Inspection on 15/04/09 for Rossmore Nursing Home Limited

This inspection was carried out on 15th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rossmore Nursing Home Limited 27/05/09

Rossmore Nursing Home Limited 15/04/08

Rossmore Nursing Home Limited 10/05/07

Rossmore Nursing Home Limited 01/02/06

Rossmore Nursing Home Limited 08/09/05

Rossmore Nursing Home Limited 04/11/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rossmore Nursing Home Limited 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1LQ     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: Beverly Hill     Date: 1 5 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 33 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 33 Information about the care home Name of care home: Address: Rossmore Nursing Home Limited 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1LQ 01482343504 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : dnd@rossmorecare.co.uk Rossmore Nursing Home Limited care home 56 Number of places (if applicable): Under 65 Over 65 56 56 56 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 8 Registration includes twelve (12) stroke rehabilitation patients and 6 day places. Date of last inspection Brief description of the care home Rossmore Nursing and Residential Home is a two-storey building, which has been converted from a number of terraced houses for its present use. It is situated about a mile and a half from the centre of Hull in a quiet residential area overlooking the playing fields of Hymers College. There is a range of shops and pubs nearby. There are bus stops close to the home and the main train station is within walking distance. Car parking is available on the street outside the home. The home provides nursing and residential care to people over the age of 65 years for needs associated with physical disabilities or dementia. The home also has a contract with Hull Primary Care Trust to provide a stroke rehabilitation service to eight people. Care Homes for Older People Page 4 of 33 Brief description of the care home The main unit has accommodation provided over two floors within single or shared rooms; one of the shared rooms has en-suite facilities. Access to the upper floor is available through the use of stairs or the passenger lift. The main unit has four assisted bathrooms and two shower rooms and the stroke unit has two shower rooms. Communal areas consist of a large lounge with doors into a dining room, which in turn leads into a small quiet room. Four shared bedrooms for the stroke unit are located at one end of the main unit and the communal areas are in a separate building. These consist of a lounge, rehabilitation kitchen, a therapies room and offices for health professionals. There is a small garden leading off from the quiet room on the main unit and a courtyard accessible for the stroke unit. Fees for the home range from 350.50 - 560 pounds per week plus a 10 pound top fee, which is determined on an individual basis. Additional charges include hairdressing, toiletries, newspapers and chiropody. Information regarding the services the home provides can be located in the service user guide and statement of purpose, both available from the managers office. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people that use this service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 16th April 2008 including information gathered during a site visit to the home, which took approximately eight and a half hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Rossmore. We also had discussions with the proprietor, the registered manager and staff members. Information was also obtained from surveys received Care Homes for Older People Page 6 of 33 from residents (some of which had been completed by their relatives) and staff members. Comments from the surveys and discussions have been used in the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live in Rossmore, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys. 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 the 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. We found there were significant shortfalls in the way medication was managed in the home and as some of these shortfalls had also occurred at the last inspection, our enforcement team sent a letter to the provider. This required them to take immediate action to improve practice and to send us details of their plans to address the shortfalls. We received an action plan from the provider quickly and we will be monitoring how the home continues to manage medication to ensure it is safe for the people living there. What the care home does well: What has improved since the last inspection? A new system of care planning, just started at the last inspection, has been completed and although an improvement as to the layout and content, some of the more personalised details need more attention - see below. Risk assessments have been completed and on the whole information from them is included in the plans of care. On one occasion noted the risk assessment had not been updated as required. The way the home recruits new staff has improved and checks are in place prior to the start of employment. The proprietor checked out with the local authority the issue regarding top-up arrangements for one resident and the issue was resolved. Care staff now receive a sufficient amount of formal one to one supervision, although the recording of it should be more detailed. The proprietor has purchased twelve new profile beds and has ensured that people requiring bedrails have ones that are appropriate and safe for the resident, bed and mattress. A system of checking bedrails has been put in place. Care Homes for Older People Page 8 of 33 Twelve new chairs have been purchased for the lounge and two new sets of bedroom furniture installed. Corridors have all been repainted, four bedrooms redecorated and a chair lift installed for a section of the home, making two bedrooms more accessible to less ambulant people. Questionnaires have been sent to health professionals to obtain their views for quality monitoring purposes. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 33 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 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed prior to admission, which means they are confident the home is able to meet them and the home has the information required to make this decision. The home continues to provide excellent intermediate care facilities for people following a stroke. This enables people to regain their skills and adapt and prepare for independent living at home. Evidence: We looked at four care files during the visit, two of which related to people recently admitted to the home and another was for a person admitted for stroke rehabilitation. The final care file was for a person requiring nursing care and had been a resident for nearly four years. Care Homes for Older People Page 12 of 33 Evidence: All the residents had assessments of need completed prior to their admission to the home. For the person receiving rehabilitation following a stroke, these had been completed by health professionals at the hospital prior to discharge and information was continually updated by them. The other care files had assessments and care plans completed by the local authority. A new assessment system (standex) had been introduced to the home and the manager showed us that this included assessment documentation to be completed on first meeting a prospective resident. The registered manager confirmed they completed the assessments prior to admission, either by visiting people at home, other residential homes or in hospital. There was additional assessment documentation to be completed after admission, when basic information could be consolidated. This system worked well and enabled the care staff to add to information and update assessment details as they got to know the person or their needs changed. Those residents at the home who receive nursing care have undergone an assessment by a registered nurse from the Primary Care Trust (PCT), to determine the level of nursing input required for each individual. There were also some residents that had had continuing health assessments completed by the PCT, when extra funding was required for their care. The home continues to provide specialist facilities to enable people to rehabilitate following a stroke. The stroke unit is a separate building in the grounds of Rossmore Nursing Home, although the eight people it can accommodate at any one time sleep in the main building in four shared bedrooms. Facilities include a rehabilitation kitchen, a dining area, a lounge and a therapy room. Health professionals had offices upstairs and managed the process of rehabilitation. They completed assessments and care treatment plans, which followed on from those commenced during the persons stay in hospital. These included physiotherapy, occupational therapy, speech and language therapy, specialist nursing services and GP facilities. The home allocated specific care staff during the day to assist in completing care programmes. At the last inspection it was noted that people in the stroke rehabilitation unit did not have a specific care plan for home staff to follow, however since then there has been a precis of information produced to run alongside treatment plans and staff are quite happy that this gives them sufficient information to care for people. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans could be made more individualised to enable staff to have a clearer idea of peoples needs and preferences, and to enable them to assist people to maintain their independence. Significant shortfalls in the management of medication meant that people were not consistently receiving the medication that was prescribed for them. Evidence: Staff have continued to work hard at improving care plans for people and to a degree this has been successful. The three care plans examined for people living in the main unit had all been written using the new standex system. On the whole the care plans identified peoples assessed needs and what the staff needed to do to meet them. To improve, the care plans could detail what the person was able to do for themselves so enabling them to be as independent as possible, and ensure staff helped to maintain this. The care plans could also be more detailed about preferences to give staff guidance about peoples wishes should they be unable to communicate them. There Care Homes for Older People Page 14 of 33 Evidence: was also an instance when one person did not have a care plan produced until after they had been in the home for eight days. This is too long and nursing staff need to ensure they are produced in a more timely way. There was evidence that people had access to a range of health care professionals and visits were documented into the care file. Those records seen included visits from specialist nurses, dieticians, GPs, emergency care practitioners following any accident in the home and opticians. There were also appointments to consultants and the audiology clinic. There was an instance in one of the care files examined where staff had not followed instructions from a dietician regarding weight monitoring. The instructions had been inputted into the care plan but weights had not been recorded. This could have been as a result of the person declining to be weighed but this must also be recorded to evidence that at least it has been attempted. There are also other means of observing fluctuations in weight other than by weighing scales and staff could have used and recorded these. Health needs were met but for one person their pain was not controlled effectively due to shortfalls in the management of medication. Risk assessments had been completed for a range of activities and it was noted that there had been an improvement in the bed rail risk assessment since the last inspection. There was an issue though of some risk assessments not being updated when incidents occurred to affect them. For example a bed rail risk assessment required updating when a person managed to dismantle the rail. Two of the care files examined also required information about how to manage some behaviours that could be challenging to others. These need to be clear in care plans or separate behaviour management plans so care staff know how to be consistent in their approach. People living in the home were generally happy with their care. We received seven surveys from people and six stated they received the care and medical support they required, always whilst one person said this was, usually. Comments from discussions and surveys were, the staff look after me, I like the home - I have no complaints, they see to my health - I need new glasses though and I cant fault it (stroke rehabilitation unit). People told us that care was provided in ways that respected privacy and dignity. However one person said that, most staff listen to her and at other times some could be a little abrupt. The manager was present during this conversation and will follow this up with staff. Out of the seven surveys received five Care Homes for Older People Page 15 of 33 Evidence: stated that staff listened and acted, always, two said this was, sometimes. Four said staff were available, always, two said, usually and one said, sometimes. The management of medication needed improvement to ensure everyone received the medication prescribed for them. Medication was stored appropriately and although the second storage room upstairs was small the temperature was monitored to ensure it did not exceed the requirements. Staff did not have any hand washing facilities in the room but there were bathrooms close by. Controlled drugs were stored in the main room downstairs. The home ran out of important pain relief medication for one resident who required close pain control monitoring prior to surgery. The resident was without their prescribed medication for three days on one occasion and five days on another. There was also an additional occasion when it was recorded nursing staff could not locate the medication for two doses. During the absences of the prescribed medication there had been a total of seven doses of Paracetamol medication given as a homely remedy, which indicated the person did require pain control. Another resident did not receive their eye drops for five days but there was no indication why. The same resident was prescribed medication at night but none had been given on the medication administration record seen. Nursing staff stated she did not require it but they had not checked out with the prescriber that it was appropriate to omit it or whether it was appropriate to administer, when required. Other medication issues were : Nursing staff Potted up medication on a tray to administer to residents, which could lead to mistakes being made. This is not following policies and procedures laid down by the home or the Nursing and Midwifery Council (NMC). Nursing staff mass dispensed Lactulose liquid from one bottle prescribed for an individual resident. This means that people are being given medication intended for someone else. A separate bottle of Lactulose is prescribed for each resident and must be used as such. The fact that lots of individual bottles of Lactulose impacts on space, is no excuse. Recording guidelines for handwriting instructions on the medication administration record were not followed. Transcribing requires full instructions and two signatures to help prevent mistakes. Codes were not defined when medication had been omitted. It is important to indicate Care Homes for Older People Page 16 of 33 Evidence: the reason why medication has not been administered to plan care more effectively and to assist health professionals in their assessments and treatment plans. The medication administration record was not signed when prescribed creams/ointments/gels were applied. The date of opening on eye drops with a time-limited shelf life was not recorded. Oromorph liquid and Temazepam, although stored as a controlled drug, should also be recorded as a controlled drug, for good practice. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples choices regarding activities were limited, as there were gaps in the provision of social stimulation. This meant that people were bored and some saw no merit in coming out of their bedrooms. The home provided meals that met peoples nutritional needs. Evidence: The assessment information included social needs, hobbies and preferences. It was not always clear that staff included this information when planning the care of residents, especially around their social needs and stimulation. Staff made some attempt to document particular activities but it was obvious that these were limited. Some residents preferred not to participate in activities and liked to remain in own rooms entertaining themselves and happy with visits from relatives. Out of the seven surveys received from residents, one person (from the stroke rehabilitation unit) stated there were activities, always, two said this was, usually, two said, sometimes and one person said, never. A further person stated they were in poor health and unable to participate. One person spoken with on the day told us they were bored and would join in things if they were arranged. We saw little evidence of stimulation during the visit Care Homes for Older People Page 18 of 33 Evidence: and other visitors to the home had been concerned about the apparent lack of stimulation. However, one care file examined had activities such as dominoes, a walk to the shops, listening to music, one to one chats and a visiting entertainer. Another file mentioned attendance at an Easter party. It would appear that the more able people participated in some activities but a section of residents, with more complex needs who would require more time and input, had little on offer. This needs to be addressed. The home did not have a designated activity coordinator and staff in surveys and discussions told us that although basic care was good, social stimulation was an area they would like to improve. Routines were flexible and people told us they could make choices about aspects of their lives within the limitations of their health. Visitors were welcomed at any time and staff spoken with told us they tried to make sure people had contact with their relatives. One resident was supported to speak to their elderly relative on the phone. Some links had been made with the local community. Children from the local school visited at Christmas to sing carols, the library exchanged books regularly, an entertainer visited monthly and some residents visited local shops. The meals provided met peoples nutritional needs and the home had been awarded a, Healthy Heartbeat award for the last ten years for providing a healthy alternative. Catering staff had also been awarded an, A in the local authoritys, scores on the doors system of assessing food safety management. Comments about the food were, its excellent, I like the food, food is good - plenty to eat, its my style, meat and two veg and the sweets are gorgeous and recently the food has been very good. In surveys five people stated they liked the meals, always or usually and two stated this was, sometimes. Catering staff provided alternatives to the main menu and a range of special diets such as, soft and liquidised, diabetic, low fat, and one person had a vegetarian option. The meal seen was well presented and staff assisted people to eat in a sensitive way. Staff support residents to complete a weekly menu sheet and an admission form details dietary needs, which is passed onto catering staff. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to complain freely and were protected from abuse by staff training and adherance to policies and procedures. Evidence: The homes complaints policy and procedure was on display in the home and people spoken with were aware of who to talk to should they have any concerns. Most people mentioned the registered manager or the proprietor by name and we witnessed residents speaking openly to them. This showed us that both were visible and accessible to residents and relatives. The home had received two formal complaints since the last inspection and both had been investigated and resolved in a satisfactory way. The Commission had not received any formal complaints about the home. Staff spoken with, and surveys received from them, indicated they knew what to do if concerns were raised with them. Staff stated they tried to deal with issues quickly before they became complaints. The staff had appropriately completed incident forms when there had been issues with people being discharged from hospital to their care. For example with inaccurate details on the hospital discharge letter. The home used the local authority multi-agency policies and procedures for safeguarding adults from abuse and had put them into practice appropriately on one occasion. There had been three safeguarding referrals made since the last inspection, Care Homes for Older People Page 20 of 33 Evidence: one made by the home and two made by health professionals about the home. All had been investigated and resolved. Staff had received training in how to safeguard vulnerable adults and, in discussions, they were clear about what they had to do should they witness anything that concerned them. The registered manager had completed more in depth safeguarding training in the referral and investigation processes. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a clean and well maintained environment for people living there. Evidence: The home continues to be warm, clean and odour-free. All seven surveys received from people living in the home stated it was fresh and clean, always. People spoken with on the day also confirmed they were satisfied with the cleanliness of the home and there were sufficient domestic staff employed. Staff told us in discussions that they had sufficient alcohol gel for hand washing, gloves and aprons in stock. The laundry was adequate for the size of the home and contained commercial washing machines and tumble driers, a clothes press and ironing facilities. Designated staff were employed to work in the laundry. The home had a redecoration and renewals plan and since the last inspection they have obtained twelve profile beds, twelve easy chairs, four of which have a special design, two sets of bedroom furniture and an additional stair lift to make two of the bedrooms more accessible to people. Because the home is a series of residential houses joined together, there are several small sets of stairs at intervals. Only one set remains without a chair lift, which means the bedrooms at the top of them can only be accessed by more ambulant people. Care Homes for Older People Page 22 of 33 Evidence: Four bedrooms have been redecorated and paintwork completed in corridors and communal areas. Some of the communal areas and corridors were looking a little jaded but the proprietor explained redecoration was a slow and lengthy process due to the type of building involved and people spoken with were happy with their home describing it as, homely. The home still has to start the process of installing privacy locks to bedrooms when they become vacant. The bedrooms seen were personalised to varying degrees according to the taste and choice of the occupant. Shared rooms had privacy screens and all bedrooms had lockable facilities as required. The home had a large lounge and a dining room leading off it. The lounge was used by several residents on a regular basis but the majority of people tended to remain in their bedrooms. Those people spoken with on the day expressed that this was their choice. The dining room was seldom used although people did occasionally use a small quiet room at the end of the dining room and used the patio area when they wanted to smoke. The patio and small garden were secure and accessible via the quiet room and a small portable ramp had been installed to make access easier for people with mobility issues. There had been no change to the stroke rehabilitation section of the home. It was well equipped and suitable for its intended purpose. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by appropriately recruited and generally well trained staff. Evidence: Out of nine staff surveys received, one stated the home had sufficient staff, always, seven stated this was, usually and one said, sometimes. Those spoken with stated they did not always have sufficient time to sit and talk to people as much as they would like and key worker (one to one) time with residents was not always possible. There had also been quite a large staff turnover in the last twelve months, twentyseven staff had left in total for various reasons. However rotas confirmed that there were usually six carers and two qualified nurses on shift during the morning (the busiest time) and four carers and one nurse from 3pm until 8pm. There were three carers and one nurse from 8pm until 8am. The manager was supernumerary and the proprietor worked in the home on a daily basis and completed some managerial and financial tasks. The home had thirty-eight residents in the main building, nineteen of which required nursing care. The numbers of staff available were sufficient in terms of numbers, although staff still perceived a shortage at times. The manager and proprietor needs to discuss this with nursing and care staff to check if any particular nursing or caring tasks have a bearing on this perception. The home provided additional day care staff to support a further six people requiring stroke rehabilitation in a separate, designated unit. Care Homes for Older People Page 24 of 33 Evidence: People spoken with and surveys from received from residents had generally positive comments about the care staff. Out of the seven surveys received from residents, five stated staff listened to them and acted on what they had to say, always - two said this was, sometimes. Four said that staff were available, always, two said this was, usually and one said it was, sometimes. Comments were, professional staff, yes they do look after me, they vary, they are all good to us - they are kind and chat to me, they are nice - some are nicer than others and you can have a laugh with the staff. The manager was present during a negative comment about care and will address this. The home has a training plan and maintains records of who has attended training and when an update is due. Staff had either completed mandatory training or had a course booked. Additional training included stroke rehabilitation, dementia awareness and diabetes. The home had 47 percent of care staff trained to National Vocational Qualification (NVQ) in care at level 2 and 3. This was a good achievement and when the additional seven care staff progressing through the course complete it, the home will have exceeded the requirement of 50 percent. Housekeepers had completed NVQ level 2 and catering staff had all completed food hygiene, one at intermediate level. Nursing staff completed a range of additional clinical training to support their ongoing professional registration. Staff stated that they received good training and it is, constantly updated. Due to the issues regarding medication management it is necessary for nursing staff to refresh their skills in this area. The majority of comments in surveys from staff stated that the morale was high and the home had a, hard working and caring staff team. One person did state that communication between them could be improved and six staff stated passing on information worked well either, usually or sometimes, with three stating this was, always. Another staff member felt that induction could be extended. Two of the nine staff surveys received stated that induction had been met only, partially. However, new staff completed the required, skills for care induction standards, which could take up to twelve weeks depending on their progress. This was in addition to three supernumerary days to formally induct them into the way the home worked. The manager should check out with new staff the progress of induction to ensure they feel all areas have been covered and record the discussion in supervision. The homes recruitment process follows guidance and policies and procedures. Staff complete an application form, references are obtained and criminal record bureau checks are completed. There have been instances when staff have been employed Care Homes for Older People Page 25 of 33 Evidence: after a povafirst check but prior to the return of the full criminal record bureau check. The proprietor has aways contacted us for advice when this has occurred, carried out all other checks and ensured the staff member is supervised when on shift. It is acknowledged that there has been, at times, considerable delay in the processing of criminal record bureau checks in Hull, which could impact on staffing levels and affect residents wellbeing. The home has a system of checking that qualified nurses have up to date registration with the Nursing and Midwifery Council. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home was well managed but specific management systems need further improvement to ensure the well being of all residents. Evidence: The registered manager had completed her registered managers award and had completed various relevant training courses in order to keep herself up to date. The majority of staff in surveys stated that they felt supported by the manager and had the opportunity to meet with her on a regular basis to discuss issues. Staff spoken with on the day described both the manager and proprietor as, approachable. The registered manager made herself accessible to residents and their relatives and many spoken with knew her name. This was important and told us she was out and about the home each day and available to speak to residents if they had any concerns. Staff meetings were held and formal one to one supervision sessions held. The amount of supervision provided to staff had improved since the last inspection but records Care Homes for Older People Page 27 of 33 Evidence: were still basic. The records should detail what has been discussed and any action points that may need following up in the next session. The home had a quality assurance system that consisted of a month by month plan (developed since the last inspection), questionnaires to residents/relatives and professional health visitors, and a series of quality audits. To improve the home needs to look at completing action plans to address any shortfalls identified in surveys, consider questionnaires to staff and local authority reviewing officers to obtain their views about the service and also consider a more tailored survey for people in the stroke rehabilitation unit. The range of audits covered issues such as, the environment, housekeeping, staff records, care plans, key worker time, medication and bedrails . The medication audit in particular needed close attention as the system was not picking up the issues found during the inspection. Also the bedrail check had not picked up the inappropriate fittings on two of them. These were addressed by the proprietor on the day. The home had completed, on time, their Annual Quality Assurance Assessment, which is requested by the Commission. This detailed what they did well and what areas they needed to improve. Finances were not assessed at this inspection but we had a discussion with the proprietor about top-up issues highlighted at the last inspection and these had been addressed quickly with the local authority. The computerised system remains the same for the management of individual personal allowances. Records were maintained, receipts obtained for purchases and monies held securely with restricted access. The home was generally a safe place for people to live in and staff to work in. Equipment was serviced and maintained, fire alarm checks carried out and staff completed mandatory training in health and safety, moving and handling, fire safety, first aid and infection control. Maintenance personnel were on hand to complete repairs, audit hot water outlets and maintain equipment. However, staff were not following policies and procedures relating to the management of medication and this could place residents at risk. Requirements regarding the safe practice of medication have been made elsewhere in the report. The sluice room on the first floor needs to be inaccessible to people when not in use due to the use of the specific equipment in there and very hot water outlet. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 The registered person must ensure that nurses only administer medication to services users that is prescribed for them by their GP. This will ensure service users health, safety and wellbeing are protected. 15/05/2009 Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Care staff must ensure that a specific residents health needs are met in relation to pain control management. This will ensure the resident remains as pain free as possible and health professionals instructions are carried out. 15/05/2009 2 9 13 A system must be in place 15/05/2009 to record the expiry dates of medication with limited use once opened. This makes sure medication is safe to administer by reducing the risk of contamination. 3 9 12 People must only receive 15/05/2009 medication that is prescribed for them on the bottle. The practice of mass dispensing from one bottle of lactulose is unsafe practice. Care Homes for Older People Page 30 of 33 This will ensure that peoples medication can be audited more accurately. 4 9 13 Staff administering 15/05/2009 medication must ensure that policies and procedures are adhered to. The potting up of medication is an unsafe practice. This will ensure the safe administration of medication and avoid mistakes and accidents happening. 5 9 13 Stock control of medication 15/05/2009 must be managed more effectively to ensure there are always supplies on the premises and people recieve the medication that has been prescribed for them. This will ensure that the identified health needs are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should contain more individualised information to ensure care staff have full details about behaviour and preferences and to enable them to help the person maintain their independence. They should also be signed by the resident or their representative to acknowlege they agree with the contents. Recording should be accurate and up to date regarding the care people receive, including key worker quality time and when people decline to accept care, for example wieght monitoring or general immersion baths. This will enable an audit of care to take place and plans to be made for Page 31 of 33 2 8 Care Homes for Older People alternatives as required. 3 9 Oromorph liquid and Temazepam should also be recorded as a controlled drug, for good practice. This will enable close monitoring of amounts used. Handwritten entries and to MAR charts should must be fully and accurately recorded and signed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. Staff should contact with the prescriber if a resident declines to take prescribed medication to check if alternatives are required or whether the dosage needs to be changed to one that suits their needs more effectively. The home should canvass peoples views about social stimulation and provide meaningful activiities and occupational stimulation, especially for people with dementia care needs. Advice can be obtained via discussion with occupational therapists and external organisations such as Alzheimers Society and Age Concern. The home should enable people to make more choices about their lives by broadening the activities and occupations available to them in, and outside, the home. Privacy locks should be installed as standard when bedrooms become vacant. The quality assurance audits for the management of medication, bedrails and key worker time should be completed more comprehensively. This will help instil confidence that areas are safe for residents and key worker time is actually being completed. The quality assurance system should be completed with action plans to address shortfalls identified in surveys and audits and the range of questionnaires broadened to include staff and local authority reviewing officers. Although the amount of staff supervision has improved and is meeting the requirements of the standard, what is written should be more detailed to ensure good recording and the ability to follow through any issues to the next session. The first floor sluice room should be inaccessible to people when not in use to prevent injury from the equipment insitu and very hot water outlets. 4 9 5 9 6 12 7 14 8 9 24 33 10 33 11 36 12 38 Care Homes for Older People Page 32 of 33 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. 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