Inspection on 22/12/09 for Little Hayes Care Home

This inspection was carried out on 22nd December 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Little Hayes Care Home 10/03/09

Little Hayes Care Home 07/10/08

Little Hayes Care Home 15/01/08

Little Hayes Care Home 29/06/07

Little Hayes Care Home 07/03/07

Little Hayes Care Home 20/04/06

Little Hayes Care Home 15/09/05

Little Hayes Care Home 27/06/05

Little Hayes Care Home 12/11/04

Little Hayes Care Home 24/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Little Hayes Care Home 29 Hayes Lane Kenley Surrey CR8 5LF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Ford     Date: 2 2 1 2 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 30 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 30 Information about the care home Name of care home: Address: Little Hayes Care Home 29 Hayes Lane Kenley Surrey CR8 5LF 02086606626 02086682449 littlehayes@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Diplotec Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Daytime staffing levels would have to be:- 4 Qualified nurses and 8 care assistants between 8:00am and 2:00pm. 3 Qualified nurses and 7 care assistants between 2:00pm and 8:00pm. Nighttime staffing levels would have to be: - 2 Qualified Nurses and 3 Care assistants between the hours of 8:00pm and 8:00am. Date of last inspection Brief description of the care home Little Hayes is a 50-bed home, which offers nursing care to the elderly. The home is situated in Kenley, an attractive semi-rural area that is in close proximity to a mainline rail station and good road and bus links. The only potential difficulty with access is that the visitors on foot would have to climb a short, but steep hill to the home. The home offers 36 single bedrooms and 7 double bedrooms over two floors, some with en-suite facilities. There are two passenger lifts for ease of access although the home is very spread out in its layout and it is quite disorientating at first. There are various communal areas available for all of the residents and a garden. The stated aim of the Care Homes for Older People Page 4 of 30 1 0 0 3 2 0 0 9 0 0 Over 65 10 40 Brief description of the care home home is to provide its residents with a secure, relaxed and homely environment in which their care, well being and comfort is of prime importance. Copies of the Statement of Purpose for the home and the latest inspection report can be requested from the home. Inspection reports can also be obtained from The Care Quality Commission via their website. At the time of this latest inspection fees ranged from £425 - £680 depending on the room occupied and the dependency of the resident. These and any extra charges payable would be discussed prior to admission. Care Homes for Older People Page 5 of 30 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: This report follows an unannounced visit to the service. However, we also took into consideration information that we have asked for or received since our last visit which was in March 2009. At that time it was noted that a new manager, with extensive support from The Care Home Support Team, had succeeded in making considerable progress in improving the outcomes for the people who use the service. The policy of restricting admissions to the home had been lifted and we made only one requirement which was relating to medication. Since that time the home has gone into administration and the manager has left. Management responsibilities are currently being overseen by Healthcare Management Solutions who have been appointed by the receivers. During our visit we walked around the home and spoke with several of the residents who currently live there. We also spoke with staff on duty and some relatives who were Care Homes for Older People Page 6 of 30 visiting. We had also been given some information before we visited by someone who was concerned about the current situation in the home. We looked at some of the documentation that the home is required to keep as evidence of its commitment to the health and safety of the people who use the service, including care plans, medication records and staff files. As yet we have not received the homes Annual Quality Assurance Assessment (AQAA) which is their annual self assessment of how well they believe the service is meeting its aims and objectives and about its plans for the future. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The management of the home is currently being overseen by a management company however, they are based in Birmingham and practical everyday support has been limited. We have asked them to provide evidence of their visits which must be at least once every month. The company has appointed a person to be in charge of the home however, she is not a registered nurse and has limited training in caring for people with dementia. Given that the home was previously the subject of a serious concerns review, which required input from The Care Home Support Team, we have raised concerns about this and asked for further clarity about how the management responsibilities are going to be discharged and monitored. Since we last visited there has been a reduction in staffing levels in the home. This is in relation to nursing and care staff and domestic and ancillary staff. Although the home is currently not fully occupied, we considered that some of the concerns that we have raised are directly attributable to these reductions. We noted that some residents are not being washed and dressed until almost lunch time. Once they are brought down to the lounge they are sitting unsupervised by care staff and without any form of stimulation. Trained nurses are helping carers to deliver basic personal care which leaves them little time to supervise them and undertake their own role. One relative told us they ( the staff) only have time to do the basics. The layout of the home, on 2 floors with various zones, has always made it very difficult to manage. In addition many of the residents are very frail and need two staff members to help them in order to ensure their safety. We noted that recently residents care plans have not being reviewed regularly which means that their changing health care needs may not be being identified and addressed. Domestic and laundry staff hours have also been reduced. Although the home appears to be clean there is no time for tasks such as carpet shampooing and some areas were malodorous on the day we visited. A pile of laundry was piled up waiting to be washed and ironed. There is very little in the way of organised activities arranged for residents, some of whom told us that they would enjoy having something to do. The budget for activities Care Homes for Older People Page 8 of 30 is limited and so far relatives have been reluctant to make any extra contributions. When we visited the home it was shortly before Christmas. However, there was little in the way of any impending festivities. Each lounge had a small Christmas tree and there was one in the hallway. A few baubles hung from the handrails. A party had been planned for the afternoon but there was no sign that residents had been encouraged to prepare for it perhaps by choosing an outfit to wear or being able to visit the hairdresser. We looked at the files of some of the newly appointed staff and they were incomplete. All of them had received clearance from The Criminal Records Bureau but other information required by the regulations was not in place. Some staff have not had uniforms issued to them, raising concerns about cross infection occurring. Some money is being kept on behalf of residents who are unable to manage their own affairs and do not have representatives to do this for them. However, this is not accounted for in a clear and transparent way and this must be addressed. Our judgement is that this home is now a zero rated. poor service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. No-one is admitted in to the home without having their needs properly assessed to ensure that they can be met. Evidence: Our last inspection provided evidence that no-one was admitted without an assessment, undertaken by the home, to ensure that their needs can be met. Those people who are funded by the local authority would have an assessment from their care manager as well. Relatives would be encouraged to be involved in the admission procedure and both they and the resident would be able to visit the home to see if it was suitable. Since our last inspection of the service, we are told that only one lady has been admitted to the home. We were able to see that an assessment from her care manager was in place. Care Homes for Older People Page 11 of 30 Evidence: The home does not offer intermediate care therefore this standard does not apply. Care Homes for Older People Page 12 of 30 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. Residents are not always having their health care needs met in the way that they prefer. Evidence: This outcome group looks at the way that the health care needs of those people who are using the service are being met. Each resident should have a plan of care which sets out exactly how they should be supported and cared for in line with their preferences. We noted that these were in place and it appeared that residents individual needs had originally been identified. However, in those care plans that we read we could not see any evidence they had been reviewed for the last two months. We discussed this with the manager and discovered that this lack of review had started around the time that staffing levels had been reduced. We are concerned that any recent changes in the health care needs of residents are not being identified and therefore we have issued a requirement to address this. Care Homes for Older People Page 13 of 30 Evidence: We could see that residents basic health care needs appeared to be met. They looked clean and tidy and were reasonably well dressed for the time of year. Those thought to be at risk of developing pressure sores had specialist equipment in place. Other health care professionals visit the home as required and we met the homes GP on the day that we visited. However, we did raise concerns about the way that peoples psychosocial needs were being met. We noted that when we arrived at the home, very few of the residents were up and about. Even though we could see that staff were trying their best and that trained nurses were also helping, this process took most of the morning with some people only just up in time for lunch. Staff told us that in order to achieve even this standard of care they often are not able to take any form of a break, working all morning without being able to have a drink. We have made requirements to address these concerns under outcome group 6. Once up, we saw that residents were left in the various lounges without access to a drink, without supervision from any staff members and completely without any form of stimulation or activity. Those people who were nursed in bed because they were unwell, generally looked comfortable however, we noted that few of them had access to a drink either. In one room we saw that a residents glass of water had been left on the radiator, which would have made it taste very unpleasant. It would appear that there is no time for trained nurses to provide any supervision or support for carers as they are spending time helping with residents basic personal hygiene needs. We looked at medication procedures in the home and generally they were in order. Administration records all have a photograph of the residents for ease of identification and we did not find any errors in recording. We have made a recommendation that there should be a list available of all staff who are trained to administer medication along with a sample of their signature so that they can be identified. We were told that medication administration practices in the home are audited regularly however, the trained nurse we spoke with was not able to produce any evidence of this. We have recommended that records of this are kept. We also noted that one resident had been consistently refusing his medication and yet there was no evidence available to show that his doctor had been informed of this. A recommendation has also been made to ensure that there are records to show that a residents doctor is informed when they are non compliant with their treatment. This outcome group also requires us to make a judgement on how well the home Care Homes for Older People Page 14 of 30 Evidence: addresses the principles of respect, privacy and dignity. While we were in the home we saw that staff were kind and polite toward the people that they were caring for. Personal care is delivered in residents own rooms. However, we considered that some practices in place in the home were not respecting peoples dignity. As we walked around the home we saw that there were lists on the wall, where anyone would be able to see them, denoting the various days that residents would be able to have a bath. We were also told that one resident had refused to have a bath because she did not want a male carer to help her and no alternative had been offered. In the laundry, we saw that some of the residents clothes had been marked with their room number instead of their name and in a black pen that would be visible from the outside. This is not acceptable for any resident and particularly undignified for anyone who goes out of the home. We have made a recommendation that future staff training should include sessions about recognising residents as people and preserving their dignity. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited opportunities available for residents to enjoy any organised activities in the home. Reductions in staffing numbers have limited the amount of interaction taking place between residents and staff. Evidence: This outcome group considers the way that the people who use this service are spending their days and if the lifestyle suits them. When we visited we raised serious concerns about the way people in the home are spending their days. The recent reduction in staff numbers has resulted in some residents not being washed and dressed, and ready to come down to the lounge, until lunch time. Once there, we saw that they are left just sitting, unsupervised by any staff member and without any stimulation or interaction. We have been told that there is a limited budget available for providing any form of supervised activity and relatives have been asked to contribute to provide funds for these to be increased. We have been told that so far response has been poor. The day that we inspected the home was three days before Christmas. There was little sign of any impending festivities. Each lounge had a small Christmas tree in the corner Care Homes for Older People Page 16 of 30 Evidence: and there was another in the hall. There were also a few baubles hanging from the handrails in the hall. A few of the residents had some decorations up in their rooms. The manager told us that she had not realised that more decorations were not in the home until it was too late to order any more. We expressed our surprise that someone had not been sent out to purchase some more when that became apparent. We were told that a party was planned for the afternoon and some of the residents we spoke with knew that it was taking place. However, there was no sign that residents had been encouraged to prepare for it by choosing an outfit to wear or the ladies being able to have their hair or nails done for them. There was also no evidence of any party food being prepared for the occasion. Just before the party, the cook went out to the local supermarket to buy some food and care staff put up some balloons in one of the lounges. We were told that the lady who visits to provide exercise to music sessions would be coming to provide some entertainment for the event. We have made a recommendation for residents to be be consulted about their social interests and for activities to be provided which will suit their needs and abilities. While we were in the home the lunch time meal was served. It was well presented and looked appetising. People told us that they enjoy the meals that they have. Traditional British food is served although special diets can be catered for. We were told that residents only have soup and sandwiches in the evening now although we know that there used to be the option of a hot snack. We have made a recommendation that there should be evidence that this has been discussed with residents in order to ensure that they are all happy with this decision. Should residents opt for a hot meal in the evening the cooks hours will also need to be reviewed. Care Homes for Older People Page 17 of 30 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 good 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 complaints procedure in place and staff have received training in order to protect resident and safeguard them from abuse. Evidence: There is a complaints procedure in place in the home and we are always notified of any incidents that happen there. No new staff are employed without the appropriate clearance from the Criminal Records Bureau, in order to prevent people who have been judged as being unsuitable to be working with vulnerable adults from doing so. Our last inspection ascertained that staff had all received training in recognising and reporting suspected abuse. Care Homes for Older People Page 18 of 30 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. Although the location and layout of the home is not ideal it is generally clean and comfortable. The reduction in hours allocated to cleaning is causing difficulties in keeping it free from odour. Evidence: This outcome group looks at the suitability of the home for the residents who live there. The home has never been ideal in terms of access, it is not close to public transport links and the nearest station is a short walk away up a very steep hill. The home is a large building and the spread out layout makes it both disorientating for residents and difficult to manage safely for staff. When we last visited, some redecoration and refurbishment had been taking place. This had resulted in extra communal space being made available which could be used to provide different activities or somewhere peaceful for residents to entertain their visitors. Decor in residents rooms is looking tired now and we noted that some of the furniture is broken and some of the curtains are hanging down. However, residents are able to Care Homes for Older People Page 19 of 30 Evidence: bring in pictures and possessions from home in order to make them more personal. This home is registered to care for people with dementia yet we noted that there is still very little in the way of appropriate pictures or reality orientation. In one of the lounges we saw that light bulbs were not all working and the clock had stopped. Items such as calendars, clocks and pictures are generally considered to be important in helping those with dementia adjust to their surroundings and consideration should be given to improving the environment for residents in this way. On the day that we visited, the home was generally clean and tidy although on the first floor, of one of the wings, there was a very unpleasant odour. Domestic hours have recently been reduced and the one cleaner on duty is not able to do any more than keep the home clean in the time that is allocated. There is no time available for her to shampoo carpets to keep them fresh and free from unpleasant smells. Some of the staff that we spoke with told us that there are not always sufficient aprons and gloves available for them to use although the manager assured us that this problem has now been addressed. We also noted that some newly appointed staff do not yet have uniforms. We raised our concerns with the manager about the risk of cross infection that may occur as they are wearing their own clothes and during the inspection they were not even wearing protective aprons. A requirement has been issued in respect of this. On the day that we visited one lady told us that she had just been helped to have a bath but it had not been very warm. When we tested the water we found that it was lukewarm to touch and we also noted several free standing heaters around. We were told that the boiler is old and there are some problems with the hot water supply. During the afternoon an engineer came out to look at the heating and we have been assured that the boiler is going to be replaced. We would expect this situation to be monitored closely to ensure that people are not cold and that they have acess to hot water. Care Homes for Older People Page 20 of 30 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. Staffing levels in the home may not be sufficient to meet the needs of the people who live there. Recruitment procedures are inadequate and may put people who use the service at risk. Evidence: Since our last inspection there have been reductions in the staffing levels in the home and we have concerns that the number of staff who are now on duty is insufficient to meet the needs of the people who use the service. We have based this judgement on evidence that was available to us when we inspected the service and also from comments that we have received from people who visit the home regularly. When we visited we saw that some residents are not up, washed and dressed until lunchtime although there is no evidence available to show that this is their choice. We saw that residents are in the various lounges in the home but there are no staff available to provide supervision for them. They are focused on delivering personal care and do not appear to have the time to sit and interact or engage with people and organised activities are limited. Trained nurses are helping to deliver personal care as well as their usual duties such as dressings and medication and have little time Care Homes for Older People Page 21 of 30 Evidence: available to supervise carers. A relative told us that staff are only managing to do the basics. The care plans that we looked at had not been reviewed for the last two months which coincides with these staff reductions. This could mean that changing health care needs have not been identified and are not being addressed. Domestic and laundry hours have also been reduced. This has lead to the washing and ironing piling up and there are unpleasant odours in some parts of the home of the home as there is no tome to shampoo carpets. We have made a requirement that there must be evidence that staffing levels have been reviewed and we will continue to monitor the situation within the home. At our last inspection we saw that staff training needs were being addressed and training was up to date. However, this will need to be part of an ongoing process. At our next inspection we will be looking to ensure that training is being maintained in order to meet the needs of the residents and also that staff supervision is taking place in order to identify any shortfalls. We looked at the files of 4 staff who have been employed by the home since the last inspection. None of them were complete. All of the staff had received clearance from the Criminal Records Bureau however we could not find any application forms, health declarations, job descriptions or contracts. Not all of them had two references and photographs were only in the form of photocopied passports. The regulations are specific about what information should be available about people who work in the home and we have issued a requirement to ensure that this is in place. Care Homes for Older People Page 22 of 30 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. Management arrangements in the home may not be sufficient to ensure the health welfare and safety of the people who us the service. Evidence: The home is one of several owned by the same Registered Providers which have recently been taken over by receivers. A management company has been employed to oversee the running of the home while its future is being decided and it is hoped that it will be able to be sold as a going concern. However, this company is based in Birmingham and although they are able to offer advice, practical everyday support has been limited. When we inspected the home we were not able to see any evidence of any monthly visits being made by the company, in accordance with Regulation 26. There was also no evidence to show that residents or their relatives have been consulted recently about their views of the home or the services provided. Some relatives have told us that they have not been formally notified of the current situation within the home Care Homes for Older People Page 23 of 30 Evidence: although there was a meeting held when the management company first took over. However, for those people unable to attend there has not been any official communication. We have also been informed that not all of the placing authorities have been notified of the situation. The management company has appointed a person to manage the home, who was previously employed in one of the other homes in the group. Although her enthusiasm for the role was evident, this person is not a registered nurse and her training in working with people with dementia has been limited. Given that the home has recently been the subject of a serous concerns review, requiring intensive input from The Care Home Support Team to improve, we have concerns about the suitability of the current management arrangements. Therefore we are making requirements firstly, that the management company must send us copies of their monthly visits. These visits must provide an ongoing evaluation of how the home is operating, any areas that need addressing and how it is intended that this will be achieved. We are also requiring the company to send us an action plan outlining the future management plans for the home and how they will be checking that these are effective. We were told that some money is kept on behalf of some of the residents in the home who do not have relatives or representatives who are able to do this for them. However, we were not able to see proper and accurate records of this. A new administrator has been appointed and we were told that she has prioritised this issue. We have made a requirement for the home to maintain appropriate and accurate records and will be monitoring this at a future compliance visit. We were not able to check that equipment and services are being properly maintained. Records in the home were being moved between offices and were not available for inspection. We asked for confirmation to be sent to us that electrical equipment including portable appliances, lifts, hoists, fire detection and fighting equipment, emergency call equipment, the heating system, soiled waste disposal and gas appliances have all been properly serviced and maintained. As yet this has not been received therefore a requirement has been issued to address this. Care Homes for Older People Page 24 of 30 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 25 of 30 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 7 15 There must be evidence that 30/03/2010 care plans are reviewed regularly. In accordance with reguation 15(1)(b) of The Care Homes Regulations 2001. In order that residents changing needs are identified and steps taken to address them 2 12 16 There must be evidence of consultation with residents about how they wish to spend their days and the activities that they would like to participate in. In accordance with regulation 16 (2)(n) of The Care Homes Regulations 2001. In order to ensure that the daily life in the home suits their needs and preferences. 30/03/2010 Care Homes for Older People Page 26 of 30 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 3 26 13 All care staff must wear 30/03/2010 appropriate clothing, in accordance with regulation13 (3) of The Care Homes Regulations 2001 In order to minimise the risk of cross infection in the home. 4 27 18 There must be evidence of regular reviews of staffing levels in accordance with regulation(1)(a) of The Care Homes Regulations 2001, In order to ensure that the needs of the people who are using the service are met. 30/03/2010 5 29 19 Staff files must contain all of 30/03/2010 the evidence required by Schedule 2. In accordance with regulation 19(1)(b)(c) of The Care homes Regulations 2001. In order to ensure the protection if the people who are using the service. 6 35 20 There must be evidence of 30/03/2010 accurate and appropriate records being maintained of any money kept on behalf of any residents. In accordance with regulation 20 of The Care Homes Regulations 2001. Care Homes for Older People Page 27 of 30 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 In order to safeguard the financial affairs of the people who use the service. 7 37 26 A copy of the report made in 30/03/2010 line with regulation 26 must be suplied to The Commission in accordance with regulation 26 (5)(a)(b)and (c) ) of The Care Homes Regulations 2001. As evidence of the continued monitoring of the service. 8 37 26 A system must be put in 30/03/2010 place whereby an unnannounced visit to the home is carried out at least once a month in accordance with the requirements set out in regulation 26 (1)(2)(3) of The Care Homes Regulations 2001. In order to provide an ongoing evaluation of how the home is operating and of any areas that need addessing. 9 38 23 There must be evidence available for inspection, to show that all of the equipment and services in the home have been maintained and serviced according to the 30/03/2010 Care Homes for Older People Page 28 of 30 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 manufacturer or regulatory body on accordance with regulation 23 (2)(c) of The Care Homes Regulations 2001. In order to ensure the safety of the people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is recommended that there should be evidence available to show that medication administration, storage and disposal procedures are being audited regularly. It is recommended that a list should be available of the signatures of those staff trained to administer medication in the home, for ease of identification. It is recommended that the GP should be informed when residents are not taking their medication in order for their health to be monitored. It is recommended that future staff training should include training relating to maintaining the respect and dignity of the people who live in the home. It is recommended that there should be evidence of consultation with residents about the meals that they are served at supper time, with a hot snack served if that is what they would prefer. 2 9 3 9 4 10 5 15 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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