Inspection on 26/11/08 for Palatine Lodge

This inspection was carried out on 26th November 2008.

CSCI 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Palatine Lodge 20/05/09

Palatine Lodge 02/01/08

Palatine Lodge 11/07/07

Palatine Lodge 19/09/06

Palatine Lodge 23/02/06

Palatine Lodge 11/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manderley Residential Care Home 17/19 Palatine Square Burnley Lancashire BB11 4JF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Playfer     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Manderley Residential Care Home 17/19 Palatine Square Burnley Lancashire BB11 4JF 01282431450 01282431450 manderleymanager@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Dr Morgiana Muni Nazerali Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following categories of service only: Care home only - Code PC, To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia- Code DE Mental disorder, excluding learning disability or dementia - Code MD Learning disability - Code LD of the following age range: 55 years and above The maximum number of people who can be accommodated is: 15. Date of last inspection Brief description of the care home Manderley Residential Care Home is a large two storey Victorian style property, situated close to Burnley town centre and bus stops. The home is registered to provide accommodation and personal care to a maximum of 15 older people with a dementia, mental disorder or learning disability. Accommodation consists of 11 single and two Care Homes for Older People Page 4 of 30 Over 65 0 0 0 15 15 15 Brief description of the care home double rooms. The upper floor is accessed via a stair lift. There is equipment and adaptations available to assist people with mobility problems. Communal space is provided in two living rooms and one dining room. All rooms are linked to the call system. On the day of the inspection the scale of fees ranged from £372.00 to £433.00. There were no additional charges. Information was made available to people by means of a statement of purpose and service users guide. The service users guide was usually given to prospective residents and/or their relatives on viewing the home or at the point of assessment. Inspection reports can be viewed in the home or obtained from the Commissions website on www.csci.org.uk Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection, which included a visit to the home was conducted at Manderley on 26th November 2008. The inspection was carried out by one inspector, however, the report refers to we as it was written on behalf of the commission. We last inspected this service on 6th May 2008 and the previous key inspection took place on 2nd January 2008. Following the key inspection, an improvement plan was requested and submitted by the registered provider, this set out the timescales by which improvements would be made to the service. The purpose of the inspection on 6th May 2008 was to check progress made to meet legal requirements identified at the key inspection. After this inspection a meeting was held with the registered provider to discuss the findings in more detail. At the time of this inspection there were nine people accommodated in the home, with one person away on social leave. During the Care Homes for Older People Page 6 of 30 inspection we spent time with the people living in the home, looked round the home, read some of the peoples care records and other documents and talked to the staff and the regional manager and the acting manager. We also consulted our records about the service. As part of the inspection process we used case tracking as a means of gathering information. This process allows us to focus on a small group of people living at the home, to assess the quality of the service provided. Prior to the inspection, the regional manager and owner completed an Annual Quality Assurance Assessment known as AQAA, which is a detailed self assessment questionnaire covering all aspects of the management of the home. This provided us with useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff and the people living in the home. Five questionnaires were returned from the staff and two were received from people living in the home. The responses from the questionnaires were collated and used throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: There were three legal requirements from the last key inspection, which had not been met at the time of this inspection. It is therefore essential that the registered provider Care Homes for Older People Page 8 of 30 ensures these issues are addressed as a matter of urgency to safeguard the safety and well being of the people living in the home. During the inspection, we found that care staff were not always following the guidance in the care plan, this resulted in one persons health not being adequately monitored. The care staff must therefore closely follow the instructions detailed in the care plans, to ensure peoples healthcare conditions are closely observed and direction is sought from professional medical staff such as District Nurses as appropriate. We also found that staff did not always assist people to move in a safe and dignified manner. This meant that peoples safety and dignity were severely compromised. The care staff must therefore carefully follow guidance about how to manage and reduce risks, to ensure that people are safe at all times. The care staff had not always maintained accurate records of all medication entering and leaving the home. These records must be accurate to ensure all medication can be easily tracked and any risks to people can be readily identified. We found that some incidents had not been reported appropriately to the relevant authorities. This included Social Services and the Commission. The registered person must therefore ensure that all such matters are reported without delay. This is to ensure an appropriate decision can be made by Social Services regarding the direction of any investigation and we can monitor the way occurrences are managed in the home. This is an area of concern as we found an incident had not been reported appropriately at the inspection carried out on 6th May 2008. When we looked at the files of new members of staff, we noted that there were significant shortfalls in the collation of records. This meant that some staff had not been fully checked before they started working in the home. The registered provider must therefore obtain all appropriate records and checks in line with legal requirements, to ensure the people are protected and safe. The home has been without a registered manager since October 2005, which means there has been no one to take the legal responsibility for the day to day running of the home. Several people have been appointed as acting manager during this time. This has meant that people living in the home and staff have had to continually adjust to different styles of management. An application must therefore be made to register a manager to ensure there is a suitably qualified and experienced person to carry out this role. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs properly assessed and they were provided with appropriate written information to ensure they were well informed about what to expect from the service. Evidence: Written information was available for residents in the form of a statement of purpose and service users guide. Since the last inspection, a new service users guide had been introduced. This was written in an easy read format and included pictures to illustrate the text. People spoken to confirmed they had received a copy of the service users guide and a copy was seen in each of the bedrooms. Copies of the last inspection report was included in the service users guide and was available for reference in the hallway. This meant people had access to suitable and relevant information about the services and facilities available in the home. Care Homes for Older People Page 11 of 30 Evidence: From the personal files seen it was evident that people had been issued with a contract. The contracts had been signed by people living in the home and/or their representative and included information about the level and payment of fees, their room occupied and peoples rights. The contract was easy to read and was presented in a clear format. This meant people living in the home and their relatives were aware of the terms and conditions of residence and knew what they could expect from the service. There had been no permanent people admitted since the last inspection, however, one person had expressed an interest in moving into the home. A preliminary assessment of needs had been carried out by a senior member of staff, which was detailed and included information from a range of sources including the persons family. The manager explained that a full assessment of needs would be carried out and introductory visits offered if the person and her family wished to pursue their interest further. The assessment form used to assess peoples individual needs covered all aspects of peoples lives including their social, personal and cultural needs. This meant the manager could be confident that the staff had the necessary skills and knowledge to meet the assessed needs of people wishing to move into the home. The needs of the people living in the home had been reassessed and reviewed by the management team as part of the care planning systems. People spoken to could recall discussing their care needs with the manager. This meant that people had the opportunity to directly affect the care they received. Two people were considering leaving the home and were consequently reviewing their options. From talking to the two people and the staff team, support had been offered to help them make a personal decision and enable them to move to a different home if that is what they decided. The two people were able to talk openly about their feelings in the home environment. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care provided did not always reflect the care plans. This meant that peoples dignity and welfare was not always sufficiently maintained. Evidence: We looked at two peoples files in detail as part of the case tracking process. Both files contained a detailed care plan, which was based on the persons assessment of needs. Personal profiles had been incorporated into the care plan documentation, which provided details about past life experiences and important events. This information was useful for staff to stimulate meaningful conversation with the person. The plans provided clear guidance for staff on how best to meet peoples needs and incorporated information about peoples wishes and preferences. Since the last inspection the number and type of care plans had been reduced, which meant that there was less paperwork for the staff and the main care plan was easier to understand and review. Whilst the care plans were useful and informative, we noted they were written in the first person, which meant there was the potential for staff to misinterpret peoples thoughts and behaviours, especially those people who had limited verbal Care Homes for Older People Page 13 of 30 Evidence: communication. The plans were supported by daily records of personal care, which provided information about changing needs and any recurring difficulties. The records were detailed and included a record of meals and activities. However, we noted that staff had not always described peoples behaviour in an understanding and respectful manner. Further to this the regional manager and the manager explained that this had been discussed during staff meetings, to help staff understand peoples needs and the importance of not making judgments in records. We also noted that staff had not maintained a complete record as specified in the care plan, of one persons drinks and the amount she was drinking. The person was ill at the time of the visit and records indicated that she had a poor diet. This meant the manager and staff were unaware of the exact amount she was drinking and could therefore not accurately monitor the risk of dehydration. Since the last inspection people living in the home had been supported and encouraged to have an active involvement in the care planning process. As such, people told us that they were familiar with their care plans and said they had signed their plans to indicate their participation and agreement. One person said, I sat with the manager and we went through it all together. Written records seen on peoples files demonstrated that the care plans were reviewed each month and updated in line with changing needs. One persons reviews had involved various professional staff to help the person make plans for the future. This meant the staff had access to up to date information about the persons well being at all times. Health care needs were addressed in the integrated health and social care plan, which included information about peoples psychological and mental health needs. People were registered with a Doctor and had access to NHS services. Whilst thorough risk assessments had been carried out in respect to one persons skin condition, we noted from the persons records that a dressing had been applied and advice had not been sought from the District Nursing team. This meant there was the potential for the person to receive inappropriate treatment and her skin could deteriorate further. Advice was sought from the District Nurse following the inspection. Risk assessments had also been carried out in respect to assisting the persons mobility. However, it was clear from the persons records that some staff were not following the guidance provided about the use of equipment and were thus compromising the persons dignity and placing the person at risk of harm. We further noted that protective bumpers were not fitted on the wooden bed rails attached to the bed, this meant that there was a risk of the person trapping a part of her body between the rails. Care Homes for Older People Page 14 of 30 Evidence: People spoken to felt the staff respected their right to privacy and confirmed personal care was carried out appropriately. People living in the home were aware of the many changes in the management and staff teams, which had been ongoing for sometime. This meant they were unsure about the overall approach to the delivery of care. However, people said the new staff were alright and they liked the established staff. The staff were observed to interact with the people living in the home in a positive manner and they referred to people in respectful terms. Policies and procedures were in place to cover the management of medicines and these were available for staff reference in the medication file. The home operated a monitored dosage system of medication, which was dispensed into blister packs by a local Pharmacist. Appropriate records were maintained in respect to the receipt, administration and disposal of medication. Suitable arrangements were in place for the storage and administration of controlled drugs. However, detailed records and protocols were not in place for medication entering and leaving the building. This meant it was difficult to audit one persons medication whilst he was away from the home on social leave and the risks of secondary dispensing this persons medication had not been assessed. In addition there were no procedures seen in relation to the administration of homely remedies. This meant there was the potential for people to be given the wrong type of medication. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were encouraged to make choices and voice their opinions to ensure they had an active involvement in their lives. Evidence: Peoples preferences in respect of social activities were recorded and considered as part of the assessment and care planning processes. People were consulted on a daily basis about the activities they wished to pursue and forthcoming activities were fully discussed at the Residents meetings. Since the last inspection, people had visited Blackpool and had enjoyed a bus trip round the countryside. Fitness and exercise sessions had also been arranged each Friday. Information about weekly activities was displayed on a notice board in the dining room and a winter activity calendar had been drawn up. However, people spoken to told us that the new activities had not been fully implemented and consequently people felt there had been limited development in this area. One person said theres not much to do, hopefully things will get better. On the day of inspection, people were observed to be watching television, chatting to staff and participating in arts and crafts. The routines were flexible and were primarily designed to meet the needs of the Care Homes for Older People Page 16 of 30 Evidence: people living in the home. People spoken to said they had a choice in the times they got up and went to bed. One person said I can do as I like and get up when I want to. The staff were observed to seek peoples views throughout the inspection and the people spoken to felt comfortable to comment on life in the home. People who completed a questionnaire indicated that they could make decisions about how they spent their day and weekends. People had the opportunity to develop and maintain personal and family relationships. There were no restrictions placed on visiting times and people were able to receive their guests in private, should they wish to do so. Refreshments were offered to visitors, to ensure they felt welcome in the home. A good level of support and understanding had been offered to one person to maintain an important personal relationship. Since the last inspection, a new menu had been introduced and peoples preferences had been fully discussed. However, people had mixed views about the meals, one person said, There are too many sandwiches and another person said, We get the same things every week. Further to this the manager explained that the new menu was rotated every four weeks, in an attempt to avoid repetition. On the day of the visit, we observed that all people were offered a variety of choices in addition to the main menu and the meal served was plentiful and well presented. Drinks and snacks were served throughout the day and at other times on request. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were consulted and their views were listened to. However, there was an inconsistent approach to dealing with safeguarding issues, which meant peoples best interests were not always safeguarded. Evidence: The complaints procedure was included in the service users guide and statement of purpose. The procedure contained the necessary information should a person wish to raise a concern. People who completed a questionnaire indicated that they were aware of the procedure and knew who to speak to if they were unhappy. In addition to the complaints procedure, there was various arrangements in place to ensure the people living in the home were consulted and their views were listened to and acted upon. This was achieved by individual discussion with key workers, group discussion at residents meetings, satisfaction questionnaires and daily conversations. According to information contained in the AQAA the registered person had not received any complaints during the last 12 months. An appropriate recording system was in place in the event of a complaint being made. Policies and procedures were in place in respect to safeguarding vulnerable adults, which included details of the relevant agencies. Staff received instruction on safeguarding issues during their induction, training and supervision sessions. Over the Care Homes for Older People Page 18 of 30 Evidence: last twelve months three safeguarding referrals have been made to Social Services, following three separate occurrences. One of the referrals was made in retrospect following our random inspection in May 2008. This was because an appropriate response had not been made at the time of the incident. It was therefore a concern to note that a recent incident which occurred between two people living in the home had not been reported under safeguarding procedures. This meant that the relevant authorities had not been informed and Social Services as the lead agency did not have the opportunity to direct any investigation. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with a clean, pleasant and well-maintained environment, which promoted their comfort and independence. Evidence: Manderley is a mature property set in its own grounds in a residential area of Burnley. The town centre is approximately half a mile away. The gardens were maintained by a gardener and could be used by the people living in the home in fine weather. Accommodation was provided in 11 single bedrooms and 2 double bedrooms, none of the bedrooms had an ensuite facility. Screening was available in shared rooms. Communal space was provided in two lounges and a dining room, which could also be used for various recreational activities. A stair lift was fitted to the stairs to ease access to the first floor. People had free movement around the home and could choose where they wished to spend their time. Arrangements were in place for general repairs and ongoing maintenance. This meant that any routine problems with the building could be promptly rectified. It was evident from a partial tour of the building that people had personalised their rooms with their own belongings and decoration was a good standard throughout. Care Homes for Older People Page 20 of 30 Evidence: People said they liked their bedrooms. One person said, Im happy with my room, I have my own things in it. Since the last inspection, various improvements had been made to the premises to aid the comfort and independence of people living in the home. A number of bedrooms and other areas had been redecorated, ramps had been installed on the first floor along with grab rails and bars and new equipment had been purchased for the kitchen. New blinds had also been fitted in most of the bedrooms. Appropriate aids and adaptations were provided to assist peoples mobility. This included two hoists and various pieces of equipment for safe moving and handling. Assisted baths, raised toilets and grab rails were also available, to promote peoples independence. People spoken to felt the cleanliness of the home was maintained to a good standard. However, peoples clothes were not always ironed after they had been washed and this had the potential to impact on peoples appearances. The manager was aware of this problem and explained that plans were in place to rectify this problem as soon as possible. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure was not always followed, which meant that people living in the home were placed at risk from contact with unsuitable staff. Evidence: The manager maintained a staff rota, which was completed in advance. The manager confirmed there was always two members of staff to support the people living in the home. The manager had protected hours for the administration of the home and ancillary staff were employed to carry out cooking and domestic duties. A person was also employed to carry out some of the administrative tasks and monitor the quality of the service. One member of staff was on waking watch duty during the night and one person was sleeping in on the premises. This meant that sufficient numbers of staff were available to meet the needs of the people living in the home. According to information supplied in the AQAA, the staffing levels were reviewed regularly and adapted where necessary to meet peoples changing needs. A recruitment and selection procedure was available and a checklist was used to track documentation required for the recruitment of new staff. The files of four members of staff were looked at in detail. Whilst all members of staff had completed an application form and had attended the home for an interview, it was a concern to note that there were significant shortfalls identified in throughout the recruitment process. These Care Homes for Older People Page 22 of 30 Evidence: included gaps in employment histories, references not sought from previous work which involved contact with vulnerable adults and one member of staff commencing work before the receipt of two references. This issue was a particular concern as similar shortfalls were identified and discussed at the random inspection carried out in May 2008. Arrangements were in place for all new employees to undertake in house induction training. Since the last inspection, five new members of staff had been employed in the home, including a new manager. This meant that people living in the home had to get to know a lot of staff over a short time and according to information provided in the AQAA some specialist staff training had not been completed. This may have affected the way staff carried out their role, as we found that staff were not always assisting people to move in a safe and dignified manner. At the time of the inspection, 8 out of 11 care staff had completed NVQ level 2, which equated to 73 of the staff team. Although the staff who completed a questionnaire indicated that they were provided with training relevant to their role, we identified concerns as stated above with some aspects of assisting peoples mobility, which could leave people at risk of harm. All the staff confirmed that they met up regularly with the manager to discuss their work in the home. This was also an opportunity for them to identify future training needs. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The absence of a consistent manager meant that people living in the home lacked the benefit of clear management and sound administration systems. Evidence: Since the last inspection, there had been a further change of manager, this meant that three people had carried out the role of acting manager during 2008. This meant that the staff and people living in the home had to continually adjust to changing management and leadership styles. Overall, the home has been without a registered manager since October 2005. Whilst the new manager confirmed her intention to apply for registration, this process had not commenced at the time of the visit. The manager had 10 years management experience in residential settings and had completed NVQ level 4 in Management and Care as well as the Registered Managers Award. There was a programme in place for staff supervision and the topics discussed during supervision were recorded on a suitable format. The manager had a programme in Care Homes for Older People Page 24 of 30 Evidence: place to provide supervision six times a year. In addition to supervision, staff were given the opportunity to attend regular formal staff meetings and handovers. This meant that the staff were able to share experiences and discuss future developments. The service had been awarded an Investors in People Award in 2007. Satisfaction questionnaires had last been distributed to people living in the home and their relatives in October 2008. Not all the questionnaires had been returned at the time of the inspection. However, people had been consulted at regular residents meetings and this had resulted in changes to the menus and activities. Whilst a detailed improvement plan and AQAA had been submitted to the Commission, an overall development plan based on the outcomes of the quality assurance processes was not seen. It was therefore difficult to determine the managers priorities and planned improvements to the service. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of the records and monies deposited on the premises was found to be correct. This meant the residents financial affairs were safeguarded. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances and infection control. Arrangements were in place for staff to receive health and safety training, including moving and handling, food hygiene, first aid and fire safety. However, according to the staff induction records seen several of the new staff were in the process of completing this training. Further to this, entries made in one persons file demonstrated that staff lacked understanding of safe moving and handling techniques and as a consequence placed the person at risk of harm. Arrangements were in place to record accidents and incidents in the home. However, we had not been notified of at least two incidents which had occurred in the home. This meant we were not aware of these incidents or how the occurrences were being managed by the registered provider and manager. Care Homes for Older People Page 25 of 30 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 18 13 (6) All allegations of abuse or harm must be reported and fully investigated under the safeguarding adults protocols. This is to ensure that the residents are fully protected. The registered person must collate all relevant checks and records in line with the Regulatory requirements. This is to ensure all staff are fully vetted before commencing work in the home. 06/05/2008 2 29 19 06/05/2008 3 38 37 (1) (2) The Commission must be 06/05/2008 notified without delay of any occurrence listed under Regulation 37. This is so the Commission can monitor events in the home and ensure such incidents are managed appropriately. Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The care provided must 15/12/2008 reflect the care plans agreed with the people living in the home. This is to ensure proper provision is made for peoples health and welfare. Peoples health and well being must be carefully monitored. This is to ensure all unnecessary risks to the health and safety of people are identified, understood and so far as possible eliminated. 15/12/2008 2 8 13 3 9 13 Detailed records must be maintained of all medication entering and leaving the building for any person wishing to stay away from the home. 15/12/2008 Care Homes for Older People Page 27 of 30 This is to ensure a clear audit path can be followed and any risks can be clearly identified. 4 18 13 All allegations of abuse or harm must be reported and fully investigated under safeguarding adults protocols. This is to ensure that people living in the home are fully protected. 5 29 19 The registered person must collate all relevant checks and records for newly employed staff, in line with Regulatory requirements. This is to ensure all new staff are fully vetted before commencing work in the home. 6 38 37 The commission must be 15/12/2008 notified without delay of any occurrence listed under Regulation 37. This is so the Commission can monitor events in the home and sure such incidents are managed appropriately. 7 38 12 People must be assisted to move in a safe manner. This is to ensure that peoples safety and dignity is safeguarded at all times. 15/12/2008 15/12/2008 15/12/2008 Recommendations Care Homes for Older People Page 28 of 30 These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Procedures should be drawn up for the use and administration of homely remedies. This is to ensure that people are administered medicines properly and safely. The new programme of activities should be fully implemented to ensure people pursue a range of meaningful activities of their choice. Peoples clothes should be ironed after laundering. This is to ensure that people have a dignified appearance. An annual development plan should be developed based on the outcomes of the quality assurance system. This is to ensure the service is developed in line with the best interests of people living in the home. 2 12 3 4 26 33 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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. 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