Inspection on 23/06/09 for Lyndon Hall Nursing Home

This inspection was carried out on 23rd June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lyndon Hall Nursing Home 14/10/09

Lyndon Hall Nursing Home 29/01/08

Lyndon Hall Nursing Home 11/09/06

Lyndon Hall Nursing Home 29/11/05

Lyndon Hall Nursing Home 05/05/05

Lyndon Hall Nursing Home 11/10/04

Lyndon Hall Nursing Home 27/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

Key inspection report Care homes for older people Name: Address: Lyndon Hall Nursing Home Malvern Close West Bromwich West Midlands B71 1PP     The quality rating for this care home is:   one star adequate 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: Karen Thompson     Date: 2 3 0 6 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 36 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 36 Information about the care home Name of care home: Address: Lyndon Hall Nursing Home Malvern Close West Bromwich West Midlands B71 1PP 01215005777 01215005551 lyndonhall@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd care home 80 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 80 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 40, Old age, not falling within any other category (OP) 40 Date of last inspection Brief description of the care home Lyndon Hall Nursing Home is a purpose built three-storey building. The Home is set in attractive grounds surrounded by mature trees. There is car parking facilities available. Entrance to the home is through a secure door that leads into a small reception area. Accommodation is provided on the ground and first floor with a staff room and meeting room on the second floor. The home is divided into four 20 bedded units, namely Poppy, Rose, Sunflower and Bluebell. Poppy unit and Sunflower are registered for the care of persons with Dementia and are situated on the first floor. Rose and Bluebell are Care Homes for Older People Page 4 of 36 Over 65 0 40 40 0 Brief description of the care home situated on the ground floor and are registered to accommodate people who are elderly and frail. Each unit has a large lounge and separate dining room for communal use. There is also a quiet lounge situated on Bluebell. There are seventy-eight bedrooms in total, sixty-six single rooms with en-suite facilities and two double bedrooms both also having en-suite facilities available on Sunflower and Rose units, and ten single rooms without en-suite facilities, five on Poppy and five on Bluebell. Assisted baths are available on each unit. A shaft lift is available to provide access to all floors. Care Homes for Older People Page 5 of 36 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: one star adequate 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 was an unannounced inspection; the home did not know we were coming. It was carried out by two inspectors who were there for one day. The focus of the inspection undertaken by us is upon outcomes for people who live in the home and their views of the service provided. The process considers the care homes capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to this field work visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manger and it gave us information about the home, staff people who live there, any developments since the last inspection and their plans for the future. We were supported thoughout the inspection process by the management team at the Care Homes for Older People Page 6 of 36 home. At present the manager is not registered with the Commission but is in the process of submitting an application to us. At the time of inspection seventy six people living at the home. Information was gathered by speaking to and observing people who lived at the home. Seven people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and training records were also examined. We left an immediate requirement with the management team at the time of the visit. An immediate requirement is a document we leave when breaches of the regulations have been identified and we have concerns about the health and welfare of people living in the home. The immediate requirement was in relation to medication practice and kitchen equipment. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The overal medicine management must improve to safeguard those people that live in the home. Activities must be available so that people living at the home home lead a stimulating and fulfilling lifestyle that meets their tastes and interests. The home needs to improve the way it provides care for people with impaired mental capacity to ensure their safety, dignity and well being is respected and promoted. A review of kitchen equipment should take place to ensure that people living at the home and staff are not exposed to any unnecessary risks. The availability of bathing equipment must be reviewed to ensure that it is working and meets the needs of people living at the home. The staffing levels and deployment of staff needs to be reviewed across the home to ensure peoples needs are met appropriately at all times by people who know them well. The training needs of staff must be reviewed to ensure they have the right skills and competences to meet the needs of people living in the home. The arrangements for wound care was not consistent which could potentially delay the healing of wounds. Complaints are investigated but issues continue to be repeated indicating that underlying causes have not been eliminated. Care Homes for Older People Page 8 of 36 Infringement of peoples rights need to be discussed with a range of multi-disciplinary professionals to ensure that rights and risks are fully considered and care practice must reflect this. A review of the quality of food presented to people living at the home needs to take place to ensure that it is edible. The quality assurance system audits should be revisited to ascertain why issues continue to be repeated. The security of the building should be reviewed so that people with impaired mental capacity are not exposed to risks. 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 36 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 36 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. Peoples needs are assessed before they move in, so they can be confident their needs will be met upon moving into the home. Evidence: Lyndon Hall provides nursing care for people who require long term or respite care. Admissions are not made to the home until either the manager or social services have undertaken a pre-admission assessment. Two files were looked at for people who had recently moved into the home. Assessments were of a good standard, were detailed and covered a number of areas, so that staff could identify peoples needs to determine if they could be met following admission to the home. People do receive a contract of residency. This document outlines the roles and responsibilities of the Southern Cross Healthcare as providers and of the service users. The manager told us in the homes AQAA we now encourage more trial visits and all Care Homes for Older People Page 11 of 36 Evidence: of Lyndon Halls staff are aware of the importance of these trial visits. The service does not provide intermediate care so we did not assess this standard. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are not being met in a consistent manner which is due to a number of failures that could places people at risk of harm. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following assessment of individual needs. It outlines what they can do independently, the activities people require assistance with and the action staff need to provide in order to support them. Seven peoples care files were looked at in detail and others were sampled for information. There was evidence that risk assessments have been completed in key areas for example manual handling, tissue viability, nutrition and falls along with dependency ratio assessment. Risk assessments are completed in order to identify areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a Care Homes for Older People Page 13 of 36 Evidence: meaningful life; that risks are reduced and peoples well-being promoted. Care staff spoken to demonstrated that they were aware of the recorded needs of people living in the home. There was evidence that people receive regular pressure relief and pressure sores were healing where people had been admitted to the home with them. Records in relation to wound care dressing however did not demonstrate that dressings were being changed as per care plan instructions. For example one wound which had care planning instructions to be redressed every two days was not occurring according to several records which were looked at such as daily records, wound charts and evaluations. The wound was being dressed either on every second, third or fourth day. Dressing being changed at the correct time promotes healing in a timely manner and this practice could damage this healing process. Everyone living in the home is registered with a local General Practitioner (G.P). They have the option of retaining their own G.P on admission to the home (if the G.P was in agreement). People had access to other health and social care professionals as required including social workers, chiropodists and opticians. This ensures peoples health care needs are being met. We spoke to a nurse employed by the Primary Care Trust attached to a G.P practice who was visiting the home. They visit weekly and liaise with the nursing staff at the home in meeting peoples health needs. They also provide training to staff working at the home in meeting and identifying health care needs. The needs of people with dementia and or challenging behavior were not being met. Peoples care needs were acknowledged but the plan to meet these was not holistic or person centred. One person spoken to who exhibited behavior that challenged was clearly able to verbalise their frustrations at an aspect of care practice that upset them. Their care records (though problematic in retrieving the information, due of staff not recording incidents fo challenging behavior in a consistent manner) demonstrated that a particular care practice did upset the individual resulting in behavior that challenged. Staff had not looked at this information and modified care practice to meet the persons needs in an individual manner. Another person with behavior that challenged had a care plan that identified that this could occur during the giving of personal care but there were no clear instructions to staff on what to do if this occurred and terminology was jargonist such as allow to ventilate feelings. Care plans were found to be in place for dementia and the Mental Capacity Act. Whilst this demonstrates that staff have an awareness of the Mental Capacity Act, it also Care Homes for Older People Page 14 of 36 Evidence: demonstrates they are not aware of how the two related to each other in the meeting of care needs. Records demonstrated that diabetic blood glucose monitoring was taking place regularly in the home. Care planning instructions for one person with high blood pressure, stated this needed to be checked monthly but the blood pressure was found to have been checked every three months. Staff need to have clear instructions and follow these based on assessed needs. The dependency assessment for one of the seven people whose file we looked at in detail was not correct. If this information is used to work out staffing levels then it needs to be accurate to ensure all peoples needs are met. Staff informed us that bathing/showering normally takes place of an afternoon. The information to demonstrate whether this had occurred could be found in several places. Of four people whose records were looked at it was found that only two received a bath or shower as their care plan had instructed in relation to frequency. It was found that bathing or showering was not occurring as often as their care plan stated it should do so. Bathing will be discussed again in the section on Environment in the report as it was found the equipment available was either broken or not liked by people living in the home. The homes medication system consisted of pre-packed pharmacy boxed medication and a boxed system with Printed Medication Administration Record (MAR) sheets supplied by the dispensing pharmacist on a monthly basis. Records demonstrated the temperature in the treatment rooms and medications fridges were within the acceptable range. This makes sure that all medication is stored with the recommended ranges. The home has copies of the original prescriptions (FP10S) for repeat medication so they were able to check prescribed medication against the MAR chart when it entered the home. Medication for returns was contained within a lockable cupboard in the medication room. We visited all four medication rooms in the home and found problems with medication on Sunflower and Poppy units. Both pre packed pharmacy boxed medication and boxed medication was found to be problematic to audit. Gaps on the MAR chart and audits demonstrated that people were not always receiving medication that had been prescribed to them. There were also issues with timings of medication. One person living at the home was prescribed medication at 7am, 12midday and 17.00hours. The MAR chart demonstrated that the 7am medication was being given by the same person doing the 12midday and 17.00hours medication round, thus a member of the trained day staff. The day shift commences at 8am. Medication prescribed at 7am and outside the normal medication round times Care Homes for Older People Page 15 of 36 Evidence: needs to be given at this time which in this instance would have been the responsibility of night staff . The prescribers specific instructions are not being followed and this will impact on the health and well being of the person concerned. One person living at the home was being administered medication covertly according to their care plan. The home had liaised with the G.P who had instructed that the medication was to be put in porridge and there was evidence that the family were aware. There was however no evidence to demonstrate that this had been discussed within a multi-disciplinary forum to ensure the persons rights and risks had been promoted. Also the G.P instructions for administering in porridge were not being followed as the medication was being place in a drink. When the decision was made to covertly administer medication this was in tablet form, the medication had since been changed to liquid formate. To covertly administer medication without all the safeguards and checks in place to protect that person could be viewed as a form of chemical restraint. The morning medication round did not start until every one had had their breakfast. Breakfasts do not begin until 9am according to staff, after they have got the majority of people up and dressed and down to the dining room. (see section on daily activities). The medication round for the morning on all four units was observed to finish between 11am and 11:45am, meaning the gap between medication rounds was less than four hours. This practice can lead to harmful effects in people as medications can interact with each other in the body and cause side effects. An immediate requirement was left in about medication timings. We leave an immediate requirement if we have immediate concerns about the health and welfare of people living in the home and require the home to take action promptly to put these concerns right. One member of staff informed us that they had attended a training course on dignity and care, which they had enjoyed and found useful. We observed one person living at the home in the dining room with other people living at the home, undressing and they had got no clothing on for the top of their body. There were no staff present in the dining room, and this was bought to the managers attention immediately. This highlights how lack of staff supervision can impact on the dignity of persons living in the home. Practices observed in the health and personal care and daily activities section are linked to the staffs ability to meet needs which is discussed under the staffing section of the report. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for visiting the home were flexible, so people are able to maintain important relationships. The arrangements foractivities needs further work however to ensure that they meet the needs of all people living in the home. There is a choice of healthy meals but the quality doesnt always meet the standards. Evidence: People are able to bring in personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere and reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. We observed a number of relatives around the home during our inspection. The home employs an activities co-ordinator for thirty hours per week, we were informed that they do work weekends and late shifts. People living at the home stated they were always pleased to see the activities co-ordinator. Care plans for people living at the home included a plan for social activities and exclusion. These need to contain more information so that activities are tailored to the individual needs, Care Homes for Older People Page 17 of 36 Evidence: expectations and preferences. The provider ensures that activities are funded and the home also has an additional fund which it has generated itself to provide activities for people living at the home. People living on Sunflower unit were observed watching tennis on a 10 inch portable television. We were told by the management team that a relative was donating another television. Social care plans for people on this unit identified that they liked to watch television and whilst it is nice to have relative involvement in the home, the home should be providing a television that is suitable to meet the needs of people living there. There is a rotating four week menu. The menu demonstrated a variety of nutritious meals and people living in the home confirmed that they are offered a choice each day. There is a dining room on each floor and there were decorated to a satisfactory standard. The dining tables at breakfast and lunchtime were presented with a table cloth and floral arrangement. The meals were nicely presented. The meal was sampled and the potatoes being served to people living at the home on the day of the inspection were found to be hard. When a member of staff was asked to sample a potato, they spat it out, confirming the potatoes were not appropriately cooked. Comments from people living at the home were mixed in relation to food ranging from like the food to I dont like it, I leave most of it, lumps of meat and gravy. One person living at the home stated they liked the cooked breakfast that was offered to them but carers still continued to place an item of food on their plate which they did not like dispite being told not to. Care Homes for Older People Page 18 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The system and arrangements in place at the home do not ensure that people can be confident that their views are listened and responded to. Overall the home is failing to safeguard peoples health and well-being and not ensure their health and well being is promoted and protected. Evidence: The home has a clear complaints procedure. The AQAA completed November 2008 stated the number of complaints within the home has decreased, however the number of complaints received in the last 12 months had not been completed on the AQAA. We looked at the homes complaint log and whilst there were only 8 complaints in the period April 08 to Nov 08, this was followed by 23 complaints in the period between Dec 08 and our visit of June 09. These figures suggest that after completion of the AQAA the complaint numbers rose significantly. Since Nov 08 the Commission has been made aware of a number of concerns. Prior to our inspection visit we received concerns about the number of staff available to meet the needs of people living in the home (this will be discussed further in the staffing section). Complaints for the period Dec 08 to June 09 varied from number of staff on duty, staff attitude and behaviour, communication with families, quality of food etc. Whilst these have been investigated and referred appropriately the repeating concerns indicate that the causes are not being addressed. We received five complaints about the home since August 2008 these were given to the provider to investigate and are included in the figures above. Care Homes for Older People Page 19 of 36 Evidence: There are 81 members of staff listed on the training matrix, the majority of staff have received training in safeguarding however 58 members of staff have been identified as requiring a refresher training in this topic. A number of staff were spoken to during the inspection and were able to demonstrate they had been provided with the knowledge on how to respond appropriately in the event of an allegation of abuse. The training matrix does not demonstrate whether staff have completed training in respect of the Mental Capacity Act 2005 so that they are aware of their responsibility in supporting people who lacked the mental capacity to make decisions. Care plans make reference to the Mental Capacity Act but this is not being linked individual needs as discussed in the health and personal care section of the report. There are a significant number of people living in the home who have some form of cognitive impairment and this is not being linked to individual needs. Care Homes for Older People Page 20 of 36 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. Some improvements are needed to ensure that the service is suitable to meet the needs of all people living in the home Evidence: The home is a detached three storey building with parking for visitors. The car park for visitors had a number of potholes so care was required when driving there. The paint is peeling from parts of the exterior and it is in need of some work to enhance the appearance and protect the building. Entry to the home is gained through two doors. On our arrival at 7:30 we found the doors to be open. We were informed by the management team that this should not have occured and is normally only open when the receptionist is in the home and available to greet people visiting the home. We are aware of one incident where a person with impaired capacity left the home and so, it is concerning that the door was open for people to leave and enter the home freely. We looked around the building found the home to be clean, hygienic and free from offensive odours. There are extensive grounds that people living at the home and visitors can use. Although extensive, the grounds offer little facility for people and their visitors to sit. There is however an enclosed garden area which has seating and a canopy cover to provide protection from the sun. We observed electric wires and gas piping protruding from a wall in the corridor on Rose Unit, which was the site of where a radiator had once hung. We were informed that this maintenance issue had not been Care Homes for Older People Page 21 of 36 Evidence: a recent concern. On the day of the inspection a maintenance operative visited the home, boxed in the pipe and wiring to reduce the risk of harm to people living in the home. The bedrooms were spacious, light, comfortable and had been personalised with the individuals own photos and ornaments to reflect their personal taste, gender and culture. All the bedrooms had a call bell, so people could call for assistance if required. En-suite facilities consisted of wash hand basins and toilets in each bedroom. Assisted bathing facilities were located within easy reach of bedrooms but they did not provide people with a choice of bathing. On the ground floor of Rose unit we found that one of the assisted bathing facilities was not working and staff informed us that people did not like using the other assisted bathing facilities as they found the seat uncomfortable. People living on this unit were consequently being showered. On the top floor on both units staff informed us that they did not like using one of assisted baths on both units as the seats were problematic. We were also informed that the shower on the Poppy unit on the first floor was out of service due to problems with the shower chair. Staff on the first floor also told us that they do not use the baths as a bath but rather put people into the bath and then shower them. As identified in the health and personal care section people are not receiving baths or showers at the identified frequency and the facilities available are contributing factor to this. There was a separate laundry located in the basement, which was appropriately equipped. We visited the laundry and no staff were present at the time of our visit to this area. We did observe two washing machines working. We are aware that the third washing machine is not working. This means washing can not be laundered as quickly and impacts on the ability of staff to return clothes to people living in the home in a timely manner. Care Homes for Older People Page 22 of 36 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. People living in the home are not always supported as they should be due to sufficient number of staff being adequately trained. Evidence: People living at the home and staff spoken to raised concerns with us about the number of staff available to meet peoples needs. The manager informed us that the home is classed as medium dependency and this means a staffing ration of one member of staff to five people during the day and one member of staff to ten people during the night. At the time of the inspection visit seventy-six people were living at the home, which would equate to sixteen members of staff for day time. The manager informed us on the day of the inspection there were fifteen members of staff working on the day of our visit. One person living at the home told us, If buzz will come and turn buzzer off and then I have to wait so long for them to come...If no one comes for so long it will go on to emergency, they dont want it to go onto emergency...Ive been told to wait ten minutes before I buzz again. Prior to this inspection anonymous concerns were raised with us about the number of staff available in the home of a night time. We spoke to both night and day staff. Staff informed us that previously there had been four carers and one nurse per unit during the day, but this had been decreased to three carers. We were informed that during the night there was one trained nurse and two to three carers for the two units. The Care Homes for Older People Page 23 of 36 Evidence: management team informed us that a carer from the ground floor should go upstairs to help staff on the first floor during the night shift but this wasnt happening. The management team also informed us they were looking at increasing carer hours by introducing a 6am to 12midnight and 6pm to 12midnight person to meet the needs of people living in the home. Staff told us they were concerned about staffing levels and care for clients and every client has a different need, lots of staff put in a complaint to head office about staffing levels but have not heard nothing from head office and that has been about four months ago, cant get then to toilet quick enough residents get upset, personally I feel absolutely shattered....I dont know if I can carry on for much longer and am looking for another job. Some of the complaints received by the home can be linked back to the availability of staff and staff attitudes which may be a sign of stress. Also the home has recently sent surveys out to relatives of people living in the home and one respondent clearly identified lack of staff affecting the quality of care their relative was receiving. Since August 2008 we have received five complaints about the home of which three have been in relation to staffing levels these were all put back to the provider to investigate. Observations during this inspection visit demonstrated that care practice is task orientated and that these staffing levels were inadequate to meet peoples needs example problems with meeting peoples needs. Four staff files were looked at it was found to meet the standard demonstrating a robust recruitment procedure. The induction and training programme is available and meets the standards for the Social Skills Council. The training matrix demonstrated the majority of staff had received training in moving and handling, safeguarding, food hygiene, health and safety, infection control and nutrition but should have been renewed according to their system. Regular updates ensure staff have up to date knowledge in meeting and protecting peoples welfare who live at the home. Fire safety and fire drill training for staff had been renewed however for about half the staff. Staff knowledge about what to do during a fire was concerning as it placed people living in the home at risk. It is therefore paramount that this training be given to all staff as in an emergency situation such as this they all need to be following the correct procedure. Care Homes for Older People Page 24 of 36 Evidence: The information supplied to us was that twenty nine of fifty one carers had achieved NVQ 2 or above. Some staff informed us that they wished to obtain this qualification but had encountered problems with meeting up with the NVQ assessor due to their shift pattern or they felt too tired too take on the extra committment of studying. Care Homes for Older People Page 25 of 36 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 adequate 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 run in order to meet the best interests of people living in the home. Evidence: The current manager is not registered with us but is in the process of submitting an application. Comments about the manager from people living in the home, relatives and staff included: , things are improving since the new manager arrived, little things, such as buzzer to hand, I think she is too young and inexperienced to run a home of this size.,the manager can talk to us like children - not sure if it is because we are all so stressed.,she didnt used to listen to us but it she does listen more now., I came here to gain experience and learn, the staff are really nice and the manager is brilliant., current manager sems ok but I wonder why we have had so may managers I wonder why it keeps changing. and manager dont see her very often always shouts hello on going by. The home is failing to deliver care to people living there. There are systems in place to Care Homes for Older People Page 26 of 36 Evidence: monitor quality aspects in the home, which include such things as regular audits for medication and care plans. Whilst these are taking place our findings in the health and personal care section of the report indicate action is required in these areas to improve outcomes for people living at the home. Surveys sent out to various people. Last month the home sent these surveys out to relatives, their comments were mixed about the care being provided at the home. There is a clear trail of downward decline in the homes overal performance since its last key inspection which the home is failing to address though its quality assurance system. Finances for people living in the home were discussed with the homes administrators. Money is held in a bank account which has sub accounts for each individual persons money. Records had receipts so the accounts could be audited. The adminstrator confirmed that no member of staff is responsible for peoples money. Health and safety records were not looked at this visit. We did find concerns in relation to the equipment being used in the kitchen and the risk it posed to both staff and people living in the home. Two of the hot food trolleys used to transport food up to the units in the home were broken. This meant one hot food trolley for two units. Staff practice was to lift the containers out of the hot trolley and place on a cold trolley and transport food over to the other unit, thus placing themselves at risk of being burnt. We were also informed by staff of a near miss where a person living at the home had gone to place their hand on the hot element inside the hot trolley when the container had been removed. The management team were aware of the two trollies not working but had not carried out a risk assessment to demonstrate they had considered the risks and how these would be reduced. The hot water dispenser in the kitchen for making drinks was not working which meant staff were obtaining water for the hot water dispenser in the staff room. The position of this dispenser, made it difficult for staff to place the flasks they were using underneath the dispenser and again placed them at risk of scalding. We were informed that the dishwasher was to not be reaching the correct temperature to meet the requirement for cleaning crockery and utensils. We were informed a few days after the inspection that an engineer had been out and serviced the dishwasher and it was deemed to meet the requirments for washing crockery. The rinse sprayer for rinsing crockery was problematic as it sprayed water onto the floor, despite the best efforts of staff using it, which resulted in a wet floor potentially placing staff at risk of slipping. An immediate requirement was left at the time of the visit. We issue immediate requirements if we have concerns about the health and welfare of people living at the home and staff and require immediate action to reduce the risk. Whilst the home has informed us post inspection that the risks have been assessed and action has been taken to reduce them, it is concerning that this hadnt been done by Care Homes for Older People Page 27 of 36 Evidence: the management team prior to our inspection. We also expect the equipment in the kitchen that has been identified as not working to either be repaired or replaced with out delay. Care Homes for Older People Page 28 of 36 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 29 of 36 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 1 9 13 There must be a robust system in place for recording, handling, safekeeping and administration and disposal of medication received into the home. To protect and promote the well being of people living at the home 26/06/2009 2 9 13 Medication must be given as per prescribers instructions and at least a four hour gap should be giving of medications should occur To protect and promote the well being of people living at the home. 26/06/2009 3 38 23 Equipment such as 26/06/2009 dishwasher, rinse sprayer, hot trolleys should be in good working order. Whilst replacements and replaces are obtained, the home must risk assess the use of these items reduce any risk to people living at the home or staff. To protect and promote the well being of people living at the home and staff. Care Homes for Older People Page 30 of 36 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 12 Wound care plan instructions must be followed or amended following reassessment to promote the best possible conditions for healing. This will ensure the health and well being of people living in the home is promoted and protected. 07/08/2009 2 8 12 Care planning and record 07/08/2009 keeping for behaviour that challenges must be based on a thorough assessment of needs and show how care is to be delivered. Care plans must be accessible to staff delivering the care and be a reflectin of the care being given. Care plans must be reviewed at the point where a persons needs change or routinely and staff must be aware of these changes. This will ensure that people living at the home have their needs meet and their rights protected and promoted 3 9 13 Medication must not be 14/08/2009 covertly administered unless a multi disciplinary decision has been obtained and is in agreement with this. Care Homes for Older People Page 31 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that the rights and risks are promoted and protected for the person concerned. 4 9 13 The medicine chart must 14/08/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the persons medicines and be signed directly after the transaction and accurately record what has occurred. To promote and protect the well being of people receiving medication in the home. 5 21 23 Bathing facilities must be in working order and meet the required needs of people living in the home. To ensure that working bathing facilities are available in the home to meet peoples hygiene needs. 6 38 23 Hot water dispenser, rinse 21/08/2009 sprayer and hot food trolleys will either be in repaired or replaced and be in good working order. 30/09/2009 Care Homes for Older People Page 32 of 36 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 To ensure that no one living at the home or staff are exposed to any unnecessary risk 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 7 Care plans must be based on a though assessment of needs and show how care is to be delivered. Care plans must be accessible to the staff delivering the care being given. Care plans must be reviewed and amended at the point where a persons needs changes or routinely and staff must be aware of these changes. Trained staff working at the home should re-familiarise themselves with the Nursing Midwifery Council Record Keeping document to promote and protect the health and well being of people living in the home. The identified frequency in the care plans of receiving a bath or shower should be made available to people living in the home and the frequency taylored to their wishes. An audit of dependency scoring be carried out to ensure these are an accurate reflection of dependency. Recording of behaviour that challenges should be organised to ensure that all information is available and does not hinder the retrieval of information which could be of benefit to people receiving care at the home. Trained staff working at the home should re-familarise themselves with the NMC Standards of Medicine Management to promote and protect the health and well being of people living in the home. Medication for return should be stored in a locked cupboard in the medication room. The home must consider the arrangements for supervising people with behaviour that challenges and staff awareness Page 33 of 36 2 7 3 7 4 5 7 8 6 9 7 8 9 10 Care Homes for Older People 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 for ensuring privacy and dignity is maintained for all persons living at the home. 9 12 The televisions provided in the communal areas of the home should meet the needs of all persons recognising the impact of visual impairment in old age. Activities should be reviewed and based on individual needs. Following this review an action plan should be drawn up and findings implemented. Food should be cooked to required standard so that it is edible. Menus should be reviewed with people living at the home. Management of complaints should be reviewed so that they are dealt with appropriately and sensitively and do not reoccur. The home should ensure that staff are trained on a regular basis in safeguarding procedures to ensure that all peoples are protected. It is recommended that the home obtain a copy of the Department of Health Guidance Mental Capacity Act 2005 core training set published July 2007 and staff are provided with training so that staff are aware of their responsiblity and peoples rights are protected. The refurishment and replacement programme should have time scales for completion to ensure things do not slip. The third washing machine should be in working order to ensure peoples clothes are laundered in a timely manner. Staffing levels should be reviewed in the home so that people living in the home receive care in an appropriate manner. Shortfalls identified in training needs such as fire, food hygiene, safeguarding, infection control, mental capacity, nutrition and specialist topics must be addressed in the appropriate learning style so that this training embeds. This will ensure that knowledge and practice mirror and meet the needs of residents. The management team should review the systems of support for staff to ensure the workforce can perform appropriately. The management team needs to capture the Page 34 of 36 10 12 11 12 13 15 15 16 14 18 15 18 16 17 18 19 26 27 19 30 20 32 Care Homes for Older People 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 commitment of those staff who show an excellent level of comittment by ensuring these members of staff are supportedto have the skills and competencies to deliver care that meets peoples needs. 21 33 Issues identified in the quality assurance systems should be swiftly addressed and monitored on a regular basis to ensure and develop more positive outcomes for people. Care Homes for Older People Page 35 of 36 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 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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