Inspection on 28/05/09 for Pine Trees

This inspection was carried out on 28th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pine Trees 15/11/07

Pine Trees 26/10/06

Pine Trees 27/02/06

Pine Trees 11/08/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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: Pine Trees 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ     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: Diana Penrose     Date: 2 8 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Pine Trees 15 Horsepool Road Connor Downs Hayle Cornwall TR27 5DZ 01736753249 01736759261 pine_trees@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Guardian Care Home Ltd care home 25 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 Pine Trees Care Home is situated in the village of Connor Downs between the towns of Camborne and Hayle. There is ample car parking at the front of the home and a footpath that leads to the main entrance. Well-maintained grounds with colourful flowers surround the home. The building is a detached bungalow with a modern extension. There are 23 single rooms and one shared room. Accommodation and facilities are on one floor. All bedrooms have a door opening onto a walkway surrounding the building. These cannot be accessed from the outside when closed. Suitable ramps and grab rails are in situ. Meals are prepared in a well-equipped kitchen and served in the spacious dining room, or individual bedroom if preferred. There is a large lounge with an adjacent conservatory. There is a patio outside with garden seating and tables. The home provides residential care for up to twenty-five elderly people. The home also provides day care and respite facilities. The Manager and a team of care staff provide personal care within a relaxed and friendly Care Homes for Older People Page 4 of 32 Over 65 25 0 Brief description of the care home atmosphere. Information about the home is available in the form of a residents guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees are from 515 pounds per week; this information was supplied during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: An Inspector visited Pine Trees Care Home on the 28 May 2009 and spent nine hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. All of the key standards were inspected. On the day of inspection 21 people were living in the home, one of these was receiving respite care. The methods used to undertake the inspection were to meet with people using the service, the deputy manager, staff and visitors to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. Some CQC completed surveys have been returned and were used to inform this inspection. This report summarises the findings of this inspection Care Homes for Older People Page 6 of 32 Residents expressed general satisfaction with the care and services provided at the home and said they are treated well. The Manager was not working on the day of this inspection. We noted some breaches in Regulations and we gave feedback about these to the Deputy Manager throughout the day. Feedback was also given to the Operations Director / Regional Manager the day after this inspection when further information was sent to the Commission to support this report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose needs to be kept up to date to ensure appropriate information about the home is available for prospective residents and enquirers. It is a requirement that people are assessed before being admitted to the home to ensure that the home has the facilities and staffing available to meet their individual needs. We found that not all people had an assessment undertaken by the manager or staff at the home. The care planning system needs to be reviewed and care plans must be in place for those who do not have them. The daily records need to be written on the day events took place as leaving gaps for people to complete later could lead to errors in the recording. It is important that the records accurately detail the rationale of care and the care delivered. Anything handwritten on the medicine administration record charts should be witnessed and signed by the person writing the order and by a witness. This will help to ensure that Care Homes for Older People Page 8 of 32 the correct order has been recorded. The name of the person authorising any change, normally a doctor should also be stated. As the doctor is accountable it is better that he or she makes the changes to the chart Some gaps were noted on the medicine charts, all medicines administered must be signed as given or a reason recorded if they are not given. This is good practice and makes it easier to audit medicine administration. The registered provider must ensure that suitable specialist bathing and showering facilities are provided. This will ensure the needs of elderly frail people are met. Although a wet room shower is being provided the bathing facilities have been unsuitable for some time and people using the service are not happy. Staffing levels must be reviewed as it is not clear that sufficient staff, with the relevant knowledge and skills, are on duty at all times to meet peoples needs. Staff and residents told us about their concerns regarding staffing levels in the home. There have been several new employees recently and the number of staff with an NVQ qualification has decreased. Recruitment, although generally satisfactory requires some attention to ensure that gaps in employment are discussed at interview, CRB disclosures are available for inspection, photographs of employees are on file and relevant job descriptions are provided. Training for all staff needs to be reviewed and a training plan devised. The induction of new staff could not be fully assessed during this inspection as there was no documentation available. The training records show that staff training has lapsed, all staff require moving and handling training and other statutory training is overdue. Medicines training has not been kept up to date and not all staff have attended abuse training. Staff should attend courses on the diseases of old age and other subjects relevant to the client group so that they have the knowledge to provide a good standard of care. The Annual Quality Assurance Assessment (AQAA) document has not been completed by the registered provider or returned to the Care Quality Commission. This is a breach of the Regulations. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is not suitable information about the home available for prospective residents to enable them to decide if the home is the right one for them. The assessment process does not ensure that peoples needs can be met by the home. Evidence: The statement of purpose inspected was the one available in the entrance to the home as no other copy could be found. It was noted that this required updating as many of the details were incorrect. However a further updated statement of purpose was sent to the Commission following this inspection this contained all the relevant information with the exception of the up to date contact details for CQC. The deputy manager said that prospective residents are usually assessed by the manager of the home who sometimes visits them at home, in hospital or invites them into Pine Trees. The person may have spent a period of time in the home receiving respite care. Care Homes for Older People Page 11 of 32 Evidence: We looked at the care records for people who recently came to live at the home. One contained no pre-assessment documentation, the most recent file only contained information from the Department of Adult Social Care (DASC). The deputy manager said that this person had spent a day in the home previously and loved it. There must be evidence in the home that people using the service have had their care needs assessed to ensure that the home is able to fully meet their needs. The lack of pre-assessments was identified in a Regulation 26 report, dated 20 May 2009, written by the Regional Manager. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service generally feel their healthcare needs are met however care planning is lacking so staff are not informed or directed on the care they have to provide. There is a medicines system that is generally good; extra attention in some areas and further training for staff will ensure a safer system. Evidence: As a result of people telling us about their concerns we conducted a random inspection at the home on 14 August 2008. At that inspection we discussed the issue of care plans and how they lacked detail and had not been reviewed. The inspection report stated We will conduct a more detailed inspection of the care planning arrangements at our next inspection. On 04 November 2008 we conducted a further random inspection to check compliance with outstanding requirements. We noted at the inspection that not all care plans had been updated. We are concerned that the care planning system has still not been updated and that some people do not have care plans in place or pre admission assessments. It is essential that this matter is dealt with to ensure that peoples care needs are Care Homes for Older People Page 13 of 32 Evidence: appropriately assessed and that there is a care plan which defines how care needs are to be met. The Company has implemented a range of pro-forma documents which include risk assessments for pressure sores, falls, nutrition, moving and handling and mobility. It was noted that these are not always completed by staff. Daily records are maintained of the care provided to each person using the service. It was noted that some gaps had been left for staff to complete at a later date, this is not in accord with daily record keeping. Doctors visits are recorded, one person was referred to the dietician and an appointment letter was seen in the file. There is no further evidence that the dietician visited or if any instructions were given. A memo was seen regarding this persons diet, written by the manager, but no evidence as to where the instruction came from for the content. People told us they are well cared for but sometimes have to wait as the home is short staffed. Surveys received said that people were generally satisfied with the care and support they received. Suitable equipment was seen for moving and handling purposes and pressure relief. No residents have pressure sores but four have special mattresses and cushions. The deputy manager said that the continence assessments have been completed and pads are provided as necessary. The home has a medicines policy that is available to staff. There is also a copy of the Handling of Medicines in Social Care document and various reference books. Patient information leaflets are also available for staff or residents to refer to. A monitored dose system is in use and seems to work well. The storage arrangements for all medicines in the home is secure and complies with current legislation. Records are kept of all medicines entering and leaving the home. There were a few gaps observed on the administration records, however, this had already been identified as an issue as someone had handwritten a question mark in the boxes. Handwritten instructions on the charts were not witnessed and signed by two members of staff. These were issues at the last key inspection. Some charts did not have a photograph of the resident included. One person is self-administering their medicines and has signed to agree to this. They Care Homes for Older People Page 14 of 32 Evidence: have a lockable drawer in their room for storage. The deputy manager was unable to show us a copy of a risk assessment in respect of this person self-administering their medicines. She told us that checks are undertaken every two weeks to ensure this person is taking their medicines. The level of support and responsibility of the care worker should be written in the individuals care plan. It should include how to monitor whether the person continues to be able to self-administer their medicines without staff invading their privacy. For people prescribed to have medicines administered, when required, we found that there were no care plans in place about the use of this medicine, or any directions on how to make an assessment if this medicine is required. Although analgesia seems to be the only medicine in this category this needs to be addressed in the care planning. There is a list of the homely remedies used in individuals care files and separate records are kept for each person when administered. The deputy manager stated that staff administering medicines have received training on managing medicines in care homes provided by a pharmacist. Leaflets regarding this training and training booklets were seen. The training records show that two people undertook medicines training in 2006 and one of these people is no longer employed to work at the home. There was no evidence during this inspection that care staff receive medicines training during their induction to the home. Some issues regarding medicines have been identified for action in a Regulation 26 report, dated 20 May 2009, undertaken by the Regional Manager. A drug error was also identified and the Commission have not received a Regulation 37 report about this. Peoples privacy appeared to be upheld during this inspection. People using the service said they are treated with respect and their privacy is maintained. Some people did not like the medi bath but said that staff try to maintain their dignity. They said they receive their post unopened and the telephone arrangements in the home are satisfactory each room has a direct line. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Entertainment and activities are on offer, visitors are welcomed and residents are encouraged to live a life of their preference. A nutritious menu is on offer but various recent changes have been unsettling for people and made the mealtimes less enjoyable. Evidence: A part time activities co-ordinator is employed to organise activities and entertainment. When she is not there we were told the care staff do activities, one to one chats and manicures. The co-ordinator seemed enthusiastic in her role and residents spoke fondly of her. She told us that a recipe book is being compiled of residents own recipes, people have been making musical instruments and next week they will be baking buns - a demo is being given by a 102 year old resident. Other activities include bingo, singers, entertainers, crafts, art and games, reminiscence, mobile shop, weekly exercises and playing ball. A monthly newsletter is produced with contributions from across the group of Guardian Care Homes. She would like to arrange trips out during the summer months but a minibus has not been organised as yet. She said she took one resident to an agricultural show recently and she enjoyed that. Care Homes for Older People Page 16 of 32 Evidence: There are posters displayed showing what is on offer to residents and photographs of people enjoying social activities. Some residents were seen enjoying a game of throwing and catching a ball during this inspection. People said they are happy with the activities on offer. Surveys received said there are always / usually activities they can take part in. There is a record of visitors to the home and there were visitors in the home during the inspection. People said they could receive visitors in private and at any time. Visitors told us they are made very welcome in the home and can call whenever they like. They said a cup of tea is always offered. People using the service told us that their individual preferences are generally respected and they are supported to maintain their independence. They said they are free to go out when they wish and some visit their families. We were told that the daily routines are flexible to suit them for example going to bed and getting up in the morning (their preferred times are written in the care files). Only one person was up and in the dining room at the start of this inspection, we were told people were having a lie in. All of the people using the service control their own money, with the help of their families and everyone has their own belongings in their rooms. A varied four-week menu was seen. It shows a set meal at lunchtime but the cook said there are alternatives available and records are kept of those who have something different. She said that there have been some changes to the menu and sample menus have been sent from head office for her to look at. These were seen and include choices at lunchtime. The cook said that fresh fruit and vegetables are included each day and there was a good stock held. She said that cakes are homemade and snacks and drinks are available between meals. People said they usually enjoy the food, there was a bad period when frozen meals were introduced but this has stopped now. They all seem to like the roast dinners with plenty of vegetables. Surveys received said that people always / sometimes like the meals. One survey included negative comments about the food in that it had changed at the beginning of May 2009 when portions became smaller with less vegetables and cheaper cuts of meat. It claims that when residents complained about the teatime sandwich choice no one listened to them We are treated like kids. I hope it never comes to them. The minutes of a recent residents meeting were seen and the meals were discussed. Claims were made of cutbacks that were deemed to be untrue. The Regional Manager told us following this inspection that new menus and types of food Care Homes for Older People Page 17 of 32 Evidence: have been tried but said this was not a budgeting issue. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies in place for complaints and adult protection and some staff have received abuse training. Previous issues of concern have not been fully addressed so residents may not be fully protected Evidence: The complaints procedure requires updating to include the CQC contact details. We were told that no complaints have been received by the home over the past year but there is a file in the administrators office to record the details and response if there were to be any. Thank you letters and cards are kept in the home. Concerns have been raised to the Commission in respect of staffing levels in the home since the last random inspection and were investigated by the Chief Operations Officer, currently the Regional Manager, who told us they had been appropriately addressed. The home has a suitable adult protection policy. The training records show that ten staff attended Protection of Vulnerable Adults training in March 2009, this did not include the manager. The training matrix seems to have only recently been set up so does not state any previous course dates. There is no evidence of what was included in the training. There have been safeguarding referrals to the Department of Adult Social Care Care Homes for Older People Page 19 of 32 Evidence: regarding this home since the last inspection. They have been in respect of the care of people using the service and staffing. There was sufficient evidence in support of the concerns and a requirement was set for the registered providers to ensure that at all times there are adequate numbers of skilled staff to meet the needs of the people using the service. Care planning was discussed with the deputy manager during a random inspection and subsequently reported to the registered providers. A response was received stating that staffing had been addressed and care plans were being updated. Further monitoring was undertaken via safeguarding meetings with the Department of Adult Social Care and community nursing team. It is evident that there are still staffing issues at the home and that not all care plans have been updated. Indeed some people do not have a written care plan at all. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, homely with the building and grounds well maintained. It is a pleasant environment but suitable bathing facilities are required to make life more enjoyable and safer for the residents accommodated. Evidence: The home is warm, homely and comfortable it is well ventilated and there is domestic style lighting. The building is spacious and on one level with suitable grab rails provided and it is well furbished and decorated throughout. People said they are happy with their rooms and the furnishings provided but as reported at the last inspection they are not happy with the bathing facilities. The medi bath is very old and is said by some people to not be in keeping with what they have been used to and it does not respect their privacy and dignity. Staff have said that the room is very small and not easy to move around in. They have also expressed concern that peoples privacy and dignity is compromised. The registered providers said some time ago that they were going to replace this bath, they must do this now as a matter of urgency. Another bath continues to be out of use as it is very small and not equipped for assisted bathing. Another bathroom is in the process of being converted into a wet room shower and work was taking place during this inspection. When completed, this will ease the situation for residents who prefer a shower. Two bedrooms were not being used as building work has commenced. We were shown Care Homes for Older People Page 21 of 32 Evidence: plans for the development and extension of the home and told that building work has halted for the time being due to building regulations and the surveys required. The plans show an intended increase in bedrooms from 24 to 35. The grounds are tidy with new boxes of flowering plants at the front of the home. There is a patio with garden furniture that is accessible for residents. At present the builders have fenced off part of the grounds and have caravan accommodation on site. People using the service said they were informed of the work commencing and a copy of the letter distributed was sent to the Commission. The home is clean and generally free from offensive odours, one room smelt of urine and we were told that every effort is being made to eliminate this. The laundry facilities are suitable for the present number of residents with one washer and one drier. People told us that the laundry system works well. Suitable hand washing facilities are provided for staff along with alcohol cleansing gel and protective clothing for infection control purposes. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is not evident that sufficient staff with a suitable skill mix are employed to meet the needs of people using the service. Recruitment practice is fairly rigorous but staff are not well trained or kept up to date so residents may not be protected or their needs fully met. Evidence: The deputy manager said there are no staff vacancies at the moment. She said a set rota is worked and generally there are three care staff in the mornings, three in the afternoons and two awake at night. On the day of this inspection the deputy manager was included in the care staff numbers. The rota showed that staff work extra hours to ensure the shifts are covered and we were told that this is their choice. We noted that one care worker was working from 08.00 - 14.00 today and due to return at 20.00 to work the night shift until 08.00 in the morning. This is not a safe practice as it does not allow for a suitable rest period between shifts. This arrangement is not in accordance with the Working Time Directive. We were told of an instance when staffing had been difficult and inexperienced staff were authorised to work together, agency staff have not been employed. We were told that a cook works from 07.00-14.00 and another from 16.30 - 18.30. Care Homes for Older People Page 23 of 32 Evidence: Staff also told usabout their engagement in ancilary duties, for example, the night staff cook eggs and so on for the residents breakfast and at lunchtime a carer waits on the tables and another goes in the kitchen to dish up food and to help with the washing up. There are separate domestic staff, maintenance man and an administrator employed. There have been several new people employed recently and the number of care staff with an NVQ has decreased. Some residents said the home is short staffed, some said that on occasions there are not enough staff in the home and they have to wait to be attended to. One person said she is left until last but does not mind because she can do things for herself. Concerns regarding staffing levels were made by some staff and they talked about some residents requiring two or even three staff to tend to their needs. They said the staff numbers do not take this into account. They said that the deputy manager is included in the care numbers on the floor when the manager is not in but gets called away all of the time. They told us about a recent meeting when they raised concerns about staffing levels. Some staff said that despite raising the issue they felt that management had not taken any notice. It is of concern that staffing levels in the home again seem to be inappropriate and that peoples needs could be neglected because of this. A review of staffing must again be undertaken taking into consideration the dependency of the people using the service. A report of the outcome and actions taken must be sent to the Commission. We were told that 38 of care staff have an NVQ either at level 2 or 3, a decrease of 32 since the last inspection. A further 13 of care staff are undertaking NVQ courses and we were told that all care staff are encouraged to commence NVQ training following induction. Five personnel files were inspected; CRB and POVA checks are undertaken and a recording is made of the date and reference number. The actual disclosure forms were not seen as they were in a locked cabinet to which the manager has the only key. One person appears to have commenced work prior to their POVA or CRB being received. Two references were obtained prior to employment of staff. Two files did not contain a photograph of the employee. Relevant certificates of training are held. There is an equal opportunities policy and a form to be completed on application for work. There are also policies for different races and cultures. One person is employed to work in three areas but only had a job description for two on her file. Interview records were Care Homes for Older People Page 24 of 32 Evidence: seen in four files but one did not explore a gap in employment. One person was recruited by the Company to work in another care home initially, her application form and interview records were not in her file. An induction pack, in line with the skills for care standards was shown to us on the computer. It was thought that these packs are not being used. Two of the staff files held a completed orientation sheet but there were no completed induction packs seen. A training matrix was seen and shows who has attended training and when. It shows that staff are not up to date with statutory training and no one has attended any other types of important training, for example dementia, Mental Capacity Act or Deprivation of Liberties. The deputy manager would like to complete a train the trainers course for moving and handling but this has not been authorised as yet. A training programme needs to be put into place to address statutory training in the first instance but to ensure staff are also trained on the diseases of old age and any other subject relevant to the current client group. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no registered manager, leadership for staff and robust systems are lacking, staff and residents do not have the benefits of a well run home. Some quality assurance and health and safety systems are in place for improvement of the service and the safety of residents, staff and visitors. Evidence: The home has had no registered manager since December 2007; this situation is clearly unacceptable. Not only is this a breach of regulations it is evident that this home is not led or managed appropriately. People using the service told us that the home seems to run well and that they sometimes see the manager. Staff views of the manager were variable. Some said she does a good job but others said she did not support the staff. Two of the four staff surveys received said they sometimes have enough support from the manager. Comments include The manager does no work on the floor so doesnt understand our job, It is worse since the new manager took over, I get on well with the manager, Care Homes for Older People Page 26 of 32 Evidence: We make it work, She doesnt come out of the office and staff do not have confidence in her. The Regional Manager said he is aware of issues regarding the management of the home and these are being addressed. An annual quality assurance survey with residents and relatives was undertaken by the home in January 2009. The completed forms were seen and were generally positive, there were a few negative comments about the grounds and staffing levels. There are various documents for auditing produced by the Company, a file was seen but had no completed forms since the last key inspection. According to a monthly monitoring form introduced recently some audits have taken place for example the kitchen, the environment, medicines and health and safety. The minutes of a residents meeting were seen on a notice board. They showed that people aired their views. The notes of the last staff meeting were seen and showed concerns expressed by the staff about staffing levels. The regional manager told us that he undertakes monthly inspections of the home and writes a report in line with Regulation 26 of the Care Homes Regulations 2001. He sent us copies of two such reports following this inspection; the file seen during the inspection had not been updated since November 2007. The registered provider has not completed an Annual Quality Assurance Assessment (AQAA) and returned it to the Commission, which is a breach of the Regulations. We were told that the reason is because they have not been able to download the document as directed and were unable to contact the Commission by phone. We advised the administrator to email for assistance. We understand this document will be completed and sent to the Commission. There is a Company policy for dealing with residents money and valuables but no money is held. The administrator said that all residents control their own money or their family take care of it for them. There are no valuables held on behalf of residents either. There are health and safety policies, procedures and risk assessments for the home. We were told that the maintenance man is responsible for fire safety in the home and he provides training for staff. There is a fire risk assessment and fire safety procedures and checks appear to be up to date. We were told that the fire enforcement notice served by the fire authority on 28 November 2008 is ongoing. Relevant service checks and maintenance records were seen, the five year electrical Care Homes for Older People Page 27 of 32 Evidence: wiring test was due in January 2009 and needs to be addressed. According to the records shown to us statutory training has not been kept up to date and this needs to be urgently addressed. If the records are correct all care staff are due for moving and handling training. The deputy manager said that someone was coming in to provide this training very soon. Appropriate cleaning takes place in the kitchen with records maintained. The fridge and freezer temperatures are recorded daily. Accident reporting complies with data protection, the home has generally very few accidents although there were ten in March 2009. The numbers of accidents are reported to head office each month. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The needs of prospective residents must be fully assessed prior to their admission to the home To ensure that the home can fully meet all of their individual needs 25/06/2009 2 7 15 All of the people using the service must have a written care plan that details how their individual care needs are to be met. It must be available to them and must be kept under review. This will ensure that staff are informed and directed on how to meet the changing care needs of people using the service. 26/10/2009 3 21 12 Appropriate bathing facilities 26/10/2009 must be provided, that are suitable for elderly people including those requiring assistance. Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure peoples health and welfare is provided for with privacy and dignity being respected. 4 27 12 A review of the 24/08/2009 management, staffing levels and skill mix of all staff must be conducted with appropriate action taken for any shortfalls or issues arising. To ensure that the care home is able to promote and make proper provision for the health and welfare of people using the service. To include their care, and where appropriate, treatment, education and supervision. 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 2 9 9 All medicines administered should be signed as given or a reason recorded if not given Transcribing on MAR charts should be witnessed and signed by two staff. The name of the person authorising any change should be stated There needs to be a sluice with a washer disinfector in the home for hygiene and infection control purposes 3 26 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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