Inspection on 08/12/09 for Merok Park Nursing Home

This inspection was carried out on 8th December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 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 30/06/09

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 14/03/2010.

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: 0 8 1 2 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 34 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 34 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 34 Over 65 0 29 29 0 3 0 0 6 2 0 0 9 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 34 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 key inspection was undertaken on 8 December 2009. Two inspectors were in the home for six and a quarter hours. from 09:30 to 15:45. The site visit is unannounced. The purpose of the visit was to check compliance with the requirements made following our visit on 30 June 2009 when it was our judgement that people who live in the home experienced poor quality outcomes. There were 24 residents in the home. We spoke to a number of people who live in the home, staff and the person in charge. We looked at communal areas of the home and 2 bedrooms. We examined a number of records including staff employment records, medication records, assessments and care plans. We have held a management review of the service following our visit with a view to Care Homes for Older People Page 6 of 34 taking enforcement action against the provider to ensure services improve. There is still no registered manager for the service, feedback was given to the person in charge. The quality rating for this service remains 0 star. This means the people who use this service continue to experience poor quality outcomes. There are 11 outstanding requirement from our last inspection, some of which have been partially met. Two additional requirements have been made following this visit. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The home must provide meaningful activities to promote the wellbeing of people who have dementia or other mental health difficulties. Sufficient information about peoples backgrounds, social needs, specialist care needs and preferences must be obtained in the homes assessment and recorded in the care plan to improve the staffs ability to provide a good service. Effective risk management, assessment and care planning systems must ensure all needs and risks are identified to promote peoples health and wellbeing and protect them 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. Increased opportunities must be provided for people to Care Homes for Older People Page 8 of 34 exercise choice and control over their own lives. Better planning is still needed to ensure mealtimes are more enjoyable and offer choice in a way people can understand. Management systems still need improvement 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 regulations to ensure continued improvement and compliance with requirements so that 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 and 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 and safe working practices to ensure people are protected from risk of harm. 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 34 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 34 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. People who are considering moving into the home cannot be confident all their needs will be assessed through admission and assessment processes. The home does not provide adequate support, training, information or guidance for staff to meet specialist needs or promote the health and wellbeing of people who have mental health difficulties or sensory impairment. 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 two individual files for people who have moved into the home since our last visit which showed that pre admission assessments are being carried out. However these assessments are brief and do not include sufficient information about the needs of the people concerned. This was of Care Homes for Older People Page 11 of 34 Evidence: particular concern where one person has severe mental health and behavioural difficulties and another has a history of falls and a visual impairment. Assessments have improved in that they now include some information about peoples background and social histories, However there is still insufficient information about interests and lifestyle preferences. Staff therefore have limited information to engage people in meaningful interaction and activities in line with their individual 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 still 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. Although some improvements have been made in the environment the home does not offer sufficient specialised services or reflect relevant specialist guidance that promotes the wellbeing of people with dementia or mental health difficulties. The person in charge has begun to record some staff training. The training plan shows ten of the twenty one staff have now received training in dementia awareness. However none of the staff have received training in the specialist mental health needs or sensory impairment needs of people currently living in the home. Staff are not provided with any guidance on these issues in care plans seen although this was discussed with the person in charge and the provider following our last inspection. The training record shows that four staff have had training on the Mental Capacity Act and Deprivation of Liberties following our visit. We are still unable to make a judgement that there are sufficiently well trained and competent staff on each shift to promote the health and wellbeing of people with mental health needs or sensory impairment. Care Homes for Older People Page 12 of 34 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 do not always have their physical and personal care needs met. Staff are respectful, gentle and patient. However insufficient information about peoples needs and preferences limit the staffs ability to provide a good service. Poor risk management systems continue to place people at risk of harm. People can be confident staff will care for them with respect and kindness however, peoples dignity is not always promoted. People are protected through the safe handling of medication. Evidence: The majority of people who responded to our last survey in May 2009 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 those seen during our visit do not contain sufficient information or guidance for staff to ensure they understand peoples needs and how to meet them in line with their wishes and expectations. Records of reviews of care consist of a recorded date which is initialled by a member of staff. There is no evidence people who live in the home are involved in the care planning or review process. No changes Care Homes for Older People Page 13 of 34 Evidence: have been made to any of the care plans seen. Daily records are still 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 needs met. Three care plans were sampled. Poor risk management systems continue to place people at risk of harm. In the three individual files seen, significant risks and needs identified in assessment documentation provided by health or social care professionals before the person was admitted to the home had not recognised or taken account of when planning care for or assessing risk to the person concerned. For example information about mental health needs, risk of falls, visual impairment, refusal of personal care or medication and significant behavioural issues have not been risk assessed or included in the plan of care. Staff may therefore be unaware of these issues and not know how to meet these needs or keep the person, other residents or themselves safe from harm and be able to ensure good quality care. 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 have improved in that some information about peoples background and social histories and former interests has been gathered at the point of assessment. However this is not being used to inform the care plan to enable staff to provide person centred care to each resident or interact with them in a meaningful way. There have been improvements to the environment to promote the wellbeing of people who live there in that clear signs now indicate where toilets and bathrooms are located. Further improvement is needed to ensure the needs of people who have dementia or sensory loss are met in line with specialist guidance. Some doors which people who live there would not or should not access have now been painted to blend in with the surrounding walls. Staff were observed providing care in a respectful way and with gentleness and patience. However nursing and care staff do not always act when peoples dignity is compromised. One person was seen to be very unkempt with dirty and stained clothing. The person in charge told us that this was because he refused personal care. The care plan recognises this but does not provide guidance and strategies for staff to ensure the persons personal care needs are met and their dignity is promoted. People who live in the home can be confident there are sufficient qualified nursing staff in the home to meet their health care needs and people are supported to access a variety of health care services such as dentists, opticians, chiropody and the local Care Homes for Older People Page 14 of 34 Evidence: GP. 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, a rota is operated, which generally determines when this will happen. Care plans still 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. There was some concern however that nursing staff on duty did not know what one of the medicines they administer to a resident was for. There was also concern where one resident habitually refuses medication which he needs to maintain health. Care Homes for Older People Page 15 of 34 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 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 people with dementia are still not offered a choice of food in a way they 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. Limited information about previous lifestyles, interests and preferences mean activities provided by staff may not be meaningful. During our observation we noted there is a large fish tank in the lounge to provide a point of interest. One person had a newspaper, another person had a book. However where homes care for people with dementia, it is expected that there should be objects around that people can touch and hold. This is still not the case in this home. Chairs were placed around the perimeter of the main L shaped lounge with no room for tables in between where people could place items. Small tables were brought out when people were served with drinks. Trays were given to some residents at Care Homes for Older People Page 16 of 34 Evidence: lunchtime who struggled to balance them on their laps. There are no individual activity programmes recorded in care plans. 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. Staff were seen to be very gentle and patient with people but were usually too busy to spend time engaging residents in meaningful conversation. There was nothing for people to do unless unless staff engaged with them. Limited information about individual interests meant staff have little information to promote meaningful conversation or support people to engage in meaningful activities. There is little information about peoples previous interests and nothing about activities on care plans seen during this visit. Records are now being maintained of activities for each person. The vast majority of entries are just about staff chatting, hairdressing or visitors. There are monthly religious church services. Religious needs are now being noted in the three care plans seen but all the entries seen were identical. The owner sent out questionnaires to relatives since our last visit, only 3 responses were returned. As a result of suggestions made by relatives before our last inspection the owner has purchased a large television for the main lounge and located it in a position where everyone can see it. There are no restrictions on visitors to the home and people are encouraged to maintain contact with family and friends. One visitor was spoken to during our visit. People who live in the home enjoy good home cooked food. There are two dining rooms in the home. The dining room at the front of the home, which is a pleasant room, is still very cramped with too many chairs for the small space around 2 large rectangular tables, this room was not used for the lunchtime meal. The internal dining room which was being used during our visit for the lunchtime meal is windowless and is a through route with 3 doors. Dining chairs have been renewed since our last visit. The main meal was pork casserole with mixed veg and potato. The alternative, according to the menu was spanish omelet. In fact the omelet was plain. Meals are still plated up in the kitchen giving people no control over portion sizes or content. People with dementia who cannot read the notice board still had no way of knowing what was going to be served or if there was any alternative. The menu is written on a white board in the dining room. The person in charge showed us a folder with photographs of meals but this was not used during our visit to help people with dementia choose their meal. Hot and cold drinks were offered throughout the day. Care Homes for Older People Page 17 of 34 Evidence: One resident asked us if we could find him a tissue as no serviettes were provided. When we drew this to the attention of the person in charge serviettes were produced. Care Homes for Older People Page 18 of 34 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 know who to speak to if they are unhappy. They are protected from abuse. Evidence: There is a written complaints procedure and a log is kept of all formal complaints. We have received information this year about poor conditions in the home which observations at our last visit in June 2009 confirmed as accurate. During this visit we saw that improvements have been made to the environment and the home was clean throughout. No further concerns have been reported to us since our last visit. The person in charge told us that staff are trained in the protection of vulnerable adults to ensure people are protected from abuse. All new staff are checked through the Criminal Records Bureau before they begin working in the home. Care Homes for Older People Page 19 of 34 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. Better standards of maintenance and cleanliness have improved the quality of life for people who live in the home. Further improvement is needed to ensure the home provides a pleasant, safe and suitable environment for the people who live there. Evidence: Improvements have been made to decor since our last visit and toilets, bathrooms and shower rooms have been refurbished to provide a more pleasant environment. Signs indicate where bathrooms and toilets are. The carpet in the main lounge has not been replaced, this is stained and ridged presenting a trip hazard to the people who walk around in this room. There is a large garden and work is in progress to provide a shelter for the use of residents who smoke. The majority of garden chairs are still unsuitable for older people, the person in charge said this would be addressed before the weather improves next year. 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 guidance to enhance the lives of the people who live there. Whilst the home employs a maintenance person and work has been done since our last visit, the overall condition of the home remains tired and shabby. Those residents who eat in the lounge are not provided with suitable table to enable them to do so comfortably. Radiator covers have still not been painted. Much of the furniture still needs replacement, bed linen is Care Homes for Older People Page 20 of 34 Evidence: thin and rough with wear and there are no tables between chairs in the lounges or suitable table for people who eat their meals there. Hygiene in the home has improved and there were no unpleasant odours at the time of our visit. A shared bedroom, which is currently occupied by one person,is located next to the lift shaft which is noisy when in use. 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 this area. All areas of the home seen during our visit were clean and tidy. There is a separate laundry. There are new commode pan washers on the first and ground floors of the home to ensure people who live in the home are protected from risk of infection. Care Homes for Older People Page 21 of 34 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. Recruitment practice now ensures people are protected from harm. Outcomes indicate there are sufficient cleaning staff to maintain a pleasant and hygienic environment for people who live in the home. Poor management systems meant it was still 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 mental health needs and other specialist 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 care and nursing staff on duty. The owner mainly employs students who work at the home for part of their time as paid care 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. In addition to care and nursing staff the home employs 2 cleaners. The owner also employs a chef and a maintenance person. Outcomes seen during our visit indicate Care Homes for Older People Page 22 of 34 Evidence: there are now sufficient cleaning hours allocated to ensure good standards of hygiene are maintained and people are protected form risk of infection. In the AQAA provided by the manager earlier in the year it stated that at least 50 of care staff have a National Vocational Qualification. The person in charge was unable to give us up to date information on this matter during our visit. People who live in the home are protected through the recruitment policies and procedures in operation in the home. Two staff files were examined for new staff recruited since our last visit. Staff files show all the information required is now in place, checks are carried out through the Criminal Records Bureau and references are obtained before staff begin work in the home. We were told at the last inspection that all staff are trained in house in infection control. basic food hygeine, 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. Records seen during this visit show that 10 of the 21 staff have done this training. The person in charge has begun work on a staff training matrix however it was not possible to see from this how many staff had received training as it only covered moving and handling, food hygiene, Deprivation of Liberties and dementia care. No training has been provided in the individual mental health and sensory needs of people who live in the home to ensure staff understand how to care for these people. We were concerned to see a member of staff being hit quite hard by a resident. Staff are not being trained in managing challenging behaviours and seemed to accept this as a normal part of their working day. Care Homes for Older People Page 23 of 34 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 continue to have a negative impact on the service people receive and, in some instances, place people at risk of harm. Evidence: The owner was away at the time of our visit. There has been no registered manager in day to day control of the home for the last 3 years. The person in charge told us that he was applying for registration at our last visit in June 2009. As yet no application has been received. 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 at our last visit that 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 live in the home to best effect when providing a service to them. Responses made to us during this visit indicate a continuing reactive rather than pro active management style. The person in charge Care Homes for Older People Page 24 of 34 Evidence: and the owner gave assurances that action would be taken to address all the shortfalls we pointed out to them at the last inspection. Whilst we acknowledge a lot of work has been done, particularly in relation to improving the environment, there is still a great deal of work to be done to bring this home up to a reasonable standard where people can be confident their individual needs will be met in line with their wishes and expectations and they will be protected from harm. 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 given that no record of their individual likes, dislikes and lifestyle choices are included in the care planning process. The owner has sent out customer satisfaction questionnaires since our last visit, only 3 were returned. Responses are now being evaluated by the service. 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 still be found throughout this report in care planning and assessment, risk management, communication and staffing issues. The owner submitted an improvement plan following our last inspection. The timescale for improvement was 31 August 2009. He told us that all residents would have a risk assessment and risk management plan based on their needs and all residents would have a comprehensive assessment and care plan. This has not been achieved. He told us that all residents would have an identified recreational and therapeutic programme, this has not been achieved. Of the 14 requirements that were made following our last visit we found that only 3 had been fully met. Only partial compliance has been achieved with a number of other requirements. These requirements therefore remain outstanding in this report. We are considering taking enforcement action against the service at this time. Compliance must be achieved with these requirements to ensure people who live in this home experience good quality outcomes. The person in charge told us at our last visit 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 not always promoted through safe moving and handling techniques. Staff were observed lifting people without using moving and handling equipment during this visit, placing themselves and the person being moved at risk. Current management systems still do not allow an audit of staff training in safe working practices. General hygiene conditions in the home have improved. Accidents that occur in the home are recorded. Care Homes for Older People Page 25 of 34 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 moving and handling practice, and unsafe floor coverings seen during our visit. The owner previously told us he visits the home regularly. We made a requirement following our last visit that monthly reports must be produced of these visits as required in the regulations. Six short reports were produced between 30 June and 31 August 2009 following our inspection. No reports have been produced since then to evidence ongoing monitoring of the home. Care Homes for Older People Page 26 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 The home must make proper 31/08/2009 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 plans should be reveiwed regularly. To ensure people are cared for in a way that meets their needs and promotes their wellbeing 2 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. 3 12 16 The home must consult service users about the programme of activities 31/08/2009 Care Homes for Older People Page 27 of 34 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 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 31/08/2009 account peoples wishes and 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. Care Homes for Older People Page 28 of 34 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 5 15 12 The home must take account 31/08/2009 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 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 Care Homes for Older People Page 29 of 34 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 an emergency. 7 30 18 The home must ensure that 31/08/2009 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 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. 8 31 26 The registered provider must 31/08/2009 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. 9 31 18 The registered provider must 31/07/2009 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. Care Homes for Older People Page 30 of 34 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 10 33 24 There must be an effective 31/08/2009 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. Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The assessment should 31/01/2010 cover all the identified needs of people who are admitted to the home, taking account of information from other agencies involved in their assessment of need. To ensure the home can meet all their identified needs. 2 10 12 The home must ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. In that staff should be mindful of issues of privacy and dignity at all times and personal care needs should be met to ensure dignity is not compromised. 31/01/2010 Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 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). 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