Inspection on 18/03/09 for Quinton House Nursing Home

This inspection was carried out on 18th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Quinton House Nursing Home 26/03/08

Quinton House Nursing Home 15/02/07

Quinton House Nursing Home 01/12/05

Quinton House Nursing Home 12/07/05

Quinton House Nursing Home 02/03/05

Quinton House Nursing Home 18/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY     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: Yvette Delaney     Date: 1 8 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY 01789720247 01789720245 angelabirioo@quinton.house.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Quinton House Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 37 Number of places (if applicable): Under 65 Over 65 3 37 dementia old age, not falling within any other category Additional conditions: 0 0 Ms Kathleen Januszka to undertake management training equivalent to NVQ level 4 by April 2005. Residents with dementia will not be accommodated in the annex. Date of last inspection Brief description of the care home Quinton House is situated in the village of Lower Quinton a short drive away from Stratford on Avon. The current provider Quinton House Ltd has owned the home since 1995. The home is registered to provide nursing care to 37 elderly residents, with three of these places registered for care of those with dementia. Accommodation is provided in two areas of the home. The main House, which accommodates up to 29 residents and a smaller annex, which is adjacent to the main building and accommodates up to 8 residents. The main house has accommodation on Care Homes for Older People Page 4 of 35 Brief description of the care home three floors with access via a passenger lift or stairs. Accommodation is provided on the ground floor of the annex. The majority of the accommodation for residents in the main house is provided in shared bedrooms. Gardens to the front and side of the main building are well maintained with access possible for all of the homes residents including those who may require a wheelchair. The owner of the home advised at the time of this inspection that the fees for residents ranged between 450 pounds and 665 pounds per week, these are subject to change and enquires should be made as to the weekly fee before admission to the home. Residents pay additional charges for the services of the hairdresser, Dentist, Optician and Chiropodist. Further charges are also made for other items or services provided by the home, 10 pounds per month is charged for toiletries. These include the transport and staff escort time to attend out patient visits if an ambulance is not booked, name tapes and fixings for clothing, sundry items and newspapers, which includes the weekly delivery charge. Care Homes for Older People Page 5 of 35 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was the first inspection of this home with the newly registered owners and was unannounced. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care Care Homes for Older People Page 6 of 35 and management of the home. Information contained within this document has been reviewed and considered and is included within this report where appropriate. Three people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking peoples care helps us to understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide/Statement of Purpose, staff duty rotas, kitchen records, accident records, health and safety records and medication records. Service users were observed during lunchtime to ascertain choices and view meals made available. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. What the care home does well: What has improved since the last inspection? A suitable cupboard has been purchased to store controlled drugs. This will help to ensure that they are properly stored and cannot be accessed without a key. The lock to the room that houses the medication and dressings has been made secure to ensure safety to residents and the staff in the home. The call bell system has been fixed to ensure that residents are able to inform staff when they need assistance or care. Care Homes for Older People Page 8 of 35 Thermostats have been fitted to hot water outlets this will help to prevent any burn or scald risks to residents. A review of the skill mix of staff on duty at any one time has been carried out and plans are being put in place to make sure there are sufficient nurses on duty at all times to safely meet the needs of residents. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information in the Statement of Purpose needs to be updated to ensure people are given current information. People receive a comprehensive assessment of their care needs to make sure they can be met before admission to the home. Evidence: The home has a statement of purpose and service user guide in place. Both documents should contain up to date information about the home to support prospective residents make an informed choice on whether to use the home. As we found at the previous inspection the statement of purpose had still not been reviewed to make sure that it contained current information. For example the organisational structure did not reflect the current staff working in the home and the last inspection report referred to, was dated 2004. A resident commented in their questionnaire that they receive enough information Care Homes for Older People Page 11 of 35 Evidence: about the home also saying But some service is not same once you are resident. A further resident said that information was given to their family. My daughter and her family came and looked over the home and were very pleased with everything. Three residents were identified to be case tracked. Care files examined showed that pre-admission assessments had been carried out. Residents files also showed that an assessment of their care needs had been carried out by social services and or the primary care trust. The documents contained sufficient information to support planning the individual care needs of residents on admission. Residents also have a functional test for mental capacity completed. This will help staff to determine if people deciding to move into the home will be able to make their own decisions and choices on their day to day care and life. Residents spoken with during the inspection were able to confirm that someone from the home had visited them to assess their care needs. Care Homes for Older People Page 12 of 35 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. Residents health, personal and social care needs are set out in individual care plans, which should result in the delivery of appropriate care. The management of medicine practices in the home are not robust enough to ensure that residents are protected from the risk of harm. Residents are generally treated with respect at all times. Evidence: The care files for three residents were examined. Work had been carried out to update care plans and provide more in depth information to support staff to meet the individual health and personal care needs of people living in the home. Information available also considered how much residents were able to do for themselves therefore promoting their independence. Daily reports are written by nurses on each shift to describe how residents spend their day, and note any changes in their general health and well being. For residents with more complex needs due to a stroke or dementia for example, care plans were detailed and actions stated were carried out. Staff were seen using moving and handling techniques and equipment properly. However talking with one of the residents we were told that due to staffing problems only one member of Care Homes for Older People Page 13 of 35 Evidence: staff was hoisting her saying and this should be two to do so safely. Care files showed that risk assessments had been completed for each area of care. Examples of these includes nutrition, falls, mobility and the prevention and treatment of pressure area damage. Where risks are identified, care plans had been developed to provide staff with direction on how to manage the risk. Risk assessments for moving and handling in reference to for example turning in bed, helping on and off the toilet had been carried out. Records show the action to be taken by staff based on the outcome of the assessment for example the equipment to be used and the number of staff needed to support the resident. The risk assessment related to falls provides criteria for staff to assess a resident against, for example a residents ability to weight bear or balance. However the assessment tool does not clearly identify how the level of risk is determined or the action staff should take if a risk is identified. Information received from family members, residents and details in the care plans told us that they were involved in planning their day to day care while living in the home. There is limited information in life histories to give staff an insight into individual residents interests and hobbies. This information would help to inform the care, provided and ensure that care is appropriate for the individual needs and preferences of residents. Information in the care plans and talking to residents showed that they have access to health professionals this includes a GP, dentist, chiropodist and optician. On the day of the inspection, a resident returned from hospital following a short stay as an inpatient. Conversations with residents and relatives confirmed that there was no problem in gaining access to a doctor or attending hospital appointments. A letter was seen from the GP to thank staff for their support during the ward round (the home). The letter summarises the outcome of the GPs visit and the further investigations to be carried out for each resident seen. A resident told us that they Wish staff could speak better English, have difficulty understanding. A member of staff was seen to use language cards. These depicted certain words related to daily living in the home in pictorial format to help the difficulty in understanding between staff and residents. Staff and some residents felt that these were useful. A resident said they usually receive the care and support they need and also said But you are sometimes required to wait quite a while. A family member told us that they are kept informed if there are any changes in their relatives health or wellbeing. Care Homes for Older People Page 14 of 35 Evidence: The management of the administration and storage of medicines in the home was checked. The Medication and Administration Records were seen for the three residents medication. These showed that the charts were signed with no gaps. The medication fridge was clean and temperature checks maintained to make sure that any medication in there is stored at an appropriate temperature to maintain their stability. Staff also recorded the minimum and maximum temperatures. Three different types of eyedrops were stored in the drug trolley when opened instead of the fridge. Instructions on the eyedrops showed that they should be stored at temperatures between 2 and 8 degrees centigrade. This does not help to make sure that the effectiveness of the eyedrops does not deterioate. Other checks made on medicines showed that medicines were moved from the original package they were dispensed in to another. Nurses started a new box of drugs before finishing the first. The balance of medicines showed some descrepancies for example one bottle of tablets contained 26 tablets instead of 31. A further box, the MAR chart and prescription showed that 60 tablets were dispensed, 80 tablets were counted in the box. The controlled drug cupboard had been replaced and the storage of medicines was good. All medicines were held in locked cabinets within a locked room. The home uses a destruction kit to dispose of any unused controlled drugs as required by law. Destroyed medication is recorded in the Controlled Drug book and also in a receipt book for the company who remove these from the premises, a copy of the receipt is kept by the home. The clinic room is clean and tidy. Records showing the temperature of the room demonstrates that a stable temperature has not been maintained. Information available told us that on some days the temperature had risen above 25 degrees centigrade. The service must assess this and take action to ensure that medicines are stored at 25 degrees centigrade and below to prevent deterioration. A fan is used to help control the temperature in the room but it is to small to be of any effect. A quality audit tool for the management of medicines in the home was seen. This was titled Audit of Drugs and Medication. The audit reads like a procedure and details what practices related to medicines staff should undertake. The document does not make it clear how the audit should be carried out. Screening to provide privacy in some shared rooms had improved. The positioning of the curtains were suitable to provide privacy on each side of the room when attending to individual care needs. The people living at the home were well groomed and dressed. Residents personal care needs are met in their own bedroom or in one of the communal bathrooms and doors were closed demonstrating that staff respect Care Homes for Older People Page 15 of 35 Evidence: residents privacy and dignity. Care Homes for Older People Page 16 of 35 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. Social and recreational activities generally meet the needs of residents. Open visiting arrangements encourage regular contact with relatives and friends. Food records and residents comments do not confirm that a choice of meal is offered to make sure residents receive a varied and balanced diet. Evidence: The cook in the home coordinates the activities that take place in the home. Exercise sessions are held and led by a person external to the organisation. Other activities documented on a weekly activity programme include outings to the theatre, potting plants, knitting and baking. The detail of individual residents hobbies and interests are included in care files. Activities were not seen to take place on the day of inspection. One residents file contained a copy of their social assessment sheet. The sheet showed what activities people enjoyed examples include gardening, knitting, sewing, watching television and listening to music. Residents spoken with said that it was their choice whether they take part in any of the social activities and how they spend their day. Comments made by residents and relatives in the questionnaires sent out by us include: More activities for the more able residents would be nice and more outings. Care Homes for Older People Page 17 of 35 Evidence: Residents were seen to have good contact with their family and a number of visitors were freely coming and going on the day of inspection. Visitors all signed a visitors book, which was at the entrance of the home. Signing the visitors book promotes the safety of residents living in the home and provides information for staff on who is present in the home in the event of an emergency. Residents spoken with, which includes those followed through the case tracking process said that their family and friends are made to feel welcome when they visit. It was not obvious that a choice of meals is offered daily. The menu on the whiteboard in one of the dining rooms showed that a two course lunch was offered. The meal for the day was sausages, mashed potato, cabbage, carrots and gravy. The desert was bananas and custard or yoghurt. We were told that a different choice to the main menu would be offered if requested. Residents commented in their questionnaire that: Always meat, fresh vegetables, salad and fresh fruit. However two other residents told us. There is never enough green vegetables and fresh fruit. and Perhaps more green vegetables would be helpful. A further resident said Supper is a bit disappointing. Residents were relaxed during teatime and enjoyed chatting to each other in the dining room. Staff were available to provide assistance as required and assisted residents in a discreet and sensitive manner. Care Homes for Older People Page 18 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel safe and listened to. Evidence: A copy of the complaints procedure is displayed in the home this makes sure that it is accessible to people using the service or visiting the home. Residents spoken with, information in the AQAA and questionnaires sent out told us that residents know how to make a complaint and who to complain to. People spoken with in the home said that they would raise concerns with the manager or senior staff on duty. A resident told us that although they knew who to speak to if they were not happy and how to make a complaint that they were Not always taken notice of. People using the services of the home felt that generally their complaints are listened to. A resident said that they would speak to head of nursing staff, sister or care nurses. We have not received any complaints about the home. The manager keeps a record of any complaints and concerns received. The home has an adult protection policy. The document gives staff direction in how to respond to any suspicion, allegations or incidents of abuse. Training records show that staff have received training in recognising signs and symptoms of abuse. In conversation staff working in the home showed an awareness of the role the local Social Services take in the event of receiving allegations of abuse. There have not been any issues raised related to adult abuse. Care Homes for Older People Page 19 of 35 Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment has improved to help provide residents with a homely place to live. Evidence: Quinton House provides accommodation for up to 37 older men and women. Observation of the home during the inspection showed that changes had been made. Bedrooms had been re-decorated, and the layout changed to provide a more comfortable space for residents. The screening in some shared rooms had been reviewed. New curtain railing had been fitted along the full length of the ceiling of the bedroom. The curtain fitted was an appropriate length and width to make sure that it could be pulled along the length of the room with no gaps. This helps to promote privacy for people sharing a bedroom. The curtains were attractive in appearance and fitted well with the decor of the bedroom. Residents sign an agreement stating that they are happy to be a sharing a bedroom. Continuous maintenance, refurbishment and re-decoration are carried out in the home to make sure the home is safe for use. Bedrooms viewed presented as warm, comfortable and homely. Some of the residents have taken the opportunity to bring in some of their own personal items this has helped to make their bedrooms comfortable. Care Homes for Older People Page 21 of 35 Evidence: At this inspection there were 34 people living in the home. People were living in the main home and in the annexe. Staff live in the first floor of the annexe. Access to staff accommodation is separate to that of the home. This will make sure that visitors for staff living on the premises do not have to enter the residents home. The home was clean and there were no unpleasant odours on the day of the inspection. Residents spoken with were all generally happy with the cleanliness of the home. Residents responded to the question Is the home fresh and clean? by saying Extremely high and My room is cleaned everyday. A relative said: We would like to tell you that unlike many care homes and nursing homes, Quinton House does not have a constant smell of cooking or Elderly Residential Odour It is a joy and delight to always find this nursing home smelling fresh and sweet. This is incredibly important for residents and staff, as well as visitors and cannot be underestimated. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, and moving and handling equipment for example, hoists. There are en suite facilities provided in the bedrooms in the annexe and walk in shower room/bathroom is provided on the first floor of the main house. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. This will help to manage the control of cross infection in the home. However, some of the bins in the bathrooms and the toilet could not be opened without using your hand, which does not support prevention of infection procedures in the home. There is a well-equipped kitchen and on the day of the inspection the temporary cook was present while the main cook was on holiday. The kitchen was clean and tidy. The food store is well organised and there are two freezers and one fridge. At this visit meat was being defrosted on a shelf in the fridge over the milk. This practice could contaminate other food products stored in the fridge and the resulting risk of cross infection to people living in the home. The meat was moved to the bottom on the fridge at the time of inspection. The home has systems in place for the management of dirty laundry and the clothes of everyone living in the home looked clean, clothing was ironed and well looked after. The housekeeper was seen to take great pride in her work. New equipment had been provided, which includes a domestic dryer and domestic steam generator iron. We Care Homes for Older People Page 22 of 35 Evidence: were told by the housekeeper that this additional equipment has helped to make laundering of residents clothing easier and improved the presentation. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels in the home do not ensure that the needs of residents will be met at all times. Staff files do not make it clear that robust recruitment procedures are followed to support the protection of residents from the risk of harm. Evidence: We examined four weeks working duty rotas. Duty rotas show that the number of nurses the home aim to have on duty is not always met in that on some days the nurses are working in the capacity of a care assistant. The deputy manager told us that there are two nurses and six carers on an early shift, one nurse and five carers on a late shift and one nurse and two carers on a night shift. Information provided by the home tells us that the home has plans to improve staffing levels in the home. The newly appointed manager works 20 hours per week over four days, based on the homes working week this leave 17 hours without management cover each week. The manager is supported by a deputy. The duty rota shows that she is included in the staffing numbers to provide care. This means that the deputy would be unable to manage the home at the same time. Correspondence in a letter tells us that two new carers and one nurse have been appointed since the inspection visit. The home has told us that they intend to provide Care Homes for Older People Page 24 of 35 Evidence: two nurses on each shift and at weekends. This will be assessed at the next inspection. The home also employs a maintenance man, administrator, laundry staff and kitchen staff to support the running of the home. The hours that the night duty staff work are not defined on the duty rota so that it is clear what hours they work. This is also the same for some day shifts patterns. There is a wide variation of shift patterns but the duty rotas does not make it clear what time the shift starts and finishes i.e. whether it is a am or pm start and finish. The four weeks duty rotas examined show us that most staff are working in excess of 50 hours every week with two members of staff working 70 hours over a week on two occassions. This is poor practice as the number of hours and double shifts could cause tiredness and impact on the effectiveness of staff. There should be sufficient breaks between working day and night shifts in line with the Working Time Directive. A night duty routine information sheet shows the tasks night staff should carry out at night. This includes a list of non care duties such as preparing vegetables, making sure that the washing is done and cleared in the laundry and washing the kitchen floors. The time and who was allocated to do these tasks and make sure that staffing were not depleted to provide residents care was not identified on the duty rota. A resident commenting on staff in the home said Staff really work, I mean work very hard. Another resident said that staff were not always available when they needed them. Three staff files were checked; these were not organised and complete to clearly show that recruitment and selection procedures in the home are robust to protect the people living in the home. Robust recruitment practices support the safety of people living in the home from the risk of abuse. There are 75 percent of the care staff with a minimum of National Vocational Level 2 qualification (NVQ) or equivalent in care. This means that residents should receive care from competent staff. The induction period covers the common induction standards. New employees are given an induction period to make sure they have a working knowledge of residents in their care. Staff told us that training includes health and safety and fire safety. During this time staff are also made aware of the policies and procedures followed in the home. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. Staff were able to confirm that they had attended training. This should mean that staff are updated in safe working practice. Other training covered includes dementia, equality and diversity. Care Homes for Older People Page 25 of 35 Care Homes for Older People Page 26 of 35 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. Most management arrangements are meeting the needs of the service. The management of residents personal monies does not ensure residents are protected from abuse. Evidence: The owners of Quinton House have recruited a new manager to the home. The new manager is a registered nurse. She previously worked in hospitals until moving to work at Quinton House. The manager has the support of a deputy, both were present at the inspection. Due to a prior committment was involved in the inspection until 2.30pm. Her deputy was present until the completion of the inspection visit. The manager and her deputy showed that they were knowledgeable about the residents living in the home. Staff were aware of their responsibilities and the lines of accountability within the home. A Compliance Manager has been employed to support the improvement of quality in Care Homes for Older People Page 27 of 35 Evidence: the home. There was evidence that a structured approach to quality assurance had started to be implemented into the home. Minutes of a staff meeting held on the 5 January 2009 were read. Topics covered include weighing residents, duty rotas and reviewing residents inventories of their clothing. As instructed in the minutes these were kept inside the inner doors of residents wardrobes. A residents meeting was held in October 2008, the new manager was formally introduced and the Christmas fair planned for last year was discussed. Residents, relatives and staff were asked by the home to complete quality assurance questionnaires. The feedback from these was generally positive. Other audits such as medication, care plan and audit of the environment are also undertaken. Carrying out quality assurance audits helps to improve the running of the home and the different approaches show evidence of residents, relatives staff involvement in the running of the home. Robust auditing system to show how monies held by the home on behalf of residents are not clearly maintained. There is an absence of clear systems to show us a good audit trail of how residents monies are managed on their behalf. Residents money is held separately in individual envelopes. Records are held of financial transactions, but individual receipts are not always held in respect of money spent on behalf of the resident and record keeping systems had not significantly improved. This was particularly noted when residents had received a service from the hairdresser and chiropodist and where toiletries had been purchased on their behalf. Individual records detailing financial transactions must be maintained in accordance with the Data Protection Act 1998. The home continues to take a sum of 10 pounds from residents for the purchase of toiletries. The home was still unable to provide suitable evidence to show that residents are given a personal choice of what products they would like to use. The home asks residents or their representative to sign a letter to opt in or out of the toiletry purchasing system. The letter provides a limited list of toiletries that a potential resident can choose from. Practices in the home should demonstrate how residents are supported to maintain their individuality while living in the home. The deputy manager takes the lead on training and records show that supervision for staff is formalised in the home. Topics discussed and action or activity that staff would be undertaking before their next supervision to demonstrate any progress made were not identified. The AQAA completed by the manager indicates that all relevant health and safety checks are carried out by the home. Certificates, maintenance records and servicing records were available at the time of inspection. Records show that moving and handling equipment, for example hoists had been serviced and the PAT testing of Care Homes for Older People Page 28 of 35 Evidence: electrical appliances had been carried out. The fire log was checked. These records indicate that fire alarms and lights are tested and that fire drills are carried out at the home. Care Homes for Older People Page 29 of 35 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 30 of 35 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 12 The home must make sure 31/05/2009 that ongoing assessments of residents care needs out are supported by the completion of an appropriate and up to date risk assessment. This will help to make sure that appropriate care plans can be developed to minimise the risk and protect the person for harm. 2 9 13 Medicines stored in the home must be administered as prescribed and checks made to make sure medicines remaining are correct. This will help to confirm that resdients are being their medicines as prescribed. 31/05/2009 3 9 13 Eye drops must be stored as 31/05/2009 directed to ensure their stability and effectiveness is maintained. Care Homes for Older People Page 31 of 35 This will make sure that residents receive treatment that will benefit their health and wellbeing. 4 26 13 Frozen meat must not be defrosted above cooked or ready prepared food in the fridge. This will help to decrease the risk of cross infection. 5 35 13 Appropriate records must be 31/05/2009 maintained in regard to the ten pounds charge to residents for the purchase of toiletries. Records must show what products the money was used for and receipts kept for toiletries purchased. Costs for these items must be clearly stated for each person. This ensures that the residents money is spent on items for them and that they are aware of what they are spending. 6 38 13 Safe practices must be maintained in the kitchen of the home. Procedures for the appropriate storage of food in the fridge and freezers must be followed. This must include making sure that frozen meat is not defrosted above cooked or ready prepared food in the fridge. This will help to decrease the risk of cross infection 31/05/2009 31/05/2009 Care Homes for Older People Page 32 of 35 and promote the health and wellbeing of people who live in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should contain current information about the home. For example up to date information on staffing in the home and details of the most recent inspection. This will ensure prospective residents have all necessary information to enable them to make an informed decision about using the home. Written entries in residents care files should be dated, timed and signed with the signature of the person making the entry. This will help to ensure that a legible and effective audit trail is available to track the care given to people living in the home. Completing a life history for residents will support staff in planning the care of people living in the home. The home should make sure that suitable risk assessment audit tools are being used. This includes a review of the falls and medication risk assessment tools. This will allow staff to undertake an appropriate risk assessment which will clearly show the level of support they need to prevent a deterioration in their health and well being. Medicines should be stored in the packages in which the home received them and not transferred from one container to another. This will make sure that different batches or dates are not mixed, which could cause problems if medicines are recalled or the expiry dates are different. A suitable audit tool should be introduced to audit the management, administration and safe keeping of medicines. The temperature of the room where medicines are stored should be monitored and appropriate measures taken to keep the temperature of the room below 25 degrees centigrade. Residents should be offered a choice of food and mealtimes. This will help to make sure that people who live in the home receive varied meal choices that they will Page 33 of 35 2 7 3 4 8 8 5 9 6 9 7 9 8 15 Care Homes for Older People enjoy and help to increase their appetite. 9 31 The manager for the care home should forward an application to be considered for the role as Registered Manager for the home. This will help to make sure that people live in a home that is well led and managed in a way that puts their best interests at the centre of the organisation. The discussion and outcome of supervision sessions with staff should be clearly recorded. This will help to make sure that staff training and development needs are identified and actioned and that staff remain competent to provide care. 10 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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