Inspection on 25/09/09 for Regent House Nursing Home

This inspection was carried out on 25th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Regent House Nursing Home 04/11/08

Regent House Nursing Home 12/06/08

Regent House Nursing Home 29/06/07

Regent House Nursing Home 20/04/06

Regent House Nursing Home 29/11/05

Regent House Nursing Home 25/05/05

Regent House Nursing Home 28/10/04

Regent House Nursing Home 28/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Regent House Nursing Home 107 - 109 The Drive Hove East Sussex BN3 6GE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 2 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Regent House Nursing Home 107 - 109 The Drive Hove East Sussex BN3 6GE 01273-220888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: matron@impex.co.uk Shafa Medical Services Limited (Head Office) care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Regent House Nursing Home provides nursing care and accommodation for up to thirty-two older people. The home is owned by Shafa Medical Services Limited, and is situated in a residential area of Hove, East Sussex. Regent House is within walking distance of local bus routes, with both Hove and Brighton town centres a short drive away. A small number of parking spaces are available at the front of the home for visitors. The home is a detached residence converted from two houses. Accommodation is provided over three floors, with a basement housing the laundry and kitchens. The home provides a passenger lift that enables residents to access all Care Homes for Older People Page 4 of 36 Over 65 32 0 0 4 1 1 2 0 0 8 Brief description of the care home parts of the building. Regent House has thirty single rooms, all with en-suite facilities. Two of these rooms are registered as shared accommodation if required. There is a large garden at the rear of the property that is accessible to residents, including those in wheelchairs or with mobility problems. There is a large, attractive sitting room, and two dining rooms. There is a further seating area in the hall of the second house. Current fees for the home range between £537 and £750 per week. These do not include extra services such as chiropody or hairdressing and details of charges for these are available from the home. Care Homes for Older People Page 5 of 36 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 key unannounced inspection took place on the 25th September 2009 from 10:00 to 18:00. It was facilitated by the appointed manager. The appointed manager is not yet registered with the Care Quality Commission but for the purposes of this report will be referred to as the manager. Prior to this inspection the Care Quality Commission sent out fifteen surveys to residents, ten surveys to staff and three to health and social care professionals. Of these, thirteen were returned from residents, seven from staff and two from health care professionals. The Annual Quality Assurance Assessment (AQAA), a document required by regulation which enables the manager and owner of the home to tell us what has happened in the home during the past year, any improvements or changes made and any plans for Care Homes for Older People Page 6 of 36 improvements in the coming year. It also includes numerical information and is used to inform the inspection report. This was received when we asked for it and accurately reflected what was happening in the home. Other methods used to inform the judgements made in this report included examination of documentation such as care plans, personnel files, health and safety documents and training plans, observation of staff working and medication rounds and discussions with management and staff. All parts of the home, including residents accommodation was seen. Eight members of staff, six residents and visitor to the home were involved in this inspection and their views on what is like to live and work in the home were gained. A health care professional was visiting on the day and gave his views on the home. Thanks are extended to residents, visitors, staff and management for their help and courtesy during the day and to those people who took the time to complete surveys prior to the inspection. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Whilst all the requirements from the last inspection have been complied with there are still some shortfalls in the home that need to be addressed and further requirements have been made. Although care planning has improved, care plans require to be personalised to the individual resident, include all their needs and to give clear instructions to staff. Staff should also ensure that care plans for new residents are completed within a timely manner. Staff should ensure that residents do not run out of medication. The provision of leisure activities is an important part of holistic care, currently there is insufficient time allowed for the provision of meaningful activities. A key area of concern was the staffing levels in the home. This included the numbers of staff provided at night and ancillary staffing levels such as catering staff. Care Homes for Older People Page 8 of 36 A visitor said If I had one criticism its that there could be more interaction between staff and residents. Residents complained of not seeing enough of the staff and staff said it was difficult to find sufficient time to talk with residents. Ancillary staff have not had moving and handling or safeguarding adults training. This could put both residents and staff at risk. Risk assessments were not in place to address risk of scalding in kitchenettes on the individual floors. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 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 36 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. Prospective residents receive sufficient information to enable them to determine whether or not the home will meet their needs and expectations. All people interested in being admitted to the home are assessed by the manager prior to admission to ensure that the home can fully meet their needs. Preadmission assessments are comprehensive and form the basis of the individuals plan of care Evidence: The home has recently reviewed the Statement of Purpose and Service User Guide, these represent the services that the home is able to offer to new and existing residents and show the current management and staffing structure. All residents have a copy of the Service User Guide. Every resident, irrespective of how they are funded, receives a contract and the homes Terms and conditions of residence. Whilst these are fairly comprehensive Care Homes for Older People Page 11 of 36 Evidence: they require a breakdown of the fees, or portion of the fees that the person will be responsible for. The manager gave assurances that this would be done, therefore no requirement has been made. All prospective residents are assessed by the manager prior to admission to ensure that the home can meet their needs and expectations. The manager takes a copy of the homes brochure and Service User Guide with her when assessing the resident, and also encourages the individual and their representative to visit the home and join residents for lunch. Three examples of preadmission assessments were examined and these were sufficiently comprehensive to inform the care planning. Following the assessment the manager informs the person in writing about whether the home can meet their needs and can admit them. The home admits residents for permanent, respite and continuing care but not for intermediate or transitional care. Care Homes for Older People Page 12 of 36 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. Although residents had a care plan, and staff knew most of their individual needs, they could be improved by residents being more involved in their development and review. The standard of medication administration generally safeguards the residents, but failure to ensure that residents have their medication in stock could put residents at risk. Evidence: In order to assess the quality of the care received by the residents, and the staffs perception of the residents needs, care plans belonging to three residents were examined. In all three care plans the majority of the the residents needs have been planned for, but there was lack of social care planning in respect of how the home intends to meet residents past and present interests or of activities they would like to be involved in.However there were records in social care plan of residents participation in Care Homes for Older People Page 13 of 36 Evidence: activities provided. Staff have omitted to include preferred times of rising and retiring, or how much care or nursing residents will require during the night. Care plans have been reviewed monthly but there is no evidence of them being formed in consultation with the resident or their representative, therefore no evidence that the resident is involved in the planning of their care or ensuring that their preferences are taken into account. Nutrition care plans and evidence that residents are being weighed on a regular basis are recorded, but one care plan was queried with the manager insomuch that the information put in by the staff to the MUST (Malnutrition universal screening tool)was showing the resident to be at low risk, but the other information in both the preadmission assessment and the care plan showed that they were at a high risk. However Staff had been acting on the information from the care planning and the other assessments and ensuring the residents needs were met. There did not appear to be any planning for the fortifying residents meals with extra butter or cream, although prescribed supplements to diets were being used. Neither the nursing or care staff, or the chef, appeared to be knowledgeable on which residents should have these,even though the risk assessments, prescribed dietary supplements and dietitian involvement showed some residents to be at risk. One care plan was not fully completed although the resident had been in the home for over a month, and there was no care planning for the mental health needs of this resident although the preadmission assessment and daily records showed mental health needs. Whilst risks have been identified in areas such as falls, moving and handling and the use of hoists, there was little evidence of how these risks were to be minimised. Senior staff should ensure that care plans define how many staff are required to undertake care on individuals and that the care plans give clear instructions to staff. Two of the three care plans included a previous life history of the resident which gave the staff a clear picture of how the resident had spent their lives prior to coming into the home. The manager stated in the AQAA (Annual Quality Assurance Assessment) that when Care Homes for Older People Page 14 of 36 Evidence: we have brief acute situations, these need to be properly recorded and care planned; and we need to have more consistency in meeting principles of person centred care. Wound care planning was in place and staff have attended training to update their knowledge of wound care and pressure damage prevention,the home seeks the involvement of the wound care specialist nurse. Following the last inspection the wound care nurse undertook a mattress audit to ensure that mattresses and cushions were suitable for the needs of the residents to prevent pressure damage, the home has almost completely replaced the mattresses and cushions as required by this audit. Daily records reflected what was written in the plan of care and were more person centred than the care plans, there was evidence that other health care professionals such as the Wound care Specialist nurse, General practitioners and Community Psychiatric Nurses were being brought in as required. A community Psychiatric nurse visiting the home on the day said They call me in appropriately and are proactive. It was apparent on observing residents that the standard of personal care was good, residents were appropriately dressed for the ambient temperature and were well groomed.Residents nursed in bed appeared comfortable and there was evidence by way of fluid and turning charts of nursing and care involvement. Comments received from surveys included: The home maintains my( residents) health and well being, I believe to a standard that we were not able to match when she was nursed at home I believe the staff do the best that they can. Residents, particularly those in their rooms, spoke of the time it took for staff to answer bells and the amount of time they spent on their own without interaction from staff. When I was in hospital if you rang the bell they came straight away, now I have to wait some time . People here seem to walk right past you without saying anything. We dont see the staff much really, and I think that that this place is run for the staff really, but there doesnt seem to be any cohesion between management and staff and no team work with the staff The care is good, the staff talk with me a lot but normally when they are on their break times as they are very busy. I sometimes have to wait a long time for the bell to be answered. We cant choose Care Homes for Older People Page 15 of 36 Evidence: what time you are woken up or go to bed.Its very noisy here at night Four other residents spoken with confirmed that they did not have a choice of times of rising and retiring and also that the call bells were not always answered in a timely manner, although this was not apparent on this day. Staff spoken with knew the needs of the individual residents and there is a key worker system in place. The system of medication administration, recording and storage safeguards the residents. All controlled drugs were correctly stored and recorded. PRN (as required) medications do not have a care plan in place which states in what circumstances the medication should be given to that particular individual, the manager gave assurances that this would be addressed. One resident had been without a particular medication for seven days, staff must ensure that this does not occur as this could put residents at risk Staff should ensure that handwritten medication charts are signed by the member of staff that transcribes these. It is good practice to also have a second person to check handwritten medication charts. End of life care plans were not in place for the majority of the residents. The home should ensure that these are completed with residents wishes for both where they wish to be cared for and any advance directives. The home has no staff that have completed the recognised end of life care training but registered nurses are familiar with the use of syringe drivers and other forms of pain control. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy the leisure activities provided by the home but these are restricted by the amount of time allocated for the provision of these. Daily routines within the home are task orientated rather than being person centred and do not ensure that residents preferences are being met. The standard of catering is variable, but the home provides a varied menu with choices at each meal. Evidence: The home has a programme of activities and employs an activities coordinator on a part time basis. Activities include a weekly outing to local shops or cafes for one or two residents, board games, monthly art sessions and monthly visits from entertainers such as musicians.The Activities programme showed that a considerable amount of the activities coordinators time is taken up with one to one sessions with the residents. Residents are encouraged to enjoy the garden and some residents do some gardening with a member of staff. The home recently organised a garden fete; and with the funds raised bought a games Care Homes for Older People Page 17 of 36 Evidence: console for the residents,the activities coordinator is familiarising herself with this and has introduced sessions with the residents which were enjoyed. Both the manager and the coordinator agreed that there should be more time for activities and that it was an important part of residents care. There was no evidence in either the care planning or the activities planning that these are tailored to fit in with residents past and present interests. It was encouraging to see that residents around the home were not left to watch television programmes selected by staff. Few residents had their televisions turned on, and were reading or listening to the radio, and those watching television stated that this was a programme of their choosing. Surveys received from residents showed that they appreciated the activities sessions but wished for more of these. We do have some activities but could do with more. Residents in their rooms spoke of seeing the activities coordinator on specific days, but one resident said: They are quite a few of us for her to get around, she doesnt have time to do any more, but I do enjoy it. A visitor said: They look after my(resident)very well, the care is good, but my one criticism is the lack of interaction between residents and staff, the staff do not seem to have the time to spend to talk to them. This was apparent during the day with staff engaged in doing various tasks around the home, one member of staff sat in the lounge for some of the afternoon with residents, and some members of staff sat and talked to residents whilst they were on their breaks. Comments from residents and observations during the day showed that the routines of the home were not sufficiently flexible to take into account residents preferences. The majority of the residents were taken to their rooms immediately following supper and three residents spoken with said that this was the expected routine to help the staff. Another resident said that We are expected to get up when staff come in about 7 or 8am I dont think you have a choice of what time you want breakfast or get up and washed. Residents can have visitors at any time of day, and visitors are encouraged to become involved in the home at both residents and visitors meetings and helping at events held. Ministers of religion visit the home and the manager said that ministers of any religion Care Homes for Older People Page 18 of 36 Evidence: can be accessed according to residents needs. The home offers a varied and nutritious menu with choices available at each meal. The majority of residents said that they usually enjoyed the food but the standard of catering was variable and that the food was not always presented very well. Two residents said that when they get a cup of tea after lunch this was appreciated. Whilst there was plenty of fresh fruit and vegetables in the kitchen, the chef said this is mainly used in the cooking, the reason given for this was that residents only like bananas. Some of the vegetables provided are from the homes garden. As previously stated in previous section in the report, care plans showed that some residents were in need of fortified meals, and there was a list of different foods which could be used to fortify and increase the nutritional content of meals in the servery. However neither the chef nor any of the staff on duty that day knew which residents would benefit from extra calorific value although all said that they thought that some residents should be having it. Pureed meals were well presented and staff were assisting residents with their meals in an empathetic and unhurried manner. Staff also took the time to ensure that the lunch time meal became a social occasion, with staff joining in conversations and there was a pleasant atmosphere. Care Homes for Older People Page 19 of 36 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 were confident that any complaints that they may have would be addressed in an open and transparent manner. However not all residents have access to the complaints procedure. Adult safeguarding training has only been made available to nursing and care staff, this could have implications in maintaining the safety of the residents. Evidence: There is a complaints procedure in place which is displayed in the entrance hall and also in the Service user Guide, none of the residents spoken with were aware of how to make a formal complaint but said that they would talk to their relatives or visitors or to the manager. The positioning of the Service User Guide in residents rooms was not accessible to some residents and this may deter residents who had complaints about the home which required a more formal arena. Currently the manager is not keeping records of any minor concerns made to the home or the actions taken. The home has had one complaint and two adult safeguarding issues during the past twelve months.One adult safeguarding was substantiated and one was unproven. The management of the adult safeguarding issues was generally good, followed national guidelines and ensured the wellbeing of the residents. Care Homes for Older People Page 20 of 36 Evidence: Members of care and nursing staff spoken with were aware of the procedures they need to follow in the event of any adult safeguarding issues and have received the relevant training. None of the ancillary staff have received any training in adult safeguarding. Care Homes for Older People Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management is continuing to work towards improving the home environment for the people that live there. Whilst cleanliness around the home has improved,lack of staff in the kitchen has resulted in this area requiring attention. Evidence: Generally there have been improvements throughout the home in maintenance and cleanliness. New carpets have been fitted in some rooms and in the second floor corridor and some of the residents rooms have been redecorated. The garden is reasonably well maintained and accessible to residents. With residents who are able and wish to do so, helping with the vegetable garden. There are areas outside, both at the front and rear of the home where rubbish such as discarded furniture and packing boxes have not yet been removed. Although this appears unsightly it does not put residents at risk. Comments received on a survey filled out by a visitor to the home said: first impressions- could be better especially with the cleanliness of the carpet in the entrance hall. Both the garden and home need some TLC ( tender loving care). Care Homes for Older People Page 22 of 36 Evidence: The home is clean but more attention to decor is needed. I like my room but it could do with sprucing up. The home has a maintenance and refurbishment plan. Both the manager and the provider should ensure that this is adhered to, in order that areas around the home are refurbished in a timely manner to ensure that the home is a pleasant environment for residents. Following a mattress audit undertaken by the Wound Care Specialist nurse last year, the home is in the process of replacing all of the beds and mattresses that were identified as being in need of renewal. The home has invested in a new call bell system which enables residents to take their call bells into the garden or other areas of the home and therefore gives greater freedom of movement. The lift was out of order for three weeks, which impeded some residents freedom of movement, this has now been repaired. There are some areas around the home still in need of refurbishment and improvement, and these include the kitchenette area on the middle floor where the sink unit is broken, areas of wall that require redecoration or maintenance and carpets in other corridors, rooms and the entrance hall which are badly worn. The lounge and dining room would benefit from some new furniture. Tables in the dining room have a coating which is warped and may pose an infection risk and some of the chairs in the lounge have cushions which do not provide a firm seating base for residents. Cleanliness in most areas of the home is much improved with the exception of the kitchen area, which required attention. Information regarding the kitchen has been passed to the Environmental Health Authority. Whilst this received 4 stars in the Environmental Health Scores on Doors initiative with some recommendations, the chefs have had no assistance with cleaning and cooking in a large kitchen other than one day a week, which has left little time for thorough cleaning. Housekeeping and laundry staff are not employed at weekends, and staff said that Its difficult to keep it reasonable at weekends, we tend to just empty the rubbish bins. Care Homes for Older People Page 23 of 36 Evidence: Some staff have received training in infection control and the home has an infection control champion (a member of staff who has undertaken training with the Health Protection Agency and continues to liaise with the agency to ensure that the home is following the correct procedures). Personal toiletries were found in two assisted bathrooms, these can have safety implications as well as impacting on resident choice. The manager gave assurances that these would be removed, therefore a requirement has not been made. The manager should ensure that all staff are aware of the need to clean the undersides of the bath seats following use. Water temperatures have been monitored on a regular basis and records show that these are currently being kept at 38C. This may be too low to ensure residents comfort and the management should consider bringing these to the maximum of the recommended parameters. Care Homes for Older People Page 24 of 36 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. There are insufficient ancillary staff hours for the size of the home which has an effect on the time care and nursing staff are able to spend with residents. Ancillary staff are not attending some mandatory training and this could put both the staff and the residents at risk. Other methods of training in the home may not be sufficiently in depth, especially in specialist fields, to ensure that registered nurses receive the information required to allow residents to have the best possible care in these areas. Recruitment practices in the home are not sufficiently robust to ensure that residents are not put at risk. Evidence: The duty rota and observations of staff working showed that whilst staffing numbers have been calculated according to the numbers of residents in the home this did not appear to have considered the size and geography of the home or the needs of the residents. Whilst residents appeared well cared for, the types of tasks that care staff were expected to do.Care staff and registered nurses spent time doing tasks which would generally be done by ancillary staff such as providing afternoon tea and laying up trays. Consequently residents, particularly those in their rooms, commented that they did not see the staff very often and there was little interaction with staff apart from when they were receiving care. Staff said that at weekends they have to take on the housekeeping and laundry which further impacts on the time spent with residents, Care Homes for Older People Page 25 of 36 Evidence: and resident outings are limited to one or two residents being taken out accompanied by the manager and the activities coordinator rather than having involvement of staff. Staff working during the day said that there were usually sufficient staff on duty on all shifts, but agreed that they spend time away from residents doing other tasks. Comments from staff both verbally and in surveys included: We need a full time activities coordinator. it can be difficult without a housekeeper or laundry at weekends, we do the bins and the best we can but no time spend with residents It is difficult sometimes on the individual floors, you have things to do and not a lot of time to talk to residents. The chef has a kitchen assistant once a week only and is responsible for both the cooking and cleaning of the kitchen.As cooking has to be a priority, there was evidence that staffing in the kitchen requires increasing. A member of night staff spoken with said that there were sufficient staff on duty at night, currently there are two members of care staff and one registered nurse at night, but on all occasions that the home has been visited, residents were seen either getting ready for bed or had been taken to their rooms as soon as the supper meal was finished.Concerns were raised that whether, given the geography of the home, sufficient staff were on duty at busy times of the night to ensure that residents were not put at risk and that their preferences were taken into consideration. All recently employed care staff undertake an induction course which is compatible with the recognised Skills for Care and are then encouraged to study for the National Vocational Level 2 in Care. Currently 9 members of the 16 care staff have this qualification. Other training relating to the care of the residents takes place by way of distance learning provided by a training company, and occasional training from the Nursing Home Specialist nurses. Discussions were held with the manager over whether the training provided by the home was sufficiently in depth for the needs of the registered nurses and whether including specialised subjects such as end of life care and dementia care by these methods ensured that care and nursing staff received sufficient training. Whilst all of the care staff have received mandatory training including moving and handling and Safeguarding of Adults training, none of the ancillary staff have received these. This must be put in place. Care Homes for Older People Page 26 of 36 Evidence: Five personnel files were examined. One member of staff had only one written reference and another member of staff had been employed with references which had been supplied by the member of staff, these had not been verified by the manager prior to employing the person, this practice could put residents at risk. Care Homes for Older People Page 27 of 36 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. Whilst management systems in place are working towards improving outcomes for residents across all areas of the home, there are still some shortfalls which have to be addressed. Failure to ensure that ancillary staff have mandatory health and safety and safeguarding training could put residents and staff at risk, and residents are at risk from scald injury due to availability of kettles in open kitchens on the upper floors. Evidence: The manager is a registered nurse and has previous management experience at deputy level in other nursing homes, she has not yet undertaken any management courses. She is not yet registered with the Care Quality Commission and is in the process of applying. Neither the manager nor the staff have received training in the Deprivation of Liberty Safeguarding, the manager is aware and has had some training in the Mental Capacity Care Homes for Older People Page 28 of 36 Evidence: Act. The manager should ensure that both herself and staff receive this training and ensure that any residents needs regarding deprivation of liberty are addressed. During discussions with the manager it was evident that she was aware of shortfalls within the home and is trying to address these. She was also aware that whilst the home has moved forward in some areas including care planning, environmental improvements and residents and relative satisfaction, there is still some way to go to ensure that the home fully meets the needs of the residents and that all areas of the care is person centred. Comments in surveys and staff spoken with described the home as having a family feel A very pleasant home It fully supports and cares for its residents and staff. The atmosphere in the home was relaxed and friendly. The AQAA was received when we asked for it and gave accurate information about the home. The home is undertaking its own quality monitoring by way of sending out questionnaires to residents, visitors to the home, this could be further improved by providing these to visiting health and social care professionals. The completed questionnaires have been audited and suggestions acted upon and changes made to practices within the home. Residents and relatives meetings are held every two to three months and these give residents and their relatives a chance to put forward suggestions or concerns they may have. Staff meetings are held every two to three months although some staff said I wish there were more staff meetings. Minutes of staff meetings were seen. The AQAA tells us that policies and procedures used in the home have been reviewed in the past twelve months and that utilities and equipment in the home have received regular servicing. The audited accounts of the company have been examined in the past year and the registration certificate accurately reflects the current situation in the home. The manager does not act as appointee for residents in the home, and records of money held for safekeeping were in order and accurate. Records and discussion with staff showed that all members of care and nursing staff now receive formal supervision at regular intervals. Regulation 26 visit reports were seen (monthly visits and reports made by the provider and required by regulation) and these had been carried out on a monthly Care Homes for Older People Page 29 of 36 Evidence: basis, reflected what was occurring in the home and discussions with staff and residents. Records seen in the home were up to date and accurate. Ancillary staff have not received some mandatory training or safeguarding training although all staff have received regular fire training. Risk assessments, which identified risks to residents were in place, apart from assessments regarding the risk of scalding from kettles in open kitchenettes on the different floors in the home. Care Homes for Older People Page 30 of 36 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 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That care plans are 10/11/2009 completed within a timely manner following the admission of the service user and that the plan of care reflects their preferences and assessed needs, that service users are involved in the formation and review of the care plan. To ensure that the service user receives care appropriate to their assessed needs immediately following admission and that care is given in a manner personal to the individual 2 9 13 That staff ensure that service users medication is kept in stock To ensure service users receive necessary medication 03/11/2009 3 12 16 That service users are consulted about their 30/11/2009 Care Homes for Older People Page 32 of 36 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 interests and the programme of activities and sufficient time is allocated for the provision of leisure activities That the routines of the home are sufficiently flexible to enable service users to make their own choices and decisions about the activities of daily living. To allow service users to spend their days in a manner, which as far as possible, is in accordance with their wishes. 4 26 13 That equipment used by service users is kept in a clean condition. To prevent risk of cross infection. 5 27 18 That staffing levels of 10/12/2009 ancillary staff and night staff are reviewed to ensure that sufficient numbers of these staff are employed to ensure the smooth running of the home and the safety of the service users. To ensure that outcomes for service users are good and that service users are not put at risk 01/12/2009 Care Homes for Older People Page 33 of 36 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 6 29 19 That prior to employing a person the manager is satisfied as to the authenticity of employment references supplied To ensure the safety of service users 01/12/2009 7 32 9 That the manager undertakes suitable training for management role To ensure the smooth running of the home. 01/09/2010 8 38 13 That appropriate risk assessments are in place as detailed in the main body of the report to ensure the safety of service users To minimise the risk to service users 10/11/2009 9 38 13 That all members of staff receive the required mandatory training. That training in the safeguarding of adults be made available to all grades of staff. To ensure service users and staff safety 01/12/2009 Care Homes for Older People Page 34 of 36 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 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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