Inspection on 04/06/09 for Pirton Grange Nursing Home

This inspection was carried out on 4th 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pirton Grange Nursing Home 24/09/09

Pirton Grange Nursing Home 09/12/08

Pirton Grange Nursing Home 17/04/08

Pirton Grange Nursing Home 12/09/07

Pirton Grange Nursing Home 20/09/06

Pirton Grange Nursing Home 19/01/06

Pirton Grange Nursing Home 15/07/05

Pirton Grange Nursing Home 30/09/04

Pirton Grange Nursing Home 14/04/04

Similar services:

Larches, The

Sunnycroft

Willowdene Farm

Grindley House Care Home

Highbury House Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Pirton Grange Nursing Home The Grange Pirton Grange Nursing Home Pirton Wadborough Worcestershire WR8 9EF     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: Emily White     Date: 0 4 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 Adults (18-65 years) Page 2 of 45 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 45 Information about the care home Name of care home: Address: Pirton Grange Nursing Home The Grange Pirton Grange Nursing Home Pirton Wadborough Worcestershire WR8 9EF 01905821544 01905821257 admin@pirtongrange.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Pirton Grange Limited care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 58. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 58 Mental Disorder, excluding leaning disability or demetia (MD) 58 Past or present drug dependent (D) 58 Past or present alcohol dependent (A) 58 Date of last inspection Brief description of the care home Pirton Grange has extended the home and provided a purpose built unit referred to as Orchard Way. The existing home is a heritage listed building and is in the process of Care Homes for Adults (18-65 years) Page 4 of 45 Over 65 0 0 0 0 58 58 58 58 1 8 1 2 2 0 0 8 Brief description of the care home being modernised and upgraded. Pirton Grange is situated near the village of Pirton in beautiful countryside south of Worcestershire. The home is two storeys with a lift to assist people with mobility problems to mobilise throughout the home. In Orchard Way all people are accommodated in single en - suite bedrooms which are specially equipped for their use. In addition to the bedrooms the home provides lounges, dining room, and specialist bathing facilities. The spacious landscaped gardens are accessible for people to use and provide a pleasant outlook from the home. The home provides 24-hour nursing care for people under the age of 65 years. There assessed health needs include Huntingdons Disease, Acquired Brain Injuries and other physical and mental health problems. People can be accommodated on long term and short term placements. Information regarding the home can be obtained from the Statement of Purpose and the Service Users Guide, which are available in the home. The European Care Group who owns other homes throughout the country owns the home. The home is without a registered manager at the moment, cover is being provided by a senior manager from the organisation. Information about the fees are not included in the Service User Guide, for up to date information about the fees please contact the home direct as the fees are based on individual needs and assessments. Additional charges are made for cigarettes and holidays abroad. Care Homes for Adults (18-65 years) Page 5 of 45 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This service was inspected in December 2008 and again in March 2009, where we found that requirements and Statutory Requirement Notices had not been met. For this key inspection we collected the evidence from these inspections. We also looked at information sent to us by the service in the form of the Annual Quality Assurance Assessment, which tells us how the service is improving, and notifications which tell us about events at the service. We also looked at information sent to us by outside health and social care professionals working for the Primary Care Trust and Social Services. Two inspectors, a pharmacist inspector and and a member of our enforcement team visited on 4th June 2009, to look at all of the National Minimum Standards and check compliance with past requirements and notices. We observed life in the home, looked at care and staffing records and met some staff and people using the service. Care Homes for Adults (18-65 years) Page 6 of 45 What the care home does well: What has improved since the last inspection? What they could do better: Assessments for people who have recently been discharged from hospital should provide more detail about the care they require. A requirement in relation to assessment has been repeated as no new people have moved to the service. People should be involved in the review of their care plans. Care plans should be more personalised to the needs, and preferences of the individual. A new requirement has been made in this area. A requirement was made to ensure that all areas of the home being used by people must be suitable for their needs and lifestyle, to ensure their health and safety is met and privacy respected. This requirement has been repeated and will be inspected in more detail at a later visit. The management of the service remains unstable which has affected the ability of the service to meet standards. The service is trying to make improvements and for the reason a requirement in relation to quality assurance has been repeated. Recommendations relating to the quality of lifestyle experienced by people using the service have not been acted upon and a new requirement has been made to make improvements in this area. Requirements in relation to risks to people using the service, and support and training for staff, have not been met. We are issuing Statutory Requirement Notices in relation to these areas. Statutory Requirement Notices in relation to the ongoing management of peoples health and support and medications have not been complied with. We are pursuing Care Homes for Adults (18-65 years) Page 7 of 45 enforcement action in relation to these areas. 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 Adults (18-65 years) Page 8 of 45 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 45 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. By failing to provide a full care needs assessment by a competent person prior to a person being admitted to the home, this may compromise their health and safety and result in their assessed health care needs not being met Evidence: The last key inspection (December 2008) rated these standards as poor and made a requirement that the pre-admission process must be more robust to ensure that only people whose care needs could be met should be admitted to Pirton Grange. The timescale for compliance with this requirement was made for 31/03/2009. However given the number of concerns and poor outcomes for people using the service that were highlighted from this inspection. Pirton Grange management volunteered not to accept any new people into the home until they had improved the quality of the service to an acceptable standard. Therefore this standard could not be assessed at this inspection. However, the need to re-assess people who are admitted to hospital and return to Pirton Grange should be completed. Any changes in the persons health and social care needs should be recorded in their care records so all staff delivering care have clear directives. This helps to ensure that the persons care is not Care Homes for Adults (18-65 years) Page 10 of 45 Evidence: compromised. Through our case tracking we identified that care records and health assessments were not being updated when a person returned from hospital and nurses were unclear, when asked, if their health care needs had changed. The last key inspection also recommended that the home provide a Statement of Purpose and Service User Guide to reflect the service in a format suitable for the people using the service. The information received in their completed AQAA informs us that this is planned for completion in the next 12 months. The Annual Quality Assessment received from the home dated 24th April 2009 completed by the acting manager told us of the homes plans for improvement for the next 12 months and these included: To update the Service User Guide and Statement of Purpose to clearly set out the revised aims and objectives and philosophy of the Home. This new Statement of Purpose will also reflect the improved physical environment of Pirton Grange achieved by a planned refurbishment and will similarly show the improved facilities and environment of Orchard Way. The Home will implement a revised pre-admission assessment of needs, which will be carried out by qualified competent staff. This assessment will be undertaken to meet the individual needs of the individual. All new prospective residents are to be assessed using the revised pre-admission assessment tool. The Home Manager will confirm in writing that their care needs can be met. Existing residents are to be re-assessed using the pre-admission assessment tool to identify and to include any additional Neurological Assessment required by Specialist Service Provider. Care Homes for Adults (18-65 years) Page 11 of 45 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care plans are not personalised to peoples individual needs and wishes and do not provide sufficient information for the staff to assist people to meet individual needs, or to help peole using the service make decisions. People are not appropriately supported where risks to their health and well being have been identified. Evidence: At the last key inspection (December 2008) we made a requirement that the quality of care records must improve to promote and ensure that the health care needs of people using the service are being safeguarded. This requirement remained outstanding from the previous key inspection (April 2008). The service was given until the end of April 2009 to improve the quality of the care records. We completed three random inspections following the December inspection - one of these was specifically to monitor compliance with this requirement. At this visit we saw that the service had made some progress with the care documentation and had appointed a new acting manager who was positive about moving the home forward. Care Homes for Adults (18-65 years) Page 12 of 45 Evidence: We were told that they had developed a new recording system and would need additional time given the amount of documentation to complete for all the residents. So the requirement was not met by the service. At this inspection (June 2009) we found significant shortfalls with the care records. We were told that the previous acting manager had transferred to work for another part of the organisation and a new acting manager was working with the nurses to complete and improve the care records for the people living at Pirton Grange. To assist the nurses in completing the care documentation, the organisation had a contract with a nurse agency to provide nurses to look after the residents - thus giving their own nursing staff the time to complete the care records to an acceptable standard. We were also told by a regional manager that the service had introduced a named nurse system where the nurse is responsible for a number of residents and maintain their care documentation. Registered nurses are also in breach of their professional accountability with the Nursing and Midwifery Councils guidance for record keeping. We talked to peoples named nurses about the individuals they were responsible for and they were unable to provide sufficient information about the individuals health and psychological assessed care needs. For example, a nurse was not aware that a person was having seizures in the home, even though the daily records and evaluation recorded fairly frequent episodes. We looked at three peoples care records in detail and these showed that : A person suffering with anxiety was prescribed medication to reduce their anxieties however the care plan failed to record at what level of the persons anxiety should the prescribed medication be administered. However nurses had given the medication and failed to record the rationale for this. We talked to the named nurses about the individuals they were responsible for and they were unable to provide sufficient information about the persons health and psychological care needs. The care plan for one person failed to describe in detail methods of communication, or triggers or reasons for their agitated behaviour. The care plan was reviewed on the 24th March 2009 and recorded to be reviewed in May 2009, this had not been completed. In another individuals care records, specialist planned interventions were not detailed or analysed as to why the person has these needs, and what might improve things for them for example, the use of rehabilitative and therapeutic programmes. We could see from the monthly evaluations when carried out by the nurses they usually consist of no change to care plan. There was no evidence of involvement of Care Homes for Adults (18-65 years) Page 13 of 45 Evidence: person, family, or health professional in these evaluations. Tools for monitoring health and well being are not used regularly. We spoke to a nurse who stated that the evaluations section in the care plan is a monthly review and is completed by the key nurse. However the care plans do not show that reviews are carried out monthly. Most entries on the care plans are recorded once only. We looked at the care records for a person with skin pressure damage. This individual had been admitted to Pirton Grange with skin damage. However it was observed that the service had failed to develop appropriate risk assessments and descriptive care plans to assist the staff in delivering the care. It was found that the assessment tools for nutrition and pressure risk damage were not being used appropriately. We read that a risk assessment for falls had been developed which had not been dated or signed, and there was no evidence of ongoing monitoring. Other potential risks highlighted in January 2009 had only been reviewed once even though it was recorded monthly evaluation. The care plans failed to provide details of peoples individual needs, likes and dislikes such as likes to have a bath in the evening, preferred female staff only for personal care. This means that people may not receive their care in a way that they prefer. The plans also failed to include information from family/advocates where the person is unable to provide information. When individual problems had been identified the care plans had not always been written or did not provide enough detail so that staff knew how to meet these needs and monitor any changes. For example, for one person who was unable to express that they were in pain, the care plan failed to provide information about non-verbal signs of pain or discomfort to administer pain relief. A person with challenging behaviour did not have a plan for staff to follow to try and minimise the risk of behaviour occurring, or what to do if this behaviour occurred. We were told by the carer that the individual does refuse toileting, but this is dependent on your approach, if you approach him right it is ok. Many people living at the home have their placement funded by Worcestershire Primary Care Trust (PCT) and, as such, their care and treatment is regularly reviewed by PCT staff - who undertake Continuing Health Care (CHC) reviews. The outcome from many CHC reviews have demonstrated that the care records are poor. The CHC reviews show that the care needs of people using the service at Pirton Grange are not effectively recognised within the care records, and plans of care do not safely and robustly protect people from harm - neither do they set out effective strategies to promote peoples independence within a risk-taking framework. This is important as people with disabilities need the opportunity to safely take risks as part of normal dayto-day living. Care records show no evidence of collaborative working with individuals Care Homes for Adults (18-65 years) Page 14 of 45 Evidence: to help support them with their day-to-day care and life activities. One person went so far as to say that staff do not know how people communicate beyond expressions of distress or relative calm. We have received several anonymous complaints since the last key inspection raising concerns about the quality of care for people using the service. These have been shared with the relevant authorities and some people have been transferred from Pirton Grange. This is where it was assessed that the home was failing to meet the assessed health and social care needs of people. The Annual Quality Assurance Assessment received from the home included in the section how we have improved in the last 12 months: We are actively involving residents and their families / representatives in the care planning and review process. Recorded in the section what we do well, the home stated Person centred care plans and risk assessments and social assessments on individual residents on file and implemented. From the findings at the key inspection the AQAA was not a true reflection of the homes progress. As a result of this inspection, and given the homes failure to comply with the requirements fully from the last key inspection we are considering taking legal action and issuing statutory regulation notices. Care Homes for Adults (18-65 years) Page 15 of 45 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not have opportunities to develop their individual social, emotional, communication and independent living skills and are not being supported in their personal development. Evidence: The last key inspection report (December 2008) rated these standards as adequate. However recommendations made in relation to leisure time and daily routines have not been acted upon. During our visit we were told that a member of staff had been working on activities for example organising outside games, getting more people involved, and some people have been out on trips. We were told that separate records are being kept of peoples activities however we did not inspect these during our visit. During our visit we observed people going about their daily lives at the home. We saw people watching television, and saw one or two people sitting in the garden or with Care Homes for Adults (18-65 years) Page 16 of 45 Evidence: newspapers. Most of the communal rooms and bedrooms had televisions which were on throughout the day. Apart from televisions there was very little opportunity available for sensory stimulation, for example computers or different rooms for relaxing or noisy activity. We did not see evidence of games and staff confirmed to us that the garden is very little used, although there had been a barbeque recently. We spoke to one person using the service who was due to be moving, who told us she was bored. We observed another person using the service who throughout the day alternated between sitting in the garden and sitting in the reception area. This person appeared to be very independent and yet was not engaged in any meaningful occupation throughout the day. Another person who is much more dependent spent all day in the same seat in the dining room. This room is often noisy and chaotic, whereas this persons care plan states that he likes his own company and peace and quiet. We did not notice any staff interaction with this person expect when giving assistance with meals. From our observations and reading peoples care files, it was difficult for us to find evidence of opportunities for people to maintain and develop their social, emotional, communication and independent living skills through leisure, relationships and daily living. Reviews of peoples care and support carried out by health and social care professionals highlight concerns that opportunity for social interaction and stimulation is limited. We looked in detail at the care and support files for four people. Social assessments for people who are more dependent have not been completed, and where they have been completed, they provide limited information. One persons support file mentions family, friends, watching television, church and the newspaper as interests. The records show that this persons family have asked for the newspaper to be read to him regularly, although staff confirm that this has not been happening. Where people have been involved in activities, such as trips to the zoo, or walks in the grounds, these are often the same few people and there is little evidence that trips are organised around peoples interests or making use of community links. One person who is nearing the end of their life has a lifestyle book which is very out of date since his health deteriorated. Records do not show whether consideration has been given to alternative stimulation or sensory experience for people in poor health. One persons care files records refer to activities coordinator but there are not further records to show that this has been done. Peoples dietary needs and likes and dislikes are recorded in their care files. We spoke to the newly promoted head chef who showed understanding of the different needs of Care Homes for Adults (18-65 years) Page 17 of 45 Evidence: people in the home. The kitchen was clean but quite small for the size of the home. We observed a lunch time and saw that the food being served looked appetizing, and people being assisted to eat their meals as described in their care plans. However we also noted that the dining room was very chaotic, noisy, and some staff were standing up to feed people which is poor practice. One staff member told us X does not like to be overcrowded, I sit down at his level, but some people stand over him. Care Homes for Adults (18-65 years) Page 18 of 45 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Significant areas of concern include management of medications, as well as management of personal care, pressure areas, epilepsy, eating and drinking, behaviour and communication, continence, and end of life care, for those people already identified as at risk and who are unable to communicate their needs verbally. As a specialist service this service is not meeting peoples specific health and personal care needs. Evidence: At previous key inspections requirements were made under regulations 12 and 13, which relate to the health and well being of people using the service as well as management of medications. Statutory requirement notices were issued when the service failed to meet these requirements. During this key inspection further evidence was found that the service has failed to comply with statutory requirement notices in these areas. We will be pursuing enforcement action to ensure that the service improves the quality of personal and healthcare support for people using the service and management of their medications. We looked at the care files for four people using the service. These people had Care Homes for Adults (18-65 years) Page 19 of 45 Evidence: recently been reviewed by social and health care professionals responsible for their placements. These reviews highlighted serious concerns with the way that peoples long term health needs are being monitored and supported by the service. Information in care plans is often contradictory and does not clearly explain to staff what they need to do to support personal care. One persons observation plan and record of intervention states to be monitored every 30 mins when in bedroom and within staff eyesight in communal areas. Observation levels to be reviewed every shift and changes in observation levels to be recorded. The reason for this is physical deterioration however no records describe what this is, or tell staff what to monitor for. An example of incidents where personal care has been neglected include sore areas being noted and not followed up and bath and shower records not being completed. One person using the service with a chronic pressure sore had deteriorated significantly during the months before our visit. Instructions in his care files state staff to monitor and observe my dressing daily and document it on the appropriate records. However during the previous few months there are gaps in records where it appears no action has been taken following poor health, no records of reviews of wounds, and out of date nutritional and skin assessments. This person had been admitted to hospital on several occasions and was in hospital during our visit, with health problems related to his wound. Some people with a diagnosis of epilepsy are not being monitored or given an appropriate support plan to alleviate some of their symptoms. Daily observation record forms are being completed but the purpose of these is not clear. Assessments are not being updated and seizures are not being consistently recorded. The staff handover sheet does not mention epilepsy monitoring where needed and where people display physical and verbal aggression in pre seizure stage there is no evidence of work being done to follow up. One persons care file states that he needs food cut into small pieces, thickened fluids, and to be weighed monthly. Elsewhere in the file it states sometimes requires meat to be pureed, but does not say why or when this should happen, and there is no record of this happening. A member of staff told us that His food is chopped up but he seems to cough a lot. I think he would be better with puree. Ive mentioned this to other staff and they say he does it all the time. The care files for this person say he was recently reviewed by a speech and language therapist and dietician, but there is no record of their review or recommendations. Care Homes for Adults (18-65 years) Page 20 of 45 Evidence: The majority of people using the service do not communicate verbally and require other methods to help tem with this. We saw that communication plans are very general, and do not describe in detail methods of communication, or triggers or reasons for agitated behaviour. We note that in the staff handover people are often described as unable to communicate where in their care plans behaviour is often described as a method of communication. For example, as my moods are unpredictable staff to be aware of trigger factors i.e. not being given time to prepare, too much noise around. Daily records show that people who communicate through different behaviours frequently show aggressive or challenging behaviour. Although incidents are recorded by staff, nothing is recorded about efforts to understand or manage this. People who have presented a challenge to the service have had increases in medication and some have moved to other services. One persons behaviour has resulted in him not taking part in physiotherapy exercises, sleeping in a chair, and not having a shower or using the toilet for long stretches of time. While daily records record many incidents, there is no record of investigation as to why this behaviour is occurring, or consideration of alternatives to make this person more comfortable or better able to express himself. One persons care file states requires continence assessment but there are no records of an assessment by staff or a referral or visit from the continence nurse. This persons continence management plan has not been regularly reviewed. In the two months before our visit there were nine incidents recorded by staff where this person had refused toileting or a shower or had been found by night staff in what they believed to be the same continence pads as that morning. This person had been found to have sore areas and no plan had been put into place to manage this. A member of staff told us that X does refuse toileting, but this is dependent on your approach, if you approach X right it is ok People using the service are at various stages of their illness and have different needs accordingly. A service is provided for people who are nearing the end of their life. We found all of the above concerns in relation to one person at the end of their life. One staff member told us X is in final stages of Huntingdons Disease. He gets very agitated during intervention. It is difficult for him to eat. He has pain relief. We are using the pain monitoring form to ascertain if he is pain, we are using this at the moment. We are supposed to observe for safety and giving drinks. However many assessments, such as those needed for pressure care, nutrition and continence had not been completed, and as a result it appeared his condition was not being monitored. One entry in the records states still very varied with diet and fluid intake, to discuss with dietician on 6th May. The records for the 6th May record no changes with no report or recommendations from the dietician. We saw from the care files that Care Homes for Adults (18-65 years) Page 21 of 45 Evidence: the pain monitoring chart had only been completed in March. Daily notes since March show that this person had been thrashing about in bed and calling out. We saw that the staff handover recorded no communication, unable to use call bell, but there is no plan in place to address this or how to monitor this persons communication or expression of pain. Pharmacist Inspector (Morag Ross) looked at the management of medication on 4th June 2009. We looked at three peoples medication records and health care plans. It was of concern that we found some poor and unsafe practice, which means that the health and wellbeing of people who live in the service continues to be at risk. On arrival at the service we were informed that we would not be able to access the medication room for a two hour period because a new floor was being laid. There was no risk assessment available to ensure that staff were aware of the situation or how they could access medication if necessary. This meant that there was an increased risk of medication not being available to administer to people who live in the service. We were informed by the manager that the supplying pharmacy had visited the home to assess and give advice on medication. We were shown a report dated 18th May 2009 from the pharmacy. We spoke with a pharmacist from the pharmacy who was visiting the home to review the medication records and to help the home improve their standards of recording and documenting medication. We were informed by the pharmacist that further medication training had been given to 8 members of staff with further training booked for 15th June 2009. The service was going to have three new larger medicine trolleys in order to ensure medication was stored neatly and tidily. The help and advice provided by the pharmacy was acknowledged as a positive move forwards for the service. We looked at three medication administration records. It was disappointing that we found errors and poor documentation for all three. For example, we saw one gap in the first persons medication record with no staff signature for administration or a code documented with a reason why medication was not given. We checked the medication available and found that the medication may not been given as prescribed. We checked the daily statement for that person and saw there was no record of any problems with medication administration on that date. We saw a risk assessment dated 7th March 2009 which stated Ensure x takes his medication. A care plan for medication was seen dated 7th March 2009 which stated on occasions I refuse medication. Sign and document. Inform GP if more than 24 hours. It was of concern that the medication administration record had not been completed because the person was being given the medication to prevent seizures. This means that their health and Care Homes for Adults (18-65 years) Page 22 of 45 Evidence: welfare was at risk. The second person was not given their medication according to doctors instructions. The medication was to be given on alternate nights to treat constipation, however staff had signed the medication administration record chart every night for 5 nights. We checked the medication available and found that the medication had been given incorrectly. This means that due to staff not following the printed instructions on the medicine bottle and on the printed medication administration record a medication error had occurred. This means that there was an increased risk of harm to the people who live in the service. We saw poor stock control of medication. For example, the second person had 5 bottles of a liquid medicine stored in a cupboard. We saw that 3 bottles had been opened and used. Two bottles had different dates of opening recorded on them and the third bottle had not been dated when opened. The medicine had a short expiry date once it was opened which means that there was an increased risk of waste and also for medication to be given that was past its expiry date and therefore increases the risk of harm to the person. It was disappointing that records of receipt of medication and available balances of medication were not always accurate and clear. For example, we found an empty tablet container in a medicine trolley. The records seen showed that there was no more medication available. The medication records did not show a date of receipt with a quantity or if a balance of tablets had been carried forward from an old medication chart. However, we found some more tablets for the person in a locked cupboard. These tablets had not been recorded onto the chart. This means that due to incomplete records there was an increased risk of a missed dose of medication and therefore of a medication error. There was a lack of clear and correct information linking medication records with the health care plans. For example, one person had difficulty in swallowing medication. We looked at the medication administration record chart. There was no information documented on how to administer the medication. We spoke to three agency staff and they informed us that the person had the medication crushed and put in some water with thickener to help him swallow. They informed us that this information had been told to them by a permanent member of staff. Later on in the inspection one of the agency staff came back and informed us that she had made a mistake and that the person could actually swallow medication. We looked in the health care plan and saw a document for the person which stated that medication could be given in chocolate yoghurt. This was not documented on the medication administration record chart. The Care Homes for Adults (18-65 years) Page 23 of 45 Evidence: lack of consistent and up to date records means that it was not possible to tell how the person took their medication which means that their health and welfare was at risk. Care Homes for Adults (18-65 years) Page 24 of 45 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always confident that their views are listened to and acted upon. Lack of staff training does not ensure that people are fully safeguarded from harm. Evidence: The last key inspection (December 2008) rated these standards as poor. At this time the home could not provide any information about their complaints management and their investigation process for complaints made directly to them. Following that inspection, Pirton Grange have displayed their complaints procedure in the entrance of the home. This is not in a format which all the people living in the home would understand. A suggestion box is located in the reception area of the home for people to make comments and remain anonymous. We looked at the complaints records kept in the home and this showed that they had included two complaints. One was passed to the home from us for them to investigate using their complaints procedure. Both complaints were upheld by the home following their internal investigation and responded to within 28 days. It was of concern, given the high number of complaints we have received and passed on to the home to investigate, that these were not included in the homes complaints records. Following the last key inspection we referred Pirton Grange to the safeguarding process (which is the multi-agency approach to review the information) given the poor outcomes for some people living in the home. Following this we have met with the Care Homes for Adults (18-65 years) Page 25 of 45 Evidence: relevant authorities and the providers from Pirton Grange to discuss their progress in improving the standards of care. The placing authorities have been reviewing individuals receiving care in the home and found that there were shortfalls for many people mainly around basic care. This has resulted in people being transferred to other care establishments. Since the inspection in December 2008 we have received many safeguarding incidents from the home in the form of a Regulation 37 notification - which is information the home should send us. However, some of these reports have provided insufficient information and we have had to contact the acting manager for additional information, which has taken them a long time to provide to us. The safeguarding incidents received have been to do with medication management, assaults between residents and residents assaulting staff, and distressed baehiour from residents. Several anonymous complaints have been received raising concerns about poor management, lack of communication, haelth and safety issues, medication management, staff competencies and skills. We spoke to staff during the inspection and they told us that they had not received adult protection training. They were able to recognise the different types of abuse and described these to us. The Annual Quality Assurance Assessment received from Pirton Grange told us We have a well-established complaints procedure, which is contained in the Statement of Purpose and Service User guide, a copy of which is given to every new potential client and is available in the office. A copy is on display in the foyer highlighting contact details and expected timescales, included in this is Care Quality Commission (CQC) contact details. Care Homes for Adults (18-65 years) Page 26 of 45 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Little consideration has been given to the suitability and personalisation of the home, to meet the needs of people using the service. Health and safety and hygiene concerns are not being addressed or planned for. Evidence: Following the last key inspection (December 2008) a requirement was made that all areas of the home being used by people must be suitable for their needs and lifestyle. This is to ensure that peoples health and safety is met and privacy respected. This requirement has not been met however due to the significance of other concerns relating to the quality of this service it will be repeated. The service has recently started to update the old part of the building and we saw the work being done to a good standard. The building as a whole is spacious with access to a large enclosed courtyard which has been used for barbeques. However our observations throughout the day are that the home could be more personalised to peoples preferences, and more should be made of the communal areas, including the garden, to create a more homely and interactive environment. For example, the decoration in the new unit is very standardised and there is no evidence that people using the area had been involved in choosing the decoration. We also observed several peoples rooms which are very bare with few personal items or decoration. We Care Homes for Adults (18-65 years) Page 27 of 45 Evidence: also did not see any evidence of sensory stimulation, for example access to computers or relaxation areas, and no evidence of consideration of age group, no signage, pictures, or social equipment. Reviews carried out by health and social care professionals in April 2009 highlighted concerns about the use of communal rooms, the lack of supervision for those who need it and the level of noise and chaotic atmosphere. During our visit we observed that the lounge room next to reception on the ground floor felt and looked chaotic with a number of staff, a lot of movement and noise, the television playing on one wall and some staff sat at a table on the front window corner. The room has very little in the way of homely furniture and appears to be mainly used as a large corridor with three doors off it. The dining room on the ground floor is also a through route to some other bedrooms and appeared very chaotic during our visit. On several occasions the tea, lunch and medications trolleys were wheeled through these areas and made a distressingly loud noise, however it was not clear whether staff were aware of this. During our visit other concerns were raised about access and health and safety concerns. For example, the medication room was not going to be accessible for two hours as the flooring in the outside corridor was being laid. No risk assessment had been undertaken and agency nurses not aware that this would be happening or what other arrangements had been made. In the morning we saw that the windows in the old building did not have restrictors and the fire door was not alarmed, people are still using this area and there were no risk assessments in place for this. We asked for this to be rectified which was done immediately. We also noted soiled gloves and aprons in an open bin in a bathroom and a hand wash dispenser off the wall in another bathroom. We spoke to nurses from an agency during our visit who said that they are concerned that they do not have the equipment to do their jobs properly. For example one nurse reported concerns about a resident coughing, but found there was no thermometer and the SAT machine was broken, so they had to call 999. Nurses reported to us that they feel embarrassed because they are not able to give adequate information to paramedics. We also had comments from some nurses that there are a lack of sinks and clinical waste bins around the home for them to carry out their work safely. During our visit we noted two incidents of concern which affected the dignity and privacy of two people using the service. One person came out of his room with two carers with his trousers waistband around his thighs so that his underwear was exposed, he walked to the dining room without this being addressed. On a later occasion we noted one person with their bedroom door open lying in their back on the Care Homes for Adults (18-65 years) Page 28 of 45 Evidence: bed with only a continence pad on. Care Homes for Adults (18-65 years) Page 29 of 45 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Recruitment has improved so that people using the service can have more confidence that staff have been properly checked. However staff are not being given the appropriate support, training or information to properly care for people using the service. Evidence: Following the last key inspection (December 2008) a requirement was made that the home must ensure that all staff employed have been recruited with all the appropriate safety checks completed. In response to a continued breach of regulation by the service a Statutory Requirement Notice was issued on April 24 2009. During this key inspection we found evidence that the service has complied with this Statutory Requirement Notice. The service has made considerable effort to recruit new staff, both nurses and care staff, and tells us there is now the full complement of mental health nurses. The service has recruited an administration manager from the provider companys services in Leeds, to ensure administration including the recruitment procedure meets required standards. We checked some staff files which showed that the recruitment procedure and practice had improved since the last inspection and the service complying with the notice. There were some minor gaps such as one reference missing and lack of clarity Care Homes for Adults (18-65 years) Page 30 of 45 Evidence: over the system for following up nurse registration. However the administration manager was able to verbally explain to us the process for following up references and nurse registrations. It would be good practice for the service to formalise these processes in writing for future staff. Following the last key inspection a requirement was made that the home must show that staff have the necessary knowledge, skills and competencies to meet the assessed needs of people using the service. While the service has started to address this by looking at the competencies of the staff, the requirement has not been met and we will be issuing a Statutory Requirement Notice to ensure compliance with this regulation. We looked at staff files and training records and spoke to nursing and care staff. We were did not see any evidence in staff files that regular supervision is being carried out with staff. One member of agency nursing staff told us that she did not have a proper induction, but spent one day with a nurse who did not know the home. One member of care staff who had not worked in care before said her induction only lasted one day however she shadowed colleagues for two weeks. This member of staff has been employed at the service for nine months and has only received fire safety training, which is confirmed by the training matrix. The member of staff has not had moving and handling training but is using equipment such as a handling belt for people who are not able to move independently. The staff training files show that not all mandatory training has been completed but will be by December 2009. The service tells us that the organisations training department will be present one day a week until December, however the training plan does not indicate which staff will be present. The training matrix shows where training has taken place in 2009 but does not show historic training, so we are unable to assess what training staff have had in the past. Some staff appear to have not had any training due to gaps in the matrix. We asked staff about their knowledge of people using the service. Nurses and care staff say there have been some improvements to the handover system but that the handover lacks medical information for example relating to asthma inhalers or epilepsy. An undated copy of the handover available during our visit confirms this. Care staff told us that despite some improvements there is still very little communication with carers. One member of care staff told us that they had only attended one handover since starting work, and was not aware of the handover at the afternoon shift change. Care Homes for Adults (18-65 years) Page 31 of 45 Evidence: To improve staff knowledge of people using the service, a key worker system has been very recently set up. We were told that the nurses worked as a team to allocate staff who know the individual and have a rapport with them. We spoke to one key worker who told us Ive just been told Im his key worker but I dont know anything about him, I wouldnt say I know how to care for X because I havent been told. Care staff show that they have a general understanding of the role of a key worker, however we were concerned that one member of staff told us that they have never had support with reading care plans, was not aware of the need to review a persons care, and had not heard of pressure area care. They told us I find out for myself what the care plan says, I have never read a care plan, I speak to people about what they want. This member of staff has been nominated as a key worker for a person at risk from pressure sores who is unable to communicate his needs verbally. Care Homes for Adults (18-65 years) Page 32 of 45 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 organisation of the home does not ensure that it is run in peoples best interests. Evidence: Since the last key inspection (December 2008), where the home received a poor rating, the service has received management cover from their head office. However, we have received information from local authorities that the area managers are difficult to contact during the week and are not able to deal with issues directly. Two acting managers and a deputy manager were appointed, and we were informed that they have decided that the position was not suitable for them. Given this, the running of the home is not stable and we have received several complaints from staff about the attitude of management and their lack of acknowlegment regarding their concerns. Pirton Grange now provide us with a weekly action plan, to update us with progress and changes in the service. A requirement was made following the last inspection that the home should establish and maintain a system for reviewing the quality of care and Care Homes for Adults (18-65 years) Page 33 of 45 Evidence: service provision, in a format suited to the needs of people using the service. In light of the current work being done to improve the service, this requirement will be repeated. Information sent to us from the home about incidents (which they are required to send us under Regulation 37) have been brief and not provided sufficient information about the action taken. We have received reports from other authorities that the home fail to recognise potential risks to certain residents and are not taking appropriate action to minimise the risk. For example, a person who demonstrates aggressive behaviour is supposed to be on a level 3 supervision (continual monitoring). However, staff working at the home were unable to explain how this was monitored. When we requested follow-up information from the home to clarify events, there has been a delay in the information being sent to us which reflects poor management. During the inspection we raised some health and safety issues, which included: The home had placed alcohol rub in areas which were accessible to residents living at Pirton Grange. When asked for the risk assessment, the home had not implemented a risk assessment prior to fixing the alcohol hand cleanser in the home. We saw a window on the first floor which had no restrictor in place. This was pointed out to the acting manager and dealt with immediately. However, a system should be in place to report any potential hazards for the safety of the people living in the home. Fire doors were not alarmed and, given the potential for people to wander out of the home, should have a clear risk assessment in place. We observed used gloves and aprons in open bins. We discussed infection control issues with the managers and the need for more clinical waste bins to be provided in clinical areas for the staff to use. The management of accidents and incidents in the home needs to be monitored to observe for any trends and potential risks to individual people. We have received concerns from the local authority that the home are not acting appropriately to incidents involving residents, and they are failing to notify the correct authorities. Prior to the inspection the acting manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This should tell us how well the home think they are performing, and should give us some information about the home, the staff and people who live there, and improvements and plans for further improvements which we would take into consideration. Unfortunately the AQAA did not provide us with much information to accurately reflect the homes current situation. Staff receive fire training and complete fire drills to ensure they have the knowledge to act appropriately to safeguard people in the event of a fire. This information was Care Homes for Adults (18-65 years) Page 34 of 45 Evidence: located in a separate file. Care Homes for Adults (18-65 years) Page 35 of 45 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 2 14 The pre-admission process must be made more robust to ensure that only people whose care needs can be met are admitted to the home. The wellbeing of people using and potentially using the service will be safeguarded. 30/04/2009 2 6 12 Reg 12 (1) (a) Care plans should be comprehensive and reflective of the individuals care needs. To promote and ensure proper health and welfare of the people living in the home. 30/04/2009 3 6 12 The needs of people with 11/03/2009 chronic healthcare conditions such as diabetes must be carefully and comprehensively safeguarded and addressed. To safeguard the health, safety and wellbeing of people using the service. 4 9 13 When a risk is identified to a 28/04/2009 persons health, safety or wellbeing, a risk assessment must be completed that provides clear guidance and instruction to staff about Page 36 of 45 Care Homes for Adults (18-65 years) 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 minimising or eliminating the actual or potential risk identified. To safeguard the health and welfare of people living in the home. 5 20 13 All nursing staff must be 26/02/2009 trained to adhere to the medication policies and procedures and also become familiar with the indications and side effects of the medicines they handle. This is to ensure that all nursing staff handle medicines correctly. 6 20 13 (2) Medication administration 16/06/2008 records must document what has been administered in order to ensure that the people who use the service are safeguarded. This remains outstanding 7 20 13 A system must be installed 26/02/2009 to check the prescription prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. All dose regimes must be clearly written on the medicine chart, and checked by a second member of staff for accuracy to ensure that the Care Homes for Adults (18-65 years) Page 37 of 45 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 staff have clear directions to follow. This is to ensure that the service user receives the correct dose as prescribed at all times. 8 20 13 The medicine chart must 30/04/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records reflect practice 9 20 13 People in the home must receive their prescribed medication correctly. To ensure that the health and welfare needs of the individuals are met. 10 20 13 The purchase and installation 26/02/2009 of a Controlled Drug cabinet that complies with the Misuse of Drugs safe custody Regulations 1973 is required. It must be reserved for the storage of Controlled Drugs only. 30/04/2009 Care Homes for Adults (18-65 years) Page 38 of 45 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is to ensure that all controlled drugs are stored correctly 11 20 13 Prescribed medication must only be administered in accordance with approved protocols. To safeguard people using the service. 12 20 13 The quantity of all medicines 30/04/2009 received and any balances carried over from previous cycles must be recorded. This is to enable audits to take place to demonstrate the medicines are administered as prescribed. 13 20 13 People in the home must receive their prescribed medication correctly. To ensure that the health and welfare needs of the individuals are met. 14 20 13 Nursing staff must record the 06/03/2009 administration of all medication onto the medication administration record charts each time medication is given to a person using the service. When prescribed medication is not administered, a defining code and reason must be entered onto the administration chart. To safeguard people using the service. Care Homes for Adults (18-65 years) Page 39 of 45 06/03/2009 30/04/2009 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 15 20 13 A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice. This is to ensure that all medicines are administered as prescribed and this can be demonstrated. 26/02/2009 16 20 13 All medicines that are 06/03/2009 administered must be in date, stored correctly in accordance with their product licences and be labelled by a pharmacist. All prescribed medicines must be available for administration and must be administered to the person they are prescribed to only. The practice of administering medicines dispensed to one service user to another must cease immediately. This is to ensure that the correct medicine is administered to the service user they have been prescribed and dispensed to and to ensure that the stability of the medication is not compromised. 17 23 13 The service must ensure that 19/03/2009 all staff are trained in recognising abuse and the Page 40 of 45 Care Homes for Adults (18-65 years) 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 correct procedure to follow. To safeguard people using the service. 18 24 16 All areas of the home being used by people must be suitable for their needs and lifestyle. To ensure that the peoples health and safety is met and privacy respected. 19 32 18(1)a Staff must attend 30/09/2008 appropriate training so that they are able to demonstrate they have the knowledge, skills and confidence needed to ensure residents? health and emotional needs are met. this standard was not met at this inspection 20 33 18 The home must show that the staff have the necessary knowledge, skills and competencies to meet the assessed needs of people using the service. Peoples health care needs are safeguarded. 21 39 24 Reg 24 (1)(a)(b) The home 12/05/2009 should establish and maintain a system for reveiwing the quality of care and service provision, in a format suited to the needs of the people using the service. 30/04/2009 26/04/2009 Care Homes for Adults (18-65 years) Page 41 of 45 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 To ensure that the veiws of people using the service are being listened to. Care Homes for Adults (18-65 years) Page 42 of 45 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 6 12 Care plans must reflect the 04/09/2009 individuals needs and preferences, and show how the service will meet their changing needs and goals by involving individuals in the creation of their care plan. Personalised care plans show how the service is enabling people to make decisons and be involved in their own care and support. 2 12 16 (2) (m) (n) The service must 03/09/2009 consult and enable people using the service to maintain and develop appropriate social, emotional, communication and independent living skills, and take part in fulfiling and meaningful activities, as part of their daily routines and interaction with family, friends and the wider community. Care Homes for Adults (18-65 years) Page 43 of 45 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 To enable people using the service to mantain an appropriate and fulfilling lifestyle inside and outside the home. 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 22 Improvements in the management of the service and provision of support to people using the service will ensure that people are kept safe and staff are confident in reporting on issues of concern. Care Homes for Adults (18-65 years) Page 44 of 45 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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