Inspection on 23/11/09 for Pavilion Court

This inspection was carried out on 23rd November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pavilion Court 28/01/10

Pavilion Court 11/02/09

Pavilion Court 16/05/08

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Pavilion Court Brieryside Cowgate Newcastle Upon Tyne NE5 3AB     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: Lee Bennett     Date: 2 4 1 1 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: Pavilion Court Brieryside Cowgate Newcastle Upon Tyne NE5 3AB 01912867653 01912865794 pavilioncourt@cshealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd care home 75 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 75 The registered person may provide the following category of service only: Care Home with Nursing - Code N 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 75 Dementia Code DE, maximum number of places 75 Date of last inspection Brief description of the care home Pavilion Court is a 75-bedded care home situated in the Cowgate residential area of Newcastle. The home opened in August 2005 and provides residential and nursing care to older people over two floors, including those with dementia care needs. All bedrooms are single and have en-suite facilities. There is a range of communal space including seven dining rooms and lounge areas. The home is attractively decorated and furnished. A range of aids and equipment has been provided. People who use wheelchairs can access all areas of the home. Off road parking is available and the Care Homes for Older People Page 4 of 32 Over 65 0 75 75 0 1 1 0 2 2 0 0 9 Brief description of the care home home is close to local bus routes. Fees for the home vary. Further information about fees can be found in the homes statement of purpose and service user guide. A copy of the last inspection report has been appended to the service user guide a copy of which is available in the main reception area. 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: An unannounced visit was made on the 23rd November 2009. A further announced visit was made on 24th November 2009. During the visit we: - Talked with people who use the service, their relatives, staff and the manager. - Observed life in the home. - Looked at information about the people who use the service & how well their needs are met. - Looked at other records, which must be kept. Care Homes for Older People Page 6 of 32 - Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. - Looked around parts of the building to make sure it was clean, safe & comfortable. - Checked what improvements had been made since the last visit. After the visit: We told the manager what we had found. Previous Requirements: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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: There has been no consistency is management and leadership at this home since we last inspected. There was also a significant drop in the quality of service here, resulting in poor outcomes for several people living here. This led to a review of the service being carried out, led by the local Safeguarding Adults team. During our inspection we found: - Care planning needs to be implemented in a more focused manner. - The supervision and engagement of people living on the dementia units needs to improve. - More attention to detail needs to be given to medication recording. - Complaints must be more thoroughly documented. - The people living here need to be better protected through the effective implementation of adult safeguarding procedures. - A permanent manager needs to be appointed. - Quality assurance arrangements need to include a focus on peoples direct experiences of care. - Archived records need to be better stored to allow efficient retrieval. Care Homes for Older People Page 8 of 32 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. Peoples needs are assessed before or at the time of moving here. Obtaining information about a persons needs is important in ensuring that everyone concerned is confident that this is a suitable place to live, and that everything is in place to make people safe and comfortable. Evidence: Before a person moves to a care home they are entitled to have an assessment of their needs carried out, either by social services or a health care worker, such as a nurse assessor. Even when a person pays for their own care, they are still entitled to such an assessment. The majority of the people staying here have their care arranged by Social Services or the NHS, but there are some who fund their own care. The manager of a care home must make reasonable efforts to obtain up to date information about those people who would like to come here. This will usually include a copy of the social workers or health care workers (care managers) assessment, Care Homes for Older People Page 11 of 32 Evidence: and a summary care plan, written by them. The home manager may also undertake their own assessment, that identifies their needs. From this information, care plans are written which explain how each persons needs are to be addressed. This is to make sure that each persons needs are looked at and then can be properly met, for example by ensuring appropriate equipment such as pressure relieving aids are in place. For those people whose care we looked at we found that in-house assessments had been carried out for everyone. These tend to use a scoring approach and standarised, or core assessment statements. Some files also contained information provided by care managers, and other professionals such as Community Psychiatric Nurses and Psychologists. These are generally completed fully, but we did find some minor omissions and a few incorrectly totaled scores. Where certain areas of risk are scored, we found that these are frequently reviewed. This can help ensure care staff are kept up to date about current levels of need, and care plans updated in an informed manner. 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 people living here receive adequately planned care, which could be further strengthened by improved observation and engagement. This can help ensure that peoples needs are more consistently met. Medicines are, on the whole, safely handled but more attention to detail is needed. Evidence: The health and personal care that people receive has to be based on their individual needs. These are identified and documented through assessments carried out by a persons care manager, the staff working here and other health and social care professionals. It is from these assessments that clear plans of care can be developed. Where people are able to express their wishes, it is good practice that they can help develop and be involved in care planning arrangements. Care plans are useful as they can help guide the care practice of staff. We found that in every case we looked at, that after a person has been admitted here a plan of care is written up. This is so that important areas of need, such as those around health and personal care, diet and social interests, can be clearly identified, Care Homes for Older People Page 13 of 32 Evidence: and the support that staff are to provide is clearly explained. For the people whose files we looked at, the care plans themselves are clear and generally relevant to the needs observed and that have been assessed. We found that some people had numerous care plans, which evidenced the care that they need and that is provided. However, some aspects were being completed for everyone living here, irrespective of need or personal circumstances. These used standard statements, and because they had been hand written for everyone will have taken a considerable time for staff to complete. To detail how each persons needs have been met staff keep regular notes about each persons welfare and a summary of the care that they have provided. These records varied in detail and quality. Some records were clear, factual and related to each persons health and personal care needs. Others simply contained brief statements, such as good diet, slept well, no problems, and so on. Where people have medical needs, evidence is kept of appointments attended, district nursing care that has been provided, and other visits by healthcare professionals. This can help ensure peoples health needs are regularly monitored and met, and proper advice and intervention sought. Importantly, a care plan is only one aspect of how care is delivered, and acts to inform how staff support each person. Of more direct relevance to people is the quality of the care actually delivered, and an important element of this is maintaining each persons dignity and privacy. During our inspection, there were no instances where personal care was carried out in the public areas of the home (other than support with eating), which shows that staff are conscious of peoples privacy and dignity. The support offered by staff was carried out in a friendly, and pleasant manner. Most people we saw were well dressed, and provided with clean, well laundered clothes. Each persons personal tastes and dress appeared to be promoted. One person with tight socks on had these changed by staff. We saw another person with long dirty finger nails, which would have benefited from help with cleaning. The people we spoke to told us that they are cared for in a good manner. The comments we heard from service users, relatives and staff included: - Really good here. - Happy with the home and pleased that I chose it for my relative. - Staff excellent but really busy, we need better management. - Smashing place, glad Im here. Care Homes for Older People Page 14 of 32 Evidence: - Its a good home. - Im happy here, theyre very good. - I receive all the care I need, no complaints. - Very happy here. - Always someone to speak to if you want information. - Think everything goes rather smoothly. - Good care of my foot. - The home offers good care ... staff try their best with the resources available to them. - I do believe we have a caring home where service users do feel this is their home and so they should. - I know as a home we have had problems, but the majority of staff do care. From the questionnaires we received people told us that they always received the care and support they needed, staff were almost always available when they needed them, almost always listen to and acted upon what people said, and almost always ensured they they received the medical care they needed. In contract to the positive comments we received, we also heard, or have been informed about incidents where people have not received the care, support and protection that they have needed. Allegations have been made about the standard of personal care provided for some people (including people being left unduly long before having their continence needs seen to, and infrequent support with washing and bathing). We have also been informed about incidents where some people living here have been physically harmed by other service users. These allegations have been referred to the local Adult Protection Team (within Social Services) to co-ordinate the action that needs to be taken. During the inspection we saw that on the dementia unit, due to current staffing deployment and the layout of the home, along with the lack of occupation (structured Care Homes for Older People Page 15 of 32 Evidence: or unstructured), there are sustained periods of time when service users remain unsupervised. This means that there are no staff present to prevent or intervene in conflicts and incidents that may occur. We did look at the hygiene records that are kept for one person. We found that during October 2009 that were bathed on 9 out of the 31 days of the month. We have been informed about some of the measures taken by the home to protect the people living here, and to improve the standard of care offered. The measures taken by the homes owners have included: - Changed and supported management arrangements (including extra staff drafted in to look at the quality of dementia care and levels of staff training.). - Increased staffing levels. - Additional staff training. - A voluntary suspension of further admissions of people to the home. As part of our inspection we spent some time observing life in part of the home where people with dementia are supported. We saw that he staff present were approachable, friendly, and attentive when provided a hot drink, and snack. During our observation, the people living here were either asleep, or passively watching TV and engaged with objects, such as their clothing. When staff spoke with service users, this was either in a neutral or good manner. They used humor appropriately, and comforted a person when they became briefly distressed. After providing the hot drink, staff spent a considerable time completing fluid balance charts for all of the service users in this part of the home. Such tasks are not based on need, and can take time away from providing care and meaningful activities. A common area where staff help people with their health care is in the way medicines are administered. Everyone living here has their medicines looked after for them. This is based on an assessment of needs and risk, carried out on a persons arrival here. To keep medicines safe, they are stored in a secure way and we found the room where they are kept to be clean and well ordered. Staff check the temperature of the medicine room and the medicine fridge to make sure that these are correct for the medication being stored. This will make sure the medicines concerned remain safe and effective. The process used here is that medicines are ordered by the Night staff, with the day Care Homes for Older People Page 16 of 32 Evidence: nurses checking them in when they are delivered by the pharmacist. The medication ordering is carried out separately by each of the different units within the home. A weekly audit of medicines is carried out against the Medicine Administration Record (MAR) charts. We looked at the medicines, and associated records for a sample of the people living here. For one person we found that the prescriptions for medicines were correct against the MAR, with no gaps on the chart. There was one weeks medication left, which was in line with the prescription. For another person we found that they had refused medications on a regular basis, this time for 7 days. The GP had been contacted regarding previous episodes of this occurring. Furthermore the GP had been contacted on the day of the inspection. A further referral to the local Challenging Behavior Team is to be made to obtain support and guidance for the staff here. The nurse has followed this up with a phone call to make sure the referral is processed quickly. For another person whose medicines we looked at, we found a gap on the MAR sheet for two medicines. We looked further, and found other medicines for people that had been administered but not signed for (all for the same medicine round). We spoke to the nurse in charge who informed us she would chase this up with the nurse responsible so she could account for the error. We also found some eye drops that had been opened, but not dated to indicate when they needed to be disposed of. Care Homes for Older People Page 17 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people staying here are not offered regular opportunities to participate in activities, but are well supported to maintain friendships and family contacts. People are enabled to express choice and control at meal times and receive varied, wholesome and well-presented meals. Evidence: An important element of the care and support offered to people when staying in care homes is based around the activities and meaningful occupation that is offered. During the two days of this inspection the planned activity was a hair dressers visit. The home has some good facilities, but currently these are little used. Most people were spending their time in lounges; watching TV, receiving family visitors or asleep. There is no activities co-ordinator employed here now, or staff member assigned to take a lead in planning co-ordinating and monitoring this aspect of care. Several people spoke to us about the lack of activities on offer. Their comments included: - More entertainment ie singers coming in. - More activities during the day. Care Homes for Older People Page 18 of 32 Evidence: - More activities for mind and body. staff suggestions for improvements included the comment: - more entertainment. Visits from relatives form an important part of many peoples day. Visitors can come and go freely, and during this inspection a family group visited to celebrate the birthday of their relative living here. They were provided with a small lounge to offer some privacy and celebrate this event together. On the whole those visitors we spoke with were all complimentary about the staff and care offered. People also commented positively to us about the food on offer. People told us about the choices they are offered and that they enjoyed their meals most of the time. A choice of breakfast, main meal, pudding and supper is offered, with special diets are assessed and catered for. Staff were noted to be helpful at meal times, and, on the whole, took the time to sit down with those who need help with eating. This can help ensure people are supported in a dignified way. Staff were courteous, encouraging people to be independent. Care Homes for Older People Page 19 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. There are arrangements in place here to protect people form abuse, but over the past year they have been inconsistently applied. Along with the complaints procedures, these have recently been strengthened to ensure peoples concerns are acted upon, and the people living here are protected from harm. Evidence: A complaints procedure is available within the home with a copy placed on display. This informs the people staying here, and those acting on their behalf, how they can make their views known and how any complaints will be dealt with. The people we spoke with told us that they know how to complain and that they are generally confident that this would be looked into. For example, we were told: - If youve got a complaint theyll sort it out. A record of complaints and suggestions is maintained, and these were reviewed as part of this inspection. 29 have been received by the home since our last inspection. One compliant has been made directly to us. This was passed on to the provider to deal with. In this case they intervened promptly to resolve the matter to the complainants satisfaction. The subject of the complaints that we looked at have been recorded, but any actions taken and the outcome of this are inconsistently documented. Care Homes for Older People Page 20 of 32 Evidence: As well as ensuring peoples views are listened to, managers and staff have a responsibility to ensure service users are protected from harm and abuse. To make sure staff know how to identify and act upon suspected abuse, they have received training on Adult Protection from the local Adult Protection team. This training was to help explain the role of adult protection, and to offer guidance to staff. The care provider has adult protection procedures, which are available in the home, should staff need guidance in this area. Since the last inspection we have been made aware of several adult protection matters that have resulted in referrals being made to social services. These have related to the alleged conduct of individual workers, allegations about poor standards of personal care, and alleged assaults between service users. Prior to this inspection, these allegations were subject to a review under the local adult protection procedures. As a result of this procedures in the home have been strengthened and staff have received guidance to ensure incidents between service users are passed onto social services for further review. This is to ensure arrangements are put in place to minimise further untoward incidents. Care Homes for Older People Page 21 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 people staying here benefit form a clean, well equiped and warm accommodation. Evidence: Pavilion Court is a purpose built care home that has been specifically designed and built to provide long-term accommodation for older people, including people who are physically frail and disabled. It is an airy, bright, modern building, set within its own grounds. Outside there is an enclosed, level garden. Accommodation is provided over two floors, with bedrooms for individual accommodation, each with an en-suite shower and toilet. Some of these are larger than others, to help meet the needs of service users who need to use wheelchairs and other mobility equipment. Communal areas are large and have homely decorations and furnishings. Several people commented to us that they were comfortable in their rooms and that the home was clean and fresh. The home was noted to be clean and tidy throughout, and measures, such as the use of hand sanitisers and disposable paper towels, help contribute to effective infection control. We did find the undersides of bath seats to be covered with a film of grime, but this was promptly addressed once this was raised with the cleaning staff. The paintwork underneath the soap dispensers in the toilets are also marked with water stains. Otherwise we found the home to be clean, and free from offensive odours. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff working here are generally qualified, receive some training relevant to their role, and recruited in a safe and robust manner. Evidence: Staffing levels will vary depending on how many people are living here and the level of their needs. At the time of the inspection there was one 1st level nurse, along with 11 cares on duty. 3 of the carers are designated as seniors with one in the position of manager for the two units that cater for the needs of people with dementia. Agency staff are used if cover cannot be obtained from within the team to cover short term absences. Before staff are employed here they have to undergo a range of checks to ensure they are able to perform the work expected of them and have the right approach to working with people who at time will need extra help and support. Robust pre employment checks will help ensure unsuitable people are not employed here. On this occasion we sampled the records for three recently recruited staff. We found that none of these staff started work before at least two references and a POVA 1st check (a check against a list of workers barred from employment in social care) had been received. Criminal Records Bureau disclosures are normally received after workers commence employment. Care Homes for Older People Page 23 of 32 Evidence: Once employed in a care service, it is important that staff obtain the training they need to understand the needs of the people they provide care for, remain up to date with good practice, and work in a safe manner. We found that the majority of care staff working here are qualified, to NVQ level two or higher, and training is available to cover a range of care related topics. To aid planning and to monitor levels of training a matrix has been developed, although due to the number of management changes here, this has not been kept up to date. A senior member of staff has been drafted in to review levels of training, update records and provide additional training where required. Training provided over the past year has included: - Fire Safety - Food Safety Awareness - Medication (Boots) - Mental Capacity Act Training. Each topic has not necessarily been undertaken by all staff. Care Homes for Older People Page 24 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 home has been inconsistently managed and record keeping arrangements have meant that older records cannot be located or easily retrieved. The home is free from hazards to the health and safety of those living and working here. This can help make sure peoples health and safety is promoted, but that leadership has been poor. Evidence: At the time of the inspection there was a temporary manager employed here. This has followed on from a series of management changes within the home. The current manager is the forth to have been in post here this year. The current manager has been registered by us, for a different home, as a fit and proper person. This means that she has no adverse criminal record, and has the skills, knowledge, experience and competence necessary to undertake her role. She is a qualified first level nurse, and holds a relevant management qualification. As part of her nursing registration she is required to undertake regular training to keep her knowledge up to date. People made comments to us about the lack of consistent management here. They said: Care Homes for Older People Page 25 of 32 Evidence: - We need better management. (This comment was not directed at the current manager, who had been on duty only one day when this comment was made.) - We need a permanent manager. - I would be happier if the home had a manager and not all of the coming and going of managers. To support the role of the homes manager, a line manager undertakes regular monitoring visits, that form part of the quality assurance of the home. We were informed that the homes line manager also undertakes regular (monthly) quality inspections. Copies for the past 3 months inspections could not be located. There have been a series of action plans developed by the homes line managers to begin to address some of the shortfalls that they have identified here, and offer structure to actions to address these. Furthermore, the views of service users, relatives and staff are now being sought at meetings with the homes management. However, quality checks do not currently include tools that focus directly on the care and experiences of the people living here (such as dementia care mapping). We found that the records kept at the home, that were inspected, were generally up to date, and held in a safe and secure manner. However, it is evident from our involvement in recent adult protection meetings that some paper based records have not been located when needed. Financial records, in contrast, are held electronically. They are subject to the scrutiny of the companys financial officers. The records we checked appeared to be accurate, and only small amounts of expenditure are made. There is currently a delay in the home receiving bank statements, and this is an IT issue that is currently being raised with the bank concerned. On the whole, staff in the home do not usually hold or manage service users finances, but where these are left with staff for safe keeping they are securely stored, with clear records in place. The home was found to be free of hazards to the safety of service users, with the exception of a cluttered storage area. Staff have received regular health and safety related training in the past, and this is to be updated. Chemicals are securely stored, and equipment serviced at the specified intervals. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Ensure that all staff follow 01/04/2009 the medicine procedure when administering medication. Residents are fully supervised to ensure they take all of their medication. 2 18 13 Provide all staff with training 01/04/2009 in the protection of vulnerable adults. This helps to protect residents from abuse. 3 26 16 Address the cause of the odours in the home. Provide bins that are foot operated. This helps to ensure that the home is hygienic and pleasant for residents to live in. 01/04/2009 4 30 18 Proved a training action plan 01/04/2009 indicating the timescales for meeting training targets. This promotes better standards of care for residents. 5 38 13 Ensure that all health and 01/04/2009 safety checks are brought up to date and continue to be checked at the correct intervals. Care Homes for Older People Page 27 of 32 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 This maintains the safety of the building for all users. Care Homes for Older People Page 28 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 8 13 Levels of care and supervision in areas where people with dementia live need to be improved. This is to ensure the safety and welfare of the people here. 25/01/2010 2 9 13 Medication recording must 25/01/2010 be completed contemporaneously, and eye drops dated when opened. This is so medication is always safely handled and error minimised. 3 12 16 A range of activities and occupation needs to be provided. This is to ensure the people staying here are offered opportunities to be engaged and stimulated in a meaningful way. 25/01/2010 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 4 16 22 The actions taken and outcome of all complaints must be clearly documented and a summary fed back to the complainant. This is so everyone can be confident that their views are listened to and acted upon. 25/01/2010 5 18 13 Arrangements for the 25/01/2010 reporting of suspected abuse must be effectively implemented and the Local Authority (Social Services) must be informed of alleged incidents or suspicions of abuse without undue delay. This is so people are protected as far as possible for unnecessary harm. 6 27 18 Staff need to be deployed in 25/01/2010 sufficient numbers to ensure at least adequate supervison and engagement on the units for people with dementia. This is so people can be kept safe and be given opportunities to lead a fulfilling life. Care Homes for Older People Page 30 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 7 33 26 Visits required under regulation 26 must be conducted at least monthly, with records kept at the home. This is so the operation of the home, and welfare of the people living here is subject to regular scrutiny. 25/01/2010 8 37 17 Record keeping arrangements must ensure that they are stored for the required period, and can be readily and efficiently retrieved. This is so peoples confidences can be assured. 25/01/2010 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 7 Care planning and risk assessment documents should be used in a more focused manner. This is so everyone is clear about what a persons needs are and time isnt spent on unnecessary paperwork. A permanent manager should be appointed here and apply for formal registration with the Commission. 2 31 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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