Inspection on 29/07/09 for The Queen Charlotte

This inspection was carried out on 29th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Queen Charlotte 03/11/09

The Queen Charlotte 25/08/09

The Queen Charlotte 05/08/09

The Queen Charlotte 24/07/09

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: Montevideo House 432 Chickerell Road Chickerell Weymouth Dorset DT3 4DQ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Amanda Bell     Date: 2 9 0 7 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 37 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 37 Information about the care home Name of care home: Address: Montevideo House 432 Chickerell Road Chickerell Weymouth Dorset DT3 4DQ 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Althea Health Care Properties Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 51 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 who can be accommodated is 51. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder (Code MD) Dementia (Code DE) Date of last inspection Brief description of the care home Montevideo House is a mostly purpose built care home with nursing, located on a main road on the western edge of Weymouth. There is a bus stop close to the home, providing a service to and from Weymouth town centre. Montevideo House is registered to provide care with nursing to elderly people with a Care Homes for Older People Page 4 of 37 Over 65 0 0 51 51 Brief description of the care home mental disorder, including dementia. The home comprises a ground, first and second floor providing accommodation for a maximum of 51 people; all are accommodated in single bedrooms with en-suite hygiene facilities. There are assisted bathrooms and communal rooms on each of the three floors. All registered parts of the home can be accessed without the necessity to negotiate steps or stairs; there is a passenger lift. In the basement are the laundry, food storage facilities, and the heating establishment; the basement is not accessible to residents and their visitors. Laundering of clothing and household linen is carried out in the home at no additional cost to residents; items requiring dry cleaning are charged extra because it is necessary to send them out of the home for this service. There is a large attractively maintained garden to one side and rear of the Montevideo House building and car parking spaces at the other side. A hairdresser visits the home each week; there is an additional charge for this service. The home is owned by Althea Health Care Properties Ltd and was registered in their name in June 2009. They have managed the service since February 2009 prior to purchasing the service. At the time of inspection there was no registered manager in place. Fees are charged weekly; at present they range between £650 and £900 per person. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality of this service 0*. This means that people experience poor quality outcomes. This unannounced key inspection was carried out over two days and involved four inspectors. On the first day two inspectors focused on the majority of key standards. To help us understand the experiences of people living at the home and observe the staff interaction we used the Short Observational Framework for Inspection tool (SOFI). This allowed a third inspector to unobtrusively observe and record life in the lounge and dining room. At the beginning of the inspection we told the nurse in charge that this would take place so that people living at the home and the staff could be informed. On the second day a visit was carried out by a pharmacist inspector. The term We is used throughout the report to reflect the findings of the Care Quality Commission CQC. Care Homes for Older People Page 6 of 37 Throughout the inspection representatives from the management team of Althea Health Care Properties Ltd were on hand to aid the inspection process. All staff we spoke with were extremely helpful and courteous and we were made welcome. We gathered information in a variety of ways, which included reports made to CQC by the home; the annual quality assurance assessment (AQAA) completed by the management team; the random inspection on 24th to 26th July 2009; a tour of the premises and discussion with those people living at, visiting and working in the care home. We also reviewed a number of care records, recruitment and training records and maintenance documentation. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Pre-admission assessments need to be completed accurately to ensure that it can be confirmed that the home can meet the needs of the person and develop appropriate care plans. The home must ensure that all needs are fully assessed, consent obtained where required and kept under review. Care plans must reflect current needs, be person centred and give staff full information to ensure that they can support the person. We saw evidence that the people living in the home experienced a passive inactive lifestyle, being encouraged to remain seated and quiet with few opportunities to engage with each other or staff. Staff struggle to interact with the residents and appear to have few skills in dementia care. A choice of foods must be offered and people assisted appropriately to ensure that all receive a diet suited to their needs and preferences. An effective method of nutritional screening needs to be put in place and followed through to ensure each residents dietary requirements is met appropriately. The home needs to develop a range of activities suited to the varying and specialist needs of people living in the home. The environment should be developed to reflect best practice in dementia care. Infection control practices need to be improved to minimise the risk of cross infection and ensure the home is kept odour free. The home must be kept clean at all times so that it is a safer and more comfortable place in which to live. The management team needs to ensure that supervision for all is suitably robust to address areas of poor practice. A more robust quality assurance system must be developed to review and monitor the care provided through internal auditing. This will identify any shortfalls in the service promptly so that action can be taken to improve. Bed rails should be fully risk assessed for individual use and a maintenance check should put in place to ensure they are fit for purpose. Care Homes for Older People Page 8 of 37 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 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not reliably record assessed needs and circumstances of prospective residents so is unable to establish that their care needs can be properly met. Evidence: We reviewed the care documentation for a person recently admitted to the home. We saw that a family member had provided written information about the care and daily routine needed. There was no evidence that a nurse at the home had undertaken a pre admission assessment themselves, which meant that they could not be sure they could care for this person adequately. The family member said that the resident had a history of falls but the home failed to undertake a risk assessment until the person had fallen and sustained an injury. The information given by the relative had not been used to formulate a plan of care which would have instructed staff what care was required. We reviewed the training records for staff and saw that, collectively, they did not have Care Homes for Older People Page 11 of 37 Evidence: the skills to meet the needs of the people living at Montevideo. Staff told us that there had been very little training since February 2009. We witnessed that the care given was not based on current good practice. Care given appeared to be task orientated rather than person centred. There was poor infection control, continence management, pressure area care, wound care, nutritional screening and medication practices. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient evidence that residents receive the care they need. Associated records and care practices require improvement to ensure staff have sufficient guidance to enable them to properly care for and protect residents from the harm and ill health that unplanned and potentially inappropriate care, risks of cross infection, and incorrect medicine administration might cause. Evidence: Care plans are intended to provide staff with the information they require to meet the health, personal and social care needs of residents. In the four care files reviewed documentation was found to be of a poor standard generally and staff were not provided with sufficient information to effectively meet the needs of the residents. Approximately 43 of residents had wounds, most of which were pressure sores. One file detailed that a pressure sore had healed but when reviewed by a nurse working for the Primary Care Trust (PCT) it was found to be necrotic and needed regular attention. At the random inspection, which took place between the 24th and 26th July 2009 we Care Homes for Older People Page 13 of 37 Evidence: identified that several residents were at high risk of developing pressure sores and the home provided air flow mattresses to reduce this risk. However they were set incorrectly and the home had no knowledge of what the correct setting should be. This meant the risk of developing a sore for those people lying on these mattresses could have been significantly increased. At that time we made an immediate requirement that they should be used in accordance with the manufacturers guidelines. We were only given assurances by the management team that the mattress settings had been checked at the end of our inspection at 5:30pm on the 28th July 2009. We reviewed some moving and handling assessments and care plans. Some indicated that slide sheets should be used when moving people in bed. Staff confirmed that there was insufficient equipment in the home to do this. Training records showed us that not all staff had received moving and handling training. On touring the premises we saw an number of bedrails attached to divan beds. These were found to be unstable, badly fitting and presented a risk of entrapment. In light of this we issued an immediate requirement that all bedrooms must be checked and made safe. Where the home is unable to make the room safe a risk assessment must be undertaken and suitable arrangements put in place. Two people we saw during the inspection had sore and sticky eyes, which was as a result of poor hygiene practices. Care plans for these individuals did not contain information about the eye care they required. One resident had a very sore mouth but we saw no evidence of appropriate mouth care. At the random inspection we informed the home that the nutritional screening in place for each resident was insufficient and inaccurate in some cases. This was still the case at this inspection. A number of people had lost weight. Fluids were given at certain times of the day and not readily available. There was no provision for snacks or other methods of food enhancement, which would mean that people had a sufficient calorie intake. We observed one person sat at a dining table on our arrival with a bowl of cereal in front of them. The cereal was still there two hours later. Records showed us that the resident had only eaten a quarter of their breakfast. No alternative was offered. The home was malodorous and most areas had a pervading smell of stale urine. This indicated that there was poor management of continence generally. Care plans for continence management did not give staff sufficient information as to how to manage Care Homes for Older People Page 14 of 37 Evidence: this particular element of care. We saw that one resident had been given breakfast in their room and was sat in an armchair adjacent to the bed, which was soaked in urine. The en suite bathroom held a large amount of heavily soiled wipes which had not been removed by staff. This added to the malodour in the room, which was not a pleasant place to sit and eat breakfast. Generally the care plans around the mental health of individuals were poor and focused on what to do if the individual was aggressive rather than being person centred and focused on what would help that person. There was some evidence that residents and their families were involved in drawing up and reviewing care plans. Visitors and staff spoken with confirmed that residents had access to their GPs, district nurses, chiropodists and opticians. We found that there was a separate medicines room where all medicines are stored securely and in accordance with the current regulations. A dedicated medicines fridge was seen to be provided and this was maintained within the temperature range specified by the manufacturers of the medicines needing refrigeration. We found that there were some items in the fridge that did not require refrigeration and storage in this way may affect how they work for the people the are prescribed for. We also found some items that were dated expired since June 2008. Within one of the cupboards we also found some sterile products that had expiry dates on them from 2002. This may place people at risk of harm by being given date expired products. We also found within the cupboards some prescribed medicines that had had the dispensing labels either partially or fully removed. This means that it is not possible to determine who these medicines have been prescribed for and if used for another person then they would be used as prescribed. We found that oxygen cylinders were stored in the room but not all are stored in accordance with the information available from the manufacturer and the signage present on the door is not that which is recommended. This means that people cannot be confident that their safety is protected. When checking the Medicine Administration Record (MAR) charts we found that there were many entries for medicines prescribed to be administered either with a variable dose or when required. Thee was some guidance available to members of staff to indicate why these medicines had been prescribed but there was no information present to indicate how the decision to administer was to be taken, how the dose to be administered was to be established or what steps were to be taken to support the person both before and after the administration. For one person we asked two members of staff to explain how the medicines worked and how the decision to Care Homes for Older People Page 15 of 37 Evidence: administer was made. They were not able to explain how the medicine worked and were unable to locate the information in the reference sources available to them. We did explain to them how the medicine worked and showed them where to find the information. One member of staff said I know what works for this person, so that is what we give her, there is no record made of this information so it would not be available to discuss with the prescriber or if another person had to make the decision about what to administer. This means that people cannot be certain that their needs will be met consistently by different members of staff. Also with the MAR records we found that people were not administered their medicines as prescribed due to there being no stock available to administer. We found that there was no effective system in place to monitor stock levels and also no effective system to follow up requests for replacement supplies to ensure the availability of the medicines. This means that people cannot be assured that they will receive the medicines prescribed for them. This may compromise their health and well being. We found that safe practice in relation to the prevention of needle stick injury and infection control for blood monitoring and administration of injections was not followed. We found boxes of lancets for blood monitoring which were labelled by the manufacturer For use by an individual self-testing person only, these were being used by members of staff to obtain blood samples. We also found that a needle had been left attached to an insulin pen device. The members of staff asked were not able to say if the needle was used or not. Also the manufacturer of the insulin pen stated in the patient information leaflet that a needle should not be left attached to the pen as this may cause leakage and result in inaccurate dosing. This means that people cannot be assured that safe systems are in place to prevent the risk of cross infection which may place them at risk of harm. People also cannot certain that they will receive their medicine safely. We found that some people have medicines prescribed to be administered at intervals such as every 3 weeks . For these people we found that the records made were not clear that they had always received the medicines as prescribed. We also found that there was not always a record made of when the next administration was to take place. For one person when asked the member of staff told us that the prescriber administered it so they would not know when it is next due. This means that people cannot be confident that they will be supported to receive their medicines as prescribed. We also found that for some entries it was recorded that the medicine was administered by the carers. We could find no evidence of the training of the carers to carry out these tasks. We also found no evidence that the tasks had been delegated to the carers by the nurse administering the medicines. This means that people cannot be confident that they will receive their medicines safely. We observed staff undertaking their work during the course of the inspection. We found that they were kind and friendly but interactions with residents were task Care Homes for Older People Page 16 of 37 Evidence: focused, for example, residents would be spoken with when they were being moved, given food or drink. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited opportunities for the residents to engage in recreational and social activities and as a consequence some people are likely to become bored, apathetic and restless. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Residents do not have sufficient choice about the meals provided to them. Evidence: The home employed 2 part time activities organisers. We saw that there was a programme of activities displayed, although we did not see the activities on the programme offered during our visit. We observed a small group of people in the lounge to help us understand what day to day life at Montevideo House was like. This took place during the latter half of the morning and over lunchtime. Generally people sat passively throughout the two hours. There were no poor interactions from staff. However, all of the good or neutral interactions related to tasks either, drinking, hoisting, mobilising or lunch. We did not observe any organised activity or anything for people to sit and do or pick up and do. Overall people were in a passive or withdrawn state of being. Care Homes for Older People Page 18 of 37 Evidence: Staffing levels fluctuated from one to six staff throughout the observational session. At one point one staff member was left alone whilst others went for their break. There were two people in the dining room and sixteen in the lounge. This staff member went to answer the front door and there was a short period of time when no staff were in the dining room or lounge. At lunch time only five people went to sit in the dining room and thirteen people just remained in their chairs. People were not asked whether they wanted to go to the dining room or made aware that it was lunchtime. People were not offered a choice at lunchtime. Only two of the six staff told people what was for lunch. Others just said, heres your lunch. Only one member of staff offered people a visual choice of squash. The rest just gave people blackcurrant squash. One staff member put paper bibs on people without explaining what they were doing. One person had domestic apron on which looked much less clinical than the paper bibs that were stuck on peoples clothing. During our random inspection visitors to the home told us that they were made welcome into the home. Care Homes for Older People Page 19 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has failed to properly protect frail and vulnerable residents from risk of harm and injury. Evidence: The home has a complaints policy, which told us that all complaints would be recorded, investigated and taken seriously. We reviewed the complaints log and found it to be blank. However, we were told by a social worker that complaints had been made by visitors to the home but were not resolved. During our inspection a complaint was made a Director of Althea Health Care Properties Limited, who took the matter very seriously. The home has a policy in place to safeguard people from abuse. We spoke with some staff who had a good understanding of this policy and the procedure of reporting allegations of abuse. However the home had failed to safeguard people. We saw that many people living at Montevideo House had bruises with unknown origins. At the time of inspection four incidents had been reported for investigation in accordance with local safeguarding guidance. Care Homes for Older People Page 20 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home has started a programme of refurbishment there are areas within it where the health and wellbeing of people living there is compromised. Evidence: The management team told us that a programme of refurbishment is planned. The lounge/dining room on the ground floor had been recently painted. The gardens looked well tended and attractive. However during the four days of our random and key inspections we only saw one person go outside, even though the weather was pleasant. All external window were in need of cleaning to allow a better degree of natural light into the building. We toured the premises and found that most of the communal areas were malodorous. There was a pervading smell of stale urine. This indicated to us that the home had poor procedures in place to deal with incontinence. The sluices on each floor were locked and only the senior carer and registered nurse had a key to get in, which meant a delay in dealing with bodily waste and used continence products. Many of the carpets looked dirty and worn. The lack of infection control procedures within the home put people living there are risk. We saw, in one bathroom, that the cabinet had a child lock on it, which was easily opened. The cabinet contained some communal toiletries and an electric razor. It was Care Homes for Older People Page 21 of 37 Evidence: recommended that toiletries should be individual and not stored in a central place. We found a number of vinyl gloves in general bathrooms and en suite bathrooms readily available to anyone entering these rooms. This posed a risk of ingestion or suffocation and we recommended that they be removed to a place where only staff could access them as and when necessary. The laundry was situated in the lower ground area. We visited it during the latter half of the afternoon. There were no staff in this area at this time but we found it to be tidy and clean. The machines were suitable for washing heavily soiled garments and were fitted with a sluice wash. However we saw that staff still hand sluiced laundry, which presented a high risk of cross infection. The waste bin was without a cover and we recommend that it is replaced with one with a foot operating lid to reduce the risk of cross infection. Care Homes for Older People Page 22 of 37 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. People living at the home cannot be assured that they are protected by a robust recruitment processes. The level of staffing and expertise in dementia care restricts the delivery of person centred care. Peoples physical needs are not always being met. Some staff have received basic training but more needs to be done to develop and train staff to carry out their roles. Evidence: We reviewed the duty rotas, which told us how many staff were on duty at any time. They showed us that there were adequate numbers on duty at the time of inspection. However staff appeared rushed at certain times of the day, particularly at meal times, when there was a high number of people to help with eating their meals. The NVQ training in care had been ongoing and approximately twelve care staff had the level 2 award or the equivalent. We reviewed the personnel files for seven members of staff. A variety of information was held on file but we found that the recruitment processes were not robust. Two members of staff were housed in the care home before their Criminal Record Bureau checks (CRBs) had been requested. Some references on file were photocopies and addressed To whom it may concern. Where CRBs identified criminal records the Care Homes for Older People Page 23 of 37 Evidence: employment of these individuals had not been risk assessed. It was evident that staff did not have the skills to meet the needs of those people in their care. Staff told us that there had been very little training in the home since February 2009. Records showed us that not all staff had mandatory training. The home was unable to produce the induction training records for those people newly recruited to work at Montevideo House. The task focused approach to care showed us that staff generally did not have a good understanding of the needs of people with dementia or how to care for them appropriately. Care Homes for Older People Page 24 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is inadequate to the current circumstances. The responsible individual has failed to reliably monitor the operation of the home and prior to the inspection had not identified the many weaknesses identified in this report. The poor management of the home means that people who use the service cannot be assured it is run in their best interests and are not properly protected from harm. Evidence: At the time of inspection there was no registered manager in place. The management team of Althea Health Care Properties Ltd have told us that they were actively recruiting to fill this position. The provider organisation had failed to adequately monitor the performance of the home and they had not identified and rectified the weaknesses described in this report. We reviewed the regulation 26 reports in the home, which were meant to give an outline as to how the home was performing. These showed us that as early as February 2009 there were concerns about the care planning, delivery of care and the cleanliness of the home. There were no measures Care Homes for Older People Page 25 of 37 Evidence: put in place to rectify the shortfalls when they were identified. The home confirmed that they held some monies for people. There were full records of any monetary transactions which had occurred on behalf of residents. We did recommend that a second signature should be sought to ensure that a more robust audit trail was in place. The home had failed to ensure that records were kept up to date and in good order. Some care plans did not contain sufficient information; care assessments generally were of a poor standard; the training matrix was incomplete. We reviewed the supervision records for staff and saw that they had stopped in general in February 2009. This meant that staff were not aware of any shortfalls in their performance and as a result residents received a less than adequate service. During our tour of the premises we became aware of a number of health and safety issues, which could have compromised the wellbeing of the residents. A number of beds had bedrails attached which were unstable and ill fitting. There were gaps between the mattresses and rails which could cause entrapment. We saw that the kitchen door, which was adjacent to the dining room, was left open and the area was left unattended at times. This meant that resident could access the area where there was a hot water geyser and a number of chemicals which were left out. Immediate requirements were left with the home that these areas were to be made safe. Care Homes for Older People Page 26 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 37 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 38 13 All bedrooms must be checked and made safe. Where you are unable to make the room safe a risk assessment must be undertaken and suitable arrangements put in place. To maintain the health and safety of those people living in the home 04/08/2009 2 38 13 You must ensure that a suitable lock is fitted and access to the kitchen by service users is minimised. To maintain the health and safety of those people living in the home 04/08/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person shall not provide accommodation to a service user at the care home unless their needs have been assessed by a suitably qualified or suitably trained person. 28/08/2009 Care Homes for Older People Page 28 of 37 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 To ensure the home will be able to meet the persons needs when they arrive in the home. 2 4 18 The registered person must ensure that the persons employed by them to work at the care home receive training appropriate to the work they are to perform. This must include training in dementia care. This will ensure that those people living at the home who suffer with dementia will receive the appropriate care. 3 7 14 The registered person must ensure that a written plan is drawn up in sufficient detail to meet the health and welfare needs of service users. To ensure that staff have accurate and detailed information to meet each persons health needs. 4 8 12 The registered person must make proper provisison for the health and welfare of service users. To ensure that people receive adequate nutrition 27/08/2009 27/08/2009 28/10/2009 Care Homes for Older People Page 29 of 37 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 and hydration and monitoring charts are completed and used effectively. 5 9 13 (2) Arrangements must be 19/08/2009 made to ensure that all medicine stock is suitable for use. This is to ensure that out of date stock is removed so educing the risk of inappropriate use. 6 9 13 (2) Arrangements must be 19/08/2009 made to ensure that safe practices are followed when obtaining blood samples and administering injections. This is to prevent the risk of needlestick injury occuring and the risk of cross infection. 7 9 13 (2) Arrangements must be made to record when medicines administered infrequently are next to be administered. This is to ensure that people receive their medicines at the intervals prescribed to have the most benficial health effect for them 8 9 13 (2) The provider must ensure that there is a safe system in place, to have 19/08/2009 19/08/2009 Care Homes for Older People Page 30 of 37 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 medicines available to administer them in accordance with the directions of the professional prescribing them. This is so that people receive their medicines as prescribed. This is so that people receive their medicines as prescribed 9 9 13 (2) The provider must 19/08/2009 ensure that there are clear protocols and guidance available for those medicines prescribed to be administered when required. This is so that people can be assured that they will receive their medicines in a consistent manner in response to their individual symptoms. 10 12 12 The registered person must consult with service users and make provision for recreational and social opportunities based on their needs and preferences. To minimise risks of boredom and associated distress. 11 15 16 The registered person shall ensure that food is provided 28/09/2009 28/10/2009 Care Homes for Older People Page 31 of 37 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 to meet the needs of service users, at appropriate times and of a sufficiently appetising standard, to encourage residents to accept adequate nutrition. This will enhance their quality of life by enjoyment of food and promote physical wellbeing. 12 16 22 The registered person shall establish a procedure for considering complaints, which is appropriate to the needs of service users and ensure that all complaints are investigated. So that the people who use the service are listened to and action is taken accordingly. 13 18 13 The registered person must make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm of abuse. To ensure that staff are aware of safeguarding guidance and report any suspicions or actual abuse to the appropriate agencies. 24/08/2009 28/09/2009 Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This must include any reports of bruising of unknown origin. 14 19 23 The registered person shall 28/10/2009 ensure that the physical design and layout of the premises meets the needs of service users, that it is kept in a good state of repair externally and internally, that there is available the necessary moving and handling equipment. this must include the replacement of worn carpets and the provision of slide sheets. To promote and protect the comfort and safety of people living in the home 15 26 13 The registered person must ensure that all staff have undertaken training in infection control. To minimise the risk of cross infection. 16 26 16 The registered person must 24/08/2009 ensure that the home is kept clean and make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. 28/10/2009 Care Homes for Older People Page 33 of 37 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 To ensure that the risk of cross infection is minimised and the home is a more pleasant place to live. 17 29 19 The registered person shall 14/08/2009 not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. To protect vulnerable people from risks of harm and abuse 18 30 18 The registered person shall 28/10/2009 ensure that all staff have undergone induction training in line with the standard of Skills for Care. This must be done retrospectively if staff have not had induction training to this standard. This is to ensure that staff have the necessary skills and competencies to meet the needs of the resident group. 19 31 8 The registered person must appoint an individual to manage the care home where there is no registered manager in respect of the care home. 28/10/2009 Care Homes for Older People Page 34 of 37 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 To provide leadership to staff and ensure that residents have good care. 20 33 24 The registered person must establish and maintain a system for evaluating the quality of the services provided at the care home. To identify any shortfalls in the service so that action can be taken to improve. 21 36 18 All nursing and care staff must be appropriately supervised To recognise training needs and personal development of staff. 22 37 17 The registered person must maintain in the care home records specified in Schedules 3 & 4 of the Care Homes Regulations 2001. This will ensure that up to date and accurate information with regard to the care home is available. 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 28/10/2009 28/10/2009 28/10/2009 1 8 The home should provide a sufficient number of slide Page 35 of 37 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 sheets to aid the comfort of service users when moving them in bed. 2 9 It is recommended that when the application of external medicines is delegated to carers that there is a clear record of the training htese crers hve received and also fo the delgation process. It is recommended that the audits currently in use are reviewed and made more robust to prevent shortfalls in the future. It is recommended that when people have medicines prescribed to be applied to the affected part that this is reflected in the care plan. The home should consider the provision of one to one activity sessions for those people unable or unwilling to participate in group activities. Broken waste bins should be replaced with foot operated ones. Where known risks, such as the ingestion or suffocation from plastic aprons and vinyl gloves, are present they should be assessed and action taken to minimise the risk. Personal protective clothing should be accessible to staff for their use and not to residents with dementia. All staff should have access to the sluice rooms. Soiled linen should not be hand sluiced. It is recommended that nursing and care staff receive formal supervision at least six times a year. 3 9 4 9 5 12 6 7 19 26 8 9 10 26 26 36 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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