Inspection on 04/06/09 for Rushymead

This inspection was carried out on 4th June 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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

Other inspections for this house

Rushymead 01/07/08

Rushymead 10/07/07

Rushymead 19/07/06

Rushymead 28/11/05

Rushymead 16/05/05

Rushymead 05/01/05

Rushymead 20/09/04

Rushymead 12/02/04

Rushymead 15/09/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Rushymead Tower Road Coleshill Amersham Buckinghamshire HP7 0LA Lead Inspector Joan Browne Key Unannounced Inspection 4th June 2009 DS0000023016.V375778.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rushymead Address Tower Road Coleshill Amersham Buckinghamshire HP7 0LA 01494 727738 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) rushymead@aol.com The Michael Batt Charitable Trust Mrs Denise Yvonne Macklin Care Home 28 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Dementia (DE). The maximum number of service users to be accommodated is 28. Date of last inspection 1st July 2008 Brief Description of the Service: Rushymead is a care home providing personal care and accommodation for twenty-eight older people with physical frailties and dementia. The Michael Batt Charitable Trust owns the home, which is a registered charity. The home is located in the village of Coleshill some two miles south of Amersham. Public transport and local amenities are not easily accessible. The building has been adapted for use as a residential care home for over twenty years and was first registered in 1991. The home is situated on three floors and is divided into three units. Each unit has its own sitting and dining areas with kitchenette facilities. There are twenty-six single rooms and one double room. Five bedrooms have en suite facilities and there is a passenger lift. The gardens are extensive and well maintained. The current weekly charges range from £520.00-£700.00 per week. Additional charges are made for chiropody, hairdressing, newspapers, toiletries and optical services. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. This unannounced key inspection was conducted by Joan Browne on the 4 June 2009 and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on the 1 July 2008. Prior to the inspection, a detailed self assessment questionnaire was sent to the manager for completion and surveys were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. We did this inspection with an ‘expert by experience’ who spoke to people using the service and staff. An ‘expert by experience’ is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. The inspection consisted of discussion with the manager, staff, some people who use the service and examination of some of the home’s required records, observation of practice and a tour of the premises. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. Six requirements were made and two of these requirements were unmet from the previous key inspection. Since the inspection the Care Quality Commission has had a management review meeting (MRM) of the service. It was agreed that a warning letter would be issued to the registered person and failure to comply within agreed timescales could lead to enforcement action being taken. We (the Commission) would like to thank all the people who use the service and staff who made the visit so productive and pleasant on the day. What the service does well: The care needs of prospective people who use the service are assessed prior to their admission to ensure that identified needs can be met. People using the service have a choice as to how they spend their day and activities are provided. People live in a home that is clean and fresh, which means the environment is well maintained. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 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. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 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 care needs of prospective people to use the service are assessed prior to admission this enables the home to be sure that it is able to meet individuals’ diverse needs EVIDENCE: The home’s annual AQAA indicated that prospective people’s needs are assessed prior to admission to the home. A review of three people recently admitted to the home care plan documentation demonstrated that pre admission assessments were undertaken. Where people had been referred through care management arrangements the home had obtained a copy of the assessment summary. The home ensures that individuals are written to and notified of the room that has been reserved for them and the weekly Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 9 charges they would be expected to contribute. Care agreements were in place and these were signed wherever possible by individuals and their relatives. Twelve people responded to the Commissions survey and eleven confirmed that they had been issued with contracts. One person said that they did not receive a contract. A social care professional who responded to the Commission’s survey said that ‘the home was very supportive and organised in assessing prospective people to the service needs.’ The home does not provide intermediate care. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has failed to ensure that there is a consistent practice in place for keeping people’s care plans under review this means that people’s identified needs may not be adequately met. EVIDENCE: The home uses a standardised care planning system detailing people’s long term and short term needs. Supplementary person centred care plans detailing how individuals wished for staff to support them with their diverse needs were also in place. We looked at eleven care plans and found that they were not being adequately maintained. For example, the practice in place for reviewing individuals’ long term needs was not consistent. Five people’s long term identified needs had not been consistently reviewed. However, the short term care plans were being reviewed monthly. It was noted that the process in place for reviewing individuals’ long term identified needs was not clear. The manager stated that the system in place for reviewing long term needs was 3-monthly. However, in some care plans it was recorded that the long term needs should be reviewed Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 11 6-monthly. There was no evidence seen to indicate that the supplementary person centred care plans were being reviewed monthly or as and when required. We noted that tippex correction liquid was used on the admission details sheet and the risk assessment record sheet for two particular persons. The practice of using tippex correction liquid on care plan documentation to correct entries recorded in error should be reviewed because the documentation can be used in an investigation. We noted that a particular person was identified as suffering from epilepsy. There was no care plan in place detailing how this identified need should be met. There was also no guidance for staff to follow detailing how to adequately support the person. A particular person was identified as being prone to falls but there was no risk assessment in place detailing the measures that should be put in place to reduce the identified risk so that staff can adequately support the individual. In the eleven care plan documentation examined gaps were noted in individuals daily personal care record sheets. The practice in place for staff to record the personal care provided was not consistent. We were told that people’s dependency needs were reviewed monthly. It was noted that the dependency needs for a particular person had not been reviewed since February 2009. We noted that five particular persons had night care plans in place but there was no evidence seen to indicate that they were being evaluated monthly or as and when required in accordance with the home’s processes. There were no photographs in place in four of the care plan documentation examined to confirm proof of identity. The manager said that she had taken photographs of individuals but they were waiting to be developed. One particular person had been living in the home since September 2008. We did not see written evidence of people giving permission for the use of photographs and this good practice should be formalised. At the previous key inspection a requirement was made for a consistent practice to be in place so that care plans are kept under review. The requirement has not been met and it is possible that enforcement action will be taken to ensure that the breach is complied with People were registered with a general practitioner (GP) who visits the home as and when required. GP and other visits such as chiropody were recorded in individuals multidisciplinary sheet records. The manager said that a particular GP visits regularly to assess individuals medical needs. The chiropodist visits every 6 weeks and the optician every 3 months. The annual quality assurance assessment (AQAA) reflected that there was no one in the home with pressure sores. We saw evidence of people’s weights being monitored monthly. Assessments for moving and handling, falls, tissue viability, nutritional and continence were in place. Health and social care professionals who responded to the Commissions survey said that the home always ensure that individuals health care needs were met. We were told that there were no individuals assessed as capable to self-administer their own medication. The medication administration record (MAR) sheets were checked and there were no unexplained gaps. There was an audit trail for all medicines entering and leaving the home. There was no controlled medication in the home on the day of the inspection. Staff identified as capable to administer medication are expected to leave a sample of their signature in the medication folder. The manager stated that regular auditing of the medication administration record (MAR) sheets is undertaken and all staff that administer medication have regular updated training in the safe handling and administration of medication. The training matrix reflected that staff were due to undertake Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 12 updated training on 19 June 2009. We noted that eye drops for a particular person was opened on the 30 April 2009 and should have been disposed of one month after opening. However, staff were still using the drops four days after the used by date. To comply with best practice guidelines it is advised that the manager should consult with the home’s supplier of medicines to ensure on their suitability for use. We observed the majority of staff talking to each other but not to people using the service. On one particular unit the carer served tea but other than to say “here is your tea” she did not interact with people using the service. We observed a staff member speaking inappropriately to a person using the service demonstrating a total lack of respect for the persons dignity and their feelings. (This is elaborated more under standard 18). The hairdresser was visiting on the day of the inspection and she was particularly good at interacting with individuals. She escorted each person back to their room or to the lounge. It was a pleasure to hear her singing with a particular person as they approached the hairdressing room. We spoke to the hairdresser who said that she cuts both male and female hair. She stated that if there were too many appointments she would always make sure she was available the next day to ensure that everyone who wanted their hair done would be accommodated. We were told that personal care, medical examinations and treatments were provided in peoples bedrooms. Individuals were able to have a telephone installed in their bedrooms if they wished to. On the day of the inspection peoples attire was colour co-ordinated, clean and tidy with attention to detail. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the 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 who use services are involved in meaningful daytime activities which meet their choice, interests and diverse needs. Individuals are able to maintain contact with their family and friends. EVIDENCE: The home employs an activity person three times a week. Information in the AQAA stated that arrangements were being made for the activity programme to be increased to four times a week. The manager verified that this has not materialised because the personal circumstances of the activity person have prevented this from happening. Consideration should be made for the home to employ someone else to cover the extra day that was available. On the day of the inspection the activities included darts, a dice game and throwing a ball both into a net and to each other. The activity person actively encouraged participation and everyone involved were enjoying themselves. All the people spoken to said that they were very happy with the activities provided and spoke very highly of the activity person. The following comments were noted: She does her very best to try and involve everyone in some activity or another. She is very good and never leaves anyone Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 14 out. You can just come and sit here and watch the others you are never forced to join in if you dont want too. We were told that entertainers visit the home to sing a couple of times a year and that the local school children visited at Christmas time to sing carols. The AQAA reflected that outings to the local pubs and garden centres were arranged and a yearly barbecue and Christmas party take place. A list of activities provided was displayed in each unit but there was no timetable for set activities and this was verified by a person using the service. The AQAA reflected that the home was developing a newsletter for individuals and their families to be informed of what activities were taking place but this had not yet materialised. The home does not have any restrictions on visiting and people are able to receive visitors in private and choose whom they see and do not see. Wherever possible people are encouraged to handle their own financial affairs for as long as they wish to, and as long as they have the capacity to do so. Information about local advocacy services was displayed on the notice board at the front entrance. Some bedrooms seen were personalised with peoples personal furniture, which meant that individuals are made aware of their entitlement to bring personal possessions with them to personalise their bedroom if they wished to. Lunch was observed on all three units. We were told that a four-week menu was in operation. The winter menu was still on offer however, we were informed that the summer menu would be available the following week. We witnessed some good practice for example, a particular person was having difficulty to cut up their food and the carer assisted without being asked. We spoke to several people about the menu and what choices were available and their responses were variable. The following comments were noted: The food is not varied enough and whilst the food was good it was a bit boring sometimes. The food is not always healthy roly poly pudding and bread and butter pudding seemed to come with custard. A person who had lamb salad for lunch commented that they had eaten lamb for lunch the day before. On checking it was found that roast lamb was served the day before for lunch. We spoke to the chef and questioned what options people who were diabetics had and we were told that they tend to make their own decisions. There were no vegetarians being catered for but we were reassured that if a person wanted something that was not on the menu it would be prepared for them. The chef was asked about the availability of fresh fruit in the lounges and we were told that fruit was normally available but the fruit had only been delivered on the day of the inspection. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding issues in the home may not be given a high priority and discussed regularly at team meetings and as a result staff demonstrate a lack of respect for people’s human rights and dignity. EVIDENCE: The AQAA indicated that within the past twelve months the home had not received any complaints. The Commission has not been made aware of any complaints about the service. One person requested for us to find out what the doctor had said about her as she had not been told despite asking several times. This information was relayed back to the manager who said that she had spoken to the individual. There was no record of a discussion taking place with the individual to reassure her. Of the twelve respondents to the Commission’s survey eleven said that they knew how to make a complaint and one said that they did not know how to make a complaint. The following additional comments were made: “My niece would do this for me if necessary and she knows who to see.” “Yes but complaint has not been acted on.” Information in the AQAA indicated that the manager was in touch with people on a daily basis and issues raised were dealt with immediately preventing the need for people to complain. The AQAA also reflected that consideration was being made for a comments and suggestion box to be made available for people and their relatives to make suggestions anonymously if they wish to but this had not materialised. The home does not appear to log minor complaints or concerns. The home must ensure that a record is maintained of all verbal complaints or concerns made by people using the service and their visitors to demonstrate that the management of the home is open and transparent. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 16 The training matrix seen reflected that staff had undertaken training in the safeguarding of vulnerable adults in July 2007. The manager verified that all staff have since undertaken further updated training in April and May 2009. The manager was advised to keep the training matrix up to date to reflect all current training undertaken by staff. During the inspection we witnessed a staff member speaking in a rude and uncaring manner to a person using the service. The individual requested to return to their bedroom. The staff member replied in an abrupt manner that the individual should wait as she was feeding another person. She then went on to have a conversation with her colleague regarding the individual and said “I think she needs her hearing checked because she doesn’t seem to understand what you say to her.” The staff member demonstrated a total lack of respect for the person’s dignity and their feelings. The incident was reported to the manager and she was aware which member of staff we were referring to. She said that the staff member had been spoken to before about her attitude. There was no written record detailing what action the manager had taken to address the staff’s behaviour. The incident was referred to Buckinghamshire County Council safeguarding of vulnerable adults team as a safeguarding matter. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the 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 is well maintained which should ensure that the environment is fully able to meet people’s diverse needs and promote independence. EVIDENCE: The home is set in secluded grounds and has been adapted for its present use and divided into three small units each with its own sitting room/dining area and small kitchenette. It has large and attractive gardens that are kept tidy. People using the service have access to all parts of the home including outside areas. There are ramps provided to enable wheelchair users to access safely. CCTV cameras were installed in the grounds and entrance areas for security purposes only and do not appear to intrude on the daily life of people using the service. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 18 The home was recently inspected by the local fire safety services and the outcome of the inspection was considered to be satisfactory. Information in the AQAA indicated that some improvement to the environment had been made. For example, the carpet on the ground floor corridor was replaced, some divan beds had been replaced with the electric type and a fire door had been installed on the top floor corridor to promote peoples safety. Bedrooms vary in size and was single occupancy with some having en suite facilities. Individuals are made aware that they can bring small items of furniture and personal belongings if they wished to personalise their rooms. Some bedrooms seen were personalised with small pieces of furniture, family photographs and mementos reflecting the characters of individuals. Bathrooms and toilets were fitted with the appropriate aids and adaptations to promote and meet the needs of the people who use the service and were satisfactorily maintained. The lounge and dining areas on each floor were pleasantly decorated and furnished. The laundry area was clean and tidy and fitted with the appropriate washing machines with the specified programming ability to meet disinfection standards. People spoken to confirmed that the laundry system worked particularly well. The following comments were noted: “The washing is done very quickly and nothing of mine has ever been lost. It seems as soon as it has gone for washing it is back again that afternoon.” “The person doing the washing takes great care of my things.” The laundry person informed us that there was the facility to hand wash people’s clothes if necessary which she was more than happy to do. On the day of the inspection the home was clean and tidy with no offensive odours. People who responded to the Commissions survey said that the home was always or usually fresh and clean. The following additional comments from a person using the service were noted: The home is cleaned daily and general up keep very good. The training records examined indicated that some staff had undertaken updated training in infection control in May 2009 and a date had been booked in June 2009 for the remaining staff to undertake training. Staff who responded to the Commission’s survey were confident that infection control practice was being promoted in the home. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Weaknesses in the home’s recruitment procedures for new staff found on this inspection could place people using the service at risk of harm. EVIDENCE: The staffing rota demonstrated that on each unit a member of staff was allocated. On the morning shift there are two additional staff floating on the three units making it a total of five staff to assist with moving and handling and personal care. This number is reduced to four in the afternoon and three at night. The manager was confident that the staffing numbers provided was adequate to meet the needs of the people using the service. However, some staff were concern about individuals’ dependency needs. The following additional comments were noted from a staff member who responded to the Commission’s survey: “I just feel that due to the mental disabilities of Rushymead residents its more like a nursing home than residential, at times its very time consuming to get the residents ready for the day or even bathed in the afternoon and being in charge of up to nine on a floor can be very hard work not to have to rush and get other chores done.” Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 20 The AQAA reflected that domestic and kitchen staff are employed in sufficient numbers to ensure that standards relating to food and meals were fully met and the home is maintained in a clean and hygienic state. A person who responded to the Commission’s survey said that ‘staff do not engage or talk enough to people using the service. We observed during the inspection that the majority of staff were speaking to each other and not interacting with people using the service. It was evident that there was no consistent system in place to monitor staff’s practice. This could mean that staff were reactive to people’s identified needs rather than proactive and lacked respect for people’s dignity and human rights. The home does not have a supervision framework in place, which means that staff are not supported and given the opportunity to discuss and review their practice with a focus on improving outcomes for people using the service. The AQAA reflected that 98 of staff have achieved the national vocational qualification (NVQ) in direct care at level 2. The personal files for the three staff members who were recently recruited were examined. All three staff had completed an application form although one form was considered to have been poorly completed. We found that the home’s recruitment practice does not comply with the current regulations and best practice. For example, all three staff commenced employment ahead of the criminal record bureau (CRB) clearance. There was evidence seen to verify that the home had obtained a PoVa first check for one staff member but not for the remaining two staff members. There was no written evidence to demonstrate that the staff members were working under the supervision of an appropriately qualified and experienced named person(s) until the full CRB clearance was obtained. Gaps in one person’s employment records were not explored at the interview. One staff member commenced employment without two written references. We noted verbal references had been obtained and these were followed up by written copies after the individual had commenced employment. One of the references received for a second staff member was addressed ‘To Whom It May Concern’. Two of the staff members had previously worked with vulnerable people and only one of them had obtained a reference from their previous employer (as required under PoVA since July 2004). Recent photographs of staff members were not in place to confirm proof of identity. A requirement is made to ensure that all the necessary documentation as detailed in Standard 29 and Schedule 2 of the Care Homes Regulations for Older people is obtained by the home before staff commence employment. On the day of the inspection the home was using the services of an agency worker. The manager was not able to confirm if the worker had been deemed fit to work with vulnerable people. The home does not appear to obtain from the agency written confirmation that agency workers have a current PoVA first check and criminal record bureau clearance and that their mandatory training is current and up to date. The manager must ensure that she gets written confirmation from the agency that staff are in receipt of a criminal record bureau clearance and they have been provided with the necessary mandatory training to perform their role. The information in the three staff members files that were recently recruited indicated that they had been provided with an induction over a period of time. However, we noted that the induction programme did not cover the homes policies and procedures for Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 21 safeguarding of vulnerable adults, which could mean that staff may not be aware of the homes policy for sometime and have clear and specific guidance when incidents need external input and who to refer the incident to. The home must consider including the homes policies and procedures for safeguarding of vulnerable adults as part of the induction training. This is to ensure that people using the service safety is protected and promoted. The training matrix seen indicated that training in infection control, food hygiene, manual handling, diet and nutrition, first aid and health and safety had taken place. Further training in medication and dementia awareness was due to take place. The manager said that all staff had undertaken safeguarding of vulnerable adults training between April and May 2009 however, the training matrix did not reflect this and the manager is advised to update the matrix. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence of unmet regulation breaches and poor recruitment procedures does not ensure that the home is run in the best interests of people using the service and this could compromise their health, safety and welfare. EVIDENCE: The manager has been in post since April 2008 and holds the registered managers award (RMA) certificate and the national vocational qualification (NVQ) level 4. She was registered with the Commission in November 2008. The manager is accountable to the board of Trustees. Care staff and ancillary staff are accountable to the manager. The manager confirmed that she updates her knowledge, skills and competence by Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 23 undertaking mandatory training and had recently undertaken training in the mental capacity act and deprivation of liberty safeguards. A deputy manager, team leaders and care and support staff support the manager in the day to day running of the home. The AQAA indicated that the manager has an open door policy and she meets with team leaders and staff daily. Some staff who responded to the Commissions survey said that communication in the home between management and staff needed to improve. The following additional comments were noted: Not enough communication between management and staff. Need more communication. We were told by the manager that the practice in the home is to have general staff meetings six monthly. The minutes of a staff meeting held in March 2009 were made available for the inspection purpose. The manager must consider the frequency of staff meetings so that a clear sense of direction is communicated to the staff team with a sound understanding of how to apply best practice operational systems to improve the service delivery. We were told that a resident meeting was held in April 2009. Handwritten brief notes of what was discussed at the meeting were made available for the inspection process. Consideration should be made for these to be formalised and circulated to people using the service. The AQAA reflected that the home obtains the views of people who use the service, as well as other stakeholders such as, family members, and health and social care professionals in the form of a questionnaire. We were told that twenty-four surveys were sent out and fourteen were returned. Although the manager had highlighted areas where the home needed to make improvements this was not done in a formalised way as there was no action plan in place for undertaking the work. Examination of the homes regulation 26 reports indicated that visits have not been consistent. It is a requirement (under Regulation 26 of the Care Standards Act 2000 and Care Homes Regulations 2001) that where a provider is not in day-to-day charge of a home they ensure a representative visits the home and completes a written report on the conduct of the home. This is another means of the people using the service being able to give their views on the home. Consideration must be made for visits to be undertaken consistently and copies of the reports required to be made available under the terms of this regulation for inspection purposes. The AQAA was returned to us by the date it was requested. Some of the information was not clear and gave limited detail on areas that the home still needs to make improvements and how this would be achieved. The home does not manage people’s finances except where they state that they do not wish to, or they lack capacity. Family members leave a small amount of money to cover items such as, hairdressing and chiropody. Records of transactions are maintained and receipts are given for all money received and expenditure incurred. The manager admitted that the planned programme of formal supervision for staff has still not been implemented. This remains an outstanding requirement from the previous inspection. It is possible that enforcement action will be taken to ensure that the breach is complied with. It is important that staff have a regular formal time of discussion so that they can review progress in their work and identify any training and development needs and review their practice and discuss the homes’ policies and procedures with a focus on Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 24 improving and achieving good outcomes for people using the service. Four staff who responded to the Commissions survey said that the manager has never met with them to offer support and discuss their work. Three staff verified that the manager meets with them ‘sometimes’ to offer support and discuss their work. The following additional comments were noted: had two staff meetings but no individual support or supervision with the current manager as yet. The main kitchen was clean and tidy and satisfactorily maintained. The AQAA indicated that the maintenance of equipment was up to date. A sample of records examined verified this. The training matrix indicated that manual and handling and health and safety training for staff were up to date. Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 2 Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement There must be a system in place to ensure that people using the service long term care plans are kept under review and that they fully identify the needs of individuals and explain how the home will meet those needs. This must include detailed guidance for staff to follow in order to adequately support individuals in all areas of their life. There must be a system in place for photographs to be on the care plan documentation for each person to confirm proof of identity. This is to comply with current regulations. Staff must ensure that they speak to people using the service in an appropriate manner. This is to ensure that people’s dignity and human rights are respected. The home must comply with the current regulations and ensure all the necessary documentation as detailed in standard 29 and Schedule 2 of the care homes regulation for older people is obtained before staff commence employment. Consideration must be made for regulation 26 visits to be undertaken consistently. Copies of reports must DS0000023016.V375778.R01.S.doc Timescale for action 20/08/09 2 OP7 17 20/08/09 3 OP18 12 20/08/09 4 OP29 19 20/08/09 5 OP33 26 20/08/09 Rushymead Version 5.2 Page 27 6 OP36 18(2) be available for inspection purposes. This is to ensure that the well-being of people using the service is being monitored and the home is being effectively managed in people’s best interests. The home must develop a formalised 30/08/09 supervision framework. This is to ensure that staff are appropriately supported and supervised. This is an unmet requirement of the previous inspection and a new timescale has been set. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rushymead DS0000023016.V375778.R01.S.doc Version 5.2 Page 28 Care Quality Commission South East Citygate Gallowgate Newcastle upon Tyne NE1 4WH National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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