary. The doctors stated in their surveys they do not have confidence when prescribing because some staff do not understand are disinterested and de-motivated. In the AQAA it states staff training on specific areas of health care takes place according to service users needs. Service users are able to meet their relatives in private or in their bedroom as they Care Homes for Older People Page 14 of 35 Evidence: wish. In the next twelve months the plans for improvement include, development of information and guidance for the service users who are able to self medicate. To provide more in depth training for senior staff to underpin their understanding of medication procedures. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided by the home need to be individualised to meet each service users need and include contact with the local community both within and outside the home. Contacts with family and friends are encouraged. Meals are well-balanced and varied with individual choices and preferences catered for. Evidence: The deputy manager stated that the home arranges church services for those service users who wish to attend, the local vicar visits the home to conduct the service. This is mainly on special occasions. Service users are encouraged to participate. The homes manager stated they are able to accommodate service users who are of different cultural religious needs. On the day of inspection the deputy manager stated that activities are available all day Monday to Friday. However on the day of inspection there were no activities in the afternoon. There is currently one activity organiser for the home and another activity organiser has been appointed and was having a weeks induction at another Anchor home. The staff undertake some activities with the service users. Care Homes for Older People Page 16 of 35 Evidence: Several service users stated they enjoy the activities, and some said they were not very good and did not attend. One service user stated his hobby was wood turning and he does not attend the homes activities because they are not want he wants to do, he is very bored, he said he spends a lot of time in his bedroom. Another service user stated she did not attend as it was very noisy in the lounge and the television is left on. The meals looked appetising and there are two choices on the menu. The menu is displayed in the main entrance of the home and at meal times the staff show the service users what is being served and they are able to make a choice. There were many comments from service users and relatives regarding meals, the majority of service users said the meals were okay, one comment in the surveys from a service user stated most of the time the meals are okay. The manager informed the inspector that she has appointed a new Chef manager who is due to commence duty within one month. Information taken from the Expert by Experience report, the following comments are observations of the home. Also, the residents comments, in most cases, using their own words. The service users are known as residents. All the dining rooms on each floor were bright and attractive with colourful tablecloths and napkins. The adjoining kitchens/serving areas were clean and tidy. There was a lack of daily menus on display. Nevertheless, weekly menus were pinned on a notice board but were in such small print I doubt that many residents were able to read them. Many of the bedrooms were vacant when visited in the latter part of the morning, as the residents liked to go to the dining room quite early to wait for their dinner. Staff were attentive to the residents helping them in a gentle and unhurried manner allowing residents plenty of time to eat their meals. A carer bought one gentleman in a wheelchair to the dining room and helped him by cutting his meat. The residents were spoken to quietly and were shown two choices of dinner so they could choose what they wanted. They had a choice of fruit juice. The residents spoken to seemed quite happy saying the food was good and they had no complaints and the staff are kind. One resident commented that she felt safe and secure at the home but she did not when she was in her own home. The meal was a choice of chicken and vegetables or braised steak in red wine with vegetables. Many residents commented that the steak was tough and was observed that it was hard for the carers to cut it up. One lady said the chicken was hard. The rice pudding seemed to be popular. Another resident commented that the care and food were good and her bedroom was kept clean and the staff always knock before entering. Another resident who spends a lot of time on a chair in her room, said the food is not bad but dislikes curry. Another resident says the dishwasher breaks down a lot and the cups taste soapy sometimes and that it is worse since the home has been Care Homes for Older People Page 17 of 35 Evidence: run by Anchor Trust. Three other residents who appeared to have memory problems seemed to be happy and commented that the food was good. Comment from another resident she thought the food could be cooked and presented better and that the home is going downhill. A gentleman who said the food could be better, especially the roast dinners/potatoes. They are not like roast potatoes, the food could be much improved. Another resident thought the food is OK and said she likes to go to the activities. She has her hair done at the hairdressers regularly but washes and bathes herself, She thinks the carers are kind. Another resident said she has been living at the home for 15 years and is happy, staff respond to the bell and are helpful, food is good but she stays in her room as she is not interested in the activities. This resident had a Service User Guide in her wardrobe. If she needs to see a doctor she makes an appointment downstairs in reception. Her daughter takes her on outings and washes her hair when she takes her home. Another resident who liked the food, is happy and likes the dog. One gentleman who says he has been at the home for 4/5 years said the activities were sometimes alright, but he gets bored, he is able to smoke in his room. There was no activities co-ordinator working on the day of the inspection and carers had been asked to organise something with the residents that morning. A few residents were in the lounge on the 2nd floor playing ball games. The expert by experience was informed by the regular manager that she is in the process of employing a new activities organiser. The only signs available detailing what activities would be taking place were in small type high on a notice board. There was nothing advertised daily to encourage residents to go to the lounge on the top floor for activities. The carers stated they wait to see who turns up and then it is decided what activity will take place. A carer said that a record of who takes part in activities is recorded, but many residents have stated previously that they are not interested in taking part. There were some decorations for Valentines Day and the Expert by Experience was informed they will have a special activity. There seemed to be little provision for residents with dementia of stimulating activities and outings. There was no evidence of an activities programme tailored to suit residents past interests, also little understanding of the needs of people with dementia either with clear signing for meals or activities. There was no evidence of any arts or crafts having taken place with the residents. Most of the residents spoken with were happy with their rooms, which were personalised with photos, their own possessions and sometimes personal furniture. Many expressed a preference for remaining in their bedrooms most of the time. Care Homes for Older People Page 18 of 35 Evidence: Residents said they were able to make choices as to the preferred times of rising and retiring and that visitors were welcome at any time. One resident spends a lot of time on a chair in her room, she says her room is kept clean, and a lovely lady cleaner looks after her and looks for items she is unable to find. The resident said that a carer had painted nail varnish on her nails. When a carer was asked about nails she said that they did manicures on Saturdays. Some time was spent talking to a lady who will be 98 years later this year. She was immaculately dressed and still able to wash and dress herself. Her bedroom was clean but she did not approve of the dog, saying it did not disturb her, but it isnt hygienic. She thought the care was OK and the food passable but did not know who was in charge and did not understand the care staff from abroad. This lady would like to listen to classical music in a lounge sometimes rather than watching television, which they can do in their bedrooms. She said she has never seen the piano being played in the home but would like to hear it. Her daughter was visiting at the time saying she had no complaints. If an appointment is needed with a doctor then it is made immediately by the care staff. A lady in another bedroom said that the carers responded to the call bell quickly. She was unable to walk unaided and was sitting in her chair smoking and watching the television. She thought the food could be cooked and presented better and that the home is going downhill, but she is always happy, she has visitors on a regular basis. The Expert by Experience was not given the impression that the home fully understood the needs of people with dementia and that there was little motivation for some of the residents. The overall impression of the home was that it was bright and clean, the mid-day meal was adequate but there was little mental stimulation for the residents and many seemed bored. A comment in a service users survey states: the TV in the lounge is always very loud and on all the time while we do activities. Staff also made some comments about service users would enjoy more outings and visiting places of interest. Activities need to be more suited to the individual service user. Two relatives and a service user stated they had had many problems with the home, and the service user stated that another service user wanders in and out of her bedroom during the day and at night and takes items. The relatives also stated when they arrived at the home one evening following a phone call from their mother, regarding the service user wandering in her bedroom, the service user said she had rung her call bell and no one had come to her, so she telephoned her relatives. The Care Homes for Older People Page 19 of 35 Evidence: relatives came to the home and saw two members of staff asleep in the lounge. The relatives also said that they arrived at the home one day and their mother was sitting on the commode eating her dinner. When they asked the member of staff why they had given their mother her dinner while she was on the commode, the member of staff was not aware they had done anything wrong. In the AQAA it states families and friends are able to join service users for a meal if they choose, eating with relatives is encouraged or preparing food together. Visitors are able to use the individual kitchenettes on each unit and be able to help themselves to drinks hot or cold from water or fruit juice machines. Open visiting for relatives to stay and have use of private lounge areas. Community participation is actively encouraged, school children visit the home from local schools. The home has links with the local church, service users visit the library close to the home. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a simple, clear and accessible complaints procedure, which includes timescales for the process. The recording and the investigation of complaints needs to be in more recorded detail. Evidence: The home has received twenty six complaints since October 2008, the complaints have been recorded and all have been dealt with by the management of the home. The inspector observed that some of the complaints have been investigated however, there is a need to make sure the detail, procedure and outcome of the complaint is recorded appropriately. The manager stated that all staff have received safeguarding procedure training. The home has a copy of Surrey County Council Multi Agency procedures. There is a poster on safeguarding procedures on each unit and another in the reception area. All the service users have been provided with a copy of the complaints procedures, which is filed in the service users guide available in their bedrooms. Two relatives and a service user made a complaint to the Expert by Experience, who asked the complainants if she could inform the inspector. The inspector involved the management of the home to listen to the relatives and service user and then to take appropriate action. The relatives stated they had made complaints previously and they Care Homes for Older People Page 21 of 35 Evidence: were not taken seriously, therefore they were not convinced that any action would be taken. However, they were satisfied that the manager had stated she would investigate their complaint. A number of service users stated they had made minor complaints but none of concern, one service users stated if they were worried they would speak with a relative or a member of staff who they felt comfortable with. One member of staff who is in great demand by the service users and they seem to be very fond of is one of the domestic staff who also provides care. The majority of service users were complimentary towards the staff and management. The inspector was shown a list of service users who have a postal vote, the management stated that all service users are given the opportunity to vote. Comments taken from the Expert by Experience report: One resident commented that she felt safe and secure at the home but she did not when she was in her own home. At the time of the inspection one resident had her daughter and son-in-law visiting, they all seemed very unhappy about several issues. She complained that another resident goes into her bedroom any time of the day and night and interferes with items in the drawers and the resident feels helpless to do anything as she is not able to get on and off her bed very quickly. The resident sits in her wheelchair for a lot of the time and says that sometimes the call bell is not answered. The daughter and sonin-law said they have made complaints previously and received letters but nothing changes. The Expert by Experience bought this family to the attention of the Inspector who has followed the complaints up with the management. In the AQAA it states robust complaint processes are in place and documented in the homes statement of purpose. Information is displayed on notice boards, leaflets are available and a copy is in the service users guide. Care specialist advice is available, confidential information is kept securely. There is a quality monitoring on complaints and adult protection issues within the home. Anchor review all adult protection processes taking place and will offer support to the home. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the service users with clean, pleasant and homely surroundings in which to live. The malodour in some parts of the home needs to be addressed with regular cleaning. Evidence: The home was furnished comfortably and service users bedrooms contained a number of personal items, most bedrooms have their own television. One service user has a cat who moved into the home with her. The bedroom is on the ground floor and this gives the cat access to the garden. There was a strong malodour in the main entrance of the home on the day of inspection. Another area that had a strong malodour was in two service users bedrooms. The home was generally found to be clean and bright. One of the cleaners in the home is very much involved with service users and care practise. Several service users were very complimentary to wards this member of staff. The home has a number of small lounges and plenty of quiet areas for service users to enjoy. On the second floor another service user has a small friendly dog. The dog seems to be very popular with some service users and some are not particularly fond of the dog. The shower room on the top floor needs a sign to indicate that there is also a toilet Care Homes for Older People Page 23 of 35 Evidence: available in this room. On the day of the inspection the shower room on the middle floor had a notice on indicating it was out of order. The inspector noted the maintenance person was working on the top floor and when he was asked about the shower room being out of order, he was not sure why. He went to check and said it was working okay and thought it may have been an odour from the drain. Each unit has its own laundry and staff mainly load the washing machines, there is a person employed for laundry duties but was on holiday on the day of the inspection. A number of bedrooms duvet covers looked crumpled and needed ironing. There are some service users who are able to smoke in their bedrooms, they have been issued with an extra large ash tray. It was also noted that some bedroom doors were wedged open and none of the bedroom doors are fitted to the fire alarm system. The inspector advised management to contact the fire officer for advice. In the AQAA it states Kitchen and laundry facilities available allow service users to be involved following a risk assessment. There is a home maintenance programme in place to ensure continuous improvements to the home. Plans for improvement is to fit air conditioners and balcony rails to be fitted with extra protection. A stair lift to be fitted to access all floors to back up the lift if and when it breaks down. The home is to have a complete redecoration in the home and external where needed. The Expert by Experience continued to tour the home and speak with service users when ever possible, during her tour she observed the home is situated on three floors and there were a number of vacant bedrooms. All the bedrooms visited were clean and many had personal items, photos and their own furniture. The communal areas were bright and attractive and well furnished. All the dining rooms on each floor were bright, attractive with colourful tablecloths and napkins. The adjoining kitchens/serving areas were clean and tidy. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of the staff is not meeting the needs of service users. The home has a comprehensive staff recruitment programme, which incorporates all areas needed to ensure, as far as reasonably possible, that service users are in safe hands at all times. However staff training needs to be up dated. Evidence: There are six units in the home and the manager confirmed the current staffing levels are two staff on each unit, and three staff on the ground floor unit. There are also two team leaders, and two deputy managers. A receptionist and administrator is located on the ground floor who supports the management of the home. There are a number of other staff involved in the operation of the home. Some staff training has been undertaken since the last inspection and some has been booked and will be completed shortly. The training records have been recently updated by management, however there are training records and certificates missing from staff files. The manager stated because of this she has booked all those staff without sufficient training records, training for first aid and a number of other courses to ensure all the staff will have up to date training. The manager stated the home has 50 of staff who have a NVQ Level 2, a team leader is in the process of completing NVQ Level 3 in care. The deputy manager and another team leader are undertaking an RMA. Care Homes for Older People Page 25 of 35 Evidence: The manager stated when she came to work at the home there was a backlog of staff application forms that had never been dealt with. According to the manager the staff had not been interviewed. The manager also stated the week prior to the inspection they had interviewed a number of possible care workers and are hoping to appoint nine care staff, depending on their CRB being clear. The inspector was also informed an activity organiser has been appointed and during the week of the inspection was undertaking an induction at another care home. Recruitment procedures are in place, however two new staff did not have an up to date photograph on file. The manager stated the photo had been taken but had not been placed in the file. The management should ensure Schedule 2 of the Amended Care Homes Regulations must be followed at all times, full recruitment procedures on all staff must be undertaken. All new staff must have a full induction and complete mandatory training. The home has a number of agency staff working in the home and full details supplied from the agency were seen for the agency staff. The manager stated the staff have been working for some time and know the service users fairly well. However, when the inspector asked some staff about service users, some were not able to remember their names. The inspector spoke to a number of service users about the staff and asked if they found the staff to be helpful, and some service users confirmed some staff were wonderful and others not so good. Some service users commented some staff are not so nice, some do not speak they just carry on with whatever they are doing and some cannot speak English very well. One service user commented that some staff speak to each other in their own language and some are always talking on their mobile phone. The manager stated that the previous week she had interviewed several proposed staff and hopefully nine applicants would be offered carer posts. On a comment survey form received from staff it states more staff required when service users have hospital or doctors appointments, to ensure sufficient staff are on duty at all times. Comments made by residents to the Expert by Experience stated, one resident was not happy as she complained that there were lots of staff changes and felt unsure of the carers, especially at nights as there is only one member of staff who has been at the home for a long time. A member of staff was working in the corridor; she said she works 6 hours a day 5 days a week. She was friendly and helpful with a couple of ladies whilst chatting and guiding them along the corridor. She seemed to be on good terms with the residents, more like a carer. She seemed to enjoy her work and wore the same uniform as the carers, with an apron over it. The agency staff wore white shirts and the permanent staff wore turquoise and navy blue tops. Care Homes for Older People Page 26 of 35 Evidence: In the AQAA it states what the home does well, staff recruitment procedures are followed, training records of staff training and a training planner has been developed for all staff updates and further training needs. The home has 50 of staff who have completed an NVQ, Induction training for all new staff, currently a new member of staff being inducted at another Anchor home, and supervision for all staff. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements in the home need to be stable to ensure an open, positive and inclusive management style atmosphere. The home has an effective quality assurance and monitoring system in place, which needs to be followed. The management to ensure relevant safety checks are undertaken on a regular basis to ensure the health and safety of service users and staff. Evidence: The manager had been in post a very short time when she was unfortunately involved in an accident, and as a result has been off work for some time. Another manager has been covering the management duties in the home until the homes manager returned to work very recently. The manager stated she was hoping to have the home at a good standard by now. The manager has completed the Registered Managers Award in 2008 as well as being an Assessor and Verifier. The manager stated before she was absent from the home she was working towards raising the standards in the home and making sure any requirements and comments raised at the previous inspection were Care Homes for Older People Page 28 of 35 Evidence: being implemented. The Regulation 26 visits were being undertaken and these were informative and prescriptive, they were written in a format covering each section of standards. The yearly Audit undertaken on 7th and 9th May 2008 identified 20 recommendations. Some of these recommendations were still outstanding. The manager stated the home does not manage any service users finances,relatives or family are mainly involved with service users finances the home does have a finance assistant who manages the homes financial account, however the manager manages the homes budget. Several records were checked and the fire records for the home had not been maintained appropriately, for example the testing of the weekly fire alarm system was last recorded on 4/2/09 and previously 10/12/08, 4/12/08 and 26/11/08. The emergency lighting is supposed to be checked monthly according to the records seen and the last recorded entry was 18/11/08. The inspector advised the home to contact the fire officer for advice regarding the service users bedroom doors, which are not fitted with any closing device in the event of a fire and some were seen to be propped open. The rota was seen and it was noted that correction fluid had been used. These documents should not be defaced as they are classified as legal documents. The staff meetings are being held on a regular basis and cover a range of topics. A comment on one of the staff survey forms suggested the meetings are more about telling staff what to do, or telling them off. Never mention anything good staff do, or any encouragement or how they could motivate the staff, the meetings are more about giving orders. The manager informed the inspector the home was awarded The Silver Star Award from the Environmental health. Some comments from service users survey forms: Everything in the home is well organised, the home is a lot better than before, indicating the home is clean and fresh. In the AQAA it states the home is supported by Corporate Services, has the expertise in finance. Human Resources are also involved with the smooth running of the home. Care planning has been updated, training is undertaken by all staff. How the home has improved in the last 12 months: New Manager and two deputies now in post. Quality assurance system identifies new manual in place and staff are working on standards within it. Deputy manager trained to cover reception and admin in the event of any absence. The home is health and safety compliance, new evacuation procedures in place and staff trained to undertake the procedures, as well as adhering to an Care Homes for Older People Page 29 of 35 Evidence: emergency evacuation in the event of an emergency. Plans for improvement in the next 12 months:Deputy managers to complete RMA, to maintain all checks are recorded monthly and action any shortfalls within Health and Safety compliance. Care Homes for Older People Page 30 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 31 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 8 13 The registered person shall ensure unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. To ensure service users are reviewed and the home is able to meet their health needs. 20/03/2009 2 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. Medication that is to be administered when necessary, needs to be administered accordingly. 27/02/2009 3 12 16 The Registered provider should consult service users about the programme of activities arranged. 17/03/2009 Care Homes for Older People Page 32 of 35 Service users are given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capabilities. 4 16 17 The registered provider 13/03/2009 must ensure a record is kept of all complaints and includes details of investigation and any action taken. All complaints must have full details of action taken and investigation, and appropriate closure of complaint. 5 26 16 The registered person must keep the home free from offencive odours. There was a malodour in the main entrance hall and two service users bedrooms. 6 27 18 The registered person must 06/03/2009 ensure that at all times suitably qualified, competent and experienced persons are working in the home. Staffing numbers and skill mix of qualified staff are appropriate to meet the assessed needs of service users. 7 30 18 The registered person must 20/03/2009 ensure that at all times suitably qualified, competent and experienced persons are working in the home. 10/03/2009 Care Homes for Older People Page 33 of 35 All staff must have receive relevant mandatory training and up dates to training. 8 38 23 The registered person must take adequate precautions against the risk of fire, reviewing fire precautions, and testing fire equipment at suitable intervals. This is to ensure the health and safety of all service users and staff. To test and record the fire alarm system and the emergency lighting. 27/02/2009 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 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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