Inspection on 03/11/09 for Maxey House

This inspection was carried out on 3rd November 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maxey House 11/11/08

Maxey House 30/05/08

Maxey House 09/10/07

Maxey House 06/03/07

Maxey House 14/02/06

Maxey House 19/09/05

Maxey House 21/03/05

Maxey House 14/09/04

Maxey House 19/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Maxey House Lincoln Road Deeping Gate, Peterborough PE6 9BA     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: Elaine Boismier     Date: 0 3 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 32 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 32 Information about the care home Name of care home: Address: Maxey House Lincoln Road Deeping Gate, Peterborough PE6 9BA 01778342244 01778345850 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Laura Louise Levin care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Maxey House is a large Georgian country residence standing in three acres of grounds. The home is within half a mile of the town of Market Deeping and approximately five miles from Peterborough city centre. The home consists of a main house with a modern single storey extension. Residential accommodation is provided in twentyseven single and three double bedrooms. Twelve bedrooms have en-suite facilities. A lounge, dining room with quiet area, and conservatory form the communal areas of the home. Residents have access to the gardens. The Registered Manager is Mrs Jacqueline Watson. Current fees range from £405 to £415 per week, depending on the size of the room. Additional costs include those for hairdressing and private chiropody. Further information about fees can be obtained from the home. Copies of CQC reports are made available on request or from our website at www.cqc.org.uk 1 0 Over 65 0 31 Care Homes for Older People Page 4 of 32 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, The Care Quality Commission (CQC), carried out this unannounced key inspection (KI), by two Inspectors, between 9:45 and 14:20 and taking four hours and thirty five minutes to complete. Before the inspection we received surveys from six of the residents but none from the staff. We also received surveys from two health care professionals. We looked at information that we have received about the home since our last key unannounced inspection (KI) of the 11th November 2008 and information about the home following our random unannounced inspection (RI) of the 9th June 2009. The home sent us, as requested, an Annual Quality Assurance Assessment (AQAA). Care Homes for Older People Page 5 of 32 The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. During this inspection we looked around the premises and looked at some of the documentation. We case tracked three of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager and the registered owner, referred to, in this report, as the management team. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? Following our RI of June 2009 we expected improvements to be made with the information provided within the Statement of Purpose (SOP) so that people had the right information about the home. The SOP has been amended and provides accurate information about the home. Following the same inspection we expected information obtained about the home, of any prospective resident, to improve, so that the home would be aware of any assessed needs of the person. This would ensure that the home would be a suitable place for any person moving in and that the home would be able to meet the assessed needs of the person. Action has since been taken to improve this area to ensure that the home is a suitable place and that it can meet the needs of the person. At the RI of June 2009 we found that not all of the care plans were actively reviewed each month; they did not always have sufficient detail within these care records to provide the staff with the guidance that they needed to meet the current needs of the person, including any changed needs. We expected the home to take action, as part of its quality assurance, to make these improvements within the care plans. Some improvement has been made with the detail of some of the care plans although there needs some further improvement to ensure people are protected by good record keeping. We made two requirements following the RI - these were about risk assessments and medication. The timescale for both of these requirements to be met was by the 31st July 2009. Risk assessments have been carried out for people who self-medicate although this action was not wholly complete. Risk assessments have been carried out for people who need help with a walking aid to ensure that any risks identified are reduced. The recruitment and training of the staff has improved to ensure people receive safe and proper care. The detail recorded within the AQAA was much better indicating that the homes Care Homes for Older People Page 7 of 32 quality assurance, for the benefit of the residents, has improved. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a good standard of information to help them in their decision where to live and they are assessed before they move in to ensure that the home is a suitable place to live. Evidence: At our RI, in June 2009, the Manager said that the Statement of Purpose (SOP) would be amended as the current SOP incorrectly stated that the Manager of the home had the registered managers ward. We looked at the current SOP and this had been amended with regards to the Managers qualifications. The document had also been updated to reflect the changes of our address and telephone number. Five of the six residents surveys said that the person had received enough information about the home that helped them in their decision where to live. On entry to the home we found information leaflets about Maxey House and what people may expect should they decide to move into the home. People we spoke with said that they Care Homes for Older People Page 10 of 32 Evidence: had visited the home before they had moved in. If they were unable to do so their relatives had made enquiries on their behalf. During our June 2009 inspection we noted ...the home has made some improvement in recording the homes pre-admission process and that the person had visited the home before they moved in. There was, however no record of the persons assessed needs although reference had been made that a hospital discharge co-ordinator had been involved in the persons admission to the home. To assess what progress the home had made within this area we looked at one of the most recent pre-admission assessments and we spoke with the Manager about this. Findings indicated that, although the details were brief, there has been some progress in how the home assesses any prospective resident, ensuring that the home is able to meet the persons assessed needs. Care Homes for Older People Page 11 of 32 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. People can not be wholly confident that all their health needs will be safely met due to the standard of medication practices and standard of recording although they can be confident that their dignity is respected by caring and patient staff. Evidence: Following our RI in June 2009 we found that the care plans were not meeting the expected standard and the Manager had agreed with our findings. The deficiencies included insufficient detail about how the staff were to meet the needs, including any changed needs, of the residents and that there was insufficient evidence to indicate that the residents had been actively consulted (and thereby consented) to their care. We expected the home, as part of its quality assurance, to improve such areas that we had reported on. The AQAA told us that such action has been carried out, such as With the agreement of the resident we work with the relatives and friends to provide the best care possible and We have improved our care planning systems to ensure we have approached and centered (sic) on the individual needs of the service user and made sure that all care staff are aware of how best to use the care plan and record all aspects properly. Care Homes for Older People Page 12 of 32 Evidence: As part of our case tracking methodology we looked at three peoples care records and we found that there had been some improvement in the standard of details provided. For example there were details of when a person liked to go to bed and what they liked to eat and drink. The guidance also noted if a person needed help with any aspect of their personal care or if they were independent with this. Also there was active evaluation of how a persons medical condition was affecting the person and how the home was managing the situation, including actively consulting with relevant health care professionals. The majority of the care plans, that we saw as part of our case tracking, had been updated although we found, and this was confirmed by the Manager, a care plan for a persons night time care, had not been reviewed since 6th April 2009. The care plan for a person who was prescribed medication to be taken when required for breathlessness did not contain any details of the circumstances the medication was to be used or detail any breathing problems and how these were to be managed. Some, but not all, of the people were able to tell us that they had been consulted about their care plans and we found that all of the care plans belonging to the people we spoke with had been signed by the person to indicate that they had agreed with their planned care. This tells us that the home is providing care that the person has agreed to have. Following our June 2009 RI we made a requirement for the home to carry out risk assessments for activities related to walking around the premises and giving medication to themselves. The timescale for this requirement was to be achieved by the 31st July 2009. We noted that there had been an improvement in the risk assessments for people requiring the help of walking aids although for one person who looks after and takes their own medication, the care plan did not identify or assess the risk to themselves or other people in the home. All of the six residents surveys said the person always or usually received the support and care, including medical care that they needed. Two of these surveys added that the home does well by Helping with bathing and They make sure that (the resident) is kept clean by having regular baths. Both of the health care professional surveys said that the peoples social and health care needs are always properly monitored and reviewed by the home. Both of these surveys indicated that the home seeks advice from these health care professionals and act on this advice to ensure that the peoples social and health care needs are met and their well-being improves as a result of the homes actions. One of these surveys Care Homes for Older People Page 13 of 32 Evidence: added, that the home does well as it Takes good care of the residents. (The home) always alerts us if a problem occurs with someone. (The home) ask(s) advice from us if needed. The other health care professionals survey said that the home does well because It appears to operate a flexible approach in term (sic) of matching the challenges of care to the wishes of the individual. From our examination of the three case tracked peoples records we saw that there were records when they had been seen by their general practitioner, a district nurse and a chiropodist. On the day we were at the home we noted that a district nurse was attending to one of the residents. This tells us that people have access to health care professionals for treatment and advice. There has been an improvement in how the home is managing a person with diabetes (mellitus) and this was evidenced in the persons more detailed care plan, to include what the staff were to do if the persons blood sugar was low i.e. test the persons blood sugar before giving them a drink of Lucozade. There was also detailed guidance if the persons blood sugar did not rise following this sugary drink: the record advised the staff to contact the emergency health service. We noted, from our observation of the person, that they were well and were actively engaging in conversation with the staff and other residents. This tells us that the person is being supported in the management of their complex medical condition. From our examination of the three case tracked peoples care records we saw that the people were weighed each month and their weights were stable, with no unintentional weight loss. For one of the three residents we read that they had gradually gained seven pounds from 3rd April 2009 and up to when they were last weighed on the 28th September 2009. This tells us that peoples well-being and health is being monitored by the home. We looked at medication and medication records for several people living in the home. In general, the majority of medication is stored securely, either in a trolley in the dining area or in cupboards in the office. But we found that there were some prescribed medicines and dressings in an unsecured room to which people could gain access. We also found a container of cream labelled for one resident in the staff room. A new cupboard has been installed to store controlled drugs and this complies with legal requirements but there was no record in the controlled drugs register of the medication stored there. At our RI in June 2009 we found that we could not account for all medication in use as there were no records made when medicines are received into home or what quantity Care Homes for Older People Page 14 of 32 Evidence: is carried over to the next recording period. At this inspection we found that this had improved but when medicines are received outside the normal ordering period the records of receipt were not completed. We also found that there was no record of one persons medication being given to them although for most other people the records made when medication is given had improved and demonstrated that people receive their prescribed medicines. For two people we found that medication was being recorded as given but not in line with the prescribed instructions and there was no documented justification for this or that it had been discussed with the prescriber. At our inspection in June 2009 we made a recommendation that any hand-written changes or additions to medication records are signed and dated by the person making the entry and checked for accuracy by a second person. During this inspection we saw that such records are still not signed. Although the recommendation has not been included in this report, it remains good practice and we expect the home to manage this. Both of the health care professional surveys said that the residents privacy and dignity are respected although we read in one of the residents surveys, completed by a relative on their behalf, the following Staff should only talk about private things in the office, not in the hearing of residents. The survey, however, did not say what these private things were about. We found no evidence of this when we observed the staff working and interacting with the residents. Nevertheless the staff should be mindful of not causing any upset to residents sensitivities or breaching confidentiality about anyone. We saw the staff knock on peoples doors before they entered. The people we spoke with said that the staff were Very good and Very patient. One of the people said that the staff Spoilt them. None of the people said that their dignity was compromised by the staff. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunities to live generally a good social life although the current range of activities needs to improve further to stimulate their interests. Evidence: Five of the residents surveys said that the home always/usually provided suitable activities that the person could take part in although the remaining survey said that sometimes this was the case. Comments included, within these surveys, said that the home could do better to Provide more activities/stimulation and More entertainment. Positive comments, about the activities, were also received within these surveys, such as ...enjoyed B.B.Q and They arrange activities like having a 40s garden party for the residents and their families which was good for those people who could not get out. The AQAA confirmed that a barbeque and 40s garden party events had taken place and we saw, from the records that we examined, that a risk assessment had been carried out for the use of a barbeque and how any risk of harm was to be reduced. The AQAA also told us that the residents enjoy the twice monthly visits from the company Sporting Chance that offers ball games for the residents to take part in. Two of the people we spoke with said that they did not take part in the activities as Care Homes for Older People Page 16 of 32 Evidence: either they were not interested in them or were not able to do so. They said that they were quite content with staying in their rooms and occupying themselves. One of the people who we case tracked expressed a sense of disappointment that there was no longer the opportunity to play Bingo as this activity had been withdrawn. The management team stated that this was due to a general lack of interest from other residents in playing Bingo. We looked at the report of a visit made by the owner to the home and this was dated the 25th September 2009. In this report we noted that views of some of the residents were recorded and this included suggestions about trips out of the home, such as a visit to a Sacrewell farm museum, Peterborough museum and Rutland Water. We looked at the activities programme for November 2009 and we found that there were timetabled events such as a monthly visit by a church minister and fortnightly visits by Sporting Chance although we found no evidence that peoples suggestions, as recorded in the registered owners report of 25th September 2009, had been included in the November plan. According to the management team, a trip out had been arranged and had taken place, in September, to a butterfly farm, in response to suggestions made by the residents. The management team told us that they had received positive feedback from the residents who went on this trip. We saw photographs of the barbeque for the 40s celebrations and we saw, from our examination of the record of food provided, that Halloween Night was celebrated on the 31st October 2009 with home made pumpkin and vegetable soup, followed by hot dogs and Scary cakes. We noted that there was a lack of activities occurring within the home and we discussed with the management team of the home how this might improve. We were told that the home is intending to improve information about the peoples interests and their life histories. Such information, we were told, should improve the standard of meaningful activities for the residents. We expect the home to improve the day-today activities provided to ensure that they are meaningful to the person. One of the residents surveys said the home is Very welcoming to relatives & friends. Both of the health care professional surveys said that the home always supported the people to live the life they chose wherever possible. Bedrooms that we visited had peoples personal items such as furniture, televisions, photographs, ornaments and pictures. All of the six residents surveys said that they always or usually liked their meals. Care Homes for Older People Page 17 of 32 Evidence: Added comments, from these surveys, said that the home does well because Meals cater for my needs and The food is homemade, fresh and excellent. Another survey said the home could do better with introducing ...a change in the food menu sometimes. According to the AQAA, as a result of listening to residents views the menu has been changed to include more fish, pasta and rice on the weekly menus. We examined the record of food provided and there is a four week rolling programme. Although one person, who we case tracked, said that there was little change in the menu, we found, from examination of the records that this was not the case. We found that there was a range of menus from roasts, fish, casseroles, jacket potatoes and sausage, egg, chips and beans. There was also a variety of accompanying vegetables, such as broccoli, carrots, cabbage and peas, including mushy peas. There was also a range of desserts, such as cakes, fruit salad with (optional) cream. The person, who we case tracked, said that they enjoyed the desserts, as they were traditional and enjoyed the previous days lunch of ham, egg and chips. All of the other people we spoke with said that the food was very good: one person said that the meat was Very tender and tasty. Although there is no choice available, as told to us by what people said and confirmed by the menus, at lunch time, there was a choice of a hot meal, at tea time, such as mushrooms on toast or sandwiches, followed by a dessert, such as muffins. Care Homes for Older People Page 18 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that if they had a complaint or concern the home would be able to deal with this in a satisfactory manner and that they can be confident that they are safe from harm. Evidence: Five of the six residents surveys and both of the surveys from health care professionals said that the person knew how to make a complaint if they wanted to and both of these latter surveys said that any concern that the person had was responded to and the person was satisfied with the action taken by the home. According to the AQAA the home has received no complaints and we have received no complaints made against the home. We looked at the homes record of complaints and none had been recorded since 2008. All of the six residents surveys said that the person knew who to speak to if they were unhappy about something and all of these surveys said that the staff always listened to what the person said and the staff acted on this information. One of the healthcare professionals surveys said that the home has a ...caring atmosphere and a residents survey said that the home Provides a friendly atmosphere. The majority of the people we spoke with said that they liked and enjoyed living at the home and had no complaints to make. Care Homes for Older People Page 19 of 32 Evidence: According to the AQAA all of the staff have attended training in safeguarding vulnerable people against abuse. The AQAA also told us that the home has improved within the last twelve months by updating the homes policies and the training of the homes proprietor and Manager in the Mental Capacity Act and safeguarding awareness which was previously called protection of vulnerable adults against abuse, or POVA. We spoke with one member of the staff who told us that they had not received training in safeguarding but, with some prompting from us, would know what constitutes abuse and would have no hesitation in reporting any incident of abuse that they might encounter. Information about what any person should do, in the event of suspected or witnessed abuse, was available throughout the home, including areas used only by the staff. According to the AQAA the home has had no allegations of abuse against any of the residents and we have received no such allegations. Care Homes for Older People Page 20 of 32 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. People live in a comfortable and generally clean home that could be better and safer with improved maintenance and with upgrading of some areas of the decor. Evidence: The AQAA told us that the home has an ongoing refurbishment programme to include replacement of flooring and furniture and redecorating bedrooms when they become vacant and before such a vacancy becomes filled. During our tour of the premises we noted that, on the whole, the decor is of a satisfactory standard although we noted that wallpaper on the ceiling above and adjacent to room 25 was coming away from the fixture. The registered owner explained that this was due to a previous leak of water, from the roof. The management team explained that carpets were routinely deep cleaned, by an external contractor. Some, but not all of the corridor carpets were clean although the remaining carpets, such as the one in the corridor by rooms 5 to 22, for example, looked discoloured with usage. The registered owner stated that this discolouration was due to wear and tear. She agreed that this needed to improve and we expect this to be managed by the home. Other areas, such as bedrooms and bathrooms were generally well-maintained. Most, but not all of the bedroom doors were closing without effort. We saw some of Care Homes for Older People Page 21 of 32 Evidence: these doors, such as those to bedrooms 5,11,16,17 and 18, were not closing without some physical effort. This poses a problem for the reduction of the risk of spread of fire. Furthermore should the doors be closed, residents may find difficulty in reopening the doors. We expect the home to manage this issue. The gardens were wellkept and the people we spoke with said that they would go out into the gardens when the weather was fine. To ensure the safety of people, when they are using hot water to wash with, the AQAA said that, within the last twelve months, We have installed push taps and regulators to all sinks and bath tubs in order to control the temperatures to a safe standard. Records of hot water temperatures were seen and these demonstrated that they were tested when the person was to have a bath; none were above 40 degrees centigrade. On the day of our inspection the Manager informed us that the boiler, to heat the home and the hot water, was not working, and had not been since 31st October 2009. We saw that mobile heaters had been provided and that the home was not unduly cold although some of the residents said that that they felt cooler. The Manager explained that the hot water was provided by an immersion heater although when we tested the hot water, from taps in a bathroom and a hand wash basin in a toilet, the water was luke warm. A person who we case tracked said that they had a wash in their room and that the water was not warm enough. The management team agreed that the immersion heater may not be adequate to fully provide hot water for residents to use. The management team explained that action had been taken to contact a plumber and their visit was awaited. The Manager stated that she was in the process of formally notifying us of this untoward event of the failure of the heating system. One of the people, who we case tracked, told us that there had been, on the 2nd November 2009, a failure in the passenger lift from operating. We saw, from the service records, that immediate action had been taken and the problem was resolved by an external contractor. The AQAA told us that, within the last twelve months, improvements have been made to reduce the risk of the spread of infection as The home has introduced a new wall mounted hand hygiene system in order to reduce the risk of infection and cross infection and during our tour of the premises we found that this was the case. All of the six residents surveys said that the home was always or usually clean and fresh. One of these surveys added The home always smells clean and fresh. Another of these surveys said, that the home could improve the smell of a persons room by Check(ing) (the) comode (sic) more often. As part of our case tracking we visited the Care Homes for Older People Page 22 of 32 Evidence: person, spoke with them and, with their permission, examined their commode. This had been used (and we were told only once) but had no stale waste products within. We were told that there were times when their relatives had to empty the commode. When we were in the persons room a member of staff visited and asked the person if the commode was to be emptied and this was done. When we asked, the member of staff said that the commode was checked at least once an hour although this was contrary to the residents view. We asked the resident if they or their family had made a complaint to the home, about this issue and we were told No. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are cared for by well-recruited staff although they cannot be wholly confident that the staff are able to always provide their care in a safe and competent manner due to a lack of underpinning knowledge with regards to the recording of care plans. Evidence: Although we have a record that we sent out six surveys for the staff to complete we have received no completed surveys from the staff. We examined the staff roster, watched the staff working and spoke with the Manager and the staff. Although the home had encountered unplanned absences, for the 3rd November 2009, action had been taken to make sure that there was a sufficient number of staff, including the Manager, to provide the care and support to the residents. A member of the staff said that there was usually enough staff on duty. According to the Manager any staff vacancies have been successfully filled, pending one vacancy for night duty, although the recruitment of an applicant is underway, to fill this vacancy. Evidence indicated that peoples needs are met in a timely manner. We saw that people were receiving care, including personal care, drinks and food, in an unhurried manner. The staff had time to talk with individual residents, in a sociable manner, Care Homes for Older People Page 24 of 32 Evidence: when carrying out their duties. All of the six residents surveys said that the staff are always or usually available when the person needed them. One of these surveys said that staffs response times could be better because When they say I will be back in a minute (they) mean just that. We saw no evidence of this and, when speaking with some of the residents, we heard of no concern such as this. However the home should be mindful of such a view and ensure that any action take by them does not evoke such a view. The AQAA said that the home currently employs seventeen care staff and eleven of these have a National Vocational Qualification level 2, or equivalent, in care i.e. 64.7 . We examined three of the staff files and found that all the required information, except a photograph, had been obtained. The registered owner said that she was aware of this omission and was taking action to complete the staffing information. Within one of the staff files we noted that all of the required information had been obtained and a criminal record bureau check had been applied for, although the result of this check had not been received. The Manager stated that the member of staff was employed and was working in a supervised capacity, on night duty. We were unable to evidence, and confirm that the member of staff was working in a supervised capacity, on this occasion. The AQAA said that the home currently employs seventeen care staff and eleven of these have attended an induction training that is in line with the Skills for Care induction foundation standards, which meets with our standards. Examination of the three staff training files indicated that the two newly recruited staff have attended an induction training and that the other member of the staff has attended training in, for example infection control, care planning, and safeguarding awareness. Other staff training records that we saw indicated that most of the staff have attended training in infection control and according to the Manager the staff have attended a one day training programme in care planning. Both of the health care professional surveys said that the staff had the right skills and experience to support the peoples social and health care needs. Due to our findings, and reported in Standard 7 of this report, the training of the staff in care planning may not, as yet, be fully embedded within their practice. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they live in a home that is improving although they cannot be completely confident that the home is wholly self-managing. Evidence: The management of the home remains stable, with no changes within the management team. We found that there have been improvements made in areas that we recorded within this report, such as some areas of care planning and the recruitment and training of the staff and an improvement in the standard of detail provided within the AQAA. The member of the staff, who we spoke with, said that they had confidence in the actions taken by the registered owner to suggestions made to her, such as replacement of items. They also felt supported by the registered owner. Although such improvements have been made the overall rating of the home remains one star i.e. adequate, due to the judgement rating for Standards 7 to 10. This indicates that the management of the home must ensure the safety and protection of residents by improved recording and improved medication practices. Such Care Homes for Older People Page 26 of 32 Evidence: improvements should not be wholly reliant on our inspection and regulatory activities but, as we explained to the registered owner, by the homes own quality assurance. This would tell us that the home is fully self-managed and therefore robust enough to ensure that people receive, overall, at least good quality outcomes i.e. 2 star. Comparing the AQAA that the home completed in 2008 with the AQAA completed by the home in 2009 we found that there was an improved standard of how the most recent AQAA was completed. It provided clear details of what the home does well in, how it has improved within the last twelve months and how it intends to improve over the next twelve months. This tells us that the home has developed its own quality assurance systems and is indicative of the ongoing improvement of the overall management of the home. Examples of information provided by the AQAA can be found elsewhere in this inspection report. Not all of the residents have chosen to have their monies safeguarded by the home and we found this out from talking with the Manager and some of the residents. Of those peoples monies safeguarded by the home we looked at three peoples personal monies and the records kept of these balances: we found that the amount of money available reconciled with the records kept. The Manager said that receipts are also kept although we did not examine these to cross reference these with the associated records on this occasion. According to the AQAA the home, within the last twelve months, has improved its training of staff in first aid, fire safety and safe moving and handling and that nine of the staff have attended training in infection control. Information provided by the AQAA also told us that two of the catering staff and nine of the care staff have attended training in safe food handling. We found, from speaking with the staff and examination of the staff training records that this was the case. The AQAA told us that service checks and tests are in date for the hard wiring of the home, fire detection and fire fighting equipment and we found records of these checks were satisfactory. Records for fire drills were also seen and the last fire drill, carried out on the 20th May 2009, was attended by 20 members of the staff. Examination of portable electrical appliance equipment indicated that some of these were to be tested, to ensure they were safe to use, by September 2009 and therefore these may now be out of date, depending on the amount of time the equipment is being used and according to the most recent fire safety regulations. We received a copy of the fire safety officers inspection (FSO) report that told us the FSO had inspected the home on the 16th April 2009 and that the report said that Care Homes for Older People Page 27 of 32 Evidence: ...the outcome was satisfactory. A certificate for the standard of food hygiene, dated 25th June 2009 was issued to the home, with a three star rating, and we saw this displayed on a notice board when we were looking around the premises. Records for the temperatures of food fridges and freezers were seen and these were recorded at least twice a day and were satisfactory. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes X 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 See next page Care Homes for Older People Page 29 of 32 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 13 Any activities that pose a risk to the person must be assessed and recorded. This is with particular regard to the administration of their own medication. The record must show how any level of risk is reduced to protect peoples health and safety. Previous requirement not fully met by the given timescale of 31/07/09. 30/11/2009 2 9 13 There must be clear record 30/11/2009 made of all medicines within the home, including the date and quantity received and when medication is given to people. This will ensure people are protected by having a clear audit trail of medicines in use and demonstrate that people receive their Care Homes for Older People Page 30 of 32 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 medicines as prescribed. Previous requirement not fully met by the given timescale of 31/07/09. 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 Care Homes for Older People Page 31 of 32 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. 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