Inspection on 17/10/08 for Quarry Bank

This inspection was carried out on 17th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Quarry Bank 29/10/07

Quarry Bank 22/01/07

Quarry Bank 30/01/06

Quarry Bank 07/09/05

Quarry Bank 14/02/05

Quarry Bank 06/09/04

Quarry Bank 09/03/04

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Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Quarry Bank Woodfield Lane Hessle East Yorkshire HU13 0ES     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Dobbin     Date: 1 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Quarry Bank Woodfield Lane Hessle East Yorkshire HU13 0ES 01482648803 F/P01482648803 amould@woodlandscare.karoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Donna Marie Hutchinson Type of registration: Number of places registered: Mr Anthony Mould,Paul Nicholas Mould care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. Service users in category DE to be 60 to 65 years of age. Date of last inspection Brief description of the care home Quarry Bank is a privately owned care home for older people, some of whom may have dementia. The home is a large, old, detached house, set in its own mature gardens in a residential area of Hessle. The local amenities are further away than easy walking distance. Quarry Bank accommodates both male and female people over the age of 65, and up to three people aged 60 to 65 years with dementia. The accommodation includes two lounges, a dining room and a conservatory. There are five single rooms and nine shared rooms. All areas of the home are accessible to people via the use of a passenger lift, portable chair lift and ramps. There is a pleasant garden with greenhouse and seating area, which is also easily accessible. A large ramp enables Care Homes for Older People Page 4 of 33 Over 65 23 23 3 0 Brief description of the care home wheelchair access to the front entrance of the home and a small car park is also located to the front of the building. Information about the services provided by the home and the latest inspection report, written by the Commission for Social Care Inspection is kept in an Admissions file, which is made available from the manager on request. The home was last inspected by the commission on 29th October 2007. The manager informed us that the weekly fees to live at Quarry Bank on 17th October 2008 are between 350 and 418 pounds. Additional charges are made for hairdressing, chiropody, personal items and toiletries and trips out from the home. 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: one star adequate 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: This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment (AQAA) Information from surveys, which were sent to people who live at Quarrry Bank, to their relatives, to staff and to other professional people who visit the home. 10 were sent to the manager to give to people at the home, and 2 were returned. 10 Care Homes for Older People Page 6 of 33 were sent to the manager to give to healthcare and social care professionals but none were completed and returned. 10 were made available for friends and family of people at the home, to complete. 2 were returned. 5 were sent to staff at the home and 1 was returned A visit to the home by one inspector, which started about 9.15 in the morning and finished at 5.15 in the afternoon, lasting about 8 hours. This visit included talking to people who live there, and to a visiting health care professional. And to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Information about what was found during the inspection was given to the registered manager at the end of the visit. 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 care home does well: What has improved since the last inspection? What they could do better: The way risk is managed in the home could be improved. Written records could be kept to show what the home is doing to minimise the risk of people coming to harm. All risk assessments could be reviewed regularly to make sure they are still accurate. Written records relating to care could be written in a more individualised way to say what people can do for themselves if they are prompted and what care staff need to do. This could help people to receive the same level of support from whoever is supporting them and help them to remain independent. These records could also record peoples preferences about socks and stockings, so that their views could be known and respected. Medication systems could be improved so that people can be confident that medicines are stored correctly. People could be provided with the opportunity to choose when it comes to snacks and meals, and people could be supported in a better way, when eating their meals. The manager could satisfy herself that all staff working at the home are very clear of Care Homes for Older People Page 8 of 33 their responsibilities about reporting occasions when people may be being abused. The homes safeguarding policy could be reviewed to make sure it is line with East Yorkshire Safeguarding processes. The floor of the toilet near the office could be replaced, to make it a more pleasant room and to remove the risk of someone tripping on the uneven surface. Staff starting work before a full police check is returned could be supervised in a more robust way, to make sure they are not working on their own with people. This would show that the manager is protecting people, as she cannot be certain that a new member of staff, is safe to work in a care setting. Record keeping with regard to staff training, monitoring how the home runs and health and safety checks could be improved to show that the home is running well and staff have up to date skills and knowledge. The fire safety officer could be consulted about the way the home helps one person to be able to go into their bedroom independently to check whether this is satisfactory, or not. All incidents, which happen at the home, which affect the people living there in a negative way, could be reported to the commission. This is to comply with the law and so that these incidents can be monitored. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed properly before they agree to move to the home, so that their needs can be checked to make sure that they can be supported appropriately if they move there. Evidence: The care records looked at confirmed that people thinking of moving to the home are assessed to find out about their needs and to make sure that staff have the skills to meet those needs should they choose to move there. The manager said that she always visits people in advance of them moving there, to talk about what particular help and support they would need. She encourages people to visit the home and see what it is like. A meeting is held about six weeks after someone moves there to make sure the move Care Homes for Older People Page 11 of 33 Evidence: has been successful and the person is happy there. The records looked at also contained a comprehensive assessment, completed by a care manager, which also describes the help and support a person would need. Whilst one person who lives at the home said that they received enough information about the home before they moved there, the other person said they couldnt remember. People expressing an interest in moving to Quarry Bank are sent a brochure and the service has a Statement of Purpose and service user guide, in an Admission file, which is given to people look at. The manager could consider producing the service user guide in a simpler format so that someone with impaired understanding could read about what sort of help is available at the home. At the last inspection the manager was required to make sure that following a preadmission assessment all people receive written confirmation that the home is able to meet their needs. This system is now in place. Intermediate care is not provided at Quarry Bank. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst peoples health and personal care needs are generally being met the records underpinning that care need to be improved. Evidence: Three care plans were looked at during this visit. These are in place to describe the care and support that a person needs in order to still be in charge of their life and be as independent as possible. Whilst carers were treating people individually the care plans did not reflect peoples individuality. For example the assessment, completed before one person moved to the home said that help was needed in all aspects of personal care and with getting up and going to bed. The amount of help needed was not written down in their plan of care so that the individual could be receiving different levels of support, depending on who was providing it. This care needs to be written in such a way, that describes how staff will support people to help them to maintain their life skills. Two records said that people should be encouraged to wash their hands and face and choose their own Care Homes for Older People Page 13 of 33 Evidence: clothes. This kind of support, which empowers people to make choices in their ordinary day-to-day living, needs to be expanded on, to cover all aspects of peoples lives. This would help people to stay in control of their own lives, as much as possible. Those people who have communication difficulties, for whatever reason, need a care plan describing how communication is to be maximised so that the individuals needs and views can still be recognised and valued. The way risk is managed at the home needs to be improved. Risk management is needed to enable people to carry on with their lives, whilst the manager puts in place individual support systems so that people can be kept safe. For example people assessed as at risk of falling need a plan of care to describe what the home has put in place, to minimise the risk of a fall happening. People who cannot walk independently need a plan of care to describe in detail the support they need. This is to protect the individual and the staff and to make sure this support is always given in a safe and consistent way. This type of information was poorly recorded. One person has a special feeding regime. Whilst all staff have received training in this procedure, and have been assessed as competent by a health care professional, the plan of care for this person is insufficient and needs to be written in much more detail. This is so that staff have detailed information to refer to, and they can be reassured that the care they are providing is right. The manager must ensure she has an up to date prescription of how much liquid feed and water is to be given each day and this must be recorded in the care plan. The records show that the home maintains good links with outside health care professionals, like the doctor, community nurse, chiropodist and dentist. One health care professional spoken with confirmed that the staff at the home requested support and guidance appropriately. A relative commented in their survey they are very quick to call in the doctor and inform me. A doctor visited two people. Both were seen in the office. It would be much better practice for people to always be seen in their own rooms, both to ensure their privacy and dignity during the consultation and to allow staff continued access to the office, where a number of items, used in the day to day running of the home, are stored. The medication practices in the home were looked at and were generally satisfactory. Two items though were in the medication trolley, but needed to be stored in a cold place so that they could work in the best way. The fridge temperature needs to be recorded daily, rather than weekly, so that the manager can be satisfied that drugs needed to be kept cool are being stored at the right temperature. Other good practice recommendations are that a record is kept of the signatures and initials of all staff that administer drugs in the home so that an individual can be easily identified, and Care Homes for Older People Page 14 of 33 Evidence: changes or additions to the Medication Administration Records sheet should be signed by two people and dated. This would help to minimise the risk of error, when the doctor makes changes. Although the record keeping needs to be improved people looked well cared for and staff were observed supporting people in a gentle and kindly manner. There was a lot of chatting and friendly banter and the atmosphere was relaxed and calm. One care worker explained how they make sure peoples dignity and privacy is respected in their day-to day-lives. A relative commented. My relative has been very well cared for. They are well and happy. It was noticed though that none of the ladies living at Quarry Bank were wearing stockings or socks. This was discussed with the manager, as some people appeared otherwise quite smartly dressed. Peoples preferences with regard to stockings must be discussed with them individually. If their choice is not to wear these items, then this must be recorded in their care plan otherwise people should be wearing these items as anybody else would do. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are supported to lead the life that they choose some practices around meals and mealtimes need changing to improve some peoples lives more, and keep others safe. Evidence: Staff at the home organise events and activities to try to make peoples lives varied and interesting. On the day of the visit some people were making Christmas cards and one care worker was supervising this activity. There is a planned programme of events displayed in the home, so that people can look forward to joining in things that interest them. One person said they werent very sociable, and rarely joined in, but staff always asked them in case they wanted to. There was a planned trip to the local pub for a Halloween party and family members were also invited. The home has a minibus. Outside entertainers also visit to provide musical events, which people can join in with. The care plans looked at recorded individuals social needs, so that staff have some knowledge of peoples backgrounds and interests. One care plan said that a person likes to listen to music in their room and this indeed was what they were doing. Doll therapy is used and one person spent a lot of time talking and nursing their life-size Care Homes for Older People Page 16 of 33 Evidence: doll. There are monthly religious services held at the home and the hairdresser visits regularly. Newspapers are delivered to the home each day and a large print weekly newspaper and television guide are provided for people with poor sight. People are allowed to walk as they choose around the home. One person has their own key to their room. Another said they chose when to get up and go to bed and the staff supported them with this. There are orientation white boards in both the lounge and dining room, telling people who is working that day and what the meals are going to be. Visitors are welcome any time. One person explained that their relative regularly telephoned from Canada and they were always given the telephone so that they could speak with them. The dining room is spacious with small tables, each seating four. Salt and pepper was provided in small sachets, to reduce the risk of people putting too much on their food, and spoiling it. The mealtime was quite a relaxed occasion, with enough staff to make sure people received help if necessary. One care worker though did not sit down when assisting a person with their meal. This is poor practice as standing over someone is not respectful and does not promote conversation or a relaxed situation. The meal that day was fish and chips with mushy peas, which people enjoyed. Vinegar was offered to people, rather than left on the tables. There was coconut sponge and custard for dessert. There was no alternative meal, however the cook was able to explain what could be provided at short notice. She was aware of peoples likes and dislikes and adapted the menu according to her own knowledge of individuals preferences. It would be good practice to offer a formal alternative meal option each day as this would provide people with real choice. Similarly people were provided with biscuits with their coffee, instead of being allowed to choose their own. Offering biscuits on a plate would provide people with choice and control. People spoken with said that they liked the food and it was generally hot enough. Whilst one person said the home provided lots of vegetables, another said they would like to have more fresh fruit. The cook was spoken with. She had limited understanding about the dietary needs of people on special diets. This was discussed with the manager, who explained that the other cook was currently on a healthy eating training course, which the second cook could then attend. It is important that people on special diets can still receive Care Homes for Older People Page 17 of 33 Evidence: interesting and varied diets. The fridge contained some foods from a relative, which had not been labelled and dated. The cook couldnt say how long it had been there and it was discarded. The manager must make sure that all opened foods stored in the fridges are labelled and dated, so that it is clear whether they are safe to eat. This would help to make sure people are not offered food, which has been stored for too long and isnt safe to eat. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and are confident that complaints will be dealt with, however people may be being put at risk because information about people being harmed is not always being shared with other professionals. Evidence: The homes complaints process is displayed in the home and is provided within the information given to people and their families when they move to the home. The annual quality assurance assessment completed by one of the senior managers prior to the visit states that there have been no complaints about the service in the last year and the manager confirmed this. The surveys completed by relatives both said that they knew what to do if they wanted to complain and were confident that their concerns would be addressed properly. People spoken with on the day though, who live at Quarry Bank, were less sure about what they would do. Comments include I wouldnt tell anyone if someone was horrid to me and dont have any trouble here. I wouldnt tell anyone. The manager and staff need to continue to stress how important it is for people to tell someone if they are unhappy about something, so that they can have the opportunity to put things right. The manager should also consider keeping a record of small niggles and negative comments that people may raise in conversation. This would help her to identify Care Homes for Older People Page 19 of 33 Evidence: recurring issues, which may need addressing. All staff receive training in safeguarding adults when they start working at the home. Nearly all care staff have achieved a National Vocational Qualification Level 2 in Care, which includes a module on the need to protect vulnerable people from harm. Two staff were spoken with on the day of the visit. One was very clear about the need to report any potential safeguarding incident immediately to the manager, even if the person asked them not to, but the other person was less sure of her responsibilities. The manager must make sure all staff employed at the home know what they must do if they hear or see something which may mean that the person is being harmed. Minutes from a recent staff meeting showed that safeguarding adults processes were discussed, as a reminder to staff of the need to keep people safe. The homes safeguarding policy however, states that the person in charge should investigate any reported abuse. This policy needs reviewing to bring it in line with national and local processes. The manager reported a safeguarding incident to the commission and the local authority appropriately in the weeks before the site visit. However the accident records showed that another incident happened earlier this year, when one person was hurt. This was not referred as a safeguarding alert. By not informing the right people promptly on these occasions, the manager is not doing all she could be to make sure people are being kept safe. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quarry Bank provides a clean, warm and comfortable place for people to live. Evidence: Quarry Bank is an old detached house, which has been adapted to provide comfortable homely accommodation. There is disabled access, both to the front door and to the well-maintained gardens. There are three communal rooms as well as a heated conservatory. One sitting area does not have a television, so there is somewhere quieter for people to sit, if that is their choice. The communal rooms have been decorated and furnished in a homely manner and the rooms were warm and well lit. Bedrooms are on the first and second floors and those looked at have been personalised with items that mean something to the individual. Most rooms are lockable, and one person holds their own key. Those shared rooms looked at each contained screens to provide privacy. All the fire doors were kept shut, except one bedroom door, which is kept slightly ajar with a book so that the person can get into the room without asking staff to open the door for them. The way this is managed compromises the fire safety systems in place and the manager must get advice from the fire safety officer. A requirement made by the fire safety officer following their inspection in Autumn 2007 was not met within the Care Homes for Older People Page 21 of 33 Evidence: required timescale, however this work has now been done. Staff were observed wearing protective clothing and one carer spoken with said that these items were readily available. Alcohol hand wash was seen around the home and all wash areas looked at had soap and towels. This all helps to minimise the risks of the spread of infection. One toilet near the office has a badly stained floor covering, which is no longer flat and could be a trip hazard. This needs to be replaced as soon as possible. One bedroom smelled of urine. The manager spoke with the domestic, who dealt with this and the room did not smell later in the day. The manager needs to monitor those rooms where smells may be a problem, as a way of auditing that the home remains free from odours and clean and fresh. Care staff are responsible for doing the laundry and this area is currently being redecorated. The manager needs to make sure that the finished flooring can be easily washed as this also will minimise the risk of cross infection. Two people commented in their surveys that items such as glasses and clothing get mislaid, and these comments were discussed with the manager. She explained that staff were alert to items getting lost and that the use of shared rooms and encouraging peoples independence did mean that items were sometimes mislaid. The manager should see if any other systems can be introduced to reduce the risk of more losses. She did however show that glasses, bought whilst people were living at the home, had their names printed on them to make it easier to identify whose was whose. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped and supported by staff who are well trained however a more robust recruitment process would make sure new staff are well supervised until all the recruitment checks are available to look at. This would contribute to keeping people safe. Evidence: There are currently 22 people living at Quarry Bank. The staffing levels of three care staff on duty through the day and two at night, as well as the manager allow staff to meet the care needs of the people living there, at this time. There is one male care worker, who generally works at night. A domestic is employed and the cook prepares the evening meal before leaving in mid afternoon. The care staff organise this meal. Almost all the care staff have completed a Level 2 National Vocational Qualification in Care. Some are working towards a Level 3 award. This means people are more likely to be cared for in a safe and consistent way because staff will have a better understanding of their role. One person said the girls are very good. They know what they are doing. Staff attend training in a variety of subjects related to the work they do. Certificates of their attendance are displayed in the home. One person spoken with said that since Care Homes for Older People Page 23 of 33 Evidence: starting work at the home less than a year ago they had attended training in fire safety, moving and handling and medication administration. They were part way through a distance learning dementia care course, had a date to attend a first aid course and were also working towards their National Vocational Qualification. The manager keeps a record of who has attended what training, but needs to identify when people need to attend compulsory updates, so that she can be satisfied that everyones knowledge is up to date. This information could not be provided on the day of the visit. Two recruitment files were looked at. Both contained the written documentation required before someone is deployed. Both people though started work before the full police check was available to look at. The manager had carried out PoVAfirst checks, which makes sure that the person isnt already barred from working in a care setting because of a previous offence. Whilst waiting for the full police check to be returned the new person should not work unsupervised. The manager explained that the staff team, with whom they worked, would supervise the new person. New staff in this situation must have an experienced named person to be responsible for their supervision on each shift. Records need to show that adequate supervision processes are in place until the police check is returned. This process contributes towards people being kept safe. One care worker explained that when they started work they were allocated a senior carer as a mentor to support them in their new work, and in learning about the policies and procedures they were to follow. They confirmed that they spent their first day learning about how the home operates and what would be expected of them. They follow a planned three-month induction programme, followed by a formal meeting with the manager after this time, when their progress is discussed. This process makes sure that all new staff receive the same learning, which provides consistency. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration systems in the home need improving to demonstrate that peoples best interests are always being promoted. Evidence: The registered manager has worked at Quarry Bank for a number of years and has undertaken extra training to help her in her management role. She showed in discussion that she had a good understanding of the varied care needs of the people who live there. Two people spoken with knew who was in charge in the home and said they often saw her walking around in the home. Staff spoken with said that she was very approachable and easy to talk with. One health care professional said the manager was always alert to training opportunities so that her staff had the skills to do their work well. Staff meetings take place every month or so although one person said these are sometimes fairly informal with no planned agenda. Care Homes for Older People Page 25 of 33 Evidence: Minutes from two meetings in the last six months were seen. If written records were kept from all these meetings they could be referred to in the future to determine what had been discussed and when. Quarry Bank and its sister home carry out annual checks where they gather views from people who live there and from outside people who have an interest in how the home runs. The file where this information is stored was very mixed up and information was almost impossible to find. The manager says some of this information is currently being analysed by the owners. The manager and staff talk informally to people to find out their views about the home. These comments could be written down so that similar comments, made by different people could be identified and acted on. This would help people to know they are being listened to. Self monitoring, and acting on this information, helps to show that the home is being run the way the people living there would like it to be run. Information gathered from customer satisfaction cards needs to be fed back to people with a plan describing what is going to be changed. This would show people that their views are being listened to and acted upon. This information needs to be stored in an accessible way, so that new responses can be checked with older ones to see if the comments are more favourable following changes made to how the home runs. The home keeps personal monies for some people who live there. This money is securely stored, and people can have this at any reasonable time, as an on-call system between the two homes means that a senior person is always available to access the cash. Two peoples monies and their financial records were looked at and were satisfactory. The home has to inform the commission about incidents in the home, which adversely affects the well being of someone living there. The manager has reported some incidents over the past year, however the accidents record book shows that several events have occurred, which should have been reported and werent. This includes one incident where one person was hurt. This should have been reported as a safeguarding alert. Another incident involved an accident, which required paramedic support. These incidents must be reported, to comply with the law. There are a range of health and safety policies and procedures in place. The home promotes safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Staff confirmed they had attended training in these areas however staff have to attend regular updating to make sure their knowledge is up to date, and information to show that this Care Homes for Older People Page 26 of 33 Evidence: was happening was not available to look at. Hazardous products are stored appropriately and monitoring arrangements are in place to ensure the delivery of safe hot water. A legionella water safety check has not been done for well over a year, and the manager said she would arrange for this to be tested. Gas and lift safety certificates were in date, but files containing health and safety documents were not well kept so this information was difficult to find. Fire safety systems are in place. Staff have attended fire safety training earlier this year and weekly fire alarm checks are completed. One persons bed had bed rails attached. These were fitted incorrectly, with too large a gap between the bed-head and the end of the bed rail. This could put the person at risk of harm. Although the manager made sure they were fitted properly there needs to be a system in place where they are checked regularly to make sure they remain in the correct place. This checking needs to be written down and the manager needs to monitor that this is being done. This will help to prevent people trapping parts of their body and coming to harm. Care Homes for Older People Page 27 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 28 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 8 13 The plan of care must include assessments of whether the person is at risk. The registered person must ensure that these assessments are kept under review and revised at any time as necessary. 30/11/2008 Written plans to minimise this risk must be in place to ensure consistent care is given. 2 8 15 The registered person must 30/11/2008 ensure that there is a comprehensive care plan in place to record the care required when providing specialist feeding. This needs to include the up to date volume of fluids to be given. This will make sure the individual receives safe, consistent care and staff can check that they are Care Homes for Older People Page 29 of 33 providing the right care. 3 9 13 Medicines that must be kept 30/11/2008 cool to comply with the manufacturers instructions must be stored in the fridge. They are likely to work better if they are stored as recommended. 4 18 13 The registered person must make sure that all staff working at the home have a clear understanding of what abuse means and know what they must do if they suspect abuse has taken place. This will contribute to keeping people safe. 5 26 13 The floor covering in the 31/12/2008 toilet near to the office must be replaced. Then it will not be a potential trip hazard and it will be a more pleasant room too. 6 37 37 The Commission must be 30/11/2008 promptly informed of all incidents where one resident is harmed, either physically or emotionally by the behaviour of another person. Incidents where people fall or become unwell must also be reported promptly. This is so that these incidents can be monitored, to check that people are 30/11/2008 Care Homes for Older People Page 30 of 33 being cared for appropriately. 7 38 13 The registered person must ensure that bed rails are fitted to the bed, checked and maintained according to Medicines and Healthcare products Regulatory Agency guidelines. This will protect people from harm. 8 38 13 The registered person must 30/11/2008 consult with the fire safety officer and comply with any recommendations he may make, about the homes way of promoting an individuals independence by not keeping a fire door shut. To make sure this management is not putting people at unacceptable risk in the event of a fire. 9 38 13 The registered person is required to provide the commission with evidence that a check has been made on the water supply to rule out the risk of legionella This will show peoples safety is being promoted 10 38 13 Foods that are opened and 30/11/2008 stored must be labelled so it is clear when they should be discarded. This will prevent people from eating foods, which may not be safe to eat. 30/11/2008 30/11/2008 Care Homes for Older People Page 31 of 33 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 7 Care records should be written in a more individualised way, emphasising the different levels of help and support people need to stay as independent as possible and stay in charge of their own lives. The temperature of the medication fridge should be recorded daily. This helps to make sure that drugs are being stored at the temperature recommended by the manufacturers. Ladies living at the home should be consulted about whether they wish to wear stockings or not. Their comments need to be written down and those views respected. People should be provided with choices. This includes being able to choose their own biscuits and being offered an alternative menu each day. This would provide people with more control of their day-to-day lives. The registered person should make sure that people requiring special diets are able to still have a varied and nutritious diet. The homes safeguarding policy needs reviewing to get it in line with the Safeguarding processes used by the East Yorkshire Local Authority so that staff at the home know what the process is and can follow it at all times. It is recommended that the registered person has a more structured system of supervision for staff that have started work before their full police check is available to look at. This would help to show that peoples safety is being protected. The way the home gathers and stores peoples views about how the home is running could be more organised. Peoples comments need to be easily accessible so that they can be referred to, and compared with previous satisfaction surveys. A robust system is needed to show that the home is being run according to what people want. The manager could consider keeping more up to date training records as this would help her to make sure that compulsory refresher training is being organised and delivered in a timely way. 2 9 3 10 4 15 5 18 6 29 7 33 8 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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. 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