Inspection on 28/07/09 for Marray House

This inspection was carried out on 28th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 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 15/04/10

Marray House 07/12/09

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 15/11/2009.

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:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gail Richardson     Date: 2 8 0 7 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 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) 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 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): Type of registration: Number of places registered: Mrs Enid Robertson Crofts,Mr Peter William Crofts 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 ( Awaiting confirmation of accuracy as of July 2009 )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. The previous inspection report is available in the entrance foyer. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over one day on the 28th July 2009 by Regulation Inspector Gail Richardson. 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 23rd August 2007. An Annual Service Review was undertaken on 30th August 2008. No visits to the home have taken place in the interim period. As part of the Inspecting for Better Lives Program we can use Experts by Experience. In this instance the Expert by Experience arrived at 10:30am and left the home at 13:40pm and was asked to look at specific areas of practice at the home. The observations and comments made as a result of the visit are included in the body of Care Homes for Older People Page 5 of 36 this report. 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 most 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. Moderate levels of 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, finances and health and safety records were examined. 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 service users 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: The registered person is required to ensure that there is a clear record of any pre admission assessments undertaken. This record must be signed and dated and used to develop a plan of care for that person. The care plan is required to be detailed and person centered. The registered person must ensure that the person using the service or their relative/ representative is involved and in agreement with the plan of care. The records maintained for people must be signed by the staff completing them and stored securely. The registered person is also recommended to include further detail to the contract of residency to clarify the fee scale for the room to be occupied. The registered person needs to ensure that medication systems are robust in all areas to ensure the safety and protection of both people using the service and staff. It is necessary that people are given the choice of a lock on their doors to ensure their right to privacy. A planned programme of activities for each person is required that supports each persons choices and preferences. These activities should be recorded to develop and promote the participation and enjoyment of activities for all. The registered person must address areas shortfalls in areas of adult protection. This must involve displaying a complaints procedure, having the appropriate policies for staff to follow and ensuring that all staff have the appropriate abuse awareness training. Care Homes for Older People Page 7 of 36 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. The risks of cross infection identified in the report with reference to the use of buckets to store and transport urine must be addressed. Further risks in the environment such as tip hazards for tall furniture and the practice of transporting people through the kitchen to access the other side of the home must also be risk assessed and appropriate action taken. Staff recruitment , induction, supervision and training records must be updated to ensure that all records are in place. They must be updated and provide a clear audit of training and supervision needed to ensure the safety of people using the service. The registered person must ensure that health and safety issues are addressed. These include hand washing facilities being made available for staff to prevent the risk of cross infection. Wheelchairs not being used without footplates. The monitoring of emergency lighting, hot water and call bells to ensure the safety and wellbeing of people using the service. The registered person must also ensure the correct recording and monitoring of accidents to promote accident prevention. As part of the monitoring of the home the registered person must ensure that the Commission receives the correct Regulation 37 notifications under the scope of notifications. Further monitoring is also needed in the form of Regulation 26 visits and reports by the Responsible Individual which must be forwarded to CQC. 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 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 9 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. We are unable to identify that these have been completed to ensure that all needs are identified and can be met prior to admission. 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. One relative told us that they had visited the home and chosen the room to be used. Each person has a contract of residency with the home. This contains details of the fees charged and the terms and conditions of residency to ensure that people are clear Care Homes for Older People Page 10 of 36 Evidence: about the service they are paying for. The contract is recommended to include the room number contracted to, as room costs vary depending on the size and position of the room. We examined two care records of people recently admitted to the home. We were told by the Matron that the other Matron completed most pre admission assessments and these were recorded straight into the care file. There are no records available to confirm that the pre admission assessments take place. However one visiting health professional did tell us that the home Makes sure they have the full medical information about a patient. There is no signed and dated assessment of identified needs to ensure that the home can meet those needs prior to admission. The home is required to ensure that it continues to meet the needs of people admitted to the home. Staff training records indicate that there has been very limited training updates for staff at the home. Areas of mandatory training such as moving and handling, infection control and first aid have not been updated and this may place people using the service at risk. People were all complementary about the care provided. They told us that they felt staff were capable and caring and could meet their care needs. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans lack detail and are not person centred. Communication of information is not consistent. 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 closely at three care plans, two of which were for people who had recently been admitted to the home. The care plan system consists of a diary which care staff write a daily record in for the handover of information. The Matron then transfers this information to the weekly record. This record contains any changes and includes visits from visiting health professionals. Any changes are then updated on the care plan. The care plan for each person is a single page document which includes all the areas of identified need. This one page document is not detailed and does not provide a person centered approach to care planning. It does not include clear aims and directions for staff to be aware of specific care needs and promotion of Independence and choice. Currently the staff know these preferences but should staff not be available this may mean that people do not get the care they want. Risk assessments Care Homes for Older People Page 12 of 36 Evidence: for mobility and risk of falls had been completed but in one instance not reviewed or updated. It was evident from cross referencing the dairy with the weekly record that not all detail is transfered from the diary and this may place people at risk. It was identified that two falls, a skin injury and an episode of loose bowels was not transfered to the daily record or the care plan. The Matron told us that a daily record is not maintained consistently if nothing happens. The daily records are dated but not signed. These are legal documents and must be signed after each entry. 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. The care plans also include a social record which is updated by care staff. This record includes any religious preferences and how these have been supported. This was also not consistently completed and in one instance nothing had been recorded for a person since April 2009. Equipment is provided where there is an assessed need,the home has hoists for moving and handling and pressure relieving cushions were observed to be used. The Matron told us that the home has a good working relationship with visiting District Nurses who assist to provide equipment needed. Wheelchairs were observed to be used . In some instances stored wheelchairs did not have footplates attached and staff must ensure that these are not used as this may pose a risk of injury to people using the service. It was observed that the systems in place for hand washing and infection control did not promote infection control. Staff wear gloves to provide care and then remove and place the gloves in a secured bin liner on the floor they are working for later collection and disposal. There are no current facilities in each area for staff to access hand wash and paper towels. There are used soap and hand towels available belonging to the person receiving the care. This may pose a risk of cross infection. Furthermore staff were observed to be moving breakfast dishes to the kitchen when not having washed their hands. The staff toilet did have hand wash but had one hand towel for all staff to use. The hand washing systems must be addressed to ensure that there is no risk of cross infection. Two people were observed to use a bucket to store urine in their rooms. An alternative is recommended to be sought to promote dignity and ensure there is no risk of cross infection. The Expert by Experience noted, In their bedroom a resident pointed to a lidded bucket containing urine saying, One of the biggest problems here is getting rid Care Homes for Older People Page 13 of 36 Evidence: of urine. and The entrances were secure but lacked antiseptic hand gel for the use of visitors. The only hand drying facilities at washbasins were communal cloth towels. We spent time observing the care being given and noted that the members of staff treated people using the service with dignity and respect . People using the service appeared relaxed in the company of the staff and the atmosphere was calm. The home employ both male and female staff to support any gender preferences for care. Staff told us that the home does well by, Keeping everybody well and happy and makes sure everybody is happy with all the meals and Makes sure the residents are fed cleaned and looked after. One visiting health professional told us that I have always found the staff at Marray House to be extremely helpful and efficient. Marray House are flexible and usually meet low level needs very well. 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. The medication systems were mostly well managed. The home uses a pre packed system and medication Administration Records were clear and are audited by the Matrons. All staff administering medications had the correct training. One person self administers their medication. There is no lockable storage provided by the home and also medications stored in the food fridge are identified but not secured. This is recommended to be addressed to ensure the safe storage of all medications. Creams stored in peoples rooms are not 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 also recommended 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. All procurement to the home and disposal of medications are clearly and safely managed. Care Homes for Older People Page 14 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. The Expert by Experience spent time discussing this area with people using the service and noted. The matron responsible for activities was not on duty at the time of the inspection. According to residents, two days previously a new singer had visited and is said to be due to return in one month. During the morning two residents were seen sat silently in front of a television in one of the two lounges not really watching a programme about home improvements. One person recalled, We had a visit a while ago from a very energetic lady who threw beanbags. Care Homes for Older People Page 15 of 36 Evidence: A resident said, I dont go down to the lounge very much as there is no conversation as we have nothing in common. Another, when their attention was drawn to the stock of videos said, matron used to play them when there was nothing on television but hasnt done so lately. The Methodist Minister visits each month for a Service and Holy Communion. A group from a Gospel Hall also visit monthly for a Service. Reference was made to an enjoyable Christmas visit by the Saltash Singers. Several people said, Its boring here and Nothing much happens here. One person said, I get up, have breakfast, have mid-morning tea, have lunch, mid-afternoon tea, supper and go to bed. Staff surveys received prior to the inspection told us that the home could do better by, Trying to find new approaches to encourage residents to partake in different activities. Would be nice for the residents to be able to do more outings, especially in the summertime if they wanted to. Take the residents out on trips and some activities to keep them active. It was noted within the care records that staff record social activity. This record was variable and was not used to record the levels of participation and enjoyment. This should be used to develop further person centered activity provision. Some people records had not been updated regularly and one person had no social record since April 2009. The Expert observed that There was no visible evidence of carers engaging with residents beyond the essentials of their tasks. Most of the time (but not always) staff were seen and heard to knock on bedroom doors before entering. No evidence was seen of personal care being given with doors open. All residents seen were clean and dressed in clean clothes. Without exception all spoken with made favorable comments about the laundry service. The bedrooms visited were clean and personalised to a great degree. One resident has a pet budgerigar and another enjoys accessing the Internet on a laptop computer and receiving visitors for whom there is a stock of beer. Some say they read a lot or watch television. Several residents said they are given breakfast in their rooms, variously at 6am, 6.30am or after 8.30am. All stated that the times were of their own choice. Without exception people were of the opinion that they awoke and retired at times of their own choosing. Care Homes for Older People Page 16 of 36 Evidence: As part of the inspection the Expert by Experience spoke with people about the meals and the dining experience. The Expert also stayed for lunch to sample the meal and have time to talk with people during lunch. The Expert by Experience told us, The building was previously two houses (now joined by the kitchen area) and has 2 separate lounges each with a dining area. It seems that residents keep to the lounge on their side of the building possibly as the only visible internal access between the two original houses is via the kitchen and staff area. It was noteworthy that conversation flowed between diners in the dining area with four covers whilst in the larger one (with two tables and 10 covers) the meal was consumed largely in silence despite attempts at stimulation by the writer. The staff had to serve meals to 10 diners in two separate dining rooms and also to 8 residents who chose to eat in bedrooms spread over two floors in two buildings so it is not surprising that they did not have time or opportunity to engage with the diners beyond the necessities of food service. The televisions in both lounges were off during lunchtime. People spoke well of the food saying, Food is very good, Overall food is good, I like all the food, Food very good - cant grumble, Im happy with all the food and from a person who eats in a first floor bedroom It is always good and nice and hot. On the day of the inspection the lunch was an excellent meal of roast beef, Yorkshire pudding, roast potatoes, cabbage and parsnips. The plates were hot as was the food. For dessert the choice was prunes, ice cream or junket with nutmeg all served with or without Cornish clotted cream. Everyone in the dining rooms cleared their plates and indicated that this was the normal standard for the food. After lunch the menu for the next days lunch and tea is announced with an alternatives being available if necessary. A full roast is served three times a week. People said that from time to time the cook seeks suggestions for future menus. The evening meal is a lighter meal and supper is also available. People were seen to have drinks in the rooms and in the lounges and people told us that they could always ask for a cup of tea if wanted. The home employs two cooks, on the day of inspection it was identified that the cook has not completed the basic Food Hygiene Certificate. This was not known to the matron of the home. 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 , policies and procedures to be undertaken should an allegation of abuse be made are not in place and may place people at risk. Evidence: The home has a complaints policy which includes timescales for responses and contact details. The complaints procedure was not seen to be displayed in the homes public areas and is recommended to be displayed to enable access to all. Both people using the service and staff told us that if they had any concerns they would raise them with the Matrons and would be confident that appropriate action would be taken. One staff told us that should a concern be raised they would tell the Matron. That person and also the matron on duty had not received any recent POVA training. 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. The homes AQAA (Annual Quality Assurance Audit ) states Staff have received POVA and NVQ training. Staff training records were unclear as to who had received training and what updates Care Homes for Older People Page 18 of 36 Evidence: had been undertaken. The last POVA or abuse awareness training undertaken by four staff is recorded as 2006. No records were available to confirm how many staff had completed a National Vocational Qualification and if this area had been updated since receiving the qualification. The home has an abuse awareness policy which is one page long and does not supply staff with sufficient information about what action to take should an allegation of abuse be made. The home does not have a copy of the Safeguarding Vulnerable Adults in Cornwall Policy and is required to access this local policy and inform staff of the actions that should be taken to protect people using the service. 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. Equipment is provided where there is an assessed need. 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. The standard of hygiene with reference to hand washing facilities must be reviewed to ensure that an appropriate standard is achieved in all areas of the home. Evidence: 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. Personal accommodation is located on two of the 3 floors of the home and is accessible to people with all levels of mobility. Stair-lift and stair access is available to each floor. The home has built a small conservatory to the front of the home and has replaced some carpets. They have also purchased a new boiler on one side of the home. The homes AQAA states that, Residents can move around the home safely. 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. Care Homes for Older People Page 20 of 36 Evidence: A visiting health professional told us that the home could do better as Decor is not very cheerful. and No separate office, kitchen used and The whole building looks generally tired and could do with brightening up. All bedrooms seen varied in size and were comfortably furnished and had been 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. Some rooms are registered for two people but are used by one. People told us that in these instances they would choose not to share. Various aids and adaptations have been put in place to assist people to maintain their independence. Specialist pressure relieving cushions were seen were there was a need. 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 whch 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. One staff member told us the home could do better by Spend more money on rooms and buildings. Another service user survey said that their Room could be decorated. 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. The standard of hygiene at the home was noted to be good with no significant malodours.Surveys from people using the service said the home was always clean and fresh. The outside garden area is paved and stepped and would allow limited access to Care Homes for Older People Page 21 of 36 Evidence: people with any level of disability of movement or wheelchair usage. One visiting health professional commented Lovely garden however no access for patients, could be made bigger. Care Homes for Older People Page 22 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 require development. Staff training is not well recorded and would appear to be mostly out of date. 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 most days Monday to Friday. Each afternoon there is a matron, a carer 2pm until 8pm, a further carer works 6pm to 8pm. Over night there is one waking staff and one sleeping staff on call. The staff on duty told us that staff turn over is low and that there were enough staff to meet peoples needs. We were told that agency staff are never used. The Expert by Experience noted. The call bell response time was said to usually be within 5 minutes but longer when they are busy. The Expert by Experience noted, Comments made about the staff included, They cant get the staff cos the pay is so low, Most are alright, Staff extremely good and gentle, We are well looked after here, Kind and gentle - nothing to grumble about Care Homes for Older People Page 23 of 36 Evidence: here, and Happy with everything. The people using the service benefit from staff who know their needs well, but there is a risk that a lack of updated training may create a risk to people who are admitted with different needs. The home do not have a staff training overview available and staff training records are not updated. Certificates displayed on the hallway walls were mostly out of date. Some staff told us that they had not received mandatory training updates. The home has staff who have achieved an National Vocational Qualification in care. There are no up to date records available to identify how many staff have completed NVQ training. There was evidence that two staff have completed an induction process. The induction was recorded as taking one day and is a single page checklist compiled by the home. There was no detail included of the areas covered and is recommended to be developed to include the areas identified in the Skills for Care Common Induction Standards. 2 recruitment files of the most recently recruited staff were examined. The recruitment procedures require further development. One application and Declaration of Rehabilitation of Offenders Act had not been signed or dated. The recruitment files did not contain job specifications, contracts of employment, interview records or medical checks. The photos stored were not clear likeness of staff. There was noted to be a gap in one employment history which was not explored and the reasons recorded. This is recommended to be undertaken. The home has recorded the Criminal Record Bureau Check number but had not recorded the date received or the date and number of the Protection of Vulnerable Adults check. This must be addressed to provide a clear audit trail of recruitment checks. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety monitoring requires development to promote prevention from the risk of harm. Financial systems for people using the service personal monies are managed in an auditable manner. Storage of records is not secure and in not line with the Data Protection Act. Evidence: The registered person delegates the management of the home to two senior carers who work as Matrons. They have been in post for many years but are not registered with the Commission. The Registered Managers post is currently vacant. Staff who spoke with us told us that they find the matrons approachable and the home is a good place to work. They told us that the home has a stable core of staff with a very low turnover and staff all know each other well. A visiting health professional told us The matrons have a caring attitude to their residents well being. Care Homes for Older People Page 25 of 36 Evidence: The management of staff induction, training and supervision may place people using the service at risk. The further management of record keeping, accident management, infection control and record storage may pose a risk to people using the service. The home implemented a quality assurance audit in May 2009. No surveys were dated. There is no audit of results and plan of action as result, available at this time. The registered person visits the home regularly but there were no Regulation 26 reports available to view the registered persons audit of the quality of the service. Records stored at the home are not stored securely and in line with the Data Protection Act. The kitchen area of the home is used to store records relating to the people using the service. This is also the main thoroughfare for staff, people using the service, relatives and visiting health professionals. This may compromise the dignity and confidentiality of people using the service as records are left out and could easily be accessed. There are established systems in place for dealing with people using the service personal finances. We evidenced that each persons personal monies were recorded and receipts checked. Staff told us they receive regular supervision but this is not recorded. The home maintains a supervision book which staff sign to say they understand the group supervision provided. No one to one supervision takes place and is required to be undertaken to identify staff training needs and promote good practice. Accident records are maintained. We were told by the Matron that no accidents had taken place since January 2009. The diary used by care staff recorded that this was not the case and two accidents had happened recently. All accidents must be recorded in line with the homes own accident policy and the records audited regularly to identify trends and incidences which may be used for accident prevention. The matron advised us that one notification to CQC of a fall had not been forwarded to the Commission as a Regulation 37 notification. The management of the home has forwarded four notifications in the last two years. The management of the home are required to ensure that the scope of notification is reviewed and all information forwarded to the Commission for our records. Records were examined with reference to safe working practices. Most records were well maintained and documented. Maintenance certificates were up to date. Some routine checks had not been undertaken, these included, the hot water checks, call Care Homes for Older People Page 26 of 36 Evidence: bell checks and monthly emergency lighting checks. All health and safety checks must be undertaken and recorded to promote the safety of people using the service. The home received a Fire Safety visit on the 12th March 2009 where several areas were identified as requiring action. We have not yet received confirmation that these areas have been addressed. Care Homes for Older People Page 27 of 36 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 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 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 3 14 The registered person is 11/09/2009 required to ensure that each person is assessed prior to admission. This is required to include the consultation with with the prospective person or their representative. A record of that assessment must be signed and dated to evidence when the assessment took place. 2 7 12 The registered person must ensure that all areas of identified need and changes are recorded in the daily record and an appropriate plan of care maintained. This will ensure that staff are aware of all changes and the care to be provided. This will also provide a clear audit of all care given. 25/09/2009 3 7 12 The registered person must 17/09/2009 ensure that the people using Page 29 of 36 Care Homes for Older People 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 the service or their relative/ representative are involved and are in agreement with the care plan provided. This is required to ensure that people are in agreement with the care to be provided. 4 8 12 The registered person must ensure that hand washing facilities are sufficient to ensure that there is no risk of cross infection. Staff must be aware of the risks of cross contamination and infection and ensure that appropriate hand wash facilities and equipment are used. 5 10 12 The registered person is 11/09/2009 required to review the use of buckets for storage and transfer of urine. An alternative is recommended to be sought to ensure that there is no risk of cross infection to people using the service and staff. 6 12 16 The registered person is required to ensure that a programme of activities is planned for the recreation 17/09/2009 11/09/2009 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 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. 7 18 12 The registered person is 17/09/2009 required to access a copy of the Safeguarding Vulnerable Adults in Cornwall Policy. This is required to then be used to inform staff of the actions that should be taken to protect people using the service. 8 19 12 The registered person is 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. 9 29 12 The registered person is required to record the date and details of all staff 11/09/2009 20/11/2009 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 members Criminal Record Bureau and Protection of Vulnerable adults checks. This is required to provide a clear audit trail of all recruitment checks to ensure the safety of people using the service. 10 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 receive a good standard of care which promotes their safety and wellbeing. 11 31 12 The registered person is required to review the management of staff training, induction and supervision. Further review of management of accidents,infection control, record keeping and storage is needed. This is required to ensure that people using the service and staff are not placed at risk by poor management. 12 36 37 The registered person must ensure that all matters 17/09/2009 18/09/2009 22/10/2009 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 under the scope of notification are forwarded to the Commission as part of a Regulation 37 notification. This is required to ensure that the Commission can monitor the actions taken by the home. 13 37 12 The registered person must ensure that all records relating to people using the service are stored securely in line with the Data Protection act. This is needed to ensure that the dignity and confidentiality of people using the service is not compromised. 14 38 12 The registered person must ensure that all accidents are recorded. This is required to ensure that appropriate action is taken to promote the health and welfare of people using the service. 15 38 12 The registered person must ensure that all health and safety checks are undertaken. These include monthly emergency lighting checks, monthly hot water checks and call bell checks. 18/09/2009 25/09/2009 25/09/2009 Care Homes for Older People Page 33 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 This is required to ensure the health and safety of people using the service. 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 2 The registered person is recommended to include the room number on each persons contract of residency to ensure that the terms and conditions for each room are clear. The registered person is recommended to ensure that all daily records recorded by staff are signed by the person writing them. The registered person is recommended to ensure that people using the service have the opportunity to lock their rooms should they want to. These locks must be accessible to staff in an emergency. The registered person is recommended to ensure that wheelchairs seen at inspection which did not have foot plates attached are not used as they may pose a risk of injury. The registered person is recommended to provide lockable storage for people who store medications within their rooms. Further lockable storage is needed for medications stored in the kitchen fridge. The registered person is recommended to ensure the safety of people using the service and staff by making sure that all hand transcribed medications recorded on the medication administration record are signed by two staff. The registered person is recommended to ensure that all prescribed creams are dated when opened to ensure the opened shelf life is not exceeded. The registered person is recommended to ensure that activities are recorded and used to promote regular, relevant social activity provision for each person. Page 34 of 36 2 7 3 8 4 8 5 9 6 9 7 9 8 12 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 9 16 The registered person is recommended to display the complaints procedure in a public area to enable access to anybody wishing to raise a concern. The registered person is recommended to undertake risk assessments for the transfer of people using the service through the kitchen/staff area to avoid any risks to people using the service. The registered person is recommended to risk assess all free standing units and ensure that any tip risk is addressed. The registered person is recommended to develop the induction process to include the Common Induction Standards to ensure a clear and detailed induction to care practices at the home. 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. The registered person is recommended to ensure that any gaps in the prospective staff members recruitment file are explored and the reasons documented. The registered person is recommended to provide all staff a minimum of three days paid training each year. Each staff member should have an up to date individual training and development assessment and profile. 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 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 staff receive supervison up to six times each year in line with the National Minimum Standards. 10 19 11 24 12 29 13 29 14 29 15 30 16 30 17 33 18 36 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. 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. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!