Inspection on 16/02/10 for Primecare Nursing Home

This inspection was carried out on 16th February 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Primecare Nursing Home 23/01/08

Primecare Nursing Home 15/02/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Primecare Nursing Home 62 Downs Grove Vange Basildon Essex SS16 4QL     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: Diane Roberts     Date: 1 6 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Primecare Nursing Home 62 Downs Grove Vange Basildon Essex SS16 4QL 0138470275 0138479658 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Choicecare 2000 Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 42 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 Primecare is a purpose built care home and is registered to provide personal and nursing care with accommodation for 42 people over 65 years of age. Accommodation is provided over two floor levels and a shaft lift is available to give access to all areas. The accommodation is comprised of thirty-four single and four shared bedrooms. Ensuite facilities have been provided in eight of the bedrooms. There are two large communal lounge areas, one on each floor and the dining room is situated on the ground floor. People living at the home have access to a patio and garden which is accessible to people who use wheelchairs. The grounds include well maintained gardens and good car parking facilities. The home is within easy reach of Basildon town centre, public Care Homes for Older People Page 4 of 33 0 Over 65 42 Brief description of the care home transport services and local amenities. The current rate of fees range from £434.60 to £625.00 per week. Additional charges are made for hairdressing, chiropody, toiletries and newspapers. Information about the home is made available to prospective residents in the Statement of Purpose and Service Users Guide. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for most of the day and met with the deputy manager in charge that day and some of the nursing/care team. The manager was not available on the day of the inspection. Prior to the visit, we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. This is a self assessment required by law. The manager was asked to complete this and this tells us how well they think are doing, what they think they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to 4 residents and 5 staff at the home. Whilst at the home we also reviewed records and undertook a tour of the premises. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be assessed prior to admission but their preferences etc. may not always be taken into account. Evidence: The manager has a service users guide in place. This was up to date having recently been reviewed but it does not contain the complaints procedure and, for example, residents views on the home following consultation. The guide is printed in a large font, which is good, but the format is very wordy and therefore not very user friendly. A review of the format and content, ideally with input from residents, is needed. The service user guide was seen around the home in some residents bedrooms. The manager has a system in place for the pre-admission assessment of prospective new residents. We looked at two recently completed assessments. These were found to be generally fully completed but very orientated towards medical needs, giving very little information about the individual and their preferences or expectations. For Care Homes for Older People Page 9 of 33 Evidence: example in the sociability/interaction section in one assessment, it stated she has friends and in another it said not applicable. In the section on daily activities there was only a brief comments on the level of support required and no person centred information. The assessment would generally allow the team at the home to know whether they could meet the needs of the prospective resident but it would not give them much information about the person themselves, which would aid a smoother transfer for that person into a care home environment. This level of information was also missing on assessments where residents could communicate well. In addition to the managers assessment tool the team also had copies of referral information from the local authority. On subsequent review of the care plans, it was noted that items from the assessment had not been transferred over into the care planning and therefore at a risk of being overlooked and/or not addressed. This related to long and short term medical conditions and pain management. Residents that we spoke to said that the staff team had been good at helping them to settle into the home and comments included I have settled in well and I feel quite at home. The most recent inspection report and the homes statement of purpose was available in the reception area. It was noted that the statement of purpose was out out date and required a review, for example the staffing structure has changed and the home is now registered with the Care Quality Commission. Care Homes for Older People Page 10 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that their care needs would be fully met and met in a person centred way Evidence: The manager has a care planning systems in place. Some of the care plans are individual to the residents and some are pre-printed and do not always fully relate to their individual needs. Overall the care planning/management at the home requires a significant review in order to demonstrate that the team at the home are managing the care of residents correctly. Many of the care plans and risk assessments are out of date and residents do not always have the care plans or risk assessments that they need in place. Risk assessment tools are also weak in places and some formats require a review. Whilst reviews show that the care plans are up to date the actual care plans themselves, after talking to care staff, do not always reflect the residents current needs, meaning that the reviews undertaken are of limited value. A self care checklist is in place in each care plan and this has the potential to be a good tool to inform individual care plans and promote residents independence, the Care Homes for Older People Page 11 of 33 Evidence: retention of skills and their own self worth. The tool identifies as to whether residents would like to help with daily living tasks such as laying tables etc. However the assessments are not always fully completed and when they are used, the information was not seen to be reflected in the care plans. A further assessment tool is also used to identify what care plans each resident would need and these were seen to be up to date but as stated previously did not always reflect residents current needs. The care plans were variable in quality. They generally contained the basic information required to provide personal care but there is little or no person centered information that relates to the individual and their preferences. The manager in her AQAA says that they promote equality and diversity by asking service users about their day to day preferences and individual choices and religious beliefs and recording these in their care plans, enabling service users to live the life they want to live. Due to the lack of evidence, we would not concur with this statement. Care plans only promote very limited independence for the resident, for example, allowing her to choose what to wear. Many of the care plans are task orientated for the staff and are pre-printed and not individual to the resident, for example, getting in the bath and unable to use the toilet. Residents did not always have the care plans that they needed in place, for example, in relation to medical needs such as arthritis, pain management, Parkinsons disease, poor eyesight and the promotion of continence etc. It is of concern that there are limited or no care plans in place for pain management, considering the amount of end of life care that the team at the home provide. Care staff spoken to said that they did not read or use the care plans and they do not write the daily notes. They said that they gave information to the nursing staff, who then completed them. On discussing the residents with the care staff, they knew their basic care needs and some cases the residents preferences. Much of the information such as, levels of dependency and individual preferences that staff knew were not reflected in the care plans seen. In some cases the care staff only knew very limited information about the residents as individuals and in some cases nothing at all. The lack of person centred information coupled with the fact that care staff do not read the care plans means that the ability to provide person centred care is limited. Staff gave an example whereby one resident was not eating well for 3 days and it was ultimately found out that they did not like gravy on their food. This could be addressed by a good pre-admission assessment and subsequent care plan. Care plans in relation to wound management by nurses were inconsistent with the prescribed dressing differing between the assessment and the actual care plan. It was also noted that measurements are not regularly taken with one current wound having no records of measurement since September 2009. This requires review by nursing staff to ensure a consistent approach to allow for an informed evaluation of wound Care Homes for Older People Page 12 of 33 Evidence: healing and subsequent planned management. Residents had risk assessments in their care plans that covered the risk of developing pressure sores. Residents were seen to have a good range of pressure relieving equipment in place. Staff were caring for residents who had developed pressure sores whilst being in hospital and the manager reports that only one resident has developed a pressure sore in the home in the last year. From talking to staff and residents, these sores were healing but there were no care plans or records in place to back up the management or progress of such wounds. Other risk assessments included continence, but these were not always completed even when the resident had a care need in relation to the management of continence. We noted that upstairs an unacceptable urine odour gradually increased during the morning and early afternoon. Residents in the top lounge are not moved for lunch and possibly not toileted if reliant on wearing pads. Residents up here need more proactive support in the regular changing of such items so that these odours do not develop and to ensure that they are comfortable. Residents also do not have a formal manual handling risk assessment in place. District nursing staff visiting the home have expressed concerns as to the quality of the care planning/management in the home, citing that risk assessments were often out of date or not in place and that the care plans were pre-printed and not individual to the resident. Residents we spoke to said I am happy, they look after me, They give me one pill a week, I am not sure what its for, There is one charge nurse who is very good with the management of my pain, he knows what is suitable, they are good with my dignity and generally kind, they manage my pain well, if you are unwell and stay in bed, they do come and check up on you. Nutritional and weight management at the home is variable and requires a more consistent approach to ensure that outcomes for residents are always as they should be. For example, one resident, who was weighed on admission, was found to have a very low weight and an initial nutritional assessment said that they were at high risk. The assessment states that the person should be weighed twice weekly - records show that this was not being done. The care plan states that should the person continue to loose weight seek advice. As the persons weight was not monitored staff could not properly assess this. The assessment also said complete a MUST nutritional assessment - this was in the care plan but not completed. A care plan was in place, not dated, that said assist to choose meals, staff to help feed and offer manageable amounts, encourage to drink and complete a food chart and weigh monthly. The care Care Homes for Older People Page 13 of 33 Evidence: plan does not outline any preferences the person may have that may encourage them to eat or drink and it is also not clear how much assistance they would need. The care plan also adds confusion as to how often this person should be weighed. A food chart had been completed which showed that the resident was eating very little. There was no evidence that this resident had been referred to the dietitian, although they were prescribed some supplement drinks. In some cases the daily notes indicated that residents were, for example, needing and having a pureed diet, when this was not evident in the care plan. Other residents were noted to have MUST assessments completed in 2008/9 but these have not be reviewed/repeated. District nursing staff visiting residential residents at the home are also concerned as to the management of residents weight and nutrition. They found that residents were not being fully assessed using the agreed tool and that when a risk had been identified the resident had not always being appropriately referred on to the dietitian. The manager in her AQAA said we have implemented the MUST scoring system for nutritional monitoring. We would not fully concur with this statement, based upon the evidence found. The manager has a monthly audit tool in place that we saw for November and December 2009 whereby some residents are monitored for weight loss and the records say, for example, that they have been referred on the dietitians etc. and this is a good tool, but it does not always link into or reflect the residents day to day care plan. On touring the home it was noted that a large number of the residents had bed rails in place and the deputy manager confirmed that most of the residents have them. On checking the records, many of the records refer to residents having these in place but there is no actual risk assessment to show that staff have assessed to see if the bed rails are safe for the resident to use. Residents consent is mentioned is some care records but this is not linked to any capacity assessment. This needs to be addressed to ensure residents safety and was discussed with the deputy manager. It is clear from the records that residents have good access to their doctors. However the records just state that the doctor has visited but does not give any indication as to why the resident was seen, what advice the doctor gave or treatment, tests organised. This is a poor practice and can affect the continuity of care and potentially outcomes for residents. Records also show that physiotherapists visit but again there is no record of any advice or specific treatment or exercises for the residents that staff could follow. Daily notes do show that residents are referred to the Macmillan Nursing Service and the physiotherapist for treatment and advice. Residents allowance records showed that they were also seeing the chiropodist. A visiting doctor we spoke to said that communication between the team at the home and his surgery was good. He felt the management of residents pain was sound and Care Homes for Older People Page 14 of 33 Evidence: that staff were quite proactive with this. He felt that staff were good at raising any concerns and that they brought things to his attention. The medication administration system at the home was reviewed. Registered nurses give out medication assisted by senior care assistants or other qualified nurses. This means that the person dispensing and signing for the medication is not always actually administering the medication. Whilst the Nursing and Midwifery Council accept that medication administration can be delegated, they state that the person actually administering the medication should be signing the administration sheet. Care staff were seen to administer medication to residents and leave them with the tablets without checking that they had been taken, Subsequent checking of the medication administration sheet showed that the administration sheet had not been signed by anyone. On discussion with the nurse on duty, they were not aware that the resident had been left with the medication and said that they had forgotten to sign the chart. The nurse delegating the task holds responsibility for ensuring that the carer is competent and suitably trained. This is not good clinical practice and procedures should be tightened up. Training records show that no nursing staff had attended any training in relation to medication since 2005 and that only two care staff have attended medication training since 2005 and one other carer may have attended a course but this is not dated. Medication administration sheets had clear prescriptions and medications were checked into the home. There is not a consistent coding system in place for the administration of as and when medication, with some staff using an appropriate coding system and others not evidencing that they have offered or considered the medication. This needs to be addressed so a clear picture of the medication that residents require is evident. We also noted that staff do not date when they have open liquid or boxed medications and this should be done as a good practice so that items can be audited if required. It was noted that staff are omitting medication, using an appropriate code, but not clarifying on the back of the administration sheet why the medication had been omitted. On discussing this with the nurse on duty that day it came to light that the manager had told the nursing staff to omit the medication and to then discuss this with the residents doctor. Any omission of medication should first be agreed with the residents doctor and evidence of any discussion and agreement should be clearly recorded. Medication audits are undertaken and the last one was completed in February 2009. This is positive but consideration should be given to adding to the audit to cover dates of opening on liquids etc. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents have some choice in their day to day lives, this could be improved upon so outcomes are better. Evidence: Care staff spoken to describe a task led routine to the day but within this they recognize that residents have choice and can give examples around this such as letting residents get up when they want to. However residents we spoke to said that whilst they had choice about what time they got up they did not have a choice about what day they had a bath on, one resident said I have my bath on a Friday, thats not my choice, thats how it is. Residents have life histories in their care plans but some of these were limited and any information was basic and reflected their pre-admission assessment rather than a discussion with the resident or their family. More work should be undertaken on the social care of residents, to help the staff team get to know the resident as an individual. For example, one life history said lived alone in warden controlled flat. This is not a life history. Life histories were also not always in place for residents who were able to communicate freely and/or had good family support. Where residents had written them themselves they were in place and detailed. Many of the residents have Care Homes for Older People Page 16 of 33 Evidence: preprinted care plan in place that identifies that they lack motivation. The objective of the plan is to increase motivation. The action for staff was seen to be sit residents in the lounge when entertainment is on, which may help and find out what they like and dont like. There was no evidence found that their preferences had been sort. Residents do not have social care plans in place, where their needs have been assessed and planned for so that they would or may be motivated and that their independence, retained skills and self worth is promoted. We spoke to one of the activities officers. She said that she had no set hours but usually works three days a week and the other officer works one day a week. This was confirmed on the staff rota. The manager in her AQAA said we have a committed team of Activities Co-ordinators who arrange daily activities for service users. There is no set programme and the activities officer said that she asked the residents what they wanted to do. Activities included quizzes, bingo, throwing balls into a hoop, word puzzles, external entertainers, exercises and talking and reading the papers. The activities officer was asked if she had any social care assessments/plans in place and whilst she said that these were in place, she was unable to find them. The activities officer does keep records of the activities offered but these were seen to be out of date, from September and October 2009 and in many cases just stated didnt do anything. To an extent there is evidence that some residents are having their group needs met but there is no real evidence that individual needs are being considered or met for the majority of residents. The monthly newsletter informs residents of any planned activities such as external entertainers visiting the home. Staff were heard to be talking to residents about Shrove Tuesday and later in the morning the activities officer held a short quiz, for ten minutes, and then put some music on. In the main hall it states that there are fortnightly outings but these are not taking place with the last one being at Christmas, to see the lights. The activities officer says that the dependency of the residents means that these are not taking place. Two residents that we spoke to in the home were of a low dependency and would be interested in outings out of the home. Residents spoken to said They have activities ladies and I wrote my own life story, I draw pictures for others to colour and I do quizzes for them, that is what keeps me busy, the activities lady pops in to see me for a chat, I stay in my room so I dont have to watch people asleep in the lounge, the activities lady has not come to see me, she gets people together in the lounge for exercises, I like the entertainers that come in and I have made a Valentines card, I have been active all my life and no I get quite frustrated as I have to rely on some-one to go out, the last time I went out was Christmas. The brochure used by the manager states comprehensive activities programme and a wide range of physical and social activities are organised to encourage residents to stay active in Care Homes for Older People Page 17 of 33 Evidence: both mind and body. . We would not fully concur with this statement. Overall social care in the home requires a significant review to ensure that residents group and individual social care needs are met. Residents should have their social care needs assessed and fully planned for to ensure that the quality of their day to day life in the home is good and that as far as possible their abilities are optomised through the promotion of independence, self worth and the retention of skills. Lunch was observed on both floors of the home. Upstairs all the residents in the lounge eat off small tables in front of them, meaning that they do not get up and move. These residents did not have access to any condiments and some staff were observed to be standing over people feeding them, which is a poor practice and insensitive to the individual needs of residents. Some staff were observed to be sitting appropriately with residents to feed them. Downstairs in the dining room, not all residents have access to condiments, there were no drinks available and no napkins. The mealtime experience for residents needs to be imporved and the promotion of residents independence should be considered. Pureed meals were noted to be served in desert bowls, giving only a small portion of food. This practice should be reviewed. Residents who ate in their rooms were given their meal and desert together. It was noted that the ice cream had completely melted before it got to the residents in their rooms. Residents were seen to have drinks available to them at other times of the day other than just at drinks rounds, from early in the morning, which is good. Residents that we spoke to said the food is not bad, you get a choice, the food has improved with the new chef in post, there is not a cooked breakfast available but you can have a breakfast at tea time, the food is not like home but its acceptable, the staff tend to dish up and put the gravy on for you, without asking, The food is quite good, often there is too much, its hot and you get two choices. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and visitors to the home cannot be fully confident that their complaints would be dealt with as they would wish and/or expect to be protected by the systems for adult protection currently in the home. Evidence: The complaints procedure, which is not displayed around the home, can be found in the statement of purpose dated October 2006. It is out of date and requires a review. The manager has a complaints log in place and this was reviewed and it was found that complaints were not fully recorded/logged and there was no recorded evidence of review or investigation available. The manager in her AQAA said that she had received one complaint and there was one currently being investigated, but there was only evidence of one reply on file with no supporting documentation. Relatives who contacted us said that they had asked nursing staff for a copy of the complaints procedure and staff were unsure what to provide and relatives were told to ask another day. The manager in her AQAA said all service users, families, visitors and staff at Primecare have access to our complaints procedure and all staff are aware of how to report complaints. She also says under our plans for improvement, ensure a copy of the complaints procedure is always available for whoever asks for it. Residents we spoke to said that they do see the manager around the home and in some cases she pops into see some residents. Comments included I am quite confident to raise any issues and complaints are seen to. Care Homes for Older People Page 19 of 33 Evidence: Since we last inspected the home has had two adult safeguarding matters referred to the local authority and this related to care management and staffing levels in the home. There were no records available that related to these matters. At the time of writing this report two further safeguarding referrals are also being investigated. The staff training matrix showed that out of 44 staff employed in the home only 5 staff have attended recent training in 2009 with only 12 further staff having attended training between 2005 and 2008. The managers training audit for December 2009 identifies that only 30 of the staff have training in this subject and in her AQAA says staff receive training in the Protection of Vulnerable Adults. This requires attention. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and well maintained home but overall it is not very homely or stimulating. Evidence: We toured the home with the deputy manager. Overall the home was seen to be clean, well maintained and a premises odour was only noted near one of the sluices where there is an ongoing drainage issue that the home are trying to address. The domestic team have a rota in place for deep cleaning bedrooms and we observed this in practice. Odours that developed during the day related to care management rather than cleaning etc. The corridors and some of the communal areas are very bare and not very homely. There are some pictures on the walls but these are minimal and often hung up high so that the majority of residents would not be able to appreciate them. This should be reviewed. The deputy manager told us that there are plans to redecorate the home and this should be considered at that time. It was also noted that there is not much furniture other than chairs in the communal areas, again this would make it more homely. Bedrooms were suitably equipped and residents had been able to bring personal items in to the home. The manager, in her AQAA said that they subcontract a maintenance man, who is always ready to assist residents personalisation of their rooms by putting up pictures etc. Relatives who contacted us said that despite Care Homes for Older People Page 21 of 33 Evidence: requests it can take some time for items, such as pictures, to be put up for people. Signage around the home is basic and could be reviewed to help residents maintain their independence and promote their self worth. Following input from residents, a new large flat screen television has been purchased for one of the lounges and in the last year additional bed tables have also been purchased. The home has a large raised patio to the rear of the home and a large garden, with good views, although access to this is limited in some areas due to slopes. The manager has an up to date fire safety risk assessment in place and records show that alarms and safety systems are being regularly checked. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot expect to be cared for by a team who are fully competent, through training and support, and deployed in a way that would meet their needs. Evidence: Staff work a series of long days at the home and on discussion they prefer this shift pattern. During the staff lunch hour it was noted that only one member of staff was covering the top floor and if they are with a resident then there are no staff available on the floor during this time. This requires a review. Agency use at the home is minimal and the rotas show that the following staffing levels are in place. 1 Registered nurse and 6 or 7 care assistants during the day and 1 registered nurse and 4 care assistants at night. These numbers also included 1 care assistant for one resident who requires one to one care 24 hrs a day. Staff confirmed that staffing levels are based upon a 1:8 resident ratio and not upon the residents dependency/needs. The manager does not have a dependency tool in place. The manager also regularly works in the home as the registered nurse in a hands on role and this includes some evening and weekend work. Residents we spoke to said I get on with the staff well, they are generally a good lot, some are better than others, They are prompt when answering the call bell and there is quite a stable team, sometimes there is a delay, if they are short staffed, some staff dont speak English very well and sometimes they cannot understand you, I get on with the staff quite well, they are busy and cant waste too much time on you, the staff are quite good, they do what you want them to do, Care Homes for Older People Page 23 of 33 Evidence: Staff spoken to confirmed that they were attending NVQ training. From the AQAA, only 4 care staff out of 25 have an NVQ qualification but it is noted that currently 14 staff are undertaking an NVQ. Staff files were reviewed to check the robustness of the recruitment process in the home. Overall the files were generally acceptable with the required checks and documentation in place. However it was noted that in two of the three files the manager herself had supplied staff with references and no interview records are kept. This approach should be reviewed to ensure appropriate references are obtained. It was also noted that several staff, who are not British citizens and/or are students are working 33 - 44 hrs per week. The management team should check that the hours working are within the current immigration/student guidance. The staff training matrix showed that there are significant gaps in staff training within the home. Only one member of staff is showing as having up to date fire safety training and only 17 out of 39 staff with up to date training in manual handling. Staff identified in a staff meeting in December 2009 that an update on fire training was required. This evidence does not correspond with the managers training audit of December 2009 where it was stated that 85 of the staff were trained and that updates were annual. Compliance levels are also low with regard to infection control health and safety, food hygiene, and the nursing staff have not attended any medication updates since 2005. It is positive to see that 18 staff have attended training on End of Life Care Pathways and 6 have up to date training on tissue viability. Other than this staff have very little or no training on mental capacity and the deprivation of liberty, care planning, dementia, diabetes etc. and other conditions associated with the care of elderly people. The manager says in her AQAA that they offer a comprehensive training programme and service users are in safe hands at all times as staff receive all the mandatory training that is required. Based upon the evidence we would not concur with these statements. The staff training programme needs to be addressed to ensure that residents in the home are being cared for by a well trained and competent team that understands their needs and can meet them in a proactive way. Staff records relating to induction were available for us to see. We noted that although given to us as completed inductions, they had been completed by the care worker but not signed off by the person inducting them and they were also not dated to show that the timing of the induction was appropriate to the date they commenced work at the home. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are significant shortfalls in the day to day management of this home that can affect outcomes for residents. Evidence: The manager has been in post since 2004 and still has yet to register with the Commission. This needs to be addressed. The manager is a qualified nurse. Records in relation to the managers ongoing training updates were not available. Overall, we are concerned as to the day to day management and development of this home and our key areas of concern are care management, complaints management, management and leadership and staff training and supervision. The manager holds regular staff meetings and minutes are taken. The minutes show that the manager identifies that there are issues in the home, such as shortfalls with the care planning and discussed the action to be taken but there is little evidence, on reviewing the care plans, to show that shortfalls have been addressed and there is no follow up at subsequent meetings. The managers quality assurance file was reviewed. The last audit for the home was Care Homes for Older People Page 25 of 33 Evidence: dated 2006/7. The availability of up to date quality assurance feedback information was limited. We found some positive feedback from residents on the food provided dated November 2009 but nothing since that date. Surveys were available for visitors to the home to complete enabling them to comment on the quality of the care provided but there were no up to date ones completed. The manager does not hold relatives meetings and deals with any matters on a one to one basis. Discussions, called the residents forum are held and the minutes of the last two meetings, September and December 2009, were reviewed. The subjects discussed are the new hairdresser, food and activities and they do provide some feedback. The manager does not appear to be involved with these meetings as they occur. In addition to this the manager completes a staff training audit, weights are also audited this is discussed further in Section 2 and Section 6 of this report. These are all good systems to have in place. Staff supervision is inconsistent and records show that some staff were supervised in November 2009 and other in June, July and August 2009. Other staff have no record of supervision. This coupled with a poor staff training programme and limited inductions could adversely affect outcomes for residents. The manager in her AQAA says that staff supervisions take place on a regular basis. Accident records were reviewed and found to be completed properly and the appropriate notification sent. The team at the home must obtain an up to date notification form under Regulation 37 from the Commission. The manager does audit and review accident records. Staff training in health and safety has significant gaps and as discussed in Section 2 of this report, risk assessments for residents need to improve and be kept under regular review. Care Homes for Older People Page 26 of 33 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 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 7 15 Residents needs must be fully assessed and each need must have a individual care plan in place that is kept under review. So that residents needs are fully met and met in a way that they would wish. 30/04/2010 2 8 14 Risks to residents must be fully assessed and the management of the risk recorded and kept under review. So that any risks to residents are managed proactively. 30/04/2010 3 8 12 The management of residents weight and nutrition must be consistent and proactive with full records in place and up to date. 14/04/2010 Care Homes for Older People Page 28 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that residents needs in relation to nutrition are met. 4 9 13 Residents must have their 30/04/2010 medication administered to them safely by staff who are appropriately trained and who follow the correct procedures. So that residents receive the medication they need, safely. 5 12 16 Ensure that residents social 14/05/2010 care needs are assessed and planned for and kept under review. So their individual and group social care needs are met. 6 15 16 Improve the mealtime 30/04/2010 experience for residents and ensure that they have choice and that their independence is promoted. So that mealtimes are enjoyable. 7 16 22 The complaints procedure requires a review and it must be freely available to people who ask for it and records must be available of any investigation held. 14/04/2010 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that complaints can be raised easily and dealt with promptly. 8 18 13 All staff must be appropriately trained in adult safeguarding. So that residents are protected as far as possible. 9 27 18 Review the staffing levels based upon the dependency/needs of the residents. So that the right number of staff are available to care for the residents. 10 29 19 Staff must provide 30/04/2010 appropriate references when being considered for employment and work within any immigration guidance. So that residents are protected. 11 30 18 Provide a training programme for all staff that ensures that they are competent to meet the needs of the residents and the responsibilities in their roles within the home. So that residents have competent staff to care for them. 14/05/2010 14/04/2010 30/04/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 12 31 10 The management of the home needs to be more robust and effective. To ensure that the home is run well and in the best interests of the residents. 30/04/2010 13 33 24 Develop the quality assurance systems in the home, based upon feedback from residents and relatives etc, so it is more robust. So that areas for development or improvement are actioned. 30/04/2010 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 1 3 Review and update the service users guide to ensure that it contains all the required information. Develop a more person centred approach to the assessment of residents to aid a smooth admission for them. Develop a more person centred approach to care planning so that residents views and wishes are taken into account. Care staff should take an active part in the care planning process to ensue that they know the residents needs and them as an individual. Review the routine of the day to ensure that it is resident rather than task led. Review the facilities to help ensure that a homely atmosphere is provided and that signage is improved and that the maintenance man is made available to residents. Page 31 of 33 3 4 7 7 5 6 12 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 8 9 10 26 28 30 36 Ensure that the home is kept free from unpleasant odours. Continue to develop the care staff team through completion of NVQ qualifications. Staff should be supported to complete their induction fully. Ensure that staff have regular supervision. 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