Inspection on 15/12/09 for Merrie Meade

This inspection was carried out on 15th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merrie Meade 13/10/09

Merrie Meade 02/07/09

Merrie Meade 09/07/08

Merrie Meade 18/07/07

Merrie Meade 16/06/06

Merrie Meade 20/10/05

Merrie Meade 05/04/05

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: Merrie Meade 3 Watergate Road Newport Isle Of Wight PO30 1XN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Ktomi     Date: 1 5 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 38 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 38 Information about the care home Name of care home: Address: Merrie Meade 3 Watergate Road Newport Isle Of Wight PO30 1XN 01983520299 01983520299 merrymeade@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Merrie Meade Residential Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 31 The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Merrie Meade is a registered residential home and provides long stay care and accommodation for older people with mental frailty and illness associated with dementia and long-term care/support and accommodation for younger adults with mental health needs. The older people are cared for in the purpose built extension, Care Homes for Older People Page 4 of 38 Over 65 0 0 31 31 0 2 0 7 2 0 0 9 Brief description of the care home which provides a suitable environment for their care needs. The younger people are accommodated in the main building. Merrie Meade is a large detached two-storey property with a two-storey extension, set in reasonable sized grounds with a summerhouse and two storage sheds, one of which is available for use by people who live at the home. The home is located on the outskirts of Newport within walking distance of the town centre shops and amenities. There is off road car parking to the front. Residents accommodation is provided on both floors. All but two bedrooms are for single occupancy, many have en-suite facilities. Separate communal facilities are provided for each service user group. There is a lift in the extension to provide access to the first floor. There is also ramped access into the garden leading from a side entrance of the ground floor. The home is owned by Merrie Mead Residential Home Ltd and at the time of this inspection did not have a registered manager. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report contains information gained prior to and during an unannounced visit to the home undertaken on the 15th December 2009. All core standards and a number of additional standards were assessed. Compliance with the requirements made following the previous inspection were also reviewed. The home was previously inspected in July 2009. The visit to the home was undertaken by two inspectors and lasted approximately eight hours commencing at 9.45 am and being completed at 5.30pm. The inspectors were able to spend time with the staff on duty and were provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Information was also gained from the notification of incidents in the home, from other information sent by the home to the commission and from the local social services safeguarding team. Care Homes for Older People Page 6 of 38 Reference is also made to the random inspection completed by the commission in October 2009. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? At the previous key inspection in July 2009 it was identified that two of the four requirements made following the inspection in July 2008 had not been complied with. A statutory requirement notice was issued which required the responsible person to ensure that all staff have the necessary training to enable them to meet the needs of the people living at the home and that the registered manager must have the necessary qualifications for managing the home. A random inspection was undertaken in October 2009 and this concluded that these requirements had been met. Four requirements were made following the previous inspection undertaken in July 2009. These have all been complied with. The home was required to ensure that all people living at the home had the opportunity to join in a programme of activities arranged by or on behalf of the home to provide mental and physical stimulation and enjoyment. The home now has a range of activities for both the younger adults and older people with some outings organised for both service user groups. People living at the home were positive about the activities as were staff. The home now has a computer with internet access for service users use. The home was required to ensure that people receive a nutritional intake suitable for their needs. People were positive about the meals provided at the home and the arrangements in respect of the younger adults meals have been changed ensuring that even if a meal has not been ordered one is available. A requirement was made in relation to the poor relationship between the registered manager and responsible individual. The registered manager has since resigned and therefore this requirement should be no longer an issue. The responsible individual was required to ensure that a monthly visit and report (known as regulation 26 visits and reports) are undertaken every month to monitor the service provided at the home. These are now occurring with reports received at the commission. Some work has also been completed at the front of the home with a new footpath to the home avoiding the car park and new bin storage area provided. Fire risk assessments have been completed and fire evacuation equipment purchased. Care Homes for Older People Page 8 of 38 The home now has sit on scales suitable to weigh all service users. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 38 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 38 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 would be assessed prior to moving into the home to determine if their needs could be met and would be provided with written information about the home and services provided. It is not possible to fully assess how the home would manage admissions. Standard 6 is not applicable as the home does not provide intermediate care. Evidence: Discussions with the responsible individual and staff members on duty are considered as is information in the homes statement of purpose and service users guide provided by the responsible individual during the inspection. The home has developed a statement of purpose, which sets out the aims and objectives of the home and two service users guides one for the younger adults part of the home and the other specifically for the older persons part of the home. The Care Homes for Older People Page 11 of 38 Evidence: information contained within the statement of purpose and service users guides is relevant to the specific needs of the people and, for the younger adults, makes house rules clear such as not smoking in the home and action that may be taken by the home if people are not confirming to the house rules. The house rules are essentially around safety and acceptable behaviour so as not to upset or disturb other people living in the home. The statement of purpose and service users guides were reviewed in May 2009 and require updating to reflect the fact that the homes registered manager resigned in November 2009 and provide up to date details of the commissions address and contact details. The guides do not contain contact details for the local social services departments. The guides are available on a standard printed format suitable for most people living at the home. The statement of purpose contained a sample contract and this provides basic information on what people who live at the home can expect to receive for the fee they pay and terms and conditions of occupancy. Again this requires updating to reflect the current name and contact details for the commission. The statement of purpose includes information about the homes admission process and this would allow for visits and day care prior to admission on an initial one month trial basis. The home has not admitted any new service users since the previous key inspection undertaken in July 2009. The home voluntarily agreed in June 2009 not to admit new people during a safeguarding investigation being undertaken by Isle of Wight social services department and until they were assessed as no longer providing a poor service. Previous reports identified that the registered manager who resigned in November 2009 undertook pre-admission assessments to determine if the home would be able to meet peoples needs. Discussions were held during the inspection visit with the responsible individual who stated that they and a senior staff member would jointly undertake pre-admission assessments. It is therefore not possible to fully assess how the home would manage admissions. Care staff confirmed that no new people had been admitted to the home since the previous inspection and records viewed evidenced that people had been living at the home since before July 2009. The service can provide respite, short stay or day care within the older persons part of the home if a suitable bedroom is available. The home does not provide intermediate or nursing care. Care Homes for Older People Page 12 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments are in place for all people however these do not all contain current information and some require reviewing placing people at risk that all their needs will not be met. Peoples privacy and dignity is generally maintained although the institutional practice of commencing getting people up at 6am is unacceptable. Medication is stored securely however there is a need to ensure that changes to medication are clearly recorded and that as required protocols are in place for all as required medication. Evidence: Four care plans were viewed, two for people living in the younger adults part of the home and two for people living in the older persons part of the home. The people whose care plans were viewed had been living at the home for varying lengths of time. The inspectors discussed with staff and people who live at the home how care needs are met. The arrangements for the storage, administration and records relating to medication were viewed. Care plans were selected at random with two viewed from each section of the home. Care Homes for Older People Page 13 of 38 Evidence: In all files looked at there was no evidence of a signed agreement concerning the sharing of information or that service users or their representatives had agreed to care plans and risk assessments. A new system of care plans was introduced in July 2009 to the younger adults part of the home. Not all information in care plans was up to date or person centred however staff appeared knowledgeable about the service users and each service user has a key worker. In one plan viewed there were relapse indicators dated July 2007 located in the back of the care plan file. Staff stated that these were still relevant however as the service user has an ongoing risk of relapse these should be reviewed and updated. The relapse indicators did not contain details of who to contact when the person was unwell and were not in a prominent place in the file. Although risk assessments were in place there was no risk assessment or management plans in respect all potential risks. There was also no evidence of up to date reviews of care plans or risk assessments. The other care plan viewed within the younger adults section of the home was also not up to date containing no information about a change in the persons nutritional and diet needs or that they are now attending college courses. The last review had occurred in September 2008 however staff stated that there had been a recent review for this person but there was no evidence in the persons file of this. One service user had had a number of medication changes and the person had been unwell however the care plan did not contain relapse indicators and limited information about medication changes. The service user is young and the care plan did not contain plans concerning aims or aspirations and gaining independence skills. Care plans in the older persons section of the home appeared to reflect peoples needs although both viewed stated that the person could not be weighed as the home did not have sit on scales however the home has recently purchased sit on scales therefore it should now be possible to weigh all service users. Care plans did contain some person centred information detailing how people unable to express their wishes may demonstrate preferences or needs. It was noted in care plans that a record is kept daily of care provided which recorded that people are woken early, washed, dressed and sat into the lounge. There was no information that this was the request of the person. One person who is unable to express an opinion was got up daily at 6am. This person, and others were noted to be sleeping in their lounge chairs at 11.00am. This was discussed with staff on duty who stated that they arrive at 8am for the day shift and that of the ten people living in that section of the home nine are usually up, washed, sometimes bathed, dressed and in the lounge. They stated that the person not up is able to express an opinion and does not like getting up early. Care staff also stated that people are usually sleepy in the Care Homes for Older People Page 14 of 38 Evidence: morning and as they did not do night shifts were not sure what time people started getting up. This issue was discussed with the responsible individual who is now acting manager of the home. She stated that she had just become aware of this and was going to investigate the morning routines in the older persons part of the home and would ensure that people are only got up when they want to get up. Care plans contained risk assessments for people developing pressure injuries (waterlow assessments). These identified that some were at medium and high risk of pressure injuries and the home had sought assistance from the district nurse with special mattresses and chair pads available and seen to be in use. Airwave pressure relieving mattresses appeared to be on the correct settings however there was no information in care plans as to how these should be set. This was discussed with care staff who stated that mattresses had been set by the district nurses but that they had not received training in their use. One stated that several days previously one mattress had been bleeping and staff had requested a staff member from the younger persons section to look at it as they had not known what to do. This was discussed with the responsible individual who stated that she would request the district nurses to provide staff with training and information in the correct use of airwave mattresses. Risk assessments had been completed for people at risk of falling out of bed and bed rails with bumpers were seen in use. Care plans contained some negative terming such as cot sides. Staff have now all attended manual handling training and the use of manual handling equipment was observed in communal areas of the home. Care plans contained risk assessments and manual handling plans. Manual handling equipment was seen to be used appropriately with two staff and full explanations and reassurance given to the person however one persons dignity was not ensured when hoist was used as the person was wearing a skirt and no blanket or cover was placed over the persons legs such that underwear was clearly visible during the hoisting procedure. It was not possible to have a discussion with most of the older people but those that it was possible to talk with stated that all their health and care needs were met, doctors were called when required and that their privacy and dignity was maintained. People living in the younger adults section of the home can have keys to their bedroom doors and raised no concerns about privacy or dignity. Records were kept in care plan files of any visits to health care services and these indicated that medical attention was sought when necessary and that regular Care Homes for Older People Page 15 of 38 Evidence: appointments and visits from chiropodists were undertaken. As identified previously some concerns about relapse indicators were identified in the care plans for younger adults and some poor recording concerning medication changes for one person. The previous report identified that the home did not have the necessary equipment to weigh everyone who lives in the home. The responsible individual informed us that new sit on scales had been purchased and these were seen. However it did appear that these were not being used as both care plans viewed in older persons part of the home showed that the people were not being weighed. This puts people at risk as weight changes are an indicator of other health needs which may therefore not be picked up in a timely manor. Medication was looked at in both parts of the home. As identified one of the two care plans viewed in the younger persons part of the home contained out of date information about their current medication. The medication records for this person were confusing as there had been a number of medication changes. The service user was aware of their medication and what they should be taking and stated that they get the correct medication. One medication had been prescribed as being up to 600mg daily. This had not been dated and it was not clear what up to means. Staff informed the inspector that the dose keeps being changed by the persons Doctor. The unclear prescription and confusing medication administration record sheets places the person at risk that they will not receive the correct medication. The service user also purchases their own over the counter pain medication and staff had not checked with the doctor the suitability of this medication with other that is taken. Some as required medication protocols were in place but not for all the as required medication the person was taking. Medication in the younger persons part of the home was stored securely with staff stating that they have done medications training via a distance learning programme. Staff stated that they did not have a written policy in the home about as required medication and it was noted that staff record this differently, some leaving the medication administration sheet blank and some putting refused in when not required. Medication was also looked at in the older person part of the home. Again this was stored correctly and there is appropriate controlled medication storage in this part of the home. There are also facilities to keep medication at cooler temperatures if this is required. Generally the medication administration records for the older people were well maintained with only a few gaps so it was not possible to tell if people had received their medication as prescribed. The home uses a blister pack system and viewing of blister packs would indicate that the medication had been administered but Care Homes for Older People Page 16 of 38 Evidence: not signed for. Some of the older people are unable to swallow tablet medication. Their GPs had signed a letter to state that all their medication could be crushed however this did not list the medication and potentially new medication could be prescribed that should not be crushed however the permission is in place for all medication which could place people at risk. Staff caring for the older people also confirmed that they have done medications training and the procedure observed during the lunchtime medication administration round was appropriate. Care Homes for Older People Page 17 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has complied with requirements made following the previous inspection and now provides a range of activities for all service users and people receive varied meals of a good quality to meet nutritional needs. Visitors are welcome at all times. Evidence: The inspectors spent time talking with people and observed part of the lunch time meal. The inspectors discussed activities with people who live at the home and viewed information about activities undertaken in daily records and related information in care plans. The previous inspection identified that whilst the younger adults had appropriate activities the people living in the older persons section of the home did not have adequate activities. A requirement was made that all people living in the home must have the opportunity of joining in a programme of activities arranged by or on behalf of the home to provide mental and physical stimulation and enjoyment. The requirement also stated that people must be consulted as to what activities they wish to have available. This was required to ensure that peoples mental and physical health does not deteriorate due to boredom. Care Homes for Older People Page 18 of 38 Evidence: Younger adults spoken with stated that there are more activities over the last few months. They stated that staff have helped them to get bus passes and also companion pases. Some trips out have occurred with one planned for the day following the inspection to view Christmas lights. Some younger adults are now attending college courses with others going to local day services and one with a supported work placement. However care plans lack a specific plan for residents activities, work, likes and preferences. A staff member is now responsible for activities and keeps a log with photos. Residents pay five pounds a year for additional TV license to enable them to have a television in their room. This is optional and one person spoken with does not have a television. The home has recently been donated a computer which was seen in the small lounge and has Internet access. A range of seasonal activities including new years buffet and a pre-Christmas party with magic show to which people could invite family or friends were planned. It was not clear within one younger adults care plan how the person was being assisted to learn and develop independence and life skills. Service users stated that staff will help them with cleaning their rooms and help with laundry as the machines are difficult to use on their own. Many of the younger adults are able to go out on their own and are encouraged to let staff know where they are going or to sign out. They appeared to understand that this was for safety reasons. The younger adults section of the home has a separate lounge and dining room. These rooms are small considering the number of younger adults the home now accommodates. There is a separate small lounge that now houses the computer. The responsible individual stated that she is looking at the issue of communal space for the younger adults. In the summer they are able to use the patio outside the younger adults lounge and have access to the homes garden and a summer house equipped with kettle and tea making facilities where they can smoke. Care plans for the older people did contain life history information and a page with information about social and leisure interests and any preferences they may have in terms of food were recorded. One service user living in the older persons part of the home able to express an opinion stated that there are now more activities with a singer entertainer visiting on the afternoon of the inspection. Staff were positive about the increased activities and stated that one service user who had been reluctant to leave her bedroom and socialise in the lounge will now do so for activities. A range of activities equipment is now available for staff. Older people have also participated in outings with one stating that she was going on the minibus trip the next evening to Care Homes for Older People Page 19 of 38 Evidence: see the Christmas lights and had been to a garden centre to see Christmas displays. However as previously identified during the day of the inspection visit the older people spent alot of time asleep in the lounge. Staff confirmed that service users often seemed sleepy and this may be due to being woken early. If people are too tired they will not be able to participate or enjoy activities. The home is providing more activities for older people and therefore the requirement has been met. Younger adults stated that they are able to have visitors as did the older people able to express an opinion. The younger adults part of the home has a small separate lounge which, whilst not completely private, could be used for more privacy for visitors if required. Most of the older people living at the home have age related memory loss and difficulty in communicating clearly, but staff supporting them demonstrated that they were skilled in communicating with them. Staff spent time ensuring that people were given the time and support to make choices and showed that they placed importance on supporting people to make decisions for themselves wherever possible. There was information in care plans about how some people may show choices. The younger adults were also seen to be encouraged to communicate and observations showed that they felt able to talk to and discuss things with the care staff on duty. Nutritional assessments were seen in the care plans for the older people and in one of the two younger adult care plans viewed. The information in the other younger adults care plan in respect of diet and nutritional needs was out of date. The previous report identified that meals at the home may not always be of an acceptable quality and that people may not receive a meal if they had not ordered one. The procedures for ordering a meal for the younger adults has now been altered. A menu is available and people can state their preference however if they do not order a meal one can still be provided. It was observed during the inspection that a person who had not booked a meal and requested this at 12.00 noon was provided with a hot meal at lunch time. The younger adults can request to have a meal saved and which they can heat up later if they are out at the time of the main lunch time meal. Some of the older people have their meals in a soft/mashed format due to eating and swallowing problems. The various parts of the meal (meat, potatoes, veg etc) are all Care Homes for Older People Page 20 of 38 Evidence: separate on the plate enabling people to sample all tastes. The older people seemed to enjoy their meals and those able confirmed that choice is provided and that meals are now of a better quality. One person was seen to have been provided with jacket potatoes (her choice) as she had not like either of the main meal options. The younger adults can make themselves hot drinks in the summer house and staff provide regular hot drinks. The older people were observed being given drinks throughout the inspection visit with one stating that if they wanted a hot drink staff always make her one. The older people also confirmed that they have a supper with one saying that staff make her favorite of hot milk cereal in the evening. The requirement in respect of meals and ensuring that peoples nutritional needs are being met has been complied with. Care Homes for Older People Page 21 of 38 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 and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People living at the home are generally safe and not at risk of abuse however there are some task orientated and institutional care practices that the responsible individual has recently become aware of and stated will be addressing with staff. Evidence: Discussions with people who live at the home and staff as well as records viewed are considered. Information from the local social services safeguarding team is also considered. Information about the homes complaints procedure is provided in the statement of purpose and service users guide. People stated that they would raise any concerns to the homes owner or to staff on duty. The home has a complaints book and this was viewed. The majority of complaints were from the younger adults and generally related to incidents when one service users behaviour had upset another service user. There was a record of action taken in respect of most of the concerns raised by service users. The home also has another file for more formal complaints. This was also viewed and indicated that complaints would be managed appropriately. Care Homes for Older People Page 22 of 38 Evidence: The number of complaints and the nature of the complaints indicates that people feel able to raise issues with the staff and responsible individual and expect that these will be resolved. Discussions with people during the inspection visit confirmed this and no one living at the home raised any specific complaints and stated that they were confident that if they raised issues they would be taken seriously and sorted out. Care staff confirmed that they had undertaken safeguarding training and discussions with them showed that they were aware of safeguarding and the action they should take should they be concerned that a service user was at risk of abuse. However it was noted during the inspection that within the older persons part of the home there are some task orientated and institutional care practices occurring. This is specifically around the getting up of people from 6am on-wards with nine of the ten older people up, washed and dressed before day staff some on duty at 8am. The first person being got up at 6am. There was no evidence in care plans that this was the wish of these people and it is unlikely that all have requested this on a daily basis. It was not possible to discuss this with the service users however staff stated that people would be unable to express an opinion and the one person who would express an opinion was the one person not up when they come on duty. Care staff had not identified that the practice of getting people up early against their wishes is abusive. This was discussed with the responsible individual who stated that she had recently become aware of this practice and was planning on changing the morning routines, however on the day of the visit it continued to be the normal routine nd needed to cease immediately in accordance with peoples preferences pr previous desired routine. This also highlights a training need as staff had not identified this as abusive and inappropriate practice. to ensure that people were not got up until they were ready to do so. A telephone call was made to the Isle of Wight Social Services safeguarding team following the inspection visit and they were informed of the above concerns. The safeguarding team were happy that the provider would be resolving the issue. The home was investigated by the Isle of Wight social services safeguarding team in 2009. This investigation is now completed and the safeguarding team are satisfied with the action taken by the home to ensure the safety of people living there. There were some concerns identified in respect of the homes recruitment procedures in that current or previous employers were not always asked to provide a reference but otherwise recruitment procedures should protected people. There were also some concerns in respect of service users personal finances which the responsible individual Care Homes for Older People Page 23 of 38 Evidence: is resolving and stated had been unaware of until the previous registered manager resigned. Care Homes for Older People Page 24 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes physical environment is generally clean and safe however it does not always meet the specific needs of all the people who live there specifically the bathing facilities and communal areas of the younger adults part of the home. Evidence: The inspectors viewed the communal areas and some bedrooms with staff and service users, viewed certificates related to equipment and discussed the home with the people who live there, the provider and with staff. Certificates and records relating to the equipment and services (gas, electric) were viewed. The home is an extended older property with the younger adults living in the original part of the home and older people in a purpose built extension to the rear of the home. Separate communal and bathing facilities are provided in each section of the home with laundry and kitchen facilities shared (although the older persons section has a beverage and snack preparation area). The AQAA completed prior to the inspection that occurred in July 2009 identified that there was room for improvement in the homes environment in terms of decoration and that service users would benefit from the installation of more showers. Since the inspection in July 2009 the home has addressed a safety concern with regards to access to the home and there is now a separate entrance and footpath from the road Care Homes for Older People Page 25 of 38 Evidence: outside the home to the front of the home without the need to walk through the homes car park. A bin storage area has also been created. The responsible individual stated during this inspection that she now intends to modernize the bathrooms in the younger adults part of the home. The younger adults live in the original part of the home and have a lounge, separate dining room and small quiet lounge. There are now seventeen younger adults with three vacancies in this section of the home. Service users identified that there is insufficient communal space. The dining room is not large enough for everyone to eat at the same time and the lounge does not have sufficient seating or space for additional seating should everyone wish to sit in the lounge to relax. People stated, and the inspectors observed that some people choose to spend their time in their rooms. In warmer weather people can sit on the patio for meals and people also have a summer house in the garden which is equipped with tea making facilities and is the designated smoking area for the home. Two bedrooms in the younger adults part of the home are registered for twin occupancy with two people currently sharing a bedroom. These people have previously stated to the inspector that they are happy sharing a room. Some rooms have en suite facilities and others are equipped with a wash basin. Some service users showed the inspector their bedroom and these were personalised and individual. The communal facilities available to service users in the older persons part of the home and in their own bedrooms were appropriate to their needs and they were able to bring in some of their own furniture if they wished to do so. As identified staff were not fully aware of how some equipment to support people at risk of pressure injuries should be used. All bedrooms in the older persons part of the home are for single use most en suite and others equipped with a wash basin. Again these were seen to have personal items in them. The home has cleaners five days per week in the older persons part of the home and three days per week in the younger persons part of the home. Care staff undertake other domestic and laundry duties involving where possible in the younger adults part of the home the service users. On the day of the unannounced inspection visit the home was clean and presented no concerns. Staff confirmed and training records evidenced that staff have completed infection control training and and that they had access to infection control equipment such as disposable aprons and gloves. Care Homes for Older People Page 26 of 38 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. The home now provides staff with the necessary skills to meet peoples needs. Staff are provided in sufficient numbers although there is a need to improve the recruitment procedures to ensure that all pre-employment checks are fully completed. Evidence: Records relating to recruitment and training were viewed. Discussions with staff and people who live at the home are considered along with information provided by the responsible individual. Information from the previous key inspection report and random inspection report completed in October 2009 are also considered. The inspectors viewed duty rotas and discussed staffing arrangements with the provider and staff. The staff are divided into two teams, one for the younger adults and the other for the older people. On rare occasions staff may cover the other part of the home but they usually work in one of the areas. Care staff confirmed this. Staffing levels on the day of the inspection were as those stated on the duty rota with three staff working with the ten older people and two staff working with the seventeen younger adults. The younger adults section of the home has three vacancies and there will be a need to review the staffing levels in this part of the home should these vacancies be filled and the younger adults section has twenty people living in it. At night two staff are provided in the older persons part of the home and one sleeping in the younger adults part of the home. It was noted that an additional staff member Care Homes for Older People Page 27 of 38 Evidence: was being provided in the younger adults section the day following the inspection when an outing was planned. Maintenance, kitchen and cleaning staff are also employed. Care staff in the older persons part of the home felt that there were sufficient staff to meet peoples needs on a daily basis however they stated that they were covering extra shifts as the home did not have enough staff to fully cover the rotas. The Christmas duty rotas had not yet been completed with Christmas day only ten days away. The responsible individual stated that new staff had been recruited but that preemployment checks had not yet been received and therefore they had not commenced working in the home resulting in the current shortage of permanent staff. Service users in both sections of the home were positive about the staff and observations on the day of the inspection visit indicated that staff and service users appeared to get on well. We observed that people living in the home appeared relaxed in the company of staff and that they appeared to ask staff for anything they needed. Staff were knowledgeable about service users individual needs. We viewed recruitment records for staff that had been employed since the previous key inspection in July 2009. Two new staff had commenced working at the home and the provider was waiting for pre-employment checks to return before other people commenced working at the home. We looked at the records of the staff who had commenced working at the home. We found that the home had not sought a reference from one persons previous employer and had accepted a reference supplied by the applicant the authenticity of which cannot therefore be guaranteed. The home did not keep evidence of identity of staff employed and could therefore not guarantee that people had the legal right to work in the UK. The home had completed the necessary checks with the police to ensure that people were not listed as having a criminal record or being on lists of people unsuitable to work with vulnerable people. No concerns were identified around recruitment records at the previous inspection in July 2009 however the report did record that there had been a requirement made concerning references at the inspection prior to that one completed in July 2008. The homes recruitment procedures were discussed with the provider and she stated that she would ensure that the necessary documentation and references would be sought however a requirement is made that the home must ensure that all pre-employment checks including references from the persons most recent or current employer are taken prior to people commencing work at the home. This is to ensure that people are suitable to work with vulnerable people. Care Homes for Older People Page 28 of 38 Evidence: The previous report recorded that over fifty percent of staff have an NVQ and the responsible individual confirmed that this was still the case with the home employing a total of twenty staff fifteen of whom have an NVQ at level 2 or above. A requirement in respect of staff training was made following the key inspection in July 2008. This was found to have not been complied with at the key inspection in July 2009 and staff training was also a feature of the safeguarding investigation undertaken during 2009 by the local social services safeguarding team. As a result of the failure to comply with a requirement the home was issued with a statutory requirement notice in August 2009 that required that the home ensure that all staff undertake all mandatory and service specific training to ensure that they have the necessary skills to meet peoples needs and ensure their safety. A random inspection to assess compliance with the statutory requirement notice was completed in October 2009 and this found that the home had provided most of the necessary training with other training booked for soon after the random inspection. The statutory requirement notice was therefore considered to have been complied with and no further enforcement action taken. We looked at staff training again during this inspection. Care staff stated that we have done much more training in the last few months and another saying we have done lots of training, there was a gap when we had no training but now its much better. Staff stated that they had done challenging behaviour, infection control, medication, COSHH (outstanding from the statutory notice) safeguarding, Mental Capacity Act and Deprivation of Liberates, food hygiene, diabetes, moving and handling, fire safety and first aid. Some staff working with the older people have also done continence promotion, care of the dying and dementia training. Staff working with the younger adults stated that they would like to do mental health training as they had not done any specific mental health awareness training. Otherwise staff felt they had the necessary training to meet peoples needs. The future plans for staff training were discussed with the responsible individual and there is now a need to produce a training progrmame for 2010 to ensure that the improvements in staff training are sustained and that the training needs of all staff continue to be met with updates provided as required. Care Homes for Older People Page 29 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not currently have a registered manager and the responsible individual has taken over day to day responsibility for the home. Concerns have been identified in respect of some aspects of care planning and medication management, institutional care practices, management of peoples personal money and recruitment procedures. Staff are not receiving formal supervision placing them and service users at risk. Evidence: Discussions with the responsible individual, staff and service users as well as records viewed and observation throughout the inspection are considered. Also considered is information that the home has sent to the commission by way of notifications and improvement plans and Regulation 26 reports. Following the key inspection in July 2009 four requirements were made and a requirement was repeated from the previous key inspection in July 2008. A statutory requirement notice was issued in respect of the unmet requirement which related to training and a random inspection to assess compliance with the statutory requirement Care Homes for Older People Page 30 of 38 Evidence: notice was undertaken in October 2009. The random inspection confirmed that the statutory requirement notice had been essentially complied with and the new requirements made following the key inspection in July 2009 are either no longer relevant due to management changes in the home or have been met. New requirements are made following this inspection in relation to staff recruitment and supervision, ensure care is provided as per peoples preferred routines and service users personal finances. The report also identifies areas that the home could improve on within the various outcome groups. The home no longer has a registered manager. The home notified the commission that the registered manager had resigned with immediate effect in November 2009. Since that time the responsible individual has taken over day to day running of the home with a senior staff member becoming the homes operational manager and a new staff member, who has not yet commenced work at the home, has been appointed as deputy and administrator. At the previous inspection it was noted that there had been a breakdown in the relationship between the registered manager and responsible individual and a requirement was made that the responsible individual and registered manager must have a working relationship as the situation was adversely affecting service users. The requirement, although not complied with, is no longer relevant as the registered manager no longer works at the home. A requirement was also made following the inspection in July 2009 that the responsible person must ensure that a visit to the home to assess the quality of the service is undertaken every month. A report of the visit must be provided to the registered manager. These are called regulation 26 visits and reports. Following the inspection in July 2009 the home commenced undertaking regulation 26 visits and reports were received by the commission of these visits. During the random inspection in October 2009 the person undertaking the visits was in the home and met the inspector. The commission requires homes to undertake these visits and reports to ensure the quality of the service provided, that people are safe and that the responsible person is aware of what is going on in the home as they are legally responsible for it. The responsible individual is now in day to day charge of the home. The requirement has therefore been complied with however during the inspection visit it was evident that the responsible individual was only just becoming aware of some issues of concern within the home in respect of institutional care practices in the older persons part of the home and some aspects of the way that peoples personal finances had been managed by the registered manager. Care Homes for Older People Page 31 of 38 Evidence: We looked at the way that the home supports people with their personal finances. The previous report from July 2009 stated that the registered manager had stated that peoples families, a solicitor or the social services receiving officer is responsible for peoples money and that the registered manager will hold small amounts of peoples personal money sent to her on a monthly basis by the person who manages the persons money and that this is then passed onto service users who sign for the money. During this inspection it was identified that peoples money from the social services receiving officer was being paid into a business account in the name of the home with the registered manager having the pin number/card. People had not been supported to open their own bank accounts. The home was aware of how much each person had in the account but due to the nature of the account people were not receiving any interest on their savings. The home also holds small amount of cash for some people and the records for this were viewed. The provider had identified that in July and August some service users were being charged of some activities from visiting entertainers that they had not agreed to and that should have been funded by the home. The responsible individual had stopped this practice once she had become aware of it and stated that she intended to repay the money. It was also noted that one person had been charged for some special foods to meet dietary needs and again the responsible individual had discontinued this and stated that the money would be repaid. The concerns in respect of the management of peoples personal money were discussed with the Isle of Wight safeguarding team following the inspection and will be reviewed at the next inspection. A requirement is made that the home must ensure that when it supports people with any aspect of their personal finances money is paid into peoples individual named accounts and they are only charged for things they have agreed to pay for and are listed in the service users guide. The home undertakes monthly service user meetings with the younger adults and minutes of a staff meeting held following the resignation of the registered manager were viewed. The report following the inspection in July 2009 recorded that the home had undertaken some quality assurance surveys. The provider stated during this inspection visit that further quality assurance work would be undertaken but that at the present time she was focusing on addressing the issues resulting from the sudden resignation of the registered manager. Staff stated and the provider confirmed that the home does not have a procedure in place for regular formal supervision of staff. Some senior staff have now completed supervisor training and the plan is to initiate a formal supervision programme for all staff. A requirement is made that the responsible person must ensure that all staff Care Homes for Older People Page 32 of 38 Evidence: receive regular formal supervision at least six times per year and that records are maintained of supervisions. This is required to ensure that people are safe and provide staff with the opportunity to raise issues and concerns to ensure the quality of the service provided to people. No concerns in respect of health and safety were identified during the inspection visit. The home has addressed the safeguarding concerns regarding the environment and now has the necessary evacuation equipment and new fire assessment and evacuation plans in place. The homes fire detection equipment is regularly checked and drills, including the night staff have occurred. Certificates for the testing of portable electrical equipment were seen. The provider was unable to find the homes gas safety certificate during the inspection. The provider arranged for a new gas safety check shortly after the inspection and a copy of the gas safety certificate dated 21st December 2009 was received at the commission. Care Homes for Older People Page 33 of 38 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 34 of 38 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 9 13 The registered person must ensure that arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are safe. Medication administration records must be clear and accurately record medication people are to have administered by care staff so that people get the medication they have been prescribed and do not become ill. 15/01/2010 2 10 12 The responsible individual must ensure that the provision of health and personal care takes into account peoples wishes and feelings. 15/01/2010 Care Homes for Older People Page 35 of 38 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 that people receive care at times they choose and not to fit into the homes routines. 3 29 18 The responsible person must 20/01/2010 ensure that all preemployment checks are completed prior to people commencing work at the home. So that people are safe. 4 35 20 The responsible individual 01/02/2010 must ensure that where they support people with any aspect of their personal money this is paid into an account in the name of the service user and people are only charged for things they have agreed to pay for and are listed in the service users guide. To ensure people are safe. 5 36 18 The responsible person must 01/03/2010 ensure that all staff receive regular formal supervision at least six times per year and that records are maintained of supervisions. So that people are safe. Care Homes for Older People Page 36 of 38 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 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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