Inspection on 01/04/09 for Meadow Lodge Care Home

This inspection was carried out on 1st April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Lodge Care Home 07/06/10

Meadow Lodge Care Home 17/03/10

Meadow Lodge Care Home 04/02/10

Meadow Lodge Care Home 14/09/09

Meadow Lodge Care Home 02/04/08

Meadow Lodge Care Home 08/10/07

Meadow Lodge Care Home 24/04/07

Meadow Lodge Care Home 27/09/06

Meadow Lodge Care Home 16/06/06

Meadow Lodge Care Home 03/02/06

Similar services:

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Meadow Lodge Care Home 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kulwant Ghuman     Date: 0 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Meadow Lodge Care Home 445 Hagley Road Edgbaston Birmingham West Midlands B17 8BL 01214202004 01212468279 info@meadowlodgecarehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Coseley Systems Limited care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 22 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 (OP) 22 Date of last inspection Brief description of the care home Meadow Lodge is situated on the Hagley Road a short distance from Bearwood shopping centre. Bearwood has a variety of facilities including banks and public houses, shops and a library. Public transport into the City Centre is available directly outside of the home. The home was originally two dwellings and has been converted to provide accommodation for up to 22 older people. The home has four shared and fourteen single bedrooms. The home has two lounges and two dining areas. Shower and toilet facilities are provided on the first and ground floors. On the first floor there are two bathrooms with bath seat lifts. There is a stair lift in the home. To the rear of the home there is a large garden that people living in the home can use. To the front Care Homes for Older People Page 4 of 35 Brief description of the care home of the home is a forecourt that provides some car parking. The home has a ramped access available. The service user guide/welcome pack states that the fees at the home are per regional Social Service/Council body contracts and the fee for people who are paying privately is 365 pounds per week. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over two days by two inspectors. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. The last key inspection for this home was in April 2008. In September 2008 we carried out a random inspection to look at the progress against requirements made during the key inspection. We felt that some progress had been made. The random inspection Care Homes for Older People Page 6 of 35 findings are noted in this report. Prior to this visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Two people living in the home were case tracked. This involves establishing the individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at to make sure that the people living and working in the home were safe. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent Have your Say surveys to the people who live in the home. We received four completed surveys from the people living in the home, two from staff working there and one relative. They told us that the people living in the home were happy with some aspects of the service. The staff felt well supported. Since the previous key inspection one complaint had been made to us about the home. This was referred back to the provider and no breaches of regulations were identified. One safeguarding issue had been raised with us following the last key inspection. This is commented on in the main body of the report. At the time of this inspection there had been concerns raised by other professionals regarding the care being provided at the home which were still being looked into. What the care home does well: What has improved since the last inspection? What they could do better: The manager needed to ensure that the conditions of registration were applied when assessing individuals who were thinking of moving into the home. Social work assessments needed to be received and assessments done by the home to determine whether they could meet the needs of the individuals before they were admitted into the home. Care plans needed to be further developed to ensure that they included all the relevant information needed by the care staff to meet the needs of the people living in the home. These included dietary, cultural and mental health needs. Care Homes for Older People Page 8 of 35 Risk assessments and management plans needed to be in place for issues such as pressure area care and mental health relapses. The management of medicines needed to be improved to ensure that all the people living in the home received their medicines as they had been prescribed. The manager needed to ensure that the dietary and social needs of the people living in the home were met in a way that satisfied the individuals. The views of the people living in the home need to be listened to and acted on as necessary. The manager must ensure that adequate infection control practices are used in the home to prevent cross infections. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process did not ensure that only people who were within the registration category were admitted to the home. The needs of the people living in the home were not always known before the individuals were moved into the home. People moving into the home were given information about the services to be provided. Evidence: The AQAA we received told us that all new service users were only admitted into the home if they fall within the homes registration. During the inspection it was found that one of the people admitted to the home did not have the needs of older people but rather those of someone with enduring mental health needs. The home is not registered to provide care for people whose main needs are those of mental health and the staff are not equipped to care for people with enduring mental health needs. The registered person must ensure that their conditions of registration are amended if they Care Homes for Older People Page 11 of 35 Evidence: wish to care for people outside of their conditions of registration. The AQAA also told us that an initial health assessment was completed for people admitted to the home however, whilst looking at the files of three people who had moved into the home recently one did not have an initial health assessment in place. The admission process did not appear to be consistently applied. For one individual the single assessment from the placing authority had been received before the individual was admitted to the home but the initial health check was carried out on the day the individual moved into the home. For the second person some documentation was faxed to the home on the day the individual was admitted to the home and stated that the care plan would be sent later. The homes assessment was not dated so it could not be determined when it was carried out however the individual told us that they had visited the home before moving in. For the third person it was difficult to determine what information was available to the home before the individual moved into the home. The records seen indicated that the individual had arrived with the social worker and stated that there was not much information. There was evidence that two of the individuals had received a terms and conditions of residence in the home, but the rooms to occupied and the fees to be paid were not recorded on one of these. The third person did not have terms and conditions of residence available on the file. Therefore it could not be determined that the people knew what they were paying for the service. There was evidence on the files that people were receiving a copy of the service user guide for the home ensuring the individuals knew what services they could expect from the home. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were care plans in place for everyone living in the home but they could be further developed to make them person centred. Not all identified risks had a management plan in place potentially leaving people at risk. The management of medicines did not ensure that everyone received their medicines as prescribed. Evidence: A the time of the random inspection of September 2008 the care plans and risk assessments were in the process of being updated. It was noted that there was some good information in the file checked but not all the information available in the daily living assessments had been included in the care plan. Some risk assessments were missing and others had been incorrectly assessed due to errors in adding up and management plans were not in place for identified risks. During this key inspection the care of two people living in the home was fully case tracked. This means that we looked at the care plans, risk assessments, medication records, spoke to staff about the care being provided and spoke to the individuals. The Care Homes for Older People Page 13 of 35 Evidence: care for three other people was also looked at but not in as much depth. The care plans had been computerised to make them easier to read. The amount of detail in the care plans was brief and they were not fully personalised to the individual. The care plan for one person who was currently receiving some input from the community mental health team did not include information about their mental health condition. It did not identify how it might express itself and what the signs of a relapse in their mental health might be or what actions the staff would need to take. if there was a relapse. It also stated that there was no specialist services. The care plan from the mental health team indicated relapse indicators and that when the individual became unwell violence could be exhibited and what staff needed to do in this situation. It stated that the outreach team would be visiting every week to assess and monitor the individuals mental health and carry out risk assessments. This information needed to be incorporated into the homes care plan so that the staff were aware of the role of the mental health team in the individuals care. The care plan did not include any information about the cultural needs of the individual for example, hair care, skin care or dietary requirements. Evidence was seen in the individuals bedroom that they did use creams and oils for their skin and hair. Daily records and conversations with staff indicated that the persons family did bring in some specific foods and that the individual asked the staff to buy some specific foods that could be cooked by the staff in the home. It is of particular concern that these issues were not being adequately addressed by the home as issues regarding cultural needs had been raised in previous reports. For another individual the care plan indicated some areas where the individual could undertake some tasks by them self and where staff needed to support and assist. The individual was a diabetic and the care plan stated that they should have a sugar free diet and eat 5 fruit and vegetables a day. There was no detail about how this was going to be achieved. There were some instructions about how much insulin needed to be given to the individual from the district nursing team. This was dated 20.1.09 however the individual was admitted to the home on 18.11.08. It is difficult to know how the staff knew what to do before this information was provided by the district nursing service. Daily records showed that on one occasion staff did not know what to do about giving insulin but there was no further information about what was done about this. It was not clear from the records whether this was in respect of the procedure for administering the insulin or the amount. On another occasion it was noted that blood sugars could not be tested as there was a problem with the machine. Care Homes for Older People Page 14 of 35 Evidence: The care plan also contradicted itself in places. In the personal hygiene section it stated that the individual did not mind a bath or shower however, in the routine on waking it stated that they liked to be washed on the bed and they were to be given a bed bath daily as they would refuse a shower. There were some risk assessments in the home for individuals including Waterlow assessments for assessing the risk of developing pressure ulcers however, where a risk had been identified there was not a corresponding management plan in place. The Waterlow assessments were not dated so it could not be determined if they were being reviewed as needs changed. For one individual it was noted from the daily records that they had developed a sore at the beginning of December, there was no management plan in place however, a pressure reducing mattress was obtained for the individual in the second half of January 2009. Some daily records indicated that the individual was being turned 2 hourly but there was no rationale as to why this was being done. It was not recorded as being required in the care plan and there was an air flow mattress on the bed that would negate the need for this. The home was keeping a record of bumps and bruises observed on individuals. There were three injuries recorded for one of the people being case tracked. We were told by the manager that these occurred whilst the individual attended the hospital. It was difficult to track that the individual had attended the hospital on these dates or that the injuries had been followed up with the hospital. During the inspection it was observed that one of the individuals was preoccupied with death and that their neck disappearing. We were told, and we observed, that the manager told the individual that they did not want to talk about death. The care plan did not mention that this was how staff were to respond to the individual. Another individual was having problems with eating. Advice from the dietician stated that the individual should have 4 fortisips daily in glasses of full fat milk. There was no full fat milk available in the home and there was no evidence that this had been delivered by the milkman. Following the inspection we were informed that this was in another fridge but the manager did not tell us this at the time of the inspection. Staff needed to ensure that the fortisips were in addition to meals and not in place of them. The care plan stated that the individual was to have all their meals pureed, and cream added to the meals and thickener added. However, food records indicated toast and bread and butter were given. The food records needed to be more detailed about how the food was served and the amounts eaten in this situation. Care Homes for Older People Page 15 of 35 Evidence: The individual was to be weighed weekly but this was not always being done. This could leave an individual at risk if they were losing weight for any reason. A letter from a medical professional stated that the individuals weight had stabilised. The staff needed to be consistent when weighing so that they used either stones or kilograms. The health needs of people were being met via the district nurses, GPs, chiropodist, dentists, mental health teams and local hospitals as needed. The records for the visits were not very easy to track as the visits made by professionals were not always recorded separately but included in the daily records. Visiting professionals to the home have commented that information passed onto staff in the home was not always passed on from shift to shift and staff in the home could not tell them about hospital visits. An example of this was when the sharps box was identified as overflowing. Staff were asked to have it removed. No action was taken until the provider was spoken to directly and then it was removed. The sharps box was not being kept locked away, was overfilled and there was evidence that staff had had to rummage through the box to retrieve a lid for the blood sugar monitoring machine. This is a very dangerous practice and puts the staff at risk of acquiring infections from needle stick injuries. We have been informed since that the needles for the insulin pen were not a risk for staff but nevertheless staff should not be taking items out of a sharps box. One comment received in the completed questionnaires to us said if there is any thing wrong with myself the staff are always there at hand as are the doctors or ambulance if need be, basically I only have to sneeze and the doctor is there. Relatives surveys said: Every care is given to help each person with their personal needs. I am very happy with the care given to my mother. I would go along way to find a home as caring as this one. Following the key inspection of April 2008 a random inspection was carried out on 11.9.08 to check on the management of medicines. It was found that although people were receiving their medicines some improvements were needed to the management system to ensure that was possible to audit all medicines in the home,self administration records needed to identify which medicines people were responsible for, copies of the prescriptions needed to be kept with the MARs to enable the staff to check that the medicines and dosages provided by the pharmacist matched the Care Homes for Older People Page 16 of 35 Evidence: prescription from the doctor. Compliance checks for those self administering medicines were not being carried out. During this inspection the medication for three people living in the home was looked at. The majority of this medication was boxed but there was some medication in the monthly monitored dosage system supplied by the pharmacist. At the time of this inspection it was the third day of the new medication cycle. Eye drops for one person stated that they should be used 5 times a day. They were being administered four times a day only. There was no explanation as to why. There was an angina spray that stated it was to be used as directed. There was no protocol in place for this or the inhaler to be used by the individual indicating when it should be administered. Looking at the previous MAR (medicine administration record) with the current one showed that Queitipine was not recorded on the current MAR. It could not be evidenced that the individual had received this medication for at least the previous two days. It was concerning that no one in the home had identified that this medication was missing and there were concerns that had the inspection not taken place when it did, the individual would not have received their medication for an unknown period of time and that it could have had an impact on their mental health. Looking at the amounts recorded as having been received on the previous MAR it appeared that their should be a supply of 56 tablets in the home. The following day we were informed that this supply of tablets had been found in the returns box in a room on the second floor of the home. Lansaprazole for the same individual showed that the amounts carried over from one MAR to the next, the number of tablets given and the numbers remaining did not always tally so that it could not be guaranteed that the tablets were being given as prescribed. This issue was eventually resolved but it was not easy to do so. For another individual Risperidone was signed as given on two days however there was none found in the trolley. A member of staff stated that they had got it out of the returns box as none could be found in the trolley. We were told that the staff must have gone into the room holding the medicines to be returned to the pharmacist and taken them out. The manager stated that she had phoned for a further supply however, there was no evidence in the communication book that this had been done. We were also told that the individual had gone to hospital and that all the medication was sent with them and it did not always come back. This did not follow as there were some medicines available. The following day we were told that the divider between the blister packs had fallen out and the missing medicines had been found with another Care Homes for Older People Page 17 of 35 Evidence: persons medicines. When we queried why the staff had said they had got it from upstairs we were told that they panicked that something was wrong and lied. This is concerning as is would suggest that staff could be untruthful in other situations where issues were identified. The returns medicines once set aside to be collected should not be accessible to the staff without the managements knowledge and shows that they are not stored appropriately. There were no controlled medicines in use at the time of the inspection and the only homely remedies in use were painkillers and the running total for these was correct. One of the people living in the home was administering their own insulin but all the other medication was being administered by the home. The individual had completed a self administration record but it did not identify which medicines they would be responsible for administering and it looked as if they were administering all their own medicines which was clearly not the case. The manager had been auditing the medicines but there was no evidence to show what had been checked and what had been found. The management of medicines needed to be closely monitored to ensure that the people living in the home were receiving their medicines. The home had introduced a suited lock system on bedroom doors and some people had keys to their bedrooms to enable them to keep their bedrooms inaccessible to others. During the inspection it was observed that one person was having physiotherapy in the lounge. It would be better if this was carried out in the individuals bedroom to promote dignity for them and to ensure that other people using the lounge were not disturbed. Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living in the home were unhappy with the meals provided by the home and did not feel that there was enough activity to keep them occupied. The people living in the home were able to make some choices about their lives. Evidence: The AQAA we received told us that that service users were enabled to make decisions and choices regarding leisure, meals, routine living, social relationships and religious aspects. There was an open policy on friends and family visiting and People could go to the bedroom or dining room with relatives. An advocate was available in the home. Documentation seen and observations made during the inspection confirmed that people were able to decide who they wished to see. Relatives were able to visit at any time and people living in the home were given control over their daily routines. People had choices of whether to sit in the lounges, dining room or their bedrooms. They could have meals in the dining room, lounges and bedrooms. There was little evidence of activities taking place during the inspection and comments received from people living in the home indicated that there was little for them to do Care Homes for Older People Page 19 of 35 Evidence: on a daily basis. Activities records generally indicated that people were watching television in the lounge. There was little evidence of any organised activities although staff spoken to indicated that board games were played. Some of the people living in the home indicated that there were occasional exercise sessions. One person stated that there was little point in going downstairs as there was no one they could speak to. There was little evidence of meaningful conversations between staff and the people living in the home. One of the surveys completed by someone living in the home said in response to questions about whether there were activities; On rare occasions, such as clothes sales or an aerobic session. Generally the answer is no. Would be nice to have excursions when weather permits. Would be nice to go to parks, shops or cinema. An improvement identified by staff was ...have more activities for residents ie outings, visiting entertainers , music, sing a longs etc. During the inspection we were able to take a meal with the people living in the home. The food was of an acceptable standard however, it was noted that there was no offer of second helpings of any of the food, there were no condiments available on the tables and there were very limited interactions between the staff and the people living in the home. This resulted in the mealtime being completed like a task rather than an enjoyable, social activity. Several critical comments were made by the people living in the home in the surveys sent to them. These included: Sometimes the meals are cold or greasy. This is a major criticism. The food is of very poor quality and not particularly nutritious. It all seems to be from frozen. Never see fresh vegetables. Occasionally some fresh fruit. ...The food is not good enough or sufficient. Myself and other residents have to buy food ourselves in order to eat properly. I myself in the time I have been here have spent hundreds of pounds buying in food for myself the food is not adequate or of good quality. Most of the meals are not good or sufficient in quantity, a few sandwiches is supposed to be your evening meal. Care Homes for Older People Page 20 of 35 Evidence: The food records did not always show the vegetables or sweet provided or how any special dietary needs were being met eg diabetic or pureed and enhanced calories. Cultural needs had not been taken fully into consideration and how these needs were to be met were not identified. For several of the people living in the home their care plans identified that they were to have five fruit and vegetables a day, or have a high fibre diet. The food records did not enable anyone to determine whether this was being achieved. One person spoken to during the inspection said, The food was of poor quality, and they did not like it. They had complained about it but nothing had been done. They asked a carer to do shopping for them. They liked sausages but the sausages provided by the home were of poor quality. They had spent a lot of money on food. The carers were lovely and couldnt be faulted. The best ones left quickly. One person living in the home was on a pureed diet and needed cream to be added to some foods and creamy milk to be added to fortisips. When we checked the fridge there was no creamy milk or cream available. There was no evidence that showed that it had been received in the home at all. Following the inspection we were told that this milk was kept in another fridge, however, the manager did not tell us this on the day of the inspection. There was a four week rolling menu in place. There was some variation in meals from one week to the next. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was concern that some people living in the home were not receiving care as required so that their health was being put at risk. Some of the people living in the home were unhappy with some aspects of the service. Evidence: At the time of the last key inspection there were some ongoing issues due to allegations being made by staff against other staff. One of these had been investigated and no breaches of regulations had been identified. The death of one person living in the home had been referred to the coroner and this matter had been concluded satisfactorily. An issue was raised following the last inspection about racism and partiality towards some staff in the home. The matter was investigated by the provider and no issues were identified. A concern had been raised following the last inspection when someone living in the home had been prescribed some strong painkillers following a visit from the GP to the home during the early evening. The home had failed to access this medicine until after mid-day the following day. The individual did not receive adequate medication for pain relief due to the actions of the home. The home was supported by the local authority to put policies and procedures in place to prevent this situation occurring again. Care Homes for Older People Page 22 of 35 Evidence: At the time of this inspection some concerns had been raised about the practices in the home in respect of the care being given to some of the people living in the home. The issues raised were regarding the management of diabetes in the home, whether the home was admitting people whom they could not care for, some moving and handling practices, management of sharps in the home and the passing on of information from shift to shift. These issues were being looked into at the time of this inspection. During this inspection concerns have arisen about the management of medicines in the home. This is concerning as issues about the administration of medicines have been raised previously, they have then been addressed and have arisen again when a situation arises in the home which is out of the norm for them. This would indicate that either the systems are not robust, staff do not understand the systems or they are not following the systems in place. The outcome is that some people have not received their medicines as they should. One of the people spoken to during the inspection stated that they had complained about the food. There was no record that any such complaint had been received. It was surprising that with the number of people who had made comments about the quality and quantity of food that no complaints had been received by the home. An allegation had also been made by someone living in the home that they had been roughly handled by the staff. The matter had been looked into by the manager and at the time of the inspection the report was being written up. We were informed following the inspection that the issue was in relation to the catheter being pull accidently whilst cream was being applied and had occured several months earlier. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises were suited to the needs of the people living in the home but some areas needed further improvement. Evidence: The home had not changed significantly since the last key inspection. Since the last inspection the front of the home had been decorated, a new washing machine had been purchased and a heater had been fitted in the assisted bathroom on the first floor. There were two lounges and two dining rooms providing communal space on the ground floor. The garden needed to be attended to to make it more appealing to the people living in the home. The lounges and dining rooms were adequate. The carpet on the ground floor would need replacing in the future and should be included in any refurbishment of the home. There was a kitchen, smoking area and two shower rooms on the ground floor in addition to four bedrooms. The laundry was located in the cellar and not seen during this inspection. The home had replaced several beds with hospital style beds. The manager needed to Care Homes for Older People Page 24 of 35 Evidence: ensure that the appearance of the bedrooms did not become too medical and maintained a homely feel. The bedrooms seen during the inspection met the needs of the people occupying them. There was a suited lock system so that people could have a key to their own bedroom. There is a stair lift that helped those without full mobility to access the first floor. A survey completed by someone living in the home said: I didnt really comprehend the implications of the stair lift at the time. As my mobility is restricted I find it difficult to use and restricts me to my room. At the time of the inspection there was no one who was unable to get downstairs. There were walk in showers, assisted bath, emergency call system, hoists and wheelchairs available for use in the home. All the wheelchairs seen during the inspection had foot rests in place ensuring that people were not being put at risk during manoeuvres around the home. The weather at the time of the inspection was quite pleasant and there did not seem to be any problems with temperatures within the home. Staff were observed to walk around from the lounge to the kitchen with gloves and aprons on. These should be changed before entering food handling areas. A comment in the communication book stated that the sharps box was in the bedroom of one of the service users and there were sharps on the floor. The cover was on the floor and the top from the glucose level monitor was found in the sharps container. This indicated that good infection control procedures were not being practiced within the home. One of the people living in the home was coughing and spitting out into a paper towel in one of the lounges. The individual had not been provided with a bin and supply of tissues to use so was holding onto the same tissue. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels were appropriate for the number of people living in the home. It was not evident that communication between staff and the manager was always successful. Evidence: There were three staff on duty in the home including the manager on the day of the inspection. There were 17 people living in the home at the time. In addition to the care staff there was a cook on duty. Staff spoken to during the inspection told us that there were usually 4 staff on duty during the morning and 3 during the afternoon and 2 during the night. One of the surveys completed by someone living in the home said: Some staff are lazy ie, wait I have to do this and are too familiar with residents. The staff need to be reminded what their job entails and how to treat and speak to residents Someone spoken to during the inspection said I cant fault the staff but the good ones leave quickly. As stated earlier, there appeared to be little interactions between the staff and the people living in the home apart from when a task was to be carried out. Care Homes for Older People Page 26 of 35 Evidence: The files of three staff who had been employed since the last inspection were looked at. They showed that all the appropriate recruitment checks had been undertaken. All the people had started their induction training packs. One of the individuals had started employment in November 2008 but had not yet completed the induction. This should have been completed within 12 weeks and the manager should have recorded that the person was competent to be left unsupervised on shift. Two of the files had evidence of training undertaken in their previous posts but there was no evidence of any training having taken place during this employment such as fire training. The training matrix supplied indicated that fire safety training was last undertaken more than six months ago for most staff. All staff must undertake fire training every six months. The matrix showed that the majority of staff had attained NVQ level 2 and some had achieved level 3. It would be appropriate for staff to undertake training in the care of people with diabetes as there are people in the home who suffer from diabetes. Two people on the training matrix were not identified as having undertaken manual handling training. It was important that they had this. Some issues have been raised by the district nursing team regarding the passing on of information between staff. The staff had not informed the manager that some medicines were missing and this meant that some people living in the home had not received their medicines as required. They had raised issues with the home about the handling techniques used with one of the people living in the home. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a manager in place that was making some improvements to the service being provided. She needed to be more proactive in knowing what was happening in the home and what areas needed to be improved to ensure that the people living in the home were happy with the service. Evidence: The manager has been registered with the commission since the last inspection. This means that there is someone in day to day control of the home to ensure that it operates safely and meets the needs of the people living there. The manager has been in the process of updating the care plans. Some improvements had been made. There were some areas of the documentation that needed to be improved upon. There were some issues that arose during this inspection that means that some of the Care Homes for Older People Page 28 of 35 Evidence: people living in the home were not getting their medicines as prescribed, some people were not happy with the food being served and peoples cultural and dietary needs were not being met. Some people said there was not enough for them to be occupied. There was no evidence of meaningful interactions between the staff and the people living in the home. The manager needed to ensure that systems were in place that helped her to get to know how people living in the home were feeling about the service they received and what could be done to improve it for them. Meetings were being held for the people living in the home to express their feelings about the home. There were staff meetings and an independent person carried out monthly visits to the home and provided a report. We were told that some audits of activities, complaints, compliments, falls and so on were carried out. These findings should be used to formulate a development plan showing what was going to be done to develop the service. The home held some monies on behalf of some of the people living in the home. For the majority of people the families managed their monies or they had appointees looking after their affairs. It was of concern that people living in the home were asking staff to buy purchases on their behalf but the manager was unaware that this was happening. There were no records of what monies had been given to the staff and what had been bought for them. A system should be put in place for managing this. There had been a number of occasions on which the emergency services had been involved due to the medical needs of one of the people living in the home. The manager had not forwarded the required notifications of these incidents to us. The manager must ensure that this is done so that it can be assured that the needs of people living in the home are being met. Following the inspection we were informed that these had been sent to us but there is no evidence to show that they were ever received by us. This issue will be followed up at the next inspection. Health and safety appeared to be managed well and all the equipment was being regularly maintained. Fire records showed that the fire equipment was tested on a regular basis as required to ensure that they were in good working order. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The manager must ensure that peoples needs are fully assessed before they move into the home. This will ensure that only people whose needs can be met will move into the home. 29/05/2009 2 4 15 The registered person must ensure that the homes registration reflects the criteria of people being cared for in the home. This will ensure that people can be assured that their needs can be met at the home and the home can show how they will meet their needs. 29/05/2009 3 7 13 The manager must ensure that the practices in the home do not put the people living or working there at risk. 14/05/2009 Care Homes for Older People Page 31 of 35 This will ensure that people are not put at unnecessary risk of harm. 4 8 13 There should be a 15/05/2009 management plan in place for all identified risks so that the staff know what actions they should take to safeguard the individuals. This will ensure that staff know what actions to take to safeguard the people living in the home. 5 9 13 The manager must ensure that the people living in the home receive their medicines as prescribed. The manager must ensure that all medicines in the home are stored in accordance with the regulations. The manager must ensure that all medicines coming into the home can be accounted for. The manager must ensure that protocols are in place for medicines to used as directed This will ensure that the people living in the home get their medicines as prescribed. 15/05/2009 Care Homes for Older People Page 32 of 35 6 15 17 The manager must ensure that the records of food served show that peoples dietary needs are met. This will enable the diet of the people living in the home to be assessed to ensure their needs are being met. 15/05/2009 7 18 13 The manager must ensure that the people living in the home are safeguarded from harm. This will ensure that the people living in the home are safe. 15/05/2009 8 26 13 The manager must ensure 15/05/2009 that there are good infection control policies and practices in the home. This will ensure that the people living and working in the home are not exposed to unnecessary risk of infection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The manager should ensure that everyone admitted to the home receives a copy of the terms and conditions of residence so that they know what services they can expect to receive and how much they should be paying for them. Weights of individuals should be monitored regularly and recorded in a suitable format. This will ensure that people who have lost or put on weight can be monitored and the appropriate actions taken. 2 7 Care Homes for Older People Page 33 of 35 3 7 Care plans should have details about all the needs of individuals living in the home so that the staff know how to assist them. Risk assessments should be dated so that they can be reviewed on a regular basis. Any bumps and bruises seen should be investigated and evidence of possible causes recorded. The manager should ensure that information about individuals health care needs is recorded in a way that is easy to track and accessible. Where individuals are responsible for administering their own medicines it must be clear which medicines they are administering themselves and what the role of the staff will be. The audits of medicines carried out by the manager should show what has been checked, and what discrepancies, if any, were identified. The manager should encourage professionals to carry out their treatments in the privacy of individuals bedrooms. The manager must ensure that the people living in the home are supported to lead fulfilled lives according to their needs and wishes. This will ensure that they are not bored. The manager must ensure that the food provided in the home is nutritious, varied and of good quality. This will ensure that the people living in the home are satisfied with the food. The home should continue to be refurbished as needed. The manager should ensure that the home is run so that the people living in the home are happy with the service provided. A report should be developed to show what the home does well, where things could be improved and what will be done to improve them. This will ensure that all interested parties are aware of how the service is planning to improve. The manager should ensure that the required notifications are forwarded to the commission. 4 5 6 8 8 8 7 9 8 9 9 10 10 12 11 15 12 13 19 31 14 33 15 37 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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