Inspection on 06/07/09 for Acorn Lodge Care Home

This inspection was carried out on 6th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Acorn Lodge Care Home 22/09/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Old Forge Care Home Beazley End Braintree Essex CM7 5JH Lead Inspector June Humphreys Key Unannounced Inspection 6th July 2009 09:00 DS0000071782.V376646.R01.S.do c Version 5.2 Page 1 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. 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. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 2 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 Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Forge Care Home Address Beazley End Braintree Essex CM7 5JH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01371 850402 oldforgecarehome@btinternet.com Eden Health Care Manager post vacant Care Home 20 Category(ies) of Dementia (20) registration, with number of places Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is 20 22nd September 2008 2. Date of last inspection Brief Description of the Service: The Old forge is a purpose built home for older people, situated in the rural setting of Beazley End, Braintree Essex. The new owners, Eden care have extensively refurbished and converted the home to provide 24 hour care for 20 older people, who may also suffer from dementia. Accommodation is all on one level and all single rooms have ensuite facilities. There is parking to the front of the home, and a large secluded garden, with a patio area available, to allow easy access for wheelchairs, and people who are less mobile. The current scale of charges is between £440.00 to £600.00 per week, with additional charges for personal items (toiletries, hairdresser, newspapers, chiropody, etc.). Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is o star. This means that people who use this service experience poor quality outcomes. This routine unannounced inspection visit took place on the 6th July 2009 and completed by two inspectors, June Humphreys and Claire Hutton who spent nine hours at the home covering all the key national minimum standards. The inspection process included talking to residents with dementia where possible, observations of staff talking to residents, information given to residents about the home before they came to live there, and most importantly how information is given to staff who provide care for the residents in the home. A tour of the building was undertaken, looking at the facilities and the environment where residents live. A sample of documentation maintained in the home was looked at to ensure the health and safety of residents is considered at all times. Five surveys were received from staff, residents, relatives and professionals who know the service. Six staff was spoken with, and discussions were held with the manager, and the deputy. We have used the information received within this report. This report also takes into account all the information CQC had received about The Old Forge since the last inspection including information provided by the service, stakeholders, professionals who have worked in the home, and also the people living at the home and their families. What the service does well: Residents expressed mixed views on the quality of the food provided, some saying it was always good and others rating it ‘as basic.’ The meals served at lunch on the day of the inspection were well presented and looked appetising and the menus seen were varied and well balanced. Residents’ bedrooms were tidy and contained personal items. Satisfactory bathroom and toilet facilities are provided. Special equipment for example Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 6 hoists and assisted baths are provided which ensures residents are supported safely and there was evidence that these are maintained and serviced as appropriate. The home has recently been awarded 5 star food hygiene certificate following an inspection by EHO. What has improved since the last inspection? What they could do better: From the evidence gathered during the inspection there are a number of shortfalls that require attention that would improve the outcomes for people who live in the home substantially. Whilst the home has been refurbished by Eden care the new owners, and generally is a pleasant environment to live in. There was an unpleasant smell of urine in the home throughout the day of inspection. Residents and relatives had said that the windows in the home were left opened and this meant the home was cold. The manager must find a means of controlling the odour within the home that does not impact on the wellbeing of the residents All parts of the home must be kept in a good state of repair in order to provide residents with a safe place to live i.e. the ceiling walls in the laundry area are cracked and peeling, and therefore difficult to keep clean. The chemical products used for cleaning were left out on the work surfaces, which could be a danger to residents. Social and recreational needs of residents should clearly show the action required by staff to help residents occupy their time and engage in activities or social interaction of their choosing Staffing levels within the home do not ensure that residents are supervised to a satisfactory level. Residents can wait for a long time before staff come to assist them. Not all of the staff members within the home were seen communicating with residents. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 7 The home’s annual development plans should include the promotion of dementia care and further training for staff that will be caring for people with dementia, contain objectives that reflect aims and outcomes for residents and are specific, measurable and time limited. 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. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are not aware of what the service provides however residents’ needs are identified through a thorough assessment undertaken prior to their admission EVIDENCE: On the day of inspection there were several different copies of the statement of purpose within the home. The manager was unable to confirm which was the current working document. The statement of purpose must be updated to clearly identify the types of people that will be admitted to the home, and how their needs will be met. It would benefit from being written in a clear, more user-friendly format. At the home’s first inspection in September 2008 initial assessments had not always been completed prior to people being admitted. The home relied heavily on the information provided from health professionals and social Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 10 services. A requirement relating to the need for the home to improve assessments was made as part of the last inspection. At this inspection we requested to look at the four most recent assessments completed, which were selected by the inspector. One assessment was not available has the paperwork was stored in the proprietor’s office upstairs which the manager did not have access to. The other three assessments requested were of a good standard i.e. “person has vascular dementia “, and the assessment clearly outlined what the person’s needs were and how the staff need to assist the person. Another assessment identified that the person had a pressure sore, and that “skin integrity is soft, brittle”, and how staff should monitor, and record care provided. All three assessments had been completed by the new manager Joanne Newland. Stakeholders who place people at the service have also expressed concern relating to assessment and care plans completed within the home over the last nine months, but evidence collected on the day of inspection demonstrated a clear improvement. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 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. Each individual within the home has a plan of care; however, these do not consistently reflect the care that is being given. EVIDENCE: Three care plans were looked at as part of this inspection. The quality of care plans has improved since the last visit in 2008. Information relating to health care needs had been updated and was clearly written by the new manager i.e. “pressure sore, grade 3 on sacrum”. “Use wheelchair and hoist to transfer, reposition two hourly”. There was evidence that supporting records have been completed by care staff, however it was evident that actions that had been taken by staff had not always been recorded in the daily care notes. Referrals to outside professionals had not always happened i.e. lack of early intervention from the district nurse service, despite information in initial assessments and care plans that would warrant careful observation and Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 12 monitoring from the date of admission. This resulted in Essex County Council issuing a breach of contract letter. Improvements seen at this inspection indicated they were of as a direct result of the safeguarding alert, the letter stated above and the significant amount of work by the new manager in working with care staff in relation to recording. Fluid and food intake charts are now in place, although they were not dated on the day of inspection. Body charts were also seen to be completed on all residents admitted from hospital. There does however continue to be inconsistency in the quality of care offered to residents. Evidence from talking to professionals, relatives, residents and observations of staff practice on the day of inspection confirmed that information in care plans are not fully acted on due the numbers of staff on duty, and the experience and skills of staff who work with the residents. The issues relating to staff is discussed in greater detail in the staffing section of this report. Examples relating to the care offered are as follows. The resident’s care plan identified that there was an issue relating to nutrition and weight loss. The care plan clearly outlined the need to ensure the person has supplement drinks, food and fluid intake charts had been completed. However the home does not have any means of weighing the person, i.e. sit on scales, and therefore the person’s weight had not been properly monitored. Staff and residents were observed within the main communal areas. It was of concern to note that a resident called out from her bedroom requesting assistance from a carer. The person’s bedroom door was left open and we observed for several minutes as the person struggled to deal with her own continence needs. We alerted staff that the person was calling for help but when walking past the person’s room 10 minutes later observed that the person was still attempting the same task, and had not been fully assisted by staff. From observation there were two staff dealing with another resident who was exhibiting challenging behaviour, and a further staff member administering lunchtime medication. A further example was provided by a professional who visited the home. They stated that two shared rooms within the home offered no privacy/dignity to residents and that a medical procedure was undertaken with one person, with no curtains being available to separate the room from the other person. The manager confirmed that the two shared rooms were numbers four and six. We noted on the day of inspection that these rooms are currently unoccupied and should not be used as a shared room until the current situation has been rectified by the installation of curtains. These examples demonstrates that residents needs do go unmet, and at times people’s dignity is not upheld. At the inspection there were four different medication policies seen. The most current was unknown. Each one had slightly different wording, and lack of clarity of what staff should be doing when administering medication. The policy needs to be reviewed and updated, and only one should be in operation to ensure staff is clear in relation to the home’s procedure. There was no clear instruction with what to do with medication that had been refused or dependent on the medication whether this should be referred to the person’s Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 13 GP. Refused medication was being stored in individual marked bags. However it was difficult to ascertain the numbers of refused tablets against the medication records (MAR sheets). One MAR sheet did not clearly state the amount to be administered. It stated “As directed on prescribed meds”. This is not adequate for staff to follow. Not all staff who were administering medication had completed the training which was stated should be completed in the various versions of the medication policy. One person who had not attended training was a senior member of staff and was involved in the training of new junior staff. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 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. People’s choices about taking part in activities that meet their needs are not met and this is further hindered by the staff team who do not engage with the residents on a daily basis. EVIDENCE: The day activities available within the home are limited, and do not ensure residents individual needs and interests are met. On the day of inspection the only activity offered was Bingo. Several residents spoken with would not have been able to join in this activity due to their level of dementia. The activity did not happen as scheduled and most residents were observed to sit in the lounge area, or go to their bedrooms. The activities programme was looked at, and did not offer any specialist activities for people with dementia i.e. reminiscence activities. The current ratio of staff does not allow for small groups, or one to one activities. Staff have not attended training relating to engaging people with dementia. There is no separate room to offer activities, and the T.V remained on in the lounge throughout the inspection. Several residents were seen not to be Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 15 watching the T.V, and appeared disengaged, as if it was just background noise. Residents observed, and spoken to with indicated they quite contented in the main part. One person who was able to express a view said “I read my books most of the time, that’s what I like to do”. There was also little evidence of positive staff interaction witnessed during the day other then when the deputy manager was administering medication and spoke to each person prior to offering them their medication. The five residents who were administered medication had spent at least an hour prior to lunch, and a further thirty minutes sitting in armchairs with limited, or no communication from a carer. It was easily observed that the interaction from the deputy was welcomed, and responded to. The home encourages visitors and several relatives confirmed that they were able to visit when they liked. One stated that there was usually a member of staff in the lounge, but they always appeared very busy, and little time was spent actually talking to residents. Another person said the home could improve by “Getting more staff and more time to keep the residents busy as they sleep too much”. The proprietor stated at the last inspection that it is the intention to appoint “an activity officer, who is knowledgable, and skilled at engaging people with dementia in meaningful activities.” Two activity officers had been appointed since September 2008, but there was no evidence to suggest that there had been any substainable improvement in what was on offer. The proprietor advised that a further appointment for an activity coordinator was in the process of being completed. A repeat requirement has been made as part of this inspection. Meals observed on the day of inspection smelt and looked appetising. The cook personally came to the dinning area and helped serve the meals. She spoke to residents, and asked them if that was what they had asked for. Earlier in the Morning the cook had spoken to each person, and went through what was on the menu and tried hard to ensure that they chose what they would like. Care plans do not include information relating to likes and dislikes, particularly in relation to the area of food and this would be particularly useful in reference to residents who have dementia and are deteriorating, and may not be able to choose in the future. in reference Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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. Residents cannot be assured that their concerns or complaints are investigated or recorded. EVIDENCE: The home has a complaints policy, but there continues to be no record of complaints received or investigated. From a discussion with a resident they stated that they had complained about not liking a particular meal but the same meal was provided on another occasion. This had not been recorded. Several other residents confirmed that they were aware of the complaints procedure, and did know how to complain, but a high percentage of the current residents find difficulty in communicating and would not be able to articulate their concerns, and would be very much reliant on family or advocates to raise concerns on their behalf. There has also been instability within the staff team which has meant residents have not been able to develop close relationships with staff, which further hinders a resident making a verbal complaint. Staff interviewed reported that there were cultural language difficulties both within the team, but also in communication with the proprietors. There was no evidence of regular resident’s meetings, or individual meetings between keyworkers and residents. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 17 The Manager must demonstrate that residents views are actively listened to on a regularly basis and that all complaints/concerns are recorded. The home would benefit from an outside advocacy to facilitate opportunities for residents to ‘speak out’, as the home is registered to cater for people with dementia, and only the new manager has completed a specialist course in working with people with dementia. Several care staff had attended safeguard training, but when interviewing these staff they were not fully conversant about what was expected of them. Most said that if they received an allegation or witnessed inappropriate practice they would speak to the manager. In the last twelve months there have been four new managers and the number of safeguarding alerts that have been made externally demonstrates a lack of understanding and knowledge of the process for reporting concerns. Staff spoken with could not confirm what they would do if the allegation was against the manager or the proprietors and therefore residents cannot be assured that they will be listened to and protected at all times. Staff who had completed the training had also left, and therefore there were a number of new staff who had not completed the training, on the day of inspection. The manager must demonstrate that all staff has received safeguarding training and that the training provides staff with sufficient information on how to recognise abuse, and the whistle blowing process. Staff must be able to use local procedures appropriately, and to refer any concerns that they may have, whenever necessary. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 19 20 and 26 Residents cannot be assured that their dignity and respect is maintained and not assured their safety is paramount. EVIDENCE: The home has been refurbished by the new owners, Eden care, and generally is a pleasant environment to live in. However there is a number of short falls that need to be addressed. There was an unpleasant smell of urine in the home throughout the day of inspection. This was particularly prominent in one person’s bedroom Residents and relatives had said that the windows in the home were left opened and this meant the home was cold. On the day of inspection a limited number of windows were observed to be open. The proprietor stated that the Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 19 home’s staff leave the windows open in the Morning to control the odour within the home. The manager must find a means of controlling the odour within the home that does not impact on the wellbeing of the residents i.e. windows being left open for long periods of time during the winter months. The resident occupying room seven has access from their bedroom to an outside patio area. This has the potential to be dangerous as there are no rails to the side of the ramp for the resident to hold onto. There is also foliage which is overgrown and needs to be cut back. As already noted in this report the two shared rooms within the home do not offer any form of privacy. I was advised by the manager that these rooms are vacant. Prior to being shared by two people the rooms must have curtains fitted to allow dignity and privacy when residents are receiving personal care, or professional health care. It is also important that prospective residents choose to share, and are compatible with the person they are sharing with. The initial assessment must clearly demonstrate that the home has consulted with the resident and that there are no concerns. The ceiling walls in the laundry area are cracked and peeling. They are not able to be kept clean. The chemical products used for cleaning were left out on the work surfaces, and the room was not kept locked. An immediate requirement was made to ensure residents were protected. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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. 27,28,29 and 30 Residents cannot be assured that sufficient numbers of skilled staff, with the relevant recruitment checks, are available at all times to provide adequate support ‘when they need it’. EVIDENCE: The home is registered to accommodate up to twenty residents. The numbers of residents living at the home has increased, from six residents to fourteen. Concerns were raised at the last inspection relating to the number of staff, and their ability to meet the needs of the residents. There has been an increase of one staff member on each shift although the number of residents has doubled. It is unclear how the proprietors have determined the staffing levels to meet the needs of the current group of residents. A number of people who were spoken with during this inspection, and several who completed surveys commented that at times “staff shortages impacted upon the care provided by the home”. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 21 On the day of inspection there were three members of staff working with the residents .The home has a new manager who had been in post for two weeks when the inspection was undertaken. She currently works Monday to Friday 9am to 5pm. The rota seen confirmed that three staff is currently on shift during the daytime’s time i.e. between 8am and 9pm with two waking night staff on each night between 9pm – 8am. Several staff spoken with acknowledged that communication, between residents and staff was a concern. Some members of staff, although being caring had very limited spoken English, and this made it difficult for staff to work as a team. This also meant that understanding residents needs, and providing the right level of care is sometimes difficult. One relative was concerned that staff speak to each other “in their own language’ and that this was confusing for the types of people who live in the home”. From the recruitment information available on the day of inspection there has been a high turnover of staff who have been employed in the home for only a short period of time. The staff that have remained are those who have accommodation within the home (located upstairs, separate to the residential service). Three recruitment records were looked at as part of the inspection. Two sets of records were incomplete and this does not adequately protect service users. One application form had been completed prior to interview, and then further information added at a later date. References were not authenticated and photos were not in place. One staff member’s file had no evidence of any references having been received. What was seen on the file were two testimonials which had been provided. These are not proof of previous employment. There is a training programme for staff which includes core training such as safe moving and handling, health and safety, fire safety, and safeguarding people. In addition training has also been provided by Essex PCT in respect of managing risks, and pressure area care. However, due to the number of staff who have left in the last twelve months, and also the ability of some staff to communicate and understand basic English the staff team are unable to be proactive in relation to key areas of daily care i.e. pressure care management. This has begun to improve because the new manager is very prominent in working with staff and residents, which has in the short time made a significant difference. The concern is that when talking to several staff on the day of inspection they were not able to provide basic information in relation to responding to safeguarding or managing concerns and complaints. Only one staff member could advise on fire evacuation, and the home did not have an evacuation procedure available. A number of staff are working at the home whilst studying to complete various N.V.Q awards. This is very positive, but remains a concern if basic day to day knowledge is not evident. Most staff stated in every case that if they had a concern they would report it to the manager, but staff needs to be able to be proactive especially in view of the Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 22 instability of the management team. Staff have also not received training in working with people with dementia which is a key area, as the home is registered to care for up to twenty people with dementia. Prior to the new manager, staff did not receive supervision, and team meetings were irregular. Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 31,32,33,35,36, 37 and 38 The residents cannot expect their health and well being to be protected by the current systems for monitoring practice. EVIDENCE: The home has been without a registered manager, since the new owners Eden care was registered in April 2008. In the last twelve months the proprietors have appointed four new managers, of which none have remained in post for longer then a period of three months. The current manager Joanne Newland was in post as the acting manager in July 2008, but had left the service prior Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 24 to the inspection in September 2008. In the absence of a full time Manager the proprietor has acted as the Manager. Due to the changes in managers, this has meant that staff and residents have not benefited from experienced and stable leadership. Combined with this a number of basic care staff have also left which has continually impacted on the quality of care that residents have been offered. One resident said “The staff are very nice, but there is a lot of changes of helpers and they have to get to know you”. Several visitors said that ‘staff were available, but not always as helpful as they would have liked’. Residents have not had the opportunity to develop good relationships with staff, and were not therefore prepared to share concerns they may have had. This related to the fact that most staff was always busy and task focused. There was limited evidence at this inspection of residents having the opportunity to express their views about how their care is delivered or to express their views about the way the home operates, for example through resident’s meetings. The home does not have any specialist advocacy services involved in the home which could support some of the residents who have limited communication skills and therefore unable to participate in this process. Health and safety issues within the home have been identified within this report. Several relate to the safety within the building and were raised within the environment section of the report. Immediate requirements were made in relation to the storage of COSHH products, and a plan of evacuation in the case of fire. Since the key inspection information has been received by the CQC which demonstrates that the manager is taking action in relation to the serious issues that were raised. The manager has worked hard to make positive changes since being in post. All of the staff members spoken with stated that there had been improvements at the home and that they found the manager to be approachable, knowledgeable and willing to participate in all areas of activity within the home. T Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 1 2 x x x x x 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 1 2 1 Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 Requirement All chemicals should be locked away and not accessible to residents who live in the home, to ensure they are safe from possible harm. IMMEDIATE Fire procedures including evacuation procedures should be known by all staff and form part of the risk assessments. IMMEDIATE The statement of purpose must be updated and clearly state the aims, objectives and philosophy of care including the types of people who can live in the home. This is to ensure the residents receive the service that meets their needs and protects them from harm. Care plans must be kept under review to ensure that all aspects of the person’s health, personal and social care needs are met, and that referrals to outside professionals are made in a timely manner to protect residents from physical harm. The manager should ensure that DS0000071782.V376646.R01.S.doc Timescale for action 06/07/09 2. OP38 13 06/07/09 3. OP1 4 (1) a &b 01/09/09 4. OP7 15 01/09/09 5. OP9 13 01/09/09 Page 27 Old Forge Care Home Version 5.2 there is one current medication policy which informs staff of good safe practices to follow within the home and keeps residents safe 6. OP9 13 Records of the administration of medicines must provide a clear audit trail and evidence that residents have received their medicines as prescribed. Medication that has been refused by residents must be accurately recorded to ensure residents are adequately protected from harm. The registered person must ensure that residents receive appropriate care and supervision which keeps them safe and protects their dignity. (This is in relation to residents not receiving appropriate personal care, and the inspector having to seek staff on a resident’s behalf.) Residents must be provided with regular opportunities to participate in social and recreational activities, which meet their needs both in, and outside the home. Information of activities and outcomes for residents must be clearly recorded. Date of 01/01.09 not met. Repeat requirement 14/08/09 7. OP10 18 14/08/09 8. OP12 16 01/09/09 9.. OP19 23 (2) (d) 10. OP19 23 (2) (b) Residents should benefit from a 01/09/09 home that is well maintained and fit for purpose. The laundry room wall which is peeled and cracked must be repaired to ensure possible spread of infection Room number seven must be 01/09/09 made safe to ensure no possible physical harm to the resident. (The patio area outside the bedroom has There no rails to the side of the ramp for the DS0000071782.V376646.R01.S.doc Version 5.2 Page 28 Old Forge Care Home resident to hold onto. There is also foliage which is overgrown and needs to be cut back.) 11. OP26 16 The service must eradicate the unpleasant odours from the home to ensure residents live in a pleasant, infection free environment. Staffing levels must be reviewed and maintained so as to ensure that residents’ needs are met. Staff must receive training in administering medication, dementia care and safeguarding, to ensure residents receive appropriate care, and are protected from possible harm. 14/08/09 12. 13. OP27 OP30 18 19 (5) (b) 14/08/09 01/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP36 OP31 Good Practice Recommendations The registered person shall ensure, that staff working at the home are appropriately supervised A permanent experienced manager should be appointed to review and develop the service. The manager should apply for registration with the commission Ensure that the complaints procedure for considering complaints, both written and verbal, made to any member of staff at the home by a service user or person acting on the service user’s behalf is documented effectively within the complaint record book/log. ‘As directed’ medication should have clear guidance for staff to follow and then staff should record why they administered this medication. 3. OP16 4. OP9 Old Forge Care Home DS0000071782.V376646.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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