Inspection on 17/08/09 for Oak House

This inspection was carried out on 17th August 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

Oak House 17/11/09

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Oak House Oak House Wexham Road Slough Berkshire SL2 4HF     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: Julie Willis     Date: 1 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Oak House Oak House Wexham Road Slough Berkshire SL2 4HF 01753528419 01753572463 manager.oakhouse@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care UK Community Partnerships Ltd Name of registered manager (if applicable) Mrs Amanda Wendy Jane Marsh Type of registration: Number of places registered: care home 120 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: (1) The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary need on admission to the home are within the following categories Old age, not falling within any other category- (OP) Dementia - (DE) (2) The maximum number of service users to be accommodated is 120. Date of last inspection 120 0 Over 65 0 120 Care Homes for Older People Page 4 of 29 Brief description of the care home Oak House is operated by Care UK. It has 120 beds divided into eight, 15 bedded units. It provides residential, nursing and continuing care to older people, some who may be suffering from dementia. The cost of the service varies between 750 and 900 pounds per week. Care Homes for Older People Page 5 of 29 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 unannounced inspection took place on Monday 17th August and Tuesday 18th August over the course of 12 hours. It was a thorough look at how well the service was doing. It took into account detailed information provided by the services Manager and any information that the CQC has received about the service since it opened for business in March 2009. This was the first inspection of the service. Prior to this visit an AQAA (Annual Quality Assurance Assessment) questionnaire was sent to the Manager along with surveys and comment cards for residents and other professionals. Responses were used to provide the inspector with information about the service. Consideration has also been given to other information that has been provided to the Commission since the home opened. The inspector toured the building, examined records and met most of the residents and any relatives that were visiting at the time of inspection. The inspector also spent time Care Homes for Older People Page 6 of 29 talking informally to staff and observing how care was being delivered to the residents. As part of this inspection the inspector attended a safeguarding meeting with members of Senior Management from Care UK. From the evidence seen and comments received the inspector considers that this service has an awareness and understanding of equality and diversity issues and would be able to provide positive outcomes for residents in the areas of race, ethnicity, gender, sexuality, disability and belief. The inspector gave feedback about her findings to the Acting Manager and Operations Manager at the end of the inspection. The cost of the service varies from 750 to 900 pounds per week. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 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 9 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with sufficient information to enable them to decide if the home will be able to meet their needs. People are assessed prior to admission however, the quality and detail of the assessment are not always sufficient to enable staff to know how to provide the right care. Evidence: The Statement of Purpose and Service User Guides are sufficiently detailed to enable a potential user of the service to decide if the home is right for them. A welcome pack is provided to each resident on admission which is in easy to read plain English and gives an overview of the services on offer at the home. It contains a copy of the written contract, which sets out in detail what is included in the fee, the role and responsibility of the provider and the rights and obligations of the individual. The Care Homes for Older People Page 10 of 29 Evidence: Statement of Purpose is specific to the home and clearly sets out the homes aims, objectives and philosophy. From examination of documentation it is clear that all residents are assessed by a senior member of staff from the home prior to admission. The quality and content of the six assessments examined, varied considerably in the quantity and quality of their detail. In the case of three people, the content of the assessment was minimal and there were large parts of the form that had been left blank. Others were highly detailed and contained sufficient information to enable staff to draw up a preliminary care plan. Information had been gathered from a variety of sources and covered all essential areas such as physical and mental health care needs, cultural and faith needs, method of communication, family and social contact, activities and leisure activities. The information in the main was clear and concise and had been gathered from a variety of sources including the resident themselves, friends, relatives, advocates and other social & health care professionals. From the information gathered a decision is made as to whether the home can meet the needs of the user or not. The home insists on receiving a copy of any care management assessment at the point of referral. In each file examined it was clear that the decision to place individuals at the home had been decided by a multi disciplinary team of professionals along with the resident and their families. All service users and their relatives are invited to the home to look around and to meet other residents and staff. Following admission all users are offered a trial period of 4 to 6 weeks before the home admits them fully. The inspector had the opportunity to speak with a number of the current residents and their relatives. One resident said, Its not bad here, I have a nice big room and the foods alright, Ive no complaints really but its not like your own home. A relative said, This is an impressive building, Mum seems to have settled in OK. Care Homes for Older People Page 11 of 29 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. The care plans & risk assessments do not provide sufficient information for staff to be able to provide safe and appropriate care. Residents are not always provided with care in a manner, which maintains their right to dignity, privacy, independence and choice. Medication administration systems are not always followed putting residents at risk. Evidence: Paper records were being developed at the time of inspection, but in the main information about the residents is stored on the Saturn computer system. Four of the care plans that were viewed on-line, appeared minimal in content and did not provide sufficient information to enable newly employed or agency staff to meet the needs of users effectively or safely. There were large gaps in some of the records. One resident had no weight chart and no bathing or showering risk assessment in place. Another had large gaps in their daily records. Risk assessments were highly prescriptive in content and did not provide staff with sufficient guidelines to reduce the hazard Care Homes for Older People Page 12 of 29 Evidence: identified. This was particularly relevant in relation to people at high risk of absconding or behaviours that may at times challenge the service. The inspector was informed that two residents had left the building in previous weeks but no records could be found to evidence this. Neither were there any risk assessments in place to identify that the residents posed a high risk. This matter was drawn to the attention of management who undertook to remedy the situation immediately. The Saturn system does however, carry out a range of assessments such as nutritional assessments, continence assessments, Barthel Index, mental health assessments, falls risk assessments, personal and night care needs assessments. The system also provides access to Braden and Waterlow Scores which are used for assessing risks associated with tissue breakdown. It is not clear how useful these assessments would be to new staff or agency workers as they need to be viewed online, which requires a certain level of training and computer literacy. The home has already identified the difficulties and shortfalls of the system and have been trying to improve the quality of both the computer held and paper records. At the time of inspection, Senior Managers and practitioners from other homes were working hard to improve the quality of the care plans overall. The inspector had the opportunity to examine several of the revised records following their completion. They were significantly improved in content and more person centred. Staff spoken to during inspection expressed dissatisfaction with they way they had been moved from one unit to another and felt that they were being given conflicting advice from different nurses and members of management. The key worker and named nurse system do not appear to be operating effectively in the home which does not provide continuity of care to residents. Service users confirm that they regularly see their GP and are referred to hospital when necessary for further advice, support and treatment. Routine screening and preventative treatments are provided to all residents of the home. On the first floor of the home there are respite beds and also beds used by Slough Borough Council Intermediate Care Team. It was clear from discussions with staff that there have been problems with communication between intermediate care professionals and staff at the home. At the time of inspection Intermediate Care Workers were not invited into the staff hand overs and had separate paper files from those being used elsewhere in the home. The Intermediate Care Team also had no access to the Saturn computer records which made it difficult for the staff to know what had happened to Intermediate Care residents when they were not on duty. This does not provide continuity of care for residents. There is a need to improve Care Homes for Older People Page 13 of 29 Evidence: communication between the two teams of staff as it was clear that staff of the home were not following the care plans of those people liable to return home. There was little evidence of promotion of self care in the unit since intermediate care residents had no opportunity to administer their own medication and had no access to the kitchenette in order to prepare drinks and snacks for themselves. There is a need to retrain staff in manual handling as poor and unsafe handling was observed during this inspection. A staff member was seen pushing a wheelchair without footplates, when challenged about this dangerous practice, the staff member tilted the wheelchair back wards onto its rear wheels causing alarm and distress to the resident and posing serious risk of injury to the resident and to the staff member themselves. Poor manual handling technique has also been identified in recent safeguarding meetings as a subject of concern. Staff were observed in general to provide residents with personal care in a discreet and sensitive manner. Residents were addressed courteously and staff knocked on service users bedroom doors and waited to be invited in before entering. Some very good practice was being provided by individual members of staff. One resident was found very distressed in the gardens and was calmed down and persuaded to sit down and chat by a member of the housekeeping staff. Senior staff have been trained in the administration of medication. A monitored dosage system is in operation at the home and medication is delivered to the home on a weekly basis. Storage systems are effective and disposal systems are safe. There was evidence in the Regulation 37 and complaint records of medication errors. The home has recently introduced regular weekly audits to address the issues raised and to ensure that staff are complying with policies and procedures and legislative requirements. The content of Regulation 26 Proprietors Representative visits have repeatedly identified medication as an area that requires improvement. The inspector spoke at length to six service users about their quality of care. All confirmed that they were happy with the quality of care provided by the home and felt that the staff were doing their best and were kind and considerate. The residents could not say if they had been involved with the way that their care was being delivered as they seemed unaware of any records kept about them. Care Homes for Older People Page 14 of 29 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. Service users are provided with the opportunity to participate in a range of leisure activities, trips out to a local garden centre and entertainments. Service users are encouraged to maintain contact with the local community, their friends and relatives. The meals in the home have improved since a new chef has been in post and the menu offer users both choice and variety. Special dietary needs can be catered for effectively. Evidence: The home employs two activity organisers, one full time and one part time and there is a further vacancy for another full time activity organiser. Observation of practice concluded that both organisers are enthusiastic about their roles and are keen to engage residents in stimulating worthwhile activities. Activities are specifically designed with the preferences and capabilities of users in mind. At the time of inspection users were engaged on the first floor with printing and craft work which they appeared to enjoy. Several residents were being escorted to the neighboring garden centre by members of staff. The inspector was informed about Care Homes for Older People Page 15 of 29 Evidence: plans to put in a new gate to enable easy access to the garden centre next door for residents. The home is organising a barbecue for residents and their relatives in forthcoming weeks. Horse-racing is a particular favourite of residents and movies are shown frequently in the ground floor cinema. The home has regular sessions of Music for Health which is particularly well received by the residents. The home was preparing for its summer garden party and items were being made in the activity sessions for sale. One resident said, I always join in, I cant see the point of missing out, the days are long otherwise another said I would like a little more entertainment, its a bit quiet otherwise. Residents are actively encouraged to keep in contact with friends and relatives and they are free to visit anytime. One relative said, I never feel in the way, the staff make me feel most welcome. Relatives can spend time alone with the users or are free to spend time in the communal areas. The Chef is well aware of the needs of the users and can cater for special diets and the specific cultural needs of each user.A cooked breakfast is offered each breakfast time along with fruit juice, grapefruit segments, prunes, cereals, porridge and toast with various preserves. The inspector spent time with the new chef and was shown around the kitchen which was clean, hygenic and well equipped. The menu at the home has been developed in consultation with the residents and is varied and nutritious. The lunch consisted of pork chops topped with sliced apple or asparagus flan or mixed salad. Lunch was served with creamed potatoes, sliced green beans and sweetcorn. Rhubarb crumble and custard followed. Residents said that the food was much better than it had been, very tasty and plenty of it and good grub here. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system. Residents feel their views are listened to and acted upon. There is a need to ensure that all staff understand what constitutes neglect or abuse as poor care practice puts residents at risk. Evidence: The service has a complaints procedure, which is up-to-date, clear and accessible to residents. The complaint policy in the home meets the requirement of Regulation and Standard. Residents are provided with information on how to make a complaint to the home, the time scale for response, and the stages and procedures if they remain dissatisfied. Examination of the complaint records indicated that there have been ten complaints made to the home since the home opened in March 2009. The details of the complaints were well documented and evidenced the investigations undertaken and the outcome provided to complainants. One matter concerning the failure to administer medication resulted in disciplinary procedures being taken against the staff members concerned. There has been no information about complaints about the service reported directly to the CQC about the home since it opened for business. However, five concerns have Care Homes for Older People Page 17 of 29 Evidence: been dealt with by the Local Authority under safeguarding adult procedures. As part of this inspection the inspector went to a safeguarding meeting concerning the care of a resident. The matters raised in the initial complaint had been fully addressed by the home. Residents generally felt confident that if they raised concerns they would be taken seriously by the home and efforts would be made to remedy any problems in a timely fashion. One resident said, Ive no complaints really, I would soon say if I had. There was evidence in staff files, the training matrix and from discussion with staff, that the majority of staff have received training in safeguarding vulnerable adults as part of their formal induction to the home. This learning is later consolidated when undertaking NVQ training in which it forms a core module. It is not clear however, if the staff fully understand how to put theory into practice as there have been several incidents of poor practice which have resulted in complaints and safeguarding referrals. Care Homes for Older People Page 18 of 29 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. Standards of decor and furnishings in this home are excellent quality and offer residents a comfortable and homely place to live. Residents benefit from living in a clean and hygienic home Evidence: Oak House is a new purpose built home. It has the aids and adaptations it needs to meet its frail elderly population. A tour of the home evidenced that the home was well maintained, clean and odour free. All furnishings are domestic in character and provide a pleasant environment for the residents. Communal areas were spacious bright and airy and well used by the residents. There is a cinema on the ground floor which shows movies and a hairdressing salon which is well used by the residents. Residents spend much of their time in the large spacious areas in the atrium of the building. Here they can watch the comings and goings of the home. This area is the focus of the homes activity programmes and on the first floor there is a piano which residents may use without disturbing other residents. On the top floor there is a kitchenette designed to enable residents to take part in domestic and catering activities. There are pleasant gardens to the rear of the property which are easily accessible. Care Homes for Older People Page 19 of 29 Evidence: They are enclosed by a fence and may be accessed by people with mental frailty without fear of people wandering from the premises. There are wild life gardens with eco friendly areas for local wildlife. There is a wildlife pond area in the centre of the gardens which is protected by a gate and railings so that it remains safe. There are plans to renovate the pond area to make it more interesting and attractive for residents. The laundry is well equipped and staffed by people that show commitment and pride in doing a good job. There have been difficulties returning clothing to its rightful owner as many items are unmarked however, procedures have been put in place to remedy the problems and there have been less complaints about wrong laundry in recent weeks. All staff have received training in infection control and were observed to use personal protective equipment appropriately. From discussion it was clear that all domestic staff understand the need to use appropriate cleaning products and chemicals safely and have had health & safety and COSHH control of substances hazardous to health training. Residents and their relatives made comments such as its a lovely building, just like a luxury hotel, I m very impressed with the design of the home, its beautiful, who could complain, its lovely here. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The skill mix of the staff team is appropriate for the size, layout and purpose of the home. Recruitment policies and procedures at the home are robust and transparent and ensure the safety of residents. Staff incompetence in relation to manual handling puts residents at risk Evidence: The inspector examined the staff files for ten employees. The content of the files met the National Minimum Standards and Regulations. From discussion with staff and management it was clear that the policies and procedures relating to selection and recruitment ensure residents safety and is robust, transparent and meets the requirements of current good practice guidance and legislation. All care staff have undertaken a full induction to Skills for Care standard during which they received training in the values & visions of the organisation, manual handling, infection control training, fire awareness, food hygiene, safeguarding adults, health & safety and first aid. Staff are also encouraged to gain a professional qualification in care. Examination of Care Homes for Older People Page 21 of 29 Evidence: the staff files and training records evidenced that many of the current staff have gained NVQ qualifications before they transferred from their previous employment. A number of the staff have NVQ level 2, 3 and 4. Others are being supported and encouraged to register onto NVQ programmes including the catering and ancillary staff. In addition a number of staff have also undertaken other training to enhance their knowledge and skills including activity based care, continence training, hoist training, medication training, record keeping, key working & named nurse training, Saturn training, dementia care training and customer care. From examination of records including the training matrix there is no evidence that staff that have received any training in the Mental Capacity Act and Deprivation of Liberty legislation to enhance their knowledge and skills about these important matters. It is not clear how peoples learning is tested following formal training as a member of staff observed during the inspection was unable to demonstrate safe handling knowledge and failed to put theory into practice. In light of recent safeguarding matters and observation of poor manual handling practice during inspection this is a cause for concern. Staff confirm that they regularly attend team meetings at which they are encouraged to express their views and opinions. However, there is an acknowledged shortfall in the frequency of formal one to one supervision. A system of supervision is currently under development, which will cover all aspects of practice, philosophy of care in the home and identifies each staff members career development needs. There is a need to review staff deployment in the home as staff spoken to during the inspection said that they were continually moved between units and onto different floors which does not provide continuity for residents and is disruptive for staff. The residents and relatives were complimentary about the staff team. Comments such as they work very hard, they are kind and friendly and I like the staff here, they are much more friendly than I thought they would be. Care Homes for Older People Page 22 of 29 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. A lack of continuity and effective management monitoring systems put residents at risk. The policies and procedures regarding residents finances safeguard their interests. Evidence: An Acting Manager is currently managing the home in the temporary absence of the Registered Manager supported by Senior Managers of Care UK. Staff say that the lack of continuity of management styles is causing them some concern but they generally remain optimistic, motivated and keen to do a good job. Communication systems in the home are poor. This was evidenced on the intermediate care unit when an intermediate care worker was not informed that a resident for whom they had been caring, had fallen over at the weekend. Likewise, staff of the home had not followed the care plans for intermediate care residents, providing a lack of continuity. Care Homes for Older People Page 23 of 29 Evidence: The lack of an effective formal structured supervision system adds to communication difficulties as there is little opportunity for staff and management to discuss areas of concern or to evaluate staff performance. There is no system for determining individual members of staffs training needs. There appears to be ineffective mechanisms for evaluating staffs understanding of the training they have received and little monitoring of individual staff members performance in their job role. There is a lack of effective management monitoring systems in the home and this has been recognised by the Organisation. Recent safeguarding investigations have highlighted a number of shortfalls in the quality of care at the home and has demonstrated some gaps in training. The lack of effective care plans and risk assessments and lack of communication between the home and the intermediate care team puts people at risk. The Organisation is keen to receive feedback from the residents and visitors to the home and has surveyed service users since the home opened. The outcomes of the surveys are being used by management to identify key areas for improvement. There is a comments and suggestions box in the reception area where peoples views and opinions are actively encouraged. The inspector spent time with the administrator and examined the procedure for managing residents monies. The system appeared to appropriately safe guard users from financial abuse. The residents cash accounts are held on computer and also in hard copy as a back up. Receipts were on file for monies spent on behalf of residents. Residents and relatives confirm that they are kept informed of what is going on in the home and have opportunities to express their views and voice concerns. Residents say that the office is always open and accessible and the manager will always make time to speak with them. The Manager of the home carries out a number of quality audits every month, which cover all aspects of service provision. The outcome of the audits are then validated by a Senior Manager and presented in the Organisations management meetings. A senior manager carries out a Proprietors Representative visit each month as required by Regulation 26. The latest visit reported that general progress is being made in all areas. Senior management are aware of recent difficulties and concerns and are working hard to remedy any deficits in the quality of the service provided to residents. Examination of health & safety records indicated that they were up to date and in Care Homes for Older People Page 24 of 29 Evidence: good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals in general to maintain the home as a safe and risk free environment for residents. There was evidence of poor quality risk assessments being carried out and a lack of effective risk management strategies being put in place for people deemed to be at high risk. Risk assessments, guidelines to reduce likelihood of occurrence and incident records for residents who have absconded from the building were not available. Observation of manual handling practice and feedback from safeguarding meetings evidenced a lack of staff knowledge about safe manual handling operations. There is no system in place to evaluate peoples learning following training sessions to ensure staff are competent and have understood what they have learned. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 3 14 A full and comprehensive assessment should be carried out by suitably qualified staff prior to a new residents admission. All information required for the care of the individual should be included in detail. To ensure that the home will be able to meet the individuals need effectively. 19/10/2009 2 7 15 Ensure that all care plans both written and computer records are kept up to date and accurately reflect the needs of the residents. To ensure that staff are fully aware of the needs of each resident and to protect residents from harm 19/10/2009 3 18 18 Ensure all staff at the home understand how to safeguard adults from abuse, neglect and exploitation. 19/10/2009 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To protect residents from harm 4 30 18 Ensure all staff are fully competent to carry out manual handling tasks To protect residents from risk of injury 5 36 18 All staff should receive 19/10/2009 regular formal supervision at least six times a year To protect residents from harm 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 19/10/2009 Care Homes for Older People Page 28 of 29 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). 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