Inspection on 08/09/09 for Magnolia House

This inspection was carried out on 8th September 2009.

CQC found this care home to be providing an Adequate 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Magnolia House 23/09/08

Magnolia House 04/10/07

Magnolia House 08/08/06

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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: Magnolia House 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX     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: Diane Wilkinson     Date: 0 8 0 9 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 38 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 38 Information about the care home Name of care home: Address: Magnolia House 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX 01482845038 01482848271 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Park Lane Healthcare (Magnolia House) Limited care home 88 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:88 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 neds on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP-maximum number of places 88 Dementia CodeDE, maximum number of places 88 Date of last inspection Brief description of the care home Magnolia House is a care home that is operated by Park Lane Healthcare Limited, a privately owned company. The home has been adapted and extended to provide accommodation and care for up to 88 older people, including those with dementia related conditions. It is situated in Cottingham, close to the border between the East Riding of Yorkshire and the city of Hull. The home stands in extensive landscaped Care Homes for Older People Page 4 of 38 Over 65 0 88 88 0 2 3 0 9 2 0 0 8 Brief description of the care home grounds that include mature trees, flowerbeds and various seating areas. Information about the home is provided to people living at the home and others in the statement of purpose and Service Users guide. Private and communal accommodation is located over two floors, both in the east wing and the west wing. Most private accommodation is provided in single bedrooms and many of these have en-suite facilities. There are various lounge and dining areas, some overlooking the landscaped gardens. All areas of the home, including the garden, are accessible to people living at the home via the provision of passenger lifts and ramps. The home is on a bus route and is easily accessed via road; there is ample car parking space for visitors and staff. Care Homes for Older People Page 5 of 38 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 inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 23rd September 2008, including information gathered during a site visit to the home. The unannounced site visit was undertaken by two inspectors over one day. It began at 9.45 am and ended at 6.15 pm. On the day of the site visit the inspectors spoke on a one to one basis with some of the people living at the home, staff, the assistant manager and a director of the company. Inspection of the premises and close examination of a range of documentation, including eight care plans, were also undertaken. The registered person submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people Care Homes for Older People Page 6 of 38 using the service. As part of the inspection process we sent survey forms to service users, staff and health and social care professionals; twelve were returned by people living at the home and seven were returned by staff. None were returned by health and social care professionals. Responses in surveys and comments from discussions with people living at the home and staff were varied. People living at the home told us that the staff are good - one person said, the staff are always very pleasant and helpful. However, we had some concerns because we received numerous comments about the home being short of staff. When asked what the home could do better, one person living at the home told us, Look after residents when they are able because there doesnt seem to be enough staff to cope with the number of residents now in the home. At the end of the site visit, feedback was given to the assistant manager and the company director on our findings, including requirements and recommendations that would be made in the key inspection report. We were told by the registered manager that the current fee for residential care is from £362.04 to £575.00 per week. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The new care plans are very detailed but some recording seen in the old care plans was out of date. All care plans must be updated monthly to ensure that staff have up to date Care Homes for Older People Page 8 of 38 information to follow. Two members of staff should sign hand written entries on medication administration records to reduce the risk of an error being made. This was a requirement at the last key inspection and has not yet been actioned. Displaying information about advocacy services would enable people to access it without having to ask for assistance; this would promote privacy and independence. This was a recommendation at the last key inspection and has not yet been actioned. Medical intervention must be sought as soon as an accident or incident involving someone living at the home has occurred when it is believed that they may have sustained an injury. A menu should be displayed in the home so that people can obtain information about the meals on offer; this promotes independence and choice and is a useful guide for family and friends. Food and fluid charts in care records should be used consistently to be effective. People who need help to eat and drink should have one to one assistance from a member of staff to promote their dignity. A photograph is needed in care records and medication records to assist new staff with identification and the emergency services should someone go missing from the home. A risk assessment must be undertaken before a bed rail is used to prevent someone from falling out of bed; this should evidence consultation with others and record decision making. Any bed rails fitted must be checked for safety on a regular basis (as per MHRA guidelines). There should be no unpleasant odours in the home to ensure that people live in clean and hygienic surroundings. Some health and safety concerns were highlighted: - bathrooms should be out of use and locked whilst maintenance is taking place - two toilet seats must be fitted - the call bell in one room must be repaired - window opening restrictors must be fitted to three windows - doors must not be held open using wooden wedges. There must be enough staff on duty to meet the assessed needs of the people living at the home. Failure to maintain agreed staffing levels could leave people at risk of not receiving the care they have been assessed as needing to maintain good physical and emotional health. Staff records should include the date that someone starts work at the home, the date their POVA first check and CRB checks are received, the date their induction training starts and ends and their first shift on the rota unsupervised. This is to ensure that all safety checks are in place prior to someone working with people living at the home unaccompanied. Two written references must be obtained prior to people commencing work at the home to ensure that only people who are suitable to work with vulnerable people are Care Homes for Older People Page 9 of 38 employed. This was a requirement at the last key inspection and has not been actioned. Management arrangements at the home should ensure that policies, procedures and practices are monitored and are consistent throughout the home. 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 10 of 38 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 11 of 38 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. We looked at Standard 3. NMS 6 was not assessed as there is no intermediate care provision at the home. People have a thorough care needs assessment and are only offered a place at the home if it is thought their assessed needs can be met by staff. Evidence: We received twelve surveys from people living at the home and they all told us that they received enough information about the home to help them make a decision about admission before they moved in. We checked the care records for eight people living at the home. They all contained assessments that had been completed prior to the persons admission to the home. The registered manager told us in the Annual Quality Assurance Assessment (AQAA) form that they have devised a new care needs assessment; examples of these were Care Homes for Older People Page 12 of 38 Evidence: seen in some of the care records we examined. We noted that a copy of a Community Care Assessment and care plan had been obtained from care management when Social Services have been involved in the admission process. This is used along with information gathered by the home at the time of the initial assessment to develop an individual plan of care for the person concerned. Care Homes for Older People Page 13 of 38 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. We looked at Standards 7, 8, 9 and 10. There are care plans in place but some need to be reviewed and updated and some have information missing; this could result in people not receiving the care they need. Peoples medication needs are met but we have some concerns about a persons health care needs not being met, and about the lack of respect for a persons dignity. Evidence: Each person living at the home has a care plan in place that is based on the information gathered at the time of the initial assessment. We did not see any evidence in the records we examined that people are involved in the development of their plan of care or sign their agreement to it. The organisation has recently started to develop new care plans for each person living at the home. The new care plans include an assessment for each area of need identified, followed by a care plan and a care plan review form, and these are a very thorough record of a persons individual needs and how they should be met by staff. Care Homes for Older People Page 14 of 38 Evidence: Each section has an accompanying risk assessment as appropriate, for example, the risk of falls, physical health, nutrition, communication and mental health, and we noted that all of this information had been kept up to date. Old records are not so thorough and there are numerous gaps in recording. One care plan had not been updated following the person having a fall, one persons food and fluid intake chart had ceased and others were seen to have out of date risk assessments in place. We noted that care plans for people living in one wing of the home had been reviewed informally every month but in the other wing some care plans had not been reviewed since June 09. Some care records had been updated to reflect changes in a persons condition or situation such as admissions to hospital and deterioration/improvement in health, but not all. There was little evidence in records examined on the day of the site vist to evidence that formal reviews of care plans take place annually; care plans must be reviewed annually for people who are privately funded and people whose placement is funded by a local authority. One concern that has been identified via recent complaints and safeguarding investigations is that staff have not recorded events thoroughly and consistently; the manager told us in the AQAA form that all staff have now had training on effective recording. This is currently being monitored by staff from one of the local authorities that commissions a service from the home. Another area of concern that has been highlighted via recent investigations is that there is sometimes a delay in staff seeking medical advice or attention. In addition to this, the Care Quality Commission (CQC) has not been informed of some of the accidents or incidents that have required medical intervention so have not been able to monitor the management of accidents at the home. The manager has been advised that medical attention should be sought immediately following concerns being raised or when someone living at the home has an accident where they may have sustained an injury, and that the Care Quality Commission should be informed. People living at the home were asked in a survey, Does the home make sure you get the medical care you need? - eight people responded always and four responded usually. We noted that some care records and medication records included a photograph of the person concerned but others did not. A photograph is needed to assist new staff with identification and to aid the emergency services should someone go missing from the home. New care plans include risk assessments for pressure care and moving and handling, and some people (but not all) have a risk assessment in place to record their use of a Care Homes for Older People Page 15 of 38 Evidence: bed rail to prevent them from falling out of bed. In two peoples care records we saw that a decision had been made that bed rails were not suitable for the person concerned; there was no record of how this decision had been reached or of any consultation with health care professionals or family members. There are nutritional risk assessments in place and people are weighed on a regular basis as part of nutritional screening. Charts are used to record a persons food and fluid intake when this is identified as an area of concern. However, one persons fluid intake chart ceased on 18/08/09 and no explanation was given for this; no changes had been made to the care plan. The deputy manager told us that fluid intake charts should still have been in use for this person. Records are held of contacts with GPs and other health and social care professionals; these include the reason for the contact and the outcome. We observed the administration of medication on the day of the site visit and noted that only one member of staff is now involved in the medication round; this makes it less likely that errors will occur. People were handed their medication and the medication administration record (MAR) sheet was only signed when they were seen to have taken it. People were asked if they required their as required (PRN) medication and how much; this was then recorded on the MAR sheet. We noted that handwritten entries on MAR sheets were not signed by two staff; two staff need to check and sign these entries to ensure accuracy. Medication was seen to be stored safely i.e. in a locked medications trolley in a locked cupboard; contolled drugs were also seen to be stored and recorded appropriately. There is now a medications fridge in each wing of the home - these are lockable and staff take the temperature and record it on a daily basis. This means that medication that requires storage at a cool temperature is now held safely. We were told by the assistant manager that all staff who are responsible for the administration of medication have completed appropriate training and training records seen at the home confirmed this. There is a list of staff names (with a sample signature) at the front of the MAR book for each member of staff who has this responsibility so that records can be checked for authenticity. On the day of the site visit we observed that staff respect the privacy and dignity of the people living at the home by knocking on doors and using their preferred name, but we were concerned about the length of time some people had to wait to receive attention. We observed that a male sitting in one of the lounges was shouting for Care Homes for Older People Page 16 of 38 Evidence: assistance to go to the toilet. There were staff in the vicinity but no-one responded to his requests for help until the inspector asked a member of staff to assist. This issue was also raised in a survey returned by one of the people living at the home; they told us that, on two occasions, they had been asked by night staff to wait for the day staff to come on duty to assist them to use the toilet - this was about a two hour wait. Most people living at the home have a single room so they are able to see visitors and health care professionals in private; there are also areas of the home and garden where people can meet with family and friends. Some people have had a telephone fitted in their bedroom so that they are able to keep in touch with people independently. Care Homes for Older People Page 17 of 38 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. We looked at Standards 12, 13, 14 and 15. A variety of activities are provided for people to take part in but this is not reflected in care records. Meal provision at the home is good and for most people dietary needs are met, but more attention should be paid to people that need assistance from staff with eating and drinking to ensure that good health is maintained. Evidence: Care records include information about a persons previous lifestyle and their hobbies and interests. There is an activities coordinator employed at the home for five days per week - she spends two days in one wing and three days in the other. We were told that the activities coordinator spends one to one time with people who do not like to join in activities but we did not see any evidence of this in records seen on the day of the site visit; care records include little information about how people have spent their day socially. The manager told us that this information is recorded in an activities book rather than in the individual persons care records. When asked in a survey if the home arranges activities for them to take part in, six people responded always, four responded usually and two said sometimes. Care Homes for Older People Page 18 of 38 Evidence: The notice board displays information about the activities on offer, including outside entertainers (once every two weeks) and social evenings; we noted that family and friends are invited to join in social evenings and people told us in surveys that they appreciated this. The manager told us in the AQAA form that some relatives also help with activities. A hairdresser visits the home on a regular basis; a hairdressing room is provided so that this is made to feel like a visit to the hairdressers. People are able to choose where and how to spend their day, although one person living at the home did tell us that it was soul destroying to spend a large part of the day sitting in a large circle around the edge of the room, all watching the same TV. Care records indicate that key worker time is primarily spent in peoples bedrooms tidying drawers and wardrobes and checking the call system. Although staff will be conversing with people during this time, it would be good to see key workers spending time with people doing things that reflect their hobbies and interests. We saw that visitors were in and out of the home throughout the day and that they were made welcome by staff. People are able to see visitors (including health care professionals) in their own room or in private areas of the home. We saw that people are able to bring small items of furniture, ornaments, pictures and photographs into the home with them to enable them to personalise their bedrooms and make them feel at home. People are encouraged and supported to exercise personal autonomy and make choices about their day to day lives, and to manage their own financial affairs for as long as they are able to do so. We did not see any information about advocacy displayed in the home; this would enable people to access this information without having to ask for advice, and would promote independence and privacy. There is a dining room in each wing of the home. Meals are prepared in the kitchen and then transferred to a servery in each wing. There is a choice of main meal and dessert at lunchtime but we noted that there is no menu on display so people did not know what was for lunch until they were offered a choice at the dining table. There is also a choice of meal at breakfast and tea times. The AQAA completed by the registered manager records that the menus have been changed recently following comments received from people at residents meetings and to reflect the changing season. We saw that some people had been provided with equipment to make it easier for them to eat independently and that staff offered assistance with eating and drinking. Care Homes for Older People Page 19 of 38 Evidence: We observed that one member of staff was assisting two people to eat their lunch at the same time; this does not promote dignity and may result in people not receiving the amount of attention needed to encourage them to eat their meals. We noted that mealtimes were unhurried and that people enjoyed social interaction with other people living at the home and with staff. Comments received from people living at the home included, meals are good and food is nice. Music was playing in one of the dining rooms throughout lunchtime but we felt that little consideration had been given to the type of music being played i.e. whether it would be enjoyed by the people using the dining room. We spent some time in the dining room during the late morning and noted that one person was sitting at a table with cold toast and tea in front of them for over an hour, and that this was only taken away when it was time to serve them lunch. This shows a lack of respect for a persons dignity and may indicate that they were not given the assistance they needed with eating and drinking. Care Homes for Older People Page 20 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at Standards 16 and 18. Complaints must be investigated within given timescales so that the homes complaints procedure is adhered to and more effort should be made to ensure that everyone knows how to make a complaint. Appropriate safeguarding alerts are made by the home. Evidence: Twelve people living at the home returned a survey and eight people told us that they knew how to make a formal complaint. Seven staff returned a survey and six of them told us that they knew what to do if someone had concerns about the home, but one person did not know what action they should take. We examined the complaints log and noted that there were two complaints recorded over the last year. Both of these had been investigated within given timescales and the complainant had been informed of the outcome. In one instance it was recorded that the complainant was happy with the outcome of the investigation and this was followed up a few days later to check that the person was still satisfied. One complaint was made about the home via the Care Quality Commission. This was not investigated within agreed timescales and had to be followed up by the complainant and the inspector. All complaints investigated by the home must be Care Homes for Older People Page 21 of 38 Evidence: investigated within agreed timescales as stated in the complaints procedure in place at the home. Some incidents that have occurred at the home (including complaints received) have resulted in safeguarding alerts being sent to the local authority; these have been investigated by the safeguarding team and on one occasion this resulted in a strategy meeting being held. The investigation undertaken by the team highlighted some concerns about ineffective recording, including that decision making was not recorded consistently by staff. This resulted in a lack of information for staff on how to deal with a specific situation or how to assist an individual service user, but the investigaton identified no poor practice by staff. An environmental health officer (health and safety) working for the local authority was involved in one investigation at the home and they expressed the same concerns about ineffective recording and the lack of robust decision making. The manager told us that most staff have now completed training on safeguarding adults from abuse and managers of the home were told at the strategy meeting that free refresher training was available for staff via the local authority. We have previously had concerns that managers at the home were making decisions about safeguarding issues without seeking advice, but we are now confident that managers understand when a safeguarding alert should be sent to the local authoirty for their consideration. Care Homes for Older People Page 22 of 38 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. We looked at Standards 19 and 26. People live in a home that is comfortable, pleasant and meets their needs. However, some maintenance issues have not been addressed and there are some fire safety risks; this could mean that people are not safe. Evidence: The home is well decorated and furnished and provides comfortable and homely surroundings for the people living there; the manager told us in the AQAA form that new curtains and bedspreads have been purchased for one wing of the home. There are extensive grounds and the dining room incorporates a large conservatory; this gives people ample access to sunlight and fresh air and provides a pleasant space for people living at the home and visitors to use. CCTV cameras are only used to monitor entrances to the home. There is a maintenance person employed at the home on a full time basis and the home is generally well maintained. We noted in one bathroom that the bath side had been removed so that maintenance of the bath hoist could take place. The exposed workings of the bath hoist could have caused harm to people living at the home, so this bathroom should have been locked so that it could not be used. We noted that there was an unpleasant odour in this area of the home; all other areas of the home Care Homes for Older People Page 23 of 38 Evidence: were free from unpleasant odours. When asked in a survey, Is the home fresh and clean?, six people said always, five people said usually and one said sometimes. One person added that the home does not smell but another said, freshen up toilets downstairs - place is starting to smell. Three windows did not have opening restrictors and this could result in someone being harmed by accidentally falling out of a window. We did not see any records to evidence that bed rails are checked for safety once fitted. One communal toilet and one en-suite toilet did not have a toilet seat fitted so were unsafe to be used by people living at the home. On the day of the site visit we saw that a wooden wedge was used to hold open the laundry room door and that some other doors were also wedged open. This creates an additional risk should a fire break out in the home. The call system is effective - staff told us that the system highlights at any point where the bell has been activited and this makes it easier and quicker for them to respond. However, the call bell was not working in one bedroom so the person occupying the room was not able to summon help if needed. The home was seen to be clean on the day of the site visit. Laundry facilities at the home are satisfactory - walls and floors that have impermeable surfaces and are easy to clean and hand washing facilities are provided for staff. One person told us in a survey, staff could take more care with my laundry i.e. wash cloths in accordance with the instructions. We noted that staff follow good hygiene practices. The manager told us in the AQAA form that most staff have undertaken training on infection control and this offers people some protection against the risk of cross infection. Care Homes for Older People Page 24 of 38 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. We looked at Standards 27, 28, 29 and 30. People are looked after by staff that are well trained and caring. However, staff are not being recruited properly and there are insufficient numbers of staff to meet everyones needs. Evidence: There are separate staff rotas in place for day care staff, night care staff and ancillary staff. The rota for ancillary staff records that there is a full time maintenance person, a cook on duty each day plus kitchen assistants, servery assistants and a laundry assistant on duty from Monday to Friday. The surveys that were returned by people living at the home were positive about the skills of the staff group and the care they provided. One person told us, the staff are always very pleasant and helpful and another said, the managers are courteous and efficient and the carers available are friendly, helpful and considerate. However, people living at the home and staff told us in surveys that the home is frequently short of staff. We examined the day staff rotas for the last four weeks for both wings and this confirmed that, on occasions, there were only two or three staff on duty when the rota recorded that there should be 4, 5 or 6 staff on duty. These low Care Homes for Older People Page 25 of 38 Evidence: staffing levels leave people at risk of harm, as they may not receive the level of care required to meet their assessed needs. One person living at the home told us when asked what the home could do better, Look after residents when they are able because there doesnt seem to be enough staff to cope with the number of resident now in the home. Managers at the home acknowledged that they have had difficulty with staff sickness and staff ringing the home at short notice to say they would not be at work. We were told that managers often work alongside care staff when staffing levels are low and that catering staff sometimes act up as care staff, but this is not recorded on the staff rotas. Return to work interviews have been introduced by the home to tackle the problem of staff not turning up for work on a regular basis and managers feel that sickness levels have already been reduced. There are no male carers at the home and it would be beneficial for the males living at the home to have the choice of being assisted with personal care by someone of the same gender; this should be considered when recruiting new staff. The manager told us in the AQAA form that 50 of staff have now achieved National Vocational Qualification (NVQ) Level 2 in Care. We checked the recruitment records for four new members of staff and saw records of Induction training in only one of them. The assistant manager told us that staff keep their own induction records until their training is completed; we recommend that details of induction training is held with staff records so that there is evidence of a persons start date and the date that they started and completed their induction training. The recruitment records that we examined included an application form, details of qualifications and training, an employment history, a criminal conviction declaration and details of two referees. The home had received two written references for one of the new employees but the other three had only one written reference in place. There must be two written references in place prior to people commencing work at the home so that all safety checks are complete. Protection of Vulnerable Adult (POVA) first checks had been obtained for all of the new employees but, because there is no start date recorded, it is not possible to check if these were received prior to people commencing work at the home. The manager must record the date that the POVA first check and CRB checks are received, the date someone starts work and the date someone works their first unsupervised shift on the rota. The supervision arrangements in place for people who are waiting for their CRB check to arrive must be recorded. This is needed to evidence Care Homes for Older People Page 26 of 38 Evidence: that the recruitment practices at the home protect people from the risk of harm by ensuring that only people suitable to work with vulnerable people are employed, and that new staff have appropriate training before they work unsupervised. The training and development plan evidences that staff receive training on moving and handling, infection control, safeguarding adults from abuse, health and safety, first aid and food hygiene - these subjects are considered to be mandatory training by the organisation and there is a system in place to highlight when staff are due to have refresher training. Care Homes for Older People Page 27 of 38 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. We looked at Standards 31, 33, 35 and 38. The manager is qualified and experienced but there have been some lapses in management responsibility, such as recruitment practices, low staffing levels and maintenance issues. There are satisfactory quality assurance systems in place and money held on behalf of people living at the home is held securely. Evidence: The home is managed by an experienced, qualified and skilled person. Due to the size of the home, two assistant manager posts have been created to help meet management responsibilities at the home. One post has been filled by a qualified and experienced person but the post in the other wing is still vacant; this has resulted in some lapses in management responsibility - recruitment practices are not robust, some areas of the home are not well maintained and there have been unsafe staffing levels on occasions. Care Homes for Older People Page 28 of 38 Evidence: Managers have regular meetings within the home and with managers from other homes in the organisation and the management team have devised the new care planning format at a series of meetings. The registered manager attends regular training updates and uses care publications and the CQC website to keep up to date with new developments in the care sector. Staff have told us in surveys that managers are approachable and supportive. There is an effective quality assurance system in place. Surveys are conducted with people living at the home and others; this gives people the opportunity to comment on the care they receive and to affect the way in which the home is operated. Resident, relative and staff meetings are held and again, these give people the opportunity to express their opinions. This information is collated and acted upon by the manager. As previously recorded, changes have been made to the menu following comments made by people living at the home. The deputy manager told us that a letter was sent to peoples relatives and representatives informing them that they would no longer hold monies on behalf of people living at the home. However, they still hold monies on behalf of five people who have lived at the home for some time; these are held securely. People have a lockable facility in their room to enable them to hold money or valuables safely. Hairdressing and chiropody is paid for by the home and this money is added to the account prepared for accommodation fees at the end of each month. We examined a selection of health and safety documentation at the home. There is an annual fire alarm test certificate in place and fire extinguishers and emergency lighting have been serviced. Records evidence that in-house fire tests and drills take place on a regular basis. We tested a sample of water temperatures at outlets around the home that are accessible to service uses and found these to be satisfactory. Some environmental risk assessments need to be updated. The manager informed us that they have now appointed a new health and safety manager who has checked the environmental risk assessments and drawn up a health and safety action plan. One of the safeguarding issues at the home was about someone who had regular falls; the CQC were not notified of these even though some resulted in admission to hospital. We examined the accident book in use at the home - this records a high number of accidents at the home but this may be due to the number of people accommodated. The CQC have been notified of some of these accidents but not all; we Care Homes for Older People Page 29 of 38 Evidence: informed the manager that the CQC must be notified of all accidents and incidents that require medical intervention. Staff have had training on health and safety topics but we are concerned that low staffing levels could lead to staff not adhering to the homes policies and procedures such as moving and handling; this poses a risk of harm for the people living at the home. The AQAA form completed by the registered manager records that all equipment and systems have been serviced in the last year and that policies and procedures at the home have been updated. Care Homes for Older People Page 30 of 38 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 29 19 There must be two written references in place for new employees before they commence work at the home. This would provide evidence that they are suitable people to work with vulnerable adults. 21/10/2008 Care Homes for Older People Page 31 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All care plans must be kept up to date to ensure that staff have access to current information. This is needed to ensure that people receive the care they need. 30/10/2009 2 8 13 There must be risk 06/11/2009 assessments in place for all bed rails in use at the home. This is to ensure that there is a record of the decision making process, that the appropriate people have been consulted and that all other options have been considered. 3 8 13 Medical attention must be sought immediately following concerns being raised or when someone living at the home has an accident where they may have sustained an injury. 30/10/2009 Care Homes for Older People Page 32 of 38 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 Medical advice must be sought to ensure that people receive the correct treatment for their injury or condition. 4 8 13 Charts used to record a persons food and fluid intake must be used consistently to be effective. This is needed to ensure that the people concerned receive enough to eat and drink to promote good health. 5 10 12 People must be taken to the toilet when they request it and not made to wait. This is needed to promote good health and to respect a persons dignity. 6 16 22 All complaints investigated by the home should be completed within agreed timescales. The home must adhere to their complaints procedure when investigating formal complaints. 7 19 23 Some areas of the home 30/10/2009 require maintenance - three windows need opening restrictors, two toilet seats need to be fitted and the call 30/10/2009 30/10/2009 30/10/2009 Care Homes for Older People Page 33 of 38 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 bell in one room must be repaired. This is needed to make sure that people are living in a safe environment. 8 19 23 Wooden wedges must not be 30/10/2009 used to hold open doors in the home. This creates an additional risk should a fire break out in the home and leaves people at risk of harm. 9 19 23 Bed rails must be checked for safety once fitted, as per the guidance issued by the Medical and Healthcare products regulator agency(MHRA). This is to evidence that risks to people are kept to a minimum and people are kept safe from harm. 10 27 18 There must be sufficient staff on duty to meet the needs of the people living at the home. People must have their assessed needs met to ensure that they remain safe and in good health. 11 29 19 There must be a record of the date a persons POVA first check and CRB checks 30/10/2009 30/10/2009 30/10/2009 Care Homes for Older People Page 34 of 38 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 are received, the date they first work unsupervised on shift and details of the supervision arrangements in place whilst waiting for CRB clearance. This is needed to make sure that staff have been declared as safe to work with vulnerable people before they work unsupervised. 12 30 18 There must be evidence that 30/10/2009 staff have had induction training prior to commencing work at the home. This is needed to ensure that people have the knowledge needed to care for the people living at the home. 13 31 12 Management arrangements 30/10/2009 at the home must ensure that policies and procedures are adhered to consistently i.e. that there are sufficient staff on duty to meet the assessed needs of people living at the home, that the home is well maintained and that staff recruitment is robust. This is needed to ensure that the home is able to Care Homes for Older People Page 35 of 38 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 meet the needs of the people living at the home as agreed in their plan of care. 14 38 37 The Care Quality 30/10/2009 Commission must be notified of all accidents or incidents at the home that require medical intervention. This is so that the CQC can monitor that people at 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 records and medication records should include a photograph of the person concerned to assist new staff with identification and to help the emergency services should someone go missing from the home. Any handwritten entries made on medication administration records should be signed by two members of staff to ensure they have been checked for accuracy. This was a requirement at the last key inspection but is now a recommendation. It would be more beneficial to people living at the home for key workers to spend social time with them undertaking activities that reflect their hobbies and interests rather than completing tasks. Care records should include information about how people have spent their day so that there is a full picture of the care provided to each person living at the home. Information about advocacy services should be displayed in the home so that people are able to access this information independently. This was recommended at the last key inspection. Page 36 of 38 2 9 3 12 4 12 5 14 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 6 15 There should be a menu on display so that people can refer to it independently to assist them in making choices, and to inform family and friends of the meals on offer at the home. People should receive individual attention at meal times to assist them with eating and drinking, to ensure that they receive the right nutritional intake to maintain good health and to promote dignity. The home should ensure that everyone is aware of their complaints procedure and how to use it. There should be no unpleasant odours in any area of the home; people should be provided with clean and hygienic surroundings. The home should consider recruiting male carers so that males living at the home have the choice of being assisted with personal care by someone of the same gender. 7 15 8 9 16 26 10 27 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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