Inspection on 15/04/10 for Marray House

This inspection was carried out on 15th 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marray House 16/08/10

Marray House 03/08/10

Marray House 02/07/10

Marray House 07/12/09

Marray House 28/07/09

Marray House 23/08/07

Marray House 20/11/06

Marray House 08/11/05

Marray House 16/06/05

Marray House 24/11/04

Marray House 06/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED     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: Gail Richardson     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 36 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 36 Information about the care home Name of care home: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED 01752844488 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Enid Robertson Crofts,Mr Peter William Crofts Name of registered manager (if applicable) Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Marray House is registered to provide personal care and accommodation for up to 23 older persons. It is a detached house situated near the centre of Saltash, close to the shops, public transport and community facilities. Peoples bedroom accommodation is provided on the ground and first floors. Stair lifts are provided to assist peoples mobility. Two Communal lounge/dining rooms , kitchen and laundry areas are provided on the ground floor. Mrs Crofts has been registered as a care provider for 28 years. The fees range from 314.25 to 325 pounds per week and the fees do not include hairdressing, chiropody and newspapers. A brochure is provided for those wanting more information about the home and its facilities. 0 7 1 2 2 0 0 9 0 Over 65 23 Care Homes for Older People Page 4 of 36 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 was an unannounced inspection, which took place over one day and one evening on the 15th and 26th April 2010 by Regulation Inspectors Gail Richardson and Antonia Reynolds. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 24th July 2009 where a 1 star adequate rating was assessed. We then met with the provider and matron and requested further information from them. We received a letter from the manager on the 30th October 2009 to tell us how the requirements made at the key inspection were being met. A random inspection took place on the 7th December 2009 to follow up the requirements made at the key inspection. We have had ongoing communication with the provider/manager of the service to ascertain the management structure and responsibilities of the home. The Care Quality Commission requested the provider/manager complete an AQAA ( Annual Quality Assurance Audit ) on the 17th March 2010, which gives details of all Care Homes for Older People Page 5 of 36 aspects of the home. When this was not received, a reminder was sent with an extended date of 31st March 2010. To this date the AQAA has not been received. Further enforcement action may be taken. A tour of the home took place and some of the bedrooms and all communal areas were seen. There were 18 people currently residing at the home. We spoke to eight of the people using the service and four members of staff, the matron was available throughout the inspection. As part of this inspection we surveyed the opinions of staff members, visiting health professionals and people using the service. Two responses were received. Comments received from those surveys and, following discussion with people using the service at inspection, all comments received are included in this report. We looked at records relating to care including three care plans, two staff files, and health and safety records. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for people living in the home and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 6 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Risk assessments must be undertaken for each person in relation to diabetes, self administration of medication and moving and handling (where appropriate). Following those assessments appropriate action must be taken to ensure that people are kept safe. The registered person must ensure that all areas of identified need have an appropriate plan of care for staff to follow . This will ensure that staff are aware of all care to be provided and will also provide a clear audit of all care given. The registered person is recommended to ensure that all identified care needs noted in the pre admission assessment are transferred to the care plan so that peoples needs are met. Care Homes for Older People Page 7 of 36 Medication systems are poorly managed and may place people using the service at risk and seven requirements and two good practice recommendations have been made in this area. There is a requirement from the previous key inspection which is raised again at this inspection about the provision of social and recreational activity. The Provider is required to review activity provision to meet the social and recreational expectations of people using the service. It is evident that people at the home do not have the facility to lock their bedroom doors or have lockable storage for personal items. The registered person is recommended to provide means to store securely any personal items. The registered person is required to inform staff of the actions that should be taken to protect people using the service. The registered provider is recommended to ensure that all staff receive training in abuse awareness and protection of vulnerable adults to ensure the safety of people using the service. The registered person is required to implement a repair / refurbishment programme to all areas of the home needing repair. This is with particular reference to all of the bathrooms / shower room which pose the risk of cross infection. This is required to ensure the maintenance of an environment which is safe for use by people using the service. The management of recruitment requires further development. The registered person must ensure that all recruitment checks are in place prior to staff starting work at the home. This is required to ensure that people using the service are kept safe from harm. The registered person is recommended to provide an overview of staff training to identify any shortfalls in training updates and enable appropriate training to be provided. The registered person is also recommended to review the sleeping night provision to ensure that staff can be contacted directly. The registered person is recommended to ensure that quality assurance audits are used to promote changes to reflect the opinion of people using the service. The registered person is required to undertake a visit to the home at least once a month and produce a report to be forwarded to the Care Quality Commission reviewing the areas outlined in this regulation. This is required to enable the registered person to have an overall view of the quality of the care provided. We observed that the home does not display a copy of the last inspection report to enable people to read the outcomes from the last inspection. This is required to happen and the home is recommended to put a copy on display. The registered person is recommended ensure that regular supervision of staff is undertaken and recorded to ensure that staff are up to date with the running of the home and promote safe working practice. The registered person is required to ensure that all areas of health and safety Care Homes for Older People Page 8 of 36 management are routinely monitored and appropriate action taken to ensure the safety of people using the service. This includes the monitoring of hot water temperatures. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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 has a Service User Guide / Statement of Purpose and contract of residency to ensure that prospective people can make an informed decision about the home. Pre admission assessments are undertaken by the home. These assessments are adequate but more detail is recommended to be included. Evidence: The home has in place a Service User Guide / Statement of Purpose to enable prospective people using the service and their relatives/representatives to make a decision about the home. This was not examined at this inspection as we were advised that no changes had been made since the last key inspection. We examined one care record of a person recently admitted to the home. We saw that the pre admission assessment had been developed to include more areas of review. This means that the person undertaking the assessment will gather more detailed Care Homes for Older People Page 11 of 36 Evidence: information to make an informed decision about if the home can meet the persons needs. We recommended that further information be included about peoples social and spiritual preferences. The home is required to ensure that it continues to be able to meet the needs of people admitted to the home. Staff training records indicate that there has been training undertaken for most staff in moving and handling and medication administration. We found that there are areas such as diabetes which staff have not received training in. Staff who spoke with us did not demonstrate confidence in the care and management of diabetes. Staff training is needed to ensure that staff both individually and collectively have skills and experience to deliver the services and care that the home offers to provide. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Risk assessments of important areas of care are not undertaken and insufficient plans of care are in place to ensure the safety of people using the service. Care plans lack detail and are not person centred. Medication systems require further review. Staff were observed to treat people with dignity and respect at all times and people feel well cared for. Evidence: We looked at three care plans, two of which were for people who have specific diabetic related care and areas of risk relating to moving and handling and falls. The care plan for each person is a single page document which includes the areas of identified need and limited instructions for staff. This one page document is not detailed and does not provide a person centred approach to care planning. It does not include clear aims and directions for staff to be aware of specific care needs. Currently the staff know these preferences but should staff not be available this may mean that people do not get the care they want. Care Homes for Older People Page 13 of 36 Evidence: We noted that two people using the service did not have relevant risk assessments relating to diabetes or self-administration of medication, moving and handling, risk of falls and pressure areas. Specific care needs such as diabetes did not include signs and symptoms to observe for, routines to manage insulin and diet and what to do in an emergency situation. Relevant care plans did not have a risk assessment for the self administration of medication to ensure that this was safe practice and how this is reviewed to ensure ongoing safety. We noted that staff were advised in the care plan that a person needed help with personal care. The care plan did not say what that help should be. It was seen that information obtained in the pre admission assessment for one person had not been transferred to the care plan and so no action to continue that area of care had been undertaken. There is no evidence that the person being cared for or their relative/ representative has been involved in care planning or agreed with the content. There was no documentation to show that care plans had been reviewed and updated to reflect any changes. We saw that in one instance changes in the persons care had been noted but the care plan did not reflect how staff should meet these needs. This may place the person using the service at risk. Equipment is provided where there is an assessed need, the home has hoists for moving and handling . The Matron told us that the home has a good working relationship with visiting District Nurses who assist to provide equipment needed. It was evident that improvements had been made in the management of cross infection with hand wash and paper towels being available in bathrooms. We spent time observing the care being given and noted that the members of staff treated people using the service with dignity and respect . The home employ both male and female staff to support any gender preferences for care. Two people using the service told us that staff spent time talking whilst undertaking tasks. One person told us that staff did not visit to just spend time with them. One visiting health professional told us that Staff always seem to be happy, clients always appear clean and cared for and generally happy in their surroundings. We discussed with the Matron that people did not have the facility to lock their bedroom door should they want to. This must be reviewed as people may want this facility. Any lock provided must be accessible by staff in an emergency. We also noted that nobody has any access to lockable storage in their rooms for personal items or medication. The home has a policy that states where a resident self medicates Care Homes for Older People Page 14 of 36 Evidence: medication must be kept in a locked cupboard. The medication systems were not well managed and may place people using the service at risk. Two people self administer their medication. No risk assessments were in place to ensure that this was safe practice. An Immediate Requirement was made to rectify this shortfall. Some medications are stored in the food fridge and are identified but not secured, this is recommended to ensure the safe storage of all medications. Some prescribed creams are not consistently clearly labelled and it was clear that in one instance a label had been removed and a name written on. All prescribed medication are for the person prescribed for and medication must not be re appropriated. One prescribed cream was incorrectly stored in the fridge and had expired its shelf life. These areas must be addressed to ensure the safety of people using the service. Creams stored in peoples rooms are not consistently signed for when administered, this is needed to ensure a clear audit trail of prescribed medications. Creams in peoples rooms are also not dated when opened. This is needed to ensure that the creams shelf life when opened is not exceeded. It is noted both at the previous inspection and again at this inspection that when staff are required to hand transcribe medications onto the administration record, that two staff sign the record. This will ensure that there is no risk of error in transcribing. The Medication Administration Records were seen to have gaps on some days when staff had not signed or provided the coded indicator to inform why the medication had been omitted. This means that it is not possible to say for certain that all medications had been given as prescribed. In some instances medication were signed for when the person was not at the home. Another instance showed a weekly medication being administered twice in one week. Medication Records need to be audited regularly to ensure that staff are following the correct administration procedure and people are getting the medications they are prescribed. One person was being administered a cream they were not written for on the Medication Administration Record. A further person had direction for medication administration which did not specify the names of the tablets to be given. This practice may place people at risk and must be reviewed by the management of the service. The home does not have suitable storage for controlled medications and is advised to address this with secure and appropriate storage Care Homes for Older People Page 15 of 36 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. The home provides some activities and people have the choice of participation. Contact with the community is maintained and visitors to the home are welcome. The meals provided are enjoyed by the people using the service and a choice is available. Evidence: The home does not employ a designated activity coordinator and does not provide specific staff time to provide activities. Staff undertake this role as part of their care duties. This area of provision has not developed or changed since the last key inspection. People using the service were seen to be mostly in their bedrooms. Three people were sat in the main lounge either sleeping or watching the shopping channel on TV. They told us that some entertainment was provided but couldnt recall what it was. Another person told us that There is not as much activity provided as there used to be. Another told us that they did not visit the lounge because there was nobody there to chat with and nothing to do. People told us that they were not taken out of the home on trips or outings unless by their families. There is limited garden or suitable outdoor Care Homes for Older People Page 16 of 36 Evidence: space available for people using the service to sit. The Methodist Minister visits each month for a Service and Holy Communion. A group from a Gospel Hall had also visited the night before. Activity provision is not planned or recorded to be used to promote person centred activity provision. Activities provision needs to be addressed and improved to ensure that people using the service have a lifestyle which reflects their preferences and satisfies their social, cultural and recreational needs. People told us that they could get up and return to bed when they wanted. They were supported to choose their own clothes and sit where they wanted to in the home. The home has now risk assessed access through the kitchen and so people using the service and relatives are required to knock on the kitchen door and wait to be assisted through the kitchen to each side of the house. There is no provision for seating or call bell should the delay be prolonged. It is evident that people at the home do not have the facility to lock their bedroom doors or have lockable storage for personal items. The registered person is recommended to provide means to store securely any personal items. We observed lunch being prepared and served. The meal looked and smelt appetizing and people told us that the quality and variety of food was very good. The menu is set by the Matron with some input from people using the service. People told us that they always have a choice of meal. Breakfast is served either in peoples bedrooms or the dining room. Lunch is the main meal of the day and the evening meal is a lighter snack type meal. People told us that they could ask for hot drinks and snacks should they want them. We observed that the kitchen cleaning routine had not been followed and the kitchen did not appear clean in all areas. The registered person is recommended to ensure that cleaning be undertaken to ensure a good standard of hygiene . We observed that large handled cutlery was used were needed and that staff cut up peoples food in the kitchen, should they need it. Care Homes for Older People Page 17 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that they are listened to and their requests and concerns acted upon. Staff training in abuse awareness has not been undertaken by all staff. Policies and procedures to be undertaken should an allegation of abuse be made are not accurate and this combined with a lack of training may place people at risk. Evidence: The home has a complaints policy which includes timescales for responses and contact details. The complaints procedure is now displayed in the homes public area. Staff told us that if they had any concerns they would raise them with the Matron and would be confident that appropriate action would be taken. Three people using the service told us that they would raise any concerns with the staff. All people using the service are registered to vote in any forthcoming elections and an independent advocacy service is accessed for people who require this service. We were advised in writing on 22/10/09 by the manager that The home has a policy of Cornwalls Safeguarding vulnerable Adults and the action to be taken by staff are displayed in the staff area and are reinforced through regular staff supervision. The home has an abuse awareness policy which is one page long and does not supply staff with correct information about what action to take should an allegation of abuse be made. The registered person is recomended to update this policy to reflect current practice. Care Homes for Older People Page 18 of 36 Evidence: Staff supervision records were also not available to identify what information had been provided for staff. Staff training in abuse awareness is limited . Three staff have received abuse awareness training and we are advised that further training is planned. This inaccurate policy together with limited staff training may place people using the service at risk. Care Homes for Older People Page 19 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people with a homely place to live. Repair/ refurbishment is needed to ensure that the home does not pose a risk of cross infection or hazard to people using the service and staff. Evidence: There have been no significant changes to the environment since the last key inspection and so some observations remain the same. The home is a large older building, which has been converted and extended. There are two communal lounges / dining rooms and a smaller conservatory. These areas are adequately furnished and decorated but appear dated. Personal accommodation is located on two of the 3 floors of the home and is accessible to people with levels of mobility that are accommodated by stair-lift and stair access. The home has built a small conservatory to the front of the home. This is limited in use because it is not heated in winter and no blinds are available in summer. As we raised in Outcome group 3, access from one side of the house to the other is only available through the kitchen and staff area. This must be supervised as there are health and safety considerations. All bedrooms seen varied in size and were comfortably furnished and had been Care Homes for Older People Page 20 of 36 Evidence: personalized to reflect the tastes of the individual person. People are able to bring personal effects and small items of furniture with them when they move to the home, which gives rooms an individual homely feel. Free standing wardrobes were observed to not be fixed to the wall and may pose a tip risk. This is recommended to be risk assessed and the appropriate action taken to remove any risk. This recommendation was raised at the previous key inspection and has not been actioned. The home appears to be in need or a programme of repair/ refurbishment . All bathrooms were in need of refurbishment. A bath hoist is only available on one side of the home and so people were observed to transfer down one floor and across the home (through the kitchen) and up one floor to access the bathroom which had the only suitable hoisting equipment. The extension was built circa 1980 and it would appear that little has changed since then. Bathrooms, showers and toilets need major renovation to bring them up to modern hygiene standards and many areas would benefit from re-decoration. At the previous key inspection we observed, In one toilet there was observed to be three pairs of soiled scissors on the window ledge. This may pose a risk of injury or cross infection and must be removed and this practice reviewed. We note that at this inspection one pair were still there.We observed that each toilet has a sign advising people to wash their hands. However, sinks are not available in communal toilets and people would have to walk to the nearest bathroom to wash their hands. The standard of hygiene at the home was noted to be good with no significant malodours. A visiting health professional told us I would always like to see liquid soap and paper towels in each room. This was required at the last key inspection to minimise the risk of cross infection. The outside garden area is paved and stepped and would allow limited access to people with any level of disability of movement or wheelchair usage. Care Homes for Older People Page 21 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs enough staff to meet the needs of the people using the service. Recruitment procedures are poor and require development to ensure that people are kept safe. Staff training is ongoing and some improvements were seen. People benefit from having experienced staff who have a good understanding of their needs. Evidence: On the day of inspection there was the matron in charge, three care staff and one cook, one of the care staff moved on to laundry duties mid morning. A cleaner was not on duty but the matron told us that the cleaner worked three days a week. Each afternoon there is a matron, two carers 2pm until 8pm, a further carer works 6pm to 8pm. Over night there is one waking staff and one sleeping staff on call. It is evident that the accommodation for the sleeping staff does not have any call facility. This means that the waking staff member may have to leave the people using the service to get help rather than being able to contact them directly. This areas needs ot be reviewed to ensure the safety of people using the service. The staff on duty told us that there were enough staff to meet peoples needs. We were told that agency staff are never used. People living at the home told us that the staff were very kind and helpful . One Care Homes for Older People Page 22 of 36 Evidence: person told us You wont find any complaints about the staff. A relative survey told us that the staff are very friendly and There is good food, very good laundry service and clothes always look good. The home do not have a staff training overview available, however, staff training records have been updated to reflect that most staff have done moving and handling, fire and medication training. Further training is planned. Certificates displayed on the hallway walls were mostly out of date. Training is needed in areas specific to peoples needs, such as diabetic care and dementia care to ensure that staff can meet peoples needs. The home has staff who have achieved a National Vocational Qualification in care. There are no up to date records available to identify how many staff have completed NVQ training. The staff induction has been developed to include the areas identified in the Skills for Care Common Induction Standards.We looked at one staff induction file and spoke with the staff member who told us that she had been supervised for a two week period prior to working alone at the home. 2 recruitment files of the most recently recruited staff were examined. The recruitment procedures are poor and require further development to ensure that they do not place people at risk. One application and Declaration of Rehabilitation of Offenders Act had not been signed or dated. In one instance no employment history was available before March 2009 . This lack of information means that the manager cannot make an informed decision about the suitability of staff by their experience. Furthermore the manager cannot establish if the person is safe to work with vulnerable people. The recruitment files did not contain job specifications, contracts of employment, interview records or medical checks. The photos stored were not clear likenesses of staff. References were received but were not dated when received to prove that they had been received prior to people starting work at the home. One staff member was noted to have started work one day before the Protection of Vulnerable Adults check had been received. Currently staff are supervised in the period between the POVA check and the Criminal Record Bureau Check is received. This is not recorded and so is not able to provide an audit trail of safety to ensure the people using the service are not placed at risk. Care Homes for Older People Page 23 of 36 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. Management of the home is not robust. Areas require development to ensure the home adheres to safe practice for the protection of people using the service. Health and safety monitoring requires development to promote prevention from the risk of harm. Storage of records is secure and in line with the Data Protection Act. Evidence: The provider/manager delegates the management of the home to senior carers who work as a Matron and senior carer. Neither post is registered with the Commission. The manager does not work designated hours at the home and has limited input in day to day running of the service. The management of risk assessment, care planning, medications and recruitment may place people using the service at risk. The provider / manager must ensure that these areas are addressed and made safe. Care Homes for Older People Page 24 of 36 Evidence: The home implemented a quality assurance audit in May 2009. No surveys were dated. There was no audit of results and plan of action as result, available at that time. We were advised that further review of quality in the format of questionnaires had been undertaken but could not be found. We are told that the provider/manager visits the home regularly but there were no Regulation 26 reports available to view the registered persons audit of the quality of the service. We observed that the home does not display a copy of the last inspection report to enable people to read the outcomes from the last inspection. This is required to happen and the home is recommended to to put a copy on display. We noted that records appear more secure and that the use as a diary for shared personal information has been discontinued. Care plans now appear to be stored in lockable cupboards in the kitchen area. The Matron was not able to find the supervision records for staff. She told us that no supervision had taken place this year. Supervision is required to be undertaken to identify staff training needs and promote good practice. Accident records are maintained and the level of accidents seen would not warrant regular review at this time. Should there be an increase in the level of accident reviews would be necessary. We noted at the previous inspection that some free standing units such as wardrobes were unstable and may pose a risk of tip/tilt injury and must be risk assessed and appropriate action taken to ensure there is no risk of injury to people using the service. Records were examined with reference to safe working practices. Most records were well maintained and documented. Most maintenance certificates were up to date. The hard wiring certificate is out of date and needs to be addressed. Some routine checks had been undertaken, but no action taken to address shortfalls. This is with reference to hot water checks which had not been checked since January 2010 when it was demonstrated that the water temperatures in some places exceeded the health and safetys guidance on upper limits.This may pose a risk of burns and scalds to people using the service and must be addressed. We observed that two boilers were accessible to people using the service. These areas should have limited access to ensure that settings are not adjusted. All health and safety checks must be undertaken and recorded to promote the safety of people using the service. Care Homes for Older People Page 25 of 36 Evidence: We observed that substances hazardous to health were stored in an unsecured way in three areas. On two occasion solutions were stored in unmarked bottles which did not display any risks or guidance for the solutions. This may pose a risk of accidental ingestion . An Immediate Requirement was issued that these substances be stored securely with immediate effect. On our second visit we found the storage of these substances to be secure. The registered person is further recommended to ensure that toiletries left in bathrooms are not shared to reduce the risk of cross infection. Care Homes for Older People Page 26 of 36 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 12 16 The registered person is required to ensure that a programme of activities is planned for the recreation and enjoyment of people using the service. The programme is required to include social interaction for all people using the service at a level of their participation and enjoyment. 17/09/2009 2 19 12 The registered person is 20/11/2009 required to implement a repair / refurbishment programme to all areas of the home needed repair. This is with particular reference to all of the bathrooms / shower room which pose the risk of cross infection. This is required to ensure the maintenance of an environment which is safe for use by people using the service. 3 30 18 The registered person must ensure that staff training is provided for all staff to ensure that they remain updated on current good practice. This is needed to ensure that people using the service 22/10/2009 Care Homes for Older People Page 27 of 36 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 receive a good standard of care which promotes their safety and wellbeing. Care Homes for Older People Page 28 of 36 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 1 7 15 Risk assessments must be 20/05/2010 undertaken for each person in relation to diabetes, self administration of medication and moving and handling (where appropriate). Following those assessments appropriate action must be taken to ensure that people are kept safe 2 38 12 The registered person is required to ensure that all substances hazardous to health are stored securely. This is required to ensure that there is no risk of accidental ingestion. 21/05/2010 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 areas of identified need have an appropriate plan of care for staff to follow . This will ensure that staff are aware of all care to be provided. This will also provide a clear audit of all care given. 20/05/2010 Care Homes for Older People Page 29 of 36 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 2 9 13 The registered person must ensure that medications are signed for correctly. This will mean that procedures are correctly folowed and medication adminstered safely 20/05/2010 3 9 13 The registered manager 21/05/2010 must ensure that all medications which are given to epople for self administration are recorded. This is required to ensure that there are records of medications provided and will provide a clear audit trail of medications taken. 4 9 13 The home does not have suitable storage for controlled medications and is advised to address this with secure and appropriate storage This will mean that should the storage be required at short notice the facility is readily available. 21/05/2010 5 9 13 All prescribed creams must be stored correctly at the right temperature and for their shelf life only. Medications prescribed for one person must not be re 21/05/2010 Care Homes for Older People Page 30 of 36 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 appropriated to another person. To remove labels and write names on boxes, may place people at risk of harm 6 9 13 When staff are required to hand transcribe medications onto the administration record, that two staff sign the record. This will ensure that there is no risk of error in transcribing. 7 9 13 The registered person must ensure that all medication prescribed are signed for when given or the required coded indicator used to explain reasons when not given. Gaps in the Medication Administration Record must be completed to ensure that there is a clear record of all medications administered. 8 29 18 The registered person must ensure that all recruitment checks are in place prior to staff starting work at the home. This would include and recent photograph, that all documents are signed and dated when received. That a full and detailed 20/05/2010 21/05/2010 20/05/2010 Care Homes for Older People Page 31 of 36 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 employment history is obtained with reasons for leaving the last employer and that Protection of vulnerable adults checks are received prior to the staff member starting work. This s required to ensure that people using the service are kept safe from harm 9 31 12 The provider/manager is 21/05/2010 required to undertake audits of the home with relation to risk assessment, care planning, medications and recruitment. This is required to ensure that the quality of service is safe. 10 33 26 The registered person is 21/05/2010 required to undertake a visit to the home at least once a month and produce a report to be forwarded to the Care Quality Commission reviewing the areas outlined in this regulation. This is required to enable the registered person to have an overall view of the quality of the care provided. 11 38 12 The registered person must ensure that hot water outlets are monitored and 21/05/2010 Care Homes for Older People Page 32 of 36 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 that they do not exceeded the health and safetys guidance on upper limits. This is required to ensur ethat people using the service are not at risk of burns and scalds. 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 is recommended to include within the pre admission assessment peoples choices and preferences of social interests, hobbies, religious and cultural needs. This will enable the manager to make an informed decision if the persons needs can be met by the service. The registered person is recommended to include sufficient detail within each care plan to ensure that they are person centered and people receive their specific choices and preferences. The registered person is recommended to ensure that all identified care needs noted in the re admission assessment are transfered to the care plan so that peoples needs are met. Creams stored in peoples rooms are not consistently signed for when administered, this is needed to ensure a clear audit trail of prescribed medications. Creams in peoples rooms are also not dated when opened. This is needed to ensure that the creams shelf life when opened is not exceeded. Some medications are stored in the food fridge and are identified but not secured. This is recommended to be addressed to ensure the safe storage of all medications. It is evident that people at the home do not have the Page 33 of 36 2 7 3 7 4 9 5 9 6 14 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations facility to lock their bedroom doors or have lockable storage for personal items. The registered manager is recommended to provide means to store securely any personal items. 7 15 The registered person is recommended to ensure that cleaning is recommended to be undertaken to ensure a good standard of hygiene in the kitchen. The registered manager is recommended to ensure that all staff receive training in abuse awareness and protection of vulnerable adults to ensure the safety of people using the service. The registered person is recomended to update the homes safeguarding adults policy to reflect current practice. The registered person is recomeded to review the sleeping night provision to ensure that staff can be contacted directly. The registered person is recommended to provide an overview of staff training to identify any shortfalls in training updates and enable appropriate training to be provided. The registered person is recommended to record how staff are supervised and by whom when they start work with a Protection of Vulnerable Adults check in place but the Criminal Record Bureau check has not yet been received. The registered person is strongly recommended to ensure that staff recruitment files contain a contract of employment, job specification, interview record and medical history. A clear photograph of the staff member is also needed. We observed that the home does not display a copy of the last inspection report to enable people to read the outcomes from the last inspection. This is required to happen and the home is recommmeded to to put a copy on display. The registered person is recommended to ensure that quality assurance audits are used to promote changes to reflect the opinion of people using the service. The registered person is recommended to ensure that regular supervision of staff is undertaken and recorded to Page 34 of 36 8 18 9 10 18 27 11 29 12 29 13 29 14 31 15 33 16 36 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations ensure that staff are up to date with the running of the home and promote safe working practice. 17 38 The registered person is recommended to ensure that toiletries left in bathrooms are not shared to reduce the risk of cross infection. The registered person is recommended to ensure that boilers are not accessible to people using the service and public visiting the home. This is recommeded to pevent people altering the temperature of hot water delivery. The registered person is recommended to risk assess all free standing units and ensure that any tip risk is addressed. 18 38 19 38 Care Homes for Older People Page 35 of 36 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. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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