Inspection on 14/12/09 for Penvose Residential Home

This inspection was carried out on 14th December 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penvose Residential Home 14/05/10

Penvose Residential Home 04/03/09

Penvose Residential Home 24/11/06

Penvose Residential Home 06/12/05

Penvose Residential Home 26/05/05

Penvose Residential Home 30/09/04

Penvose Residential Home 25/05/04

Penvose Residential Home 06/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Penvose Residential Home 1/2 Tothill Avenue St Judes Plymouth Devon PL4 8PH     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: Stella Lindsay     Date: 1 4 1 2 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 33 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 33 Information about the care home Name of care home: Address: Penvose Residential Home 1/2 Tothill Avenue St Judes Plymouth Devon PL4 8PH 01752663191 01752663191 penvoseresident@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Joyce Sylvia Reed care home 15 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 15 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other cattegory (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Penvose is privately owned and aims to provide long-term residential care for people over the age of 65 years. The home is registered to provide care and accommodation for up to 15 older persons who may also have dementia. The home does not offer a service to people whose mental health issues cause them to display anti-social behaviour or aggression. The home does not provide an intermediate rehabilitation care service, however it occasionally admits people whom need short-term respite care. It is not registered to provide nursing care. The home was originally two houses Care Homes for Older People Page 4 of 33 1 0 0 3 2 0 0 9 15 0 Over 65 0 15 Brief description of the care home built on a hill so access to many rooms requires people to be able to manage short flights of stairs between the two lounge rooms. Stair lifts provide access to the first floor. Penvose is not suitable for wheelchair users. On the split level ground floors are two lounges and the dining room. There are 13 single bedrooms and one double. None have en-suite toilet facilities. The home is situated in a residential area of Plymouth a short bus ride from the city centre. It is also opposite a large park. At the back of the house is an enclosed patio garden and at the front there is a garden. The home has a cat and two budgies. Limited off road parking is available for visitors at the rear of the home otherwise on street parking is available subject to parking restrictions. Penvose has a no smoking policy. The current fees at Penvose start at 377.93 pounds a week. Additional charges include a hairdresser, a Chiropodist, personal toiletries and newspapers. Information about Penvose can be obtained directly from the home. Care Homes for Older People Page 5 of 33 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: The quality rating for this service is zero stars. This means the people who use this service experience poor quality outcomes. This inspection took place on 14th December 2009 and was unannounced. One inspector carried out the inspection, but the report is written as we, as it is done on behalf of the Care Quality Commission. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Four staff completed and five residents returned these, some with help from relatives, as well as two health professionals who visit the home regularly. During our visit we made a tour of the premises, and spoke with the Registered Provider, Mrs Joyce Reed, the Matron who is responsible for care in the home, and five other staff members. We met with residents in the lounge and dining room, and visited people in their private accommodation. Care Homes for Older People Page 6 of 33 We looked at care plans and records, and saw how medication is administered and recorded. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Penvose. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Two immediate requirements were made during this visit, in order to prevent potential harm to residents. 1) Fire doors were held open by wooden pegs, which means that in the event of a fire people would be at risk. Hold-open devices had been fitted to the doors, but were not in working order. Systems for checking safety in the home should be in place. 2) Medication was in general being administered carefully and accurately, but the records had not been altered when a prescription had been changed, which could have lead to a resident being given the wrong dose. A system should be in place to alert staff, and ensure they are aware of any changes. There were five requirements made at the last inspection in March 2009 that had not been met. 1) Training had not been provided yet for all staff in Protection of Vulnerable Adults from abuse. 2) Recruitment records did not contain all the references and proof of identity as required by the regulations to protect residents from potential harm. 3) Staff had not been provided with training in first aid, which is necessary to ensure they may respond in an emergency and assist residents in a way that protects their health and safety. 4) The records kept relating to service users money were still not entirely accurately maintained, and not all money was accounted for. Care Homes for Older People Page 8 of 33 5) The home had not informed the Commission of events that had occurred in the home that affected the welfare of residents, as is required by regulations in order that the Commission may monitor the homes practice in dealing with events. Further requirements were made; 1) The Job Description of the Matron and any senior staff involved in management of Penvose must be reviewed, in order that the responsibility for all management tasks is made clear, the person is accountable for their achievement, and the staff are given time for these tasks. 2) We saw that a resident was ushered into another persons private accommodation for a consultation with their GP. This is unacceptable, as it infringes the privacy and dignity of each resident. 3) Unfortunately, the cat that has been living at Penvose has developed disabilities and habits that make it unsuitable for life in a care home. The Commission has no objection to companion animals, but in order to meet the regulations with respect to avoiding infection and toxic conditions in the home, different arrangements must be made. A Recommendation is repeated from the last inspection; that staff should receive regular supervision to provide them with support and to review their work performance and training needs. Further recommendations were made with respect to; 1) Staff should receive training in good practice in the care of people with dementia. 2) The home should provide all residents with a statement of terms, in order to be clear about what is included in the service, and any terms of discharge. 3) The homes assessment procedure should be more comprehensive, to ensure the home is suitable for meeting peoples needs. 4) Care plans should be further developed, to include peoples social and cultural needs. 5) More social activities and outings should be provided, as well as engaging residents in activities of daily life in the home. 6) An assessment of the property should be commissioned from an Occupational Therapist, and their advice followed with respect to making the home as accessible as possible for the residents, to enable them to be as independent as possible. 7) A regular check should be made of safety within the home, with records kept. 8) A call bell system should be provided that has to be cancelled by staff at the point of call rather than in the hallway, and doors to residents private accommodation should be fitted with locks that are suitable to promote their privacy and dignity. If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 33 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 10 of 33 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 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some information is available for prospective service users and their representatives, and they are welcome to visit. Assessment of peoples needs before admission needed to be more comprehensive, to ensure that the service was offered appropriately, and the staff given full information in good time. Evidence: All four residents who returned surveys to us said they had sufficient information before moving in to help them come to this decision. The home owner said that prospective residents and their families are welcome to visit at any time, and they prefer people to visit without making an appointment, to see us in a true light. We did not see that people had been given a statement of terms, clarifying what was included in the service. The home owner supplied us with a blank version, but we did Care Homes for Older People Page 12 of 33 Evidence: not see completed ones on file, and none of the people who returned our surveys said that they had been given one. With respect to the most recent admissions, records showed that Senior staff in the home had consulted with a District Nurse and a Social worker. They told us that they had been to visit, in one case, but had not made a record of their observations. They said their practice is to consult with the local District Nursing team before offering accommodation to a resident who has nursing needs such as dressings or regular injections, or receiving a resident home after hospital treatment, to ensure that they are able to take on any nursing responsibilities. One admission had been made in an emergency with little information provided to the home. Staff in the home had produced a brief care plan within three days, using information provided by the client themself. The home has a form called the Initial Client Assessment which had been used for gathering information about prospective service users. The Matron told us they had also used it for people returning to Penvose from hospital. The Matron said she planned to revise this form, and should do so in order to include all information as required by standard 3 of the National Minimum Standards, to enable a comprehensive assessment to be made. The decision as to whether or not the home can suitably offer a service, with reasons, could be included in this recording. Although respite care may be offered, Intermediate care is not provided at Penvose. Care Homes for Older People Page 13 of 33 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. Though daily records were kept to ensure that staff knew what had been done and what needed to be done for residents, the care plans were not full enough to give a clear picture of peoples overall needs and aspirations. A good system was in place to administer medication to residents, but staff were not alert to dealing with alterations in prescriptions. Evidence: Daily records were kept for each person. Staff had recorded the care tasks they had completed, so that they were accountable for what they had done. A Handover file was kept, with a separate page for each resident, and the Senior in charge shared this information with staff coming on duty. Personal files were kept in residents private accommodation. We examined a sample of these which were seen to be accurate, though they could benefit from further development. There was evidence that the home had been working in collaboration with health professionals. A continence chart had been kept for one resident at the instigation of the District Nurse. To be effective this chart needed to be checked regularly and Care Homes for Older People Page 14 of 33 Evidence: decisions made about any action needed. However, the District Nurse was still visiting regularly, and would be able to ensure that these evaluations were properly made, and any action taken in response. Information from her visits was recorded in red in the residents care plan. Three of the four people who returned our surveys said they always get medical support when they need it, while the other said usually. A GP attended during our visit, following a minor accident. Another told us that the staff had drawn their attention to residents health problems in a timely way, and had always produced the records and information correctly as needed. A monitored dosage system of administering medication was in place, to help staff to give the right medication every time. In general the system was working smoothly, but we found that one resident was taking medication which had to be given at a different dosage periodically, following blood tests. We saw that the dose had been changed but that this had not been recorded in the Medication Administration Record, and we made an immediate requirement that this be done in order that the staff would ensure the resident received the correct dose. The Manager needed to provide a method of ensuring such alterations are always highlighted to staff. In general, we saw that staff treated residents with respect. However, we saw that a resident was ushered into another residents bedroom when visited by their GP. This practice must stop as it contravenes the privacy and dignity of residents. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents at Penvose are not provided with a good range of social activities or involved in activities of daily living. The meals provided are good in quality and offer choice. Evidence: Staff told us that residents are taken a cup of tea at 7am, if they want one. They get up when they want to, and one regularly chooses to rise at 10am. One resident is regularly awake during the night, and night staff can supply drinks and snacks if required. We saw visitors sitting with residents during the morning, and people watching television in the afternoon. One resident was out all day with their family. We did not see other activities arranged for residents, but staff told us that armchair exercises are lead once a fortnight, and they said they had taken people for walks in the park. We were also told that the home owner sometimes plays the organ, and that a Church group visits once a month. Bonfire and Halloween parties had been held. Arrangements were being made for Christmas at the time of this visit. We were told that a raffle had been held to raise money for a party. This was to be organised by staff, and residents could invite family members. Their regular Church visitors were Care Homes for Older People Page 16 of 33 Evidence: coming to sing carols. There is a tradition at Penvose of serving Christmas dinner of roast turkey on Christmas Eve, with roast pork served on Christmas Day. There was no evidence that this had been discussed with residents. The reason given was that many of the residents would be out on Christmas Day, but this year nine (of the current 12) were expected to be at home. Residents in surveys told us that they would like more activities to stimulate their minds. Staff said they considered there should be more activities, and also said they would appreciate training in motivating residents. We did not see residents engaged in activities of daily life such as baking or folding laundry with staff, and we found that residents rarely go out unless their family or friends take them. We shared lunch with residents in the dining room and found the meal to be nutritious and very tasty. Fresh vegetables were presented in a way that residents could enjoy, and there was choice and attention to the needs of those with special diets. Staff ate with residents which helped make it a pleasant social occasion. The cook told us that she is able to order ingredients as she needs them, and has ordered specific items for individual residents, such as a new residents favourite breakfast cereal. The cook told us she was given good information about dietary needs when new residents moved in to Penvose, and she had knowledge of some special dietary needs. The Matron told us she would look up information if people were admitted who had differing requirements. Recently admitted residents had been asked for their likes and dislikes. Care Homes for Older People Page 17 of 33 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 was a suitable complaints policy and procedure, but not all residents were aware of it. Residents may not be fully protected as staff have not all received training in dealing with abuse and the home owner was not clear about the actions she should take in the event of an allegation being made. Evidence: Since the last inspection the CQC had not received any complaints about Penvose. All four people who completed our surveys said they would know who to speak to if they were unhappy, but only two said they knew how to make a complaint. The policy was on display in the entrance hall. The homes policy on the Protection of Vulnerable Adults from abuse was lacking the contact details that the person in charge of the home would need in order to correctly report any allegation of abuse that might be made. Mrs Reed and two of the senior staff had attended training on the Protection of Vulnerable Adults. All other staff still needed this training, which had been the subject of a requirement made at the last inspection. In spite of having attended this training, Mrs Reed was not clear on the action that she should take in the event of an allegation of abuse being made. She remembered about the local agreement called the Alerters Guidance when prompted. It is vital that the Care Homes for Older People Page 18 of 33 Evidence: person in charge of a care home knows who to report any such allegation to, in order that residents are protected. Staff knew that they must inform the home owner of any allegation made, even if they had been working alongside an alleged perpetrator for many years, as many of these staff had done. There had been an investigation of poor practice earlier in the year, which had a profound effect on the staff, as it put a spotlight on their work and in particular the efficacy of their record keeping, which had not been good enough to show whether or not they had provided good care. They had worked with health care professionals to improve this aspect of their practice. Staff told us they felt they were more open with each other and with the home owner as a result of this effort. This is good, as a willingness to reflect on the way things are done is key to improving practice in the home. Care Homes for Older People Page 19 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This house is comfortable and attractive, and its residents were able to manage the flights of stairs. There were problems of hygiene and safety that needed urgent attention. Evidence: Mrs Reeds husband takes responsibility for all maintenance and also gardening. The home has been proud to have won Plymouth in Bloom competitions. Newly admitted residents told us they were very happy with their redecorated and carpeted room. We did not see a plan of proposed refurbishment or maintenance, and we found that some safety issues had not been dealt with in a timely way. This house is not suitable for people who have severe mobility problems, because of the staircases. The people we met in upstairs rooms were all able to get downstairs when they wanted to. One relative told us they were pleased that their resident had been offered a room on the ground floor as it allowed them greater independence and ensured their safety. None of the bedrooms had en suite toilets. All were provided with a commode, often for night time use only. There is a call bell system, but staff have to go to the hallway to cancel the calls, which is disruptive when they are upstairs and is not ideal. If bells were cancelled in residents rooms, staff could not cancel the bell without seeing the person. Care Homes for Older People Page 20 of 33 Evidence: Doors to private accommodation had previously had Yale locks fitted. These had been disabled to prevent any risk of residents locking themselves in. Suitable locks had not been provided. The home owner said that she had asked residents if they wanted one, and none had said they did. These should be fitted when rooms are vacated, to promote the privacy and dignity of incoming residents. They should be the type that residents can close from the inside with a knob, and that staff can open from the outside with a master key, in an emergency. This house has large attractive windows, some with interesting views across the garden or park. Double glazing had been fitted to some, to insulate the rooms from cold and noise. Hand sanitizer had been provided in entrance halls. The laundry was provided in a utility room, which was seen to be in good order. There was a back up domestic style washing machine in a newly converted conservatory, where clean clothes were brought to for sorting and ironing (by night staff). Staff showed us the red bag system that was in place for soiled linen, to prevent cross contamination. This is good practice, but staff were concerned that the bags did not dissolve as they should. The cleaner told us that Mr Reed had a powerful carpet cleaner that he would bring for her to use. We suggest it should be freely available, as its use was needed at the time of this visit. One bedroom had a bad odour, in spite of staff efforts. As well as professional advice on the health problems of the occupant, the home owner should consider cleaning regimes and floor coverings. There is a house cat which, though popular with the residents, has disabilities and habits that make it unsuitable for living in a care home. Care Homes for Older People Page 21 of 33 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. There is a small team of committed staff, but training had not been provided to encourage the development of a team able to provide person centred care and meet residents specialised needs. The level of staffing restricted the ability of the team to provide activities and deliver person centred support. Documentation of recruitment was poor. Evidence: We saw that staff on duty were caring and working well together. Penvose has been good at keeping staff, and several have worked together for many years. Relatives told us that they found staff to be friendly, caring and reliable. The level of staffing is variable. When we arrived on a Monday morning, there was a senior member of staff, working with two care assistants, a cook and a cleaner. The home had an atmosphere of calm, and we did not hear call bells ringing. Staff had time to talk with us, and residents confirmed that staff came in good time when they used their call bell. However, after 2pm the Matron was on duty with one care assistant. This was a regular arrangement, meaning either that the Matron does not have time to complete management tasks, or residents do not have staff attention for activities. It also means it is not possible for staff to accompany a resident outside the home. The Matron should be supernumerary except in exceptional circumstances. Most residents who completed our surveys said that staff were available when the Care Homes for Older People Page 22 of 33 Evidence: needed them, but they also said they did not have enough activities provided. A night care worker told us that there is only one resident currently who is awake during the night, the others are settled, so one awake carer and one on sleeping in duty is sufficient. Staff told us they enjoyed working at Penvose, and they felt the teamwork was good. We examined the documents of the most recently recruited staff. We found that Criminal Record Bureau clearances had been obtained on behalf of all, which is good practice to protect residents from potential harm. However, the documents were not in good order, and we did not see references obtained on behalf of each person employed, or proof of identity as required by the regulations. This failure to have satisfactory checks on file for staff employed to work in the home was the subject of a requirement at the last inspection. It remains outstanding, leaving residents at risk of potential harm if unsuitable people were to be employed as a result. We advised Mrs Reed to consult with Matron and the senior staff to evaluate the best way forward, to delegate to the Matron or another senior member of staff and give them the time to maintain these records fully and accurately. There was little evidence of training since the last inspection. Mrs Reed and two Senior staff had attended training on Protection of Vulnerable adults from abuse. A requirement had been made for all staff to attend. Moving and handling training had been booked for the following month. One carer said they were keen to start their NVQ, while another told us they had a diploma in Health and Social Care and had done a course in Food Hygiene. Up to date qualifications in first aid, fire safety, and control of infection were not in place. Staff would also benefit from training in the care of people with dementia, to enhance their understanding of the people they are caring for, of person centred practice, and to enable them to improve the lives of the residents in accordance with current good practice. Relatives told us they had heard comments from staff about residents which showed a lack of understanding of their condition, and staff themselves said they were keen to receive suuch training. Care Homes for Older People Page 23 of 33 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 were failing to assure the safety of residents in the home. There was no evidence of proactive leadership towards improving practice in the home. Evidence: Mrs Reed is the home owner and registered provider of Penvose. She is accountable for management of the home and is actively involved in its day to day running. She has appointed a person to be responsible for the supervision of staff and care in the home.and This person is called Matron and she has achieved the Registered Managers Award, and is working towards NVQ4 in Care. Mrs Reed should review all management tasks, and consider which further tasks she should make the responsibility of the Matron or another senior member of staff as some management tasks were not being completed satisfactorily. This included recruitment documents not being gathered properly, to ensure the suitability of staff and in turn protect the people living in the home, and unsatisfactory provision of training. The Matron was not allowed sufficient time for management duties, so the staff rota Care Homes for Older People Page 24 of 33 Evidence: also needed to be reviewed. She had a half day as supernumerary for management duties, and this needed to be reviewed in consideration of her responsibilities. Tasks had gradually moved from the home owner to the matron without proper review, and due to the shared responsibilities there had been no process of review. Mrs Reed should consult with Matron and the team to consider and agree the best way forward. The Matron said that questionnaires had been circulated to residents and their relatives or representatives. She agreed to supply the CQC with a summary of feedback. A recommendation was made at the last inspection that staff should receive regular supervision to monitor their work performance. The Matron said that she was providing informal supervision to staff, in particular she had been available to discuss policies and procedures with staff when they had been studying for their National Vocational Qualifications. A regular system should be put in place, with records kept, to provide staff with support and review their work performance and training needs. Five requirements made at the previous inspection had not been met. These included the failure to provide training in the Protection of Vulnerable Adults for all staff; and training in first aid to ensure that there is always someone on duty who is able to take appropriate action in an emergency. We were told that training in moving and handling had been booked for 19th January 2010. We saw potentially unsafe practice where a care assistant was helping a resident climb a flight of stairs, and had not considered the best way to offer support. Another requirement not met was in respect to the failure to fully account for cash held on behalf of residents. We examined all cash held in the Managers office on behalf of residents. There were only four; three had not recorded any transactions for several months, but they were accurate. The other had a sum of money not accounted for. There had been in place a suitable form to record incomings and outgoings, a running balance, and all signed for by the service user, but it had not been completed to the present day, and a sum of money was unaccounted for. We were aware that there had been falls and other events occurring in the home, but we had not received a notification since June 2009. A requirement had been made at the previous inspection regarding the home owners legal duty to provide these notifications. Two immediate requirements had to be made at this inspection, to assure safety of Care Homes for Older People Page 25 of 33 Evidence: residents in the home. One was made because some fire doors were seen to be pegged open, which means that they would not close if there a fire, and residents would be at risk of harm. Hold-open devices had been fitted, but were not in working order, and may not have been for some time, as wooden door pegs were in use. The fire precaution system had been serviced professionally in February 2009. We found that a keypad lock had been fitted to a fire exit, because it was close to the door of a resident who might leave that way by mistake. The home owner must consult the Fire Safety Officer and make suitable provision for people to escape in an emergency. The other Immediate Requirement was with respect to administration of medication, and is recorded in section 2 of this report. Care Homes for Older People Page 26 of 33 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 18 13 Arrangements must be 30/06/2009 made, by training or other measures, to prevent service users being placed at risk of abuse. Staff must be able to recognise the signs and symptoms of abuse and know what to do should they suspect someone is at risk. 2 26 13 The registered person must 31/07/2009 make suitable arrangements for the training of staff in first aid and to provide safe moving and handling of service users. This is to ensure staff have the necessary skills to respond to an emergency and to assist service users in manner that protects their health and safety and that of the service user. 3 26 19 People must not be 31/03/2009 employed at the home unless satisfactory outcomes have been obtained in relation to all the information as detailed in Schedule 2 of the Care Homes Regulations 2001 Two written references must be obtained in relation to the Care Homes for Older People Page 27 of 33 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 applicant prior to the commencement of their employment to ensure as far as possible only suitable staff are employed. 4 35 Sch 4 (9)17(2, 3a) The Registered Provider must 12/12/2006 ensure that all financial records of monies held on behalf of residents are accurate and up to date. The registered person must inform the Commission of any event that affects the well-being or safety of a service user. This is to enable the Commission to monitor significant events with each service and peoples safety. 31/03/2009 5 38 37 Care Homes for Older People Page 28 of 33 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 9 13 Any change in the 31/12/2009 prescription of residents medication must be recorded in the Medication Administration Record, and highlighted to ensure that staff are able to administer medication correctly. 2 38 23 All fire doors must be kept 31/12/2009 shut, unless held open by an approved hold-open device. This is to protect residents from harm in an emergency. 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 10 12 Medical examination and treatment must be provided in the residents own room, in order that their privacy and dignity may be respected. 29/01/2010 2 26 13 In order to meet regulations 29/01/2010 with respect to preventing infection and toxic conditions in the home, new arrangements must be made for the cat, Care Homes for Older People Page 29 of 33 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 so that its unhygienic habits are no longer impinging on quality of life in the home. 3 31 12 The home owner must ensure that the home is conducted in a way that makes proper provision for the health and welfare of service users by clarifying the role and responsibilities of the Matron and other senior staff in a Job Description. This is to ensure that people with management responsibility know what they must do and are given time in which to do it. 4 38 23 The home owner must consult with the Fire Safety officer with respect to a lock on a fire exit. This is in order to enable people to leave the building in the event of an emergency. 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 05/03/2010 05/03/2010 1 2 All residents or their representatives should be provided with a statement of terms by the home, so that they know Care Homes for Older People Page 30 of 33 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 what is included in the service, and any notice period. 2 3 The assessment process should consider peoples care needs comprehensively. All observations made during assessment of a clients needs prior to admission should be recorded, along with the decision as to whether or not the home can meet their needs, along with any reasons. This is in order to be clear about whether the home is suitable to meet the needs of a new service user. Care plans should be further developed to give staff fuller information about peoples health conditions, and to include a personal profile, to give staff a view of the persons life and interests. Staff should engage residents in activities of daily living, and provide social activities that stimulate and engage people. It would be good practice for a Senior member of staff to discuss the complaints procedure with all residents or their representative, as not all were aware of how to make a complaint. There should be a method of regular checking, with records kept, to show that maintenance tasks are dealt with in a timely way. The home owner should consider provision of a call bell system which requires staff to go to the point of call to cancel the bell. The home owner should commission an assessment of the premises by an Occupational Therapist, to find whether the best is being made of the space and facilities available, to promote the residents mobility. Locks should be fitted to residents private accommodation, which are suitable for them to use, unless risk assessment suggests otherwise. Cleaning regimes, and provision of equipment and floorcoverings, should be reviewed in oder to avoid odour in residents private accomodation. The red bags supplied for safe laundering of soiled linen should be checked for suitability. Staff should receive training and support in good practice in the care of people with dementia, to enable them to enrich Page 31 of 33 3 7 4 12 5 16 6 19 7 22 8 22 9 24 10 26 11 12 26 30 Care Homes for Older People 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 residents lives within and outside the home and to provide suitable social activities to engage and motivate the residents. 13 33 A summary of the feedback gathered by the home should be produced, to share with residents and their representatives, and to inform the management about any improvements that might be included in their planning. Staff should receive regular supervision to monitor their work performance and training and development needs. 14 36 Care Homes for Older People Page 32 of 33 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. 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