Inspection on 21/04/09 for Rosehill House

This inspection was carried out on 21st April 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosehill House 28/04/08

Rosehill House 01/05/07

Rosehill House 02/05/06

Rosehill House 13/09/05

Rosehill House 09/06/05

Rosehill House 24/02/05

Rosehill House 02/06/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosehill House Keresforth Road Dodworth Barnsley South Yorkshire S75 3EB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jayne White     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Rosehill House Keresforth Road Dodworth Barnsley South Yorkshire S75 3EB 01226243921 F/P01226243921 layla14rosehill@btconnect.com NONE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Azad Choudhry,Mr Aurang Zeb care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosehill House is situated on the outskirts of Dodworth Village. It is approximately three miles from Barnsley town centre and ten minutes drive from the M1 motorway. The home is a detached property within its own grounds, providing personal care for 27 older people. There is car parking space to the front, side and rear of the property. To the front of the property is a large patio/terrace with garden furniture. Ramps are provided to the main entrance at the side of the building and to the patio. Access to the patio can also be gained via the patio doors from the lounges. The accommodation is on two floors. A passenger lift is provided. 0 Over 65 27 Care Homes for Older People Page 4 of 32 Brief description of the care home The Service User Guide, the Statement of Purpose and the homes last inspection report were displayed in the main entrance. Prospective admissions were given a copy of them on enquiry. Fees were 351.50 pounds per week. Hairdressing, toiletries and newspapers were not included in the weekly fee and were charged separately. This information was provided on 21 April 2009. Care Homes for Older People Page 5 of 32 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 was a key inspection conducted by Jayne White, inspector. We visited without giving the service any notice. Ms Layla Wrigley, the manager was present during the visit. She is not yet registered with the Commission. The manager completed an Annual Quality Assurance Assessment (AQAA) before the site visit. This gives the service the opportunity to tell the Care Quality Commission (CQC) how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 28 April 2008 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. Care Homes for Older People Page 6 of 32 We sent surveys to people living at the home, asking them about their experiences of living there, health professionals, asking them about their experiences of working with the home and staff, of their experience of working at the home. Six surveys were returned by people that lived there, two from health care professionals and one from a member of staff. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received, as were some of their representatives. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. We checked all the key standards and previous requirements. All this information and peoples, representatives and staffs opinions and comments were considered for inclusion in this report. The manager was provided with initial feedback from the inspection during and at the end of the visit. The Care Quality Commission (CQC) wishes to thank people living at the home, the staff and the manager for their assistance and co-operation during the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Controlled drugs records and medication were being dealt with in a way that protected people. People were being taken into the dining room nearer the time when their meal would be ready, so they werent kept waiting, without a drink and no stimulation. Footplates were being used on wheelchairs being used to mobilise people, but the service was asked to continue monitoring this. Staff had received fire training, to provide them with the knowledge of the procedures Care Homes for Older People Page 8 of 32 to be used in the event of a fire. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could be confident the care home could support them. This was because there had been an assessment of their needs, which told the home about them and the health and care support they needed. Evidence: When we looked at peoples surveys it told us five people had received enough information about the home before they moved in so they could decide if the place was right for them, one said they couldnt remember. One commented, had a warm welcome when visiting prior to making decision to move in (even invited to a social event before decision made). No appointments necessary to look round. All said theyd received a contract. One commented, given to son. When we spoke to the representative of someone who had moved in they said, looked round lots of homes, staff a big thing in choosing - got such a welcome. Just dropped in. Its a nice atmosphere. We liked how staff talked to residents. Talked with Care Homes for Older People Page 11 of 32 Evidence: Layla. Then mum visited. Mum - happy as Larry. Mum chose herself to go into care. We looked at three peoples files to check that pre admission assessments had been undertaken. This told us that prior to the admission taking place, staff from the home carried out an assessment of peoples needs. This confirmed that the service was appropriate for the person and provided staff with information to formulate an individual plan of care. We saw in one of the files, the home was consulting with and requesting reviews from professionals when the persons needs were changing. Care Homes for Older People Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were receiving the health and personal care they needed. In the main, medication practices supported people in a safe way. Staff attitude and approach to care was based on respect for people, which promoted peoples rights and dignity, however, they needed to show more respect for peoples clothes (see environment). Evidence: The AQAA told us the service had improved in the last 12 months by having a falls risk assessment, plus individual risk assessments for moving and handling and smoking. It stated a care plan review form is to be introduced and completed by the manager monthly. It told us everyone admitted to the service had nutritional screening carried out. We looked at three care plans to check this. A care plan had been formulated, including any assessments of presenting risks. The care plans included good information about people. Risk assessments were in place for pressure areas, falls, nutrition, smoking and moving and handling. The plans were being regularly reviewed and the changes in peoples conditions being observed and recorded. A previous requirement made at the last inspection about people and/or their representatives being involved in drawing up and reviewing their care plans was removed, although Care Homes for Older People Page 13 of 32 Evidence: the service still need to take care that they do this in all instances. The care plans identified that health care professionals did visit people to assist in maintaining their health care needs. Two health care professional surveys were returned. They both stated the care service usually sought advice and acted upon it to manage and improve individuals health care needs. They commented, any changes in presentation are reported to myself. Possible changes in rare medication are willingly discussed, options appear to be discussed frequently with clients as to any possible improvements in care and Layla has phoned me for advice about individual clients and when the home had diarrhoea and vomitting. One stated, individuals health care needs are always met by the care service, one usually. They commented, I have had no concerns. Any requests are usually discussed and dealt with appropriately, Im quite satisfied the clients I have on placement there are being adequately cared for and when Layla identifies a problem she will seek out appropriate help until it is resolved. One commented, documentation could improve. When we looked at peoples surveys they all stated they always receive the personal and medical care they needed. They commented, care and support always willingly given and if required a GP or any other medical support it is acted on straight away. When we spoke with staff they showed a good knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for. One member of staff returned their survey. They stated they were always given up to date information of the needs of the people they cared for. They commented, every resident who presents a new problem is recognised and the problem is put in place in their care plan, so every member of staff is to read it and act accordingly. We observed staff working to observe how staff valued and respected the privacy of people. There was clear and respectful communication between people and staff and staff treated people in a kind manner. Staff spoke clearly and at a steady pace with people. On the whole, we saw that people looked clean, were well dressed and appeared to receive a good level of personal care. This indicated respect and dignity by staff when caring for them. One of the health care professional surveys that were returned stated the service always respected peoples privacy and dignity, one didnt answer. One commented, I have observed nothing to indicate otherwise and I have had relatively little contact with clients or the opportunity to directly observe staff working with clients. However, when opportunities have arisen or in passing, staff are friendly and helpful to clients and thoughtful of the clients needs. Care Homes for Older People Page 14 of 32 Evidence: Medication storage arrangements for medication held by the home identified medication was stored securely in locked trolleys within locked cupboards. However, when we looked round the living environment a jar of sudocrem that looked like it had been prescribed for someone as the prescribing label stated as directed, but the name was torn off. A sample of four peoples medications in stock and medication administration records (MAR)were checked. Medication adminsitration records we checked were completed with staffs signatures. An audit was unable to be undertaken on two medications because the prescription date, didnt correlate with the start date on the MAR. Peoples allergies were not recorded on the MAR. This could result in the person being given medication that will induce a reaction if staff did not recall information that was recorded in their care plan. The audit included sampling of two controlled drugs to check requirements from the previous inspection. These were satisfactory. When we spoke to staff they told us they had received medication training, but it had not included an assessment of their competency to deal with medication. Both health care professional surveys returned didnt answer whether the care service supported people to administer their own medication or manage it correctly where this was not possible, but they did comment, medication is monitored and administered by staff and I believe all medication is administered by home staff. The clients I have been involved with were unable to administer their own medication or manage it. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person was treated as an individual. They were as independent as they could be, lead their chosen lifestyle and were given the opportunity to make the most of their abilities. The care home could support some people better in following personal interests and activities. People were able to keep in touch with family, friends and representatives. People had meals that were good quality and on the whole met peoples expectations. Evidence: The AQAA told us every person had an individual activity plan and staff are allocated time during each shift to spend time doing activities. It stated the entertainment and activity schedule is displayed in the reception area and they had outside entertainers every six weeks. The hairdresser attends every Tuesday and there are weekly church services held by Dodworth Church. The local chapel attend to sing every 6 weeks. Despite what the AQAA told us there was a mixed response from people about whether activities arranged by the home were those they could take part in. Three said always, two sometimes and one never. Comments included, residents have been asked for suggestions for activities they would like to do and these have been arranged, I dont because I have a bad ..., but I would like to, bingo, gardening, Care Homes for Older People Page 16 of 32 Evidence: baking and art and craft. When we spoke to people and their representatives about their daily life they said, just sit here, talk to staff, its normal - meet other people and talk to them, like owt else - one day might not be as good as another, cant beat this, I sit outside in sunshine and I like trousers now - I choose what to wear. Two people told us of activities that were arranged. They included a band coming and a man playing a violin, concerts and bingo. Another wasnt clear about any activities arranged. One preferred their own company and busied themselves with the TV, digital photo frame, reading and doing puzzles. One of the health professional surveys that were returned stated the service usually supported people to live the life they chose, one didnt answer. When we spoke to people and their representatives it told us their representatives were able to visit the home at any time and were made to feel very welcome. We saw that everyone coming into the home was offered hospitality and staff took time to make sure friends and family were made to feel comfortable whilst visiting. There was a mixed response from the surveys about whether people liked the meals they were served. Three said always, two usually and one sometimes. One person commented, meals are varied, well cooked and well presented. All fresh ingredients, everything cooked and baked on premises. When we spoke to people about the meals that were served it told us that generally people liked the meals they were served. They commented, meals, very good. On a Sunday my husbands invited and foods good. We took lunch with people in the dining room. The dining room was comfortable and provided a pleasant environment for people to dine in. The tables were nicely set with flowers. However, the chairs you sat on to eat your meal made you sweaty and therefore uncomfortable. Other people agreed. A choice of meals was not identified on the menu board and none was offered to people. People were served good portions. The meal time was a positive and pleasant event. The meal smelt nice, looked appealing for people and tasted nice. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Care Homes for Older People Page 17 of 32 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. A complaints procedure was in place and people and their representatives could feel confident that any concerns they had would be listened to. Policies and procedures were in place to protect people from abuse, but they hadnt always been followed and staff training was needed in those procedures. Evidence: The AQAA stated the complaints procedure was displayed on the notice board in the reception area. We saw this and informed the manager information about the Commission, within the complaints procedure now needs updating. The AQAA told us 8 complaints had been received in the last 12 months that had all been resolved within 28 days. We gave advice to the manager about improving the recording of complaints. Surveys returned by people told us they always knew who to speak to if they were not happy and knew how to make a complaint. They commented, manager actively encourages us to bring any worries/problems to her attention, no matter how small, manager always willing to listen and solve the problem, see manager in charge and Leyla, Pat Smith, any carer. This was confirmed when we spoke to people. They said, (theyve) never done anything wrong to me, not bad, cant say its cruel and nowt wrong to say. One representative said, if unhappy, would say - Laylas approachable - she contacts me - its a 2 way thing. Care Homes for Older People Page 18 of 32 Evidence: One health care professional survey told us the service always responded appropriately if they or the person using the service had concerns about their care, the other stated not applicable. One commented, responses have been prompt and courteous. The survey returned by staff told us they knew what to do if the person or their representative had concerns about the service. They commented, always see the manager who will then make arrangements to talk with the person(s) having the problem and try ways of rectifying it. Similar information was received when we spoke with them, including reporting any allegations, although they said they had no concerns about any care practices. However, not all staff had received adult safeguarding training, including staff left in charge of the shift. The AQAA told us there were policies/procedures/codes of practice in place to protect people from harm and abuse, that had been reviewed in February 2009. The service had the local adult safeguarding policy and procedure, which was readily available for guidance if an incident took place. The manager had received adult safeguarding training and was aware of the multi agency procedures to be followed in the event of any allegation being made. However, she had not followed this in one instance because the family hadnt wanted it taking any further. Care Homes for Older People Page 19 of 32 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. There was a well maintained living environment that was clean, tidy and a comfortable environment for people to live and enjoy, however, all parts of the environment were not safe for people. Evidence: The AQAA told us the services ability to maintain the environment had been reduced in the last 12 months due the absence of a handyman, which the service were now advertising. It told us that following an audit of bedrooms decorating and refurbishment had commenced. Everyones surveys told us they thought the home was always fresh and clean. People were happy with their rooms, that most of them had personalised with pieces of their own furniture and possessions. When we looked round the home, the environment was suitable for the needs of people that lived there. The communal lounges and dining area were generally well decorated and were a comfortable environment for people to live. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible, however, the bathroom on the ground floor that was used for bathing people was also being used to store wheelchairs. This does not make it a pleasant environment for people to have a bath and presents a hazard for people using the Care Homes for Older People Page 20 of 32 Evidence: bathroom. The toilets had been adapted to assist people with their independence when going to the toilet. When we opened the door to go to the laundry in the morning, at the bottom of the stairs peoples clothes and a kylie had been thrown down. This does not promote infection control, neither does it show respect for peoples clothes and the practice should cease. A health professional survey stated they felt the home could improve by greater attention to the environment, bedrooms and communal areas. Care Homes for Older People Page 21 of 32 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. People received support as there were enough staff on duty. People could not have full confidence in the staff, because sufficient checks had not always been done to make sure they were suitable to care for them. In the main, people received care from a well trained staff team. Evidence: When we looked at the surveys returned by people it told us that staff listened and acted on what they said. Five said staff were always available when they needed them, one usually. Comments included, when ... requests the toilet staff assist them, unless staff are assisting someone at the same time of request, efficient and pleasant staff and if ...wants a drink, staff get them one. This was reflected when we spoke to people during the visit. Comments included, staff very kind, staff sit and chat. They care and staff ok. The staff survey told us there were usually enough staff available to meet peoples needs. They commented, obviously, sickness is an issue at times, but we are always fully staffed, but they also commented it could be better if (we) have an extra member of staff available throughout the day, so that every service user could have the added extra support they may need if they should need it. When we observed staff on duty, they worked hard, were patient and showed Care Homes for Older People Page 22 of 32 Evidence: empathy to people. There was mutual respect between people and staff and their conversations were relaxed and friendly. The AQAA told us staff received training in equality and diversity. It stated the service worked closely with Barnsley Metropolitan Borough Council, Quality Care Partnership and independent training services to attempt to meet mandatory training and National Vocational Qualification needs. This meant 75 of staff were trained to NVQ level 2 or above, two staff were trained in infection control and four catering and fifteen care staff were trained in safe food handling. The staff survey stated their induction covered everything they needed to know to do the job when they started very well, they were given training relevant to their role, that helps them understand and meet the needs of people and keeps them up to date with new ways of working. They stated they felt they had the right support, experience and knowledge to meet the different needs of people. They commented, any problems we can see the manager who is an RGN and is experienced in the problems we seem to acquire, which are usually small problems, so we feel we have plenty of support and experience. When asked what they did well they stated, inhouse training on a regular basis and all staff do attend. I feel we have a knowledgable team to support the service users. We looked at three staff files for their training records to confirm information in the AQAA and what staff had told us when we spoke with them. There was some evidence that training took place in all of the files, including, induction, fire safety, moving and handling, food hygiene, adult safeguarding, prevention and control of infection and equality and diversity. However, there wasnt always training certificates on file to verify the training and training undertaken prior to appointment hadnt been verified. When we spoke to the manager she stated no staff were trained in first aid and there wasnt a risk assessment in place to demonstrate the training staff needed in order that they were competent to deal with accidents and incidents. One of the health care professional surveys that were returned stated staff usually had the right skills and experience to support peoples social and health care needs, one didnt answer, but commented, I have not been aware of any problems. The new manager has just employed a number of new staff and in the little experience I have had with care staff, they have had the appropriate knwoledge and applied it to their practice. The staff survey that was returned stated the service carried out employment checks such as a criminal record bureau (CRB) check and references before they started Care Homes for Older People Page 23 of 32 Evidence: work. They commented, every relevant check was carried out to the best of my knowledge. The AQAA also stated all staff have enhanced CRB and protection of vulnerable adults (POVA) first check prior to commencing employement and that everyone who had commenced employment in the last twelve months had satisfactory pre employment checks. However, when we looked at two personnel records to check this, both files did not have full employment histories, which meant the recruitment procedure was not sufficiently robust enough to protect people. References and CRBs or a POVA first check were in place. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager had the qualifications required of the person in charge in day to day control of the delivery of care, but needed to submit an application to be registered. Where the service held monies on behalf of people it was not always managed in a way that protected them. There were some aspects of health and safety that needed to improve, so that the safety of people was maintained. Evidence: The AQAA stated the service have had problems recruiting a manager and this has reduced implementation of improvements over the last 12 months. A manager, Ms Layla Wrigley had been appointed, but wasnt yet registered. A deputy manager was employed in February 2009. Health care professionals in their surveys commented, communication is very good, well managed, regular support from operational director Pat Smith and families appear comfortable to speak to care staff/manager on a regular and informal basis. Care Homes for Older People Page 25 of 32 Evidence: The staff survey told us the manager met with them to provide support and discuss how they were working and ways of passing information about people between staff always works well. This view was supported by staff we spoke with. They said, everyone loves her (Layla) to bits, its been a good team since Layla, Laylas loads better, home runs smoother, smells nicer, different atmosphere, came back because of Layla, things done - rotering, flexible with this, problems with residents and shes positive. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It provided satisfactory information of the current situation within the service, what they had improved in the last 12 months and what they could do better, to identify a plan for improving the quality of life for people. The AQAA indicated systems were in place to check the quality of the service provided, for example, resident/relative meetings held quaterly and feedback from these and questionnaires analysed by manager and implemented where possible. The service said they were planning to implement individual resident questionnaires re social activities, food preferences and the environment. The area manager visited the home on a regular basis and completed a report of her visit about the quality of the service provided. The AQAA stated a procedure was in place for safeguarding peoples money. We looked at the money kept by the home on behalf of two people. In one instance records were kept and money tallied with the records, with receipts and double signatures in place. For the other, the record had a balance of minus £13 and no double signatures. The manager stated the money would have been taken from the residents funds, but a note on the file stated owes Pat. We observed the fish man also being paid from the residents funds. The manager stated the amount would be reimbursed from the next weeks petty cash. Clearly the petty cash is insufficient for the purpose it is used and should be increased, as it is not acceptable that money is borrowed from the residents funds to do this. The AQAA stated maintenance of equipment was in place for portable electrical equipment, lifts, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, premises electrical circuits, emergency call equipment, heating and gas appliances. We checked that a soiled waste disposal contract was in place and it was. Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. We looked at the training matrix and one staff file to confirm fire training and drills were undertaken. Staff had received fire training, but Care Homes for Older People Page 26 of 32 Evidence: staff on nights had not been present on a drill. This could place people at risk if staff were not competent in putting into practice the training they had received. The health and welfare of people could not be fully protected because despite a requirement at the last inspection for the service to address the door leading to the cellar to be locked, this was found open. A lock was in place, but hadnt been used and the key was hung at the side. Since the inspection the manager stated an electronic keypad had been fitted that automatically locked when the door closed. Although we observed people being moved safely, it was discussed with the manager that this did not seem as if it was common practice and needed monitoring. This was because it was seen that one person was transfered into 3 different wheelchairs to get one with footplates, which indicated to us it was not routine to transfer people to a wheelchair with footplates. The wheelchair was dirty and one of the tyres was wearing. The stand aid was marked. These were brought to the attention of the manager to address. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 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 18 18 Regulation 18 (1) (c) (i) This also relates to standard 28, qualifications and standard 30, staff training. All staff must receive adult safeguarding training. So that staff receive training appropriate to the work they perform. 23/09/2009 2 18 13 Regulation 13 (6) All allegations of harm or abuse must be reported to the local adult safeguarding team who will co-ordinate a response to the allegation. So that policies and procedures are followed that protect people from harm or abuse. 23/07/2009 3 35 12 Regulation 12 (1) (a) Money must not be borrowed from residents funds to pay for bills and be loaned by individual residents. 24/07/2009 Care Homes for Older People Page 29 of 32 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 So that residents funds are protected and used for the purpose they are there for. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 So that people are protected by the homes policies and procedures for medication, all medication should be safely stored and medication should only be used for the person it is prescribed for. To reduce the risk of people being given medication that will trigger an allergic reaction, medication that people are allergic to should be recorded on the medication administration record. To make sure staff are competent to deal with medication, an assessment of their competence should be undertaken. So that an audit is able to be undertaken and the risk of any discrepancies removed, more care must be taken with making sure the medication administration record records the actual start date the medication is given to people. This also links to standard 15, meals and mealtimes. The service should discuss with everyone how they could improve activities and meals for people, so that they are suitable for everyone. This also links to standard 19, premises. So that people are using chairs that are comfortable to sit on, the service should consider changing the fabric on the dining room chairs. This also links to standard 38, safe working practices. So that bathrooms are a pleasant and safe area for people to bathe, wheelchairs should not be stored there. This also links to standard 10, privacy and dignity. To promote infection control and show respect for peoples clothes, clothes should not be thrown down the steps into Page 30 of 32 2 9 3 4 9 9 5 12 6 15 7 19 8 26 Care Homes for Older People 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 the laundry. 9 28 This also relates to standard 30, staff training and standard 38, safe working practices. A risk assessment should be undertaken of the training staff require so that they are sufficiently trained and competent to deal with accidents and incidents that may occur. The staff should then receive this training. This also relates to standard, 30, staff training. To verify training that staff have undertaken, certificates of any training or qualifications should be on file. This includes training or qualifications that have been identified on application forms. So that people are sufficiently protected by the homes recruitment policies and procedures full employment histories should be obtained for staff that are employed. Registration of the manager is necessary to comply with Section 11 of the Care Standards act and so that the Commission can assess her fitness to be registered as manager. So that people and staff are safe in the event of a fire, night staff should receive regular fire drills. 10 28 11 29 12 31 13 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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