Inspection on 06/04/09 for Nyton House

This inspection was carried out on 6th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nyton House 13/04/10

Nyton House 30/09/09

Nyton House 03/07/09

Nyton House 23/06/09

Nyton House 15/04/08

Nyton House 15/12/06

Nyton House 31/01/06

Nyton House 24/08/05

Nyton House 01/02/05

Nyton House 29/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report Care homes for older people Name: Address: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL 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: Val Sevier Date: 0 6 0 4 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. things that people have said are important to them: 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 They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Older People Page 2 of 31 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: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia old age, not falling within any other category Number of places (if applicable): Under 65 0 0 Over 65 1 23 Mrs Mary Davis Mr Philip Norman Davis Mrs Joy Hilary Care home 23 01243 543228 01243 543039 Daviscarehomes.nyton@virgin.net Additional conditions: The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection: 1 5 0 4 2 0 0 8 Care Homes for Older People Page 4 of 31 Brief description of the care home: Nyton House is a care establishment registered to provide accommodation for up to twenty-three service users in the category OP (old age not falling in any other category) and one named person in the category DE (E) over sixty five years of age. The establishment is situated in the village of Westergate. Local bus routes are near by. Accommodation is provided on ground, first and second floor level. A vertical lift services each floor. All rooms are generally for single occupancy however there are five rooms that can be used as doubles providing the occupancy levels do not exceed twenty-three. The service is privately owned. The proprietors are Mr and Mrs Davis. The registered manager is Mrs Joy Hilary. The current fees range from £450 to £850. (£850 is for a double room) 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: zero star poor service Our judgement for each outcome: How we did our inspection: The quality rating for this service 0 star. This means the people that use this service experience poor quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: the Annual Quality Assurance Assessment (AQAA) completed by the home, and an unannounced visit to the home, which was carried out on the 6th April 2009, during which the inspector was able to have discussions with the owner Mrs Davis, Joy Hilary the manager and staff and have interaction with the residents at the home. During the visit the inspector looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff and Care Homes for Older People Page 6 of 31 residents, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Care Quality Commission. We received 13 surveys: 5 from staff and 8 from people who live at the home; on the day of the visit we were also able to speak with three relatives who were visiting. Since our last visit the manager applied and was successful in being registered with us for the service. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Requirements made after our last visit have not been met this has placed people living at the home at risk of harm. Care plans must detail the care and support needs for individuals where support has been identified, so that staff are aware of what they need to do for people who live at the home. Risk assessments must be carried out where a risk has been identified with action to minimise the risk for people who live at the home as far as possible especially for those with mobility issues or risk of skin breakdown. Medication records are not correct for those who self medicate, for variable doses and for knowing what medication had been received by the home. Care Homes for Older People Page 8 of 31 The procedure for recruiting staff must ensure that there are CRB, POVA first and references before employment commences, to protect those people that live at the home. Staff must receive training in mandatory areas such as manual handling, fire, first aid, COSHH and food hygiene. They must also receive training in areas where it has been identified that they need to support a specific individual need such as diabetes or stroke. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other people as needed. Evidence: We received the AQAA for the home which stated that:” On enquiry for future clients, by offering a quality pre-admission assessment we are able to identify their needs prior to admission, put in place all the nursing equipment and staff trained to meet their needs ready for admission. We encourage clients to have a trial stay before commiting themselves to the home long term. We do not charge administration fees for new clients coming into the home”. This was supported by evidence in the records at the home and with talking with relatives of individuals who had moved to the home in the last few months. The assessment includes the following areas: a contact names sheet, personal details, medical details for example doctor and health issues; social information for example previous occupation, children and social history; allergies; next of kin. This information is also included on another assessment sheet with larger spaces to write and includes medication. Care Homes for Older People Page 11 of 31 We looked at four care plans, which included these assessment sheets; one individual we saw had requested to go to church. We could not see in the care plan how this request was being met. Comments from surveys indicated that the service users had enough information about the home before they moved in. We noted that one of these responses was from someone who was self funding. Four service users who commented indicated that they have not received a contract regarding the service delivery by the home. We noted that one of these responses was from someone who was self funding. Care Homes for Older People Page 12 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 the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records and systems within the home do not always ensure that the personal and healthcare needs of people who use the service are met safely and effectively. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The home’s AQAA told us that: “Our staff are all experienced in giving support for washing and hygiene, they are supervised to ensure that they show respect and offer dignity and privacy whilst the care is given. We offer care as the clients wish, including bathing and showing to the clients preference. We also support those who need daily help with washing and dressing and our staff also ensure that the laundry both bed linen and clients personal clothes is done quickly and returned. Manicures are offered and a visiting chiropodist ensures that the client’s feet are in a good state. The hairdresser visits weekly and supports both male and female clients. Clients able to leave the home to see GPs are escorted, otherwise GPs and District Nurses visit the clients in their own rooms. We also seek additional support from other professionals within the Multi-disciplinary team to ensure all their health care needs are acted on (dieticians, Mental health team etc) The care plans address the individual care and are updated at least monthly which is agreed by clients or their advocate”. Care Homes for Older People Page 13 of 31 Following our last visit we made three requirements regarding care plans, risk assessments and pressure areas. We sampled four care plans of people who use the service, two of whom had moved to the home in the last year. The care plans sampled were being used in conjunction with medication records and other health-monitoring tools that are used as part of the care planning for individuals. The first care plan we saw had not been reviewed monthly but five times since September 2008, the last time March 2009. There was evidence of assessment tools such as Waterlow and Barthel, also identified needs in personal care, mobility, mental capacity, emotional and social needs, medication and self-medication. We saw a risk management care plan for this individual dated 11th September 2008 which stated that they had a diminished capability to walk. The eating and social care plans stated that this individual enjoyed their meals with others. The mobility care plan had not been updated to reflect that since using a wheelchair the dining room was no longer accessible for this person. The second individuals care plan had not been fully completed; the information in place was dated 26th March 2009. It was not clear when this individual had moved to the home. There was a pre admission assessment. We saw a Barthel assessment airway and breathing and circulation care plan. A self-medication assessment was in place, which had not been signed by the individual. The third individual’s file we saw, it was unclear when this person had moved to the home, some documents were dated 25th February 2009 and others 16th March 2009. The pre assessment indicated that the person wants to attend church services. We could not see a plan of care on how the home would facilitate this wish. There were clear instructions for staff on relieving anxiety of the individual and prompting to dress in appropriate clothing as unable to control own body temperature. We saw that a mobility assessment had been carried out which had not been signed. There were risk assessments in place with reduction measures for identified risks. The fourth plan we saw was for an individual who had returned to the home on 18th March 2009 following discharge from hospital. The person had suffered from a fall fracture. The care needs had changed since they were last at the home as evidenced by notes on the review page of the care plan, which stated, that two carers are needed to help them to move as not very mobile and that encouragement to eat food was identified. The mobility care plan had been updated on 28th March 2009 stating ‘needs two carers can walk with frame short distances very unsteady’. The manual handling assessment was last carried out on 24th February 2009. We saw that five care plans had had information added on 28th March 2009, for example ‘small meals and Fortijuice given, encourage to drink more’. There was no evidence seen how this was to be monitored. Care Homes for Older People Page 14 of 31 ‘Needs help with washing and dressing, with all care’ we saw no detail of how this was to be carried out. We discussed the care plans with the manager who said that as she had been away the care plans had not been updated properly. We also spoke to the manager about the monitoring tools the home use for example the Barthel scoring system for care. There was no written information as to how the scores had given and what the staff were to draw from that score. The manager stated that staff and she knew what the score meant and what the individual needed. Following our last visit we made three requirements regarding medication. The requirements have not been fully met and alternative action by the commission is being considered. The home had written policies and procedures for the management and administration of medication. Medication was kept in locked and secured medicine trolleys, a cupboard just outside a bathroom and where required in a medical refrigerator. We saw that there was a homely remedies agreement that had been signed by the GP on 9th February 2009. We saw a list of specimen signatures of staff that handle medication. The medication records we saw on this occasion were dated between 23rd March 2009 and 16th April 2009. Individuals who had been assessed to administer some or all of their medication had secure storage in their rooms for the medication. However we did note that staff had not always signed to say that the individual was self-medicating for a medication and the MAR chart was blank, nor that staff had signed over the medication to the individual. We saw that one individual has three types of pain relief two of which they administered themselves, CoCodamol and Tramadol. The individual also has a Fentanyl patch every three days. We saw no plan of care regarding the pain relief. The individual has also been prescribed Buccasten as required for nausea and vomiting we did not see a plan of care for this. Medication administration records (MAR) did not always have a record of the amount of medication that the home had received or when it had come into the home. We saw that where there was a choice of dosage for example Co Dydramol one or two tablets, there was not always a record of what amount had been given. Lactulose 5 – 15mls as required no dosage recorded each time it was given. One individual was prescribed Movicol one or two daily there were no signatures or amounts on the MAR charts from 23rd March to the date of the visit. We saw a MAR chart where Lansoprazole had been changed by hand to 30mg from 15mg there was no evidence to say who had authorised this or when. Another individual who has been prescribed Movicol we saw that one sachet daily had been written by hand and underlined, we also saw along the MAR chart area for this medication, three sachets. From 28th March 2009 to the date of our visit we saw that various amounts had been recorded ranging from one to three. We saw that three individuals had been prescribed pain relief creams and or ointments. There were no signatures for these medications or any evidence stating that the Care Homes for Older People Page 15 of 31 individual was self-medicating. We saw that one individual has been prescribed three pain relief creams. One individual was prescribed Temazepam 10mg at night there were no signatures on the MAR record from 23rd March 2009 to the date of our visit. Another person had been given Lactulose on four occasions between 24th March 2009 and 5th April 2009. This was recorded on the back of the MAR chart where ‘as required medication can be recorded. This individual is not prescribed this medication and it is not a homely remedy. We spoke to the manager about this at the time and she said it had occurred when she had been away. Staff were observed speaking and assisting individuals with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. People we spoke with at the home had high praise for the staff and management saying that nothing was too much for them and that they felt well cared for. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The home has several areas where people can choose to sit for example a room with a piano and one with books. Some choose to stay in their rooms to watch television for example one couple have had satellite television fitted, many people have their own phones. There are regular visits from the hairdresser and mobile library, monthly church visits if individuals wish to participate. Activities taking place in the home were seen posted on the notice board in the hall. Activities provided include crosswords, musical afternoons and trips out. The home operates an open visiting policy and maintains family ties; the home enables regular visits and has arranged for family meals in a small dining area. People living at the home are encouraged to exercise control over their lives and it is their choice to participate in social activities if they wish. Visitors spoken with said that staff try to help the people living at the home to maintain their rights and for them to be able to make informed choices around daily living. The AQAA sent by the home stated: “Offer daily activities for clients (11am - 12noon Care Homes for Older People Page 17 of 31 each weekday) to choose from and join in as they wish without pressure. We have links with community groups, save the children, the local churches, who come in and bring the community and activities to those who can not get out easily. We take part in a stamp collecting and sorting scheme where by the clients help to sort out donated stamps which go towards raising money for Leprasy victims in the third world. This gives those who wish to help self worth, being useful still to others and also offers a gathering where they can chat and intergrate with others in the home. We encourage the cleints to visit each other in their own rooms, like listening to audio tapes, having drinks together, chatting, playing cards or the favourite is listening to music. We offer lunch and tea to visitors, but due to numbers we have to ask in advance for bookings, to avoid too many visitors coming on the same day, to retain links with the community, family and friends as a good will gesture and also to informally spread the word of our home through indirect advertising with meals. Our wonderful garden offers some clients with the opportunity to have an area to look after themselves or just enjoy. It offers a great topic of converstation at lunch time as they look out on the garden, seeing which flowers and birds are on display each day. This was made more accessible to wheelchairs some time ago”. In what they could do ‘better’ the home stated in their aqaa that: “Staff to become more involved, especially those who do not wish to join in with group activities. At present it seems that only certain staff do this, so we need to review the staffs awareness as to the importance of this area and how it can make such a difference to the clients on a day to day basis.” People who use the service who passed comment on the day were complimentary about the food provided. The meals seen looked nice and were presented in a way that looked appealing. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals and diabetics. People who live at the home could choose where to eat and some preferred to eat in their rooms. It was observed that staff asked individuals what they wanted for the next meal and if it was not on the menu then they had what they wanted. Service users commented in their surveys that food was “outstanding and delicious”. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not protected through the home’s complaints process. The staff have not had training to support their knowledge and understanding of safeguarding and protection issues putting people at risk of harm. Evidence: The homes complaints procedure was seen to be available in the information given to people who use the service. There have been no complaints received by the commission. The manager advised that the home promotes an open door approach to relatives and people who use the service, to help resolve complaints and issues effectively. Following the visit to the home we were advised that a safeguarding alert had been received by social services regarding an incident at the home involving medication. Notification had not been received from the home about the incident in expected timescales. The home has the West Sussex safeguarding adult policy, however we could not see evidence that staff had had training in this area. Staff spoken with and staff surveys indicated that there has not been training and that the whistle blowing policy is not working to protect people who live at the home. We spoke with the manager who said staff request training and that training has been undertaken with dates and times recorded. The home’s AQAA stated: “Staff are recruited ensuring they are suitably safe to work in the home, with POVA and 2 written references as well as a full interview complete with a pre-employment questionnaire and questioning to test their skills and experience and whether or not they are the right type of person to work in the vulnerable elderly care sector. Care Homes for Older People Page 19 of 31 Staff are inducted with a senior member of staff, being supervised throughout their shifts until their completed CRB has been returned. They are then supervised on a regular basis whilst on shift throughout their employment. Complaints are acted on quickly and actions taken to protect the clients as well as prevent reoccurrence of the problem again. Each complaint is investigated and documented to ensure it is investigated within the 28 days and that the outcome is detailed for auditing purposes. Complaints are dealt with without names and malice to ensure that the clients and staff are given the opportunity to use whistle blowing and complaints without fear of retaliation. Complaints are acted on according to the wishes of the clients, taking into account the Safeguarding of Vulnerable Adults procedure for WSCC”. People who use the service and their representatives have commented in the surveys we received and on the day when we spoke with them, that the home staff are approachable and that they feel listened to. The manager is available to speak to one commented “I have no complaints about this home at all”. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. Evidence: We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible with wheelchairs. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures, to make it feel like home. Nyton House is situated in its own large, well kept grounds. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The AQAA for the home stated: “ The home is furnished to the period it was built in, with colour schemes which offer a bright, cheerful rooms both private and communal for clients to enjoy. The conservatory/dining room is a bright and airy room where visitors can also enjoy meals with the clients without constraints on space and comfort. Act quickly on rooms vacated and refurbish to groups high standard, we continually redecorate the rooms to ensure the home is to an excellent standard and the soft furnishings are replaced when wear and tear occurs. We ensure that the room meets the cleints needs and that staff can access the room and that the room is ergonomically suitable for their mobility needs and equipment Care Homes for Older People Page 21 of 31 needed for them. The home is checked as the regulations indicate to ensure that the machinery, electrics, plumbing etc are all in a safe working order to avoid any risk to them or the staff that use them. The kitchen is well stocked and maintained to ensure that there is no risk of contamination and our recent EHO inspection showed we have an EXCELLENT kitchen with staff skilled and trained to provide the best possible food and food safety for our residents. The new lift ensures that all floors are accessible with a wheelchair (except for 3 rooms which have steps leading to them). Our grounds are wheelchair friendly and offer a wonderful and safe additional space for the client and their families to enjoy in the good weather. We have covered areas to offer relief from the sun in hot seasons. The Garden (which is vast) constantly needs to be attended to, the gardening staff do regularly change the borders and plant new seeds and annuals to ensrue the garden does look its best at all times. The home and the grounds are all risk assessed and actions taken to ensure they remain safe with actions taken to reduce risks where necessary” 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have not received the mandatory training that is expected each year, and it was not clear that staff have received training to meet all the needs of people who use the service. The lack of checks in the current recruitment process places people who use the service at risk. Evidence: The AQAA for the home under ‘what we do well’ stated: “Ensure that the staffing level and skill mix relates to the current care needs. In addition to this we also ensure laundry, maintenance and domestic staff are at least adequate to the needs within the home at that time. We have 75 of care staff who are NVQ 2 or above currently”. Under ‘what we could do better’; “Due to staffing sickness many shifts amongst the staff was hard on those who had to cover the shortfalls, management of staff within the group could have been better handled, taking staff from the other home to support us in such a difficult time, but they too had sickness and annual leave to juggle so could not help us. Supervisions need more time allocated to ensure the feedback session is performed thoroughly”. The staffing structure at the home consists of: manager, support workers, kitchen staff, laundry and housekeeping. On the day of the visit we saw that there were four care staff on in the morning and two in the afternoon. The cook works from 8.30am – 5.30pm. Two waking night staff are on duty throughout the night. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. On the notice board in the second office which care staff use, we saw a note written and dated 20th February 2009; ‘please will staff make a list of refresher courses they should be attending in the next six months. Please complete by the end of the month’. Care Homes for Older People Page 23 of 31 We saw one person had requested training in challenging behaviour, dementia, diabetes and medication. We asked the manager how this worked she said staff asked for updates. We asked about mandatory training that needs to be updated at regular intervals and were told that staff say what they need. We asked if the management knew when staff needed updating and were told it was checked against staff files. We were told that in-house training was to be given by a manager from another home, which was due to have started in March 2009 but hadn’t. One member of staff who has NVQ 2 and 3 said that since they started in 2005 they thought they had had safeguarding adults training twice, fire training in December 2008 and no manual handling training. We looked at six other staff files to look for evidence regarding training. One staff member had had an appraisal 21st March 2008 and had requested manual handling update, palliative care, dementia and strokes. There was no evidence on her file that these had been undertaken. A second staff member was seen to have had catheter and suppository training and basic first aid in March 2008. Another three files showed that staff had had basic first aid on 19th March 2008. One training course was seen to have booked with an outside provider - Environmental Health for food handling on 28th April 2009. We saw that some staff had had an annual appraisal between January and March 2008. Supervision is recommended as six times a year in the care standards we saw in the staff files that for three staff, two last had met with the registered manager Mrs Hilary in July 2008, and a third in January 2009. The registered provider Mrs Davis said that their priority since our last visit had been NVQ training and that of their fifteen staff eight had wither NVQ 2 or 3. There were also three nurses working as care staff. We spoke with the registered provider Mrs Davis, when we looked at staff files, as a requirement had been made following our last visit. We looked at three files for staff that had begun work at the home since our last visit. Of the three one had completed an application form. The registered provider Mrs Davis said another had transferred from the other home she owns and no paper work had been carried out at Nyton. The third she thought had had one but it was not available. The staff member, who had completed an application, had a POVA and CRB check however there were no references. The registered provider Mrs Davis said that she had seen them but was not happy with them and requested that two more were obtained we asked where they were and she spoke with the staff member while we were there however they were not readily available in the home. Only one member of staff had a POVA First although a second staff member had a CRB with the POVA First included. We saw that one staff member had had an induction and it had been signed as completed. A second had not had theirs signed off and there was not one for the transferee. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of good management practices and improvement in significant areas such as care plans, pressure area records, current medication administration and recording and recruitment practices, place people who use the service at risk. In addition the lack of clear training records and plans for staff training to meet the needs of individuals and to protect the health and welfare of staff and people who use the service place all at risk. Evidence: The AQAA for the home under ‘what we do well’ stated: “I consistently work on a budget, reducing wastage and ensure money is spent to the best for the client, quality not waste. I continually seek improvements to which the home can benefit, including management changes and improvements. I run a happy home where the clients are happy and content. When I am not on shift, there is always a level 3 NVQ member of staff whom I can trust to run the home in my absence. I am also on call as is my Deputy should I need to be contacted when off duty or on holiday, both day and night. I am supported by the homes owner to ensure that we carry out the required checks on staff both before and after employment, training meets the requirements, as the manager updates met the requirements for my role, regulation requirement checks are in place to ensure it does not pose a risk to those who live and work within it, the care Care Homes for Older People Page 25 of 31 plans are completed and updated by staff which is over seen by myself, quality assurance surveys are carried out to ensure that we offer at least the adequate provisions for the clients, staff and visitors, risk assessments are completed and updated and acted on for clients care, the home and the work carried out in the home, accidents are acted on and report made should they need referrals to appropriate bodies (RIDDOR) and that the business if profitable and that the home is safe and secure for the clients and staff to live and work in. The home has a clear and indexed policy and procedure file, which relates to all aspects of the home and the staffs roles to ensure that the clarity is throughout the home for staff to follow and act on”. The manager is a nurse although she is not employed as a nurse at the home, which provides personal care. The manager has completed her NVQ 4 and since the last visit has been registered with the commission as the manager for the home. The manager stated that people who use the service and their relatives or representatives and the staff, are able to discus all aspects of the running of the home generally or on a personal level. This opportunity is offered in resident, relative and staff meetings, and in questionnaires, which are sent out regularly. We saw a summary, which had been completed in March 2009 for the most recent surveys from the home. Care provided – generally satisfactory Food – varied quality and presentation excellent. Activities – three regular people in art class enjoy. Those able to participate in other activities enjoy. Staff attitude – one or two have expressed concern over a few carers attitudes which have since been addressed. Individual monies & valuables can be locked in lockable boxes in the resident’s room. It was noted that the home’s equipment, plant and systems were checked and serviced or implemented at yearly, or six monthly or as manufacturers require for example; passenger lift and hoists; fire safety equipment portable electrical equipment; and hot water system. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. There was a fire risk assessment for the premises; tests of equipment and regular risk assessments of the premises and working practices were undertaken regularly with fire alarms set off weekly and monthly checks of fore equipment. From the records seen it was not clear if staff had had fire training twice in the last twelve months. Records said when training was due for example April and October 2008 however the record did not show if the training had been carried out. We spoke with the manager and proprietor about the issues we found throughout the day care plans, medication; concerns re staff bullying, recruitment and training. We have noted comments from them throughout the report in the section to which they applied. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes X 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 Sch 3 (1)(b) People who use the service must have clear individual care plans describing the support that staff give to meet identified needs 15/07/2008 2 8 13 (4) (b)(c) Where it has been identified that people who use the service are at risk from falls, a risk assessment must be put in place to lessen those risks. 13(1)(b) 15/07/2008 3 8 4 9 13 (2) Individuals who have been 15/07/2008 identified with potential risks to their pressure areas or with actual skin breakdown must have a risk assessment in place, be reviewed by the GP and the care plan updated to include how the risks are to be reduced and specify how wound care needs are to be met. Individual medication records 15/07/2008 must state the amount of medication given where there is a choice of dose for as required medication. The records must also state the reason the medication was given and any effect it had. Medication records must show the amount of medication received at the home by whom and when. 15/07/2008 5 9 13 (2) Care Homes for Older People Page 27 of 31 6 29 19 Sch 2 (5)(6)(7) A thorough recruitment of 15/07/2008 staff must include references, CRB and POVA First checks to protect people that use the service. Care Homes for Older People Page 28 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 9 13 (2) Staff must not administer 01/05/2009 medication to individuals that has not been prescribed or agreed under homely remedies. Medication can only be given when it has been prescribed by an authorised person, or it is a homely remedy, in order to safeguard people who live at the home 2 18 13 (6) The registered provider and 01/05/2009 registered manager must support staff with the whistle blowing procedure of the home. For staff to feel safe in reporting their concerns of issues that affect the well being and safety of people living at the home. The registered person must keep a record of all issues that are reported under safe guarding adults and any 01/05/2009 3 18 17 (1)(a) Care Homes for Older People Page 29 of 31 4 18 13 (6) 5 38 37 (1)(2) action that is taken. Records must be kept to show what action the home is taking to protect the individuals that live at the home. The registered person must 07/07/2009 ensure that staff receive training in safeguarding adults. Staff must receive training in safeguarding adults in order to protect the individuals living at the home. The registered persons must 01/05/2009 notify the Care Quality Commission regarding anything that affects the well being of individuals at the home under Regulation 37, within expected timescales. Te CQC must be informed of all occurrences that affect the well being of individuals who use the service. 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 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. 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