Inspection on 12/08/09 for Regents House Rest Home

This inspection was carried out on 12th August 2009.

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

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

Other inspections for this house

Regents House Rest Home 15/08/08

Regents House Rest Home 22/03/08

Regents House Rest Home 28/09/07

Regents House Rest Home 01/02/07

Regents House Rest Home 27/02/06

Regents House Rest Home 12/12/05

Regents House Rest Home 16/02/05

Regents House Rest Home 18/10/04

Regents House Rest Home 09/03/04

Regents House Rest Home 16/01/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Regents House Rest Home 206 Regents Park Road Southampton Hampshire SO15 8NY Lead Inspector Nick Morrison Key Unannounced Inspection 12th August 2009 10:00 DS0000012319.V377162.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Regents House Rest Home Address 206 Regents Park Road Southampton Hampshire SO15 8NY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02380 322 101 sandra.regent@hotmail.co.uk Mr Ian Newson Mrs Jean Newson Mrs Sandra Pearl Anaszko Care Home 17 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0), Physical disability (0) Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) 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) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Physical disability (PD). The maximum number of service users to be accommodated is 17. 2. Date of last inspection 18th March 2009 Brief Description of the Service: Regents House is a large period property that has been adapted to provide residential care for up to 17 older people. The accommodation is both single or shared bedrooms available on the ground and first floors with a passenger lift to the first floor. None of the bedrooms have en-suite facilities but do have a wash hand basin. There is a lounge, dining room and garden with patio area for residents to use. The building is accessible. The home is close to local shops and amenities. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 12th August 2009 and lasted from 11:00am until 5:00pm. The inspection was undertaken by two Inspectors. During the inspection we looked around the premises, looked at the files of six service users and spoke with four people who live in the home. We observed the support they were receiving. We also met the Manager, spoke with three members of staff and observed interaction between staff and service users. We also discussed aspects of the service with the representative of the Providers. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. During the course of the inspection and the writing of this report we have referred to the homes Annual Quality Assurance Assessment (AQAA), which is a self-assessment they are obliged to provide us with. We also referred to previous inspection reports and information we have about the home. The home is registered for seventeen service users. On the day of the inspection visit there were twelve people living in the home and they were all men. Six service users were involved in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The home does not currently meet the identified needs of the people who live there. It does not have the level of staffing or the systems in place to do so. Pre-admission assessments do not identify all the needs a person might have, care plans do not provide clear information on how needs are to be met and are not kept up to date. There are discrepancies between care plans and risk Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 6 assessments, there is a lack of activities and stimulation and the healthcare needs of people living in the home are not monitored and addressed effectively. The building is poorly maintained and unclean. This affects the privacy and dignity of people living there. Pre-employment checks are not satisfactory. There is a lack of evidence that staff training has a positive effect on practices within the home. The Management of the home is ineffective in ensuring that peoples needs are met and they are protected from risk. Seven of the eight requirements made at the previous inspection had not been addressed by the time of this inspection. 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. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose gives people information about the service provided. Pre-admission assessments do not contain sufficient information for the home to be able to identify and respond to peoples needs. EVIDENCE: We looked at pre-admission assessments in the files of six service users and reviewed the update Statement of Purpose which had been sent to us by the home. The Statement of Purpose has been reviewed since a requirement was made at the inspection on 15th August 2008. It now contains all the required information. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 9 The home requires a care management assessment for each person before they move into the home. The home also has its own assessment of need for each person moving into the home. There were two areas of weakness in the assessment. First they did not contain clear information about people’s nutritional needs and, secondly, they did not all contain much information about each person’s history. The lack of these two items of information in the assessment process have contributed to the home not meeting the nutritional or stimulation needs of people living in the home. Since the inspection the Manager has informed us that there was additional information available from people’s pre-admission assessments bit that this was kept separately because she perceived that staff were “only allowed information that was on a need to know basis.” Information about people’s nutritional and stimulation needs is clearly something that needs to be known by people supporting that person. The fact that this information is not available to staff presents further concerns. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not reflect people’s current needs. Some care plans give specific instruction about action to be taken, some do not. The lack of specific instruction means that people may not receive consistent support in the way they need it. Some needs identified on care plans are not being met. Some risk assessments were kept up-to-date and some were not, which may put people at risk of harm. Medication was administered safely. The privacy and dignity of people living in the home is compromised by the poor state of the building and maintenance issues that had not been addressed. EVIDENCE: Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 11 We looked at the care plans of six people living in the home and compared them with the support we observed those people receiving and with what those people told us about the service they were receiving. We also referred to information we had been given by Southampton Social Services and spoke with the Manager and the Providers’ representative. Since recent concerns by the Social Services Department the Manager has reassessed the needs of some people living in the home and concluded that some of them now need nursing care, which the home is unable to provide. The Social Services Department have also expressed some concerns about moving and handling practices in the home and this, at the time of the inspection visit, was the subject of a safeguarding investigation. An Occupational Therapist (OT) had been into the home during the week of our inspection visit. We were informed by the local safeguarding team that the OT still had concerns about moving and handling practices within the home. The Manager told us she thought practices in the home were now good and was not clear about why the OT still had concerns. As a result of a requirement made at the inspection on 15th August 2008 and re-made at the random inspection of 18th March 2009 the home had reviewed and re-written care plans with the aim of ensuring that they provided clear instruction to staff about what they needed to do in order to address people’s needs. The Manager informed us that the home had bought in the services of a consultant to re-organise their care planning processes and systems. The new plans were laid out well and detailed the current situation, the objective and the action for each identified need. Whilst most of the items on each care plan had been re-written to provide clear instruction, we found some instances of instruction being written in vague and general terms such as “full assistance needed” to describe how staff were to address a person’s personal care needs. The fact that this is vague and not specific means that individual members of staff may address the person’s needs in different ways and so they will not receive a consistent service. It also means that their personal care needs may not be fully met. Since the inspection the Manager informed us that there were clear instructions for staff about the action they needed to take. We did not see these at the time of looking at the care plans. If there are clearer instructions for staff, these should be written on the care plan or kept with the care plan. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 12 We also found that some peoples mobility needs were recorded in a vague way. One person’s care plan said, in respect of mobility, “poor to none, full assistance from staff, hoist needed at times.” The care plan had been reviewed on 5th June 2009. The same person’s moving and handling risk assessment had been reviewed on 6th July 2009 and the outcomes of this had not been reflected in the care plan. This means that the care plan was not up-to-date and had not been reviewed to reflect the person’s changing needs. The moving and handling risk assessment stated that other equipment was needed when supporting this person with various different movements, but this was not reflected in the care plan. The fact that the care plan did not reflect the person’s current needs may contribute to them being moved with the wrong equipment and may result in them, or the staff supporting them, being physically harmed. It also highlights that the risk to the person are not being adequately managed. Another care plan described a person’s ‘toileting needs’ as “Incontinent, full assistance from 1 or 2 members of staff, incontinence pads used.” This fails to describe the exact support the person needs and is vague about how much staff support is needed. Again, this may result in an inconsistent service and/or the person’s needs not being fully met. We observed a number of items listed on peoples care plans that did not appear to be addressed on the day of the inspection. Examples of this included: One care plan said “Make sure his walking frame is within reach.” We observed this person throughout the day of the inspection visit and his walking frame was not within reach of him at any time. This meant that the person was prevented from using the frame to get out of his chair and move freely around the home. It also means there is a risk of the person trying to get up out of the chair without the frame and this may result in physical harm. This risk is not being managed. During the inspection we thought this person’s needs may have changed and that he is no longer able to use his frame independently, in which case his care plan does not reflect his current needs. Four of the six care plans said “Encourage to mix with others.” This was recorded on four of the six care plans we looked at. Throughout the day we did not observe any staff encouraging service users to mix with each other. This meant that people were not encouraged to mix with others and that their need for stimulation and conversation was not met. One care plan said “Spend time talking to him, especially about the local area as this will cheer him up and stimulate memory.” We observed this person throughout the day and of the inspection visit and did not see staff talking to Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 13 him except to encourage him to eat his lunch. This means that he may not be receiving the stimulation he needs and that he is not ‘cheered up’. The same person’s care plan said “Ask if he is comfortable.” We observed this person throughout the day and of the inspection visit. He did not look comfortable, but we did not observe a member of staff asking him if he was comfortable. This means he may be at risk of developing pressure areas and associated health problems and/or just may be uncomfortable throughout the day. This risk was not being managed effectively. Another part of the care plan for the same person said “Encourage a high intake of fluids. / Fluid input and output are to be observed.” We observed this person throughout the day of the inspection visit and he was offered two drinks during the time we were there. He had the first drink when we arrived (a cup of tea) and had drunk about two-thirds of it. No-one encouraged him to drink any more of the tea before it was eventually taken away. The Manager informed us that there were no records of his fluid intake. This means that the home is not closely monitoring fluid intake in an effective manner and may result in the person suffering from de-hydration. Since the inspection the Manager informed us that the person may have had drinks on the day that we did not know about as there were times during the inspection when we were not in the same room as the person. However, the lack of records of fluid intake means that this is not verifiable. At the previous inspection on 18 March 2009 we had concerns about records of food and fluid intake for people who had an identified need relating to this and wrote a requirement for the home to keep and maintain records in relation to this. The risk of de-hydration was not being managed effectively. Four of the six plans said “Offer him to play in organised activities.” This was recorded on four of the six care plans we looked at. There were no organised activities in the home and so this was not going to be achieved for any of those four people. As well as no planned activities we saw no evidence on the day of the inspection visit of any informal activities being initiated by staff. This means that people in the home may be bored and are not having the amount of stimulation they require, according to their care plan. One person’s care plan said “Ensure his bedroom and any other areas he uses are well-aired.” On the day of the inspection visit there were no windows open downstairs and no fresh air coming into the home. We observed the air to be stale and odorous. This means that this person, and potentially others in the home, is not receiving the fresh air they need and may be at risk of developing health problems as a result. This risk was not being managed. One person’s care plan said “Staff to spend time daily talking with him. He loves to converse and it helps his self esteem.” We did not observe any staff undertaking this task on the day of the inspection visit. The person wandered Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 14 around the home from place to place. We spent some time speaking with him about what it was like to live in the home. One of the things he told us was that there was not enough to do in the home so he spent most of his time just smoking. This means he appears to lack the stimulation he requires, according to his care plan, and that his needs regarding stimulation and self-esteem are not being met. It also results in him smoking more and therefore he is more at risk of developing further health problems. This risk is not being managed. Since the inspection the Manager has informed us that she spent considerable time with service users on the day of the inspection, including planting pots on the patio. It was evident that, although care plans had been re-written and updated but there was little or no positive outcome of this for people who live in the home, which is the purpose of care plans. We had made a requirement at the previous key inspection on 18th March 2009 that service users’ risk assessments must be kept under regular review and updated as necessary. We had made requirements regarding risk assessments at the last four inspections, dating back to 28th September 2007. The risk assessments had been updated along with the care plans when the home had bought the services of a consultant. As described above, the moving and handling risk assessment for one person did not match the information on his care plan. Although most of the risk assessments seen on the day of the inspection were up-to-date and reviewed we still have concerns about the home’s ability to maintain this. Our concerns relate to the fact that care plans are not followed and, as these need to be informed by the risks assessment process, it may also be the case that risk assessments are not followed. The home also has a history of not monitoring risk assessments adequately and it is clear that the needs of people living in the home appear to change over short periods of time. The issue of care plans and risk assessments is a repeated area of concern for this service. This report highlights a number of areas where risks are not being managed. We observed medication being administered over the lunchtime period and the member of staff administering it checked the medication before it was given and signed the records after it had been administered. Medication in the home appeared to be stored securely and safely. Medication records seen were kept up-to-date. The privacy and dignity of people living in the home was partly maintained. People living there appeared well-presented and no personal care was provided in communal areas. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 15 Privacy and dignity in the home was compromised by some aspects of the building. The general poor repair of the building meant that it was not a particularly dignified place to live and this was compounded by the odour within the building. Privacy and dignity was also affected by the fact that some bedroom doors were not lockable and the fact that one room did not even have a door handle. The risks to people’s privacy and dignity were not being managed. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Planned activities are not provided in the home. This suits some people but not others. Service users are able to keep in touch with friends and families. Service users have control over their own lives, within the limited facilities provided by the home. The nutritional needs of service users are poorly managed. EVIDENCE: We looked at daily records, spoke with staff and people living in the home and referred to peoples care plans. We have made requirements regarding the lack of activities in the home at the previous two inspections. The home still has no organised programme of activities for people who live there. The Manager informed us that she had Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 17 consulted with service users and that they had said they did not want an organised programme of activities. Some of the people we spoke with in the home did tell us they were not interested in an organised programme of activities. One person told us there was not enough to do in the home. Four of the six care plans we looked at stated that the person needed to be encouraged to join in with organised activities. The lack of any organised activities in the home means that these needs are not going to be met. In addition to there being no organised activities in the home, we also observed a lack of everyday interaction with people and a general lack of stimulation. As described in the previous section of this report, many people had identified needs that needed to be addressed by staff spending time sitting and talking with them. We saw no evidence of this on the day of the inspection visit. This may have been partly due to the fact that for a lot of the time staff appeared to be very busy preparing meals and cleaning the home. However, when staff did have time to spend with people living in the home there was still a lack of interaction and stimulation. The issue of stimulating activities is a repeated area of concern for this service. An example of this was the person whose care plan stated “spend time talking to him, especially about the local area as this will cheer him up and stimulate memory” needed one-to-one support at lunchtime, but the member of staff did not take the opportunity to discuss anything with him, although she had nothing else to do at the time. The only interaction she had with him was to occasionally encourage him to take another spoonful of his lunch. Staff spoken with during the inspection told us there was a singer who occasionally came into the home to provide entertainment. They also said they sometimes did some gardening with some people who live in the home. They also said that service users sometimes listened to music and that they also did some ‘reminiscence’ with people. When asked what this entailed they told us it was talking to people. One service user told us “I’m not interested in activities; I just do crosswords or watch the television”. In the lounge there was a large, flat screen television that was not working. We were told it was due to be fixed a couple of days after the day of the inspection. The home’s Annual Quality Assurance Assessment (AQAA), which they are legally required to provide to us, was completed on 12 January 2009 and told us that one of the areas they planned to improve was to provide more entertainment. By the time of this inspection, in August 2009, that had not happened. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 18 People we spoke with in the home did tell us they had regular contact with families and friends and that there was support from the home to maintain this where necessary. On the day of the inspection visit we spoke with one person who was going out for the afternoon to meet a friend at the pub. We have also had previous contact from friends and relatives of people living in the home who confirmed that they were able to visit their friend or relative in the home. People living in the home did appear to be able to exercise some choice and control over their own lives. They told us they were able to choose what time they got up and what time they went to bed. One person told us he had chosen to clean his own room as he did not like staff coming in and moving his ornaments around. Some of the people living in the home were able to choose whether or not they went out, as they were able to do so without staff support. The records of food consumed in the home showed a variety of meals were provided. At lunchtime there was a hot meal and there were a variety of sandwiches each evening for tea. The food records were based on the assumption that everyone had the set meal at lunchtimes unless, as the Manager told us, they had something different in which case it would be recorded. When reviewing these records with the Manager we found there were some discrepancies in what she had said because some people were unable to eat the set meal and there was no record of what they eaten as an alternative. This means that, although an alternative may well have been available for those people, there is no record of the food they consumed at those times. There was one meal available at lunchtime and we were told by staff and the Manager that, if a person did not want the set meal, an alternative would be provided. When we looked at the food storage we found that the home did not use fresh milk, but instead used UHT milk. The menu for each day was written on a card and a copy was put on each table in the dining room so that people knew what the set meal was on that day. On the day of the inspection visit the meal was lamb stew with boiled potatoes, with milk jelly for pudding. The tea-time menu was a variety of sandwiches, tea/coffee and cakes. We did observe that some people were eating fresh fruit after their lunch. Different service users told us the food was “quite good”, “good” or “very good.” Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 19 Staff preparing meals had received training on food hygiene and some staff had received some training in nutrition. One person needed one-to-one support to eat his lunch and this was provided. Other people did not need any help to eat. The member of staff providing the one-to-one support was the only member of staff in the dining room over the lunchtime period. Other staff were in and out of the dining room bringing people their lunch and taking away plates. Over lunch there was no discussion or interaction between people living in the home. It was silent throughout the period except when one person leaned across to another and whispered something. The fact that a lot of people had identified needs relating to being involved in conversation and mixing with others meant that mealtimes were an ideal opportunity for some of those needs to be met. In addition to the member of staff providing one-to-one support over lunch not taking the opportunity to generate discussion, no other members of staff used this time to interact with service users either. Since the inspection the Manager has informed us that she feels the silence over the lunchtime period may have been due to service users “feeling edgy” about the inspection process. We observed one service user who was ready for his lunch for twenty minutes before lunch was ready. He waited all that time for lunch to be ready but, when it came, he took one mouthful and then left the table. His bowl of stew was left at the table and later a member of staff came along and put his milk jelly next to his uneaten stew. Later, a member of staff came along and picked the uneaten stew and milk jelly and took them both away. We spoke with the service user after lunch and asked why he had not eaten his meal. He told us it was hard and he was not able to eat it as he had no teeth. We asked if he had been offered anything as an alternative. He told us he had not. We asked if he was hungry and he indicated he was but would wait until five O’clock for his sandwiches. Since the inspection the Manager has informed us that the menu was discussed with this person prior to Inspectors arriving and also that he had been offered an alternative. We later looked at the weight monitoring records for this person and found that he had been weighed on 1 May and had lost eight pounds since the previous month. In June had put two pounds back on, but had not had his weight monitored between 1 June and 12 August when we did the inspection, despite significant weight loss and fluctuation. This person’s care plan stated “always let him know what’s on the menu and discuss alternate meals with him” and that this was in order to “ensure that he receives optimum nutrition to maintain stable weight and a healthy lifestyle”. However, this did not happen in practice and so the need may not be met. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 20 It was clear from the fact that his weight had not been monitored and that on the day of the inspection visit he had not received the main meal of the day that the home was not meeting his nutritional needs. When we discussed this with the Manager at the end of the inspection she went to talk with a member of staff and came back and told us that the person had been offered an alternative meal that day. The issue of monitoring people’s nutrition is a repeated area of concern for this service. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints policy and a process for recording and responding to complaints. People living in the home are not able to protect their own privacy due to maintenance issues with the building. Areas of poor practice in the service put people at risk of harm. EVIDENCE: The manager told us the home had received no complaints since the previous inspection. They had a system in place for recording and responding to complaints and a complaints policy that was made available to everyone living in the home and, where appropriate, their relatives. Service users we spoke with told us they were aware of how to make a complaint if they needed to. Staff working in the home told us they had received training in the protection of vulnerable adults and their training records confirmed this. Service users told us they felt safe in the home and had no concerns about protection issues. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 22 We did observe that one bedroom could not be locked from the inside and so it was not possible for the person in that room to maintain their own privacy. We also found that one bedroom door had no handle at all, making it difficult for the person to get in and out of their room. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is poorly managed and poorly maintained. Practices in the home fail to promote good infection control. EVIDENCE: We toured the premises and went into all the communal areas as well as six service user bedrooms. We found a number of building and maintenance issues that needed to be addressed: A toilet seat in one of the bathrooms was loose and came off in the Inspector’s hand. This presented a risk to people living in the home who may have fallen off the seat. DS0000012319.V377162.R01.S.doc Version 5.2 Page 24 Regents House Rest Home - - - - The arm of a chair the Inspector sat in in the dining room came off. This also presented a risk to people living in the home. There was a general odour throughout the building. We observed that this may be due to a combination of factors including a commode not being cleaned, carpets in bedrooms being unclean, the caged bird in the dining room and the fact that windows were not opened to allow fresh air into the home. The vanity sink unit in one person’s bedroom was broken. Where bedrooms were shared there was only one call alarm switch shared between the two people. This means that one of the people may not be able to reach it and call for staff support in an emergency. The carpets in two bedrooms were loose and presented a tripping hazard. The carpets in three other bedroom were badly stained and in need of cleaning. One bedroom could not be locked from the inside which means that the person in that room could not maintain their own privacy. One bedroom had no door handle, making it difficult for people getting into the room. The general state of the home was poor and badly maintained. Paintwork throughout the home was chipped. The windows at the front of the home, outside the dining room, were rotting. There were cobwebs, unclean walls and damaged wallpaper. We had previously made requirements regarding various aspects of the building and the home had responded to these as necessary. At the inspection on 15 August 2008 we had made a requirement that there must be an effective system in place to identify maintenance issues and to ensure that they are responded to in a timely manner. At the random inspection on 18 March 2009 we found that the Manager had put a system in place and was undertaking daily checks of the building to identify maintenance issues which were then listed as things that needed to be addressed. In the AQAA the home sent us on 12 January 2009 they told us they needed to employ a “regular handyman” for ongoing maintenance issues. By the time of this inspection, on 15 August 2009, the home had still not employed anyone in this role. The AQAA also told us that one of the things the service could do better was to have more decorating. There was no evidence of any recent decorating at the home during our inspection. Despite a history of responding to requirements we have made regarding the building, the home has failed to identify and respond to maintenance issues through their own processes. The issue of building maintenance is a repeated area of concern for this service. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 25 There were infection control procedures in place in the home as well as cleaning schedules. Despite these, the building has unclean feel about it. Specific issues were carpets in bedrooms, cobwebs and unclean walls, as described above. The home does not employ a cleaner and so cleaning duties are undertaken by care staff in the home. In one person’s room we observed a commode that had not been cleaned after being emptied and it was also rusty. There were also no towels or soap dispensers in some of the bathrooms and toilets. There was an odour throughout most of the building and a lack of ventilation and fresh air. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not sufficient staff on duty at all times to meet the needs of service users This, and the confusion about moving and handling, compromises the safety of people in the home. Service users are not fully protected by the homes recruitment policies and practices. Staff training issues are being addressed but the training staff receive does not always improve the outcomes for people living in the home. EVIDENCE: On the day of the inspection visit there were three members of staff on duty as well as the Manager. There was no cook or cleaner and these duties had to be undertaken by the care staff. The day shit in the home was from 8:00am until 8:00pm and the night shift was from 8:00pm until 8:00am. There was one member of staff on the night shift and staff told us they could call on the Provider’s son, who lives on the premises, if more support was needed. On Saturdays, during the day, there were two care staff and the Manager on duty. On Sundays there were just two members of care staff. These staff had Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 27 to undertake cooking and cleaning duties as well as caring for the people living in the home. Care staff told us they thought there was sufficient staffing in the home. Our concerns were that, on the day of our inspection, there were three members of staff as well as the Manager and the needs of people living in the home were still not being met. This suggested that, at the weekends with fewer staff on duty, even fewer of the needs of people living in the home would be met. The homes AQAA, completed on 12 January 2009, told us that four of the seven staff working in the home had achieved a National Vocational Training (NVQ) certificate in care at level 2 or above. We looked at the files of three staff working in the home. Pre-employment checks were satisfactory for two of them. On the third person’s file there were two references, both supplied by friends, and an employer reference addressed ‘to whom it may concern.’ This indicates that the employee had brought the reference with her rather than the home having sought it. The danger with this practice is that the home cannot be sure the person ever worked for the employer, or even if the employer exists. This, together with the other references being from friends, means that the home had not undertaken sufficient checks to ensure that the person is suitable to be working in the home and to ensure that people living in the home are not at risk. The issue of staff recruitment records had been raised with the home at four previous inspections. Since the inspection the Manager has informed us that the file we looked at had been looked at during a previous inspection and that the Inspector had been satisfied with it. She also said that there had been previous recognition that the home met the standards concerning the employment of staff. The AQAA the home provided us with in January 2009 told us they were planning to improve the service by ensuring they “never take on a new member of staff without a full documented reference.” Staff files also demonstrated what training they had undertaken. Two of the staff had had training in moving and handling. The third had not but the home had arranged moving and handling training for all staff for the day after our inspection. Staff had also received training in basic nutrition, health and safety, the protection of vulnerable adults and the mental capacity act. Although staff had received training moving and handling, the Occupational Therapist still had concerns about practices within the home. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 28 Also, staff had received training in basic nutrition but we had concerns, as described above, that the nutritional needs of people living in the home were not being met. These two issues question the quality of the training provided and/or the Manager’s ability to ensure that training is understood and embedded in practice. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager has had no training in managing services for older people and the home is poorly managed. This means that people cannot be sure that the home will be run in their best interests or that their needs will be met. The quality assurance system in the home is insufficient to ensure that the service develops in response to the needs and wishes of people living there. Workplace risk assessments are in place but the home needs to demonstrate that they are kept under regular review. EVIDENCE: Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 30 We looked at the Manager’s training records, health and safety records within the home, the home’s quality assurance records and spoke with the Manager. We also referred to previous inspection reports and the home’s Annual Quality Assurance Assessment (AQAA). The Manager informed us at our inspection on 28 September 2007 that she was working towards a National Vocational Training (NVQ) qualification at level 4. Since that time, and despite us having made requirements at the three inspections between then and now, we still have no confirmation that she has completed this training. The most recent requirement we have made regarding this was that the Provider and the Manager must ensure that the Manager has any necessary training to ensure that the home is well managed. The Manager’s training records showed that since the previous inspection she had only undertaken updated training in the administration of medication. The Manager has no training in management of care homes and this is reflected in the poor way this service is managed. The issue of the Manager’s training is a repeated area of concern for this service. Since the inspection the Manager has informed us that she had enrolled on two courses. One was in care planning and documentation and the other was in Management in Care. There have been requirements made at each of the twelve inspections of the home in the last six years. The information supplied to us in the AQAA of 12 January 2009, compared with the requirements we have had to make since then, demonstrates that the Manager is unable to identify for herself the improvements needed in the service and that she has to rely on these being highlighted by the Care Quality Commission during inspections. There is evidence that the home has responded to requirements made in the past but, at later inspections, the same requirements have had to be made again because improvements that appear to have been made have not been sustained and embedded in practice. Examples of this relate to staff recruitment records, quality assurance, maintenance and medication storage and records. There are seven requirements from the previous inspection that remained unmet at the time of this inspection. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 31 There are now also additional requirements that have had to be made as a result of this inspection. The Manager informed us that the home has no dealings with any aspect of service users’ finances. We had made requirements regarding the quality assurance system in the home in five of the last six inspections but they appear to have still not grasped the importance of this and how to improve quality assurance. On the AQAA the service sent us in January 2009, when asked what changes they were planning to make to the service as a result of listening to people who use it, the home was not able to identify any improvements. The home does have a system in place for sending out questionnaires to people who use the service for them to comment on the service they receive and these have been in place for a couple of years. However, the home does not have a process for analysing this information and ensuring that it forms the basis of an annual development plan which can then be shared with service users to demonstrate how their views may affect the service they receive. The fact that people living in the home have received questionnaires for a number of years and then are not involved in what the service plans to do with their comments, and how the service might change to reflect their views, is likely to result in them not bothering to fully express their views when presented with subsequent questionnaires as they may feel there is little point. We had made a requirement at the inspection on 15 August 2008 that workplace risk assessments in the home must be kept under review and updated as necessary. We looked in the workplace risk assessment file and found there were records stating that the assessments had been reviewed each month between September 2008 and March 2009 when we did a random inspection to see if this and other requirements had been complied with. We noted at the time that the requirement regarding workplace risk assessments had been met. The fact that the records of them being reviewed stopped in March 2009 indicated that reviewing the assessments had ceased at that time. When we discussed this with the Manager she showed us another copy of the risk assessment which was kept in the home’s policies folder. She pointed out that there was a record that the policy folder had recently been reviewed and, as the assessments were contained in this folder, they would have been reviewed at that time. This did not explain why there were specific workplace risk assessments review records that had not been kept up to date and suggested that the assessments had not been monitored for the four months previous to this inspection. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 32 We had explained to the Manager at the previous inspection that the record of the review of the assessments should be attached to the assessment to demonstrate that that is what they referred to. The Manager had not done this. Since the inspection the Manager has informed us that she had changed the system of review recording so that it was now clear exactly what documents had been reviewed and when. She also told us that the risk assessment we saw was a spare one she kept in her office for staff to use for their college work. When we had asked the Manager for the risk assessments we had not asked for a spare one, but for the one used by the home. If the correct document was not available on the day of the inspection visit it raises further concerns as to whether or not the home has an up-to-date working document to demonstrate how risk are managed in the home. Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X N/A X X 2 Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The home must identify the social and the nutritional needs of people in the pre-admission assessment in order to ensure that the needs of people using the service are identified and addressed. Care plans must be kept up-todate and must reflect people’s current needs in order to ensure that the current needs of people living in the home can be addressed. Risk assessments must be kept up to date and must reflect people’s current needs in order that people living in the home are safeguarded from potential harm. A programme of activities must be put in place to ensure that the social and stimulation needs of people living in the home are met. Where needs are identified related to the nutritional needs of people living in the home records must be kept in order to demonstrate that these needs DS0000012319.V377162.R01.S.doc Timescale for action 30/09/09 2 OP7 15 30/09/09 3 OP7 13 30/09/09 4 OP12 16 30/09/09 5 OP15 16 30/09/09 Regents House Rest Home Version 5.2 Page 35 6 OP8 12 7 OP19 12 8 OP19 23 9 OP26 16 10 OP26 16 11 OP27 18 12 OP29 18 13 OP30 18 14 OP31 9 are monitored and addressed. The healthcare needs of people living in the home must be monitored and responded to appropriately in order to ensure that people remain healthy. Facilities must be provided so that people living in the home are able to maintain and protect their own privacy. Maintenance issues must be identified and responded to in a timely manner in order to ensure that people living in the home are safe and have a pleasant environment in which to live. The unpleasant odour in the home must be addressed in order to ensure that people living in the home have a pleasant environment in which to live. The home must be kept clean and free from the risk of infection in order to ensure that people living in the home have a pleasant environment in which to live and are free from the risk of infection. Staffing in the home must be reviewed in order to ensure that at all times there are sufficient staff to meet the needs of people living in the home. The Registered Person must ensure that no-one works in the home without satisfactory preemployment checks being in place in order to ensure the safety of people living in the home. Training provided must reflect current good practice and must inform care practices in the home in order to ensure that people living in the home receive the support they need and remain safe. The Manager must have the DS0000012319.V377162.R01.S.doc 30/09/09 30/09/09 30/09/09 30/09/09 30/09/09 30/09/09 30/09/09 30/09/09 30/09/09 Page 36 Regents House Rest Home Version 5.2 15 OP33 24 skills and training to manage the service effectively in order to ensure that the home is managed so as to meet the needs of the people living there. There must be an effective system of quality assurance that focuses on the views of people living in the home and measures how well the service is meeting their needs and that monitors compliance with the home’s legal and statutory requirements. 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Regents House Rest Home DS0000012319.V377162.R01.S.doc Version 5.2 Page 37 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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