Key inspection report
Care homes for older people
Name: Address: Marsh House Residential Home Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT 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: Marie Cordingley
Date: 1 9 1 1 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 33 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 33 Information about the care home
Name of care home: Address: Marsh House Residential Home Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT 01772600991 01772601893 marshhouseres@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Marsh House Care Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home Marsh House is registered to provide residential care and accommodation for up to 33 people. The home is situated in a rural area close to the towns of Chorley and Leyland. There are 23 single rooms and 5 double, some of which have en-suite facilities. There is a large dining room and a number of communal areas available for residents use as well as well maintained grounds with seating and patio areas. These areas are accessible to people who use a wheelchair and there is also a stair-lift in Care Homes for Older People
Page 4 of 33 Over 65 33 0 3 0 0 4 2 0 0 9 Brief description of the care home place. Ample car parking space is provided. The registered manager is Mrs Gail Phillips. At the time of this visit, the information given to the Commission showed that the fees for care at the home vary from 367 - 410 pounds per week, with added expenses for newspapers, hairdressing and chiropody. Care Homes for Older People Page 5 of 33 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this home included a site visit which was carried out on an unannounced basis. This meant that the manager and staff did not know the visit was to take place until we arrived. During the visit we spent time with residents, talking to them and observing their daily routines. We also held discussions with staff at the home and the acting manager. We carried out a tour of the home looking at communal areas and a selection of residents private accommodation. We also viewed a variety of paperwork including residents care plans and staff personnel files. Prior to our visit we wrote to the manager and asked her to complete a very comprehensive self assessment. This gives us a lot of information about how the home is managed. In addition, we wrote to a selection of residents and staff and asked them Care Homes for Older People
Page 6 of 33 to take part in a written survey about their opinions of the service provided. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Since the last inspection the registered manager has updated the homes Service User Guide to ensure that it provides up to date and accurate information. In addition the manager had made the guide available in a variety of formats to help ensure more people have access to the information within it. The number of carers at the home who hold National Vocational Qualifications in care has increased since the last inspection. Now, over half of the carers employed at the home hold these qualifications. Improvements have been made to the reception and dining areas of the home. Care Homes for Older People Page 8 of 33 What they could do better: We found that some peoples care plans lacked detail about their social care needs and their own views and wishes about areas such as activities. When planning residents care it is important to do so in a person centred manner. Gathering and using social history information will assist staff to recognise and respond to people as individuals. A number of concerns were identified in relation to the way peoples medicines are managed. We also found evidence that a previous requirement made regarding the training of staff in this area had not been met. Peoples health and wellbeing is at risk if their medicines are not carefully managed. A number of requirements and recommendations have been made in relation to this matter. Whilst carers appear to be aware of the importance of providing residents with the opportunity to take part in regular activities, a lack of planning for each individual resident means that activities are not always in line with all residents needs and preferences. In addition, a lack of clarification regarding a budget for activities means that standards in this area could fall further. The majority of people told us that they liked the food provided at the home. However, we were concerned to note that there appeared to be little choice for residents in this area. On the day of our visit we spoke with a number of people minutes before their lunch was served and none of them had any idea what they would be given. We were told that an alternative meal could be provided for anyone who didnt want the one served but any resident wanting an alternative would obviously have to wait longer while it was prepared. Several areas within the home are in need of improvement. We pointed out a number of problems to the registered manager during our visit. In addition, we noted the fact that some residents bedding, carpets and furniture were looking very tired and shabby. During our visit we found one area of the home to be particularly malodorous. This issue has been raised in previous inspection reports. We were most concerned to find that the the home were not always following careful recruitment processes. We found evidence of one staff member being employed at the home prior to any references being received or a Criminal Records Bureau check being carried out. Such background checks are in place to help ensure the safety and wellbeing of people living at the home and must be carried out at all times. In discussion, the manager advised us that she had not received any guidance or clarification on what (if any) budget she had for staff training. As such, she was not able to plan or book any training. We advised the manager that this information must be clarified to ensure that staff training programmes continue. In discussion with staff and the registered manager, there appeared to be little understanding of external management arrangements for the home. One staff member said We dont know who is in charge really, and the registered manager told us that she was unsure who the next point of contact would be after her, should anyone want to take a particular matter further. As a result of this lack of information, the homes complaint procedure had not been updated and residents and relatives did not have accurate information about lines of accountability. Care Homes for Older People
Page 9 of 33 Whist the manager showed an understanding of the principles of risk assessment we found a number of potential hazards that had not been assessed during our tour of the home. These included issues relating to access in and out of the home and some relating to coshh (control of substances hazardous to health). These issues were pointed out to the manager who was asked to address them as soon as possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 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. People who live at the home may not receive the support they need if information obtained during the assessment process is not always included in their care plans. Evidence: A Service User Guide is available for people who are considering a move to the home. This document includes various information such as the facilities available and the service provided. It also gives a picture of daily routines in areas like mealtimes and activities. Since the last inspection the manager has carried out some work to ensure the Service User Guide is available in a variety of formats including large print to meet peoples individual needs. We were able to confirm that the manager had ensured information in the Service User Guide was kept up to date and she confirmed that she had updated the
Care Homes for Older People Page 12 of 33 Evidence: document in line with recent changes in ownership of the home. Unless people have to move into the home very quickly because of an emergency situation, an assessment of their needs is carried out before their admission. This means that the manager can be sure that a persons needs can be met at the home and that the home is the right one for them. It also means that staff have a good understanding of the persons care needs and can provide the right level of care straight away. We viewed a number of residents pre admission assessments and found that in general, they were well detailed in terms of medical and personal care needs. However, some assessments lacked detail about the social aspects of peoples lives such as relationships, hobbies and preferred daily routines. These are important areas that need to be explored so that peoples care can be planned in a person centred way. Person centred planning means recognising and valuing peoples individuality and providing their care accordingly. We noted in one residents assessment we viewed that important information relating to their dietary needs had not been followed through to their care plan. This caused us concern because if this sort of information is not included in peoples care plans there is a danger that they will not get the care they need. Care Homes for Older People Page 13 of 33 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and wellbeing could be at risk if medicines are not carefully managed. Evidence: As part of our case tracking exercise we examined a number of residents care plans. We found that in general, they provided a satisfactory level of information. However, we did find some examples where information was missing. For example, we tracked the care of one resident who had been assessed as being at high risk of becoming malnourished. Whilst there was a nutritional risk assessment in place, the residents care plan didnt contain any information about the action required by carers to minimise this risk. We also found areas of peoples care plans that lacked the sort of detail needed to help ensure that their care was provided in an individualised, person centred manner. Peoples care plans for instance, contained very little information about the person themselves, their relationships, history or how they liked to spend their time. When we viewed residents daily care records we were able to confirm that people
Care Homes for Older People Page 14 of 33 Evidence: living at the home had regular access to community health care when they needed it. We also noted that carers appeared to identify concerns quickly and seek the necessary medical advice straight away. We noted that the risks to residents in areas such as falling or developing pressure sores had been assessed and action identified by carers to minisimse these risks was clearly stated in most cases. We looked at medicines administration. Part of the morning medicines round was observed. As seen at our previous visit we saw that someone was left a pot of medicines to take in their own time. This respects their choices and independence. But, it is recommended that this preference is recorded and written consideration is given to potential risks. Similarly, there could be clearer guidance for staff about any support people who choose to self-administer medicines may need to manage their medicines safely. Medicines were administered by staff who had completed certificated medicines training. But, we were concerned to find that staff trained in medicines handling were not on duty throughout the night. We saw that several people were prescribed medicines when required but arrangements were not in place to enable these to be safely administered throughout the night, if requested. We saw that someone was not given a medicine labeled before meals in the morning because they had already eaten breakfast before day staff came on duty. We saw other examples where arrangements were not made to ensure special medicines instructions such as, before food were followed. We looked at medicines stock and records. Records showing the administration of medication were generally up-to-date except those showing the use of external preparations e.g. creams, which were not so well completed. This meant that it was not always possible to tell whether creams had been used correctly. Additionally, there was not always information for staff about the use of these creams within peoples care plans. This is recommended to help ensure creams are applied correctly, when needed. Similarly, we found that there was not always clear guidance for staff about the use of medicines prescribed when required. This is important to help ensure staff know when these medicines may be needed, so they can be safely administered. Records were completed to show the receipt of the monthly medicines order, but Care Homes for Older People Page 15 of 33 Evidence: where medicines were received into the home at other times, this was not always recorded. It is important that complete records of medication received are maintained to enable the safe handling of medicines to be accounted for (tracked). Most medication administration records were pre-printed by the pharmacy but where handwritten entries were made these were not checked and countersigned. This is recommended to reduce the risk of mistakes. We found that medicines including controlled drugs were stored securely. But, we saw that medicines were not always securely handled during the medicines round. It is important that medicines are safely locked away to reduce the risk of miss-handling or miss-use. The manager carries out regular medicines stock checks but wider audits (written checks) of medication handling were not completed; this is recommended to help ensure medicines are safely handled and that should any weaknesses arise, they will be identified and quickly addressed. Care Homes for Older People Page 16 of 33 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 activities programme in the home may not be in line with all residents preferences. People would benefit from the opportunity to make choices about what they eat. Evidence: We spoke with a number of residents and staff and also viewed records of activities that had taken place in the home. We found that there were some group activities regularly arranged such as quizzes and arts and crafts but records showed that it tended to be the same small group of residents who took part. There was no record of any one to one activities being provided for residents but some staff told us that they did carry these out when possible. When we looked at peoples care plans we found that there was little information about their personal preferences in relation to activities or peoples previous hobbies. This information is important because it helps staff to provide activities that are in line with peoples individual needs and wishes. In discussion we were told that due to recent ownership changes some areas such as
Care Homes for Older People Page 17 of 33 Evidence: activities budgets had yet to be clarified. The manager and staff were not aware whether or not they had a budget for activities and it was confirmed during the inspection that some visiting entertainers and a visiting exercise trainer (apparently both enjoyed very much by the residents) were going to be cancelled until further notice as it was unclear if there were any funds to pay them. We joined residents in the dining room while they were waiting for lunch to be served. The dining room looked pleasant and tables were nicely set. We spoke with the residents in the dining room and asked them what they were having for lunch. We were very concerned to note that none of the residents actually knew. We asked residents if there were menus posted up anywhere, one resident replied No, we dont know what we are having until its put in front of us. In discussion we were advised that an alternative meal could be provided for any resident who didnt want to have the meal on the menu. However, we were concerned that if people werent made aware of what meal was to be provided then they would not be able to request an alternative. We discussed our concerns with the registered manager and have made some requirements and recommendations in relation to these matters. Care Homes for Older People Page 18 of 33 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of clear information about who will deal with complaints means that peoples concerns may not be dealt with effectively. Evidence: The home has a complaints procedure in place which gives information about how to raise concerns. We were advised by the manager that the complaints procedure is now available in a number of formats including large print and braille. However, the registered manager advised us that she had not updated the complaints procedure to reflect recent changes in ownership of the home. She told us this was largely due to the fact that she was unclear herself about who would deal with complaints on behalf of the new owners. The manager was advised that this information must be clarified as soon as possible so that people using the service and their representatives have clear and accurate information about who to contact. We received a number of completed surveys from people who live at the home and they gave us their views on the way their concerns were dealt with. Several residents told us that they did not know how to go about making a formal complaint and all those who responded said that they did not feel able to raise concerns on an informal basis within the home. All homes are required to have procedures in place that must be followed if it is
Care Homes for Older People Page 19 of 33 Evidence: alleged or suspected that a resident has been the victim of any form of abuse, these are generally referred to as safeguarding procedures. We spoke with a number of staff and the registered manager about the homes safeguarding procedures and found that they all had a good understanding of them. In addition, we were able to confirm from records held within the home and discussions with staff, that training is provided in this area for all new staff members. Care Homes for Older People Page 20 of 33 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made in some areas to ensure that people are provided with a good standard of accommocation. Evidence: During our visit we carried out a tour of the home viewing all the communal areas and a selection of residents private accommodation. We found that in general, the home was warm and comfortable. We also noted that some improvements had been made within the home since our last inspection, for example refurbishment of the reception area and dining room. However, we noted that there remain a number of areas within the home that require attention. Various problems with the environment were pointed out to the manager as well as the fact that decor, carpets and soft furnishings in some residents bedrooms were looking tired and shabby. Discussions took place with the manager who advised us that there had previously been an improvement programme in place which would have eventually seen all areas of the home updated. However, the manager was not able to say whether this plan would be continued under the new owners. The majority of people who responded to our written survey told us that the home
Care Homes for Older People Page 21 of 33 Evidence: was usually fresh and clean. However, several people commented that it was only sometimes clean. During our tour we found most areas to be acceptable, however we did notice that one area of the home was particularly malodorous. This is an issue which has been raised with the home previously. We discussed this with the manager and advised her that a review should take place of domestic hours at the home to ensure that there are enough domestic staff to keep the home fresh and clean at all times. There are guidelines in place for staff regarding infection control and records confirmed that all carers are provided with training in the area. Care Homes for Older People Page 22 of 33 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 safety and wellbeing of people who live at the home could be at risk if careful recruitment procedures are not followed at all times. Evidence: We viewed a selection of staff personnel files during our visit. We found that whilst the home have procedures in place for the safe recruitment of new staff members these were not followed at all times. We viewed the file of one staff member who had commenced employment at the home several months previous. We found evidence that the manager had not completed all the appropriate background checks before the staff member had started work. This was of concern as it is necessary to complete the appropriate background checks such as Criminal Records Bureau checks and references to help ensure the safety and wellbeing of people living at the home. We discussed our concerns with the registered manager during our visit and have made a requirement in relation to this matter. We looked at the homes staffing rotas and spoke with carers and residents. In general, people told us that staffing levels were adequate to meet the needs of people living at the home and that sickness and leave were generally covered by regular staff so that there was no need to use agency staff.
Care Homes for Older People Page 23 of 33 Evidence: The majority of carers we spoke to told us that they received a useful induction at the start of their employment and that they were given adequate support and assistance during this time. However, when we looked at records of staff induction we found that these were not always completed properly and in one case there had been no records made at all. We also noted that on the day of our inspection a staff member carrying out her induction was shown on the rotas as an additional member of staff. We advised the manager that rotas must show when people are being inducted and shadowing other staff members, so that the rotas give a true picture of the staff on duty at any one time. The home have a training programme in place for carers. We found that the majority of carers had completed their mandatory training and over half the carers held National Vocational Qualifications in care. However, it was noted that not all night carers had been provided with training in the safe administration of medication. As such, this had led to a situation where any resident requiring medication at night could potentially be denied it as their was no one on duty with the appropriate training to give it to them. We discussed the budgets for training with the manager who told us that there was some confusion about this. Due to recent changes in ownership, the manager advised us that she was not clear whether she had a budget to provide staff with training. We advised her to clarify this matter as soon as possible. Care Homes for Older People Page 24 of 33 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current lack of clarification regarding various aspects of the running of the home including lines of accountability could lead to residents experiencing poor outcomes. Evidence: At the time of our inspection the home had changed ownership in that a management company on behalf of the homes administrators had taken over its running. In discussion we found that the registered manager and staff did not have a full understanding of how the new arrangements were to work and there were a number of areas that needed to be clarified, for example arrangements for staff training budgets and budgets for activities. The AQAA was received within agreed timescales but not completed to a good standard. Information was brief and lacked supporting evidence. In addition the AQAA failed to tell us what action had been taken in response to previous requirements and recommendations. During our visit the manager was unable to tell us how the new
Care Homes for Older People Page 25 of 33 Evidence: owners proposed to monitor the quality of the service provided and whether people living at the home were experiencing good outcomes. A number of staff spoken with during our visit told us that they felt very uncertain about their roles and issues such as pay, holidays and terms and conditions had not been agreed with them. One carer said We feel like we are in limbo, nobody knows who is in charge and we dont even know if we are going to receive our wages. Whilst morale was inevitably low, staff told us that the team were pulling together and ensuring that the wellbeing of residents remained the priority. However, it is inevitable that staff morale and goodwill will deplete if people are not provided with information about things that are important to them. The home has a health and safety policy in place which is supported by individual procedures in areas such as fire safety, infection control and moving and handling. We were also able to confirm that the majority of staff had completed their mandatory training in these areas. However, during our tour of the building we identified a number of concerns which could compromise the health and safety of people living at the home. We noted some concerns in relation to the security of the home and pointed these out to the registered manager. We advised the manager that all points of access to the home need to be considered when carrying out risk assessments for the security of the building. During our tour we noticed the presence of some items namely toiletries, cleaners and other chemicals that could prove hazardous to some residents who have dementia. Again, we pointed this out to the manager and explained that risk assessments needed to be carried out to clarify the hazards and what action is required to keep people safe. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made 23/06/2009 to ensure medicines can be safely administered throughout the night to ensure people can always be safely given any medicines they may need. 2 26 23 All parts of the home must be kept clean and free from offensive odour. This is to help ensure that residents are provided with comfortable accommodation 30/06/2009 3 37 17 An accurate record of the duty rota and shifts worked must be maintained in the home. This is so that the manager can effectively monitor staffing levels. 30/06/2009 Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Peoples care plans must adress all their assessed needs. This is so that carers have an understanding of peoples needs and the action required to meet them. 19/12/2009 2 9 13 Complete records of all 21/12/2009 medicines received into, and administered (including external preparations) must be maintained. This is to support and evidence the safe administration of medication. 3 12 16 Activities that are in line 19/12/2009 with all residents needs and wishes should be provided on a regular basis. This is so that people who live at the home have the opportunity to choose how they spend their time. Care Homes for Older People Page 28 of 33 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 4 15 16 People living at the home 19/12/2009 must be provided with meals that are in line with their individual needs and preferences. This is so that they benefit from an appealing and varied menu and are able to choose what they eat. 5 16 22 A procedure which contains clear, accurate information about how to go about making complaints must be developed and provided to residents and their representatives. This is so that people can be confident that their concerns will be dealt with effectively. 19/12/2009 6 19 23 All parts of the home must be kept clean and reasonably decorated. This is so that people are provided with safe, comfortable accommodation. 19/05/2010 7 29 19 Appropriate information as described in Schedule 2 of The Care Homes Regulations, 2001 must be obtained for all new staff members before they commence employment. 19/12/2009 Care Homes for Older People Page 29 of 33 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 to help ensure the safety and wellbeing of people living at the home. 8 31 7 Clear lines of management accountability must be agreed and provided to the Commission. This is to help ensure that the home is run in the best interests of people who live there. 9 33 24 Procedures must be in place to ensure that the quality of the service and outcomes for people using the service is constantly monitored. This is to help ensure that good standards of care are consistently maintained. 10 38 13 With regards to the storage of potentially harmful substances and chemicals, risk assessments must be completed and clearly show any action required to keep people safe. This is to help ensure the safety and wellbeing of people using the service. 11 38 13 With regard to points of access to the home, risk assessments must be completed and clearly show 19/12/2009 19/12/2009 19/02/2010 31/12/2009 Care Homes for Older People Page 30 of 33 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 any action required to keep people safe. This is to help ensure the safety and wellbeing of people using the home. 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 More attention to the social aspects of peoples lives should be paid during the assessment process. This is to help ensure that the process is more individualised and that peoples care can be planned in a person centred manner. Peoples care plans should be more individualised so that their care can be planned in a person centred manner. There should be more written information about how safe self-administration is supported to help ensure people receive any help they may need to do so safely. Handwritten entries should be signed and countersigned to reduce the risk of errors. Peoples care plans should contain more information about their hobbies and things that they enjoy doing. This is to help ensure that the activities provided are in line with peoples individual needs and wishes. Arrangements should be clarified regarding activities budgets. This is so that staff can plan activities and entertainment for residents. Menus should be produced and provided for residents on a daily basis so that they can choose what they have to eat. An improvement plan that includes all areas of the home should be implemented to help ensure that peoples accommodation is maintained to a good standard. Arrangements for the cleaning of residents equipment, for example, wheelchairs should be clarified to help ensure
Page 31 of 33 2 3 7 9 4 5 9 12 6 12 7 8 15 19 9 22 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 that these tasks are carried out when necessary. 10 26 The domestic hours for the home should be reviewed to ensure that these are sufficient for the home to be maintained in a clean, hygienic state. Rotas should make clear the position of staff members on duty and identify people carrying out their induction. Arrangements for budgets for staff training should be put in place. This is to help ensure that the manager is able to deliver carers training programmes effectiveley. Records of the induction of all new staff members should be completed, signed by both parties and maintained within the home. This is to help ensure that new staff receive adequate support and supervision. 11 12 27 29 13 30 Care Homes for Older People Page 32 of 33 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 33 of 33 - 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!
