Inspection on 19/11/09 for Loose Court

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

Other inspections for this house

Loose Court 26/04/10

Loose Court 23/02/10

Loose Court 18/03/08

Loose Court 03/04/07

Loose Court 27/10/05

Loose Court 03/05/05

Loose Court 15/12/04

Loose Court 18/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 16/02/2010.

Key inspection report Care homes for older people Name: Address: Loose Court Rushmead Drive Maidstone Kent ME15 9UD     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: Sarah Montgomery     Date: 1 9 1 1 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 42 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 42 Information about the care home Name of care home: Address: Loose Court Rushmead Drive Maidstone Kent ME15 9UD 01622747406 01622749948 debbiecarson@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Regal Care Homes (Maidstone) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 46. The registered person may provide the following category/ies of service only: 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 categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Loose Court was a domestic house until 1982, when it changed to a care home for the elderly. The house has had purpose built extensions. The accommodation comprises of three lounges and integral conservatory, and two dining areas. There are 35 bedrooms of which 4 are double rooms, 16 single rooms, and 15 single en-suite rooms. There is a Care Homes for Older People Page 4 of 42 Over 65 0 46 46 0 Brief description of the care home lift to access the (15) first floor bedrooms, as well as stairs for those more ambulant. Some internal/external doors have keypad locks for the security and safety of residents. The home has a small-enclosed garden. The care home is currently registered as a residential care home for 46 older people (over 65 years) with a diagnosis of dementia. Loose Court is approximately 50 yards from the main Loose Road where local bus services are available to the town centre of Maidstone approximately 4 miles away, where there are two main line railway stations. Please contact the home for information regarding current fees. A copy of the most recent inspection report can be seen in the main hallway of the home. Care Homes for Older People Page 5 of 42 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 key inspection was conducted by Sarah Montgomery and Wendy Mills, both Regulatory Inspectors with the Care Quality Commission. They were in Loose Court care home on November 19th 2009 from 10:30am until 8pm. During the inspection they spoke with representatives from Regal Care Homes, senior staff at the home, service users, relatives, and visiting professionals. Three additional relatives spoke with the inspectors over the telephone. Several records including care plans, assessments, and staff files were assessed. Time was also spent observing working practice. The Commission received a completed annual quality assurance assessment from the home. Information from this document was used to inform the inspection process. All outcome areas apart from one have been assessed as poor. The report has 19 requirements. Care Homes for Older People Page 6 of 42 The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. Care Homes for Older People Page 7 of 42 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 42 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 42 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 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users cannot be confident their needs will be appropriately assessed by the home. Prospective service users cannot be confident that the information contained in the statement of purpose and service user guide reflects current services offered at the home. Evidence: Standards 1 and 3 were assessed. To assess these standards we looked at the statement of purpose, service user guide, and admissions policy. We also looked at pre admission assessment for four residents, and spoke with staff and residents from the home. We cross referenced this information with care plans and risk assessments. In addition we looked at the homes annual quality assurance assessment. This is a document sent to us by the home which tells us what the home is doing. Care Homes for Older People Page 11 of 42 Evidence: The homes statement of purpose tells prospective residents and their representatives about the home. This helps people to make an informed choice about where to live. We have found many inconsistencies in the statement of purpose, and this means that prospective service users are not getting accurate information about Loose Court. Some examples of these inconsistencies are: all bedrooms have privacy locks on doors, and all bedrooms have a lockable facility to secure valuables and personal items. This is not the case. A large number of bedrooms have no lock at all, or even a handle. The door is simply pushed to open. On our tour of the home, most bedrooms did not have a lockable facility. Another example is: prior to any new admission to the home a full needs assessment is carried out which is based on person centred care. Of the four files we inspected with regard to pre admission assessment, just one service user had a pre admission assessment. The other three service users had not been assessed prior to admission to the home. The registered person must ensure that information provided to prospective service users and their representatives is correct. As stated above, evidence found with respect to pre admission assessment is poor. The one assessment we did assess contained little information, with many key areas such as medication and type of dementia left blank. This assessment was insufficient, and did not explore all the health and personal care support needs of the individual. Some risks were identified, but when cross referenced with daily care notes and with risk assessments, it was clear that risks were not being managed in a way which ensured the health and welfare of the service user. An example of this is an assessed risk which stated poor nutritional intake, food must be monitored. No evidence could be found of monitoring either food or fluid intake, other than recording meals offered. The pre admission assessment viewed was not person centred. The personal care section of the form contained a tick box system. There is no room on the form to assess or describe the amount of support needed, or to record the personal preferences and wishes of the service user. Care Homes for Older People Page 12 of 42 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. Service users cannot be confident their health and personal care needs will be met. Evidence: Standards 7, 8, 9 and 10 were assessed. To assess these standards we looked at care plans, risk assessments, inspected documents and records which told us how the home meets individual health care needs, including medication, and spoke with staff and service users about how the home ensures people are treated with respect and dignity. We also looked at the homes annual quality assurance assessment, and at information supplied to the Commission from relatives and other professionals. The homes statement of purpose tells prospective residents that once a service user takes up occupancy a personalised and individual care plan is drawn up. The homes annual quality assurance assessment tells us our care plans are reviewed by keyworkers to ensure continuity of care for all residents. Staff spoken with did not understand the keyworking role, nor could they outline details in care plans of their key residents. They told us they do not review care plans, and that this is the role of Care Homes for Older People Page 13 of 42 Evidence: management. Four health care plans were inspected. They all lacked sufficient detail to be considered effective documents, and staff would be unable to ascertain what support needs the individual had. None of the care plans recorded any personal wishes or preferences of the individual. This means the home has not sought the views of the service user, or their representative. The care plans contained statements regarding needs, for example: needs encouragement to eat. However, there was no guidance for staff about how to do this, and no record of how meals should be presented (for example: pureed). there was also no guidance or correct recording around management of weight loss and potential malnutrition. Risk assessments were equally poor, again with statements pertaining to the risk (for example: risk of falls), but no supporting guidance about managing and reducing the risk. On all files we found risk assessments that had not been completed. One person who we were told has mobility difficulties, and requires assistance, has not got a moving and handling assessment. The home has completed a general risk assessment for all service users with zimmer frames. The risk assessment states that all frames are to be removed during mealtimes. This takes away residents liberty and choice. Loose Court must find different ways to ensure the health and safety of residents without removing their means of getting around. We spoke with staff about their knowledge and understanding of care planning and risk assessment. They told us they were not confident about care planning, with the majority of staff spoken with unable to speak in detail about individual care plans. The senior team at the home recognise there are significant shortfalls in this area, and are in the process of reviewing all residents with a view to updating careplans. We looked closely at how the home responds to and manages the health concerns of residents. During the inspection we spoke with healthcare professionals who were visting the home. They told us that they are always made welcome to the home and that the home has made some good progress with some residents. They gave an example of one person who was discharged from hospital with a severe pressure sore which is now healing well due to the care given in the home. However, they also told us that there are days in the home when communication is poor. There is a daily diary for the visiting professionals but staff at the home have sometimes failed to put details of those residents who need to be seen in the diary. This has led to a delay in meeting the health care needs of some residents. They also said that they were concerned that Care Homes for Older People Page 14 of 42 Evidence: the home lacks leadership and therefore the continuity of care can suffer on occasions. There was no evidence in the care plans to show that the home seeks the advice of health care professionals, such as continence nurses and therapists, on behalf of the people who use this service. However, all the residents are registered with local GP practices and district nurses visit the home on a regular basis. We found evidence that senior care staff in the home are making poor judgements about residents who are unwell. For example, a service user was identified with a health care need, but did not receive attention for four days. This demonstrates that residents may be at risk due to the inexperience of staff and lack of leadership at the home. We looked at the way the home manages and administers medication. There have been a number of medication errors over the past months. Although the home is required to tell us about those that seriously effect the health and welfare of the people who use this service, they did not tell us and we learned of the errors from the safeguarding team who have a duty to share such relevant information with us under the No Secrets guidance. Since the last inspection a new mediation room has been created. This provides good and safe storage for medicines. The Medicines Administration Records (MARs) for the current month were examined in detail. No recent errors in entries were found and these records were neatly kept. One handwritten entry was found to have been made but not signed or counter signed. The home should ensure that all hand written entries made in the MARs are signed and countersigned. Medicines were stored tidily and there is a trolley for administering medicines on the ground floor and a medicines bag for those on the first floor. There are no controlled drugs being used in the home at present but there is an approved controlled drugs cupboard should this be needed in the future. One of the most serious recent medication errors occurred because there was confusion in the way the home manages medicines being received into the home and those being returned to the pharmacy. Although systems for receipt and return have improved and staff are now aware of how the error occurred, there are still no named staff who are responsible for these tasks. Consequently there is more room for error in the future. We were told that the home is looking at ways of improving this and identifying key members of staff who to be responsible for ensuring that receipts and returns are properly managed. Care Homes for Older People Page 15 of 42 Evidence: We looked at working practice and policies in the home which tell us about privacy and dignity for service users (Standard 10). Observations during the inspection found that staff interact well with residents, however, we did observe some incidences where staff spoken quite sharply to residents, and did not display sufficient understanding to the situation, or to meeting the needs of a resident with dementia. We know the home has problems with clothes going missing. The home must ensure that laundry is returned to the individual, and that they have systems in place which enables this to happen. Care Homes for Older People Page 16 of 42 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. Service users cannot be confident they will be supported in their lifestyle choices, or be supported to excercise control over their lives. Service users would benefit from robust nutritional screening. Evidence: Standards 12, 13, and 15 were assessed. To assess these standards we looked at records which told us about the daily routines in the home, and about how service users are supported to make decisions regarding their daily lives. These included activity records, daily individual notes, and care plans. We also looked at how the home meets service users nutritional needs by looking at menus, observing mealtimes, and speaking to service users and to the cook. In addition, we looked at the homes annual quality assurance assessment, and looked at information supplied by relatives and other agencies to the Commission. The homes statement of purpose tells prospective service users there are a range of therapeutic activities available on a daily basis. These include flower arranging, arts and crafts, reality orientation, remininscence and armchair exercises. The service user guide says that after lunch it is time to join our activity of the day, and goes onto Care Homes for Older People Page 17 of 42 Evidence: state that after supper we have our activity coordinator who will arrange all different events for you to participate in. Selotaped to every wardrobe is a weekly activity planner. When we looked at daily notes, there was no reference to participation in activities. During the inspection we did not observe activities, and were told by a carer we are too busy to do activities. We were told that the home does have an activities coordinator, and there was evidence of some thought being put into activites (the activity planners). However, this has not transferred into everyday practice, and residents are not provided with sufficicent opportunities to exercise their choice in relation to leisure and social activities and cultural interests. The annual quality assurance assessment (AQAA) states that cultural, social, religious and recreation interests are beginning to be identified in the initial assessment. We found no evidence of this when assessing pre assessment documentation, and care plans did not note previous life historys or interests. The AQAA goes on to say activities are currently on an ad hoc basis relying on the choices made by residents. There is a list of activities to help prompt staff and service users. Evidence gathered during the inspection tells us there are significant shortfalls with how the home support service users with lifestyle choices. The home has an open door policy and service users are supported to maintain contact with family and friends. During the inspection several service users received visitors. We spoke with five relatives, all of whom told us they were made to feel welcome in the home, and were able to meet with their relative in private should they wish to. Although we found the food at the home to be well presented and there is use of fresh produce, We found significant shortfalls in how the home supports people with nutritional needs. There is poor communication regarding residents present and changing needs in terms of their nutrition. It is of concern that staff fail to understand the importance and significance of liquid food supplements, often given when the service user has had a drink, and does not want another. Food supplements are given to service users when there is concern about their nutritional intake. The home is not robust in ensuring individual service users receive these supplements correctly. In addition, the needs of service users with diabetes are not fully met. This is causing unnecessary distress to diabetic service users. We spoke to the cook. She told us that she has enough food to enable her to cook nutritious meals for the residents. The milk and bread for the home are delivered fresh. Fresh fruit and vegetables are purchased from a local wholesaler and all other Care Homes for Older People Page 18 of 42 Evidence: food was delivered by a catering company. There does not seem to be any process for making local purchases, for example, should a resident fancy a something different such as yoghurt or ice cream. The cook told us that she prepares special diets for some residents. However, we were concerned to find an entry made by a staff member in one care plan that stated,Diabetic. No Change, but underneath this entry a relative had written that the home had promised to provide diabetic cakes but still had not supplied any. This entry clearly indicated that there was a change in needs and the carer reviewing the care plan should have noted this. We observed teatime in the dining room and found that this resident had still not been provided with diabetic cakes and was clearly upset not to be able to have the same things to eat as the other residents (cream chocolate buns). In addition, when this person asked for a cake they were told you cant have them, youre a diabetic. The staff member made no effort to offer a suitable alternative to the cakes. We raised this with the operations director, who assured us this situation would not arise again, and that specialist diabetic cakes would be purchased for this resident. Food supplements are given when there is concern about nutrition. However, relatives told us that the timing of these supplements and how they are served, for example, whether hot of cold, in a cup or through a straw, is inconsistent. Poor pre-admission assessments mean that personal food preferences are not identified prior to someone coming to live at the home. The cook told us that she gets to know what each resident likes and will prepare something different for them if she knows the menu has something they do not like. The carers are responsible for monitoring food intake. Relatives tell us that there are inconsistencies in the way the home monitors nutrition and seems to depend on which staff member is on duty. Some are more hard working that others and one or two are just plain lazy. Our inspection of records upholds the view that nutritional screening is not robust.Furthermore, when asked, the cook told us that she is not always informed when a service user has not eaten. Care Homes for Older People Page 19 of 42 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users cannot be confident they will be protected from harm. Evidence: Standards 16 and 18 were assessed. To assess these standards we looked at the homes complaints policy and adult protection protocols. We spoke with residents about how they make a complaint, and spoke with staff about their understanding of their responsibilities regarding protecting residents from harm and abuse. We also looked at information the home had sent us in their annual quality assurance assessment, and looked at information given to the Commission from relatives and other agencies. The homes statement of purpose tells prospective service users that; at Loose Court care home we are very much into ensuring all our service users are safe and protected from any form of abuse. Their annual quality assurance assessment tells us; staff are aware of abuse issues and some have received training in abuse. There are significant shortfalls in how the home responds to complaints and protection of service users. There are no systems in place to ensure service users are protected, and no systems in place to report concerns or significant events to the Commission and other agencies. The current management team at the home have limited understanding of recognising adult protection issues, and none were aware of the protocols around reporting incidents. There have been a high number of safeguarding Care Homes for Older People Page 20 of 42 Evidence: concerns at this home for the past few months. None have been reported to us by the home, and we have learnt of the concerns from the safeguarding teams. We wanted to see how the registered person ensures staff are trained in adult protection. Senior staff at the home could not tell us if or when staff had been trained. We asked for the homes training matrix. This was not available. There were no records in the home to demonstrate staff had been trained in adult protection. We asked a member of the senior management team to email us the training matrix. Despite several further requests by telephone following the inspection, the training matrix was not forthcoming, and the home have failed to provide us with any evidence of staff training. We spoke with senior staff and care staff about adult protection with regard to their skills in recognising an abusive situation or incident, and their knowledge about how to respond and how to report it. Their answers evidenced significant shortfalls in their understanding of adult protection. It was clear that no one at the home, from carers to members of the management team has an good understanding about how to keep people safe, how to recognise what abuse is, how to underpin their knowledge with sound risk assessments, or how to respond appropriately to abusive situations in terms of management and reporting. The registered person must urgently review current staff skills and staff training, and ensure that staff at the home have the skills and knowledge required to respond to adult protection issues, which will ensure the vulnerable adults in their care are kept safe. We looked at the homes complaints procedure and spoke with service users and relatives about how they can make a complaint. The homes complaints procedure is not user friendly, and could be confusing to a person with dementia. It has a picture of a dinner plate with a question mark on it. Service users spoken with could not tell us how they would complain, or if they were aware of the complaints procedure. Some relatives told us they had made complaints to the management team and were dissatisfied with the response. When we looked at the homes complaints log, these complaints had not been filed or recorded. We are aware that the management team have recently started to have relatives meetings, and they see these meetings as a way to address general concerns. A senior manager informed us that the complaints log would be updated, and Regal Care Homes are committed to ensuring all complaints are listened to and responded to appropriately. Lack of leadership, poor training and communication, and an inadequate complaints procedure lead the Commission to have significant concerns about how service users at the home have a voice, and are able to communicate when they are unhappy or Care Homes for Older People Page 21 of 42 Evidence: concerned. We could not find any evidence that the home has consulted with service users about their care or lives at the home. Staff had told us how busy they are, and we did not see staff sitting and chatting with service users. We are concerned that there is not a culture in the home where service users have an opportunity to speak to staff. The home must ensure that service users in the home are given opportunities for giving their views and opinions. Care Homes for Older People Page 22 of 42 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. Service users live in a comfortable home, but cannot be sure it is hygienic. Evidence: Standards 19, 24 and 26 were inspected. To assess these standards we looked at communal areas of the home and some bedrooms. We looked at protocols and systems the home adopts to ensure the home is kept clean and hygenic. We also looked at information contained in the homes annual quality assurance assessment, and at information from relatives and from other agencies. The homes statement of purpose tells prospective residents all bedrooms have privacy locks on doors, and all bedrooms have a lockable facility to secure valuables and personal items, and that our domestic staff will make sure your room is clean. The above statements are not supported by our inspection findings. We found a high proportion of bedrooms doors had no locks on the doors at all. They were doors that required pushing to open, and did not have a door handle on the outside. This means that residents can wander into other peoples rooms putting privacy and dignity at risk. The home must provide suitable locks for these doors. Similarly, of the 14 rooms we inspected, only one had a lockable facility to ensure valuables are kept safe. The home must provide lockable storage for all service users. Care Homes for Older People Page 23 of 42 Evidence: There is one area in the home where there are strong and very offensive odours. This appears to have arisen from poor management of incontinence. Although we were told that the home has strict cleaning routines, and the rest of the downstairs was clean, it has not been possible to eliminate the odour. We have been told that similar concerns had been raised weeks before by the safeguarding team, and the home responded by replacing half a carpet. A bedroom in this corridor was consumed by foul odours. The deputy manager agreed it was unacceptable for anyone to sleep in this room. We immediately asked the home to consult with the resident and their representatives with a view to a move to a clean and hygienic room that morning. When we enquired at 7.45pm that evening if this had been done, we were told it hadnt, and it would be done the following day. We questioned the delay, and the room move was made that evening. We are concerned about the homes management of and response to continence issues, and question their understanding and practice of upholding service users dignity and respect. The home must seek urgent advice about the management of incontinence in order to eliminate the root cause of the problem. This concern was compounded when a member of staff told us they were too busy to do any activities, with the main reason stated as the new toiletting routine for all residents. We were told that every resident is taken to the toilet every hour (whether they need it or not). This is not person centred care, nor is it an appropriate measure to manage individuals continence needs. It further demonstrates the homes lack of knowledge and skills with regard to caring for older people with dementia in a person centred manner. The home has a new extension and new rooms that have been recently registered by the Commission. They are well furnished. However, in three of the rooms that are now occupied we found that the televisions had been switched off at the wall. In one room we had great difficulty in plugging the television in and then found that we could not work it. We asked the staff if the service users in these rooms would be able to plug in and work the television controls. We were informed they would be unable to. All lounges and dining areas were inspected. They were found to be comfortable, warm and odour free. There was a range of soft furnishings, music and televisions for the residents use. All areas were free from hazards and residents were able to move around safely. We spoke with some service users about the environment. All spoken with expressed satisfaction with their bedrooms and with the lounges. Care Homes for Older People Page 24 of 42 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. Service users cannot be sure they are supported by competent staff. Evidence: Standards 27, 28, 29 and 30 were assessed. To assess these standards we looked at records which told us about staff skills and staff numbers. This included information about training and staff rotas. We also looked at staff recruitment records. This told us whether staff were being recruited appropriately, and whether information regarding the staff members suitability for the post was obtained. This information included references and police checks (criminal records bureau). The homes statement of purpose tells prospective service users that all staff are trained by experience qualified seniors, staff are carefully screened, staff training needs are regularly assessed. The annual quality assurance assessment under what we could do better, tells us ensure staff are trained in compulsory areas (abuse, dementia). We found significant weaknesses in the way staff are trained, and in the competencies of the staff team. This has a major impact on service users. On the day of the inspection staffing rosters showed good staffing levels. In addition, some staff had come in especially to attend a medication course but a communication Care Homes for Older People Page 25 of 42 Evidence: breakdown meant that the course did not run. Therefore some of the staff returned to work at the home. We found that some staff are working between 54 and 60 hours each week. There is quite a high proportion of overseas staff. One staff member said that they have quite good English but are shy. One relative told us that she could not understand an overseas staff member when she was telling her about some serious concerns about her mother over the telephone. This was very worrying for her. We were told that additional staff have been scheduled on each shift since the safeguarding concerns. While it is positive that staffing numbers have increased, evidence gathered at this inspection told us that staff do not have the appropriate skills to adequately care for service users. Examples of this are poor care planning and lack of understanding of how to meet care needs, poor response and management of nutrition, poor response to service users continence needs, lack of skills regarding recognising abuse, and a general lack of understanding of the needs of people with dementia in terms of care provision and appropriate ways of communicating. As stated in outcome area four, the training matrix was not available, and despite several requests, still has not been provided to the Commission. We spoke to four members of staff in private, and four others during the course of the day. They were open and honest with us. We asked them what recent training they had received. They told us theres a lot of things not right at the moment, training, communication. Were really trying to do our best, and senior management are supportive but they dont really know about care. The annual quality assurance assessment (AQAA) tells us under what we do well some staff are being trained or undertaking NVQ level 2 or 3. This information is too vague to be considered useful. Further on in the AQAA, we are told that out of 22 care staff, just four have NVQ2 or above, and only one staff member is currently working towards an NVQ. There is no evidence to tell us that staff have received training in any area. There is confusion amongst staff as to which training they can expect to do in work time and which they are expected to take in their own time. We were told by a senior member of the Regal Care Homes management team that staff are expected to undertake mandatory training in their own time and are not paid to attend training. Care Homes for Older People Page 26 of 42 Evidence: We asked to see all staff meeting minutes from May 2009. They could not be found. We were emailed the minutes of one staff meeting (dated October 15th 2009), and informed that any previous minutes could not be located. The minutes from October 15th indicated the home were aware of many shortfalls, and identified problems in medication, care planning, training and supervision. These minutes also recorded the following the meeting ended with the staff being told that a mental capacity act was being held on Saturday 24th with two sessions being held. Staff were not pleased at being told they were not going to be paid for attending. This tells us that the service does not support or encourage the development of a competent team. There was no evidence of a comprehensive training plan, and no records of staff training that has been undertaken. Evidence from observation, discussion with staff, and information obtained from relatives and social and healthcare professionals tells us that the quality of support at the home is unpredictable, inconsistent or poor. Staff are not skilled to meet the specialist physical and emotional needs of the residents. Staff are expected to work as keyworkers but do not appear to have had the necessary training to enable them to understand the purpose and function of this role. When asked to explain the role of keyworker, staff could not tell us what the role involved aside from telling us they ensure that their key resident is happy and presentable on a daily basis. We examined four staff files, chosen from the staff on duty at the time of inspection. These files were not well organised, and it was difficult to find records required for our inspection purposes. We did see adequate information on file consisting of references, application form, identification and criminal record bureau checks (CRB). However, the home had kept the CRB on file. This could be seen as a data protection issue as only the CRB number is required to be on file. The week following the inspection the home was visited by The Borders Agency (immigration). They found that two staff were working at the home illegally and had forged documents. This tells us that the home have not been robust when recruiting staff, and demonstrates that the home has failed to ensure the protection of service users through their recruitment procedure. The staff files we assessed did not include those inspected by the Border Agency. Care Homes for Older People Page 27 of 42 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 home is not being managed properly and there is no leadership, guidance and direction to staff to ensure service users receive consistent quality care. This results in practices that do not promote and safeguard the health, safety and welfare of the people using the service. Evidence: Standards 31, 32, 33, and 38 were assessed. To assess these standards we looked at information which tells us how the home is run. This includes the qualifications and experience of the manager, the ethos and management approach of the home, records which demonstrate the home monitors how it is run, and documents which evidence the health, safety and welfare of service users are promoted and protected. In addition, we spoke with members of the management team, and with residents and staff, and looked at information the home gave us in their annual quality assurance assessment. The homes statement of purpose tells prospective residents that the home has a Care Homes for Older People Page 28 of 42 Evidence: substantial management structure. Our evidence demonstrates that this is not the case, and there are significant shortfalls in how this home is being managed. At present, the home does not have a registered manager or an acting manager. This means that no one is taking responsibility for what has happened at the home, or taking responsibility for the day to day management of Loose Court. The current management structure is unsatisfactory and potentially puts service users at risk of harm with regard to their health and welfare. The companys estates manager has assumed day to day control of the home, but has no experience of managing a care home, and no knowledge of care standards or regulations. He admitted to us that no one is managing the home. The deputy manager and team leader have not received appropriate training, and do not have sufficient skills or knowledge about management, leadership, or dementia care. Not one of the senior team has appropriate knowledge about adult protection. There are no clear lines of accountability in the home. Feedback from the staff team tells us that they find the estates manager approachable, but lacking in any knowledge of management of a care home or dementia care. We are aware that the company has arranged for a manager from another home to visit the home a couple of times a week. We also know that the company are striving to recruit an experienced manager. However, they have failed to ensure the home is properly managed, or that residents are cared for appropriately. This had lead to significant concerns being raised by the safeguarding teams and by relatives. Evidence gathered throughout the inspection demonstrated that the home is drifting and lacks purpose and direction. The operations director told us he recognises the home is currently being reactive and understands that a proactive approach is necessary to ensure standards are raised. Serious safeguarding concerns about the home means that other health and social care professionals regard the home as ineffective and that service users are potentially at risk of harm. Evidence from the annual quality assurance assessment (AQAA) tells us that the home does not have effective quality assurance or quality monitoring systems. None of the homes 46 policies and procedures named on the AQAA have been reviewed since Care Homes for Older People Page 29 of 42 Evidence: February 2006. This includes the safeguarding policy, values of privacy, dignity, choice, fulfilment, rights and independence, concerns and complaints and continence promotion. While at the home we were given copies of four policies. These were not dated. There was no evidence that the home seeks feedback from service users or seeks their views about the service they receive. We looked at how senior members of the team support care staff through supervision. While it was encouraging to be informed that the deputy manager and team leader undertake supervision of staff, they informed us they had not received any training in how to supervise staff and were not sure if they were doing it right. We looked at some supervision notes. Information from these notes demonstrated that supervisions are not being carried out effectively, with personal development, training, competency issues, and team concerns not being addressed. When we raised this with the senior staff they told us they were doing their best but knew they needed training in supervision. We are concerned that senior staff at the home do not have insight into the shortfalls of the home. Information provided in the AQAA (filled in by the deputy manager) was contradicted by our findings. We are also concerned that the AQAA states we are aiming to register the home to be able to accomodate residents with nursing care needs. Our inspection has evidenced that the home is failing to meet the needs of current residents, and staff are not competent, trained or skilled sufficiently to provide adequate care to the current service users. It is recommended that the homes AQAA is updated to provide accurate and current information about the home. The registered person is required to ensure safe working practices to ensure the health, safety and welfare of service users and staff are promoted and protected. Evidence gathered at this inspection tells us that staff are not trained in moving and handling, fire safety, first aid, infection control, adult protection, care planning or risk assessments. The AQAA demonstrates that equipment has not been appropriately maintained. The soiled waste disposal has not been serviced or tested since February 2005. The gas appliances have not been tested at all. The heating system, emergency call equipment, fire detection and fighting equipment, hoists, lift, and the portable electrical equipment, have not been tested since February 2006. The premises electrical circuits have not been tested or serviced since February 2006. This means the environment is potentially hazzardous to staff and service users. This home is failing to meet the needs of service users, and significant shortfalls have Care Homes for Older People Page 30 of 42 Evidence: been identified in all outcome areas. While it is encouraging that the Responsible Individual recognises the current failings at the home, and has given a commitment to improvements, we must stress that the timescales for these improvements must be short, and the registered person immediately needs to put into place systems and work practices to significantly raise standards for service users and for staff which safeguard indviduals and protect and promote the health, safety and welfare of people at the home. Care Homes for Older People Page 31 of 42 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 32 of 42 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 1 4 The registered person must produce a statement of purpose and service user guide which tells service users and their representatives about the home. The registered person must ensure that prospective residents and their representatives have correct information about all services and facilities at the home. 22/01/2010 2 3 14 In order to meet individuals 31/12/2009 particular support needs, the registered person must ensure that prospective service users are competently and thoroughly assessed prior to admission to the home. This includes demonstrating appropriate consultation with the service user and their Care Homes for Older People Page 33 of 42 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 representative has taken place. Prospective service users are currently not competently assessed prior to being offered a place at the home; therefore support needs are not being met. 3 7 12 The registered person must 29/01/2010 develop comprehensive care plans which detail support needs of individuals. The home must demonstrate they have consulted with service users, and have taken into account their wishes and feeling. Current care plans are inadequate and do not contain support needs of individuals. The home has not consulted with service users or their representatives regarding care plans. The registered person must 08/01/2010 develop robust risk assessments that support people to have a safe but fulfilling life. Current risk assessments are inadequate and do not safeguard service users. Risk assessments must ensure that no service 4 7 13 Care Homes for Older People Page 34 of 42 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 user is subject to physical restraint unless this is authorized intervention that has been pre-approved using the Deprivation of Liberties safeguards assessment process and is kept under strict and documented review. 5 8 12 The registered person must 31/12/2009 ensure that the health needs of service users are met and keep and maintain accurate health care and nutrition records. The registered person must ensure that they respond, without delay, to health concerns, and that service users are given access to health care professionals for medical treatment. This includes seeking advice from specialist continence nurses and nutritional specialists to make sure the right support is given and that specialist advice is sought and followed when conditions change. Current systems do not promote or maintain proper provision for the health and welfare of service users. Care Homes for Older People Page 35 of 42 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 6 9 13 The registered person must 31/12/2009 ensure they have there are safe and robust systems for managing medicines in the home. The home must ensure that that all medicines administered are signed for and there are safe systems to return spoilt items to the pharmacy. Current systems are vulnerable to error putting service users and staff members at risk 7 12 16 The registered person must 29/01/2010 consult service users about a programme of activities, taking into account hobbies and interests. The home must then make suitable arrangements and provide sufficient support for service users to participate regularly in activities of their choice. To ensure service users social needs are met. The registered person must 29/01/2010 develop a complaints procedure which is accessible and suitable for service users with dementia. To ensure service users are able to communicate concerns and complaints. 8 16 22 Care Homes for Older People Page 36 of 42 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 9 18 37 The registered person must ensure they inform the Commission, without delay, of all significant events at the home that are outlined in this regulation. To ensure the health, safety and welfare of service users is met. 31/12/2009 10 18 13 The registered person must ensure that all staff receive accredited sufficient and effective training in adult protection (recognizing and responding to signs of abuse) and that they are competent to use this knowledge. To ensure the health, safety and welfare of service users is met. 29/01/2010 11 24 12 The registered person must ensure that service users are able to have privacy in their own rooms, and have lockable storage faculties available to them in their rooms. Unless the reason for not fitting and supplying locked faculties is explained in the supported by a comprehensive best interests assessment within 29/01/2010 Care Homes for Older People Page 37 of 42 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 individuals care plans; Doors to service users private accommodation must be fitted with locks suited to service users capabilities and accessible to staff in emergencies. The registered person must ensure that each service user has a lockable storage space made available to them and is provided with the key to this storage. 12 26 16 The registered person must ensure the home is odour free. To ensure that service users live ion a clean and hygienic environment. 13 27 18 The registered person must 29/01/2010 ensure that the home employs staff who are competent to carry out their duties Staff must be skilled, qualified and competent. This includes achieving 50 of the staff team being NVQ qualified, and includes all staff receiving suitable training. The registered person must supply to the Commission a rolling programme of training which demonstrates accredited 29/01/2010 Care Homes for Older People Page 38 of 42 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 training has been organised and booked in a timely fashion. Furthermore, all staff must have an individual training profile. 14 29 19 The registered person must ensure that they operate a thorough recruitment process ensuring the protection of service users. This means the registered person must ensure the documents supplied by prospective staff members are authenticated and validated by the employer. A manager must be appointed to manage the care home. The registered person must ensure a qualified and competent person is appointed to manage the home. The registered person must keep the Commission informed of the progress in the recruitment of a manager and inform the Commission who is in day to day charge of the home in the interim. 29/01/2010 15 31 8 29/01/2010 Care Homes for Older People Page 39 of 42 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 16 33 24 The registered person must ensure they seek the views of service users and other stakeholders. The registered person must develop robust quality assurance systems. Staff working at the care home must be appropriately supervised. The registered person must ensure that all staff receive regular supervision which is carried out by senior staff who have received Have the necessary skills, training and experience appropriate to this role. 29/01/2010 17 36 18 29/01/2010 18 37 17 The home must keep and 29/01/2010 maintain appropriate records. The registered person must ensure that records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. Equipment provided at the 29/01/2010 care home for use by service users or by staff must be maintained in good working order. 19 38 23 Care Homes for Older People Page 40 of 42 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 The registered person must ensure the health, safety and welfare of service users and staff are promoted and protected. 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 41 of 42 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 42 of 42 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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