Inspection on 23/09/09 for Marlowe House

This inspection was carried out on 23rd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marlowe House 18/10/08

Marlowe House 06/11/07

Marlowe House 06/06/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Marlowe House School Lane Hadlow Down East Sussex TN22 4HY     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: Jo Mohammed     Date: 2 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Marlowe House School Lane Hadlow Down East Sussex TN22 4HY 01825830224 01825830924 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: AUM Care Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Marlowe House is registered to accommodate up to twenty older people. The home is a detached property that has been converted and extended for its current use. It is situated on the outskirts of Hadlow Down village near the town of Uckfield. The home is arranged over three floors, service users accommodation is provided on the ground and first floors and staff accommodation on the second floor. There is a chair lift and two staircases between the ground floor and first floor. The home provides fourteen single and three shared rooms. There is a conservatory and dining room. There are two lounges; one on the ground floor and another on the second floor leading into the office. A large garden surrounds the property with some seating and off road parking. Care Homes for Older People Page 4 of 35 Over 65 20 0 1 8 1 0 2 0 0 8 Brief description of the care home More detailed information about the services provided at Marlowe House including current fees, the homes statement of purpose, service user guide and copies of inspection reports can be obtained directly from the home. Care Homes for Older People Page 5 of 35 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: This report reflects a key inspection based on the collation of information received since the last inspection, a review of the homes Annual Quality Assurance Assessment [AQAA] and last inspection report. Two inspectors conducted an unannounced site visit on the 23rd September 2009 between 10am-5.30pm. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care settings. For the purpose of this report, those living at Marlowe House are referred to as residents. Marlowe House is an established home that provides residential care for up to twenty older people. There are currently thirteen residents living in the home. The home is owned by AUM Care Ltd. The Registered Person also owns another older peoples home in East Sussex. Care Homes for Older People Page 6 of 35 The site visit included a partial tour of the premises, examination of some care, medication, staffing, menus and general records. The visit also included meeting residents, the Manager, owner and some staff. Ten surveys for residents were sent to the home prior to the inspection. Two were returned. The comments made by these residents under what the home does well was:- Food, bath and staff contact and they look after me. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 35 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 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not sufficiently evidencing how they provide prospective residents and their representatives with information about the home or how they undertake detailed pre-admission assessments. This is necessary so that residents can make an informed choice about where to live and know that their needs can be met. Evidence: It was evidenced in records examined that there was insufficient pre-admission assessment details and information given to residents about the services the home could provide to them. Documentation relating to a resident admitted to the home after the last inspection in October 2008 was examined. Limited pre-admission information was available;apart from an admission sheet dated 12th January 2009 with details of next of kin, General Practitioner and on the reverse of this sheet a checklist covering some aspects of daily living. Attached to a letter from the home offering a placement to this resident for a Care Homes for Older People Page 10 of 35 Evidence: trial period was a blank admission questionnaire. The homes pre-assessment format requires further development to ensure it covers all aspects of residents daily living needs and is recorded in more depth. There were no completed care management assessments or care plans found. In another file belonging to this resident a contract was seen. This identified the first four weeks in the home as a trial period. There was a questionnaire for relatives to fill out in helping to get to know the resident;however it was not evident how this information had been incorporated into the residents main file or seen by them or linked to a care plan. There was no evidence on this residents file to show if they had been informed or seen the homes service user guide or statement of purpose. The Manager advised the service user guide was kept on the computer and a copy was given to residents and relatives. During the site visit, the content page of the service user guide was printed off; however the full document was not presented. The homes statement of purpose evidenced was undated, incomplete and did not contain all the required information. There was no reference to staffing, management or structure. The home does not provide intermediate care. Care Homes for Older People Page 11 of 35 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. There was insufficient information in residents care records and risk assessments to enable staff to be fully informed and guided in providing good care. The lack of information could lead to residents and staff being vulnerable and at risk of harm. Medication practices are not sufficiently detailed to form the basis of giving safe care. Evidence: Three residents records were examined. Each resident has two files. It was unclear how active the second file is as this contained a mixture of duplicate, old and current information. The information written in residents care records and risk assessments was unclear and incomplete. There was no evidence that staff had training in record keeping, writing care plans or risk assessments. Records of residents changing needs care needs are not clear. The care records were muddled with some contradictions in current care practices and routines. The home use care plan review sheets; these were dated August 2009, previous review sheets were dated March 2009. Care records and risk assessments are not being reviewed regularly enough. The care plan review sheet contained Care Homes for Older People Page 12 of 35 Evidence: different headings with brief information as to how care should be provided, this did not cover all areas of daily living relating to residents health, personal and social care. Next to each heading are primarily brief review statements saying new objectivescontinue or to monitor and record. Alongside these review sheets is undated profile information that appears to be used to add-on residents care details. In one residents care records it was identified they were diabetic controlled, it was unclear how they were to be monitored or the assistance required as there was no evidence of this information in their records. The Manager later advised this resident had tests that were clear and they were not diabetic. This information has not been updated. In respect of the management of this residents behaviour the guidance to staff is recorded only as To be monitored. It was unclear how this person was to be monitored. It was reported that two staff support this resident when they have a bath. There is no detailed information documented in their care records regarding this support or how other behaviours and risk is managed or monitored. In respect of another residents records there was insufficient evidence to show how this persons behaviour was managed when they may be confused or disorientated. There were gaps and insufficient evidence to show the action taken to prevent or minimise the risks to residents in respect of falls, wandering or risks associated with wide window openings; contradictory information was recorded in residents care records. Within residents main files were undated general daily routine sheets that were basic in detail and task orientated rather then showing comprehensive evidence of personal preferences. There was evidence of dates kept for appointments,visits with General Practitioners, District Nurses, other health care professionals, the management of pressure sores and a record of baths taken. The Manager reported a Physiotherapist visited the home monthly and a Chiropodist every six to eight weeks. It was said that a lot of residents are able bodied with three needing assistance. It was also said that several residents are unsteady and supported to and from the dining room. Entries in residents daily notes primarily described whether they stayed in their rooms, meals eaten, how slept, personal care remarks and watching TV. There was limited evidence to show how the quality of residents daily lives were promoted in respect of their interests, leisure, hobbies and outings. The homes communication book is inappropriately being used to record residents daily Care Homes for Older People Page 13 of 35 Evidence: information and at the evening staff handover. These practices do not afford confidentiality. In respect of another residents care records examined. It was identified with the Manager to start maintaining written records of the action taken to date in seeking the support required from health care professionals as this had not been fully documented other than recording some telephone conversations. There is a need to arrange for a formal review of this residents health and social care needs as there has been some deterioration. The care needs of this resident must be clearly documented within a care plan as it was found that matters relating to two significant issues were not adequately recorded. There was some contradictory information about medication and insufficient records of review during this deterioration. In other records examined for this resident was information and advice from a healthcare professional relating to their personal care and short term memory loss. This information remains current as it contained on-going guidance that had not been transferred into an active care plan. Medication systems and records were examined. Daily medication was found to be stored safely.There was no medication chart in place for a prescribed cream for a resident. One resident self medicates a gel. Residents who self medicate must be risk assessed. On the list of those staff deemed competent to administer medication was one staff member who stated they had not received any training in medication, although they were on the list of those trained and acted as a second signatory check with another member of staff in administering a drug to a resident. According to information obtained from the homes Annual Quality Assurance Assessment [AQAA] the medicine policy was reviewed in January 2009. The home need to ensure the type of Controlled Drugs register and Controlled Drugs cabinet used within the home complies with the Royal Pharmaceutical Society in respect of the construction, fitting of the controlled drugs cabinet as the home stores a controlled drug. Care Homes for Older People Page 14 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although it was described that the majority of residents are able and maintain contact with their families; activities organised do not encourage access to the community and not enough emphasis is placed on residents past and present preferences. Evidence: A number of residents were observed and met during the course of the inspection. Several residents were enjoying watching a classic film in the lounge. There was a large selection of books, DVDs, videos and games available. Newspapers are delivered according to residents personal preferences. One resident was doing their tapestry and it was said some other residents like to knit and read. One resident spoke highly about a night carer describing how they had gone the extra mile when they had not been well. It was identified that residents could do bingo and quizzes and there was plenty of activities if people wanted them, however it was said not a lot of residents join in. Another resident said they were happy, the food was good and they joined in with activities. The Manager said there was an activity board with details of whats on and they were going to start a newspaper trolley. The Manager also conveyed how there was nothing to do locally. Activities such as singing and monthly church services were Care Homes for Older People Page 15 of 35 Evidence: reported as taking place and the night staff organise table top days. It was said that residents families do personal shopping and take residents out. For those residents without family it was reported that staff bring in clothes and DVDs. The Manager said she would take one resident into town for coffee. It was mentioned several times how residents did not want to do activities and most like to stay in their rooms. A hairdresser visits the home weekly. The owner has access to a minibus and it was said some residents go out and others do not want to. The schedule of residents daily routines in residents care records and daily report notes identified under the Health and Personal Care section of this report makes minimal reference to residents leisure and recreational activities. Information taken from the homes Annual Quality Assurance Assessment [AQAA] identifies the home provides a large number of activities. Comments extracted from the AQAA include That they entertain and talk with residents. That family members are invited to celebrate special days and that residents and family members express happiness with the service provided. The home plans to provide more outside activities when transport can be found. In the AQAA it says how over the last twelve months activities have improved with more choices and residents have been able to attend more outside activities with family and friends. From the information gathered during the inspection, it is recommended the home develop, explore and actively seek residents participation in promoting and providing additional, meaningful, leisure and community activities. Residents described the food in the home as good and excellent. Breakfast is served in residents rooms. There is a four week menu in place with a choice of meals on most days, it was reported that alternative meals are possible. On the day of the inspection there was no alternative to the menu, the main meal served was roast beef. A resident who was heard saying they were not keen on the menu choice was not offered an alternative. It was reported that the Manager goes round and asks residents if they are ok with the menu. One resident chooses to have their main meal in the evening and a snack at lunchtime. When the cook is off care staff cover this role. Care Homes for Older People Page 16 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The services records, policies, procedures, training methods and general understanding does not fully protect residents from harm and abuse. Evidence: At the last inspection, a recommendation was made to use a dedicated complaints book to ensure confidentiality and record the outcome of complaints. Following examination of the complaints book; a torn out page documenting in detail the nature and outcome of a personal complaint by a resident was recorded. This information was on display for all to see. It was brought to the Managers attention to ensure complaint information be stored confidentially. A complaints policy was seen in the main house folder with a review date of 2007. This policy requires updating to reflect Social Services and the Care Quality Commissions [CQC] name and contact details as no contact information was evident. The content should be reviewed to ensure it contains an accurate account of the protocol in place for the management and response to complaints. An undated Whistle-blowing policy was available. This may also require updating. The home does not have a copy of the Sussex Multi-Agency guidelines for safeguarding vulnerable adults and when asked if they held a copy the Deprivation Of Liberty Safeguards [DOLS] booklet was produced. The multi-agency safeguarding guidelines must be obtained. The homes policies about the protection of service users Care Homes for Older People Page 17 of 35 Evidence: had not been reviewed or updated since 2006. The Manager advised the last training course undertaken by staff in adult protection was undertaken in 2008 using a DVD. Following discussions and examination of staff training records. It was identified how a staff member who had been in post over a year had not received training in the Protection of Vulnerable Adults. There was evidence when speaking to this staff member they demonstrated awareness of referring abuse matters to the Manager or owner. However, based on the overall findings during this inspection; the Registered Persons must ensure staff receive up to date safeguarding training by an accredited trainer rather than relying solely on DVD training material. Care Homes for Older People Page 18 of 35 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. The people who reside in the service do not live in a home that is fully maintained, hygienic and safe. Evidence: Information taken from the homes Annual Quality Assurance Assessment [AQAA] identifies the home is safe and clean with residents bedrooms in the process of being re-decorated. The main bathroom has been re-organised and re-decorated and a new top of the range washing machine purchased. The home identifies they could make more use of the outdoor space and that all staff are trained in infection control. A partial tour of the premises was undertaken. On arrival at the home, a strong odour was apparent. Three bedrooms seen had been touched up with paint, rather than full decoration. The garden was in need of attention as its appearance was overgrown. The home does not have a written maintenance plan. A first floor toilet was found to have a locking mechanism in place that would prevent easy access in an emergency situation, there was no handwash or towel available. The Manager advised this toilet was usually for staff use and normally kept locked. It was noted there were several wide window openings around the home without restrictors; the Manager advised these had been taken off by residents. Risk assessments regarding this were not evident. The Environmental Health Officer must Care Homes for Older People Page 19 of 35 Evidence: be consulted about these environmental risks. Emergency lights records showed there had been a problem during the year lasting for three months whereby some of the emergency lights had not been working. There was no record to show how this matter had been monitored or dealt with until after three months when an entry was made to say it was all working. The Fire Officer must be consulted with about this fire safety matter. A recommendation made at the last inspection regarding risk assessing the front gate entrance and if necessary put in measures to reduce risk was discussed. The Manager reported that individual risk assessments had been drawn up for residents. Examination of these showed limited and minimal information in respect of whether residents are prone to wandering. Risk assessments must clearly identify the action to be taken in minimising these risks. The Manager advised the owner was going to put up a caution sign on the gate for the elderly; this was not in place at the time of the site visit. Laundry facilities were not examined on this occasion. Care Homes for Older People Page 20 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not adequately trained in safeguarding and manual handling and there is no comprehensive overview of staff training; this places residents at risk of harm. Where the staff teams duties are divided between care and domestic tasks, there should be care staff in sufficient numbers to meet residents changing care needs and undertake activities to ensure they are comprehensively supported at all times. Evidence: We had a discussion with the Manager and owner about staffing levels and the staffing rotas were examined. The Manager advised she worked 9.30am to 5.30pm between Monday to Friday and occasional weekends. Two staff including a deputy were reported as leaving the home last week. The Manager said staffing levels were being maintained and if there was an increase in residents, more staff would be needed. Residents living in the home were described as able bodied, apart from three who need assistance. A description was also given that the majority of residents were unsteady and supported to and from the dining room with two residents in particular requiring more support. There is some disparity of information as to the needs of residents. Examination of the the staff rota did not include the Manager or which staff were responsible for cooking meals in the absence of the cook. At the present time there Care Homes for Older People Page 21 of 35 Evidence: are thirteen residents living in the home. The staff team is comprised of female carers. It was identified that current staffing levels include two care staff between 8-2pm and two care staff between 2-8pm. There is one waking night and one sleep-in member of staff on duty each night. Ancillary staff comprise of a cleaner working Monday to Friday between 8am-2pm and a cook from 9am-2.30pm who has three days off one week and one day off on alternate weeks. The Manager confirmed when the cook is off a carer would cover these duties and that catering duties were kept separate from care work. The Manager advised they were looking into employing one live-in carer to cover sleep-in duties. It was reported that a resident requires the support of two staff when bathing; the cleaner assists at these times by staying on the floor to cover for about 20 minutes. The cleaner also helps to give out residents breakfasts in the morning. A review of staffing levels with a view to increasing them to facilitate more activities and meet residents individual care needs is considered necessary. In respect of staff training there are gaps. Staff are six months out of date with manual handling training. The Manager said further training was booked to take place in October 2009. A staff member who has been in post a year requires Protection Of Vulnerable Adults [POVA] and medication training. Fire training for staff has taken place. There is no overall staff training matrix in place to monitor staff training. The type of training delivered is primarily done using DVDs and workbooks. Information contained in the homes Annual Quality Assurance Assessment [AQAA] identifies that four staff have a National Vocational Qualification in care at level 2 or above and that all staff have completed Skills for Care induction. Recruitment information was examined. It was raised with the Manager how on the homes application form there should be reference to the Rehabilitation of Offenders Act 1974. The reference forms used do not allow for referees to state the capacity in which they know prospective staff or for them to print their name. Staffs Criminal Record Bureau [CRB] checks are held on the homes computer. Recruitment practices do not list all the required information required by legislation. Care Homes for Older People Page 22 of 35 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 service is not being effectively managed. The daily running and overall management of the home requires improvement as there is a lack of understanding, underpinning knowledge and pro-activeness in fully meeting the National Minimum Standards for older people and compliance with legislation. Evidence: During the course of the site visit, we met with the Registered Manager and Registered owner. The Manager has worked in the home for ten years. Closer attention in the overall running of the home by the Registered Manager and Registered owner is necessary. The home is not being audited properly. The management of care records, risk assessments, record keeping, quality assurance, staffing levels and training is in need of addressing. The content of the homes Annual Quality Assurance Assessment [AQAA] that was submitted to the Care Quality Commission [CQC] prior to the inspection had gaps making it difficult to assess and measure how the home was running. This matter was Care Homes for Older People Page 23 of 35 Evidence: raised with the Manager at the inspection. Residents spoken to were complimentary about the home and the staff team. Staff members seen also conveyed how they liked working in the home. There is currently no training arranged for the Manager or staff team to receive training in the Deprivation of Liberty Safeguards [DOLS]. The last recorded staff meeting minutes were dated 7th January 2009; the content of these were brief, there was no evidence to show staff had signed or read the minutes and the regularity of these meetings is infrequent. There is a fire risk assessment dated 8th September 2005 which was examined. The content of this had not been reviewed since 2005 and there was no evidence to show how the actions identified at the time had been addressed. The fire officer must be consulted with about these fire safety matters. The manner in which staff supervision sessions are conducted requires improvement. The Manager advised based on a previous recommendation made at the last inspection that around every two-three months staff supervisions are held and that a new form had been devised in dating and collating supervisions. However from examination of records and speaking to staff; supervisions are conducted by direct observation only. The frequency of these supervisions are not enough as noted from records examined in that only three had taken place this year. The Manager has not had training in conducting staff supervisions. In respect of residents finances. The Manager described how eleven residents manage their own monies or their families. It was reported that Social Services manage one residents monies; the home send in receipts for monies spent who in turn refund the home. One residents monies are handled by the Registered owner. It was described how the Manager purchases items, submits receipts to the Registered owner who in turn refunds monies spent. Other than an envelope containing receipts and some cash there is no other formal record kept of these transactions. A letter addressed to the Manager of the home from probate researchers about this resident was seen and queried as it identified the resident no longer had capacity and was asking the Manager to act on this persons behalf, sign and return a form. The Manager advised this resident was sent another copy of the letter, which the resident signed and returned. No copy of this letter was retained and no record kept on file that a letter Care Homes for Older People Page 24 of 35 Evidence: had been sent on behalf of the resident. When the Manager was asked if residents had secure storage facilities to keep their monies safe; the response was initially unclear. It was though ultimately confirmed there were facilities in place. The Registered Persons must ensure residents monies are safeguarded. There is a need for the home to introduce clear records and protocols regarding the management, handling, safe-keeping, source and expenditure of residents monies. This must be clearly identified in residents care records. As good practice, persons working in the home should not act as agents for service users. A requirement was made at the last inspection about quality assurance systems. The information available showed positive responses had been received from relatives in Sept 2009. Some of the comments made included;- More music, maintain garden area. Provide seating area at front of property. Perhaps some outings would be lovely. Collect for Sunday services. Trust managers view on what needs doing. Lovely atmosphere, refreshments always offered, everyone appears happy and well. We feel very fortunate that we have found this home, staff look after, home is perfect, food is excellent. The home does not issue quality assurance questionnaires to residents and use to send questionnaires to other professionals although they no longer do this. The Managers response to current quality assurance practices was the home use preadmission questionnaires, review residents care plans monthly and see family members. There is no formal collation of quality assurance information or adequate auditing in this area. At the last inspection, a requirement was made for the Responsible Person to visit the home at least monthly unannounced and a supply a copy of the Regulation 26 report. It was reported the Responsible Person rings the home everyday and visits about two to three times a week. It was conveyed that on a Wednesday the Responsible Person would make notes following discussion about matters such as food and staff. A copy of the Regulation 26 report is not left in the home. The Responsible Person advised the last formal report was done about two months ago. He was requested within 48 hours following the inspection to forward a copy of the last Regulation 26 report to the Care Quality Commission [CQC]. This information was received and showed the last Regulation 26 report was in May 2009. The frequency of these visits are not as regular as they should be, a copy of the report is not available in the home and the Regulation 26 reports do not identify all issues or action taken as a result of findings. Care Homes for Older People Page 25 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 35 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 1 6 The Registered Person must 31/12/2009 review the content of the homes Statement of Purpose and Service User Guide to ensure they contain all required and up to date information. To ensure service users are fully informed. 2 3 14 The Registered Person must ensure that detailed pre-admission assessments for service users are compiled with clear plans of care based on this information drawn up. To ensure service users needs have been fully assessed. 31/12/2009 3 7 15 The Registered Person must ensure service users care plans and risk assessments contain accurate, current and detailed information in describing the assessed and 31/12/2009 Care Homes for Older People Page 27 of 35 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 changing needs of service users in all aspects of their daily living, health and social care. These must be reviewed regularly. To ensure the assessed and changing needs of service users are fully documented. 4 7 17 The Registered Person must improve upon the way service users daily records are maintained. To maintain the confidentiality of service users and quality of information 5 9 13 The Registered Person must obtain, store and record controlled drugs in accordance with The Misuse of Drugs and Misuse of Drugs [Safe Custody] [Amendment] Regulations 2007. To protect service users. 6 16 22 The Registered Person must ensure service users complaints are stored confidentially. The Registered Person must ensure all complaint protocols and procedures 31/12/2009 31/01/2010 31/12/2009 Care Homes for Older People Page 28 of 35 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 contain accurate and up to date information. To protect confidentiality and ensure up to date information is available. 7 18 13 The Registered Person must update all safeguarding policies and procedures and obtain a copy of the Sussex Multi Agency guidelines for safeguarding vulnerable adults. The Registered Person must arrange for staff to receive accredited training in the protection and safeguarding of vulnerable adults. Service users need to be protected from harm and abuse. 8 19 13 The Registered Persons must consult with the Environmental Health department in addressing the following;Attention must be given to wide window openings and the safety of service users inside and outside of the home. Robust risk assessments must be compiled identifying the action to be taken in 31/12/2009 31/12/2009 Care Homes for Older People Page 29 of 35 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 minimising risks identified. A record of the outcome of this consultation must be available in the home. To protect service users health, safety and welfare. 9 19 23 The Registered Person must audit and produce an action plan in respect of the following;The Registered Person must ensure the premises are kept in a good state of repair internally and externally. All parts of the home must be kept free from odours. A written maintenance plan must be produced including renewal of the fabric and decoration of the building. Service users must live in a home that is safe and well maintained. 10 27 17 The Registered Person must 31/12/2009 ensure an accurate staff rota is maintained identifying all staff on shift and the capacity in which they are working. 31/12/2009 Care Homes for Older People Page 30 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure service users are in safe hands at all times. 11 27 18 The Registered Person must 31/12/2009 ensure that at all times suitably qualified, competent and experienced staff are working in the home in such numbers so as to comprehensively meet service users needs. To ensure service users are fully supported and not at risk of harm or abuse. 12 28 18 The Registered Person must ensure all staff receive mandatory training and this is updated at regular intervals. The Registered Person must provide training that is based upon current practice and use appropriate accredited resources. To ensure service users are supported by an effective and well trained staff team. 13 29 19 The Registered Person must ensure all staff recruitment information is obtained prior to employment and kept in order. To protect service users. 31/12/2009 31/12/2009 Care Homes for Older People Page 31 of 35 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 14 31 10 The Registered Persons must having regard to the size of the care home, the statement of purpose, and the number and needs of service users carry on or manage the home with sufficient care, competence and skill. To ensure the home is run and managed properly. 31/12/2009 15 33 26 The Registered Person must 31/12/2009 arrange for the home to be visited once a month unannounced and prepare a written report on the conduct of the home. A copy of this report must be available in the home and a copy given to the registered Manager. There must be evidence to show how action points identified have been addressed. To ensure the service is comprehensively audited. 16 33 24 The Registered Person must introduce robust quality assurance systems. The views of service users, professionals and other interested parties should all be sought. The information collated, published and findings actioned. 31/12/2009 Care Homes for Older People Page 32 of 35 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 So that the home is run in the best interests of service users. 17 35 17 The Registered Person must 31/12/2009 introduce clear records of all monetary transactions relating to service users identifying the management, handling, source, expenditure and safe keeping of their monies. So that service users are protected from abuse. 18 38 13 The Registered Person must 31/12/2009 consult with the Fire Officer to ensure the emergency lights are in order and the content of the fire risk assessment of the building is reviewed, updated and contains all the required information. A record of the outcome of this consultation must be available in the home. So that service users health, safety and welfare is protected. Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The Registered Person should arrange for the Manager and all care staff to receive formal training in care planning, risk assessment, reporting and recording-keeping. The Registered Person should explore more ways of introducing additional, meaningful activities into the home and facilitate service users access and participation in the community. The Registered Person should ensure regular staff meetings are held. The Registered person should ensure that all care staff receive individual, regular and formal supervision at least six times a year. The Registered Person should arrange for the Manager to receive training in how to conduct staff supervisions. 2 13 3 4 32 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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