Inspection on 25/08/09 for The Promenade Residential Care Home

This inspection was carried out on 25th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Promenade Residential Care... 06/09/07

The Promenade Residential Care... 13/09/06

The Promenade Residential Care... 21/02/06

The Promenade Residential Care... 08/06/05

The Promenade Residential Care... 04/02/05

The Promenade Residential Care... 10/08/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Promenade Hotel Marine Drive Hornsea East Yorkshire HU18 1NJ Lead Inspector Diane Wilkinson Key Unannounced Inspection 25th August 2009 10:00 DS0000019709.V377349.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 2 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 Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Promenade Hotel Address Marine Drive Hornsea East Yorkshire HU18 1NJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01964 533348 01964 537868 julia@promenaderch.co.uk Continuing Care Services Limited Mrs Irene Phyllis Poole Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) named service user under 65 years of age may be accommodated within the maximum number. The condition is to cease when the named Individual ceases to live at the home. 6th September 2007 Date of last inspection Brief Description of the Service: Promenade Hotel is a privately owned care home that is registered to provide care and accommodation for twenty-four older people, including those with dementia related conditions. The home is located on the sea front in the town of Hornsea, in the East Riding of Yorkshire; it is close to local amenities and public transport facilities. The building originally comprised of three houses that were converted into a hotel and restaurant, and later into a care home. Accommodation is provided on three floors; the first and second floors are accessed via a stair lift. There are two lounge areas and a dining room on the ground floor, and private accommodation is provided in fourteen single rooms and 5 shared rooms. The home has an extensive garden at the rear and car parking is available at the front and rear of home. Information about the home is available for prospective and current users of the service in the home’s service user’s guide that is available from the registered manager. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star – adequate service. This means the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 6th September 2007, including information gathered during a site visit to the home. The unannounced site visit was undertaken by two inspectors over one day. It began at 10.00 am and ended at 4.15 pm. On the day of the site visit the inspectors spoke on a one to one basis with two people living at the home, two members of care staff, the administrator and the registered manager. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. As part of the inspection process we sent survey forms to people living at the home, staff and health and social care professionals; 9 were returned by people living at the home, eight were returned by staff and four were returned by health and social care professionals. Comments were mainly positive, such as, ‘the home has a high quality of care. The residents’ needs are met well and they are always relaxed and cheerful’ and ‘good staff relationships and great training opportunities’. Other anonymised comments from surveys and from discussions with people on the day of the site visit are included throughout the report. The manager told us that the current fee for residential care is from £372.04 to £421.20 per week. At the end of this site visit, feedback was given to the registered manager on our findings, including requirements and recommendations that would be made in the key inspection report. The previous key inspection for this service took place on the 6th September 2007 and the quality rating awarded was ‘adequate’. In September 2008 the service had an Annual Service Review and we recorded that the home continued to provide a ‘good’ service; this was an error on the part of the Care Quality Commission (then the Commission for Social Care Inspection). The service has actual had a quality rating of Adequate since September 2007. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 6 We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People have a full care needs assessment prior to their admission to the home and are only offered a place if it is felt that their care needs can be met. A copy of a person’s care plan and risk assessment details are attached to daily diary sheets so that care staff have easy access to this information. However, some care plans and risk assessments need to be more detailed. People tell us that their privacy and dignity is respected by staff. People tell us that they know who to speak to informally if they have any concerns and that they know how to make a complaint. There is a staff rota in place that records details of all of the staff on duty and evidences that there are sufficient staff on duty to meet the needs of the people living at the home. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 7 Money held on behalf of people living at the home is managed safely. People tell us that there are activities available within the home that they can take part in. Visitors are made welcome at the home and are supported to take their friends and relatives out. People at the home and visitors enjoy spending time in the garden. The laundry facilities are suitable to meet the needs of the people living at the home and we saw that staff follow good hygiene practices. Money held on behalf of people living at the home are managed safely and appropriate records are kept. What has improved since the last inspection? What they could do better: Some people (but not all) have a care plan and risk assessment in place that details their capabilities and assistance needed from staff with personal care and other aspects of daily living; this depends on who has written the care plan. Care planning must be consistent to ensure that everyone living at the home has their individual needs met. Care plans should include a photograph of the person concerned to assist staff with identification. Care plans should be reviewed on a monthly basis and Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 8 should include information about any activities undertaken, visitors seen or outings so that there is a full picture of the care provided at the home. Medication policies and practices must be more robust to ensure that people living at the home are protected from harm. There should be a true choice of meal at lunchtimes and for the evening meal so that people are able to choose from various options. Meal portions should meet the individual needs of the people living at the home. The complaints log should record full details of the complaints investigation, including whether the complainant is satisfied with the outcome. These records should always be dated. Staff must not commence work at the home until all safety checks are in place; this is to ensure that only people considered suitable to work with vulnerable people are employed. Induction training should be recorded in individual staff records and should include information about the start and end date, the actual programme of training undertaken and any ‘shadowing’ shifts. The manager must monitor systems in place at the home to ensure that policies, procedures and practices are being followed. This includes robust care planning and risk assessing, the administration of medication and health and safety systems such as the use of the accident book, the maintenance of equipment and systems and the control of substances hazardous to health (COSHH). The quality assurance systems should be more robust so that people are consulted and have the opportunity to affect the way in which the home is operated. 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. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Standard 6 was not assessed as there is no intermediate care provision at the home. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a full care needs assessment prior to their admission to the home and are provided with relevant information before their admission. EVIDENCE: We received nine surveys from people living at the home and they all told us that they have been given written information about the home’s terms and conditions (or contract) and that they received enough information to help them decide if the home was right for them before they moved in. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 11 We checked three care plans and all were seen to include a statement signed by the person concerned to say that they were made aware of the service user’s guide before they signed a contract with the home and were given information prior to admission to help them with their decision making. Care records include an initial referral form, a ‘resident reception record’ (although this document was blank in one of the care plans seen) and a care needs assessment. The care needs assessment is a ‘tick box’ type and includes areas such as continence, hearing, sight, dentures and mobility. A copy of the community care assessment and care plan produced by care management is obtained when Social Services have commissioned the placement. All of this information is used to develop an individual plan of care for the person concerned. A risk assessment is also undertaken at the time of the initial assessment. Again, this is a ‘tick box’ assessment that includes information such as the risk of falls and the assistance needed with toileting and dressing; additional information is recorded for each task such as the level of assistance needed from staff. There is no intermediate care provision at the home. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are individual care plans in place that require some improvements to ensure that a person’s current needs are met and medication policies and practices are not robust enough to protect people from the risk of harm. Staff respect the privacy and dignity of the people living at the home. EVIDENCE: The information gathered at the time of the initial assessment is used to develop a ‘resident’s action plan’ (an individual care plan) for each person living at the home. In two of the three care plans examined we noted that Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 13 action plans were not accompanied by a photograph of the person concerned; this is useful for new staff to aid identification and to assist the emergency services should someone go missing from the home. We noted that people living at the home had signed their agreement to their individual plan of care. Action plans include short term goals and risk assessments. The short term goals include information such as ‘supervision with personal hygiene’, ‘all help with showers’, ‘escorting to and from her room and on lift’ and ‘dietary needs – Type 2 diabetic’. Risk assessments are recorded on a tick box format that includes a small amount of space for additional comments and result in a score that indicates the person’s level of risk. Both documents need to include more specific information about the actual assistance needed by staff and what the person is able to do without assistance. Daily diary sheets are accompanied by a copy of the ‘resident’s action plan’ and risk assessment document so that staff have easy access to this information; this is good practice. There is evidence that care plans are reviewed formally every year but care plans and risk assessments are not always reviewed informally on a monthly basis; there are some management notes and some key worker records in care plans, but these are not consistently recorded every week/month. Care plans include information about a person’s medical history and information about medication they are currently prescribed. Two of the care plans that we examined included a record of contact with health care professionals including the reason for the visit and the outcome. One person’s care plan did not record this information. People at the home told us that they are provided with transport to go to the surgery or to hospital appointments but that sometimes there is a delay in arranging medical appointments. Two of the people whose care plans we saw are prescribed Warferin and we noted that one person had received a printed record of any changes to the prescribed dosage from the GP’s surgery but details for the other person had been taken over the telephone and were recorded on pieces of paper and then filed with medication records; there was a risk of these getting mislaid. We later took advice from the CQC Pharmacist Inspector who informed us that the GP has a responsibility to put this information in writing to the service user; the manager agreed to contact the surgery to arrange this. A health care professional told us when asked what the service does well, ‘very approachable, always ask for advice if unsure and welcome new ideas’. Care plans included some information about pressure care and continence care such as, ‘promotion of good continence day and night’ and ‘management of good continence pads’. Although everyone has a general risk assessment in place, we did not see any specific risk assessments for pressure care or nutritional screening and we did not see any evidence that people are weighed on a regular basis as part of nutritional screening. Some people have been provided with a bed rail to prevent them from falling out of bed; these are accompanied by appropriate risk assessments and are Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 14 checked by a contractor every six months. In addition to this, regular in-house checks should be made to ensure that bed rails remain safe. The training and development plan records that senior staff who are responsible for the administration of medication have undertaken appropriate training. We observed the administration of medication on the day of the site visit; we noted that the senior carer washed her hands prior to commencing this task and small pots of water were prepared so that people had a drink to take with their medication. Medication was taken from the Nomad pack and taken to people at the dining table in a small pot. People were asked discreetly if they required PRN (as required) medication for pain, and if they would like one or two tablets. Medication administration record (MAR) sheets were signed when people had taken their medication and in the case of PRN medication, the carer also recorded 1 or 2 at the side of their signature. A new medication trolley has been purchased. Medication that requires storage at a cool temperature is stored in the kitchen fridge in a separate container – we saw that fridge temperatures are checked and recorded daily. We observed that there are leaflets in place about all medication prescribed for people living at the home so that staff can check information about possible side effects, the reason for taking the medication etc. We checked the recording on medication administration records and were concerned that some handwritten entries for medication prescribed (for example, Diazepam) had not been signed by staff and did not include the dosage prescribed by the GP. When the medication had been administered for 28 days, the records had not been transferred to a new medication administration sheet but a further entry for the same drug had been recorded on the same sheet; this could result in confusion for staff who may administer a double dosage of medication prescribed. In addition to this, we saw on some MAR sheets that medication prescribed four times daily had been altered to twice daily by staff; the manager said that this was at the insistence of service users and that this had been discussed with either the GP or the pharmacist. However, there was no written evidence to support this. We discussed our concerns with the CQC pharmacy inspector who gave advice and also suggested that the manager should obtain advice from the PCT community pharmacy technician; we gave the manager this person’s contact details. The medication policy in use at the home is dated August 2006 and there is no evidence that it has been updated. One person was given their ear drops to self-administer at the dining table and we suggested that it might be preferable to give them the ear drops after lunch to protect the person’s privacy and dignity, and that of others sitting at the dining table. Four surveys were returned by health and social care professionals. In response to the question, ‘Does the care service respect peoples’ privacy and Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 15 dignity?’ three people responded ‘always’ and one person ‘usually’. One relative who helped someone complete a survey told us, ‘I am always consulted and informed of any changes in my mum’s health and well being. The staff always maintain her dignity and self-esteem. They make sure that she always has clean clothes and organise her hair appointments. Her eye tests and chiropody needs are always met’. There are private areas of the home where people can meet visitors and health care professionals in private and some people have a single room. Some people have chosen to share a room and we noted that these bedrooms have dividing curtains provided to promote privacy. Some people have had their own telephone fitted in their bedroom so that they can remain in contact with family and friends independently. We did see that there was a notice on one toilet wall recording details of the incontinence products used by some people living at the home; this does not protect a person’s privacy and dignity as the toilet may be used by visitors to the home. The accident book in use at the home is a communal record and we advised the manager that separate sheets would be preferable in order to protect a person’s privacy. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live their chosen lifestyle and to remain in contact with family and friends. Meal provision is good but there should be a true choice of meal for lunch and for the evening meal. EVIDENCE: Some care plans seen on the day of the site visit included information about a person’s hobbies and interests and family history, but others did not. Nine surveys were returned by people living at the home and when asked, ‘Does the home arrange activities that you can take part in?’ six people responded ‘always’ and three said ‘usually’ or ‘sometimes’. One person added, ‘organise lots of activities. It has pets – fish and birds. Lovely garden – well tended’. We noted that people are encouraged to live their chosen lifestyle and are encouraged to make choices about where they spend their day and how to Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 17 spend their day. There is no activities coordinator employed at the home but staff do arrange in-house activities. However, these are not recorded in care plans and this results in an incomplete picture of the service provided for each person living at the home. Some people have had their own telephone fitted in their bedroom so that they can remain in contact with family and friends independently. On the day of the site visit we observed that several visitors came to the home and that some took their relatives out; both people living at the home and visitors made use of the garden. The manager agreed that access to the garden is not ideal and told us that they had plans in place to improve this. Care plans evidence that people are helped to exercise choice and control over their lives. There is information available in the home about advocacy services; this enables people to obtain these details without having to ask for advice, and promotes independence and privacy. One person told us that they use the services of an advocate. We saw that people are encouraged to bring small items of furniture, photographs, pictures and ornaments into the home to personalise their bedrooms. We observed the serving of lunch; this is just a light meal as the main meal is served in the evening (apart from Sunday lunch). People were given half a tea cake for lunch plus a cake, and a drink of juice and tea; we saw that people were asked they would like more. When asked in a survey, ‘Do you like the meals at the home?’ five people said ‘always’ and four said ‘usually’; some people told us that, although the food is good, they sometimes get small portions. The cook told us that she tells people each morning what the meals are at lunchtime and in the evening and if people don’t like the meal on offer they are provided with an alternative. The meals for each day are recorded on a menu board in the dining room and this does not record that there is a choice. There is a four-week menu in operation and this is changed occasionally as a result of suggestions made by people at the resident’s meeting; the menu records a good variety of meals. The cook has not been provided with a list of people’s likes and dislikes but she is aware of these, as she talks to people on a daily basis. No special diets are catered for but the cook told us that when liquidised diets are prepared they liquidise each ingredient separately. All of the people living at the home use the dining room and we saw that people were offered appropriate assistance and that lunch was a social occasion where people chatted to friends and staff. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People tell us that they know how to make a complaint, both formal and informal, but complaints investigations need to be recorded more thoroughly. Most staff have now undertaken training on safeguarding adults from abuse and this offers some protection to people living at the home from the risk of harm. EVIDENCE: We noted that the complaints procedure is displayed in the home and there is a complaints log in use to record any complaints made to the home. There was only one recent complaint in the complaints log and that was dated 1st May but we were not sure whether this was 2008 or 2009. The complaint was from someone living at the home about being assisted to get out of bed in an inappropriate manner by a member of staff. The manager had spoken to the member of staff about the incident but the records were not clear, were not dated and did not record if the complainant was satisfied with the outcome or Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 19 if any further action was needed to protect the complainant. All of the people living at the home that returned a survey told us that they know who to speak to informally if they are not happy and eight of the respondents told us that they know how to make a complaint. Staff told us that they know what to do if anyone expresses concerns about the home. Four health/social care professionals returned a survey and when asked, ‘Did the care service respond appropriately if you, a person using the service or another person have raised any concerns?’ two people said always, one said usually and the other said that this was not applicable. The manager told us that training on safeguarding adults from abuse is mandatory training and that staff have to undertake this every year. Some staff had undertaken this training in 2008 and others had undertaken in 2009; six staff had undertaken the training on both dates. The manager told us that she and the deputy manager have undertaken manager’s awareness training on safeguarding adults from abuse. On two occasions this year the manager has made appropriate referrals to the safeguarding adults team at East Riding of Yorkshire Council. These were investigated by the team, and the home and the Care Quality Commission were informed of the outcome. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and laundry facilities are satisfactory but some health and safety concerns were highlighted. Good hygiene practices are followed by staff. EVIDENCE: There is a maintenance plan in place for 2005/6 and 2006/7 but we did not see an updated version. We toured the premises and noted that, in general, the home is well maintained. A new walk-in shower has been created and this provides room for people to be assisted by staff if needed. The manager told Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 21 us that the large lounge has been redecorated but that two bedrooms remain in need of redecoration following flood damage. There is a new ‘room check record’ form in use up to 20/4/09 and then records ceased. The manager told us that a new maintenance plan would be developed based on information recorded at these room checks, so they should be reinstated. We noted that the floor tiles in the toilets adjacent to the dining room were loose and created a trip hazard. There are two sets of stairs to the first floor and one includes a stair lift. There is little space for people to move around the stair lift and again, this could create a trip hazard. We overheard a conversation between two people living at the home about the difficulty in reaching the call bell in one of the bathrooms if assistance was needed. The manager should look at all of these areas and complete risk assessments and/or put improvements in place. We noted that there are window opening restrictors in place; this protects people from the risk of an accident involving a fall from a window but still allows fresh air into the premises. We saw a letter from the Fire Officer recording a recent safety visit to the home and this recorded that they were satisfied with the arrangements in place. The laundry room is outside; equipment is satisfactory and the floors and walls are readily cleanable. Some cleaning materials are stored in the laundry room and this is not always locked; cleaning materials and any other materials that could be consumed mistakenly by people living at the home must be stored in a locked cupboard. The home was clean and hygienic on the day of the site visit and we observed good hygiene practices being followed by staff; disinfecting hand wash is readily available for staff and others. There were one or two slight odours in bedrooms and these were being addressed by staff. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient trained staff on duty to meet the needs of people living at the home but staff recruitment practices are not robust and this leaves people at risk of harm. EVIDENCE: We examined the staff rota and noted that the staff recorded reflected the actual staff on duty. The rota records the role of each person on duty, including the manager and the deputy manager. There are four staff on duty each morning, three staff in afternoons and evenings and two staff during the night. In addition to this, there is a cook on duty in the morning and afternoon, a kitchen assistant on duty in the morning and evening and two domestic staff on duty each day. We received eight surveys from staff – in response to the question, ‘Are there enough staff on duty to meet the individual needs of all the people living at the home?’ seven responded ‘usually’ and one responded ‘always’. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 23 We examined the recruitment records for three new members of staff. All included an application form that recorded the names of two referees, a health questionnaire, details of their current employer, education and training details and a criminal record declaration. We were concerned that in two instances the person commenced work prior to two written references or a Protection of Vulnerable Adults (POVA) first check being in place. This could result in people who are not suitable to work with vulnerable people being employed and leaves people living at the home at risk of harm. The manager told us that this has been a necessity due to low staffing levels. We noted that a record of the interview questions and responses are retained for future reference and that staff sign a document to confirm that they have received a copy of the General Social Care Council (GSCC) code of conduct and the home’s health and safety policy. We did not see any evidence that new staff ‘shadow’ existing staff as part of the induction process and we only saw evidence of a person’s induction training in one set of records. The manager told us that the senior carer keeps a record of induction training for new staff; this information should be held with staff records. We examined the training and development plan in place at the home. This records that most staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and that other staff are working towards both NVQ Levels 2 and 3. The plan records that staff have attended various training sessions over the last two years including dementia awareness, palliative care, sensory deprivation, diabetes, infection control and moving and handling. Two staff have also undertaken training on nutrition and food awareness. A member of staff told us in a survey, ‘staff are well trained for their roles and training is always on going for all staff members’. The training plan records that some staff have not undertaken training on food hygiene and first aid. The manager told us that first aid training is booked for staff at the beginning of November and that food hygiene training is also to be provided this year. The manager told us that fire safety training is provided in May and September every year. Training records evidence that 15 staff did this training in October 2008 and that six staff did this training in June 2009. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is experienced and qualified to carry out her role but we are concerned that medication practices, recruitment practices, quality assurance systems and some health and safety systems are not robust. Monies held on behalf of people living at the home are managed safely. EVIDENCE: Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 25 The manager was not at work on the day of the site visit but called in at the home to meet the inspectors. The manager is experienced and is qualified to run the home – she has a care qualification and has achieved the NVQ Level 4 Registered Managers award. She told us that she did the manager’s refresher training on safeguarding adults from abuse in May 2009 (along with the deputy manager) and attends other in-house training sessions with staff. She also reads care journals to endeavour to keep her practice up to date. However, we are concerned that medication and recruitment practices have not been managed in a way that protects people from the risk of harm and that care plans and risk assessments are not robust. This means that people who use the service may not be protected from the risk of harm and may not have all of their needs met. The manager told us that the home has retained the Investors in People award and has achieved QDS (the local authority quality scheme) Parts 1 and 2. We noted that some surveys were sent out in October 2008 and that responses were positive. The manager told us that any areas that needed improvement were actioned. However, the information received was not collated and people who took part in the survey were not given any feedback. We advised the manager that information received in surveys should be used to inform the development plan for the following year. One manager’s meeting has been held this year – topics for discussion included night staff sleeping on duty and staff speaking to residents loudly and disrespectfully. A staff meeting was held in April 2009 and topics discussed included training, the tendering process, people’s needs and the Care Quality Commission. The most recent resident’s meeting was held in February 2009 and the minutes evidence that social events, food, staff, the TV, the rear garden and ‘any problems’ were discussed. We noted that the minutes of the most recent staff meeting recorded that meetings would be held every three months but records evidence that all meetings held at the home are not regular. The current frequency of meetings does not give people the opportunity to express their opinions or affect the way in which the home is operated. We examined some of the monies held on behalf of people living at the home and associated records; these were found to be accurate. Receipts are obtained for any expenditure made on behalf of people and when money is handed over for safe keeping. Petty cash is held so that money can be given to people when the administrator is not present and then this is later reconciled with financial records for the individual concerned. Communal receipts are issued by the hairdresser and chiropodist but this can be cross referenced to individual records – purchases made at the Fashion Show are supported by individual receipts. We examined a selection of health and safety documentation held at the home, including the accident book. We noted that one person had been scalded on Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 26 three occasions but there was no record of how these incidents had been followed up. In fact, very few accident/incident records included information about any action taken to prevent reoccurrence or to address any concerns. Water temperatures in bedroom, toilets and bathrooms are tested regularly to ensure that water is kept at the correct temperature; this protects people from the risk of being scalded. We saw that there are appropriate arrangements in place to alleviate the risk of Legionella in the water supply. Safety information about cleaning products and other chemicals in use at the home has been obtained. Mobility hoists, bath hoists and the stair lift have been serviced within the last year and there is a five year period inspection of the electrical installation in place. Portable appliances were tested in June 2009 and there is a gas safety certificate in place. On the day of the site visit we did not see any evidence that the nurse call system had been serviced during the last year. However, the manager sent us information following the site visit to confirm that the call system was serviced on 4/9/09. There are environmental risk assessments and a fire risk assessment in place; the fire alarm system was checked by a qualified contractor in July 2009 and emergency lighting and fire extinguishers were checked in January 2009. Inhouse fire tests are undertaken on a monthly basis and we saw that these are carried out consistently. However, we did overhear someone living at the home comment that they had not seen a fire drill in the two years that they had lived there. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Robust and detailed care plans must be in place for each person living at the home. These must include information about a person’s health care needs and must give clear guidance to staff on how individual care needs will be met. There must be specific risk assessments in place for any areas of care relevant to the individual concerned, including pressure care and nutritional screening. These must give clear guidance to staff on how individual care needs will be met. The medication administration record form used by staff to record medication prescribed by the GP and received from the pharmacist must record accurate information, i.e. the strength of the drug and the times that the drug is to be administered. Medication administration record DS0000019709.V377349.R01.S.doc Timescale for action 30/10/09 2. OP7 OP8 12 30/10/09 3. OP9 13 25/08/09 4. OP9 13 25/08/09 Page 29 Promenade Hotel Version 5.2 forms must be used as per the home’s policies and procedures and instructions from the GP and Pharmacist. Alterations can only be made following written instruction from the person’s GP. 5. OP9 13 Medication administration record forms must be used by staff for a 28 day period (and no longer) to evidence that a person has taken their prescribed medication. Staff must not commence work at the home until all safety checks are in place. Failure to do so could result in people who are not considered suitable to work with vulnerable people being employed. A copy of the gas safety certificate, details of a portable appliance test and evidence that the nurse call system has been serviced must be forwarded to the Care Quality Commission by the timescale given. (This information was subsequently received by the CQC). 25/08/09 6. OP29 19 25/08/09 7. OP38 23 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is good practice to include a photograph of the person concerned with care plans; this assists new staff with identification and assists the emergency services should someone go missing from the home. DS0000019709.V377349.R01.S.doc Version 5.2 Page 30 Promenade Hotel 2. OP7 3. 4. 5. OP9 OP9 OP10 6. OP12 7. OP15 8. 9. OP16 OP19 10. 11. 12. OP19 OP26 OP30 13. OP31 Care plans must be reviewed by staff at the home on a monthly basis. This is needed to ensure that staff are working with up to date information about the person concerned. Any handwritten entries made on medication administration record sheets should be signed by two staff to ensure accuracy. The policies and procedures on the administration of medication should be reviewed to ensure that the content is up to date. More consideration should be given to respecting a person’s privacy, for example, communal recording in the accident book and notices about personal issues on display within the home. The registered person should make sure that there are records kept of people’s level of involvement in the activities provided in the home. This would help both in the individual and group planning of activities in the home. This was a recommendation at the last inspection in August 2007. People should be provided with a true choice of meal at each mealtime and staff should ensure that people are aware of this. The home should ensure that meal portions suit the individual needs of people living at the home. All complaints should be recorded clearly in the complaints log, including information about the complainant’s satisfaction with the outcome. Some safety aspects of the premises need to be addressed, i.e. the uneven floor tiles in the identified toilets, access on the stairs that include the stair lift and the location of call bells. There should be a programme of routine maintenance and renewal of the fabric and decoration of the premises in place. Cleaning materials should be stored in a locked cupboard or similar to protect people living at the home from the risk of harm. There should be evidence that induction training meets Skills for Care requirements. Induction training should be recorded in individual staff records and should include information about the start and end date, the actual programme of training undertaken and any ‘shadowing’ shifts. The manager should ensure that all of the policies, procedures and practices at the home are adhered to (including care planning) and that there are monitoring processes in place to ensure compliance. DS0000019709.V377349.R01.S.doc Version 5.2 Page 31 Promenade Hotel 14. 15. OP33 OP38 16. OP38 The registered person should make sure that the Quality Assurance system is fully utilised to support people to be involved in the development of the home. Health and safety systems in place at the home should be monitored to ensure that they are adhered to – this would ensure that people living at the home are protected from the risk of harm. This includes the maintenance of equipment by qualified contractors by the due date and the control of substances hazardous to health (COSHH). There is an accident book in use but entries should be monitored so that any patterns are identified and dealt with. Promenade Hotel DS0000019709.V377349.R01.S.doc Version 5.2 Page 32 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. 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. 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