Inspection on 02/09/09 for Oldfield Residential Home

This inspection was carried out on 2nd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oldfield Residential Home 09/02/10

Oldfield Residential Home 11/08/09

Oldfield Residential Home 28/05/08

Oldfield Residential Home 10/10/06

Oldfield Residential Home 27/02/06

Oldfield Residential Home 03/11/05

Oldfield Residential Home 09/02/05

Oldfield Residential Home 06/10/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Maple Lodge

Polesworth Group 32 Station Road

Heathlands

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Oldfield Residential Home Derrington Road Ditton Priors Bridgnorth Shropshire WV16 6SQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sue Woods     Date: 0 2 0 9 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 32 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 32 Information about the care home Name of care home: Address: Oldfield Residential Home Derrington Road Ditton Priors Bridgnorth Shropshire WV16 6SQ 01746712286 01746712411 oldfield@oldfieldcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Simon James Badland care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 45. 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: Old age, not falling within any other category - Code OP (maximum number of places 45) Dementia - Code DE (maximum number of places15) Learning Disability - Code LD (maximum number of places 1) Date of last inspection Brief description of the care home Oldfield Residential Home is a care home for older people, registered to provide accommodation and personal care for up to 45 people. The home is situated on the edge of the small Shropshire Village of Ditton Priors, which Care Homes for Older People Page 4 of 32 15 1 0 Over 65 0 0 29 Brief description of the care home is in is in a rural location therefore there is limited access to it by public transport. The property is a purpose built single storey building, and offers both single and double bedroom accommodation, some rooms provide ensuite facilities. The home has been extended in order to upgrade the living accommodation offered to the people who live there. The grounds are well-maintained with shrubs, mature trees, flower borders, lawns and woodland walks. The home makes its services known to prospective residents in the Statement of Purpose and Service User Guide. People are consulted about the service provided at Oldfield by questionnaires, that are given to people living at the home, families, friends and staff. In addition the manager regularly speaks with people to find out their views. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. The unannounced key inspection of Oldfield Residential care home took place on 2nd September 2009. The inspection started at 10.05 am and lasted six and three quarter hours. The inspection reviewed twenty one of the key standards (on this occasion we did not look at outcomes in relation to service users money) for care homes for older people and information to produce this report was gathered from the findings on the day and also by review of information received by the Care Quality Commission (CQC) prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the inspection we, the commission, met people who live at Oldfield and spoke with five people both in private and in small groups. We spoke in general with care staff, domestic and kitchen staff and we gave the deputy manager surveys to hand out to staff to complete if they wished. We received four back. Care Homes for Older People Page 6 of 32 As well as observing the daily routines of people living at Oldfield we also looked at four care files belonging to people who live at the home, four staff files and other records referred to within this report. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection that took place on 28th May 2008. This included; Notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. We found that we have received a high number of notifications in relation to people tripping or falling. We were also told that the manager of the home had left and that a new manager had been appointed. The Annual Quality Assurance Assessment. (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. The AQAA was completed by the manager who has now left the home but identified areas where she considered that the home was doing well as well as identifying areas where improvements were needed. Five allegations that have been made about care practices or incidents that have happened within the home within the last four months. The Annual Service Review that we carried out on 28th May 2009 suggesting that the quality of the service provided may have changed A complaint made to CQC in relation to standards within the home that was investigated by the registered provider. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Oldfield has been through a number of management changes that have impacted on the quality of the service provided. Although it is recognised that the home offers an acceptable quality of care there is a concern that a number of procedures need to be reviewed and tightened up to ensure that people living at the home are protected. Care Homes for Older People Page 8 of 32 Medication arrangements require review to identify why errors are being made when staff are receiving medication into the home. Protocols are also required so that staff administer medications taken as and when required consistently and when appropriate. Recruitment practices require significant attention. The manager and any staff involved in the recruitment of staff must know what pre employment checks they are expected to make and what actions they should take to ensure vulnerable people are kept safe. Overall quality will be improved by having care plans that are more person centred with information being gathered about the whole person including their goals and aspirations. Risk assessments that support activities of daily living are not always being reviewed and again this must happen to ensure peoples safety. An audit of the incidence of falls within the home will identify if any further actions can be taken to reduce the likelihood thus keeping people safer. Laundry arrangements are causing distress to people living at the home, their relatives and also the staff trying to manage them. A new system needs to be researched and developed to ensure that no one has to wear other peoples clothes and that the service can be delivered effectively within the hours allocated for the tasks. Staffing levels have meant that people have less opportunities to enjoy activities, both within and outside of the home. Call bells are not always answered promptly meaning that some one could need help and not be attended to and opportunities for people to have a cooked option of evening meal are restricted with current staffing levels. 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 32 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 32 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 who may like to live at Oldfield, or their representatives, are provided with the majority of information needed to enable them make a decision as to whether the home will be able to meet their needs. Additional information will further assist this decision making process. People who live at Oldfield have their basic care needs assessed before they move in. This means that the manager can be sure that the home is suitable for people who move in and they can meet their identified care and support needs. Evidence: The home provides information to people prior to their admission to tell them about the home and what services it can and cannot provide. The service user guide is readily available and informative about the services offered at the home. The statement of Purpose however did not contain required information meaning that people may not have sufficient overall information in order to decide if Oldfield is the right place for them. The manager said that she would update this document to Care Homes for Older People Page 11 of 32 Evidence: contain all required information and at a later date will produce all information in an easy to read format making it more user friendly. She also said that she would include in the document any environmental restrictions that may affect a persons access to certain parts of the home or restrict people entering and leaving the home as this information may also affect the decision as to whether the home is right for the person looking for residential care. People are only admitted after the manager has seen a copy of their assessments of need carried out by health and or social care professionals. Such assessments were seen on all care files seen and are supported by the managers own assessment carried out upon admission. People told us that they knew Oldfield before they moved in after living locally for many years. One person told us This is the place where I wanted to come. The home does not offer intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the people who live at Oldfield are generally met, with staff respecting peoples wishes and privacy enabling them to have a good quality of life however issues in relation to certain housekeeping arrangements mean that peoples dignity is not always being maintained. People are generally safeguarded by the homes system for handling, storing and administering medication although written guidelines, and better recording methods, to support the administration of medication taken as and when required will offer better protection and the home must identify a way of reducing human error when counting medication into the home upon admission. Evidence: Care plans were seen to be in place for everyone we met as part of the inspection. People told us about the care and support they need and expect and this was seen to reflect information in care plans. In conversations staff demonstrated an awareness of peoples care and support needs and again these were seen reflected in the care plans. Plans promote and encourage people to remain independent and one person told us that he was very happy that he could look after himself. Care Homes for Older People Page 13 of 32 Evidence: People who spoke with us in private and as part of a general discussion said that they were happy at Oldfield. People who were unable to speak with us looked comfortable and relaxed. Staff were seen to support people discreetly and sensitively giving people time to make decisions and were polite and courteous during all interactions seen. Staff had time to sit and talk with people. The care plans that we reviewed had all been developed after an initial assessment of need from either a health or social care professional and reviews were recorded as being held regularly and when peoples needs change. Although the plans contained basic care and support information the manager is planning to develop the plans to be more person centred in the future and include information about peoples life history for example so that staff can have a better understanding of the person they are supporting. Although staff were seen to treat people with the utmost respect an issue with the homes laundry arrangements are failing to enable peoples dignity to be maintained. A problem with the lack of suitable labeling of items has meant that it is not always possible to recognise whose clothes belong to who. There were piles of underwear items in the laundry that the laundry worker had no hope of identifying leaving it to staff to recognise items. This is unrealistic and on the day of the inspection a lady came to us and said she was wearing an item of clothing that was not hers and asked for someone to look into it. Later in the day the person was still wearing the clothes item that did not belong to her. People have access to see a GP or district nurse as needed meaning that the home is supported to ensure peoples health care needs are fully met and that people can remain at Oldfield while receiving essential treatment to keep them well. Staff said that the home does well looking after the residents. The manager has assessed peoples risk of falls and other areas where people had been identified as being vulnerable although there is still a high incidence of falls within the home and the manager is reviewing this to see if the home can take any more steps to keep people safe. Risks of everyday living were seen to have been assessed however had not been reviewed on all occasions as directed in the care plan. This may lead to people not receiving the right amount of support thus making them vulnerable. Medication arrangements at the home are satisfactory overall however despite the home having a system in place to record the amount of medication being received into the home staff are still making mistakes in the process thus leading to confusion as to whether a person has received their medication or not, or received too much. Despite initial staff training this is an ongoing issue and now requires an immediate solution to keep people safe. At the time of the inspection the manager said that she would do a full audit of medication on site and for the future ensure that two people sign Care Homes for Older People Page 14 of 32 Evidence: medication into the home thus reducing the risk of human error and thus protecting the people who live at the home. Likewise it was not clear when other medication, prescribed for as and when required, should be given and this may mean that the person could be given medication unnecessarily or inappropriately. The medication cabinet was well organised and there were no gaps seen in records for administration suggesting that the process overall is safe. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Oldfield enjoy a relaxed lifestyle and are visited by family and friends meaning that they can stay in touch with the people who matter to them. People currently have limited opportunities to be stimulated mentally or physically meaning that their expectations, preferences and recreational interests and needs are not being met. People enjoy a varied diet according to their assessed needs although options are sometimes limited by staffing levels meaning people cannot have a choice of evening meal. Evidence: On the morning of the inspection people living at the home were either relaxing, sleeping or doing crosswords, jigsaws or watching television. One person was having her nails done by a staff member. In the afternoon the deputy manager reported that a group of people were enjoying a game of skittles. The manager reported that the activities coordinator who had been appointed is currently working to provide care given staffing shortages but was confident that as staffing levels improved that she would return to this role. The main lounge was well used throughout the day although there are two televisions in there, one at each end. On the day of the inspection both were on different channels making it very difficult to hear either. The second television Care Homes for Older People Page 16 of 32 Evidence: was added to the room in response to a complaint that not everyone could see the one television. However a better alternative is needed as current arrangements have not resolved the initial problem. People living at Oldfield look forward to meal times. Everyone said they enjoyed the meals. On the day of our visit everyone was having steak and kidney pie for lunch. There was no alternative on the menu but the cook said that she would prepare something different if someone said they didnt like it. For the evening meal people had sandwiches and cake. The cook said that the alternative was beans on toast although this as not recorded on the menu board and in reality staffing levels would not have enabled staff to prepare a warm alternative if requested. The manager is aware of this problem and said that an advert has been placed to recruit an additional staff member to cover this time. We found that people do not have a real choice in relation to meals although people can choose where they eat. One person told us that he liked his meals in his room and his care plan reflected this decision. Tea time was observed to be quiet and unhurried. People ate in the dining room or in their own rooms as was their preference. There was no evidence that any specialist activities are arranged to involve, engage and stimulate people with dementia meaning that their social and recreational needs may not be being met. This means that some people spend their time wandering, or sitting alone with minimal interactions. One person who stayed in her bed at all times had a radio playing quietly in her room and according to her daily notes had regular visits from her family and friends. Although she had regular checks from staff there was no evidence that anything other than meeting her physical care needs were being met. Care Homes for Older People Page 17 of 32 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. People living at Oldfield are now protected by procedures in place for managing complaints, concerns and allegations of abuse and can be confident that their views and concerns will be listened to. People may be vulnerable however if people unsuitable to work with vulnerable people are not appropriately checked prior to their appointment. Evidence: Oldfield has a complaints policy and procedure that would guide the manager to investigate any complaints made about any aspect of the running of the home. People told us that they would tell someone if they had a problem and one person requested to speak with the manager at the time of the inspection re a concern and this was actioned immediately demonstrating the managers willingness to listen to people and make changes whenever possible. The home has received two formal complaints in relation to various aspects of the running of the home. The one complaint was largely not upheld but the home took action to make improvements as a result. The home is currently working with one family following the second complaint investigation that was upheld to improve the service provided to one person living at Oldfield. The new manager of the home is aware of procedures in place to safeguard people from abuse and ensure that any allegation is managed appropriately working with outside agencies to ensure openness and support for the vulnerable person. The home has a copy of the multi agency guidelines which it has followed since the appointment Care Homes for Older People Page 18 of 32 Evidence: of the new manager. We found that one incident had been reported to CQC but had not been referred to the safeguarding team. When we raised this with the home they promptly made the referral and have shown that they now work with all agencies to protect and safeguard the people living at Oldfield. The home has worked with the safeguarding team on five occasions over recent months. Allegations were substantiated on four of those occasions and the home has also taken prompt and appropriate action to ensure that staff found to be unsuitable to work with vulnerable people are not employed at the home and this ultimately protects people who live at Oldfield. Recruitment practices however have made people vulnerable and these will be referred to in the staffing section. Staff who spoke with us had all received training to recognise and report abuse and said they would be happy to refer any incident to the manager meaning that people can feel confident that abuse would not be ignored, thus keeping them safe. Records showed that the majority of staff have now received training in the Protection of Vulnerable Adults and Abuse. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at Oldfield is generally satisfactory however plans to refurbish bathing and toilet areas and redecorate and improve communal areas will make the home a safer and more stimulating place to live. Evidence: Oldfield comprises of two distinct areas. The original building and the extension. The extension is decorated and maintained to a good standard. The original building is in need of redecoration and refurbishment to make it safer and to reflect the needs of the people the home supports. For example the manager said that corridors need to be redecorated in neutral colours and handrails to be fitted to assist people when moving from one area to another. The manager was advised to seek advice in relation to providing a safe and stimulating environment for people with dementia as this would improve their overall quality of life. She has already started putting pictures on peoples bedroom doors to help them recognise their rooms when this is a problem. Bathrooms were not well used according to staff and the manager. People prefer the shower facility and en suites where available. However they are used by some and thus should be refurbished to make them safe and more hygienic. Likewise one toilet also requires work to improve the flooring. Bedrooms seen were spacious and personalised to peoples individual tastes. The main lounge was large with two televisions. The home uses an intercom system to communicate between the two areas. The home should look at the impact of both of these arrangements on the Care Homes for Older People Page 20 of 32 Evidence: people who live at the home. The front door was difficult to open. People had to ask the manager who was in her office to let them in as the door appeared to stick. The AQAA stated that the home now has a handy man who works full time on repairs and maintenance issues. The manager has identified a number of jobs she wants him to prioritise to improve the overall standard of accommodation and make the home more accessible to people living there and visiting. The home takes infection control seriously thus reducing the risks of any infection spreading within the home keeping people safe and well. The home was seen to be clean and free from offensive odours on the day of the inspection suggesting housekeeping arrangements are satisfactory. Plastic gloves and aprons were seen through out the home for staff to use and they were being used appropriately. Staff have received training in relation to infection control although the new laundry assistant was waiting for this training as part of her induction. She was aware of arrangements in place for storing laundry ready for washing and has already requested new laundry baskets to reduce the need or staff to have to carry dirty laundry around the home. The home took action to improve standards in the kitchen following a routine inspection from the Environmental Health Officer ensuring that the kitchen remains safe and hygienic. Care Homes for Older People Page 21 of 32 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. The people who live at Oldfield receive good care and support from a motivated and trained staff team enabling their needs to be effectively met within the home. People are not protected by the homes recruitment practices meaning that people who are unsuitable to work with vulnerable people may be employed putting people who live at the home at risk of harm. Evidence: Everyone who we spoke with said that enjoyed working at Oldfield The majority of staff felt that they had good support and training opportunities and training records reflected that all staff receive at least the minimum mandatory training, including training in relation to recognising and reporting abuse within the home, equipping them with the skills needed to carry out their roles safely and effectively while protecting vulnerable people. Care staff have not received training in more specialist areas such as dementia care and we consider that this training will better enable the team to meet the needs of people living at the home. It was reported that senior staff have completed this training and there are plans for all staff to attend. The manager is aware of the requirements for staff to receive regular and recorded supervision and will be priorotising this task. We looked at four staff recruitment files and found that not all information required to ensure that people are recruited safely was available. We also found that when issues Care Homes for Older People Page 22 of 32 Evidence: were identified during the recruitment process they had not been followed up to formally assess any risks to the people living at the home. As a result we could not be sure that the home had acted to ensure that only people suitable to work with vulnerable people were recruited thus potentially placing people living at Oldfield at risk of harm or abuse. We recognise that the manager has only been in post for two weeks however the organisation has senior managers who should have been checking that people recruiting staff were qualified and competent to do so. This had not happened. The manager told us that people living at Oldfield are not involved in the recruitment process. One person who started working at the home yesterday had not received an induction into her role and was unaware what her exact job role was. The manager said that she is priorotising the recruitment of staff as she was aware that the quality of the service was being compromised with current arrangements. Staff felt that staffing levels were adequate and one staff member told us that they always had time to meet peoples needs. However on occasions call bells were sounding for quite a while before being answered and the home has no one to support with evening meals and to arrange activities. As an interim measure the manager is using regular agency staff to reduce the number of hours that staff were doing to help out in order to improve overall quality within the home. Observations made at the time of the inspection reflected that staff are polite and courteous, respecting peoples privacy and dignity while carrying out personal care and support tasks. Staff were described as being lovely. The manager said that the staff are a credit to the home. Staff told us that the home does well by ensuring high standards are met at all times. The only suggestion for improvement was that staff could Have more time to spend with residents. This suggestion reflected our findings on the day of the inspection. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The newly appointed manager of Oldfield is offering stability and support to a home that has experienced a number of challenges over the last twelve months that have potentially impacted on the quality of the service provided. This will ultimately improve the overall quality of care provided at the home. Evidence: The current manager of Oldfield has been in post for only two weeks and in that time she has provided a positive influence on the home. Staff were complimentary about the new manager in terms of leadership and support. One staff member said Also the new manager has been a great help and has not been here for long and we can see the changes. The manager has the skills and experience to provide effective management although additional training in recruitment procedures will make her more effective to safeguard the people living at the home. Prior to this appointment we believe that management changes over recent months caused instability for the home and this has impacted upon the quality of the service provided. One person who lives at the home told us that previous management arrangements were poor. He Care Homes for Older People Page 24 of 32 Evidence: was very positive however about being able to approach the new manager in relation to changes he wanted made in relation to his care and support. The new manager has prioritised a recruitment drive for new staff and has started a program of redecoration within the home to make it a nicer place for people to live. Despite these changes the home has some challenges in relation to improving medication arrangements, especially for people visiting the home for respite care and reviewing practice in relation to appointing new staff. Both of these arrangement are currently impacting on the quality rating of the home and making people who live there vulnerable. The manager acknowledged both of these concerns. The manager has a budget to make improvements and is positive that she has the support of senior managers to address issues. The manager plans to review accidents and incidents within the home to see if the number of falls reported within the home can be reduced. She is also looking to improve arrangements for managing laundry and making sure that risk assessments are reviewed regularly. These actions will make Oldfield a safer place to live. Staff are trained in health and safety matters and a result provide safe care to people living at the home. We did not look at arrangements for managing the money belonging to people who live at the home on this occasion although they were deemed satisfactory at our previous inspection in 2008. We believe that the home now has a system in place for reviewing quality within the home and identifying and listening to the views of people who live at Oldfield. The homes AQAA stated that We send out questionnaires to families and Service Users, and also staff questionnaires are attached to pay slips annually, all are encouraged to return the questionnaires to the manager where they are scrutinised and any problems or issues arising from them are dealt with. People living at the home said that they have been asked by the new manager what they think about the home. This suggests that people are consulted on how they feel the home is run and that any comments will be listened to and acted upon. Care Homes for Older People Page 25 of 32 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 32 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 13 Protocols must be developed 30/09/2009 and implemented to make sure that staff know under what circumstances thay can administer medicaions prescribed as and when required. This is to make sure that people do not receive medication inappropriately placing their health and welfare at risk. 2 13 The home must review the 21/10/2009 policy and procedure to reduce the risk of mistakes happening in the recording in of medication to the home This is so that the home can demonstrate how much medication is available and provide an audit trail if it is thought that an incorrect dose has been administered. 3 9 18 Staff must receive refresher training in the safe 21/10/2009 Care Homes for Older People Page 27 of 32 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 administration of medication on a regular basis or following a medication error to ensure that they are competent and have up to date knowledge in relation to the homes policies and procedures in relation to safe practices. This is to reduce the likelihood of staff making mistakes and to ensure that their current practice is safe minimising the risk of harm to people living at the home. 4 10 12 Arrangements for managing 21/10/2009 laundry must be reviewed to ensure that everyone has access to their own clothes at all times. This is to ensure that people do not wear other peoples clothes by mistake thus compromising their dignity 5 12 12 The home must ensure that 30/10/2009 routines of daily living and activities are made available to suit peoples expectations, preferences and capacities This is to ensure that People are stimulated mentally and physically to enable them to lead full and active lives. Care Homes for Older People Page 28 of 32 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 6 19 23 The bathroom must be safe to use by people living at the home and flooring in bathrooms and toilets must be hygienic. This is to keep people living at the home free from infection and harm. 30/10/2009 7 27 18 Care and ancillary staff must 14/10/2009 be provided in sufficient in numbers to ensure that the care needs of people who use the service, particularly those with Dementia, are appropriately met This is to keep people safe and enable them to enjoy a good quality of life 8 29 19 Two written references and one of these from the last employer, CRB and POVA checks must be obtained on all new staff prior to their commencement of employment This is to ensure safety and protection of people who use the service 28/09/2009 9 29 19 The home must ensure that all information is considered and assessments are made as to the safety of people living at the home when 28/09/2009 Care Homes for Older People Page 29 of 32 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 issues arise in relation to staff recruitment information This is to ensure that everyone living at Oldfield can be safe and protected from abuse. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The manager should produce all information documents in an easy to read format so that they provide required information in a format that is suitable for the people who may wish to read them. The manager should use information available within the home to put together a Statement of Purpose to ensure that people interested in living at Oldfield can have information available to help them make the decision as to whether the home is right for them. Risk assessments should be reviewed as agreed in the care plan to ensure that they remain current and reflect peoples needs. It is recommended that all care records are kept are up to date and accurate so they reflect all care given Care plans should be more person centred to reflect peoples life histories, goals and aspirations. It is recommended that the home should record reasons why medication given as and when required is given. This is to demonstrate that it was necessary. It is recommended that the home provides real alternatives to main meals to ensure that people can have a choice. It is recommended that the home review the environment to make sure that it is fit for purpose in relation to 2 1 3 7 4 5 6 7 7 9 7 8 15 19 Care Homes for Older People Page 30 of 32 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 supporting people with dementia This is to enable people to maintain their independence as far as possible. 9 19 it is recommended that routine maintenance tasks are carried out promptly to ensure safe and free access to the home by everyone. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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