Inspection on 23/09/09 for Penn House Residential Care Home

This inspection was carried out on 23rd September 2009.

CQC found this care home to be providing an Poor 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penn House Residential Care Home 08/10/09

Penn House Residential Care Home 16/02/09

Penn House Residential Care Home 28/01/08

Penn House Residential Care Home 05/10/06

Penn House Residential Care Home 04/05/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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: Penn House Residential Care Home 169 Penn Road Wolverhampton WV3 0EQ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rosalind Dennis     Date: 2 4 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 35 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 35 Information about the care home Name of care home: Address: Penn House Residential Care Home 169 Penn Road Wolverhampton WV3 0EQ 01902345470 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Shanta Arjan Odedra,Mr Arjan Bhoja Odedra,Mr Vijay Odedra,Daljit Takhar,Jasvinder Takhar care home 24 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 to be accommodated is 24. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 24 Dementia (DE) 24 Date of last inspection Brief description of the care home Penn House Care Home provides personal care and accommodation for 24 older people with Dementia. The home is an early Victorian two - storey building that has been adapted internally to meet the needs of older people. There is easy access to local amenities, which includes a park, churches, temples, a library and shops. The home is located approximately 1 mile from the city centre and a local bus service stops nearby. The accommodation consists of two lounges and one of these is a large L shaped Care Homes for Older People Page 4 of 35 Over 65 0 24 24 0 1 6 0 2 2 0 0 9 Brief description of the care home lounge, and a dining room. There is one double bedroom and 22 single bedrooms and seven of these have en-suite facilities of toilet and wash hand basin. There are communal bathrooms/showers and toilets on each floor. The home has a passenger lift, in addition to two staircases. There is a small patio, otherwise there is limited outside space for people to access. There is car parking at the front of the premises. People who use the service and their representatives are able to gain some information about Penn House from the Statement of Purpose and Service User Guide. The reader is advised to contact the service for up to date information on the fees charged by the home as these were not included in the Service User Guide at the time of inspection. The last key inspection of Penn House was undertaken on the 16th February 2009. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over two days by one inspector. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the inspection taking place we looked at all the information that we have received, or asked for, since the last key inspection on 16th February 2009. 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 the home has not been keeping us informed. We also looked at information which had been sent to us from other agencies, including the local safeguarding adults team. The inspection was triggered following concerns raised to us about the home. Care Homes for Older People Page 6 of 35 Three people living in different areas of the home were case tracked in detail. This involves establishing individuals experiences of living in the care home by meeting them, observing the care and support they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Two people we case tracked were able to tell us about their day to day life at the home and the support they receive from staff. Another person was not able to give us this information so we observed the care given by staff during the day. We looked around some areas of the home and observed a sample of care, staff and health and safety records. We spoke with staff during the inspection to establish their views of working at the home and if anything needs to be improved. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of not receiving the care they need because they are admitted without the home looking at whether it can meet their needs and if the staff have the necessary skills and knowledge. People are provided with information about the home, however this does not contain enough information and is not an accurate description of the service people are currently receiving. Evidence: At the start of our inspection we asked to see the care records for one person. We were given a folder of different papers, which we found contained notes about two people who live at the home. The file was very disorganised, which meant it was difficult to see the specific needs each person has and their reason for admission to the home. We established from looking at the folder that the home had not assessed these peoples needs either before or at the time of their admission to the home, therefore it is not clear how the home was able to decide it could meet their needs. Care Homes for Older People Page 10 of 35 Evidence: We also found that, since their admission, the home has not looked at any possible risks to their health, safety and welfare and neither person had a care plan to inform staff how they want their needs met. We looked at the care records for two other people, which showed their needs had been assessed. For one of these people information had been sought about their preferred daily routines, likes and dislikes so that staff should know how to meet their needs according to their wishes. We looked at the service user guide, which contains information about the home, so that people are made aware of what the service provides. We saw a copy of the guide in the reception area along with the homes statement of purpose and copies of both were seen in peoples bedrooms. We saw the Service User Guide included information on care planning noting that all service users will have a care plan which reflects their requirements, which we found is not happening. The Guide says a complaints procedure is attached and in the copies we saw it wasnt and the Guide did not state the weekly fees, which it should so that people know the exact fees charged by the home. Care Homes for Older People Page 11 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk of not receiving the care they need because the home is not identifying or managing risks to people and their care is not planned Evidence: We examined care records for four people and this shows that the home is not adhering to legislation or good practice guidance in how it assesses, plans and reviews peoples care. Two people did not have any form of care plan or assessment of possible risks to their health, safety welfare. One of these people needs staff to know how to manage a medical condition they have and there was no care plan or risk assessment to guide staff to manage this condition, or when to seek professional advice. We saw in their records that they were admitted to hospital when the level of sugar in their blood became very low and on their return to the home the District Nurse provided guidance to staff regarding the persons diet. We saw the home keeps good records about the amount of diet and fluids people eat and drink and saw that the home followed the guidance of the District Nurse. However staff should have known what action to take to avoid this situation happening, resulting in this persons admission to hospital. Their care records showed that despite the hospital admission Care Homes for Older People Page 12 of 35 Evidence: staff had still not written a care plan or looked at how to reduce the risk of this happening again. We saw a District Nurse had requested the home to take action to see why the person was experiencing a particular health problem, three weeks after this being requested by the District Nurse, there was no record of action being taken. In another persons care records we saw staff had written in 2005 that the person needed to be encouraged to walk more. Their care plan was last reviewed in November 2008 when it was written needs to be walked more, there was nothing in their care records to inform staff how this should be done or whether any moving and handling equipment is needed to support the person to move safely. Their care records described how they recently developed a sore area on part of their body and had a cream applied. A care plan had not been drawn up in how to monitor or care for the sore or to inform staff of the name of the cream to be applied. In one section of the care records staff had written needs to lie on her bed for half and hour every day. On the day of inspection we did not see this happening and the person was seen seated on an ordinary chair in the lounge throughout the day. One persons care records described the numbers of staff and equipment needed to support the person with their daily activities, however this had not been updated since May 2009. This persons care records showed they had recently fallen at the home and went to hospital, however this had not triggered the home to look at possible reasons for the fall and to take action to minimise any risks of this happening again. We also found for three people who had bed rails in place on their beds nothing had been written down in the form of a risk assessment to show that the risk to the individual of bed rails being used had been looked at. The bed rails we saw were not fitted correctly and after informing the home, staff took action and altered the bed rails. It is concerning that a requirement was made at the last inspection in respect of the fitting of bed rails and the home had still not ensured they can use bed rails safely and in accordance with relevant guidance. We issued an immediate requirement, informing staff at the time of inspection and informing the owners by letter of the need to take action by 28th September 2009 to ensure all people living at the home have a written plan of care, based on an assessment of their needs. When we returned to the home on the 24th September we looked at the Medication Administration Record (MAR) for one of the people we had case tracked. We had seen Care Homes for Older People Page 13 of 35 Evidence: in their notes they had an allergy to a medicine, however the MAR chart being used by staff to give out medication said the person did not have any allergies to medication. Their current MAR chart showed they had received several doses of a similar medicine to the one they are allergic to. We informed the staff they needed to seek advice straight away from the persons GP. This shows that poor recording by staff is putting people at risk of receiving medication which should not be given. This resulted in us serving a Code B notice, which is used whenever we are involved in an investigation, which may result in a criminal prosecution. In this instance Penn House had breached Regulation 13(2) and Regulation 12 of the Care Homes Regulations, which is an offence under the Care Standards Act. Our pharmacist inspector conducted an inspection of medication practices at the home and judged medication arrangements as poor. The report for that inspection is available as a separate report. Most of the people living at Penn House at the time of this inspection were unable to give their views on the home and the care provided, so most of this inspection is based on observation, looking at documentation and speaking with staff. Two people who were able to communicate their views, spoke of their satisfaction with how the staff help them with their care, although they commented that improvements could be made with activities, their room being warmer and more choice with meals. Their relatives told us they are pleased with how they are looked after but viewed there could be more going on at the home. Another person told us they are happy with their care and the staff at the home. Other people who were less able to speak with us, looked clean and appeared comfortable. On both days of the inspection people spent long periods of time seated in the lounge with limited interaction from staff. Care Homes for Older People Page 14 of 35 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. People are not provided with opportunities to enhance their social well-being according to their preferences, needs and capabilities. People are provided with a varied diet although more effort is needed to ensure menus are based on what people want to eat Evidence: Observations on both days of inspection shows there is very little in the way of stimulation and as identified at other inspections there is nothing to show that specialist activities are being arranged to involve, engage and stimulate people. On both days, a staff member who we were informed was there to assist with activities, assisted one person to complete a jigsaw in the lounge and the person appeared to enjoy this. However no other activities were seen to be provided for anyone else. Two people we spoke with and their relatives described how they view there is not much going on, one of these people commented there is never anything going on. They told us they would like to do Bingo and would like to be offered different activities so they can choose whether to take part or not. We looked at a book which is used by staff to record activities. Observation of this showed some activities such as arts and crafts, jigsaws take place but there was nothing to suggest this is based on what people want or according to their capabilities. An example of the lack of specialism, Care Homes for Older People Page 15 of 35 Evidence: skill and competence of staff was demonstrated within a written record made about a game of darts which had been played and described how one person refused to play as they could not see. There was nothing to suggest a more suitable activity was then offered. We spoke with staff who agreed that more needs to be done to meet peoples social needs. Because of a lack of information in the care records of the people we case tracked it was difficult to establish whether people have specific cultural, religious and spiritual needs and if these needs are being met at Penn House. Two visitors to the home described how they are welcomed by staff and are able to visit when they want to, which means people can maintain relationships which are important to them. We spoke with the cook, who confirmed that there is always a choice of meals and we heard staff asking people what they would like to eat. The cook was aware of catering for special dietary needs. Menus showed a choice of main meals which are prepared by the cook and we were informed that care staff assist with providing teas in the evening. The menus were displayed in the corridor by the kitchen and were therefore not visible to people who live at the home. Two people told us they viewed there is too much mince on the menu and not enough choice, comments which were fed back at the end of the inspection. On both days people appeared to be enjoying their meals and we saw people being offered and assisted with drinks on a regular basis. Care Homes for Older People Page 16 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is not available therefore people are not informed of how to make a complaint or raise concerns. People are not protected from the risk of harm and abuse because processes such as recruitment, care planning, risk assessment and administration of medication are not robust. Evidence: Whilst looking around the home we did not see a copy of the homes complaints procedure and the Service User Guides we looked at did not contain a copy. This means people may not know the procedure to follow if they wish to complain. Two people we spoke with and two visitors confirmed they would feel comfortable raising their concerns to staff. We looked at where complaints are recorded which showed the last recorded complaint was in March 2008, however we are aware that a complaint has been raised recently and this had not been recorded. We found through observation and speaking with people that part of this complaint, which could impact on the safety of the people concerned, had not been acted upon by the home. Two staff we spoke with could confirm their role in safeguarding adults who live at Penn House from the risk of harm or abuse and they told us they had received training in abuse awareness. We looked at seven staff personnel files and saw that only two of Care Homes for Older People Page 17 of 35 Evidence: these staff have received training in recognising and reporting abuse. We could not establish how many staff overall had received training in recognising and reporting abuse because a training plan was not available. There was nothing to suggest that staff have received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act oversees decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. We made a referral to the local safeguarding adults team after the inspection because of our concerns that the home is failing to safeguard people from harm. Concerns have also been raised recently to the safeguarding team from healthcare professionals involved with people who live at the home. At the time of inspection we were concerned that people who have difficulty mobilising had been unable to go upstairs at night because the passenger lift was broken. Care Homes for Older People Page 18 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment which is homely but does not fully promote their wellbeing and safety, and this puts people at risk of injury. Evidence: We looked at the rooms for the people we case tracked, which were clean and spacious. We saw that people are able to bring in items which are important to them, such as photographs, pictures and small items of furniture. Some rooms have an ensuite facility of toilet and wash hand basin, other rooms have a wash hand basin only and people had commodes in these rooms. The decoration in communal areas, such as lounges and peoples bedrooms was satisfactory. Hard floor coverings are in place throughout the home, however we observed this has resulted in some beds being less stable as they are now able to slide on the floor. Two people discussed this with us during the inspection as both people had fallen out of bed and were fearful they might fall again. This had also been raised by a healthcare professional and we saw that no action had been taken to reduce the risk of it happening again. We informed the management representative at the time of inspection who took appropriate action to address this for the two people who had fallen. We also saw that not all beds had headboards attached, meaning it would be difficult for people to sit up in bed and which may create an additional risk when bed rails are used. Two people told us their bedroom is usually not warm enough for them and we felt Care Homes for Older People Page 19 of 35 Evidence: that parts of the home were cool on the first day of inspection. The temperature improved on the second day. We went to check the temperature of the hot water from a wash hand basin and found a significant leak from the basin, and the water was draining out underneath into a large bowl. The basin was cracked. We looked in a book as we were informed it is where staff report when equipment needs attention, there was no record of this being reported. We spoke with the homes maintenance person who was not aware of the problem. At the start of the inspection we were told the passenger lift had broken down the day before and people who could not walk upstairs had slept in the lounge. The provider assured us the lift would be attended to. On our return to the home on the second day we were informed that new parts were needed for the lift and therefore it was still not in working order. The lift remained out of action until the day after the inspection. Staff had taken some action to provide alternative sleeping arrangements, but it is concerning there was such a delay in the repair. We observed staff using protective clothing to reduce risk of cross infection. However other observations during the inspection shows a need for improved infection control practices. A toilet to be used by people living at the home had a sign asking people to wash their hands, but we saw there was no soap. A small bathroom had a sign on the door saying Use as sluice only and we saw that commodes continue to be washed in a bath. This is not only unhygienic but means there are less available bathrooms for people to use. The door to this room was unlocked and a trolley with cleaning fluids on it was found in this room. This is unsafe as it means people are free to go into the room and access the cleaning fluids. We asked to see written information on the cleaning fluids, which the home should have so that staff know what they are, the safe way to use and store them. We were informed by the management representative that it is unlikely there is any information on them. The local Environmental Health Department visited the home in May 2009 and found poor level of compliance with food hygiene. The owner informed us that action was taken after the visit and views that all deficits have been met. This was not explored further during our inspection. On both days of our inspection people were dressed appropriately and clothing appeared clean. We observed the homes laundry, which is accessed by a steep flight of stairs. The flooring has been improved as recommended at the last inspection, however further attention is needed to this room as we saw dust on the walls and floor and clean laundry was placed next to dusty areas. We noticed there was no means for staff to be Care Homes for Older People Page 20 of 35 Evidence: contacted or call for help whilst working in the laundry. Outside space for people is very poor. We asked to see the garden which is available for people living at the home to use and were informed the only accessible space is a small patio. The garden is fenced off with tape, overgrown and is on a steep incline. The patio is small, with a few garden ornaments and there is no suitable garden furniture. The Deputy Manager spoke of how she hopes to develop the garden area to provide a sensory area. Throughout the home there was nothing to stimulate or promote positive responses from people or suggest awareness of good practice guidance on dementia care. Care Homes for Older People Page 21 of 35 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. People are not safeguarded from the risk of harm and abuse because the home has a poor recruitment procedure and staff do not have the skills to ensure all care needs are met. Evidence: The staff we spoke with said they enjoy working with the people who live at Penn House and view that people receive good care. Staff viewed that improvements could be made with provision of activities and that more staff could facilitate this. The owner told us how he has put more staff on duty. We looked at staffing rotas which showed that on some days an additional member of staff covers busy times of day, for example first thing in the morning or late evening and staff spoke of the benefits of this extra staff member. However the rotas show this does not happen every day. On both days of our inspection staffing levels appeared sufficient to meet the basic care needs of the people living at the home. We were not present at the home to speak with staff who work at night to establish their views of staffing levels. Staffing rotas show that two care staff work at night. However, we have recently been made aware that a person who lives at the home, left unnoticed in the evening and staff working day shifts reported to us they are aware that some people at the home walk around at night. We were also informed that care staff at night are expected to undertake additional tasks such as ironing and care staff who work in the day assist with laundry and the kitchen. This has been reported at other inspections. Staffing levels and Care Homes for Older People Page 22 of 35 Evidence: allocations need to reviewed by the owner to ensure there are sufficient, skilled staff available to meet peoples needs, dependency and improve outcomes for people. We examined seven staff personnel files to look at how the home recruits staff. We found the home had not ensured these staff had all the necessary pre-employment checks undertaken to ensure they are suitable to work with vulnerable people. One member of staff had recently started working at the home without any references being obtained, other recently appointed staff had only one reference, or their references were not supplied by their last employer and started working before their full Criminal Record Bureau Disclosure (CRB) had been obtained. Checks called POVA First checks had been completed but staff should only start work when the employer is satisfied that all other checks have been completed. A sample of these staff files had been checked at the key inspection in February 2009, but there was no indication that a robust approach had been taken to obtain information which was missing at that time. Checking of the files for two staff who have worked at the home for sometime shows they started work without any checks being made. It has been a requirement from the last two inspections for the registered person to improve how staff are recruited. It is of serious concern that improvements have not been made. This resulted in us serving a Code B notice, which is used whenever we are involved in an investigation, which may result in a criminal prosecution. In this instance Penn House had breached Regulation 19 of the Care Homes Regulations, which is an offence under the Care Standards Act. We are currently considering the action we will take as a result of this breach. Observation of staff files shows that Induction to Skills for Care standard has not been provided, therefore it is not clear how new staff are equipped with the skills to meet peoples needs or are assessed as competent in their role. There was no evidence of any induction for two newly appointed staff members. Out of the seven staff files seen only three had certificates to show training undertaken. Two staff told us they had completed a recognised qualification in care (NVQ). The deputy manager informed us that moving and handling training is planned and she wants staff to have training in pressure area care. It was difficult to establish what staff training has taken place recently because an overall training plan was not available. Staff appear to have the abilities to attend to peoples basic care needs, but there is a lack of awareness, skill and competence to provide more specialist care, including the care of people with dementia or diabetes. Care Homes for Older People Page 23 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are not effective, the service is not being run in peoples best interests and people cannot be confident that their health, safety and welfare is being promoted. Evidence: Penn House has been without a Registered Manager since October 2007. An acting manager who was working at the time of the key inspection in February 2009, was not available at the time of this inspection. Our findings show this service is not being managed well or in the best interests of the people living at the home. We met one of the owners on both days of the inspection. On the second day of the inspection we informed the owner of some of our concerns, however he was unable to stay for the duration of our inspection or be present when we gave feedback. A manager from another care home had been deployed by the owner to be present during the inspection and they assisted us on both days. A deputy manager has recently started working at Penn House and they spoke of how they and other staff want to put things right, giving examples of trying to organise training in pressure area care and Care Homes for Older People Page 24 of 35 Evidence: obtaining equipment to move people safely. A representative of the company conducts monthly unannounced visits. We observed the reports produced as a result of a visit in June and July 2009.This shows that the process would benefit from being improved as it does not suggest that processes which impact on outcomes for people are looked at in depth. For example there is nothing in the report to indicate that records of complaints are looked at and the report for July confirms there is a programme of activities, but our findings show this not adequate. Robust monitoring should be able to identify when improvements need to be made. Observation of care records and where staff record incidents and accidents show a lack of follow up action being taken by staff and management to look at why incidents have happened and what can be put in place to reduce the risk of it happening again. The management representative agreed with us that there appears to be a high incidence of incidents and accidents at the home, although it is not clear the reasons for this. The registered person needs to audit events such as accidents to determine if there is an underlying cause and take any appropriate action. We have not been kept informed when incidents or accidents take place which is a requirement of our regulations, for example we have not been notified when people have been admitted to hospital and when a person was given a medicine they were not prescribed for. We looked at a selection of maintenance and servicing records, which demonstrates some systems are in place to help ensure the home and equipment is safe, for example we saw up to date records for the checking of electrical appliances and gas. However we saw that fire safety checks, noted as needing weekly checking had not been checked for four weeks. We spoke with the maintenance person who told us he has recently started checking valves on hot water outlets. We were shown where staff are expected to record temperatures of hot water in the care home, the last recorded check was in May 2009, staff were not aware if any other checks have been made. This shows that there is no routine procedure to check water temperatures on a regular basis to ensure people arent scalded. Risks to people are not being assessed and there is no effective management plans when risks are identified. As noted earlier in the report we also found for three people who had bed rails in place on their beds nothing had been written down in the form of a risk assessment to show that the risk to the individual of bed rails being used had been looked at. The bed rails were not fitted correctly and after informing the home, Care Homes for Older People Page 25 of 35 Evidence: staff took action and altered the bed rails. There is no system in use by the home to monitor bed rails on a regular basis to ensure they are consistently fitted correctly. We also informed the management representative about the beds we had seen without headboards attached to the bed and she confirmed action would be taken. We contacted the fire officer, before our inspection following concerns which had been raised to us about exit doors being locked. The fire officer visited during the inspection and confirmed the arrangements were satisfactory but for the home to ensure the homes fire risk assessment was amended to reflect possible risks, such as staff who may not be tall enough to reach the locks. We did not look at how the home enables people to comment on the service or how the home is involved in the management of peoples finances. Care Homes for Older People Page 26 of 35 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 The records of the administration of medicines for the people who use the service must be robust and accurate This is to demonstrate that all medication is administered as prescribed. 02/03/2009 2 29 19 Two written references and 15/04/2008 one of these from the last employer, CRB and POVA checks must be obtained on all new staff prior to their commencement of employment in order to ensure safety and protection of people who use the service. 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 in order to ensure safety and protection of people who live at the home. 12/03/2009 3 29 19 Care Homes for Older People Page 27 of 35 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 1 7 15 People must have their care 28/09/2009 needs assessed and planned in the form of a care plan. This is to ensure people receive the care they need and to provide information to staff on how the persons care needs are to be met. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Assessment of peoples care needs must be undertaken before they are admitted to the home. This is to ensure people can be confident the home will meet their needs and avoid the home admitting people whose needs cannot be met. 03/11/2009 2 8 12 The home must ensure any risks to the health, safety and well-being of people living at the home are identified, recorded and managed according to the persons wishes and capabilities and on advice from health care professionals. 03/11/2009 Care Homes for Older People Page 28 of 35 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 This is to ensure that unnecessary risks to the health and safety of people are identified and as far as possible eliminated. 3 8 13 People who need bed rails 03/11/2009 must be assessed for the risks associated with the use of bed rails This is to ensure bed rails are used appropriately, safely and in accordance with guidance provided by the HSE and MHRA. 4 12 12 People living at the home must be provided with a range of activities that are appropriate and meet their individual needs and capabilities. This is to promote well-being and ensure that the social needs of people living at the home are met. 5 16 12 Complaints made to the home must be acted upon, recorded and the person who made the complaint informed of the action taken This is to reassure people that if they raise complaints they will be dealt with and 17/12/2009 16/12/2009 Care Homes for Older People Page 29 of 35 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 that outcomes for people will be improved as a result. 6 16 22 A complaints procedure must be provided and in a format suitable for the people who live at the home. This is to ensure people know how to make a complaint. 7 18 12 Arrangements must be made to ensure all staff have a clear understanding of adult protection and whistleblowing procedures This is to ensure people living at the home are protected from harm or abuse and if allegations are made staff will know the procedure to follow. 8 19 13 The Registered Person must take action to ensure all parts of the home, including outside spaces and equipment is wellmaintained and safe This is to ensure that people live in an environment which is well-maintained and unnecessary risks to peoples health and safety are identified and as far as possible eliminated. 03/12/2009 17/12/2009 19/11/2009 Care Homes for Older People Page 30 of 35 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 9 27 12 Staffing levels in all areas of the home and for all shifts must be reviewed to take account of peoples needs, dependency and layout of the home This is to ensure peoples needs are met safely and promptly. 03/12/2009 10 29 19 Staff recruited by the home must have all required preemployment checks undertaken. This to protect people from the risk of being cared for by staff who are unsuitable to work with vulnerable adults 24/09/2009 11 30 18 All staff should have an induction programme and training appropriate for the work they are to perform This is to ensure staff are competent and have the skills and knowledge to meet the needs of people living at the home (including specialist needs). 31/12/2009 12 31 12 Arrangements must be made to ensure that a suitable, competent manager is appointed to provide leadership and direction to Penn House to 24/12/2009 Care Homes for Older People Page 31 of 35 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 improve the outcomes for the people who live there. This should also ensure that people will have confidence in the care home because it is led and managed appropriately 13 38 12 Robust processes must be put in place to ensure appropriate action is taken following incidents and accidents and that CQC and other relevant persons are notified. This is to reduce risk of future occurrence and keep those who have an interest in the welfare of people living at the home informed. 14 38 13 Hot water at all outlets 03/11/2009 accessible to people living at the home should be monitored to ensure that the temperature is maintained at 43 degrees C. This is to reduce the risk of scalds to people at the home. 15 38 13 Bed Rails must be assessed, fitted and maintained in accordance with MHRA/HSE guidance. 03/11/2009 03/11/2009 Care Homes for Older People Page 32 of 35 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 This is to protect people from the risk of harm and promote their safety 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 Service User Guide should be amended to show the fees charged by the home. This is to ensure people are provided with clear and up to date information on fees and to assist them in their decision making. The home should introduce a system of evaluating the effectiveness of activities on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. The home should consider providing copies of the homes menus in formats which people understand and in different locations, so that people are aware of the current meal choice. This is to assist people in choosing meals they like. Staff should be provided with training about the Mental Capacity Act and Deprivation of Liberties. This is so that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. The internal and external environment should be developed in accordance with good practice guidance for people with dementia. This is to promote positive responses from people and enhance well-being. The home is strongly advised to liaise with infection control specialists to review how commodes are cleaned and consider more suitable arrangements. This is to reduce the risk of infection and ensure people are protected through the homes infection control procedures. Staff files should be audited. This is to ensure that all preemployment checks have been completed, to meet 2 12 3 15 4 18 5 19 6 26 7 29 Care Homes for Older People Page 33 of 35 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 legislation and protect people living at the home. 8 30 A training matrix/planner should be developed, so that it identifies when staff have attended training or when training is due or planned. Training and development plans should be completed for staff. This will enable individual training needs to be identified for staff. The Registered person should consider developing how the service is monitored during monthly unannounced visits. This is to show that outcomes for people are monitored closely so that action can be taken to improve the service. All staff should be made aware of guidance documents on the safe use of bed rails. This is so that all staff are able to recognise the correct fitting of bed rails. The risk of staff accessing and working alone in the laundry should be assessed. This is to ensure staff are safe and that there is a system in place to notify staff if they are needed in another part of the home. A system should be developed to monitor all incidents and accidents so that action can be taken to determine the cause and reduce risk of future occurrence. 9 30 10 33 11 38 12 38 13 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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