Inspection on 20/01/10 for Nether Place Nursing Home

This inspection was carried out on 20th January 2010.

CQC found this care home to be providing an Poor 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nether Place Nursing Home 29/06/09

Nether Place Nursing Home 22/01/08

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 13/03/2010.

Key inspection report Care homes for older people Name: Address: Nether Place Nursing Home Chestnut Hill Keswick Cumbria CA12 4LS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jenny Donnelly     Date: 2 0 0 1 2 0 1 0 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 31 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 31 Information about the care home Name of care home: Address: Nether Place Nursing Home Chestnut Hill Keswick Cumbria CA12 4LS 01768773267 01768773267 Netherplace@hometrustcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hometrust Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people 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. The maximum number of people who can be accommodated is: 32 Date of last inspection Brief description of the care home Homecare Trust Ltd purchased Nether Place in July 2007. A new manager, Mr Andrew Humphries took up post in September 2009. The home is registered to provide nursing care for up to 32 older people, although they currently only accomodate a maximum of 27, as double rooms are being let singly. Nether Place is a traditional stone building which retains many of its period features alongside a a newer extension. It is situated in a residential area on the outskirts of Keswick. Accommodation is over two floors, served by one passenger lift. There are Care Homes for Older People Page 4 of 31 Over 65 32 0 2 9 0 6 2 0 0 9 Brief description of the care home three lounges and a conservatory for shared use as well as a seating areas in the large entrance hall. There is a well-kept garden with spectacular views over the Lakeland fells. Bedrooms vary in size and shape, with the majority having ensuite facilities. There are assisted bathing facilities and an on site laundry and kitchen. There is an informative enquiry pack available from the home for anyone interested. The weekly fees at the time of this visit ranged from £396.00 to £500.00, according to individual care needs and the bedroom occupied, plus any registered nursing care contribution due from the government. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was returned to us late because the manager was new in post, had not completed one of these before and needed more time. The AQAA was fully completed and gave us the information we asked for. We also sent surveys for the manager to distribute to people living in the home, their relatives and the staff. These surveys were not given out to people until after the return by date stated on the forms. One person telephoned to give us some verbal feedback about the home, saying the return by date on the survey had already passed so they thought it was not worth completing. We received three completed staff surveys. Care Homes for Older People Page 6 of 31 The pharmacist inspector, Angela Branch made an unannounced visit to the care home on 19th January, and examined the handling of medication by looking at relevant documents, storage and meeting with the manager and other staff. The pharmacy inspection took four and a half hours. Feedback was given to the manager during and at the end of the inspection. The lead inspector, Jenny Donnelly, visited unannounced on 20th January between the hours of 09.30 and 15.30. During this visit we (the Care Quality Commission) toured the building, and spent time with people in their bedrooms and in the lounges, where we watched lunch being served. We spoke with people living in the care home. We also spoke with the manager, the registered provider and the staff on duty. We looked at files and documents that backed up what we were told and what we saw. Feedback was given to the manager and provider during and at the end of the inspection. Since the last key inspection in February 2008, we have completed one annual service review in February 2009, and one random pharmacy inspection in June 2009. Some requirements were made following the pharmacy inspection, hence a return visit by the pharmacy inspector at this time. Copies of these reports are available from the Care Quality Commission, or from the care home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Since the last inspection there have been a number of environmental improvements to the home. This included swapping some bedrooms and lounge areas, creating new bedrooms with en suite facilities and opening up the entrance hall. The laundry had been moved away from peoples bedrooms, and the kitchen had been refurbished. A sluicing disinfector had been purchased for better cleaning of nursing Care Homes for Older People Page 8 of 31 utensils. People told us they liked the changes and thought the home was better for it. The Statement of Purpose and Service User Guide had been updated to reflect changes in contact details and to include the new manager. A new handyman, housekeeper and chef had been employed. The manager had implemented individual staff supervision sessions and was updating the training plan. An activity organiser post had been advertised and work had started on planning activities and occupation for people. Following the last pharmacy inspection in June 2009, the recommendations made at that time had been actioned, but other problems with the management of medicines were found this time, and one previous requirement is repeated. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 31 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 31 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 31 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. Hometrust Care Limited provided people with good information about the services and facilities offered at Nether Place. The admission assessment was thorough and enabled people to know if the home would be able to meet their individual needs. Evidence: We saw there was good information for people about Nether Place Nursing Home, describing the facilities and services offered. The information was set out in a Statement of Purpose and Service User Guide, which had both been updated recently to reflect the change in manager and update the contact details for the company. Copies of these documents were given to people on request, as well as being on display in the home. People could also access information about Nether Place from the Hometrust Care Limited web site. We looked at the admission procedure for new people moving into the home and found this included a detailed assessment of their needs. We saw a completed Care Homes for Older People Page 12 of 31 Evidence: assessment and this had been done with a good level of detail using a standard format to help staff capture all the necessary information. The home also had copies of relevant information from other professionals, including hospital discharge information and assessments by the persons social worker. The assessment helped staff to ensure they had everything in place, including any equipment needed, for new people arriving. These assessments were used to draw up a plan of care for the person, and this is commented on further in the next section of this report. People we spoke with told us that the staff had made them feel welcome when they arrived in the home. People said they, or their families, had been able to come and look around the home, to see the vacant rooms and speak with the manager or staff. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People told us they were well looked after, but care records were poor, out of date or missing, and did not evidence that the care given was appropriate. The handling of medicines was poor and left people at risk of not receiving the correct treatment. Evidence: We spent a day in the care home and observed and spoke with people in the lounges and privately in their bedrooms. We also observed staff working throughout the day. We saw that people looked well cared for, were appropriately dressed in clean clothing, with tidy hair, and the gentlemen had been shaved. Those people who stayed in bed appeared comfortable and had their drinks, newspapers and call bells close at hand. People told us they felt looked after, saying, I am very satisfied with my care here, and I am OK, they look after me here. We saw that staff attended to people who stayed in their bedrooms, and spent time checking on people in the lounges. The manager showed us a new care plan format he was drawing up and planning to Care Homes for Older People Page 14 of 31 Evidence: introduce, but this was not person centred. In the meantime the original care plans were still in use, although the manager had introduced a separate daily record file, so that staff could make their daily notes without getting each persons care plan file out. We were concerned this could lead to care plans not being referred to and not being updated as peoples needs changed. The care plans we looked at were out of date and were not sufficiently detailed about peoples individual needs and wishes. One person had a printed basic plan that had no information that was individual or personal to their particular needs. The plan had not been updated since last summer, and did not show the nursing interventions that had taken place since. Risk assessments for skin care, handling needs and weight monitoring were also out of date. The plan stated weekly checks were required on this persons blood pressure and blood sugar levels. Records showed blood pressure had been checked roughly on alternate months and blood sugar was last recorded over a month ago. It may be these checks were no longer considered necessary, but the care plan had not been changed to reflect this. Another plan we looked for was missing, and although the manager thought a care plan had been in place, it could not be found. This person required intensive nursing, with needs including wound care, and symptom control for management of pain and nausea. There was a pre-admission assessment on file and staff had written daily care notes, stating dressings changed and analgesia given. But there were no care plans or risk assessments to guide staff in caring for this persons complex needs. The manager and registered provider could not explain this, and assured us a plan would be written before the end of the day. It was difficult to evidence if people had good access to health care because care records were so poor. Staff told us one person, who had suffered significant weight loss, had been seen by the dietician, but there was no record of this visit, or of any advice given. The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the manager, and other staff. Overall, we found that the handling of medication was poor. There were significant concerns meaning that people were not safeguarded against medication errors that could affect their wellbeing and could cause harm. We looked at records for receipt, administration and disposal of medication for a period of just over seven weeks. Some of these records were incomplete so that we did not know exactly how much medication was received into the home or how much Care Homes for Older People Page 15 of 31 Evidence: had been disposed of. Some administration records contained errors and the reasons why people missed their treatment were not clear. We saw that some medication was inappropriately disposed of and the home did not have proper arrangements in place for the safe disposal of medication that comply with Waste Disposal Regulations. These mistakes meant that it was not possible to fully account for all the medication and people were at risk of receiving their treatment incorrectly. Ordering procedures for medication were inadequate and we saw a number that ran out including pain killers and sedatives. This could adversely affect people if they do not get the treatment they need. We also saw that during one period when a medication had run out staff administered an alternative form of the medication that was not prescribed and this resulted in the person receiving an excess dose for two days. We watched the preparation of medicines for administration. Staff showed poor and potentially harmful practice by preparing and giving the medication for three different people all at once in unlabelled pots. This places people at risk or receiving the wrong medication. We looked at a sample of care plans and protocols for managing people with when required medication such as pain-killers and sedatives, and those with complex needs. These contained little guidance and were inadequate. We saw a person who had lost a significant amount of weight and who had been assessed as high risk of malnutrition who did not have a plan to manage their diet including the use of prescribed food supplements. Another person was prescribed a medication when required that had a dual purpose. There were no records to say for what condition this was prescribed, and there was no care plan to provide guidance on management of the person. This could lead to them not receiving the treatment when they need it and receiving it when they do not require it. Overall, the storage of medicines was satisfactory though there was medication found that was no longer needed and should be disposed of to prevent it being given again in error. Medicines liable to misuse, called controlled drugs, were checked and were in order. The manager had started to do checks, or audits, of medication. However, these were inadequate and did not pick up many of the concerns raised at this inspection. Audits should be done more thoroughly so that concerns are highlighted and dealt with promptly to keep people safe. Care Homes for Older People Page 16 of 31 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 manager was in the process of trying to increase the provision of activities and occupation in response to peoples requests. The quality and choice of food was good, but more attention is needed to ensure everyone receives an adequate diet. Evidence: A number of people we spoke with were disappointed with the provision of activities and occupation in the home. We were told, There is nothing much for people with dementia, and, someone used to come and play board games, but they dont come anymore. The manager had already told us he was planning to improve the activities and occupation in the home following similar comments received in a recent survey. They had advertised, and were in the process of appointing an activity organiser, and the manager had started some preparation work on activity planning. The home had developed links with the local Alzheimers Society day centre, and hoped to learn some skills from them, which would benefit people living in the home. Throughout the day we saw staff engaging different small groups of people in dominoes, and there was a general knowledge quiz. People told us this was unusual, and care staff stated they didnt have time to do this every day, perhaps just twice a week. There was a Care Homes for Older People Page 17 of 31 Evidence: Nether Place newsletter, and this showed photographs of Christmas activities and entertainment which people enjoyed. One person told us everyone used to get a copy of the homes newsletter, but this didnt happen anymore, and it was difficult to read now it was just pinned on the notice board. The manager agreed to address this, and told us relatives could access the newsletter on the Hometrust Care Limited web site, or request a copy by email. People told us they were happy with the meals served, saying, The food is very good, theres always two choices, The meals are alright, I get what I ask for, and, The food is nice. The home operates a three week menu that is updated seasonally, and offers a good selection and variety of foods. A cooked breakfast was available, the main meal was served at lunch time, and consisted of two main choices and dessert, the evening meal was a lighter hot dish, soup and sandwiches and dessert. A new chef was appointed last year, and the manager was in process of appointing a second chef to cover evenings and weekends, rather than have agency staff or carers doing this. The chef had knowledge of peoples special dietary requirements and catered accordingly. We saw meals being served in bedrooms, and in the lounge and dining areas. While staff were attentive and patient with people that needed help with eating, we saw that staff were not always able to properly explain the menu choices and we saw an uneaten meal being taken from a person without any question being asked, or alternative offered. There was a lack of nutritional assessments in care plans, and no evidence that peoples weight was being monitored regularly, even those taking prescribed dietary supplements. More importance needs to be placed on ensuring people are taking adequate amounts of food and drink, and maintaining a healthy body weight. Care Homes for Older People Page 18 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns and complaints were listened to and acted on in a timely manner and any necessary changes were made to put things right for people. Evidence: There was a copy of the complaints procedure on display in the home as well as within the Statement of Purpose and Service User Guide. We also saw there were reminders about how to raise concerns and complaints in the homes newsletters. Two complaints had been received by the manager. An investigation into one found the complaint to be upheld and an apology was made, and actions were taken to prevent a re-occurrence. The second concern was made in a response to a resident/relative quality assurance survey questionnaire. We judged the provider was right to treat this concern as a formal complaint. An investigation into this was ongoing, although some immediate actions had been taken to address some of the issues raised. We saw the correspondence relating to both complaints and judged that peoples concerns had been listened to, taken seriously and were being properly addressed. Prior to this inspection we (the Care Quality Commission) received one anonymous letter and one telephone call reporting concerns about staffing levels in the home. As a result of this we decided to bring forward our inspection and we comment on the staffing arrangements in the staffing section of this report. Care Homes for Older People Page 19 of 31 Evidence: There were safeguarding procedures in place to guide staff in how to recognise and report any concerns or allegations of abuse. Staff had received training in this during the last year, and had access to a copy of the Cumbria multi-agency guidelines on safeguarding. We did not witness any abusive practice on the day, and no one told us of any serious concerns. Care Homes for Older People Page 20 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in warm, clean, comfortable, and well maintained home that meets their needs. Evidence: Since the last inspection a number of changes had been made to the layout of the home. This included swapping some bedrooms and lounge areas, creating new bedrooms with en suite facilities and opening up the entrance hall. The laundry had been moved away from peoples bedrooms, and the kitchen had been refurbished. People told us they liked these changes and thought the home looked better for it. The home was well maintained, warm, clean and comfortable throughout. There was a main lounge, two smaller sitting rooms and a large conservatory for people to use. The lounges were pleasantly decorated, warm and comfortable. The conservatory had been made water tight and the provider hoped to rebuild and extend this. There was also a small seating area in the entrance hall where some people liked to sit. The home has a large garden, and there were plans to improve access to this. There were adaptations to help people with mobility problems, including grab rails, a passenger lift, hoists, bath seats and other equipment such as nursing beds and pressure reducing mattresses. Care Homes for Older People Page 21 of 31 Evidence: There were two assisted baths, two showers and plenty of spacious toilets. Work was being done to improve signposting around the home to help people find their way. Toilet doors had been re-painted using a dark colour that stood out against the corridor walls, and picture signs were going to be put on the doors. Twenty three of the twenty seven bedrooms had an en suite toilet. Bedrooms varied in size and shape, were nicely presented and had been personalised and made homely with photographs and other personal possessions. The laundry worked efficiently and we saw there were good infection control procedures in place, with hand washing facilities easily accessible to staff and visitors. Peoples clothing and bedding appeared nicely laundered. A new sluicing disinfector had been purchased for the safe and thorough cleaning of nursing utensils. A new housekeeper and a new handyman had been employed. Care Homes for Older People Page 22 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people expressed concerns about staffing levels although we judged the home did employ sufficient suitably trained staff to meet peoples assessed care needs. Evidence: We had received one anonymous letter and one telephone call raising concerns about staffing levels in the home. We also received some surveys from staff which told us, We need more staff. The staff surveys also told us, The home is good at involving families about service user care, and considers relatives to be part of the Nether Place family, and, It is a good home, and comfortable for those who live here. There were nineteen people living in the home on the day of this unannounced inspection. The staff on duty comprised of 1 registered nurse, 3 care staff, 1 cook, 1 housekeeper, the manager, the registered provider (who was visiting that day) and an additional carer/administrative support worker. The company also employ a maintenance man, and a health and safety officer to work across their three homes in Cumbria. We looked at staff rotas and spoke with the staff on duty who confirmed that the usual day time staffing for care staff, was 1 nurse and 3 carers, reducing to 1 nurse and 1 carer at night. We judged this to be sufficient for the 19 people in residence, and our observations throughout the day backed this. We saw that people looked well cared Care Homes for Older People Page 23 of 31 Evidence: for, and received attention from staff throughout the day. We monitored the call bells and found they were answered within a reasonable time, and we observed that people who called for help in the lounge were attended to quickly. We could find no evidence that the home was short of staff. However, people we spoke with on the day told us, We usually have to wait longer, and, Staff dont usually have time. People also told us staff were nice and helpful, and efficient. We asked the manager to check that on other days, staff continued to be as organised and efficient as we had seen. The manager worked two or three nursing shift a week, with the remainder of his time spent on office duties. The provider told us that she would cover the managers nursing shifts over the coming days so he could be free to attend to the shortfalls we found in the care records and medicines. The manager had been checking through staff training records and drawing together a training matrix to help him plan training for the coming year. The matrix showed that training had taken place last year for moving and handling, fire safety, infection control and safeguarding. Two staff had completed dementia awareness training at Stirling University, but one had left, and another person was now due to attend this. Fire training was due to take place again later this month. Some staff were overdue moving and handling training and plans were being made to address this. Six of the thirteen care staff had completed a National Vocational Qualification (NVQ) in care at level 2 or above, and three more were registered to start. We checked the recruitment practices, and looked at the files of three staff employed in the last six months. We saw that people had completed application forms, attended for interview and had references and criminal records bureau checks completed before they took up post. Care Homes for Older People Page 24 of 31 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. Management listened to people who used the service and acted on their wishes. But overall management was not robust enough, and did not deliver a safe, consistent quality of service. Evidence: The new manager, Mr Andrew Humphries, had been in post since the 7th Septmber 2009, and needs to apply for registration with the commission. He was waiting for the receipt of certain documents he needs to submit with his application. The manager is supported by an operations manager who visits the home at least once a month, and by the registered provider who also visits. Homecare Trust Limited had systems in place to monitor the quality of service provided at Nether Place. They had sent out their own quality assurance questionnaires to people in December. We saw the completed responses which were mostly complimentary, with some people asking for more activities and some requests for residents/relatives meetings. A meeting was set up but had to be cancelled due to Care Homes for Older People Page 25 of 31 Evidence: heavy snow, this had been re-scheduled. An activities organiser was being appointed and an activity plan was being drawn up. One complaint was raised through the surveys and this was being dealt with. We judged that the manager and provider had listened to what people had said and had acted on their wishes. There were some checks, or audits, on medication, but these were inadequate and had not identified the concerns highlighted at this inspection. There had not been any checks or audits on care records, which were poor and out of date. Regular audits would enable the manager to identify and correct these problems straight away. In line with regulations, the company carry out monthly monitoring visits to Nether Place and write a report of these visits. Again a more robust quality checking process would highlight shortfalls in the service and allow improvements to be made more quickly. The service had a strategic plan in place that detailed priorities for the coming year, such as further environmental improvements, staff training and supervision, and plans for consultation with people using the service. The manager keeps money on behalf of some people for safe keeping. We looked at the system for this and found the money was kept secure and there were records of each persons accounts. However, the actual money had been pooled together in one cash tin, and should be separated into individual containers/wallets for each person, as it was previously. This enables individual audits of peoples money to be carried out at each transaction. There was a good system of staff supervision in place, and since coming into the post the manager had held individual supervision sessions with the majority of staff. These had been recorded on supervision records, and signed by the manager. We suggest these are also signed by the staff member to confirm the record is an accurate reflection of the discussion that took place. We looked at the general health and safety arrangements in the home. Staff had received health and safety training including fire safety, and moving and handling training. Some of this was due for renewal and plans were being made for this to happen. We saw evidence that the homes equipment had been checked to ensure it was safe and in good working order. We saw that routine checks had been carried out on the lift, hoists, bath seats, fire alarms and fire equipment. Water temperatures were monitored to ensure they were within safe limits. Care Homes for Older People Page 26 of 31 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 9 13 There must be complete and 31/08/2009 accurate records of all medication received, administered and leaving the service in order to account for all medicines. Care Homes for Older People Page 27 of 31 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 Each person must have an 15/02/2010 up to date care plan setting out in detail their health and personal care needs, that takes into account their indivudal wishes. So staff can consistently deliver the level of care and intervention that people need in a way that is acceptable to them. 2 8 13 Up to date risk assessments and treatment plans must be in place for managing peoples health care needs. So people receive the support and care they need with nutrition, skin care, moving and handling needs and other nursing interventions. 15/02/2010 3 9 13 The manager must ensure that staff employ safe medicines administration practices. 15/02/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people receive thier medication safely and in the prescribed doses. 4 9 13 Medicines that are no longer required must be disposed of properly using a licensed waste disposal company. To dispose of unwanted medicines safely and comply with Controlled Waste Regualtions. 5 9 13 Ordering procedures for medication must be reviewed. To prevent peoples medicines running out. 15/02/2010 15/02/2010 6 9 13 There must be complete and 15/02/2010 accurate records of all medication received, administered and leaving the service. So that all medicines can be accounted for. 7 33 24 There must be a robust 15/02/2010 quality monitoring system in place. To ensure that staff are working in accordance with the homes policies and procedures to deliver a consistent standard of service to people. Care Homes for Older People Page 29 of 31 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 9 It is recommended that care plans are more thorough and provide staff with clear guidance on managing peoples specific care needs for the administration of complex or when required medication so that they are managed safely and effectively. It is recommended that the manager undertake more thorough checks, or audits, of medication so that risks are identified and managed without delay to keep people safe. It is recommended that the plans to improve the provision of activities and occupation for people be put into practice and are continued. It is recommended that staff more carefully monitor peoples nutritional intake to ensure everyone is receiving an adequate diet. It is recommended that peoples money being held by the home is not pooled together, to allow for easier individual auditing. 2 9 3 12 4 15 5 35 Care Homes for Older People Page 30 of 31 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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