Inspection on 16/06/09 for Perth House Care Home

This inspection was carried out on 16th June 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Perth House Care Home 10/09/09

Perth House Care Home 09/07/08

Perth House Care Home 20/08/07

Perth House Care Home 31/10/06

Perth House Care Home 30/01/06

Perth House Care Home 10/05/05

Perth House Care Home 18/10/04

Perth House Care Home 27/07/04

Perth House Care Home 07/10/03

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care 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: Perth House Care Home Athlone Close Chaddesden Derby DE21 4BP     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: Jill Wells     Date: 1 6 0 6 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 34 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 34 Information about the care home Name of care home: Address: Perth House Care Home Athlone Close Chaddesden Derby DE21 4BP 01332717550 01332717550 kevinjowett@derby.gov.uk Derby.gov.uk Derby City Council care home 39 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Perth House is situated within a residential area of Derby city. It is registered to provide residential care for 39 Older People, although following the refurbishment there are only 36 beds available. All bedrooms are single and are provided across two floors, which are connected by a shaft lift and staircase. A variety of communal areas are provided. The service provides places for up to 10 people for intermediate care. This is to support people to regain their independence, with a view to returning home. There are also up to 4 short-term care beds. This accommodation is on the ground floor. Long-term residents accommodation is on the first floor. All areas of the care home are accessible to people living at the home and seating is provided in the Homes garden. There is parking available for visitors. Fees are calculated by the assessment and collection section in Social Services and are based on capital and any regular income. At the time of inspection the fees were between £108.10 - £350 per week. Further information regarding the fees can be obtained by contacting the Registered Manager at Perth House or through your local Social Services office. Inspection Care Homes for Older People Page 4 of 34 Over 65 39 0 Brief description of the care home reports by the Care Quality Commission are available at the service. Care Homes for Older People Page 5 of 34 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 the service is 0 star. This means the people who use the service experience Poor quality outcomes. The inspection visit was unannounced and took place over 9 hours. There were 29 people living at the home on the day of the inspection. 9 residents, 5 staff, 5 visitors, and 2 assistant managers were spoken with during the visit. We also looked at all the information that we have received, or asked for, since the last key inspection on the 9 July 2008. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 34 The previous key inspection report. Completed surveys from people living at the home. Case tracking was used during the inspection visit to look at the quality of care received by people living at the home. 4 people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The medication systems were unsafe and could potentially put people at risk. Some fire doors were being propped open, which again could put people at risk. Up-to-date care plans were not always available for care staff to read so that they were fully aware of individuals needs. This was partly due to a printer that had been broken for two months. Confidential information was not always stored securely. A previous requirement had not been met concerning staff receiving up-to-date training in safeguarding adults. This time scale had been extended. If the new timescale is not met, enforcement action will be considered. Although most staff had completed other mandatory training, including refresher Care Homes for Older People Page 8 of 34 training, some staff had not received up-to-date training in first aid and moving and handling. Night staff were not receiving six monthly fire training as required. Not all staff that administer medication had received training to safely do so. Staff were not receiving regular formal supervision to support them in their role. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. There was detailed information available about the service, including intermediate care. Peoples needs were not always fully assessed before being admitted to the service. Evidence: There was a file available in the foyer and the first floor lounge with information about the service. This included a statement of purpose and service user guide. There was also information about advocacy services, how people can access their records, the homes equality and diversity policy and information concerning adult protection. The document said that people were encouraged to stay for a trial visit before they made a decision to stay. People spoken with were able to confirm this. The relevant documents had not been revised to reflect the name change to the Care Quality Commission. There was a copy of the homes terms and conditions in each of the 4 peoples files Care Homes for Older People Page 11 of 34 Evidence: that were seen. Not everyone had an up-to-date full needs assessment before being admitted to the home. For example one person was admitted for respite care with an out of date care plan from the community home care service. This only gave information about what help they needed whilst they were in their own home. The annual quality assurance assessment completed by the manager said that each resident on admission has a care assessment and risk assessment in consultation with the resident. The service provided up to 10 places for intermediate care and 4 places for short-term care. These were all on the ground floor. Information about intermediate care was seen in the intermediate care bedrooms. This helped people understand the aim of maximising their independence, with a view to returning home. There was a team of staff that worked with people who had been admitted for intermediate care. These included a community nurse, physiotherapists and occupational therapist who visited the home, as well as care staff. There was a kitchen available to assist with rehabilitation. The community nurse who worked with the people admitted for intermediate carewas spoken with. She said that the staff at the home had a good understanding of promoting peoples independence with a view to rehabilitation. She said that she received very positive comments from everyone about the staff and people usually wanted to come back. Care Homes for Older People Page 12 of 34 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. There was not a safe system for receipt, storage, administration, recording and returning medication. This could put people at significant risk. There was not always an up-to-date plan of care available for care staff to read and follow in order to meet individual peoples needs. Evidence: The annual quality assurance assessment completed by the manager said that each resident had a care plan that is updated, in order to recognise changing individual needs. A full range of risk assessments are carried out. Log sheets are updated regularly and shift handovers cover all residents individually. Medication is ordered, stored and dispensed according to regulations by trained staff and self medication is available where appropriate and safe. During the inspection visit four peoples records were seen. Up-to-date service user plans were not kept in each persons individual file. There were separate files for each wing in the home. Each persons care plans, risk assessments and recent daily logs were kept in these files. This was for easy access for care staff. One persons care plan Care Homes for Older People Page 13 of 34 Evidence: could not be found. The manager on duty explained that this had been completed on the computer, however as the printer had been broken for two months, this could not be printed off and made available for care staff. One persons file that was seen showed a care plan from their previous stay in November 2008. This had not been revised to reflect their changing needs for this period of respite care. Records showed that GPs, district nurses and other health professionals were called when required. An optician was visiting on the day of the inspection visit. Residents spoken with confirmed that they could see a GP at any time. A visitor spoken with said that, care is good, people are looked after very well. Two people staying for respite said that they had enjoyed the break and one person said that it felt like a holiday. An assistant manager was observed administering medication. There were several areas of poor practice seen. This included handling medication without protective gloves, placing fingers inside glasses of water for people to take their medication, and signing that medication had been administered before this had been done. Medication had been removed from the blister pack for one person and had been signed as administered, however they were asleep, and the medication had to be left in a plastic pot in the medication trolley, which was not a safe practice. One persons records and balance of medication was checked. They had run out of one medication, but staff had signed that an extra 3 had been given. On counting the persons other medication, there was one tablet unaccounted for. Another persons medication records and a check showed that they had three additional tablets remaining, that had been signed as administered. Another person had a tablet remaining in their blister pack, however the medication administration records showed that this had been signed as given. One person had been prescribed a schedule 3 controlled drug. This was being administered by night staff, however they had received no training in medication administration. The medication administration records showed that 9 tablets had been given, however only six had been taken out of the blister pack. The date format on the blister packs were not being followed. Tablets from the previous month were being used rather than returned to the pharmacist. These remaining tablets were not being recorded. An audit trail of this medication was not possible due to the poor and unsafe system being used. A complaint received in 2009 included the concern that a person admitted for respite care had not been given all of their medication to reduce agitation. The person had shown signs of agitation during their stay. The outcome of the investigation showed Care Homes for Older People Page 14 of 34 Evidence: that one tablet had not been given. Training records showed that one manager who administered medication had not received medication training and the registered manager and an assistant manager had not received refresher training. The manager on duty explained that due to being short staffed, a relief care assistant and intermediate care worker covered the previous night shift. The medication administration records for this person had been left blank. The manager said that the relief night staff had told her that they had not given this medication as the person was asleep. Night staff were also administering pain relief. A care assistant spoken with said that care staff received the keys for the medication room in order to access skin creams. The keys were returned at the end of the shift. Creams for skin were administered by care staff. Sheets were kept in peoples bedrooms for care staff to sign that the cream had been administered. One sheet that was seen showed several gaps, making it unclear whether the cream had been given The code used on the medication administration records were not being used correctly. For example a code was being used for loose bowels, however this person was not give their medication because they were asleep. There was not a safe system for medication that needed to be returned. This medication was in an open box on the floor of the medication room, near an open window that could easily have been wrenched open. There were a number of loose tablets in a pot in this box. There was not a record of these in the returns book. The manager said that this book was completed at the end of the month. Identifying them at this stage would have been difficult. One person spoken with administered their own medication. They were not storing this medication in a locked area, but in a bag on their Zimmer frame. The manager on duty explained that there were not keys for all of the lockable drawers. There was not a risk assessment concerning one person administering their own medication, however there was a signed declaration that the person wished to keep their own medication. Staff were generally seen treating people with respect. However the manager on duty was seen administering eyedrops to a person in the lounge area and a care assistant was seen putting on a persons tension stockings in another communal area whilst other residents were able to watch. This did not respect peoples privacy and dignity. Care Homes for Older People Page 15 of 34 Evidence: The physiotherapist instructor visiting the home said that staff were very good at communicating relevant information about residents. Care Homes for Older People Page 16 of 34 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. Activities are organised but could be further developed to meet individual needs. The meals provided were varied and nutritious to ensure that people had a balanced diet. Evidence: The annual quality assurance assessment completed by the manager said that they offer activities in line with residents expressed wishes, including a very popular weekly exercise class. Light gardening is possible in the newly modernised garden area. During the inspection visit a monthly activities sheet was displayed in the foyer, however this was for the previous month. The activities advertised were hairdressing, intermediate exercise class, a party and outside entertainer to celebrate the bank holiday and a residents meeting. There was a separate area for day care on the ground floor. People from the community came in three days per week, and residents at the home could join in with activities. On the day of the inspection visit a physiotherapy instructor was doing the weekly exercise class. This was predominantly for people on intermediate care, however anyone else within the home could join in. The activities organised by care staff were recorded in a diary. However there were very few entries. The entries that were recorded included a quiz, skittles, and board games. Care staff explained that it was their role to organise activities but when Care Homes for Older People Page 17 of 34 Evidence: staffing levels were reduced due to low occupancy, activities were difficult to arrange. Staff thought that more activities took place than was recorded. There were occasional residents meetings. Minutes of these meetings showed some consultation, particularly around trips. Six people had recently been to Skegness, supported by staff and a boat trip was planned in August. The satisfaction surveys undertaken by the home in March 2009 showed that all 5 people who responded were satisfied with the activities and outings. One person wrote in our survey that the home could improve by, having more entertainment and activities. Some people commented that there were only sometimes activities arranged that they could take part in. Residents spoken with generally felt that there was not a lot of activities taking place, but none spoken with particularly want to take part in activities. There was not evidence in peoples files of their hobbies and interests or any one-to-one consultation concerning activities that they wished to take part in. Several visitors were at the home on the day of the inspection visit. They all felt welcomed at the home. One person commented that since long-term residents had been moved to the first floor, they were less inclined to use the outside areas. Observations of the outside areas throughout the day showed only people staying for respite care on the ground floor sitting outside. A resident spoken with confirmed that they could go out if they wished to, but it seems a long way to go. All residents spoken with were very satisfied with the meals provided. 10 people that returned our surveys were generally happy with the meals. The cook was spoken with. She confirmed that there was a choice at every meal time. People were asked a day in advance what their preference was. The second choice was always a vegetarian option. Cakes and pastries were home-made and fresh fruit and vegetables were used. Care Homes for Older People Page 18 of 34 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. Lack of up to date training for staff in safeguarding procedures may potentially put people at risk. Evidence: After the previous inspection visit 9 July 2008 a statutory requirement was made that all members of staff working at the home must receive training in safeguarding adults procedures so that people living at the home are protected from abuse. Training records and the assistant manager confirmed that this requirement had not been met, although an assistant manager had e-mailed the training department on two occasions giving the names of 20 staff that required this training. The importance of this training and the requirement in place was not stressed in this e-mail. An action plan had been sent to the Commission by the registered manager after the previous inspection visit. This stated that a list of all staff needing adult protection training had been drawn up and arrangements will be made for the training to take place. The annual quality assurance assessment completed by the manager said that adult protection training is part of the staff induction training and staff are receiving training on safeguarding adults in relation to deprivation of liberty. There was the complaints procedure displayed at the home. This did not reflect the name change Of the Care Quality Commission. Residents and visitors spoken with said that they felt able to go to any of the managers to discuss any concerns or complaints that they may have. Care Homes for Older People Page 19 of 34 Evidence: The complaints records were seen. There had been two complaints since the last inspection visit. One was concerning the attitude of a care assistant. The second was concerning inadequate care provided during someones stay for respite care, particularly around medication and personal care. These had been investigated by an external manager and a written response provided to the complainant. . Care Homes for Older People Page 20 of 34 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. People live in a clean, well-maintained and comfortable environment that meets peoples needs, however some health and safety issues concerning fire may put people at risk. Evidence: The annual quality assurance assessment completed by the manager said that the home was in a good state of repair and equipment was well maintained. Health and safety, control of substance hazardous to health (C.O.S.H.H.) and infection control guidelines are in place and followed. Residents can personalise their bedrooms and bring their own possessions with them. The grounds and pathways have been improved. The foyer and main staircase had been re-carpeted, some bedrooms have been re-decorated and had new floor covering.The long-term aim is to renovate the upstairs bedrooms to the standard of those downstairs. There was a passenger lift as well as a staircase for access between the floors. This gave people on the first floor access to the garden areas, however a visitor spoken with said that their relative had used the outside area much less since being moved to the first floor. A visitor spoken with had expressed concerns to the managers about the new fire doors put on bedrooms. They appreciated the safety aspect, but were concerned that Care Homes for Older People Page 21 of 34 Evidence: as their relative could no longer open this door, this was reducing their potential for independence. At the time of the inspection, this bedroom fire door had been propped open by staff using a chair, which was not safe practice. There are two lounges and two dining rooms, as well as a quiet room and a smoke room. There is a small phone room for private telephone calls. The smoke room was in need of redecoration. There was not a risk assessment for this room and a large box of matches was seen in the room when it was not in use. During the inspection visit the home was found to be clean, with no unpleasant odours. People spoken with said that furniture was comfortable. There was a range of bathing options available. Staff spoken with said that there was sufficient equipment available to ensure that supporting people with their moving and handling needs was done safely. Bedrooms had reduced from 39 to 36 since the development of the intermediate care service on the ground floor, as some bedrooms were used to create en-suite facilities. Several people commented that the facilities on the ground floor for intermediate care and respite care services was of a better standard than the facilities on the first floor for long-term residents. A recommendation was made after the previous inspection visit that the accommodation upstairs should be brought up to a comparable standard to that downstairs. The action plan received by the registered manager in August 2008 stated that, The Council currently have no funds available to upgrade the upstairs of Perth house, though a review of its entire residential provision for older people is in progress. One person spoken with commented that their bedroom was very comfortable. Another person at the home for respite care said that they enjoyed the seating area. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were generally well trained and competent, however not all refresher training was taking place to ensure that staff had up-to-date skills and knowledge to meet peoples needs. There were sufficient numbers of staff to support the people who use the service. Evidence: The homes statement of purpose said that there was a minimum of 3 staff on duty during the day, with adjustments made to the staffing levels if there was a higher or lower level of need. It stated that there was always a manager on duty between 7:15 AM-10:15 PM. At night there were two waking night staff on duty. Staff spoken with said that there was often 4 staff on duty, 2 staff on each floor, but due to present low occupancy, this had been reduced to 3 staff. Two staff spoken with said that they felt that the present staffing levels met peoples needs. There were no residents at the homewith high dependency needs at the time of the inspection visit . During the inspection visit in the afternoon there was a period of 20-30 minutes where there were no care staff on the first floor. A resident and a visitor commented about this. During this time all care staff were on the ground floor having a handover meeting with a manager. However there were also two managers in the office on the ground floor. Care Homes for Older People Page 23 of 34 Evidence: A resident spoken with said that they thought that staff came quickly when they rang their call bell, although not everyone could do this. A person staying for respite care said that they had been poorly during their stay and felt well looked after during that time. The community nurse spoken with said that staff were really friendly and had time for people. A resident spoken with said staff were, very understanding and would help if they could. Another person said that, staff work had, though at times they are under pressure. A relative had wrote a letter thanking staff for the excellent care and support provided to their relative. The annual quality assurance assessment completed by the manager said that all staff had completed induction training. 19 out of 24 care staff had completed NVQ 2 Care or above, which was above the minimum standard and should be commended. Training records were seen. These showed that most people had received the mandatory refresher training, however as previously stated staff had not received refresher training in safeguarding adults and night staff had not received medication training. Although most people had up-to-date training, there were some staff that had mandatory training over a year overdue. Night staff were not receiving fire training every six months as required. The manager explained that a new CD had arrived to assist them with this. Care Homes for Older People Page 24 of 34 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. The management systems are not sufficiently robust to provide adequate monitoring, supervision, consultation and safe, organised record keeping, to ensure that peoples rights, interests and health and safety are protected and promoted. Evidence: Information from the annual quality assurance assessment was that the registered manager was qualified to NVQ 4 level and has over 30 years experience in residential care for older people. The manager stated that there was an open office door policy to allow ease of access to the senior staff team. Procedures and policies were in place to safeguard peoples health, safety and well-being. All records were subject to internal and external audit and inspection. The registered manager plans to work three shifts per week supernumery to allow time for management tasks. The manager acknowledged that office systems require further improvement. The assistant manager on duty during the inspection visit had some difficulty accessing some of the records required by regulation. Additional administrative time Care Homes for Older People Page 25 of 34 Evidence: had been provided to improve office systems, and some improvements had been made, although further work was required. The management team holds regular meetings to discuss their work and the development of the service. Several staff spoken with commented that all managers were approachable and they felt able to talk to them about any concerns. Staff records showed that regular staff supervision was not taking place. One workers file showed that their last supervision was in 2007. This was highlighted at the previous inspection visit. Staff meetings were taking place, although these were infrequent. There were no minutes available of any staff meetings in 2009. Surveys had been circulated to residents, but only five had been returned. The responses had been analysed and an action plan had been devised. Occasional residents meetings were organised. Minutes of the last meeting showed that residents were consulted. Residents had made a recent suggestion to switch off televisions for an hour after lunch to allow a quiet time. Staff said that this was now being done and most residents appreciated this. One person commented in our survey that the home needs to, include service users more in decisions about the home and another person said that, staff need to listen to me more There was little evidence that people were regularly consulted about the day to day running of the home. Peoples views about the service that they have received when they had stayed for respite and intermediate care were not obtained or recorded. The service manager responsible for the service was spoken with during the inspection visit. They said that there was a six monthly audit of the service to consider planned developments and improvements. The last recorded audit in January 2009 stated that the Commissions requirement for adult protection training was still outstanding. It was also highlighted at this audit that regular staff supervision was not taking place, and training was not up to date. The audit was reviewed in April 09 and it was recorded that several areas had still not been done since January 09. A medication audit had been completed in February 2009 and a response had been requested by 30 April 09, but had not been completed. At the previous inspection visit there was a requirement made that, a representative of Derby City Council must visit minimum monthly and record their findings. These Care Homes for Older People Page 26 of 34 Evidence: records must be available for inspection. During this inspection visit these reports were requested, but only one could be found. After the inspection visit several reports were e-mailed to the Commission and most had been completed. Although senior managers were involved with the service and systems were in place to monitor the work, insufficient action had been taken to deal with shortfalls. As stated previously the service had reduced the number of registered places from 39 to 36. A request to revise the registration with the Commission had not been received. Fire systems were checked by managers, including equipment and fire drills, although fire records were quite disorganised. Although the information provided by the registered manager was that portable electrical equipment was last checked in March 2009. This certificate could not be found during the inspection visit. Other servicing records were checked including emergency lighting, emergency call equipment and the gas safety certificate. All were in order. The manager on duty could not provide copies of notifications sent to the Commission as required by law. The Commission had no records of notifications been received, however information from the manager was that there had been 5 deaths, 22 admissions to accident and emergency as well as a serious outbreak of diarrhoea and vomiting, all of which should have been reported. Confidential records were not always secure. There were times when there were was no manager in the office and confidential records were on display. A room on the first floor used as a storage and meeting room held some confidential records. This room was not locked. Care Homes for Older People Page 27 of 34 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 Regulation 18 All members of staff working 30/09/2009 (1) c at Perth House must receive training in safeguarding adults procedures. This is so that people living at the care home are protected from abuse. Previous timescale was 31 December 2008. This has not been met. A time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be considered. Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Each person must receive an 31/07/2009 up-to-date assessment of their needs, with a copy provided to the home, before they are admitted. This assessment must be kept under review and revised if there are any change of circumstances. This is so that everyone can be assured that the persons needs can be met at the home. 2 7 15 There must be an up-to-date 31/07/2009 plan of care available for each individual. This must be available for care staff to read and follow. This is to ensure that care staff are aware of the action that needs to be taken so that each persons health, personal and social care needs are met. Care Homes for Older People Page 29 of 34 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 3 9 13 All staff and managers that administer medication must receive training in safe handling, administration, storage and recording of medication. This is to ensure the health and safety of people living at the home. 17/07/2009 4 9 13 Any person who has been assessed as safe to self administer their medication must have a written risk assessment and must keep their medication secure at all times. This is to ensure the health and safety of people living at the home. 30/06/2009 5 9 13 There must be safe systems 30/06/2009 for the recording, handling, safekeeping and safe administration of medicines received into the care home. This is to ensure the health and safety of people living at the home. 6 10 12 The arrangements for health 30/06/2009 and personal care must ensure individuals privacy and dignity are respected at all time with particular regard to assisting with health and personal care. Care Homes for Older People Page 30 of 34 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 so that individuals privacy and dignity is respected at all times. 7 19 23 Fire doors must not be 30/06/2009 propped open. There must be a safe system for allowing individuals independent access to their bedrooms, whilst preventing the risk of spread of fire. This should be done in consultation with the fire service. This is to ensure that there is a safe fire system that does not affect individuals independence. 8 19 23 There must be a risk 10/07/2009 assessment completed concerning the smoke room. This is to ensure that the room is being used safely. 9 30 18 All staff and managers must receive training appropriate to the work that they are to perform. This includes refresher training in moving and handling, first aid and six monthly fire training for night staff. This is to ensure that all managers and staff have upto-date information and 30/09/2009 Care Homes for Older People Page 31 of 34 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 knowledge to assist them in their duties so that people are protected. 10 36 18 The registered person must ensure that people working at the care home are appropriately supervised. This is to ensure that care staff receive adequate guidance, support and opportunities to discuss their development in order to assist them in their work. 11 37 17 All confidential records concerning staff and service users must be kept securely in the care home. This is to ensure that the home meets the Data Protection Act as well as confidentiality and privacy of people at the home. 12 37 37 The registered person must 30/06/2009 give notice in writing to the Commission without delay of the occurrence of the death of any service user, the outbreak of any infectious disease, any serious injury or illness, any theft, burglary or accident, allegation of misconduct, or any event in the care home which adversely affects the 30/06/2009 28/08/2009 Care Homes for Older People Page 32 of 34 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 well-being or safety of any service users. This is a requirement under the Care Standards Act 2000 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 All documents available for people at the home should reflect the name change to the Care Quality Commission. This is so that people know who to contact if they wish to do so. Each person should be consulted about their social interests and arrangements should be made to enable them to engage in the activities of their choice. Up-to-date information concerning activities provided should be made available for people at the home. This is to ensure that peoples social and recreational interests and needs are met. The complaints procedure should reflect the name change Of the Care Quality Commission. This is so that people know who to contact if they wish to do so. The system of staff handover meetings should ensure that residents are not left alone for a significant length of time. This is to ensure the health and safety of people living at the home. The quality assurance and quality monitoring systems should be further developed, based on seeking the views of service users. This is to measure success in meeting the aims, objectives and outcomes for people living and staying at the home. 2 12 3 16 4 27 5 33 Care Homes for Older People Page 33 of 34 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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