Inspection on 26/04/10 for Manor Court

This inspection was carried out on 26th April 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Manor Court 06/07/10

Manor Court 14/04/10

Manor Court 23/02/10

Manor Court 14/03/08

Manor Court 26/02/07

Manor Court 30/06/06

Manor Court 18/10/05

Manor Court 27/04/05

Manor Court 04/11/04

Manor Court 04/08/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Manor Court 31 Churchfield Lane Darton Barnsley South Yorkshire S75 5DH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shelagh Murphy     Date: 2 6 0 4 2 0 1 0 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 34 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Manor Court 31 Churchfield Lane Darton Barnsley South Yorkshire S75 5DH 01226382321 01226381299 manorcourt@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Centres Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 32 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: 32 The registered person may provide the following category of service: Care Home only Code PC To service users of the following gender: - Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, maximum number of places: 22 Dementia - Code DE, maximum number of places: 10 Date of last inspection Brief description of the care home Manor Court provides residential care for older people; the home has 32 beds. It is in the village of Darton with easy access to shops, post office, church, local village club Care Homes for Older People Page 4 of 34 Over 65 0 22 10 0 2 3 0 2 2 0 1 0 Brief description of the care home and health centre and it is on the main bus route. The home accommodates people on two floors and there is a passenger lift. Manor Court has 28 single bedrooms, 7 of which are en suite and 2 double bedrooms. The upper floor accommodates 10 people. The home has 3 lounges and 2 dining rooms. There are extensive gardens, with lawns and an enclosed area, garden furniture and a water feature. There is parking at the front of the building. The scale of charges ranges from £356:77 to £535:87 per week. For further information about the service, its fees and admissions procedures please contact the manager of the home directly. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means that people who use the service experience poor quality outcomes. Shelagh Murphy (Lead Regulation Inspector) carried out this unannounced visit to the service over two days. Day one was on 26th April 2010 and Sue Turner (Regulation Inspector) joined her from 11.30am on this day. The second day was on the 6th May 2010. The total time spent on site by inspectors was 20 hours. In the report we make reference to `us and `we. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who lived at this home. Some time was spent with five people who used the service. Three staff attended interviews with us. On the day of the site visit opportunity was taken to make a partial tour of the Care Homes for Older People Page 6 of 34 premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. The inspectors checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in February 2010. The progress made has been reported on under the relevant standard in this report. 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 34 What the care home does well: What has improved since the last inspection? Since our last inspection in February 2010, the home had met the majority of requirements and recommendations set at this time. Only two requirements had not been fully met and as the timescales set for these had not expired these have been carried forward. Some of the staff responsible for devising care plans had completed training to ensure they had the skills necessary to carry out this task. This training will need to be offered to all other staff responsible for writing care plans. We would also recommend that care plans should be devised using a person centred approach to better meet peoples individual needs and wants. People and their families have had opportunities to attend care plan reviews and this should ensure that peoples individual views, needs and wants were recorded appropriately, to protect peoples rights. People had been offered keys to their bedrooms and lockable facilities had been ordered for each persons bedroom. This will enable people to keep their valuables safe. More outings and activities had been organised for people to ensure that they could access the local community. This will also enable people to meet their social needs. Staff told us that people with dementia care needs were regularly supported to access the garden areas of the home and to go on outings to help meet their social needs. We saw evidence that people with dementia care needs were offered access to their bedrooms at all times. This protects peoples rights. People were enabled to exercise the choice to smoke outside and we observed several people taking up this opportunity. This protected peoples rights. 15 of the 28 people who lived at the service have had their needs reassessed to ensure they were still appropriately placed at the home. Other people living at the home will need to have their needs reassessed within the next few months. This should ensure that people living in the home are all appropriately placed. Care Homes for Older People Page 8 of 34 The relief manager showed us evidence that peoples risk assessments had been reviewed and were now adequate to ensure that people were not placed at unnecessary risk. Medication administration systems were checked during our second days visit and we found the home had made significant improvement to the way medication was stored, how staff were trained, how medication administered was recorded and how medication was re-ordered and audited. This will significantly reduce the probability of medication errors occurring again and therefore should protect peoples health and welfare. The manager had devised a new complaints system which has ensured that all complaints records made over the last year have been filed in this folder along side a description of the the outcomes to the complaints. This will help to protect peoples rights. There had been no complaints made about the service since our last inspection to either the home or us. This indicates that the service is now managing peoples concerns more effectively. The home had worked with the local authority adult safeguarding team to ensure that people who lived at home were safer. They had carried out adult safeguarding investigations and will need to continue attending safeguarding case conference meetings as required by the Local Authority safeguarding team. The staffing levels had been increased to five care staff working at the home during the day. There were three care staff now working on the nightshift. This staffing level was observed to be adequate to meet peoples diverse and complex needs during our site visit. Some of the staff who worked with people who had dementia care needs have had appropriate training to ensure they understand how to meet peoples complex needs. We checked a selection of staff recruitment files and found each member of staff had enhanced CRB checks in place to ensure they were appropriate to work with vulnerable adults. We saw evidence that Regulation 26 reports had been completed on a regular monthly basis. This demonstrated that the providers had been checking and monitoring the quality of the services they provided to people. This enabled them to take remedial action as required to improve the service. Overall, we found that the records required by the regulations to ensure peoples health safety and welfare had been maintained up-to-date and accurate. Since our last inspection 10 of the 20 staff had completed first aid training to ensure peoples safety. What they could do better: All of the people who lived at the home should have their needs reassessed to ensure Care Homes for Older People Page 9 of 34 they were appropriately placed at the home. All staff who are required to devise care plans should be offered appropriate training to ensure they have the necessary skills to complete this task competently. The manager should meet the local GPs to advise of the difficulties the home encounters when too much medication is prescribed to people over a monthly period of time. This should prevent the home storing too much medication, reduce the amount of wasted medication, and prevent medication errors within the administration system. There are still some staff who need dementia care training to enable them to gain understanding of peoples complex care needs. People should be offered more choices about the meals at the service. To ensure people could make appropriate choices. The dining room furniture should be cleaned to ensure that people were able to eat in an appropriate environment. The management at the service must continue to work alongside Barnsley safeguarding adults team, to ensure that all safeguarding investigations are carried out robustly. Since the day of the inspection the home has made a number of safeguarding referrals to the local safeguarding team regarding poor care practices and for this reason we cannot be sure that people are always consistently protected from harm. Action needed to be taken to prevent and eradicate malodours in the home. To ensure people were living in a fresh environment. A refurbishment programme needs to be devised and then action taken to ensure that all areas of the home offer people a homely and comfortable environment. Senior managers should speak to staff and people who live at the home to try to allay their concerns about the future management of the home. A senior manager told us that a permanent manager had been recruited. They advised they will be taking up a new post in the near future as soon as they had received employment checks to ensure they were appropriate to work as a manager with vulnerable adults. The new manager will then be required to register with us to ensure the service is being managed by appropriately skilled and experienced person. 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs had been assessed prior to them moving in to the home. Some peoples needs had been reassessed to ensure the home could meet their current needs. Evidence: We wanted to ensure that peoples needs had been adequately assessed at the home and this is what we found. We checked three peoples needs assessments. They contained adequate details to ensure that peoples needs could be met by the staff at the home. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were met in a dignified manner. The care planning system was not person centred, but it enabled staff to support peoples health and social care needs. Risk assessments had been improved to ensure adequate control measures were in place to protect people. Medication procedures had improved and staff had recieved training to administer medication in a safe manner. Evidence: We wanted to ensure that peoples current health and social care needs were adequately recorded in care plans and this is what we found. We checked three care plans and found each persons health, personal and social care needs were set out in individual care plans. They were adequately detailed to ensure that staff knew how to support people safely. The care plans checked had been reviewed on a monthly basis. However, on one care plan we saw evidence that aspects of the care plan, regarding a persons communication needs, had not been reviewed for two months. This this was brought to the managers attention, to rectify. The care plans checked were not devised using a person centered approach and we Care Homes for Older People Page 13 of 34 Evidence: would recommend that this approach is used in the future to better meet peoples individual wants and needs. We saw evidence that some, but not all staff, who were resposible for devising care plans had completed appriopriate training. However, all of the staff who complete this task now need to be offered this training. To ensure staff had the necessary skills and knowledge. We saw evidence in two care plans that peoples relatives had been included in reviews of their care. One person who lived at the home told us, they had been asked by staff for their views on their care and this had been included in their care plan. The care plans checked showed evidence that people have had the opportunity to see the doctor, dietician and district nurse. This helped to ensure that peoples health care needs were adequately met. We checked three peoples needs assessments to ensure that adequate control measures had been put in place to protect people from unnecessary risks. The needs assessments checked were adequately detailed and had been reviewed over the last month. On the second day of our visit we concentrated on checking the medication systems within the home to ensure peoples safety and this is what we found; Five senior care staff had completed medication administration training, from Boots chemist trainers, in April 2010. Two other carers had begun a 12 week medication course in order that they would be able to give out medication at the end of this training. The medication training completed, ensured that there were adequate numbers of staff trained to safely administer medication to people at the home. We cross-referenced the staff trained to administer the medication with the staff rota over the last three weeks and found that at all times during the night and day there had been an and appropriately trained member of staff on duty to administer medication. This was an improvement from last inspection and will protect peoples health and welfare. We then checked the stock of controlled drugs (CD) stored at home and looked at the recording systems in place. We found a vast improvement in the way the medication was stored, it now had a separate CD cabinet, the stock of medication counted tallied with the balance in the CD book and on the MAR (Medication Administration Records) sheets. This practice helped to safeguard peoples welfare. Care Homes for Older People Page 14 of 34 Evidence: We then checked the other medication systems in the home. The home used the Boots Monitored Dose System (MDS). We checked the medication for nine people who lived at the home. Some people required PRN medication, some people daily medication, some people required CD medication and some people required daily creams and/or other external preparations. We found that medication for these people had been administered and recorded as given appropriately. The manager told us that they had returned all the excess medications and preparations to the pharmacist to ensure that the home was not overstocked with medication. We also checked to ensure that people had adequate stocks of medication to meet their needs and found they had. The only concern we noted was that a person who had their medication increased in the middle of the MDS system. The GP had prescribed a full month medication three times daily instead of the 15 tablets actually required to meet this persons needs until the next cycle of medication began. We advised the manager that they needed to address this with the GP to ensure that they were not being overstocked with medication as this had led to problems previously. We saw records in the clinic room that CD and regular medication audits were being carried out by senior managers at the organisation over the last month. This will ensure that any issues are picked up promptly and demonstrated that senior managers were checking the systems to ensure peoples safety. We spoke to two senior care staff who advised us that they believed the medication procedures were now much safer and practices had improved greatly. Overall, we were satisfied that the service had greatly improved the safety of medication administration and staff practices in relation to medication recording procedures and systems. We observed staff interactions with people and saw how friendly and approachable staff were. People were treated with positive regard, staff were informal and friendly with people they supported that were respectful at all times. We spoke to five people who lived at home and they all told as the staff treated them with dignity and respected them. They said, Its lovely here, better than living on my own. Care Homes for Older People Page 15 of 34 Evidence: Oh yes, we are treated well by staff, they are all good. Staff are very nice, they help you in anything they can. Ive got no complaints, they treat me with a lot of respect. They protect my dignity and our room is our own, they make sure we can keep our privacy. We also recieved ten surveys from people who lived at the home and their comments included, They (staff) make time for us. They (staff) make us happy. Personal care is very good. Most things are fine. Care is good, meals are nice. I like everything about it, its a good home. We also recieved information from staff surveys, in which staff made the following comments, We are a welcoming home, because we are a small home we can get to know our residents and offer them a home from home service. Our residents are cared for in a friendly atmosphere and are treated as individuals with individual needs. These examples demonstrated how the staff afforded people dignity and respect. Care Homes for Older People Page 16 of 34 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. Overall, people found the home met their expectations in relation to daily life and soial activities. People had opportunities to meet their social, cultural and recreational needs. Steps had been taken to ensure that menus reflected people likes and dislikes and a new menu was to be introduced at the beginning of May 2010. Evidence: We wanted to find out whether people found the lifestyle in the home met their needs and wishes and this is what we found. We saw evidence on the communal noticeboards in the home that some daily activities were available to people. These included bingo, hairdressing, meals and beauty care, outside entertainment and the chance to purchase goods from a mobile shop. On the day of our inspection we observed the activities coordinator supporting people with activities, including `Beetle, which they appeared to enjoy as people were laughing and joking with each other and the staff. The activities coordinator now has a separate area to provide activities to people, to offer them privacy and a quiet area to have their nails painted or hands massaged. This helps to protect peoples dignity and privacy. Care Homes for Older People Page 17 of 34 Evidence: Since our last inspection in February 2010, people who lived at home told us there had been many more outings and day trips, these included trips out in the mini bus to local garden centres, to a fish restaurant, pub lunches and parks. These activities helped to ensure that peoples social and recreational needs were met. During our second visit to the home we saw evidence that a buffet had been provided for people who lived at home and their relatives and that an entertainer (singer) had been booked for the event. We observed that people from the dementia care unit and from the residential unit attended this event and that many peoples friends and family also attended. This helped to ensure that people were able to socialise and maintain contact with their family and friends. We recieved many comments about activities, when we surveyed people who lived at the home and their comments included, Activities are good. I like the entertainment. We are kept entertained with activities. This demonstrated that these people were generally satisfied with the activities at the home. People told us that they could have visitors at any time and that they could see visitors in private if they so wished. We saw evidence that staff made visitors feel welcome, offered them refreshments and ensured they had privacy. This helped to ensure that people were supported to maintain close relationships with family and friends. The relief manager told us they had met with relatives recently and that minutes of the meeting had been taken and circulated, to ensure that all relatives who were not able to attend the meeting were kept up-to-date with information about the home. This helped to ensure that peoples families were involved in the running of the home. We observed the lunchtime meal. The tables had been set with and napkins, vases of flowers, glasses and cutlery, some tables had condiments. However, we saw that some of the tablecloths had food debris and spills on them prior to people using the dining room. As did most of the dining chairs. This was not good practice and this did Care Homes for Older People Page 18 of 34 Evidence: not respect peoples dignity. From our discussions with people we found that overall they were very satisfied with the menu and quality and variety of food on offer. People told us, The food is lovely. Its A1 quality. I really enjoy the food here. People who lived at the home also returned surveys to us and their comments about food at the home included, Meals are good. Meals are good and we get the food we like. Meals are well prepared. However, we noted that people were not offered a choice of main meal. People were offered a choice of drinks with their meals. We then discussed these issues with the manager. The manager told us they would ensure that the dirty table cloths and chairs were cleaned as a priority. They also told us that a new menu had been developed and and would be introduced on 1st May 2010, which offered people a choice between two main meal and two deserts. They went on to tell us that these menus had been devised after consultation with people who lived at the home by asking for their likes and dislikes of food and also to ensure that peoples nutritional needs were met. This was good practice and should ensure that people receive a balanced diet, which meets their individual needs, likes and dislikes. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally peoples concerns were listened to, but not acted upon effectively. Not all staff are alert to signs of abuse which means that people are not consistently protected from harm. Evidence: The service had a complaints procedure, which was accessible to the people who lived at the service and their relatives. The relief manager told us that they had not received any complaints since the last inspection. We had not received any complaints about the service since the last inspection. However, information received via the Local Authority identified that some concerns had been raised regarding care practices but had not been actioned promptly, even though the relief manager showed us evidence that a new complaints file had been devised. We asked three people if they knew how to make a complaint and they all advised us that they would speak to the manager or staff if they had any concerns. We spoke to two relatives and asked them if they knew how to make a complaint, they told us they had concerns about some aspects of an individuals care. We asked a senior manager to discuss these issues with the relatives on the day of our inspection and the matter was resolved without them having to make formal complaint. Care Homes for Older People Page 20 of 34 Evidence: The relief manager showed as evidence that 90 of the staff team had completed adult safeguarding training since our last inspection. On the day ofour inspection the relief manager told us that one safeguarding referral had been made to Barnsley adult safeguarding team and that five previous safeguarding referrals were still being investigated. Due to the fact that these investigations were ongoing we were not able to report the findings. At a safeguarding meeting after our inspection, with the providers and the Local Authority there was evidence that numerous practice issues remain outstanding, this included a further anonymous concerns relating to poor medication practices, inappropriate use of call bells by staff, staff not having correct induction training and inappropriate use of language by staff. All of the referrals were raised by the management at the service, which demonstrated their commitment to transparency. However, because of the nature and number of these outstanding safeguarding referrals we could not be confident that people were fully protected by the current practices at the service. Care Homes for Older People Page 21 of 34 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. Overall, people were living in a warm, safe and comfortable environment. There were adequate hygiene and infection control measures in place to protect peoples safety. Evidence: We wanted to see if people lived in a safe and well maintained environment and this is what we found. People who lived at the home told us they liked the home, that it was cleaned on a regular basis and that their bedrooms were furnished to meet their needs. Three people who lived at the home told us they keys to their bedrooms and this ensured they could manintain their privacy. We carried out partial tour of the building and found that it was adequately maintained, clean and safe. However, there were numerous and areas within the home in need of redecoration as walls had scuffed and dirty marks on the paintwork. For example the quiet lounge and the main lounge had scuffed and stained walls. The dining area was well decorated, but we found chairs which were dirty and stained and required cleaning or replacement. Action needed to be taken to address these issues, as this did not provide people with a clean and homely environment in which to live. Care Homes for Older People Page 22 of 34 Evidence: We checked three peoples bedrooms, all were clean, fresh and people told us theyd been personalised to meet their needs. Some people had ensuite bathrooms. We checked a number of bathrooms and toilets and found them all to be clean and fresh. However, they were in need of redecoration and refurbishment to provide people with a homely environment. These concerns about the environment were brought to the providers attention at the last inspection. The manager told us that as a result of our last inspection extra domestic staff had been employed and a renewals and refurbishment programme for the home was being devised at the time of this inspection. This should ensure that people live in a homely and clean environment. During the second day of our visit we saw evidence that the ground floor hallway and a lounge area were being re-decorated to ensure that people are living in a clean and homely environment. We were shown records which demonstrated that some new furniture, including chairs and new carpets had been purchased, in order to refurbish some areas of the home. This would ensure that people were living in a more homely and comfortable environment. Staff told us that since our last inspection people who lived in the dementia care unit had all been reassessed to ensure that their needs could be met within the home. They also told us that people who lived in this unit had been offered far more opportunities to access external seating areas and to access the local community on a more regular basis. We also observed and staff told us that people who lived in the dementia care unit had access to their bedrooms at all times. This will better meet peoples complex needs. The home had an adequate laundry area and equipment to ensure clothing and other laundry was washed effectively. This ensured that peoples clothing and bedding could be washed and ironed safely. We wanted to check if the home had an effective hygiene and infection control measures in place and this is what we found. The majority of the staff team had completed infection control training in 2009 and therefore had the skills and knowledge to carry out infection control practices safely. We observed staff wearing aprons and protective gloves whilst offering people personal care. This protected peoples health. We made a second visit to the home on 6/5/10. And during this visit we saw evidence Care Homes for Older People Page 23 of 34 Evidence: that the ground floor hallway area was being decorated as was lounge three. The manager showed us evidence that new carpets and chairs had been purchased for the home. When we arrived at the home there was a strong malodour in the entrance hall area this was pointed out to the manager. We went back to check this area later in the day and the odour was no longer present. This was brought to the managers attention to ensure that people were supported with continence care as apppropriate to meet their individual needs. Staff surveys were completed by three staff and their comments about the environment within the home included, We have a nice conservatory, but it is now being used as an office and should be used for service users. Some furniture and equipment in the home needs updating. We also recieved surveys from people who lived in the home about the environment and their comments included, Bedrooms are nice and clean. The home is clean. Care Homes for Older People Page 24 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived in the home were protected by the staff recruitment procedures. The staffing levels met peoples diverse needs. Staff training had improved significantly, which ensured that the staff were better equipped to meet peoples needs safely. Evidence: We wanted to check if people who lived in the home had their needs met by the numbers and skill mix of the staff team and this is what we found. The relief manager told us that the staffing levels had been increased to ensure that there were now five care staff on duty at all times during the day. They told us that three staff were always on duty during the night shift. We observed that this number of staff was adequate to meet peoples needs on the days of our visits. The three staff we interviewed told us that the increase in staffing levles had enabled them to better meet peoples needs. They gave us the example of supporting people with mobility and personal care tasks was now easier as they had more time to spend with people. However, one member of staff told us they had also been given extra duties to complete such as making and checking beds each morning. And when we recieved surveys back from three staff, one staff said, Carers are expected to do jobs that should be done by domestic and laundry staff. The relief manager should discuss this with the staff team to ensure that staff have adequate time to spend offering Care Homes for Older People Page 25 of 34 Evidence: people care and support. Since our last inspection in February 2010, we also noticed that the increased number of staff had had a positive effect on the people who lived in the home as they told us that staff were now easier to find and spent more time with them, talking to them and supporting them. We noticed that call bells were answered far more quickly and that visitors to the home were able to access to the home without having to wait for a long time before staff opened the door for them. We asked three staff who worked with people with dementia care needs whether they have been offered training to understand how to meet peoples complex needs. All of the staff told us they have completed this training in the last year. The manager told us that 9/20 care staff had completed the NVQ 2 care award, that 4/20 staff had completed NVQ 3 care awards and that 8 staff had been enrolled on to the NVQ 2 award from May 2010. This helped to ensure that staff have been assessed as having the appropriate skills and knowledge to support peoples care needs. On the first day of our visits, one member of staff had phoned in sick and they had been replaced by an agency carer to ensure that the home still had five staff to support people. This demonstrated that the management were committed to ensuring that the increased staffing levels were covered during staff sickness and this will better protect peoples welfare. We wanted to check to see if people were supported and protected by the homes recruitment policy and practices and this is what we found; We checked three staff recruitment files. Two of the files had the full details required to ensure that the staff were suitable to work with vulnerable adults. The other file had an application form which did not contain the persons full employment history, this had obviously been picked up by a manager and the persons work history had been written on a separate piece of paper that fell out of the file. This was brought to the managers attention to address. We also queried one CRB check and found that the manager had completed a risk assessment and was satisfied that the person was still fit to work with vulnerable people. We checked to see if the staff team had the necessary training to support people and overall the staff training matrix showed that most staff had completed fire safety, food Care Homes for Older People Page 26 of 34 Evidence: hygiene, moving and handling, infection control, first aid and health and safety training. This was positive and demonstrated the providers commitment to ensuring staff were adequately trained in these mandatory fields. Care Homes for Older People Page 27 of 34 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. People were now living in a safer and better managed care home. Evidence: Since our last inspection in February 2010, two relief managers had been employed to manage the service. This had obviously caused some disruption and concerns for the staff and people who lived at the home. When we asked them about the management of the home we recieved a mixed response. The staff we spoke to over two days told us that the relief manager was approachable and listened to their views. That relationships between the staff and management had improved and that they had attended staff meetings with the relief manager and senior managers and had found these positive. This we were advised had helped to ensure better communication between the staff team and managers. However, we also recieved three staff surveys in which they told us, Care Homes for Older People Page 28 of 34 Evidence: Staff morale is low. There is unfairness in the way some staff are treated. We need a consistent management team. One member of staff said, The systems in place to share information about service users does not work well. Another member of staff said, Employ a manager who is experienced and capable of doing the job. There has been numerous managers at this home and a few carers have been doing what they like and nothing is done about it, they need to employ some senior carers who can do their job. When we looked at the survey results from people who lived at the home, their views on the management of the service was quite clear, they told us, Dont keep having different managers, we just get to know them and they leave. I dont like the changes with the managers all the time. And theres been a lot of changes lately. These staff and service users concerns need to be looked into further. And the management team needed to talk to people about the current and proposed management arrangements to allay peoples fears. A senior manager told us on the first day of the inspection that a permanent manager had been recruited to manage the service and they were now waiting for employment checks prior to them taking up the post. This should ensure that people can be supported by a stable management team. Since the inspection in February 2010, we had recieved regular updates from senior mangers as to the improvements made at the home, to ensure improved outcomes for people. This demonstrated that the service was working with us and taking our concerns seriously. We asked the relief manager whether, providers (Regulation 26) reports had been completed since our last inspection. We were shown evidence that these checks had taken place on a regular monthly basis. This ensured that the provider was monitoring the quality of the service to ensure peoples safety and welfare. We wanted to check if peoples financial interests were safeguarded and this is what Care Homes for Older People Page 29 of 34 Evidence: we found. Some people who lived at the home told us their relatives managed their finances. The administrator told us that they managed some some peoples finances on their behalf. They told us people had individual bank accounts to ensure they received interest on their savings. They told us that a regional administrator came in to audit peoples finances on a monthly basis. They also advised us that the manager audited the petty cash system on a weekly basis. This will help ensure that peoples financial interests are safeguarded. Overall, we found that the recording systems within the service had improved since our last inspection for example complaint records and outcomes were kept in a separate file, staff recruitment files contained relevant information to keep people safe and regulation 26 reports had been carried out and copies of these had been kept for inspection. These records helped to ensure peoples rights and welfare were protected. We looked at whether the health, safety and welfare of people who lived at the home and the staff who work there were promoted and protected. Most staff had completed mandatory training to protect peoples health and safety. As part of the site visit we examined some of the maintenance and servicing records for the home. There was an electrical circuit certificate dated 28th May 2008, the fire detection and fighting equipment had been checked in April 2010, fire drills had been undertaken on a six monthly basis the last one had been carried out on 24th of January 2010. Fire alarms had been tested weekly. Water temperatures were being checked on a weekly basis and records of this were kept. These checks helped to ensure peoples safety and welfare were protected. During our inspection we checked the registration certificate for the service and found that it was out of date and needed to be replaced by the appropriate Care Quality Commission certificate, which had been sent out to the home. This was pointed out the manager who was advised to take action to ensure they were displaying the correct certificate of registration. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 12 Medicines must be safely administered as prescribed at the right and best times. And, Sufficient stocks of medication must be maintained at the home, without overstocking to enable continuity of treatment 17/05/2010 2 27 18 The registered person must 30/06/2010 ensure that staff who are working with people with dementia care needs must be offered training on how to meet their complex needs. This will better protect peoples welfare. 3 31 9 The registered person must ensure that a manager is appointed and applies to register with CQC. To ensure the service is managed by an appropriately skilled and experienced person. 30/06/2010 Care Homes for Older People Page 31 of 34 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 The registered person must ensure that all care plans are reviewed on a regular monthly basis and that these reviews are dated and signed. To ensure that peoples needs are clearly recorded. 30/08/2010 2 18 13 All allegations of poor care practices must be actioned promptly and effectively by the management team. So people have confidence in the service that outcomes have imporved. 24/06/2010 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 3 The registered person should ensure that as peoples needs change they are reassessed to ensure they are appropriately placed. Care Homes for Older People Page 32 of 34 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 2 7 Care plans should be devised using a person centred approach model. To ensure peoples individual needs and wants are met. The registered person should ensure that all staff who are responsible for devising care plans are adequately trained. The registered person should ensure that only the correct quantity of medication required for a person is requested from the GP on a monthly basis. To ensure that the home does not begin to become overstocked with medication. People should be offered a choice of meals at mealtimes to ensure their needs and wishes are met. The dining room table should be set with clean tablecloths before people are offered their meals. To protect peoples dignity The dining room chairs should be cleaned to ensure that people are eating their meals in a clean and homely environment. To protect peoples dignity. The registered person should take action to ensure that people are protected from harm or the risk of harm or abuse. In that they should follow the advice given by Barnsley adult safeguarding team regarding the management of safeguarding investigations. To protect peoples safety. Appropriate action should be taken to ensure any malodours in the home are eradicated. The registered person should ensure that there is a refurbishment plan devised for the home to ensure that people are living in a homely, safe and well maintained home. All bathrooms and toilets should be checked and appropriate action taken to ensure these rooms are refurbished and redecorated to provide people with a homely environment. Senior managers should speak to staff and people who live at the home to address their concerns about the current and proposed management arrangements at the home. 3 4 7 9 5 6 14 15 7 15 8 18 9 10 19 19 11 21 12 31 Care Homes for Older People Page 33 of 34 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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