Inspection on 30/06/09 for Merok Park Nursing Home

This inspection was carried out on 30th June 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merok Park Nursing Home 15/03/10

Merok Park Nursing Home 08/12/09

Merok Park Nursing Home 10/07/07

Merok Park Nursing Home 15/05/06

Merok Park Nursing Home 17/01/06

Merok Park Nursing Home 15/04/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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: Merok Park Nursing Home Merok Park Nursing Home Park Road Banstead Surrey SM7 3EF     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: Ruth Burnham     Date: 3 0 0 6 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 35 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 35 Information about the care home Name of care home: Address: Merok Park Nursing Home Merok Park Nursing Home Park Road Banstead Surrey SM7 3EF 01737352858 02086527702 cooppencare@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Maleenee Coopen,Mr Soondressen Cooppen care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Merok Park is a large detached property located within a five-minute drive or fifteen minute walk of Banstead town centre and its amenities. The home currently provides accommodation and nursing care to twenty nine service users who are elderly and some of whom suffer from dementia. The home has twenty-five single and two double bedrooms. Fourteen of the single rooms have an en-suite toilet and washing facility and all other rooms have a hand wash basin. The rooms are arranged over two floors Care Homes for Older People Page 4 of 35 Over 65 0 29 29 0 Brief description of the care home and the first floor can be reached by staircase or passenger lift. There are three toilets, a bath and a shower on the ground floor and three toilets, a bath and a shower on the first floor. The toilets and bathrooms are located in such a way that all bedrooms have a toilet and bathing facilities nearby. There are two lounges and two dining rooms on the ground floor and a large kitchen. The home stands in its own large gardens and has parking spaces to the front of the building. Fees at this home are in the region of £550 to £750 per week and do not cover hairdressing and chiropody costs. 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: The site visit, which forms part of the homes unannounced key inspection, was undertaken on 30th June 2009. Two inspectors were in the home for six hours. from 09:00 to 15:00. The inspection was a thorough look at the service and including a visit to the Agency. We asked the owner to complete and return the Annual Quality Assurance Assessment (AQAA)before our visit. This was returned to us and evidence for some of the information provided was looked at during our visit. This indicated that the information the owner sent us was aspirational rather than factual. We used an observational tool. The Short Observational Framework for Inspection (SOFI) for one hour during the visit. There were 26 residents in the home. We spoke to a number of people who live in the home, staff, the person in charge and the owner. We inspected most of the premises. We examined a number of records including staff Care Homes for Older People Page 6 of 35 employment records, rota, medication records, assessments and care plans. We met with four members of staff. Before the visit we sent ten surveys to people who live in the home; ten to their advocates; ten to members of staff; five to health professionals and five to care managers. Twelve surveys were returned: Four from people who live in the home; one from a care manager and seven from relatives. We have received information raising concerns about the service this year. The last inspection took place on 10 July 2007. We have held a management review following our visit and will be requesting an improvement plan from the provider as a result of our findings. There is no registered manager for the service, feedback was given to the person in charge and the owner at the end of the visit. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: The home must provide adequate support, stimulation and a suitable environment to meet specialist needs and promote the wellbeing of people who have dementia. Sufficient information about peoples backgrounds, social needs and preferences must be recorded in the care plan to improve the staffs ability to provide a good service. Effective risk management systems must protect people from risk of harm. The home must ensure peoples privacy and dignity is always promoted. The lifestyle experience of people who live in the home needs improvement to ensure their social and recreational needs are met in line with their individual abilities, expectations and preferences. People have limited opportunity to exercise choice and control over their own lives. Better planning is needed to ensure mealtimes are more enjoyable and offer choice in a way people can understand. We observed during the SOFI that people need more stimulation and the opportunity to engage in activities that are meaningful to them. Peoples concerns and suggestions are not always listened to. Comments in our surveys included:They could ensure more regular personal issues are seen to. Repairs to the crumbling garden wall need to be completed. Two relatives commented that Communication could be improved and better use could be made of the garden. Standards of maintenance and cleanliness must be improved and the management must take account of the specific environmental needs of people who have dementia. Care Homes for Older People Page 8 of 35 Recruitment practice needs tightening up to ensure people are fully protected. There should be sufficient cleaning and maintenance staff to maintain a pleasant and comfortable environment for people who live in the home. Management systems must be improved to ensure the home can monitor that care staff are suitably qualified and competent to meet the specific needs of people who live in the home including dementia and other mental health needs. The registered provider must register a manager for the home and ensure he prepares monthly reports following his visits to the home in line with the Care Homes Regulations so as to ensure people can be confident in the management of the home. There must be an effective system for evaluating the quality of the services provided at the care home to include and take account of the views of people who live in the home. The AQAA must provide accurate information to the Commission. The annual development plan for the home should be based on a systematic cycle of planning action - review, reflecting aims and outcomes for service users.To ensure people are provided with good quality services in line with their wishes and expectations. The registered person must ensure there are effective risk management systems, safe working practices and suitable arrangements to maintain good standards of hygiene to ensure people are protected from risk of harm or infection. 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 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. People who are considering moving into the home can be confident their needs will be assessed through admission and assessment processes and their physical needs will be met. However the home does not provide adequate support, stimulation or a suitable environment to meet specialist needs or promote the wellbeing of people who have dementia or other mental health difficulties. Evidence: People have their needs assessed before they move into the home to ensure their needs are understood. The home has a policy and procedure on admission to and discharge from the home. The person in charge is trained in the principles of assessment of peoples needs. Either the person in charge or the owner carry out all pre admission assessments. We reviewed a random sample of four peoples individual files which showed that pre admission assessments are being carried out. Some original assessment documentation has been archived. The owner and person in charge were advised that all documents should be signed and dated and original Care Homes for Older People Page 11 of 35 Evidence: assessment documentation should remain on peoples files. Assessments seen do not include sufficient information about peoples background and social histories, interests and lifestyle preferences. Forms to capture this information are in place in files sampled but have not been completed. Staff therefore do not have the information they need to engage people in meaningful interaction and activities in line with their individual backgrounds, wishes, expectations and lifestyle choices. The majority of people who live in the home are experiencing significant levels of dementia or mental health difficulties. It was clear during the visit that the home does not have the capacity to meet these specialist needs in a way that promotes the wellbeing and enhances the quality of life for people who live there. The home does not offer sufficient specialised services or reflect relevant specialist guidance such as providing an environment that promotes the wellbeing of people with dementia and helps them to find their way around. There was no collective staff training record or plan so we were unable to make a judgement that there are sufficiently well trained and competent staff on each shift to meet the specialist needs of people who live in the home. The home does not provide intermediate care. 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. People who live in the home have their physical and personal care needs met, staff are respectful, gentle and patient. However insufficient information about peoples backgrounds, social needs and preferences limit the staffs ability to provide a good service. Poor risk management systems place people at risk of harm. People can be confident staff will care for them with respect and kindness however, peoples privacy and dignity is not always promoted. People are protected through the safe handling of medication. Evidence: The majority of people who responded to our survey were satisfied with the care and support their relatives receive. They were unanimous in their praise for the helpful, gentle and caring staff. People who live in the home have a plan of care. However reviews do not take place on time and are not set up to monitor changing circumstances. Daily records are minimal with little information about how the care plan has been followed or the welfare of people promoted. Lack of information gathered in the assessment process means people may not have their social, emotional and spiritual needs met. Five care plans were sampled. These are adequate Care Homes for Older People Page 13 of 35 Evidence: for health and personal care needs. There is limited guidance and information to enable staff to meet peoples emotional and social needs or preferences. Two relatives who responded to our survey said communication needed improvement. Examples were seen where decisions had been made between the person in charge and relatives either in direct opposition to the wishes of the resident or against the persons best interests. For example One person had restricted access to their bedroom because the person in charge said their relative felt they spent too much time there. Another person could not move freely around their room because the person in charge said their relative wanted all their equipment in their bedroom, even though most of this was not used by the person. The person in charge said he complied with relatives wishes because he did not want them to complain. There were no risk assessments in place in relation to any of these issues. Poor risk management systems are placing people at risk of harm. This was a very hot day, there were no contingency plans and no risk assessments in the event of a heatwave. There were no fans in the home, when we drew this to the attention of the owner he sent someone out to purchase fans for the home. Some bedrooms, particularly the shared room, were unbearably hot, the person in charge was unaware of this and there were no room thermometers to monitor temperatures. People were supplied with drinks regularly in the lounge but the midday meal was a hot dinner, no alternative was offered. The service is unable to demonstrate up to date knowledge of social care issues relevant to peoples individual needs where they have dementia. Care plans do not contain information about peoples background and social histories, former interests and preferences to enable staff to provide person centred care to each resident or interact with them in a meaningful way. The environment does not promote the wellbeing of people who live there in that it has not been designed with the needs of people who have dementia in mind in line with specialist guidance. There are signs on doors around the home but these are often inappropriate and would be difficult for people who have dementia to understand. Doors which people who live there would not or should not access also have pictorial signs to add to their confusion. The layout of the home is difficult for people who have dementia in that there are many corridors with doors that all look the same. Staff were observed providing care in a respectful way and with gentleness and patience. however they did not always notice when peoples dignity was compromised and take action to promote dignity and privacy. For example one resident had pulled up their dress, staff did not rearrange their clothing until we pointed this out to them. Care Homes for Older People Page 14 of 35 Evidence: One person was seen walking through the home with no clothing from the waist down. The catch on one persons bedroom door was broken so it can just be pushed open from the outside. it was of further concern that continence briefs are not labeled individually and, once laundered are redistributed to people who need them. People who live in the home can be confident there are sufficient qualified nursing staff in the home to meet their healthcare needs and people are supported to access a variety of health care services such as dentists, opticians, chiropody and the local GP. There was some concern however that records in individual files to monitor peoples health are not being completed. For example, forms in place in individual files to monitor vital signs had not been completed since 11 May 2009. The home does not facilitate independent choice. Facilities and staffing in the home do not allow residents to choose when they wish to shower or bath, bathrooms are kept locked and a rota is operated, which generally determines when this will happen. Care plans do not show when people would like to have a bath or shower. People are protected through the safe handling of medication. Medication is stored securely and administered by trained staff in line with current good practice guidance. Records seen were in good order. Care Homes for Older People Page 15 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience of people who live in the home needs improvement to ensure their social and recreational needs are met in line with their individual abilities, expectations and preferences. People have limited opportunity to exercise choice and control over their own lives. People enjoy good home cooked food however better planning is needed to ensure mealtimes are more enjoyable and offer choice in a way people can understand. Evidence: The lifestyle experience of people who live in the home does not satisfy their social and recreational interests and needs or lifestyle choices in that staff are not provided with adequate information or training to meet these needs in line with peoples wishes and preferences. There is a lack of information about previous lifestyles, interests and preferences to guide staff to provide meaningful activites. Two people who responded to our survey commented that better use could be made of the garden. During our observation we noted there is a large fish tank in the corner of the lounge to provide a point of interest. However there were no magazines or objects people can touch and hold. Chairs were placed around the perimeter of the main L shaped lounge with no room for tables in between where people could place items. The TV was on but many of the people in the lounge were unable to see it and no one appeared interested in Care Homes for Older People Page 16 of 35 Evidence: watching the programme selected by staff. Small tables were brought out when people were served with drinks. There is no activities programme either for the home or for individuals within their care plan. The home has an outside contract for activities, a person who provides activities visits the home on Thursday and Friday afternoons and an entertainer comes to the home monthly. At other times staff are expected to provide activities as they can between carrying out their other duties. During our observation a member of staff brought out a large plastic football and offered to play catch with some people, all of whom declined or just looked confused. One person was given a lap tray with a large puzzle which, if assembled would not fit onto the tray so could not be completed. A member of staff worked with him to put together what would fit on the tray. Staff were seen to be very gentle and patient with people but were too busy to spend time just chatting, there was nothing for people to do unless unless staff engaged with them. lack of information about background and social histories meant staff had little information to promote meaningful conversation or support people to engage in meaningful activities. Peoples previous interests are not recorded. There are monthly religious church services. The owner sent out questionnaires to relatives earlier this year to confirm their satisfaction with the service provided. Those returned were seen during our visit. A number of suggestions and negative comments included in the responses appear to have been ignored. For example one relative suggested film shows, there have been none. When asked about this the person in charge said people can watch films on TV, clearly the layout of the lounge precludes this and this would not cater for individual needs, interests and choice. One relative suggested people would benefit from a large table for activities. The person in charge said they could go to the dining room however this has not been facilitated. Another suggestion was for a larger TV where people could see it. The owner said he planned to purchase one in the future but no timescale has been decided. No recorded evaluation had been made of responses to questionnaires. The person in charge said he and the owner had talked about the contents but had no explanation of why no action had been taken. In the Annual Quality Assurance Audit (AQAA) the owner told us they have regular meetings with service users through a Service User Forum, residents and relatives tea parties and residents meetings. When asked when these meetings take place the person in charge and the owner were unable to give any information to confirm these meetings actually happen and there are no records of any such meetings. We could find no evidence of any kind that the views of residents are taken into account in the way the home is run. Care Homes for Older People Page 17 of 35 Evidence: There are no restrictions on visitors to the home and people are encouraged to maintain contact with family and friends. People who live in the home enjoy good home cooked food. There are two dining rooms in the home. These rooms could not be described as pleasant. The dining room at the front of the home is very cramped with too many chairs for the small space around 2 large rectangular tables. The internal dining room is windowless and is a through route with 3 doors. Many of the dining chairs are badly stained. We observed people being taken to the dining rooms from 11.30 am onwards. The meal was served at 12.30. some people were therefore sat at the table waiting for a very long time. This was the hottest day of the year so far and people were served a hot dinner of roast chicken with gravy and vegetables, no one was offered a cold alternative however ice cream was served for pudding. The owner said they could have sandwiches if they didnt want the main meal however no one was actually offered a sandwich. Salad was not on offer, in fact no one was offered any choice of food at all at the midday meal and meals are plated up in the kitchen giving people no control over portion sizes or content. People with dementia who cannot read the notice board have no way of knowing what will be served or if there is any alternative. The menu is written on a white board in the dining room. Although the person in charge told us in the AQAA that service users are now more involved with menu planning he could not give any examples of this. Hot and cold drinks were offered throughout the day. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected from abuse however their concerns and suggestions are not always listened to. Evidence: The owner tells us there have been three complaints about the service in the last year, none of which have been upheld. There is a written complaints procedure and a log is kept of all formal complaints. People who responded to our survey said they knew how to make a complaint. We have received information this year about poor conditions in the home. Our observations at this visit confirmed this information to be accurate. Failure by the owner and person in charge to take action on comments and suggestions made in their own customer satisfaction survey or to provide a forum where people who live in the home and their representatives can express their views indicates that people who live in the home are not always listened to. Staff are trained in the protection of vulnerable adults to ensure people are protected from abuse. Care Homes for Older People Page 19 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor standards of maintenance and cleanliness and failure to take account of the specific environmental needs of people who have dementia has a detrimental effect on people who live in the home. Evidence: The layout of the home is not suitable for its stated purpose to provide care for people who have dementia in that adaptations have not been made to promote their wellbeing. For example signage is not appropriate, Colour in decor is uniform throughout the home. patterned carpets may increase confusion. There is a large garden but this is spoiled through use as a rubbish tip. A large greenhouse and attached aviary are overflowing with discarded furniture and equipment, spoiling the view from a number of bedrooms and one of the lounges. A disused commode pan washer stands in what used to be a flower bed. The majority of garden chairs have no arms and are unsuitable for older people. All the chairs and benches are very dirty and there are no tables or parasols to provide shade. One relative who responded to our survey expressed concern about the crumbling state of the garden wall. One of the toilets had a bolt on the inside which could compromise the safety of residents as it could not be opened from the outside in the event of an emergency. The home does not provide a homely and pleasant environment which meets peoples individual and collective needs in a way which is designed with reference to relevant Care Homes for Older People Page 20 of 35 Evidence: guidance to enhance the lives of the people who live there. Whilst the home employs a maintenance person, the overall condition of the home is tired and shabby. Much of the furniture is worn and stained. Paintwork is dirty and damaged. Flooring in a number of areas is also stained or flecked with paint. There is a general unpleasant odour throughout the home which staff attempt to mask with the overuse of air fresheners. A shared bedroom is located next to the lift shaft which is noisy when in use. Although curtains are provided around beds the layout of the room does not provide the occupants with clearly designated private areas. There was no evidence these residents had made a positive choice to share as both people have dementia. The person in charge said they had not been offered a single room. In the recent report from the Environmental Health Department following their inspection of the kitchen they noted that food safety management system needs detailed attention to ensure compliance and gave a list of items requiring attention. The report also stated that it was noted that the kitchen is becoming very tired and the owners should seriously consider thinking about refurbishing. A number of areas of the home were dirty, particularly the shower room where we found a wet cigarette butt on floor and a half eaten biscuit on window sill. The shower unit was very dirty with mould in patches, a plastic garden chair was being used as a shower chair. The hot tap on the sink was broken and there was a nail brush shared by all residents who use this room. The hot water in the shower was very hot although the homes water thermometer registered a low temperature. The person in charge said a thermostatic valve was fitted and had been tested, he agreed to do an immediate safety check. There is a separate laundry. There are commode pan washers on the first and ground floors of the home. The ground floor washer is out of use and the first floor washer was rusty and very difficult to open. A further sluice room on the first floor had an overpowering bad odour.The person in charge confirmed staff were washing commode pans in toilets which places people who live in the home at risk of infection. Care Homes for Older People Page 21 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. People who live in the home benefit from the support of the committed and caring staff team. They can be confident there are sufficient numbers of care and nursing staff on duty to meet their needs. Recruitment practice needs tightening up to ensure people are fully protected. Outcomes indicate there are insufficient cleaning and maintenance staff to maintain a pleasant and comfortable environment for people who live in the home. Poor management systems meant it was not possible to make a judgement that care staff are suitably qualified or competent to meet the specific needs of people who live in the home including dementia and other mental health needs. Evidence: People who live in the home benefit from the support of the committed and caring staff team. They can be confident there are sufficient numbers of staff on duty to meet their needs. The owner mainly employs students who work at the home for part of their time as paid carers and nursing staff and part of their time on placement as part of their college courses. Staff observed during our visit were gentle, kind and patient with people who live in the home. The staff rota was examined, this showed there are sufficient numbers of staff on duty at the home, including qualified nursing staff, throughout the day and night. Although the person in charge told us that 2 cleaners are employed in the home we Care Homes for Older People Page 22 of 35 Evidence: found areas of the home that were dirty, smelled unpleasant and posed a risk of infection to people who live there. The owner also employs a chef and a maintenance person. Outcomes seen during our visit indicate there are insufficient cleaning and maintenance hours allocated to ensure the home is cleaned and maintained to a reasonable standard. In the AQAA provided by the manager it stated that at least 50 of care staff have a National Vocational Qualification. People who live in the home are largely protected through the recruitment policies and procedures in operation in the home. Four staff files were examined and three members of staff were interviewed. Staff files show some shortfalls in recruitment processes designed to protect the people who live in the home in that there were some gaps in employment histories. Checks are carried out through the Criminal Records Bureau and references are obtained. The owner said that all staff are trained in house in infection control. basic food hygiene, first aid, fire safety, health and safety and moving and handling. The home uses a company which provides videos to cover these subjects. Staff watch the videos and then take an exam at the home to test their competence. The exam is not externally invigilated. The owner said he has also arranged for a outside trainer to come in and provide training for staff about how to care for people who have dementia. There was no staff training matrix and no central development file and it was therefore impossible to ascertain how many staff have undertaken training. No staff meetings have been organised in the last year. Care Homes for Older People Page 23 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home cannot be confident the home is managed effectively or in their best interest. Ineffective quality assurance and management systems have a negative impact on the service people receive and, in some instances, place people at risk of harm. Evidence: There has been no registered manager in day to day control of the home for the last 3 years. The person in charge said that he is applying for registration. The person in charge is a registered mental nurse and has been managing the home for the last 2 years. The owner is also a registered mental nurse, he told us he visits the home several times each week. Our findings at this visit show that neither the person in charge or the owner are using their knowledge about the needs of people who have dementia to best effect when providing a service to people who live in the home. Responses made to us during the visit indicated a reactive rather than pro active management style. The person in charge and the owner gave assurances that action would be taken to address all the shortfalls we pointed out to them. Care Homes for Older People Page 24 of 35 Evidence: People who live in the home and their representatives cannot be confident their views will be taken account of in the way the service is run. In the AQAA the person in charge told us that the views of people who use the service are sought in a variety of ways including service user forums and residents meetings. We found that neither of these meetings were taking place. The owner sends out customer satisfaction questionnaires however responses were not evaluated as part of any quality assurance system and comments and suggestions in responses received have been ignored. Ineffective management systems have a detrimental effect on people who live in the home in that current systems do not support effective quality monitoring. Examples of this can be found throughout this report in care planning and assessment, risk management, the environment, communication and staffing issues. The Annual Quality Assurance Audit was completed and received before the inspection, however this did not accurately reflect the current standard of service and was aspirational rather than a true reflection of the quality of service people receive. A number of examples were found such as statements in the equality and diversity section where the person in charge states that regular audits of equality and diversity are undertaken. There was no evidence of any such audit.The owner showed us the development plan for the home, this was not based on a clear cycle of action, planning and review of the service and contained no timescales. The person in charge told us in the AQAA that they do not act on behalf of people who live in the home in relation to their finances. He said the home pays for services such as hairdressing and chiropody and then invoice relatives or representatives. Time did not permit an audit of this system during this inspection. The safety and welfare of people who live in the home is promoted through safe moving and handling techniques. Staff were observed using moving and handling equipment with great care and sensitivity to residents. The person in charge informed us that fire safety training was taking place on the evening of our visit. Current management systems did not allow an audit of staff training in safe working practices. General hygiene conditions in the home showed that the person in charge and the owners are not ensuring safe working practices by training and supervising staff and providing suitable equipment to protect people from the spread of infection. Examples seen were the use of a nailbrush communally, dirty bathrooms, washing commode pots in toilets or bathrooms, using dirty bibs and slings and the general poor state of cleanliness in the home. Dates recorded by the person in charge and the owner in the AQAA of when installations and equipment were last serviced indicate that equipment and installations are safe. All accidents that occur in the home are recorded. Care Homes for Older People Page 25 of 35 Evidence: Poor risk management systems could place people at risk. Current management systems are failing to identify or take appropriate action to minimise risks Such as poor hygiene practices, maintenance and heatwave as identified throughout his report. Although the owner tells us he visits the home regularly there are no monthly reports of these visits as required in the regulations. Care Homes for Older People Page 26 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 27 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 7 13 The home must ensure 31/08/2009 unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Including risks associated with heatwave in that temperatures, particularly in bedrooms should be monitored. To ensure the safety and comfort of people who live in the home. 2 7 12 The home must make 31/08/2009 proper provision for peoples health and welfare, so far as practicable ascertain and take into account their wishes and feelings. In that the service users plan must set out in detail the action to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Care Page 28 of 35 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 plans should be reveiwed regularly. To ensure people are cared for in a way that meets their needs and promotes their wellbeing 3 12 16 The home must consult 31/08/2009 service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation. In that peoples interests should be recorded and they must be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities with particular consideration given to people with dementia. Individual and group activity programmes should be in place. To improve the quality of life and physical, mental and emotional wellbeing of people who live in the home 4 14 12 The home must take into account peoples wishes and 31/08/2009 Care Homes for Older People Page 29 of 35 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 feelings and conduct the home so as to maximise service userscapacity to exercise personal autonomy and choice in all aspects of their lives by ascertaining and taking account of their views and presenting lifestyle choices in a way in which people with dementia can understand. To improve peoples quality of life by maximising the control people have over their own lives. 5 15 12 The home must take account of peoples wishes and feelings. In that meals must be provided in a congenial setting, offering a choice of food in an appropriate way to suit peoples capacities, including people who have dementia. To ensure mealtimes are enjoyable and people understand the choices on offer. 6 16 12 Comments and suggestions in the homes surveys about how to improve the service should be taken seriously and acted on. 31/08/2009 31/08/2009 Care Homes for Older People Page 30 of 35 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 So people can be confident they are listened to. 7 19 23 The Registered person must 31/08/2009 ensure that the physical design and layout of the premises meet the needs of the service users.They must ensure that all parts of the care home are kept clean and reasonably decorated; Shared rooms suitable to maintain adequate private space; the garden is suitable and safe for use and appropriately maintained with suitable seating. Bedroom doors should not be locked or rooms overly cluttered so as to impede peoples access to their own rooms. To ensure that everyone who live in the home, including people who have dementia, can find their way and are comfortable and safe. Suitable locks should be fitted to toilet doors which can be overridden by staff in an emergency. The home must make suitable arrangements for maintaining satisfactory standards of hygiene in the care home and keep the 31/08/2009 8 26 16 Care Homes for Older People Page 31 of 35 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 care home free from offensive odours. Arrangements must be made to ensure recommendations made by the environmental health officer are implemented. Commode pan washers must be in good working order. In that all areas of the home should be effectively cleaned to provide a pleasant and safe environment for residents. 9 29 19 The registered person must obtain full and satisfactory information in relation to staff employed including a full employment history, together with a satisfactory written explanation of any gaps in employment. To ensure people are protected. 10 30 18 The home must ensure that staff employed to work at the care home receive training appropriate to the work they are to perform. Training provided in the home must be adequate to ensure all staff understand how to meet the specific needs of people who have dementia or mental health 31/08/2009 31/08/2009 Care Homes for Older People Page 32 of 35 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 difficulties and documentary evidence of any relevant qualifications and training must be maintained. To ensure staff are competent to meet the needs and promote the wellbeing of people who live in the home. 11 31 26 The registered provider must make immediate arrangements to prepare a monthly report of his visits to the home. To ensure people can be confident in the management of the home. 12 31 18 The registered provider must make immediate arrangements to register a manager for the home who is skilled and competent to carry out this role. To ensure people can be confident in the management of the home to meet their needs and provide a good service. 13 33 24 There must be an effective system for evaluating the quality of the services provided at the care home to include and take account of the views of people who 31/08/2009 31/07/2009 31/08/2009 Care Homes for Older People Page 33 of 35 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 live in the home. The AQAA must provide accurate information to the Commission. The annual development plan for the home should be based on a systematic cycle of planning - action - review, reflecting aims and outcomes for service users. To ensure people are provided with good quality services in line with their wishes and expectations. 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 3 23 Individual assessments should cover peoples social interests, preferences and lifestyle choices. Where rooms are shared, they should be occupied by service users who have made a positive choice to share with each other. When a shared place becomes vacant, the remaining service user has the opportunity to choose not to share, by moving into a different room if necessary. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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