Inspection on 26/08/09 for Madeleine House

This inspection was carried out on 26th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Madeleine House 22/02/10

Madeleine House 09/11/09

Madeleine House 19/10/09

Madeleine House 24/06/09

Madeleine House 11/07/07

Madeleine House 24/08/06

Madeleine House 23/11/05

Madeleine House 05/05/05

Madeleine House 10/12/04

Madeleine House 09/06/04

Madeleine House 20/11/03

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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: Madeleine House 60 Manor Road Stechford Birmingham West Midlands B33 8EJ     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: Sue Scully     Date: 2 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Madeleine House 60 Manor Road Stechford Birmingham West Midlands B33 8EJ 01217861479 01217850621 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.anchor.org.uk Anchor Trust care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 41 Physical disability - over 65 years of age (PD(E)) 41 Dementia (DE) 10 Date of last inspection Brief description of the care home Madeleine House is registered to provide residential care for up to 41 residents who are over 65 years of age and require assistance for reason of old age and physical disability. This includes ten residents who can be accommodated for reasons of dementia care. The Home is owned and managed by Anchor Trust. It is a modern two Care Homes for Older People Page 4 of 37 Over 65 0 41 41 10 0 0 2 4 0 6 2 0 0 9 Brief description of the care home storey building set back off the road in its own grounds with adequate off road parking to the front of the building. It is well maintained internally and externally and is run as one unit. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the care quality commission (CQC) is listening to the views of people who use the service. We look at outcomes for people by seeing if the home meets peoples needs and maintains their health and well being. The initial part of the Key inspection was unannounced and was completed by two inspectors over two days. Unannounced visits mean that the service did not know we were coming. The benefit of this means we can see a true reflection of how the home is being run and what life is like for people living in the home. This inspection report also includes three unannounced visits by the pharmacist inspector and a follow up visit by us 2 weeks after the initial 2 day visit. The two days were spent observing the daily life of the home. We talked to people who use the service, a social care professional, a relative and to the staff and management. To enable us to ensure peoples needs were being met we case track peoples care. Case tracking helps us understand how the information about the persons is used to ensure their health and welfare is being Care Homes for Older People Page 6 of 37 maintained. We looked at records such as peoples care files, health care records, details of activities people attend, and health and safety records such as accidents. The pharmacist inspector looked at the ways medicines were administered. Our follow up visits were because we have concerns about how this home is providing care for people. We also received information from relatives and health and social care professionals who work with the home. The information from these sources helps us to understand how well the home is meeting peoples needs. The manager is also required to complete an annual quality assurance assessment (AQAA). The commission sends this documented to the manager before the inspection. The (AQAA) tells us about any improvements that are being made in the future and also gives the manager the opportunity to tell us how they are meeting peoples needs. The (AQAA) is a legal requirement that the home must complete as part of the inspection process. Information from the (AQAA) has been included in the report. As part of the initial two day inspection a number of serious concerns arose about the quality of peoples care in the home. As a result our initial findings and evidence we shared with the home a third day was needed to follow up progress. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The assessments process must clearly identify how the home will meet peoples needs in relation to dementia, challenging behaviour and people who may present as self neglecting by refusing help with their care.. There must be clear procedures in place to monitor peoples health needs and social wellbeing. Risk management plans must be in place to minimise the risks to people so people are cared for safely. Medication administration must only be administered by staff who have been deemed competent, with on going assessments to ensure people receive their medication safely. There must be clear procedures in place to safeguard people from potential abuse. All complaints must be fully investigated in a timely manner and the outcome recorded. There must be procedures in place to ensure peoples flats are kept clean at all times. The home must establish the dependency levels of all people living in the home to reflect the staffing ratio enables staff to care for people safely. The day to day management of the home must ensure the service is run in the best interest of the people who live there. All records relating to protecting people must be up to date. All accidents in the home must be investigated and monitored to ensure any one who is repeatedly having falls, the appropriate health professionals are informed. There must be a robust Quality Assurance Systems (QA) in place to identify the short Care Homes for Older People Page 8 of 37 fall in the service as well as any good practices. A represented from the organisation must ensure they write a report to ensure people are being cared for and people views of the life within the home have been taken in to account. This will assist in the services monitoring procedure and identify when improvements are required. 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 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information to be able to make a decision whether to move into the home. Information is collected on peoples needs but more details were needed where this includes mental health issues to ensure that all needs are accounted for and met. Evidence: The information given to people before they move into the home is in the form of a service users guide. This tells people about the organisation and what services can be provided by the home. As part of the inspection process we use this information and involve people who use the service to seek their views in respect to being able to make a decision based on the information provided by the home. People told us the information that the service had given to them was okay . We looked at the information collected when deciding if the home can meet a person needs. Most of the information comes from the person who is moving into the home and this includes Care Homes for Older People Page 11 of 37 Evidence: medical history and details about their needs. An assessment is also completed by a social worker. Some people have dementia or lifestyle issues and further information about these would assist the home in making the decision whether the home can fully meet the persons needs and inform the staff about the best way to ensure that peoples well being is maintained. A trial visit to the home such as a tea or lunch visit is undertaken to enable the person moving into the home to have a look around the home and meet other people living there in some situations more than one visit may be needed. Standard 6 was not assessed as the home does not provide intermediate care. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and welfare is not monitored and reviewed to ensure they are cared for safely. People cannot be confident they will receive their medication as prescribed placing them at risk of harm. Evidence: We looked at five peoples individual care plans. Care plans are documents where information is recorded about peoples health and care needs and gives staff information about how to care for the person to meet these needs in the way the person wants. Everybody had a care plan but we were concerned about gaps in the information in the care plans we looked at. For example, peoples health conditions were recorded but there was little information to say how this may affect the person or signs to look for that may indicate a person was unwell. This may mean that a person becoming unwell is not identified soon enough and they do not get speedy treatment. Some people were identified that had refused assistance with personal care regularly due to Care Homes for Older People Page 13 of 37 Evidence: their dementia or other health issues. We did not find that staff were given information about what they were to do in these circumstances or at what point they would intervene. There was no safety management plans in place. This means people went a long time without assistance with their personal care and this in some cases affected their health and well being. We found that care plans did not respond to peoples change in need. A person following an xray was to have ice applied to the affected area at all times. There was no plan for this and no records to show this had been done. People coming out of hospital do not have their care plans reviewed, or a plan in place to ensure that their needs remain the same or to meet new needs. When new health related concerns are raised peoples care plan do not change so staff do not have the information to care for people safely or monitor their progress. Peoples nutritional needs were not managed well. People were not weighed on a monthly basis as would be expected. We found people had lost weight over a period of time and this did not result in consultations with health professionals, or the monitoring of weight regularly. There were no plans to take sufficient steps to ensure that people had fortified food. Where monitoring was suggested it was not carried out. For example one care plan indicated that a person should be weighed monthly, records showed us this had not occurred and there was a gap of 4 months. In one situation we found a health professional had been called but we could not find that plans had been put in place as a result of that consultation. These failures put peoples health at risk. Accident records for falls and the follow up of falls was not good. While the accident records were completed in most cases there was no follow up information to show how staff had cared for people in the period after their fall. For example the accident record for one said fell over arm of chair it hurts , there were no further records to show if the person had sustained an injury or had received medical treatment. Another accident record said slipped off the commode, said they were okay but has a skin tear to backbone there was no further information to say what treatment had been given. Records showed us that people living in the home had fallen a number of times without their falls being risk assessed and reviewed. Therefore a lot of accidents were not identified as a possible change in a person needs. For example their mobility and their health. This means the falls continued and the risks to these people was not being minimised or managed. During the visit we involved people using the service who told us that the staff were very kind and looked after them. They told us if they asked for anything then the staff Care Homes for Older People Page 14 of 37 Evidence: would get it for them. For example if they were cold the staff would get them a blanket, or they could have their meals in their rooms. They could also have their meals in their flats. Care staff spoken to demonstrated their knowledge about how they ensure people are given choices and their privacy and dignity maintained. The pharmacist inspection took place on a different day to the main inspection. It lasted four hours. The reason for this inspection was to check compliance with the requirements left at the last inspection on 24 June 2009 where serious issues were found regarding the handling of medicines, resulting in three requirements being left. Two of these three requirements had not been met at this inspection. We have issued a Statutory Requirement Notice due to the non-compliance. Failure to meet these requirements within a set timescale may result in further enforcement action being considered to bring about compliance in order to ensure peoples safety, health and wellbeing. A total of twelve peoples medication was looked at together with their corresponding Medicine Administration Record (MAR) charts. Two care assistants were spoken with, one of whom had direct responsibility for ordering the prescriptions. All feedback was given to the manager. The home had installed a system to order and check prescriptions and medicines delivered to the home. Not enough time was allocated to check and correct any errors or omissions before they were administered. This was highlighted at the last inspection and has not been addressed. This system had not always been followed and resulted in one person not having five prescribed medicines available to administer. A new prescription had been ordered once staff realized there were none left too administer. Staff blamed the community pharmacy for not collecting and delivering the medication, when in fact they had not ordered the prescription in time to ensure a continuous supply. This was a requirement from the last inspection and had not been met. The dose of one medicine could not be checked as no copy of the prescription was available to check it against. This had resulted in one dose not being given as the care assistant was unsure what dose to administer and then it was administered daily despite no checks with the doctor to confirm this was what he requested. This was a requirement from the last inspection and had not been met. Once the medication had been received the quantity of the medicines had been recorded on the MAR charts for the majority of the medicines but not all. Where it had been recorded this enabled audits to take place to demonstrate whether the medicines Care Homes for Older People Page 15 of 37 Evidence: had been administered as prescribed. These audits indicated that staff had recorded they had administered medicines when they had not or the incorrect dose had been administered. One inhaler had been recorded by care staff that it had been routinely administered for a period of 58 days but none had actually been administered at all. The person apparently self-administered the inhaler but it had not been identified that she had failed to use the inhaler correctly and staff had recorded they had administered it. No self-administration risk assessment had been undertaken. Gaps were also seen and it could not be demonstrated whether the medicine had been administered or not. Reasons for non-administration had not been recorded. The MAR charts failed to accurately record exactly what had taken place at all times. Hand written MAR charts should have been checked by two members of staff for accuracy. Despite assurances from the manager that this did occur, upon further questioning of the staff, only one care assistant had checked in the medicines received from the community pharmacy. Hand written MAR charts failed to record all the relevant information for example the quantities of medicines, the date of the MAR chart and the dose. Without such information staff cannot administer the medicines as prescribed and management cannot assess staff competence. This was a requirement from the last inspection and had not been met. One medicine was found in the medicine trolley and available to administer but there was no record of this on the MAR chart. All medicines available for administer should be recorded on the MAR chart or removed from the premise if no longer required. The medicines have been moved to a dedicated medicine room from the staff room. Despite the manager knowing that it was too hot to safely store medicines they had still been moved to this room. The temperature was between 27C and 30C. All medicines must be stored below 25C to ensure their stability and stop them being spoilt. An air conditioning system was supposed to be installed but there was no vent or power to actually install this. There were inadequate locked storage facilities within the room. Medicines were found in open boxes and bags. The key to the medicine cabinet was found in the door on entry to the room. Anyone gaining entry to the room would have access to these medicines within. The morning medication round did not finish until 11clock and the lunchtime round started at 10clock. At least four hours should elapse between doses to reduce the risk of potential overdose. The care assistant on duty assured the commission, that pain relieving tablets for example, paracetamol, was not administered during that medication round but at a later time but other medicines were not. This is of serious concern. Care Homes for Older People Page 16 of 37 Evidence: The medication round was observed and the medicine trolley was locked when left unattended. This was a requirement from the last inspection and had been met. The senior care assistant responsible for ordering and checking in medicines undertakes a quality assurance system to confirm staff competence in their safe handling of medicines but this had failed to identify the issues found during the inspection. The manager was unaware that there were any problems regarding the unsafe practices in the handling of medicines in the home. A further visit was undertaken by the Pharmacist inspector on 10th September 2009 to assess compliance against the requirements left at the previous inspection on 19th August 2009. The medicine management remained poor and no progress had been made to improve systems within the home. Medicines were still not administered as prescribed. Staff still do not adequately check the MAR chart before the administration of medicines resulting in the errors seen. They do not accurately record what has occurred and fail to order medicines in time to ensure a continuous supply. Despite detailed feedback given from the last inspection the manager has not installed a quality assurance system to assess staff competence in their safe handling of medicines. No assessments had taken place for the people who wish to self medicate their own medicines or any compliance checks undertaken to ensure they safely do so. In one instance there was no record in the home as to what medicines one person was taking. Discrepancies were seen between the recorded doses on the MAR chart against the care plans and external health care professional visits and it could not be demonstrated exactly when the dose changed or if it was correct. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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 have the opportunity to attend individual or group events in the home and in the community. This enables them to take part in activities of their choice.The meals provided are balanced and variable, however people who have lost weight are not routinely monitored. Evidence: We looked at how people living in the home spend their time on a day to day basis, people told us they attend activities such as bingo, video club, spend time reading books from the past, reminiscing about the old days, attending garden parties, and in general have a variety of things to do. The home employs an activity coordinator to ensure people living in the home have different activities to do. As part of this inspection the coordinator was consulted and found to be very enthusiastic about her job and keen to seek new ideas regarding ways of encouraging participation in a range of activities. A hairdresser visits the home once per week. The home has a dedicated room for hairdressing on the first floor, on the day the hairdresser goes to the home the activity coordinator spends time on a one to basis with people living in the home. Entertainment from an external person attend the home once a week, and coffee Care Homes for Older People Page 18 of 37 Evidence: mornings are held so the people living in the home can socialise with other people. Catering staff are employed to prepare all meals. Menus are available on the tables within the dining room. The vast majority of people took their meals in the dining area where the tables were laid with condiments for easy use. We observed the lunch time meal and staff were seen to ask people what they wanted and help people who needed assistance discreetly. People told us that they could have what they wanted, they only had to ask. A number of people said the food was good and they enjoyed their meals. People who have meals in their rooms do not always get a choice of meal. Staff are not always aware if they have eaten their meals. For example during the visit to the service on 10th September it was identified that one person was not eating their meals and was throwing them in the bin. We were unable to establish if the person had lost weight or how long this had been occurring as staff do not monitor if people have had a balanced diet. There is a notice board to identify which people in the home are diabetic, require a soft diet and peoples preference. However when speaking with the chief we were told the kitchen staff do not monitor what people have eaten as this was the responsibility of the care staff. The lack of responsibility for recording peoples weigh has lead to some people losing a considerable amount of weight. The chef has no knowledge of peoples weights and is only told about the people who need special diets such as diabetic and people who have a soft diet. When looking at care plans for people who have lost weight they did not inform the kitchen staff of a need to monitor what people were eating and drinking. (Please see standard 8) Care Homes for Older People Page 19 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be confident their views will be listen to and action taken to resolve issues of concern. Communication between the staff team and management does not protect people from potential abuse. This means information is not routinely reported to ensure the relevant agencies are informed. Evidence: The home has systems in place for people to raise their concerns and complaints but not enough information is available in an easy format for people to know what will happen as a result of this. This means that people cannot be sure at what point to take their concerns further. The homes complaints procedure has no timescales and focuses on formal complaints and does not recognise the importance of capturing the small concerns as a way of improving the service. The logging of complaints was not completed in a way that they could be audited quickly and this means that themes of dissatisfaction with the service were not addressed quickly enough for example; we observed a message from the team leader that had been written on a notice board that was not recorded in the complaint log. The acting manager said this information had not been passed on. Another complaint had been made on 24th July 2009 but no outcome had been recorded. A relative said the change in management has made it difficult to have confidence that their views were being herd and some complaints have been repeated. Care Homes for Older People Page 20 of 37 Evidence: We also take into account discussion with local health and social care professionals under multi agency safeguarding adult arrangements. A number of safeguarding referrals have been made since the last inspection which are still under investigation and resulted in the contract with Birmingham City Council being suspended in terms of new people being placed at the home. We will not refer to the allegation in the report until the investigation has been completed. During our visits we identified four instances of concerns relating to three people living in the home which have also been referred to social services and these are now under investigation. the home whilst being well decorated is not set up or decorated in a way that best meets the needs of people with dementia. the corridors for example are decorated with walls and floors the same colour scheme. there are no pictures on the walls, and all doors are the same colour. This will lead to further confusion and disorientation for a person with dementia. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that provides a physical environment that is clean and maintained. Where relevant the service has not achieved the desire outcome for people with dementia or people that may challenge the service. Evidence: Access to the building is via a bell and this should mean staff are aware of who is in the building providing that they check identification or calls to the home. The front entrance has a ramp for easy access for people who use wheel chairs. People living in the home have their own individual flats and have access to a dining area and communal areas such as lounges if they wish to use them. As part of the inspection process we involved people living in the home and asked their views about the home. General comments were people like their flats and said that they could sit in the lounge if they wished or spend time in their flats. We were able to view four of the flats which were clean and personal to the individual. We had concerns about people who do not often go in to the communal areas. For example, people with dementia, that are behind closed doors, how staff ensure that they are safe as cited above people not eating their meals. There were no management plans in place to monitor these people. Care Homes for Older People Page 22 of 37 Evidence: Relatives told us that they would often ask staff to clean their relatives flats, because of stale odors, or that peoples clothes that had been worn were put back in the person wardrobe because the laundry had not been taken down. A person living in the home refused to go into their flat as they felt the flat was making them ill, it was identified that the odors in the flat was the cause, as the person refused all support from staff. There was no management plans in place to identify when intervention was needed by other health care professionals for a possible reassessment of the persons needs. Care Homes for Older People Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can not be confident that staff have the information available to them so they can care for people safely. People cannot be sure all staff has been assessed as competent to look after them. The lack of a needs profile of all peole living in the home means that the provider canot be sure there is always enough staff on duty and this then puts people at risk. Evidence: As part of the inspection we spoke to staff and looked at staff rotas and staff files. We also sought the views of the people living in the home as to how they see staff and how staff ensure their needs are being met. Comment from people living in the home include, Staff are very good but they are run of their feet It takes a long time for staff to answer my buzzer as they are so busy They are very nice. The rotas showed us that there are four care staff each morning and four care staff each afternoon with three night staff. Staff feel that this is not enough staff as the medication round can take up to three hours to complete which means that staff are very busy and the team leaders are not available at that time so any concerns they have a bout people have to wait. The manager told us that the staffing levels had not Care Homes for Older People Page 24 of 37 Evidence: been based on the needs and dependency of the people living in the home which needs to be looked at. Training records showed us that staff do receive training in areas such as first aid, manual handling and dementia care along side NVQ level 2 or above in care. The AQAA tells us that over 50 of care staff have achieved NVQ level 2 or above. Recruitment records were sampled and these showed us the necessary checks were completed such as references criminal records checks and application forms. Where staff have an illness such as allergies a risk assessment should be completed to ensure they have the information in the case of an emergency. Although training has been given in required areas in some cases this training has not been timely. We are concerned that training given has not resulted in good outcomes for people, which shows that training has not been effective. We had no records to show that peoples competency had been assessed after training. Comments received we do a lot of things well, I dont really know if we give good care as I dont know what good care is I have not been shown. The morning is very hard, we have been told to answer the buzzers first and leave the people if they are safe, but people living in the home tell us they have been forgotten. It a lovely home we look after the residents really well, when we have reliable staff and we all pull together Care Homes for Older People Page 25 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not managed in the best interest of the people who live there. This means peoples health care needs are not routinely reviewed or monitored placing them at risk of harm. Evidence: Over the last 18 months there have been five different managers in this home. This means the management structure has not been stable resulting in poor communication between the staff team and management. An acting manager has been in post for a number of months. The acting manager hold NVQ level 4, registered manager award and has previous experience of management a residential home. The care plans, daily records and communication books we sampled showed us the communication in the home between care staff, team leaders and managers is not robust and areas of responsibility not clear. We found when care staff report issues of concern, information is not checked and action is not always taken. This results in poor communication with health professionals, relatives and a poor service for people Care Homes for Older People Page 26 of 37 Evidence: living in the home. We found the home was working on a very reactive basis and there was insufficient planning and management to work pro-actively to improve peoples lives. Essentially, manager and seniors have failed to act on key information provided by care staff placing people at risk of harm. We had a number of comments about the management structure in the home. The changes of managers were thought to have contributed to the lack of direction in the home. The numbers and gender of agency staff on certain shifts had increased the work load for permanent staff. We found dissatisfaction that the home had been allowed to deteriorate so far without action being taken by the service provider. we noted on the 10th September 2009 that the medication administration system was unsafe and this was conveyed to the senior manager in Anchor for urgent action. Although there are organisational systems for Quality Assurance and requirements for the service provider to assure itself that the quality of service given is good, the failures in this home have not been identified or responded to quickly enough. This calls into question the systems used to audit the Health and personal care elements of the service. (See Standards 7-10) We are concerned that elements of the service delivery that have been identified by relatives as being not good enough have only sustained improvement for a short time resulting in repeat complaints. We looked at the arrangements for managing peoples money and found that this was generally satisfactory. People are assisted in managing small amounts of money for their additional expenses such as hairdressing, chiropody toiletries and so on. The service provider holds a central account to hold peoples money which people or their representatives are given the information that this a non interest bearing account. We looked at 2 peoples records and found that the receipts and record tallied. The home has petty cash to pay for anything the person wants and the cost is put against their account. The home holds a computer and a paper record. The amount in the account is checked on a regular basis. The home buys in some items that the people can buy, records were not detailed enough for us to determine whether this was not for profit and better records need to be held. The health and safety arrangements in the home are maintained and equipment is tested regularly such as safety gas checks manual handling equipment, and call systems. The reporting of accident and incidents are not always reported to the relevant health Care Homes for Older People Page 27 of 37 Evidence: care professionals or social care authorities. For example accident records showed us that a significant amount of falls had occurred over a period of six months. There is an audit completed however no action is taken to identify if there are any patterns to see if the falls occur at certain times or if people have health related problems. The acting manager does not complete an overview of accidents. (Please see Standard 8) Care Homes for Older People Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 All dose regimes must be 24/07/2009 clearly written on the MAR chart and checked by second member of staff for accuracy. All relevant details must be recorded including the date, quantity, dose and strength of the medication This is to ensure that staff have clear, accurate directions to follow and audits can take place to demonstrate that the staff adminsiter the medicines as prescribed and records reflect practice 2 9 13 A system must be installed 24/07/2009 to check the prescriptions prior to dispensing and to check the dispensed medicines and MAR charts received into the home for accuracy. All discrepancies must be addressed with the health care professional in a timely fashion. All medicines must be available for administration at all times This is to ensure that all medicines are administered as prescribed and are available to be administered at all times Care Homes for Older People Page 29 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The service must ensure detailed information is collated about peoples dementia and challenging behaviour so they can meet the persons needs. This will mean that clear management plans are put in place to care for people safely. 25/09/2009 2 7 15 Care plans must be generated from a comprehensive assessment detailing the actions staff need to take to ensure that all aspects of peoples needs are being met. This will ensure staff have the information to monitor and review peoples changing needs. 25/09/2009 3 8 13 Peoples health and welfare 25/09/2009 must be monitored that includes peoples weight, specialist medical treatment, Page 30 of 37 Care Homes for Older People 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 and any other instructions by other health professionals deemed to ensure people stay healthy. This will ensure peoples current needs are know and will be met. 4 8 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. This is to ensure that staff who administer medication are assessed on a regular basis and appropriate action is taken if audits indicate that staff do not administer the medicines as prescribed. 5 9 13 All service users must be risk assessed as able to self administer their own medication and regular compliance checked 19/09/2009 20/09/2009 Care Homes for Older People Page 31 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action undertaken and documented. This is to ensure that they can handle their medication safely as the doctor has prescribed 6 9 13 All medicines available for 19/09/2009 adminsitration must be recorded on the MAR chart or returned to the pharmacy for destruction if no longer required. This is to ensure there is a record of all medicines on the premise in line with current regulations. 7 9 13 All medicines must be stored 20/09/2009 in compliance with their product licences and in a locked facility at all times. This is to ensure their stability and the service users are kept safe. 8 9 13 The medicine chart must record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be 19/09/2009 Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed. The records must reflect practice 9 15 16 People must have a choice 25/09/2009 of meals available to them at all times in particular people who do not have their meals in the communal areas. This will ensure their dietary needs are met. 10 16 22 All complaints must be logged and thoroughly investigated. This will ensure peoples views are listened to and actions taken to address their concerns. 11 18 13 Robust procedures for responding to unexplained injuries must be implemented. 25/09/2009 25/09/2009 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure people are safeguarded and protected from harm 12 26 16 People flats must be cleaned 25/09/2009 regularly and action taken where self-neglect is identified. This will ensure other professionals are consulted. 13 27 18 an assessment of peoples 25/09/2009 dependency on assistance or supervision must be undertaken to be sure there is enough staff to meet peoples needs and wishes taking into consideration the size and layout of the building. This will ensure people receive assistance and supervision when they need and wish. 14 30 18 Training undertaken by staff must be monitored to ensure what staff have understood is put into practice. 25/09/2009 This will ensure staff professional development and mean safe working practices at all times. Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 15 31 8 An application must be submitted to the Care Quality Commission for the position of registered manager. This will ensure the day-today management of the home is undertaken in the best interest of the people who live there. 25/09/2009 16 33 24 An effective quality assurance system that is robust and identifies where there are failures in the service provision must be set up. This will ensure action is taken quickly to address issues of concern. 25/09/2009 17 37 17 The records that are required to ensure people are protected, and the service is run effectively must be up-to-date. This will ensure accurate information is available at all times. 25/09/2009 18 38 37 Accidents within the home must be recorded monitored, reviewed and action taken to reduce the risks to people using the service. 25/09/2009 Care Homes for Older People Page 35 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure people living in the home are kept safe. 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 should be reviewed to add additional information and give more attention to detail to ensure they are more person centred. It is advised that at least four hours should elapse between medicine rounds to reduce the risk of potential overdose. clear lines of communication and responsibility must be developed. this is to ensure that people, their representatives and health professional can be assured peoples up to date health and wellbeing is being monitored. 2 3 9 32 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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