Inspection on 16/12/09 for Mount Pleasant, St Agnes

This inspection was carried out on 16th December 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mount Pleasant, St Agnes 16/10/09

Mount Pleasant, St Agnes 02/10/09

Mount Pleasant, St Agnes 01/04/09

Mount Pleasant, St Agnes 27/01/09

Mount Pleasant, St Agnes 14/10/08

Mount Pleasant, St Agnes 19/05/08

Mount Pleasant, St Agnes 21/01/08

Mount Pleasant, St Agnes 03/08/07

Mount Pleasant, St Agnes 03/05/06

Mount Pleasant, St Agnes 16/02/06

Mount Pleasant, St Agnes 23/06/05

Mount Pleasant, St Agnes 11/02/05

Mount Pleasant, St Agnes 07/09/04

Mount Pleasant, St Agnes 29/06/04

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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: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD     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: Ian Wright     Date: 1 6 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 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 36 Information about the care home Name of care home: Address: Mount Pleasant, St Agnes Rosemundy St Agnes Cornwall TR5 0UD 01872553165 01872553776 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Susan Ann Sear,Mr Godfrey William Sear care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To accommodate one named service user under the age of 65 years (62 years) Date of last inspection Brief description of the care home Mount Pleasant is located near the centre of St. Agnes. The registered providers are Mr G Sear and Mrs S Sear. Mount Pleasant provides accommodation and personal care for up to 22 older persons. The accommodation is on one level; there is full access around the home for people who use the service. There are 20 rooms of which 18 are for single occupation and two shared rooms. The majority of bedrooms have an ensuite toilet and washbasin facilities. Communal areas and rooms are decorated and furnished to a satisfactory standard. The kitchen area is clean and organised. The house is set in well laid out gardens, with pleasant views of the town and countryside. There is satisfactory parking for visitors. The home is close to local amenities with access to transport links into the main city of Truro. The range of fees at the time of the inspection was £308-£470 per week. A copy of this and previous inspection reports is available from the Care Quality Commission via our customer services team or Care Homes for Older People Page 4 of 36 Over 65 22 0 1 6 1 0 2 0 0 9 Brief description of the care home website. Alternatively the registered provider should be able to provide a copy. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place in eight hours in one day. All the key standards were inspected. The methodology used for this inspection was: (1)To case track four people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussion with staff about their experiences working in the home. (3) Discussion with other people using the service, and their representatives. (4) Observing care practices. (5) Discussing care practices with management. (6) Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgement made in the report.) Care Homes for Older People Page 6 of 36 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 36 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 8 of 36 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. Information provided to people who use the service (e.g. regarding services offered) is to a satisfactory standard. For example all people who use the service receive a statement of terms and conditions of residency or contract when they move to the home. This ensures people are aware of their rights and responsibilities. Pre assessment procedures are satisfactory. This helps to evidence that pre admission procedures are satisfactory, and should assist the registered provider to be clear that they can meet the persons needs before admission is arranged. Evidence: The registered provider has a satisfactory statement of purpose and service user guide (home brochure). A copy of the service user guide is given to the person / family when admission is arranged. We would advise a copy is also kept in the foyer of the home. We inspected files for four people. One of these people has moved to the home since Care Homes for Older People Page 9 of 36 Evidence: the last key inspection. In regard to the person recently admitted, an assessment had been completed by the registered persons before admission was arranged, this was documented and the assessment was contained in the persons file. We were able to inspect contracts for people admitted to the service. These seem to be to a satisfactory standard, and a copy is provided to the person using the service and / or their representative. Care Homes for Older People Page 10 of 36 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. Generally people appear happy with their support and care, although improvement is required to care planning, notifying the commission regarding certain events and incidents, and some aspects of medication procedures. Improvement in these areas will give people living in the home, and their representatives, more assurance their personal care needs are being met. Evidence: Not all people who we case tracked had a care plan. For example one of the four people was admitted in October 2009, but there was no care plan on the persons file. Another person, who was not in the case tracking group, also did not have a care plan. This person was admitted in November 2009. We were concerned about the latter person subsequently had a serious fall. This may have been avoided if there was a clear care plan, and a mobility assessment in place. The staff team were regularly reviewing care plans on a monthly basis. The reviews were generally documented thoroughly however these have ceased to occur, for the people we case tracked, from the summer. It is essential that care plans are regularly Care Homes for Older People Page 11 of 36 Evidence: reviewed, updated and /or rewritten as peoples needs change. We also looked at records of health care support. Records of GP support is generally satisfactory, although in respect of some people using the service, we could only ascertain GP support from daily care records. Records of support received from district nurses, community psychiatric nurses (where appropriate), dentists, opticians and chiropodists were harder to track. Staff told us that people get domiciliary support from opticians and chiropodists (where wanted and required). However, the sections at the front of the care plans regarding the name and phone number of the professionals involved was left blank in many cases. Records of these interventions were limited or non existent.It needs to be clear in care plans when this support is required and who is providing it. It needs to be possible to ascertain at a glance when people last saw the relevant health care professional. Should the person not require this support, or not wish for it, this needs to be clearly recorded in the care plan. This information will ensure staff clearly know the people concerned are getting this support regularly as required. We inspected daily records for people living in the home. We are concerned about the completion of these. Staff are making a record that care is given on individual note pads. This information is then given to senior staff who transfer the information to care records. The registered provider said this was done to minimise error. However we think it is important that the person providing the care writes their own records so the lines of accountability are clear. We were given assurances at the last key inspection on 1st April 2009 that care planning would improve at the home. It is clear to us this has not happened. If there is not sufficient improvement, within the timescales set, the commission may take enforcement action. We have raised concerns with the registered provider that we have not been notified either verbally or in writing regarding some events, which they are required to inform us about by law. This includes deaths, and an accident which occurred in the home and resulted in the person having to attend accident and emergency at the hospital. Full details of events and incidents which we require verbal and/or written notification are outlined in the Care Homes Regulations 2001 under regulation 37. It is essential that the registered provider re-reads the regulation, and ensures we are notified appropriately. We inspected the registered providers medication policy. This needs some amendment. For example there needs to be information regarding what arrangements Care Homes for Older People Page 12 of 36 Evidence: are in place for the storage of insulin, and any medication which is self administered. Subsequently the registered provider needs to provide suitable locked storage for this in peoples bedrooms. If medication, which is self administered, is kept on the person of the individual resident a risk assessment should be completed, and the action recorded in the persons care plan. We inspected the homes medication system. Storage of general prescribed medication is satisfactory. The registered provider said a new purpose built storage system is on order and should be delivered in the next few weeks. Medication records are appropriately maintained. However, it is important totals for new medication stock are recorded on medication sheets. Storage and recording of general and controlled drugs is satisfactory. Staff, who administer medication, appear to have received formal training regarding medication procedures. We spoke to several people who use the service who were complimentary about the care they received. People said they felt their privacy and dignity was respected by staff. People said they were always referred to by their preferred name. Care Homes for Older People Page 13 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines and arrangements regarding food meet the needs of the people living in the home. However there should be further development of the provision of activities available to people living at the home. Evidence: People using the service, who the inspectors spoke to, said they could get up and go to bed when they wished. Routines in the home appear relaxed. There was a nice friendly atmosphere in the home on the day of the inspection. The home had been decorated very pleasantly decorated for Christmas. People living in the home are allowed to have their pets with them. For example at least one person has a dog. People living in the home are also allowed to smoke in their rooms, where it is safe for them to do so. There are not many structured activities available in the home although a person does visit the home to provide keep fit sessions. The registered provider has said it is difficult to motivate people to participate in other activities. Concerns were expressed to us by health care staff regarding the provision of Care Homes for Older People Page 14 of 36 Evidence: activities in the home. As a consequence we looked at this matter during a random inspection on 16th October 2009. We said the registered provider needs to develop activities available for people living in the home. This may not involve structured sessions, but may entail one to one work with individuals living in the home. The week of the inspection, the registered provider has employed an additional member of staff and part of this persons role will be to spend at least two hours a day completing activities with people living in the home. These may include group work, but also one to one activities with people such as letter writing, walks around the garden etc. The person concerned is working with people using the service and the staff group to ascertain different ideas to improve the activities available. This is a really good new initiative. People are very positive about the food provided. There is always two options of main meal at lunch time, and people living in the home were very complementary about the standard of food. There is also a choice of evening tea, and people appear to have hot and cold drinks / snacks available to them. Tea and coffee making facilities, and fresh fruit were available in the small lounge. Concerns were expressed to us by health care staff regarding the provision of specialist foods for people with diabetes. We looked at this matter at a random inspection on 16th October 2009. At that time we found that since the health care staff had raised their concerns with the registered provider, improvement regarding the provision of appropriate food stuffs had occurred. We stated every effort should be made to provide people with an informed choice of menu options. If people do not adhere to staff advice this needs to be discussed with relevant external professionals, and documented for example in a risk assessment. We found also that care planning regarding this matter needed to be improved. A copy of this random inspection report dated 16/10/2009 is available from our customer services department. We found improvement regarding the provision of foods for people with diabetes. For example a diabetic option is always provided at meal times and clear records are being kept. The health care trust has worked with the registered provider to ensure that additional external training will be provided for some staff early in the new year. Care Homes for Older People Page 15 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider has a satisfactory complaints policy, although some minor amendments need to be made. The adult safeguarding procedure is satisfactory, but we still need to be more assured that the registered providers will take more proactive action, in future to resolve difficulties and concerns without external intervention to tell them to do so. Improvement in this area will give people who use the service, their representatives and the statutory authorities more assurance that people are safeguarded at this service. Evidence: The registered provider has a complaints policy. This is generally satisfactory; although it now needs updating to give details of how to contact the Care Quality Commission. We also suggest the complaints procedure issued to people who use the service (e.g. as part of the service user guide) contains details of relevant social service department complaints procedures. If people receive funding via the local authority (or health authority) they have a statutory right to use these procedures. We received a concern from external professionals regarding the following: * Lack of heating * Poor supply of hot water * Concerns about the provision of food for people with diabetes. * Lack of activities provided * The operation of a dog grooming business in the grounds of the home. We have published a random inspection report,dated 16th October 2009, outlining our Care Homes for Older People Page 16 of 36 Evidence: findings. Health care professionals put in a safeguarding referral regarding these matters via Cornwall Councils Adult Safeguarding procedure. This process is not completed, and there is a further meeting in the new year (2010) regarding these matters. However, the commission is satisfied, from the evidence gathered at this inspection that satisfactory progress is being made regarding the issues of concern. The commission, and other statutory authorities do need to be assured that the registered providers take a suitable proactive approach to minimising difficulties and problems when they occur. For example previous inspection reports have detailed concerns about heating and water supply. Although the matters have been resolved, sustainable solutions have not been implemented and repeated concerns have been raised to us, and to other authorities over the previous few years. It is essential that when the registered providers are presented with an issue they take appropriate action without the statutory authorities having to intervene. Such failure to resolve issues does raise concerns for us about the fitness of the registered providers, and we need to be more assured that concerns about their actions / perceived inactions are resolved. The adult safeguarding policy has been amended and this is now satisfactory.We assessed training records for twelve staff. Eight of these staff have attended adult safeguarding training. The registered provider needs to continue to ensure staff attend this training, as it becomes available. All staff files assessed contained a Protection of Vulnerable Adults /Independent Safeguarding Authority First check (to ascertain people employed are not on a list of people unsuitable to work with vulnerable people). Staff also have a full Criminal Records Bureau check (to ascertain staff do not have any criminal convictions etc. which would deem them unsuitable to work with vulnerable people). Care Homes for Older People Page 17 of 36 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. Mount Pleasant is generally a comfortable and homely environment. However there are significant, and ongoing concerns about hot water and heating provision. We are also concerned about peoples ability to access call bells in their bedrooms. These matters cause us concern that the home may not be a suitable for the elderly and vulnerable, unless assurances are given that the matters are rectified. Evidence: The building was inspected. There is suitable shared space, for example, a large lounge and dining room. There is also a small quiet area with seating, and this area also includes fresh fruit, and tea/ coffee making facilities which people using the service can access. Communal lounges are generally pleasant and homely. Toilet and bathroom facilities are suitable in size and facilities provided. Bedrooms are decorated and furnished according to individual tastes. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. We were told by the owner that people using the service can be provided with a key to their bedroom if they wish. We were told people are asked if they want to be able to lock their bedrooms when they move in. The building is generally maintained to a satisfactory standard, although there is room for some cosmetic improvement, in some areas of the home. For example some of the Care Homes for Older People Page 18 of 36 Evidence: carpets are beginning to look in need of replacement, and some of the paint worksuch as in the lounge is scuffed and needs attention. We have again had concerns raised about the inadequate supply of hot water, as outlined above, but this problem now seems rectified. If there are further concerns regarding this matter we may need to take enforcement action. The home currently has storage heaters in each bedroom, and in the communal areas. There are no storage heaters in some of the bathrooms and toilets. The system is now very dated, and it is difficult to regulate the temperature of the home. This is made more difficult as the registered providers have removed the dials which would enable people using the service and staff to regulate the heaters. The registered provider has told us that they have done this as people using the service will move the dials, making the rooms cold because of lack of knowledge / capacity to use the heaters. We issued a statutory requirement at the last inspection for the registered providers to replace the dials but this has not been carried out. There have been concerns raised regarding a satisfactory temperature being maintained in the home. For example the home was thought of as cold when an external professional visited on 21st September 2009, and when we visited to carry out a random inspection on 2nd October 2009. When we completed the inspection on 2nd October 2009, we issued an immediate requirement for an appropriate ambient temperature to be maintained in the home. We visited to check compliance with this requirement on 16th October 2009 and found satisfactory action had been taken. The Care Quality Commission thought it was necessary to inform Cornwall Councils Public Health and Protection department of our concerns. An Environmental Health Officer visited the home in December 2009. The officer found the temperature of the home, although adequate, was below the 21 degrees Celsius the registered provider said they were trying to maintain (i.e. actual readings taken by the Environmental Health Officer were between 19 degrees and 20.9 degrees Celsius in the five areas where the temperature was measured.) The registered provider was informed that although they could not be prosecuted under the Health and Safety at Work Act 1974, which the department is empowered to regulate, storage type heating is not an effective form of heating for this type of establishment. At this inspection we took temperatures in several areas of the home. On the morning of the inspection, the temperature varied from 0 degrees Centigrade to 3 degrees Celsius outside the home. In the rooms we measured, the temperatures ranged from 19.4 degrees to 20.1 degrees. Although the home, in general felt warm, these Care Homes for Older People Page 19 of 36 Evidence: readings are below what the registered provider states the home should be according to the temperature they are trying to maintain. A safeguarding meeting was held on 10th December 2009 regarding this, and other issues. (See for example the Complaints and Protection section of this report). At that meeting CQC, health, social services and the police informed the registered provider of their concerns about the issues raised regarding hot water and heating. The professional group informed the registered provider that the current system for heating the home and the water should be replaced. The police said the registered provider could be prosecuted if people were to die as a result of the lack of satisfactory heating. The registered provider has said to us, and to professionals at a safeguarding meeting, that they are looking into costings to replace the system. A further meeting will be held in the new year (2010) regarding this matter to look at what action has occurred. The Care Quality Commission has said suitable temperatures must be maintained in the home, and has issued a strong recommendation that the current system for heating the home and the water is replaced. If the registered providers fail to provide satisfactory heating and hot water to the people who live in the home, on an ongoing basis, this could result in the Care Quality Commission taking enforcement action. Thermostatic valves have been fitted to all hot water taps. The registered provider said a fault in the design of this system was the cause of the recent problems regarding inadequate flow and temperature of hot water. They have said this problem has been rectified. We advise the registered provider to check water temperatures, at regular intervals e.g. weekly/ monthly and record the temperature to ensure the valves are working correctly. We did raise a concern that a bath was run for a person using the service, but there was no means for the staff to check the water temperature. There was also no recording system in place. Again, it should not be assumed that as thermostatic valves are fitted, these are fool proof, and it is essential to check hot water temperatures before people bathe. The Health and Safety Executive have published guidance regarding this matter which can be viewed or downloaded from their website at: www.hse.gov.uk/lau/lacs/79-5.htm It is therefore essential that appropriate monitoring of water temperatures take place particularly in regard to when people bathe. Care Homes for Older People Page 20 of 36 Evidence: We have also raised concerns in previous reports regarding hot surfaces in regard to storage heaters. When these are on fully there is a danger of scalding for example if a person was to fall against one of the heaters. The registered provider assured us, when we completed the inspection on 2nd October 2009, that covers were on order. However these have still not been fitted. Even if the heating is replaced radiators must be covered. Again the Health and Safety Executive have published guidance regarding this matter which can be viewed or downloaded from their website at: www.hse.gov.uk/lau/lacs/79-4.htm We noted that the length of some of the leads for call bells was insufficient in some of the bedrooms. This could result in people using the service not being able to summon help if the call bell was not near enough to where they are sitting or their bed. In some bedrooms we noted there was no cord. This must be reviewed as a matter of priority to ensure that all people have access to a call bell. The building was generally clean and hygienic on the day of the inspection although we noted some extractor fans needed to be cleaned. A cleaner is employed at the home. Laundry facilities appear adequate, although floor covering needs replacing as it is not an impervious surface. The registered provider said they had tried to paint the floor with specialist paint but this was not successful. Soap and paper towels need to be provided for the wash hand basin in the laundry. We noted that some cleaning materials had been decanted into containers which were not properly labeled. This is against COSHH health and safety guidelines (Control of Substances Hazardous to Health Regulations 1988), and the matter needs to be addressed. Care Homes for Older People Page 21 of 36 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. Staffing levels appear satisfactory to meet the needs of people currently accommodated at the home. However we recommend additional staff members are employed to decrease the pressure of providing cover at the home by the current staff group. Staff were viewed positively by the people we spoke to. Recruitment and training records are only adequate, and we have issued statutory requirements for improvement in these areas. Good recruitment and training standards help to ensure people who use the service receive good quality care from people who are deemed fit, skilled and knowledgeable to work with vulnerable people. Evidence: On the day of the inspection there were three care staff on duty from 07:00 until 1400. Two staff on duty from 1400 until 21:00. A cleaner and cook are employed and were on duty on the day of the inspection. An administrator has been employed and works during the day. One waking night member of staff is on duty from 21:00 to 07:00. The registered providers live in the neighbouring bungalow. The record of staff hours (recorded in the house diary) appears to show there is satisfactory staffing levels provided for the people currently accommodated. We received concerns regarding staffing levels on some days at the home. This has resulted in staff having to work additional hours-sometimes completing a double shift from 7am to the evening. This may suit some staff but not others. The registered Care Homes for Older People Page 22 of 36 Evidence: providers of the home need to be vigilant that the Working Time Directive guidelines are being adhered to, and also that staff are not becoming too tired which could have an impact on the quality of care delivered. We discussed this matter with the registered provider. The registered provider said she had tried to recruit staff but it had proved difficult to find people of a satisfactory calibre. We raised concerns that we were aware one member of staff was due to leave shortly, and this would make the staffing problems more acute. Staff expressed concerns to us that they did not know how the Christmas and New Year period would be covered as the person who was leaving was originally due to work shifts over this period. We advised the registered provider that agency staff may need to be used rather than increasing the burden on the remaining staff members. We requested a copy of the rota for the Christmas and New Year period, and this was sent to us after the inspection was completed. This showed satisfactory staffing was to be provided for the period. We spoke to people using the service and they were all positive about the support they received from staff members. Staff are viewed as kind and caring, and people said staff do what they can to meet their needs. Personnel records were inspected for twelve staff (i.e. staff on duty during the 24 hour period on the day of the inspection plus some additional members of staff including people recruited since the last inspection). There are some gaps in records of information which is required in personnel records, as required by the regulations. For example: * One person did not have an application form, and there was therefore no record of their employment history. * Two written references are required to be obtained. One member of staff recruited since the last inspection only had one reference, and a second person did not have any. However the registered provider said references had been obtained for the latter person, but these have not presented to us. *Three members of staff did not have evidence they were medically fit (i.e. a self declaration of fitness). * Several people did not have evidence to verify their identity. However this information would have been obtained when a Criminal Records Bureau check was applied for. All people did however have a Criminal Records Bureau check (CRB) and a Protection of Vulnerable Adults First check (POVA First) / Independent Safeguarding Authority First check (ISA First). Apart from the omissions outlined above other records were satisfactory. We looked at whether staff had a National Vocational Qualification in care. According Care Homes for Older People Page 23 of 36 Evidence: to the records assessed, four people had a copy of an NVQ certificate in care on file. The registered provider has said people can obtain an NVQ 2 in care when they come to work at the home. We checked records of training staff have received. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level) (3) All staff must have manual handling training and regular updates of this (e.g. annually) (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. In regard to the records assessed: (1) Staff had a record of fire training. (2) Most of the staff had a valid first aid certificate. On the day of the inspection there was satisfactory first aid cover during the day, and at night. (3) Most staff had received manual handling training in either 2008 or 2009. However some staff did not have a certificate to verify this including the person who was on a waking night duty. (4) Most staff had a record of receiving infection control training, although certificates to verify this were not available on some files. (5) Nine staff had a record of food hygiene training, although not all files had a certificate to verify this. Both cooks require to have a new certificate as there was not evidence presented to us that they had attended a food hygiene course in the last three years. Other staff need to receive this training as necessary (i.e. if they handle food).(6) Staff who have commenced employment since the last inspection have a record of formal induction since they commenced employment. (7) There is satisfactory evidence that the majority of staff have attended training regarding the Mental Capacity Act 2005 / Deprivation of Liberty safeguards, and also Adult Safeguarding training (regarding the prevention of abuse). Care Homes for Older People Page 24 of 36 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. We continue to have some reservations about the management of the home. We need further evidence over time that the registered providers are proactive in bringing about, and sustaining improvement of the service. For example improvement of the homes quality assurance procedures is required. Improvement is also required to procedures to manage peoples valuables and finances. Health and safety standards are generally satisfactory although some improvement is required to health and safety training and procedures to minimise the risk of legionnaires disease. Improvement of these standards and other areas in the report will give more assurance that the home is managed to a satisfactory standard. Evidence: The registered providers have owned and managed the home for nearly 20 years. Mrs Sear said she has attended a City and Guilds Advanced Management course, and an accountancy training course. Mr Sear is from an electrical engineering background. A Care Officer is employed five days a week to supervise care staff. An additional senior has been employed in the last week. The focus of the latter persons job will be to Care Homes for Older People Page 25 of 36 Evidence: improve administrative procedures and day activities at the home. Although there has been an overall improvement in the operation of the service in the last two years, we remain concerned whether this improvement will be sustained. For example we were concerned that action was required by CQC and other agencies regarding heating and hot water issues as outlined earlier in the report. It is not clear to us that appropriate and timely action would have taken place without external input. There are some requirements in this report for example regarding care planning, and recruitment and training issues which we have had to raise repeatedly in order for the registered provider to maintain minimum standards. It is essential that the registered providers take appropriate action-for example regarding their quality assurance procedures- to improve and maintain standards in these and other areas if the current rating of the home is to be maintained and improved. We inspected the registered providers Quality Management Policy. This requires amendment. For example it needs to clearly state what the processes are at the home. A survey of the views of people living in the service was completed by the registered provider in 2008. This needs to be recompleted, and /or other measures put in place to ascertain peoples views of the service and how the registered persons intend to monitor and improve service quality. We have requested an Annual Quality Assurance Assessment (AQAA) to be completed and returned by the provider by 5/1/2010. This is a self assessment, completed by the owners of the home which outlines to us how the service is run and any plans there are for its development. It also provides us with a data set confirming policies in place, health and safety checks completed and information about people living and working in the home. We assessed arrangements regarding the management of the finances of people who use the service. There was evidence that receipts are provided for any expenditure carried out on behalf of individuals. Money is also kept locked in the homes safe and access is restricted to senior staff. If senior staff are not available, people using the service are able to have their money via the petty cash float and this is later reimbursed. However we raised concerns that records kept for the management of individual monies had not been updated for a significant period of time, and it is essential these are maintained appropriately. We were told no valuables are kept on behalf of people who use the service. The registered provider has a health and safety policy. There is also a fire risk assessment. Testing of fire extinguishers and the fire system appears to have been Care Homes for Older People Page 26 of 36 Evidence: completed appropriately by external contractors. In regard to fire precautions emergency call points are tested weekly. Suitable checks have been completed on fire doors and fire drills have been completed appropriately. Emergency fire lighting is regularly completed. Records of fire training of staff is satisfactory. An external health and safety audit has been completed, and the results were satisfactory. The environmental health officer has visited regarding food hygiene standards (March 2009), and health and safety standards (November 2008). The results of the reports are satisfactory. The health and safety officer has recently visited the home again regarding the heating. Information regarding this is outlined in the Environment section of the report. Portable electrical appliances were last tested in December 2009, and the electrical hardwire circuit was been tested in January 2009. This is deemed satisfactory by the contractor. There appears to be suitable precautions regarding the prevention of legionella, although a risk assessment regarding this matter needs to be written. Moving and handling equipment has been tested and is satisfactory. Some improvement is required to training relating to health and safety issues as outlined in the staffing section of the report. Care Homes for Older People Page 27 of 36 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 Care plans must contain 01/02/2009 suitable detail to inform and direct staff to provide care to people using the service. Care plans need to be reviewed at least monthly. Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 2 25 12 Fit radiator covers to storage 01/07/2009 heaters This will help to ensure the risk of scalding is minimised 3 25 23 People using the service 01/11/2009 must be able to have control over the temperature in their bedrooms (e.g. to switch heaters on/off and regulate the temperature.) This will help to ensure people using the service have satisfactory heating and ventilation in all parts of the care home used by them 4 33 24 Further develop the quality 01/02/2009 assurance system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, Page 28 of 36 Care Homes for Older People 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 health and safety etc. Measures taken should be included in the quality assurance policy. This will help improve service quality and help minimise risks to staff and people who use the service Care Homes for Older People Page 29 of 36 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 Care plans must contain suitable detail to inform and direct staff to provide care to people using the service. Care plans need to be reviewed at least monthly. (Previous timescale of 01/11/2009 not met. Fourth Notification.) Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 01/03/2010 2 9 13 The registered provider must ensure there is a suitable system in place to manage the storage, recording, administration and disposal of medication. The medication policy needs some amendment as outlined in the text of the report. 01/03/2010 Care Homes for Older People Page 30 of 36 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 will help to ensure medication is managed safely 3 10 37 Any incidents and matters outlined in regulation 37 of the Care Homes Regulations 2001 must be reported to the commission without delay. This will ensure the commission is notified of all matters required under this regulation, and should help to give assurance that, where necessary, appropriate safeguards are put in place. 4 18 12 The registered providers 01/02/2010 must take appropriate action to resolve the concerns as part of the current safeguarding investigation. The registered providers need to ensure they take more proactive action in future to resolve concerns before it it being necessary for the statutory authorities to intervene. This will help to ensure that people who use the service receive suitable support from the registered persons 01/02/2010 Care Homes for Older People Page 31 of 36 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 about any concerns they or their representatives have. 5 22 23 All people using the service 01/02/2010 must have ready access to a call bell when they are in their bedrooms This will ensure people can summon help when it is required. 6 25 23 People using the service 01/03/2010 must be able to have control over the temperature in their bedrooms (e.g. to switch heaters on/off and regulate the temperature.) (Previous timescale of 01/11/2009 not met. Second Notification) This will help to ensure people using the service that they have satisfactory heating in all parts of the care home used by them. 7 25 12 Fit radiator covers to storage 01/03/2010 heaters / radiators. (Previous timescale of 01/07/2009 not met Second Notification) This will help to ensure the risk of scalding is minimised Care Homes for Older People Page 32 of 36 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 25 13 Ensure records are kept regarding the testing of hot water temperatures (e.g. when people are bathing). This will help to ensure the risk of scalding is minimised and suitable checks are completed to ensure thermostatic valves are working correctly. 01/02/2010 9 26 12 Storage of cleaning materials must comply with COSHH guidelines (e.g. stored appropriately and in clearly labelled containers). This will help ensure the risk of accidents regarding to hazardous materials is minimised. 01/02/2010 10 29 19 The registered provider must ensure satisfactory recruitment checks are performed regarding any member of staff employed to work in the home. For example all staff must have an employment record, two written references, written documentation to verify their identity and a self declaration regarding medical fitness. These measures will help to ensure that staff employed 01/02/2010 Care Homes for Older People Page 33 of 36 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 work in the home are deemed as suitable to work with vulnerable people. 11 30 18 Staff must receive training 31/03/2010 which is required by law. For example staff must receive training as outlined in the body of the report (i.e. fire training, food hygiene, first aid, manual handling and infection control). This will help to ensure people who use the service are supported by suitably trained and skilled staff 12 33 24 Develop a quality assurance 01/03/2010 system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, health and safety etc. Measures taken should be included in the quality assurance policy. (Previous timescale of 01/08/09 not met 4th Notification) This will help improve service quality and help minimise risks to staff and people who use the service 13 35 17 Improve arrangements regarding the management of valuables and monies 01/03/2010 Care Homes for Older People Page 34 of 36 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 belonging to people who use the service. For example accurate and up to date records must be maintained for individual monies. This will help ensure monies and valuables belonging to people using the service are looked after appropriately. 14 38 12 The registered provider must ensure a risk assessment is written regarding measures in place to minimise the risk of legionnaires disease This will help ensure the risk of legionnaires disease is minimised to the people living in the home. 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 01/03/2010 1 2 12 16 Expand day activities available to people who use the service. Details of local authority complaints procedures should be included in the homes complaints procedure / individual service user guides. Replace the storage heaters in the home with a central heating system to ensure there is suitable heating and hot water at all times for people using the service. Employ more care staff to minimise the burden on the existing staff members to cover shifts at the home. Page 35 of 36 3 25 4 27 Care Homes for Older People 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. 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