Inspection on 03/11/09 for Morecambe Bay Care Home

This inspection was carried out on 3rd November 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Morecambe Bay Care Home 22/03/10

Morecambe Bay Care Home 06/01/10

Morecambe Bay Care Home 12/11/08

Morecambe Bay Care Home 27/05/08

Morecambe Bay Care Home 29/11/07

Morecambe Bay Care Home 07/11/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Morecambe Bay Care Home Gleneagles Drive Off St Andrews Grove Morecambe Lancashire LA4 5BN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Cordingley     Date: 0 3 1 1 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 33 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 33 Information about the care home Name of care home: Address: Morecambe Bay Care Home Gleneagles Drive Off St Andrews Grove Morecambe Lancashire LA4 5BN 01524400255 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: morcambe.bay@sshc.co.uk Four Seasons (No 7) Limited care home 87 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care Home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. Physical disability Code PD. The maximum number of service users who can be accommodated is: 87. Date of last inspection Brief description of the care home Morecambe Bay Care Home is owned and managed by Four Seasons, a company that operates a number of care services at various locations throughout the United Kingdom. Morecambe Bay Care Home is a Care Home with Nursing; it consists of 4 self-contained units. Torrisholme House and Bare House each offer care for 20 older people with Dementia. All bedrooms are single and located around a landscaped courtyard. Grange House offers 30 ensuite bedrooms to older people who require nursing care. Cartmel House is registered to care for up to 17 adults with a physical Care Homes for Older People Page 4 of 33 Over 65 0 87 0 87 0 87 1 2 1 1 2 0 0 8 Brief description of the care home disability. Each of the 4 units are staffed separately, with a qualified nurse in charge of each unit. There is an acting manager in post at the home. Morecambe Bay Care Home is situated relatively close to the Promenade in Morecambe. Each of the units/houses within the centre have their own lounge and dining room and other facilities, for example, bathrooms and toilets. Each unit is on the ground floor offering easy access to all the facilities. Only the central part of the home has a first floor where the Managers office is located and the administration office for the home. The staff room is also located on the first floor. 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 inspection of this home included a site visit which was carried out on an unannounced basis. This meant that the manager and staff did not know the visit was to take place until we arrived. During the visit we spent time with residents, talking to them and observing their daily routines. We also held discussions with staff at the home and the acting manager. We carried out a tour of the home looking at communal areas and a selection of residents private accommodation. We also viewed a variety of paperwork including residents care plans and staff personnel files. Prior to our visit we wrote to the manager and asked her to complete a very comprehensive self assessment. This gave us a lot of information about how the home is managed. In addition, we wrote to a selection of residents and staff and asked them Care Homes for Older People Page 6 of 33 to take part in a written survey about their opinions of the service provided. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Assessment processes have been reviewed to try and ensure that people benefit from a more individualised assessment and admission. To help these improvements, a new system has been implemented whereby a keyworker is allocated to a prospective resident and is involved in the assessment and admission of the person. This means that new residents and their relatives have a link person that they can discuss any concerns with throughout the process. Care Homes for Older People Page 8 of 33 There have been some improvements to the arrangements for activities within the home. The home have now employed an activities coordinator who has worked with residents to develop a programme that is in line with their needs and wishes. We spoke with the activities coordinator and found that she had also worked hard to ensure that individual activities are provided to people on a one to one basis. Further improvements have been made to peoples accommodation and several areas have been updated since the last inspection. The refurbishment plan will continue until the whole home has been improved. Since the last inspection there has been an increase in the numbers of staff who hold National Vocational Qualifications at level 2 or above. Over half the carers employed at the home now hold these qualifications which means the home have achieved the national standard in this area. What they could do better: Whilst we found some examples of very good care plans we were concerned to find one residents care plan failed to address some very important areas of need. We were advised that this persons care plan had not been completed which was of concern because the resident had been admitted to the home almost one month previous. We also found examples of necessary actions in care plans not being carried out. For example, one residents care plan stated that she needed to be weighed on a weekly basis but records showed that this had not happened for several weeks. We had some concerns about the way residents medicines were being managed at the home. We found some examples of inaccurate record keeping and stock not adding up with records. We also found some examples of residents not being given their prescribed medication because the home had ran out of stock. We were concerned to note that one resident had stored and administered some medicines himself without a risk assessment being carried out to determine he could do do safely. During our visit we became aware of an incident that had occurred during which a resident had been injured. We were concerned to note that the home had failed to follow their safeguarding procedures and had not reported the incident through the appropriate channels. We were unable to confirm that a risk assessment had been carried out following this incident to reduce the risk of it happening again. Throughout our inspection we spoke with a number of people who expressed concerns about staffing levels at the home. All the staff we spoke with told us that they were struggling to cope following recent reductions in the number of staff on duty throughout the day and night. In general, people consulted did not feel that the reduced staffing levels reflected the needs of people living at the home. Discussion with staff and records confirmed that formal one to one supervision is not taking place on a regular basis. We looked at files of staff members which in our opinion, were in need of additional supervision for various reasons, and found some examples where no supervision had been provided at all. A number of requirements and recommendations have been made in this report in relation to the above matters. Care Homes for Older People Page 9 of 33 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 10 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 11 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. Assessments are carried out for each person before they move into the home which means their care can be planned effectively. More attention to the social aspects of peoples lives during assessment would help ensure that their care is provided in line with their individual preferences. Evidence: A Service User Guide is available for anyone wanting to know more about the home. This is a useful document that provides information about the services and facilities available and fees charged. The guide also gives a picture of daily life at the home by describing arrangements for areas such as mealtimes and activities. In discussion we were advised that the guide is available in a variety of different formats such as large print and audio, to help ensure that everyone has access to the information within it. Care Homes for Older People Page 12 of 33 Evidence: Unless a person has to move into the home very quickly because of an emergency situation, an assessment of their needs is carried out before their admission. This means that the manager can be sure that a persons needs can be met at the home and that the home is the right one for them. It also means that staff have a good understanding of the persons care needs and can provide the right level of care straight away. We viewed a number of residents pre admission assessments and found that in general, they were well detailed in terms of medical and personal care needs. However, some assessments could have contained more detail about the social aspects of peoples lives such as relationships, hobbies and preferred daily routines. These are important areas that need to be explored so that peoples care can be planned in a person centred way. Person centred planning means recognising and valuing peoples individuality and providing their care accordingly. We did note however, that the manager had introduced measures to improve assessment processes so as to make them more individualised. Such measures included a new assessment format which prompted the assessor to gain more person centred information. We were also advised that a new system had been introduced whereby a keyworker would be appointed to a prospective resident throughout their assessment and admission process to try and help ensure it is more personalised. Care Homes for Older People Page 13 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. Peoples health and wellbeing is at risk if medication procedures are not consistently followed. Evidence: As part of our case tracking exercise we viewed a number of residents care plans. We found that care plans were generally very comprehensive in terms of peoples physical and health care needs. Some examples were particularly good and provided a good deal of information about peoples preferences in relation to their daily routines and how they would like their care to be provided. We noted that efforts had been made to make care plans more person centred and in most cases, particularly on the units for people with dementia, their care plans addressed areas such as social activities, relationships and emotional wellbeing. However, when we tracked the care of one resident who had lived at the home for around a month, we found that her care plan was very brief and failed to address some very important areas. When we discussed this with the unit manager we were Care Homes for Older People Page 14 of 33 Evidence: advised that the residents care plan had not been completed. This was of concern given the length of time that the resident had lived at the home. We also found some examples where instructions and guidance in peoples care plans had not been followed. For example, one persons care plan stated the need for them to be weighed at least once weekly due to the fact that they were at high risk of becoming malnourished. However, records showed that this resident had not been weighed for several weeks. There are procedures in place to assess the risk people face in areas such as developing pressure sores or falling, for example. We looked at some examples and found that where people had been assessed as being at risk, detailed guidance was in place for staff to ensure that the correct measures were taken to keep people safe. However we were concerned to note that following a recent incident during which a resident had been injured no risk assessment had been carried out to help reduce the possibility of it happening again. As part of the inspection we examined medication records and stock. We found that whilst the home had procedures in place for the safe receipt, storage, administration and disposal of medicines, these were not always followed properly by staff. We looked at a selection of stock records and compared them with residents medicine administration records and stocks of medicines held within the home. We found a number of examples where the records did not coincide and where stocks of medicines were not in accordance with records. We found examples of errors in record keeping which in some records had been carried on by several members of staff because they had been copycat signing and not checking what they were administering carefully enough. In one example, staff had signed on two occasions that they had given tablets even though there had been none in the home at the time. We also found several examples of residents running out of medication. We were advised by a nurse on duty at the time of our visit that one resident had purchased pain relief tablets himself and was keeping them in his room and self administering them. However, there was no risk assessment in place to ensure that the resident could manage the medication safely. Some residents at the home are prescribed medication on an as and when required basis. It is important in these circumstances that staff have the necessary information Care Homes for Older People Page 15 of 33 Evidence: to ensure that people are given the medication when they need it. We viewed the records of some residents prescribed medicines on an as and when required basis and were unable to locate any written instructions or guidance in relation to this. Competence assessments are carried out for all staff members responsible for giving medication so that the manager can ensure that they are competent to do so. However, when looking at the file of one staff member who had made an error when administering some medication we could find no evidence that her competence assessment had been reviewed or that the manager had discussed the error with her in a formal manner. We have discussed our findings in relation to medication with senior managers from Four Seasons and have made a number of requirements in this report. 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 home has a varied activities programme in place but there is a danger that residents will not benefit if there are not enough staff to deliver the programme. Evidence: People we consulted told us that they felt the home have improved the activities provided for residents. One person told us There seems to be a lot more going on now, and more people get the chance to do things. Another resident told us about a fancy dress party that had taken place a few days earlier, she said she had really enjoyed this. The home has now employed a full time staff member to organise activities and ensure that residents are provided with the opportunity to spend their time doing things they enjoy. We spoke with the activities coordinator who advised us that her aim was to ensure that peoples individual needs and wishes were taken into account when planning activities. We were pleased to note that each resident has their own individual activities plan that describes the things they enjoy and the support they need. We were also advised that when people take part in new activities, an evaluation is carried out to determine Care Homes for Older People Page 17 of 33 Evidence: if it was right for them and should therefore be offered again. We noted that there were a variety of activities both inside and outside the home regularly provided for residents. Through discussion we were able to confirm that people have the opportunity to take part in activities within the home such as arts and crafts and watching visiting musicians. There are also trips out organised, the home has access to a minibus at certain times, and residents where possible, are supported to go out on a one to one basis. Other trips out include theatre visits and some residents had recently taken up swimming at a local leisure centre. The activities coordinator explained that time was regularly spent with those residents who were not well enough to take part in group pursuits and quiet one to one time doing things such as reading or hand massage was provided. Whilst we found there were good arrangements in place to provide a variety of activities for people living at the home we did receive feedback from a number of people we consulted that staffing levels were not always adequate to follow activities programmes through. One carer told us The activities co-ordinator puts things in place for carers to do when she is not here, but to be honest we dont have time to do them. Another carer commented They have some good ideas but we just dont get chance to spend time with people doing nice thing like that, I wish we did. Written menus confirmed that people are offered a varied diet and that there are a number of alternatives available at each meal time. We observed staff members discussing the options available with residents and recording their choices. We also observed the chef arranging to make a different meal for one resident who didnt want any of the choices on the daily menu. We spoke with the head chef who confirmed that she was provided with adequate resources to ensure people enjoyed a good standard of catering. She also confirmed that there were good systems in place to ensure that residents individual dietary needs and preferences were recorded and fed through to her. There are written menus available in each dining room for the residents information. However these are written in small print and not accessible to a number of people. We have recommended for some time that consideration be given as to how information about menus can be provided to people in a more accessible way. Care Homes for Older People Page 18 of 33 Evidence: Care Homes for Older People Page 19 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. There are processes in place to help safeguard people living at the home. However they must be followed consistently to help ensure peoles safety and wellbeing. Evidence: The home has a complaints procedure which is written in a clear and easy to understand manner. We were able to confirm that the procedure is available in a variety of different formats including large print and easy read to help ensure that more people have access to the information. We confirmed that there are processes in place to record all complaints along with the outcome of any investigation and subsequent action taken. We viewed the record that showed that all complaints recorded since the last inspection had been dealt with appropriately. All homes are required to have written procedures in place that must be followed if it is alleged or suspected that a resident has been the victim of any kind of abuse or neglect. These are generally referred to as safeguarding procedures. The staff members we spoke to had a good understanding of the homes safeguarding procedures and the majority were able to confirm that they had received training in this area. Care Homes for Older People Page 20 of 33 Evidence: However, during our visit we became aware of an incident that should have been reported in line with safeguarding procedures but had not been. We discussed this with the area manager and have made a requirement in relation to the matter. Care Homes for Older People Page 21 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. People who live at the home are provided with safe, comfortable accommodation. The ongoing improvement plan will help ensure all areas of the home are maintained to a good standard. Evidence: Morecambe Bay Care Home is a large home which is arranged in four separate units. All residents accommodation is provided on a single room basis and the majority of people living there have en suite facilities. All residents living accommodation and facilities are located on the ground floor. We carried out a tour of the home and found that all areas of the home were clean, warm, and comfortable. We also noted that the home was furnished and maintained to a satisfactory standard. There had been a number of improvements made since the last inspection although there were still some parts of the home that would benefit from a general update. We were advised by the area manager who was at the home on the day of our visit, that the next phase of the refurbishment plan was due to start in January 2010. It is envisaged that this will be the final phase and will see every remaining area updated. The home has clear guidance in place in relation to infection control and staff we Care Homes for Older People Page 22 of 33 Evidence: spoke with were aware of the procedures to be followed. In addition, records confirmed that all staff receive training in infection control at the start of their employment. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safety and wellbeing of people who live at the home is at risk if staffing levels are not adequate to meet their needs. Evidence: We viewed personnel files for several staff members which confirmed that the home generally follow careful recruitment procedures. Records confirmed that all potential staff members are asked to attend a formal interview and complete an application form which includes a full employment history. At least two references are obtained, one being from the most recent employer where possible. In addition, no staff member is allowed to start work until Criminal Records Bureau and POVA (protection of vulnerable adults) clearance has been obtained. We did note that some Criminal Records Bureau disclosures were several years old, one disclosure was found to be six years old. We discussed this with the area manager who advised us that there was no policy in place for re-checking staff after a certain time period. We made a recommendation that this be reviewed to further ensure the safety and wellbeing of people living at the home. The home has good processes in place for providing new staff members with induction training. As part of their induction, staff members are supported to work through a comprehensive work book which covers all the relevant areas in line with Skills for Care Homes for Older People Page 24 of 33 Evidence: Care standards. However, when we viewed records of recently appointed staff members we found that records in relation to induction and probation were not always completed properly. We spoke to a number of staff who were quite complimentary about the ongoing training provided. One staff member told us The training is definitely available for those that want to do it. Records showed that carers training includes all the mandatory health and safety areas such as moving and handling and infection control, as well as additional areas including caring for people with dementia. Over half the carers employed at the home have been supported to obtain National Vocational Qualifications in care at level 2 or above. These figures are an improvement on those provided at the last inspection and mean that the home are now meeting national standards in this area. We consulted a number of staff members during our visit and discussed staffing levels. We were consistently advised by all those we consulted that staffing levels, particularly those on the units for people with dementia were not adequate. A number of carers expressed their concerns about recent reductions in staffing levels. Comments included We are just not coping at the moment, and I dont think we are meeting even basic needs. One carer explained that there were several residents on the unit she worked on that had complex needs and required two carers to assist them with various tasks throughout the day. The carer dont feel that this had been taken into account when staffing levels had been reduced. One staff member we spoke with told us that she had raised concerns about staffing levels on a number of occasions with managers. She advised us that she had not received any feedback since. Another carer told us that some relatives were expressing concerns about staffing levels during visits to the home. In viewing the complaints book we did note that there had recently been a formal complaint made by a relative which partly referred to staffing levels. We discussed our concerns about staffing levels with the area manager and have made some requirements relating to the matter. Care Homes for Older People Page 25 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 quality of all aspects of the service provided need to be monitored effectively to help ensure that good standards are maintained. Evidence: This home has now been without a registered manager for a significant length of time. There is currently an acting manager in place but no application has been received as of yet, by the Commission. The failure to register a manager was discussed with the area manager who advised us that application would be submitted to the Commission as soon as possible. At the time of our visit the acting manager was on leave and the home was being overseen by a manager from another home operated by Four Seasons. This manager was cooperative and helpful throughout as was the area manager from Four Seasons who joined us on our inspection. The home has various quality assurance processes in place to help ensure that good Care Homes for Older People Page 26 of 33 Evidence: standards are maintained. However some of our findings during the inspection indicated that these need to be more effective. For example, we found some issues with the way staff were managing residents medication, but no evidence that these had been already identified or addressed through the homes internal audit systems. The majority of staff we spoke with told us that they were not provided with regular supervision where they could meet with their manager and discuss areas such as daily practice, training or any concerns they may have. We viewed supervision files and confirmed this to be the case. We sampled supervision files of one staff member who told us she had raised concerns, another staff member who told us she was finding the long shift patterns very difficult and another where there had been a practice issue (these are all issues that would make supervision particularly important) and were unable to find any evidence that supervsion had taken place. Information provided by the manager prior to the inspection confirmed that there are procedures in place to protect the health and safety of residents, staff and visitors to the home. Regular checks on facilities and equipment were also confirmed in this information. During our visit we were concerned to hear about an incident during which a resident had been injured. On checking the residents file we could find no evidence that a risk assessment had been carried out to help minimise the risk of the incident reocurring. It is important that when risks or hazards are identified, these are assessed and measures put in place to help keep people safe. Care Homes for Older People Page 27 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 7 15 All residents care plans must 31/01/2009 provide an holistic picture of their care needs including care needs relating to social aspects of their lives. This is so people have a greater say in the way their care is provided. 2 9 18 It must be ensured that all 31/01/2009 staff members who deal with residents medication are competent to do so. This is to help ensure that peoples medicines are managed correctly. Care Homes for Older People Page 28 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 A care plan must be in place for each resident that outlines all their care needs and how these are to be met. This is so that carers understand peoples needs and actions required. 03/12/2009 2 7 15 Where actions are deemed as being necessary in a residents care plan, for example, that a resident needs to be weighed on a weekly basis, then they must be carried out at all times. This is to help ensure that people get the care they need. 03/12/2009 3 9 13 A risk assessment must be carried out for any resident wanting to store and administer their own medication. 03/12/2009 Care Homes for Older People Page 29 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 This is to help ensure the health and wellbeing of people using the service. 4 9 13 Arrangements must be in place to ensure that people receive their medication as prescribed. This is to help ensure the health and wellbeing of people using the service. 5 9 17 An accurate record of all 03/12/2009 medication received, administered and disposed of must be maintained in the home. This is to help ensure the health and wellbeing of people using the service. 6 18 13 The homes safeguarding 03/12/2009 procedures must be followed at all times. This is to help ensure the safety and wellbeing of people using the service. 7 27 18 It must be ensured that 03/12/2009 there are adequate numbers of staff on duty at all times to meet the needs of residents. This is to help ensure the safety and wellbeing of people using the service. 03/12/2009 Care Homes for Older People Page 30 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 8 31 8 The provider must propose a 03/05/2010 suitably qualified and experienced manager for registration with the Commission. This is to help ensure that the home is managed effectively. 9 36 18 All staff working at the home 03/02/2010 must be provided with adequate supervision. This is to help ensure that staff are able carry out their roles well. 10 38 13 Unnecessary risks to the health and safety of people who live at the home must be identified and minimised. This is to help ensure the safety and wellbeing of people who live at the home. 10/11/2009 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 3 The manager should continue to develop the pre admission assessment process to make it more personalised. This will help ensure that people receive care that is in line with their individual needs and wishes. The timescales for completing new residents care plans should be reviewed to ensure that carers have access to 2 7 Care Homes for Older People Page 31 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 the appropriate information and guidance as soon as possible after a residents admission. 3 9 Clear instructions should be in place for residents prescribed medicines on an as and when required basis. This is to help ensure that people get their medication when they need it. Medication competence assessments should be kept under regular review and reflect any issues in relation to a persons competence as having been recognised and addressed. This is to help ensure that people dealing with residents medicines are competent to do so. Arrangements for re-ordering peoples medicines should be reviewed to help ensure that they dont run out of the medicines they need. Consideration should be given as to how menu information can be made more accessible to people who live at the home. This is to help ensure that people have the opportunity to make choices in their daily lives. The home should continue with the environmental improvement plan to help ensure that people are provided with a good standard of accommodation. Consideration should be given as to how the outdoor space on Cartmell Unit can be made more accessible for residents. The frequency of Criminal Records Bureau checks on existing staff members should be reviewed. This is to help ensure the safety and wellbeing of people using the service. Records should be kept for every staff member that confirm induction and regular probationary meetings have taken place. It is strongly recommended that staff working unusual shift patterns, for example 12 hour shifts, be constantly monitored through formal supervision. 4 9 5 9 6 15 7 19 8 19 9 29 10 30 11 36 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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