Inspection on 14/09/09 for Meadow Lodge Care Home

This inspection was carried out on 14th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 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 01/04/09

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 16/02/2010.

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 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: Kulwant Ghuman     Date: 2 4 0 9 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 40 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 40 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: Coseley Systems Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 Care Homes for Older People Page 4 of 40 Over 65 22 0 0 1 0 4 2 0 0 9 Brief description of the care home the home there is a large garden that people living in the home can use. To the front 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 40 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 one and a half days. On the first day there were two inspectors and on the second day there was one inspector. The pharmacist inspector visited the home alone on another day. The home did not know we were going to visit. On the first day of the inspection a lady called Barbara Stoddart also visited the home. She is known as an expert by experience. This means that she has used care services and she visited the home to provide an independent view on the home and the service it provides. During her visit she spoke to 10 people who were living in the home, had lunch with them, looked around the home and observed interactions. She wrote a report about her visit and her comments have been included within this report 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 Care Homes for Older People Page 6 of 40 regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the 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. These are reports about things that have happened in the home that they have to let us know about by law. We did not ask for an Annual Quality Assurance Assessment (AQAA) for this inspection as one had been provided for the previous key inspection in April 2009. The AQAA is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing 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. Two other files were also looked at. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. During the course of the inspection we spoke with five of the people living in the home, one visitor, the manager, and two staff to get their views on the home. We sent nineteen Have your Say surveys to people who live in the home and their relatives, ten to staff and five to professionals who visited the home. We received four surveys that had been completed by people living in the home. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: The staff must ensure that the admission procedures are followed so that the people living in the home are safeguarded from harm. Greater detail should be recorded at the assessment stage to ensure that the home are able to formulate care plans that are more person centred. The manager should ensure that there are systems in place to enable audits to be undertaken to check that people living in the home are provided with the support that they want. The quality assurance system currently fails to identifies issues that need to be addressed in good time. The people living in the home should be consulted on how the service provided by the home can be improved and the plans put in place to achieve this. The fabric of the building should be invested in to make it a more homely and comfortable environment. Although some aspects of the management of medicines in the home has improved Care Homes for Older People Page 8 of 40 there are still issues outstanding such as medicines not having been recorded on MAR charts, hand written MAR charts include all the important details. External health care visits should be clearly documented and staff admininstering medicines should follow the procedures and have knowledge of the medicines being administered, risk assessments and compliance checks should be carried out for people who were managing their own medicines. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 40 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 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written information is available to people thinking about moving into the home to help them decide if the home is suitable for them but the information is incomplete. This means that they do not have all the information they need to make a fully informed decision. The admission process is not robust and did not always safeguard the people moving into the home. Evidence: The service user guide in place had been updated in January 2009 but it did not give a guide of the range of fees charged at the home. This would enable people deciding whether the home was suitable for them or not to know what they would be paying for the service. The service user guide included other information needed for people to help them decide on whether the home was suitable for them. Care Homes for Older People Page 11 of 40 Evidence: We looked at the process undertaken when admitting four people moving into the home. We were told that people visited the home before they moved in however there was no documented evidence that this had taken place or when. Care plans from the placing social workers had been received by the home so that they could use the information included in the care plans about the individuals needs. The level of information included in these varied considerably meaning that sometimes the home had little information about the individuals needs. The home carried out an assessment of need however this was very basic consisting of tick boxes covering areas such as safety and environment, mobility, eating and drinking, continence and communication. This meant that there was very little individualised information about their needs. We were told by the manager that she then wrote up the care plans with the information that she held in her head. This was not an ideal way in which to carry out an assessment and formulate a care plan as information could get mixed up or forgotten and can lead to generic care plans being developed. We were told that two of the people did not have a contract on their files as they were in the home on respite, and the other two had not been given contracts yet. This meant that the people did not have an agreement in place that told them what services they could expect to receive, what their responsibilities were and how much they would be paying for the service. We noted that the staff were not always following the admission process adequately. One person who was admitted from hospital did not have a discharge letter with them and the staff did not check that they had the correct medication which resulted in them not having all their medication for three days. This resulted in the health of the individual being put at risk. Care Homes for Older People Page 12 of 40 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. Records did not show that peoples social and health care needs were always met. Risk assessments were in place but sometimes staff did not implement them. putting people at risk of injury. Whilst the majority of medicines had been administered as prescribed and records reflected practice further work is required to ensure that the regulations are fully met. Evidence: The four files we looked at all had a care plan in place. The care plans consisted of several sheets covering lots of areas of need including general health, using the stair lift, mobility, shaving, eating and drinking, night needs and so on. There was no evidence to show that the individuals had been involved in drawing up the care plans. There were some inconsistencies noted in the assessments and the accompanying care plan suggesting that the people did not get their needs met in a suitable manner. For example, in one assessment it stated that their was no incontinence however, the care plan stated that the individual wears a pad day and night with no rationale why Care Homes for Older People Page 13 of 40 Evidence: they were needed. For another person the assessment stated meals to be of soft food only and one carer to help with feeding and one carer to be present at all times to assist with feeding. The care plan stated bite size pieces and soft food and staff to assist with feeding as she finds this task hard to do. During the first day of the inspection it was observed that the individual had been given slices of toast cut into two and there was no one assisting them to eat. For another person in some documents it stated that they had dentures and in others that they had their own teeth which was confirmed by the manage One of the care plans stated that the individual liked to look clean and tidy at all times. When we met the individual it was clear that he had not had a shave for a couple of days. We looked at the personal hygiene sheets to see when the last shave had been recorded as the records stated the staff to shave him. No record of a shave had been recorded and the sheets showed that people were generally being given strip washes. This was discussed with the manager who was unaware that the shaves had not been recorded and that refusals of baths or showers had not been recorded. The social work care plan for one of the people who had recently moved into the home stated that the goal was to have my care provided in a culturally sensitive manner. This was discussed with the manager as no mention was made in the care plan of any cultural needs. We were told that the social worker had been asked about this and told that there were no specific needs. There was no record of this so that it could not be verified. All contacts with professionals regarding the care of the people living in the home should be documented to show that issues had been followed up. There were some risk assessments in place covering issues such as use of the hoist, wheelchairs, mobility, use of stair lift, nutrition and preventing the development of pressure ulcers. One of the care files looked at did not have risk assessment in place for the prevention of pressure ulcers although it was noted that systems were in place to prevent ulcers developing. Staff did not always follow the risk assessments. For example, one persons care plan stated that when using the stair lift the belt was to be used. Staff were observed to be assisting the individual but the belt had not been used. This could put individuals at risk of injury and staff must follow the risk assessments in place. People living in the home were put at risk of cross infection through poor practices such as staff not changing protective clothing when handling food and when wandering around the home and protective clothing in the kitchen not being thoroughly cleaned each day. Care Homes for Older People Page 14 of 40 Evidence: There was evidence that the people living in the home had access to GPs, hospital services, chiropodists and district nurses to ensure that their health needs were being met. It was not always possible to track whether medical services had been contacted when an issue had arisen as the visits were not always recorded. There were some very good details of one persons insulin regime ensuring that he received the support he needed from the staff. During examination of the communication book it was noted that a district nurse had requested that the weight of one individual be monitored as he had lost weight. The manager was not aware of this and no one had been monitoring the individuals weight. It was noted that a baseline weight of individuals was not recorded on admission of people moving into the home so that it could not be determined if they were receiving adequate nutrition. The staff were unsure as to who was responsible for weighing people. There was no system in place to ensure that the weights of the people living in the home were monitored on a regular basis. The home uses a monitored dosage system for the management of medicines in the home. The pharmacist inspector visited the home following our inspection to look at the management of medicines in the home however, on the first day of the inspection whilst looking at the admission process it was noted that on admission the staff at the home failed to check the medicines brought in by an individual from hospital. This meant that the individual went without an important medicine for three days and there could have been a serious affect of not having had the medicine. In addition, the charts drawn up on admission to record the medicines that had to be given had the wrong dates recorded on them. The fact that the wrong dates had been recorded was not identified until the inspection although several staff had given medication out. This means that the records were not a true reflection of what had happened. It was also noted that some medicines were being stored in a fridge along with some food stuffs. Medicines should be stored in a separate fridge to minimise risks of contamination and so that access is limited only to people who administer medication. During the second day of the inspection it was observed that whilst staff were giving out medicines they had put the medicines of several people into small pots which they were carrying on a tray and taking it around the home. This was pointed out to the staff and the manager who confirmed that this was not the correct procedure. This increases the risk of a drug error, where the people living in the home may be adminstered the incorrect medication. Care Homes for Older People Page 15 of 40 Evidence: Some of the people living in the home were suffering from chest pains and kept some sprays on their persons to be used when they were in pain. The care plans did not include any details on how staff were to manage these incidents. For example, after the sprays had been administered how long should they wait for the pain to subside or when to call the ambulance. The pharmacist inspection lasted two hours. It took place on a different day to the main inspection. Six peoples medication was looked at together with their Medicine Administration Record (MAR) charts and care plans. One senior care was spoken with who handled the medicines and all feedback was given to the owner, Mr R Bagga. All the medicines were kept in a locked medicine trolley which was chained to the wall when not in use. Separate storage was available for the correct storage of controlled drugs. One medicine was due to reach its expiry date the day after the inspection. No further supply had been sought and the care assistant had no understanding about the medicines short expiry date. Two eye drops requiring refrigeration were found in the trolley and so stored incorrectly. Both were no longer used and had not been removed from the trolley. A system had been put in place to check the prescriptions prior to dispensing and to check the medicines received into the home for accuracy. This appeared not to have been done for this month as copies of the prescriptions dated back to July. Two medicines were no longer available to administer to one person and it was unclear whether staff had forgotten to order them or the doctor had discontinued them. The senior care on duty had no knowledge of the reasons why. One person had been moved to hospital and all his medicines were sent with him to the ward. No record was made that this had happened. This included one medicine recorded in the controlled Drug register. In addition further medicines were found for him in the trolley that had not been recorded on the MAR chart. There must be a record of all medicines on the premise available for each person. The manager undertakes regular audits but the owner was not able to provide any further details. Hand written MAR charts were generally poor as some lacked important details for example, the dose, strength and formulation of the medicines. All the quantities of medicines received into the home had been recorded enabling audits to take place to assess whether they had been administered as prescribed. Audits Care Homes for Older People Page 16 of 40 Evidence: undertaken during the inspection indicated that the medicines had been administered correctly. The care plans regarding the peoples clinical conditions were poor. It was difficult to find information which the care assistants would need to be able to fully support the peoples clinical needs. External healthcare professional visits had not been documented. No information could be found as to why certain medicines had been prescribed. No supporting medical care plans had been written for staff to read. Some care plans contained conflicting or incorrect information so again their value was questionable. The senior care assistant spoken with had a very poor understanding of what each medicine was for. She was unable to explain the correct symptoms of one medical condition and also how to administer emergency prescribed medicines to alleviate the symptoms. The lead inspector was told that people suffering from this condition were sent straight to hospital without administration of the prescribed medication. No further training has been sought even though this had already been highlighted by the lead inspector. In line with Government guidelines all staff that handle medicines should know what they do and also common side effects. Without such knowledge it would be difficult to fully support the people in the home. People were encouraged to self administer their own medicines. No risk assessments had been undertaken to assess whether they could do so safely and no compliance checks had been done to confirm that they did take them as prescribed. All but one of the bedrooms looked at had appropriate locks on them and people had keys to their bedrooms if they wanted. We saw a confused person wander in and out of this bedroom during the inspection which meant that the privacy of the occupant of the bedroom could be compromised. Bedroom doors with panes of glass had curtains in place to ensure that privacy and dignity was maintained. One of the care plans looked at referred to the individual by the incorrect gender throughout the care plan. This was raised with the manager who stated that it was her error in typing and that none of the staff had highlighted this. This could indicate that care plans were generic and not person centred or that peoples dignity was not being respected. Care Homes for Older People Page 17 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides some activities but these fail to meet individual needs in a responsive manner. Evidence: People living in the home could exercise choices in what they wore, whether they stayed in their rooms or sat in the communal areas of the home and whether they had visitors or not. There was not much evidence of individuals having contact with the local community through visiting local shops or amenities such as theatres, libraries or restaurants. The care plans we looked at did record what people liked to do. For example for one person it stated that they were not interested in any activities and for another it stated likes friends to visit, spends time watching television, listening to radio and in the garden. Likes to watch action and western films, likes news and antiques road show. There was no evidence in the files that the individual had been been involved in any of these activities. Care Homes for Older People Page 18 of 40 Evidence: The activity sheets we looked at for another person recorded them watching television, reading a newspaper and occasionally chatting with staff. An expert by experience visited the home and spent some time with the people living in the home and gave her views. Her report stated: The garden area had potential but needed attention to make it into a more pleasant area for residents to sit out. The TV was on in both lounges. Residents seemed disinterested in what was on and didnt know how to turn off the TVs if they wanted to. I spoke with around ten residents during my time at the home. All said there were no activities provided and no trips out. Many said they were bored. Two residents mentioned that recently someone had come and done physical activity with them with music but only the one time. There was no evidence of any resources except some books in the bookcase. Asked what they did all day, one said Nothing just sit here all day. Another said I would love to go out and be wheeled anywhere. One of the people we spoke with told us she was able to choose her clothes, she had never been asked if she wanted a bath or shower and just had a wash. She spent a lot of time in her room because she did not feel she was able to relate to the other people living in the home. Staff spoken to said they did offer books and puzzles but people didnt always take up the offer. The manager told us that people were taken out to the local shops but felt that this was not being recorded. There was no evidence to indicate that visitors were not welcome in the home and visiting was allowed during all reasonable hours. One was seen visiting during the inspection. The care plans recorded what religious needs the people living in the home had and they were supported to have these needs met. The expert by experience had lunch with the people living in the home. She said: Most said that the food was not very nice and that they were not usually offered a choice. Before lunch I was asked if I wanted cottage pie or jacket potato but noticed that no one else in the room was asked if they wanted anything different. I was told that every day a plate of food is brought in and put before them. The drink on offer Care Homes for Older People Page 19 of 40 Evidence: was pink squash in the usual plastic cup. No one was offered a choice of anything different. I asked for water. There was no choice of dessert, it was sponge pudding with custard , mine was lukewarm and a bit tasteless. A resident who has very high cholesterol could not eat the dessert but she was not offered an alternative. The first course, cottage pie, peas and cabbage was okay. I was told that it was usually not as good as this. There were some apples in a bowl, but nobody touched them, I think older people need fruit to be cut up and made to look inviting if they are to be encouraged to eat it. Tea I was told was at 4.30 pm and usually something on toast or a sandwich. After that there was only a drink and biscuit before bed. A long stretch with no food. There was no interaction between staff and residents during the mealtime and no interaction between residents themselves in the dining room where I was. Lunch was a rather depressing experience which no one appeared to enjoy. There was no menu although I was told there was one in the kitchen. One person said that There is nothing to go downstairs for. They also said that relatives bought in convenience meals for them from a local store which staff heated up. They said this was because the food was so bad. The food is appalling, diabolical. There is one thing on the menu and you have to have that. Its austere here. Everything is run on as low a budget as possible. Some of the care files that we looked at stated that the individual should be provided with five fruit and vegetables a day. The staff could not tell us how this was being achieved. The food records did not always record the vegetables on offer. The cook showed us some fresh vegetables and fruit in the cupboard. We discussed ways in which the amount of fruit and vegetables in the diet could be increased. There was a menu available in one dining room but it was doubtful if any of the people living in the home ever looked at them. We looked at the food records and noted that there was a rolling menu with some variation of the main meals from week to week. The menu could be made more interesting and varied. The tea menu consisted mainly of sandwiches although there was cheese on toast and scrambled eggs on occasions. Snacks were very limited with plain bread and butter or biscuits on offer. The cook was keen to learn and it would be advisable for him to be provided with training on the nutritional needs of older people and menu planning so that he can organise the menu to incorporate these needs and the shopping adjusted accordingly. The quality of the food and the satisfaction of the people living in the home with the Care Homes for Older People Page 20 of 40 Evidence: food was raised with the home at the last inspection. Comments made by the people living in the home to the expert by experience indicated that they were still unhappy with some aspects of the food. The home needs to address these issues. One of the people living in the home was on a soft diet and it was noted that their diet consisted mainly of fortified mashed potatoes. The person preparing the meals stated that the individual could not have meats as they could not be easily mashed and was unaware that a food processor was available in the home. There was a large amount of thickener being left over from month to month for someone who needed their food thickened. The individual on the soft diet was not losing weight but their diet was not nutritionally varied and there were no systems in place to monitor what they were eating. Care Homes for Older People Page 21 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were generally safeguarded from harm but if people have concerns they cannot be sure that they will be listened to and the necessary actions taken. Evidence: Surveys that had been completed and returned to us told us that people knew who to speak to if they were unhappy or concerned about anything. We had not received any complaints since the last key inspection and none had been recorded in the home. No adult protection issues has been raised in respect of the home since the last key inspection. The staff that we spoke to had some knowledge of adult protection and what to do if there were any suspicions. Some of the new staff needed to have this training. We had received one concern about an argument between two staff. This issue was referred back to the home but the manager informed her that there was no evidence of the incident in the home and she could not investigate it any furhter. Some people told the expert by experience that the stair lift did not work properly all the time. It was concerning that the reaction of the owner was so hostile to suggestions that the stair lift was not working properly. It was subsequently confirmed by the engineer that there was a fault in the stair lift. Care Homes for Older People Page 22 of 40 Evidence: Some people told the expert by experience that their laundry often got misplaced. There was no record of this in the home although the matter had been raised with staff. All minor grumbles should be recorded to show that the people living in the home are listened to and their concerns acted on. The manager was aware of the suggestion that one person was not happy at the home. She told us that she had discussed with the individual and a family member but no records of these actions had been made. The manager was not aware of a complaints log although she stated that she did record it in the quality assurance system. There should be a record of all complaints or concerns raised with the home and a record of the actions taken in response maintained. Discussions during the inspection indicated that people were being discharged from hospitals late in the evenings and at times without the appropriate information. The manager should challenge these events on behalf of the individuals to ensure that people are being discharged at appropriate times and with full information. This would help to ensure that discharge procedures are suited to the needs of the individuals and appropriately managed. The admission process for one individual was not adhered to and because their medication was not checked against any documentation it meant that the individual did not receive one of their medicines for three days. Care Homes for Older People Page 23 of 40 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 stay in an environment that is adequate but basic and which needs upgrading in some areas. Evidence: The home had not changed significantly since the last key inspection in April 2009. The expert by experience was shown around the home on the first day of the inspection and she stated: There were two staircases, one with a stair lift, two very small dining rooms and two lounges. The furnishings were adequate; the carpets will need to be replaced soon as they were grubby in places. There were a few double rooms; others were mostly single rooms just with small sinks. One room I saw did not have any personal affects to identify the individuals it accommodated and was furnished sparsely. The other room I was invited into was very cluttered and chaotic with jars of ointment and pills all round the bed. The radiator in the room could not be adjusted so the lady resident said she had to put up with whatever temperature it was set at and she said that it was usually too hot. She was able to open the window just about six inches but that was all and then the traffic noise was quite intrusive. I had noticed that it was hot in the upper areas of the home. I visited the toilet downstairs and upstairs, there were no paper towels in any of the Care Homes for Older People Page 24 of 40 Evidence: dispensers to dry hands on. In the morning I flagged this up but in the afternoon found the same in the upper toilet. We looked around the home during the second day of the inspection and the views of the expert by experience were confirmed. However, on the second day there were paper towels in the toilets. We checked the water temperatures in some of the bathrooms and they were found to be at an appropriate temperature. One of the bathrooms was found to be locked and we were told that some of the people living in the home locked it when they were having a smoke in there. The fire alarm system was not activated as there was no smoke detector in their. We found the bathrooms and toilets to be functional. There was nothing in them to make them homely or inviting. Bedrooms were basic but included all the required furniture. Not all bedrooms could be locked and this could impact on the privacy of the people occupying them. The windows in one bedroom had been pushed open so that the fire escape was accessible. The curtains were falling off as curtain hooks were missing. The carpet in some bedrooms had become stained and worn and needed to be replaced and several bedrooms needed redecorating and the bed linen replacing. Temperatures in bedrooms could not be adjusted as the controls were not accessible due to the radiator guards in place. The smoking area needed to be refurbished to make it a more appropriate smoking area. The homeliest areas of the home were on the ground floor and included the lounges and one dining room although the carpets on the ground floor have been stained as a result of smoke damage due to a fire. The home was generally clean although in one bedroom there was a musty smell. The kitchen was clean and fridge and freezer temperatures were being recorded to ensure that the foods were being stored at the correct temperatures. During the first day of the inspection it was noted that a chicken that had been bought fresh and been frozen however no date of freezing was recorded. The use by date had passed and its Care Homes for Older People Page 25 of 40 Evidence: safety could not be guaranteed. This was brought to the managers attention however, during the second day of the inspection a chicken was found in the freezer with a freezing date that was put on after the use by date. The deep fat fryers needed to be regularly cleaned so that they were maintained in a clean and hygienic condition. On both of the days of the inspection it was noted that the cooks overall was badly stained which was against good hygiene practices. Care staff were seen wearing blue aprons, that should be worn in food handling areas, around the home. There should be a cleaning schedule in place that enables the manager to audit the cleaning processes in the kitchen in particular and the home in general. Care Homes for Older People Page 26 of 40 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. People have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them but they do not always follow the policies and procedures in place. Evidence: There were three care staff on duty at the home during the inspection in addition to the manager and a cook. We looked at the files of five staff who had recently started working in the home. Four of the five people had had an induction into the home. For the fifth person there was no evidence of an induction programme. A suitable induction programme should be in place for people who are not employed as carers that should include topics such as adult protection, complaints, fire evacuation procedures and health and safety. New care staff were undertaking an induction which covered the skills for care competences and included some shadowing in the home. The recruitment procedure ensured that the appropriate checks including police checks, references and proof of identity were in place. Some of the people working in the home were students and they were found to be working more than 20 hours. We were later informed that as their courses were related to the work they were doing Care Homes for Older People Page 27 of 40 Evidence: they were able to undertake more hours. There was no evidence that this was the case on their files or that the work had been authorised by the secretary of state to indicate that the recruitment procedures were in line with employment legislation. The cook had only been in post a short time so was getting used to the home. It would be useful for him to receive training in the nutritional needs of older people and how to plan menus to meet their needs. The training matrix showed that staff had had a variety of training however most of the training had been provided over 12 months ago. This means that some people may not have had refresher courses to update them on the knowledge they required to carry out their roles. The training matrix needed to be updated to show when refresher training was required and to show staff who were currently employed in the home. The training matrix showed that the majority of staff had achieved NVQ level 2 or above which was above the required levels. During the inspection we noted some instances where staff were not following the procedures in the home. These were particularly in respect of the management of medicines,infection control practices and use of equipment such as the stair lift. It was also noted that staff tested the hot water temperatures however, these records showed that temperatures had been recorded for rooms that did not exist. This would call into question the validity of the tests that they were carrying out. Also when staff are going into bedrooms they did not appear to feed back any maintenance issues. For example, in one of the bedrooms the window restrictor and closure mechanism and curtains needed attention. The occupant told us this had been the case for some time but the manager was not aware of this. During the pharmacist inspectors visit it was noted that the staff did not have sufficient knowledge about the medicines they were administering. Comments made by the expert by experience from her visit to the home included: Most residents said that staff were helpful and they had no complaints about them. One said that sometimes it was difficult to understand their accent, but that mostly they could make themselves understood by the staff. Another said they have their job to do and they just get on with it. I saw very few spontaneous interactions between staff and residents. Care Homes for Older People Page 28 of 40 Evidence: A number of residents appeared wary or nervous of speaking out. One said Better the devil you know. The staff seemed a bit wary too, although they made obvious efforts to be helpful. The atmosphere overall was a bit tense and there was no laughing or joking. During the inspection we were told that the staff were up and down and that the owner spent all his time in the office. During the second day of the inspection we did see some good interaction between the staff and one person who had received a delivery of furniture and the manager had obviously built up a good rapport with another person who was living in the home. This issue has been discussed on previous occasions and again during this inspection. The manager told us that staff were wary of inspectors and this could be the reason. Care Homes for Older People Page 29 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management processes in the home fail to ensure that issues that need further development are highlighted and the appropriate actions taken to improve the quality of the service. Evidence: The registered manager has many years experience of managing a care home and has been managing this home for some time. The home has found it difficult to maintain a consistent level of improvement of the quality of care provided in the home. There appear to be few systems in place to monitor the practices in the home, and this means that issues are not picked up and resolved in good time. These issues such as adherence to admission processes, monitoring of nutrition, weights, daily recordings, social activities, management of medication, maintenance and arranging for medical attention are not highlighted and dealt with. The overall effect being that Care Homes for Older People Page 30 of 40 Evidence: the people living in the home receive a service that is basic. Following inspections the home does try to address issues that have been raised but fail to develop practices further. The home is reactive to issues that arise but are not proactive in identifying what actions should be taken to improve the service. It is evident that the home does not have sufficiently robust procedures in place to ensure that people are safeguarded when things do not go according to the norm. The equipment in the home is generally well maintained however, the fabric of the building is not being maintained to a high standard and this is leading to the home presenting as being grubby and not invested in and was not providing the people living in the home with a good quality of care. Comments from the expert by experience appear to sum up the impression being presented to someone who is not involved in the home: In my opinion the overall environment in this home is quite basic and devoid of frills. More effort could be made to make it more cheerful and homely. The outside area too, needs attention. Though staff appear to be doing their best, I believe the quality of life for residents to be poor overall. Residents appear mostly resigned and accepting of the regime but several did express their opinion frankly and articulately. The management should consider how they can improve the quality of life for residents by asking their views about the food on offer ,choice and quality, what activities or hobbies they would like to pursue, and about all other aspects of their daily lives. They should then ensure that adequate resources are provided to meet the requirements of the individuals in their care. There were audits being carried out to quality assess the service being provided in the home however, these were not looked at during this inspection. We looked at the management of money on behalf of the people living in the home and these were generally acceptable however, records needed to be maintained of when bank cards were given to the manager, when they were returned to the owner of the card and copies of receipts of money withdrawn on behalf of the people living in the home kept on their files. Examination of the fire records showed that the appropriate checks were being undertaken. The manager should ensure that records of the fire drills show which staff have attended to ensure that all staff are involved in a drill within the appropriate Care Homes for Older People Page 31 of 40 Evidence: timescales. During the inspection we were told about a problem with the stair lift. The engineer confirmed that there was a problem with the stair lift which was resolved. It was concerning to observe the hostile reaction of the owner when the expert by experience raised the issue. Care Homes for Older People Page 32 of 40 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 33 of 40 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 8 12 The registered person must ensure that the advice of medical professionals is followed. This will ensure that the health of the people living in the home is monitored 31/10/2009 2 9 13 The system installed to 06/11/2009 check the prescriptions prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy must be implemented. All discrepancies must be addressed with the healthcare professional. This is to ensure that all medicines are administered as prescribed at all times 3 9 13 Medicines must not be 07/11/2009 secornary dispensed for several people at a time and carried round the home. Page 34 of 40 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that the medicines do not get mixed up and the people living in the home get the medicines as prescribed. 4 9 12 All service users must be risk assessed as able to self administer their own medication and regular compliance checked undertaken and documented. This is to ensure that they can handle their medication safely 06/11/2009 5 15 16 The registered person must 23/10/2009 ensure that all the necessary equipment is available in the kitchen. This will ensure that people on specific diets receive a nutritional and varied diet. 6 16 22 A record of all complaints 24/10/2009 and concerns raised with the actions taken in response must be maintained. This would show that the views of people were being listened to and acted on. 7 26 13 Good infection control 31/10/2009 procedures must be followed in the home. Care Homes for Older People Page 35 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that cross contamination will be kept to a minimum. 8 35 17 The registered person must ensure that the records for the management of monies safeguard the people living in the home. This will ensure that the people living in hte home are safeguarded from harm. 9 38 13 The registered person must 23/10/2009 ensure that all windows are kept suitably restricted at all times. This will ensure that the people living in the home are not at risk of harm or injury. 10 38 23 The registered person must ensure that the fire detection system covers all areas of the home. This will ensure that any fires will be identified as soon as possible safeguarding the people who live in the home. 31/10/2009 31/10/2009 Care Homes for Older People Page 36 of 40 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 1 The range of fees charged by the home should be indicated in the service user guide. This will tell people how much the home charges for the service it provides. Contracts should be issued to people at the point of moving into the home. This will ensure that they have information about their rights and responsibilities. Records should be kept of the needs assessment carried out in respect of the people moving into the home. This will ensure that people moving into the home have theire needs adequately assessed and met in a person centred way. The registered person should ensure that there are systems in place to ensure that the people living in the home get the assistance they need to meet their. The registered person should ensure that adequate records are maintained so that the assistance being provided can be monitored to ensure that people receive the assistance they need. The people receiving a service, or their representatives where appropriate, should be involved in drawing up their care plans to ensure that they get the support they want in the way they want. The registered person should ensure that all risk assessments are in place for all service users. This will ensure that all the staff are aware of what precautions need to be in place to safeguard the individuals. The registered person must ensure that all requests for and visits by medical professionals are recorded so that the way in which health needs are met can be tracked. The registered person should ensure that a baseline weight of people moving into the home is recorded so that their health can be monitored. Current prescriptions should be kept with the MAR charts to enable staff to check the medicines received. This will ensure that the people living in the home are given the medicines that they need. It is recommended that all staff are trained in the indications and side effects of the medicines they handle, to ensure that they can fully support the service users clinical needs. Page 37 of 40 2 2 3 3 4 7 5 7 6 7 7 8 8 8 9 8 10 9 11 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 12 13 9 10 It is recommended that all MAR charts are checked and signed by a second member of staff for accuracy. The registered person should ensure that care plans refer to the individuals according to their gender. This will show that people are treated with respect and their dignity maintained. People living in the home should be provided with meaningful activities to occupy them and maintain their interests. The people living in the home should be provided with opportunites to maintain contact with the local community. The registered person should take steps to ensure that the people living in the home are happy with the meals provided in the home. All minor grumbles should be recorded to show that the people living in the home are listened to and actions taken. All the people living in the home should be able to lock their bedrooms. This will ensure that they can keep their personal space private. The registered person should ensure that all areas of the home are homely, comfortable and welcoming. The people living in the home should be able to adjust the temperatures in their bedrooms with ease. This will ensure that they are comfortable in their bedrooms. Foods bought fresh and frozen in the home should have the date of freezing recorded. This will ensure that the food is safe for consumption. The registered person should ensure that cleaning schedules are in place to enable the practices to be audited. The registered person should ensure that all information is available in the home to show that all employment legislation has been complied with. The registered person should ensure that the cook receives training on the nutrional needs of older people. This will ensure that the nutritional needs of the people living in the home are met. 14 12 15 16 13 15 17 18 16 19 19 20 19 25 21 26 22 26 23 29 24 30 Care Homes for Older People Page 38 of 40 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 25 30 The training matrix should be kept updated and show the dates when refresher training should be undertaken by. This will ensure that staff get their skills and knowledge updated regularly. The registered person should ensure that all staff undertake an induction programme that is suited to their role. This will ensure that they have all the information they need to keep the people living in the home safe. The registered person should ensure that adequate systems are in place to monitor the practices in the home and assure a good service is being provided. 26 30 27 31 Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!