Inspection on 02/06/09 for Monks Haven Residential Home

This inspection was carried out on 2nd June 2009.

CQC found this care home to be providing an Adequate 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

Monks Haven Residential Home 04/12/09

Monks Haven Residential Home 01/12/08

Monks Haven Residential Home 10/12/07

Monks Haven Residential Home 17/06/07

Monks Haven Residential Home 08/10/06

Monks Haven Residential Home 10/05/06

Monks Haven Residential Home 24/02/06

Monks Haven Residential Home 04/08/05

Monks Haven Residential Home 19/10/04

Monks Haven Residential Home 21/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Monks Haven Residential Home 55-57 Beverley Terrace Cullercoats Tyne & Wear NE30 4NX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Gaffney     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Monks Haven Residential Home 55-57 Beverley Terrace Cullercoats Tyne & Wear NE30 4NX 01912521957 Telephone number: Fax number: Email address: Provider web address: geoshineltd@aol.com www.monkshaven.co.uk Name of registered provider(s): Type of registration: Number of places registered: Geoshine Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Home may admit up to one person, 55 years of age and above within the SI category of registration, (not exceeding total number of places registered) Date of last inspection Brief description of the care home Monks Haven is situated on the sea front at Cullercoats and is a large, older style adapted building. The Metro and other transport links are close by. The home provides residential care for up to 33 older people, of whom up to 10 may have dementia care needs. Nursing care is not provided. Bedroom accommodation is spread over three main and two mezzanine floors. There are 27 single bedrooms of which three have ensuite facilities. There are also three double bedrooms. There is a passenger lift to the three main floors and a stair lift has been installed between the top floor and the second mezzanine floor. Access to some bedrooms, bathrooms, and toilets is via a Care Homes for Older People Page 4 of 33 Over 65 10 23 0 0 Brief description of the care home small number of steps. The following communal facilities are also provided: two lounges and a dining room; two bathrooms and one shower room; nine toilets; a kitchen, small conservatory and adjoining utility rooms. The home has a small, attractive paved area to the front and a yard area to the rear of the building. Street parking is available to the front and rear of the home. Copies of Commission inspection reports are available from the home on request. The current scale of charges is 374 pounds to 424 pounds. Information about fee charges is included in the homes service user guide and statement of purpose. Additional charges are made for hairdressing, chiropody, newspapers, and taxis. Care Homes for Older People Page 5 of 33 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at: information we have received since the last key inspection visit on the 01 December 2008; how the service dealt with any complaints and concerns since the last visit; any changes to how the home is run; the views of people who use the service and their relatives, staff and other professionals. Care Homes for Older People Page 6 of 33 Following the last inspection in December 2008, the provider/registered manager, Dr George, has recruited a new manager, Mrs Harrison. An application to register Mrs Harrison will shortly be forwarded to the Commission. An unannounced visit was made on the 02 June 2009. During the visit we: Talked with people who use the service, some of the staff and the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements have been made since the last visit. What the care home does well: What has improved since the last inspection? What they could do better: Ensure that all staff are subject to robust pre-employment checks. This will help make sure people are cared for by suitable staff. Ensure that potential safeguarding concerns are notified to the Commission without delay. Also, advice about such concerns must be sought from social services and the local safeguarding team without delay. This will help people using the service to feel confident that staff know how to keep them safe. Ensure that the homes statement of terms and conditions specifies who is responsible Care Homes for Older People Page 8 of 33 for paying the fee and how any fee increases will be handled. This will help to ensure that prospective service users have a clear idea of what they can expect once they move into the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory arrangements are in place for assessing the needs of people before they are admitted into the home. This means that people can be sure that staff will know how to meet their needs when they move into the home. Evidence: Admissions into the home do not take place until a full assessment of need has been carried out. During the inspection, Mrs Harrison undertook two pre-admission assessment visits to determine if the needs of the people concerned could be met at Monks Haven. Mrs Harrison is an experienced and appropriately qualified practitioner. As part of the inspection, three peoples care records were looked at. Mrs Harrison had obtained copies of the social services assessment and care plan for two people. For the third person, because they lived a considerable distance away from Monks Haven at the time, Mrs Harrison sent a copy of the homes pre-admission assessment document to the care home they were then living in. The information received enabled Care Homes for Older People Page 11 of 33 Evidence: Mrs Harrison to make an informed decision about whether Monks Haven could offer a suitable placement. The home has a contract that sets out what service users can expect once they move into Monks Haven. Mrs Harrison is in the process of updating each service users terms and conditions and copies are being placed in peoples care records. During their interview, a service user made reference to a concern that they had had to raise with their care manager about whether they had originally accepted their bedroom as a single or a double, into which another person could be admitted. This matter was satisfactorily resolved. However, as part of this inspection, the homes statement of terms and conditions was checked. Although the statement is generally acceptable there are some omissions. The statement does not specify who will be responsible for paying the fee and how fee increases will be handled. Also, given the concern that arose about whether the above service user had accepted a single bedroom or a place in a double room, the statement has not been updated to provide appropriate clarification. Care Homes for Older People Page 12 of 33 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. Good progress has been made in improving the arrangements for meeting peoples personal and health care needs. This will help people to benefit from living in a service where staff are clear about how to meet their needs and keep them healthy and safe. Evidence: Following an inspection carried out in December 2008, Dr George was asked to ensure that peoples care plans contain clearly identified needs and statements of desired outcomes. It was also recommended that peoples care plans should be recorded on the correct formats and updated monthly. An audit of a sample of care plans showed that the new manager has significantly improved the format and content of peoples care plans. Historical information has been archived ensuring that staff are using the most up to date care plans and assessments. Peoples care plans now contain more information about their needs and cover most of the areas referred to in the National Minimum Standards. Desired outcome statements have been completed. New care plan formats have been introduced and are being used consistently. These improvements will provide staff Care Homes for Older People Page 13 of 33 Evidence: with better information about peoples needs and how they should be met. All of the care plans looked at had been reviewed within the last month. However, the monthly care plan review records contain limited information and do not provide a good overview of how effective peoples care plans have been in meeting their needs. Mrs Harrison reported that she is in the process of reviewing peoples current financial care plans. However, these were unavailable at the time of the inspection. Care plans covering peoples future End of Life needs are not in place. This could result in staff being unclear about peoples wishes about how they want to be cared for at the end of their life. Mrs Harrison is carrying out assessments of peoples capacity to make decisions using a recommended assessment tool. These assessments should help staff to provide appropriate care to the vulnerable people living at Monks Haven. Although staff have received initial Mental Capacity Act and Deprivation of Liberty training, the provider reported that arrangements will be made for staff to complete more in-depth training as places on relevant training courses become available. Also, it was identified that the home does not have a policy setting out how staff should respond to the Mental Capacity Act and Deprivation of Liberty Regulations. Mrs Harrison is in the process of revising each persons preventative health care risk assessments. In two peoples records, assessments addressing the risks posed by falling, pressure sores, self-neglect and poor mobility have been devised. Mrs Harrison said this work has almost been completed. However, a standardised assessment tool has not been used to assess the risks posed by peoples susceptibility to developing pressure sores. Nutritional risk assessments have not been completed for some people. Mrs Harrison said that the people concerned are not risk at risk of over or under nutrition. Arrangements are in place to ensure that people receive optical care. However, Mrs Harrison was unable to locate evidence of when one service user last received an optical assessment. The home has experienced difficulties arranging for a NHS dentist to visit Monks Haven. Due to the expensive call out fee that the homes current dentist is charging, Mrs Harrison intends to locate another dentist to meet peoples needs. Following an Immediate Requirement Notice issued during the last inspection, additional incontinence pads were purchased to meet peoples needs until the delivery of the homes next order. Arrangements were also put in place to ensure that staff only use incontinence pads for the people for whom they have been prescribed. Senior staff have been made aware of the importance of ensuring that prompt referrals are made to the continence care service. Also, a usage chart has been placed in peoples bedrooms to help staff monitor when extra supplies of continence pads may be Care Homes for Older People Page 14 of 33 Evidence: required. No concerns about continence pad usage were identified during this inspection. People living at Monks Haven have access to health care services both within the home and in the local community. All service users are registered with a GP practice and medical advice is sought whenever staff have concerns about a persons well being. A small sample of care records was looked at during this inspection. This showed that arrangements have been made for two newly admitted service users to see a chiropodist and an optician. Also, one of these people has received input from their community psychiatric nurse on a number of occasions. However, for one service user who has lived at the home since 2006, details of when they last saw a chiropodist, optician or dentist are not available in their care records. Keeping an easily accessible record of when people receive health care support will help senior staff to maintain an overview of when future appointments need to be arranged. The home has a medication policy that is available for all staff to read. All medication is stored in a locked trolley and cabinet to which only senior staff have access. Although tidy, the medicines trolley was not clean. Identification photographs have been placed in peoples medication records. Records covering the administration and disposal of medication are generally satisfactory. Staff administering medication have received accredited training. Mrs Harrison intends to ensure that relevant staff update their accredited training on an annual basis. Following an inspection carried out in December 2008, Dr George was asked to ensure that all medication received into the home is immediately booked-in and an appropriate record kept. The requirement also specified that staffs competency to administer medication should be assessed. Staff are now expected to immediately book-in any medication received into the home. Staff generally record in peoples Medication Administration Records that their medication has been booked into the home. However, there were some gaps in one persons records. Mrs Harrison has devised a tool to assess staffs competency to administer medication. Assessments will be updated every six months and certificates of competence will be placed on staffs training files. Assessments of staffs competency to administer medication had not been carried out at the time of the inspection. However, Mrs Harrison later confirmed that this work has been carried out following the inspection. The Commission has not been informed of any incidents involving the misadministration of medication. Generally, staff administered medication in a safe and professional manner. However, a senior carer was interrupted on a number of occasions as they administered medication. Such interruptions could lead to people Care Homes for Older People Page 15 of 33 Evidence: receiving the wrong medication. No requirements were issued following the last pharmacy inspection of the home. People using the service said that staff are polite, considerate and consult them about the care that they receive. They also said that they are well looked after and have no concerns. Care Homes for Older People Page 16 of 33 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 arrangements for meeting peoples lifestyle needs are not fully satisfactory. This means that people do not always have opportunities to experience a lifestyle that satisfies their personal, social and cultural interests and needs. Evidence: Information about peoples leisure interests and activities is obtained at the point of admission into the home and used to devise a care plan. A sample of three peoples care records was looked at during the inspection. Staff have completed a social needs care plan for each person. Following an inspection carried out in December 2008, Dr George was asked to ensure that staff provide activities in line with the homes programme of activities and that they keep better records about the activities provided and who joins in. Dr George was also asked to provide service users with opportunities to access external events and trips out. Following her appointment, Mrs Harrison has reviewed the arrangements for delivering social activities within the home. For example, the time of the tea-time meal has changed from 4pm to 5pm. This has created more time within which care staff can deliver afternoon activities. Details of the activities planned for each day are now displayed on a whiteboard located in the main lounge. Staff were observed Care Homes for Older People Page 17 of 33 Evidence: providing the planned activities for the afternoon session. The homes social prgramme shows that activities do take place. For example, a regular weekly exercise class is held to help keep people fit and healthy. There is a monthly church service that people can attend if they wish. Birthdays and festive events are celebrated. Information about the activities that people participate in is recorded in their care records. However, records show that a limited range of activities is provided. Also, there is no programme of external social events and outings. Mrs Harrison has identified that improvements still need to be made to the homes performance in this area. A mixed response was received from service users about the provision of activities within the home. People interviewed as part of the inspection said that some activities are arranged by the home. Of the eight people who returned surveys, four said that the home always or usually arranges activities that they can take part in. Four said that this only happens sometimes. People who use the service are supported to maintain important personal and family relationships. Visitors can be seen in private or meet with their relatives in the lounge and dining areas. No-one spoken with could recall the home placing any restrictions upon their visitors. However, there are no care plans providing staff with guidance on how to support people to maintain important personal relationships. The home has a varied menu that offers choice. Arrangements are in place to ensure that peoples meals contain the right nutritional balance. People said that they enjoy the food served and are consulted daily about what they would like to eat. People have access to snacks and drinks in-between meal times. Following recommendations made in the report that followed the December 2008 inspection, new crockery and linen have been purchased. However, it was identified that all crockery continues to be washed by hand. Providing a dishwasher would enable staff to reduce the amount of time they spend in the kitchen following meal times and enable them to spend more time with service users. The inspector observed service users taking their tea-time meal. The meal served looked nutritious and appetising. Staff responded to peoples needs in a caring and sensitive manner and provided them with the assistance they needed to eat their meal. The atmosphere was relaxed and unhurried. Of the eight people using the service who returned surveys, all said that they always or usually like the meals served at the home. The kitchen and food storage areas are clean and tidy. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes management of complaints is satisfactory. The arrangements for keeping people safe are not fully satisfactory. Because of this, peoples welfare may not be appropriately safeguarded. Evidence: The home has a complaints procedure a copy of which has been placed in each persons bedroom. This procedure can be made available in alternative formats on request. The majority of service users who returned surveys said that they have been told how to make a complaint. Staff interviewed were clear about how they would handle a complaint. The Commission has been notified of one complaint since the last inspection. The complainant expressed concerns about the homes lift being out of operation. The lift was repaired promptly, once the maintenance company took delivery of the parts needed to make the repair. North Tyneside Council and the Commisison were satisfied that the registered manager took appropriate action to address this problem. The home has a safeguarding adults policy that provides staff with clear guidance on how to handle adult protection concerns. The local safeguarding team has checked the policy to ensure it is compliant with best practice guidance. All staff have completed safeguarding training with the exception of a newly appointed member of staff. People interviewed as part of the inspection said that they feel safe and well cared for. Staff Care Homes for Older People Page 19 of 33 Evidence: were clear about how they would handle a potential safeguarding incident. Following an inspection carried out in December 2008, Dr George was asked to provide staff with training in how to use the homes whistle-blowing policy and procedures and to review the policy to ensure that it is up to date. Staff interviewed said that they had not received this training but said that they would not hesitate to report bad practice. The whistle-blowing policy has not been updated. There has been one safeguarding issue since the last inspection. This involved a service user assaulting another person living at the home. The safeguarding concern came to light as part of a social services review. Following an investigation, North Tyneside Council expressed concern about the homes senior staff failing to recognise the assault by one service user of a fellow resident as a potential safeguarding issue. Because of this, the home failed to notify the Commission of the incident and they did not contact social services or the local safeguarding team. The Commission also views this failure with concern. Following inspections in October 2006 and June 2007, Dr George was asked to ensure that notifications required under Regulation 37 of the Care Homes Regulations are made without delay. This was also repeated in a statutory notice served in July 2007. However, there is evidence of a real improvement in making the required legal notifications since the Statutory Notice was issued. Following discussions with North Tyneside Council, a decision has been made that senior staff, including the registered manager, will be asked to complete the advanced safeguarding training. Care Homes for Older People Page 20 of 33 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 arrangements for maintaining and improving the homes decoration, furniture and fittings are generally satisfactory.This means that people live in accommodation that is decorated and furnished to an adequate standard. Evidence: The home provides a physical environment that meets the specific needs of people living at Monks Haven. There is an annual development plan that sets out what improvements will be made to the homes decoration, fixtures and fittings during 2009. A copy of the plan has been made available to the Commission. A detailed record is kept of all maintenance work carried out at the home. Premises related requirements made following the last key inspection have been complied with. A number of improvements have been made since the last inspection and these have improved the overall appearance of the home and its facilities. At the time of the inspection, the dining area was being redecorated. An additional heater has been installed in the recently refurbished bathroom. Repairs have been made to the kitchen ceilings and the carpet next to the laundry has been cleaned. However, although it was recommended in the homes previous inspection report, an additional heat source has not been provided in the conservatory. People using the service are able to make use a range of aids and adaptations such as grab rails, a bath hoist, a walk-in shower and an adapted specialist bath. In order to Care Homes for Older People Page 21 of 33 Evidence: provide level access to some areas of the building a number of ramps have been installed. The ramp leading from the dining room to the ground floor corridor bedrooms has a steep gradient. Although hand rails have been fitted to either side of the ramp, the gradient could make it difficult for people to use it independently. Although recently refurbished, the ground floor bathroom looks stark and impersonal. It has not been redecorated following the refurbishment. People are able to bring their own furniture and possessions with them when they move into the home. In some of the bedrooms visited people have chosen to personalise their rooms. A small number of bedrooms have en-suite facilities. On the day of the inspection the home was clean, tidy, odour free, well lit and comfortable. Generally, the kitchen was clean and hygienic. However, the deep fat fryer was covered in grease as was the toaster beside it. The senior carer on duty addressed this issue immediately. The registered manager has completed the Department of Health infection control self-assessment checklist. This will help to ensure that the home is meeting best practice infection control standards. Care Homes for Older People Page 22 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for ensuring that only suitable staff are employed at the home are inadequate. This means that people using the service cannot be confident that they will be cared for by suitable staff who have been subject to robust pre-employment checks . Evidence: An examination of the homes rotas show that there are enough qualified and experienced staff rostered on duty to meet peoples needs. There is a rota which sets out what shifts are being worked and by which staff. The following numbers of staff are usually provided throughout each 24-hour period: two care staff, including a senior carer, cover the night time shift from 10pm to 8am; three care staff, including a senior carer, cover the daytime period from 8am to 10pm. Domestic and catering staff are also available each day. Dr George and Mrs Harrison are supernumerary to the care rota. The rotas contain the necessary information. There is evidence that the mostly recently appointed member of care staff received an in-house induction. However, there is no written record confirming that the weekend cook received a suitable induction. A member of staff who had recently started work at the home, and who had worked there previously, confirmed that they received a brief induction provided by the deputy manager. However, a written record of the induction has not been completed. This member of staff was unclear about whether they had completed Care Homes for Older People Page 23 of 33 Evidence: their Skills for Care induction training. The personnel files for this person and another new member of staff, did not containSkills for Care completion certificates or equivalents. Mrs Harrison has made arrangements for a new member of staff to complete their statutory training to ensure that it is upto date. Over 70 per cent of the staff team have obtained a relevant qualification in care. Staff have completed a range of statutory training such as first aid, infection control, health and safety, fire prevention and food hygiene. Some staff have also completed specialist training aimed at meeting the needs of older people, such as dementia awareness and falls prevention training. Since the last inspection, Dr George has delivered a series of training sessions covering such areas as MRSA, Clostridium Difficile and Diabetes. This means that people using the service can feel confident that they are being cared for by qualified staff who have completed relevant training. Following an inspection carried out in December 2008, Dr George was asked to ensure that applicants for posts at the home supply a full employment history and other relevant information required by the Care Homes Regulations (2001). To check compliance, a sample of staff records was looked at. This showed that job applicants are required to complete an application form. However, a number of concerns were also identified. The application form completed by one member of staff only required them to provide employment history covering a 10 year period. There was no written evidence in one staff members personnel record that Dr George followed up disclosures detailed in their Criminal Records Bureau (CRB) certificate or information supplied in their application form. In addition, there was no evidence that written references had been obtained for this person and the applicant had only supplied details for one referee. Also, the applicant had supplied an incomplete employment history and provided no explanation of the gaps. An Immediate Requirement Notice Form was issued at the time of the inspection as the inspector judged that a potential breach of Schedule 2 and Regulations 7, 9 and 19 of the Care Homes Regulations (2001) had taken place. Relevant information was removed from the home using a Code B Notice issued in line with the Police and Criminal Evidence Act. Also, some of the staff files checked did not contain proof of identity, documentary evidence of relevant qualifications and training, recent photographs or completed contracts of employment. Failure to complete the required pre-employment checks could lead to unsuitable staff working at the home and this has the potential to place people using the service at risk. Care Homes for Older People Page 24 of 33 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 arrangements for ensuring that peoples health and safety is promoted, and their well-being protected, are satisfactory. People using the service are able to benefit from living in a home where their health and safety is adequately promoted and protected. Evidence: The registered manager is a qualified medical doctor, has obtained the Registered Managers Award and has managed the home for a number of years. Dr George has made arrangements to update his statutory training where this is needed and is in the process of completing a qualification that will enable him to assess and tutor staff completing a National Vocational Qualification in Care. Since the last inspection, Dr George has appointed a new manager, Mrs Harrison, who will shortly apply for registration with the Commission. Mrs Harrison has already identified areas for improvement and is taking action to address shortfalls in practice. Mrs Harrison has a clear view of the standards of care she would like see operate within the home and is providing strong leadership to achieve this. Mrs Harrison has also made arrangements Care Homes for Older People Page 25 of 33 Evidence: to ensure that her statutory training is upto date. Most people living at Monks Haven have their money managed on a day-to-day basis by the home. Each person has their own separate purse in which their money is kept. Peoples money is kept secure at all times. Two staff sign the records of money spent on peoples behalf and receipts of any purchases are obtained. Balances matched with the amounts of money recorded on peoples financial records. Mrs Harrison confirmed that some peoples bank account books and other valuables are kept in the safe. However, there is no record of this. Requirements and recommendations about the homes financial records have been made in previous inspection reports. Although improvements have been made, clear financial records of all transactions involving peoples money are not being kept. There are systems in place to monitor the quality of care provided at the home. Following a requirement set in the report that followed the December 2008 inspection, the Commission required Dr George to carry out an annual audit of the quality of care, services and facilities provided at Monks Haven and complete a written report. Dr George was also asked to forward a copy of the report to the Commission. Since the last inspection, a review of the services and facilities provided at the home has been undertaken. Details have been forwarded to the Commission. The provider carries out regular visits to monitor the quality of services and care provided at the home. People and their relatives are issued with surveys to obtain their views about the performance of the home. Satisfaction surveys were last issued in March 2009 and an analysis of the results has been produced. This showed that people using the service are generally satisfied with the care they receive. However, some people said that they are not always happy with the activities provided or the choices they are given with regards to the food they eat. There were no health and safety concerns noticed during the inspection. The home has a current gas safety certificate and all electrical equipment was tested on the day of the inspection. Arrangements are in place to test the safety of the homes hoisting equipment which was last carried out in May 2009. Fire prevention checks are carried out. For example, the homes fire alarms had been checked on five occasions in May 2009. There is an up to date fire risk assessment and the homes fire extinguishers and emergency lighting have received an annual service. All staff have participated in at least two fire drills during the previous 12 months. Care Homes for Older People Page 26 of 33 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 28 17 Ensure that staff files contain: a full employment history; a contract of employment that relates to Monks Haven; all of the information required by Schedule 4. This will help to ensure that only suitable staff are employed within the home. 01/04/2009 Care Homes for Older People Page 27 of 33 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 1 18 13 Ensure that potential safeguarding concerns are notified to the Commission and the local safeguarding team without delay. This will help people using the service to feel confident that the home is prepared to take all necessary action to keep them safe and free from harm. 01/07/2009 2 29 7 Ensure that the following 12/06/2009 information is obtained for all staff employed by the home: -An enhanced Criminal Records Bureau (CRB)disclosure certificate; -Two written references; -A full employment history, together with a satisfactory written explanation of any gaps in employment. This will help to ensure that only suitable staff are employed at the home. Care Homes for Older People Page 28 of 33 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 2 5A Ensure that the homes statement of terms and conditions specifies who is responsible for paying the fee and how any fee increases will be handled. This will help to ensure that prospective service users have a clear idea of what they can expect once they move into the home. 03/08/2009 2 29 7 Ensure that the following information is obtained for all staff: -Documentary evidence of relevant qualifications and training; -Proof of identity and a recent photograph. This will help to ensure that only suitable staff are employed at the home. 20/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The homes statement of terms and conditions should state whether a bedroom is to be used as a single or double room. Ensure that people using the service have an up to date statement of terms and conditions. Page 29 of 33 2 2 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 7 Ensure that all management and care staff complete training in the use of the Deprivation of Liberty Regulations. Ensure that the home has a policy setting out how staff will be expected to comply with the Deprivation of Liberty Regulations. Ensure key workers complete monthly reports covering peoples well-being and any important events that have taken place in their lives. Ensure that a MUST preventative nutritional risk assessment is completed for all service users. Ensure that service users are provided with an opportunity to receive regular dental care. Use a standardised risk assessment tool to assess peoples susceptibility to developing pressure sores. Ensure that: -Senior staff are not interrupted whilst medication is being administered; -A record of the medicines received into the home is recorded on the Medication Administration Records supplied by the pharmacist. This should include each item of medication contained in the medication cassettes. 4 7 5 7 6 7 8 9 8 8 8 9 10 11 11 11 Ensure that an End of Life care plan has been devised for each person. Ensure that the homes End of Life policy and procedures cover the latest guidance issued by the Department of Health . Ensure that a varied and stimulating programme of social activities are available within the home. Devise a programme of external outings and events. Ensure that all senior staff complete the North Tyneside Council advanced safeguarding training as soon as possible. Carry out a review of the homes whistle-blowing policy and procedures to ensure that they are up to date and compliant with the latest developments in social care. Provide staff with training in how to use the homes 12 13 14 15 12 12 18 18 16 18 Care Homes for Older People Page 30 of 33 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 whistle-blowing policy and procedures. A record of any training provided should be included in each staff members training record. 17 18 19 19 19 22 Install suitable heating in the conservatory to ensure that it can be used throughout the year. Repair or replace the homes dishwasher. Arrange for an assessment to be carried out to ensure that the homes ramps are suitable and safe given the needs of people using the service. Ensure that a written record is kept of any discussions held with staff regarding concerns disclosed on their CRB certificate. Revise the homes employment application form to include a requirement to provide a full employment history. Ensure that applicants for posts at the home are asked to bring with them to their interview evidence of any relevant training they have completed during their previous employment. Ensure that any agency staff supply a copy of their personal CRB disclosure certificate and proof of identity on the first day of their employment at the home. Ensure that: -Staff supply a signed statement confirming whether they have any convictions or cautions; -Where relevant, staff files contain fully completed contracts of employment. 25 30 Where relevant, ensure that each staff file contains a certificate of completion, verified by the manager, confirming that they have have completed their Skills for Care (TOPPS) training. Ensure that a written induction record is completed for all newly appointed staff. Take prompt action to register the new manager. Ensure that the homes 2009 annual development plan addresses concerns raised by service users in their quality satisfaction surveys. Page 31 of 33 20 29 21 22 29 29 23 29 24 29 26 27 28 30 31 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 29 35 Ensure that each person has an upto date financial care plan which is accessible at all times and which complies with the good practice guidance issued by the Commission. Ensure that the financial ledger used to record transactions involving peoples money includes the following details: the date on which transactions take place; the reason for the transaction; the date on which money has been booked in; the date on which money has been booked out; recording receipt details; staff and service users signatures. Ensure that a record is kept which details: what valuables are held in the safe; the date on which valuables have been booked into or out of the safe; the signature of the member of staff responsible for booking valuables into and out of the safe. 30 35 31 35 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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