Inspection on 01/04/10 for Sandhurst Lodge

This inspection was carried out on 1st April 2010.

CQC found this care home to be providing an Poor 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sandhurst Lodge 29/04/10

Sandhurst Lodge 01/12/09

Sandhurst Lodge 05/11/09

Sandhurst Lodge 23/10/09

Sandhurst Lodge 13/10/09

Sandhurst Lodge 02/10/09

Sandhurst Lodge 22/04/09

Sandhurst Lodge 23/04/08

Sandhurst Lodge 30/04/07

Sandhurst Lodge 20/09/06

Sandhurst Lodge 27/06/06

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Sandhurst Lodge 58 Ampthill Road Bedford Bedfordshire MK42 9HL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Geary     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Sandhurst Lodge 58 Ampthill Road Bedford Bedfordshire MK42 9HL 01234352051 F/P01234352051 sandhurst_lodge@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Surinder Kumar Gulati Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: Date of last inspection Brief description of the care home Sandhurst Lodge is a care home registered to accommodate up to 10 people whose primary care needs on admission fall within one of the following categories: old age, dementia, mental disorder (excluding learning disabilities) and physical disabilities. The home is located on a busy main road in the heart of Bedford town within close proximity to the local hospital, and amenities including transport links. The accommodation is set out over three floors - accessible via a staircase and a shaft lift. All bedrooms are single occupancy and communal facilities include a small lounge and Care Homes for Older People Page 4 of 33 Over 65 10 10 10 0 0 0 2 3 1 0 2 0 0 9 Brief description of the care home lounge/diner on the ground floor. At the time of this inspection, two vacant rooms were being used to provide additional communal space - a quiet room and an activity room. At the time of this visit, work was still in progress to extend the home to create a further 7-8 bedrooms - all with ensuite facilities. Bedrooms in the older part of the home do not have ensuite facilities. A new enclosed garden/sitting area has been created to the side of the property. Information about the home is available within the Statement of Purpose (SoP) and Service User Guide (SUG). Both are available within the home along with a copy of the most recent inspection report for this service. The SUG states that the fees for the home at the current time are £457.06 per week upwards. 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: zero star poor 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: Sandhurst Lodge is a care home registered to accommodate up to 10 people. At the time of this inspection, there were only 5 people living in the home and an embargo on new placements funded by Bedford Borough Council, had been in place since 24th July 2009. A key inspection is a thorough type of inspection when we look at all of the key aspects of a service. For this key inspection, we looked at all the information that we have received or asked for since the last key inspection of this service on 1st December 2009. This included surveys which we sent to the home to give out to people who live there, relatives and the staff. We received 3 surveys back from people living at the home, 10 from members of staff and 1 from a relative, carer or advocate. Care Homes for Older People Page 6 of 33 We looked at notifications that we received from the home. This is information about the service that the home has to tell us about by law. We also looked at information that we asked the home to send us before our visit. This included a response to our December 2009 inspection report requirements, a response to a request for an Improvement Plan, and an annual quality assurance assessment (AQAA) for the home. An AQAA is a self-assessment that focuses on how well outcomes are being met for people using a service. The information that we received did not provide us with the necessary assurance that the provider had a good understanding of his legal responsibilities and obligations for carrying on a care home. We carried out an unannounced visit to the home on 1st April 2010 which lasted around 8 hours. During the visit to the home we met most of the 5 people who currently live there. Some people were able to talk about what it is like to live at the home. Some people did not use words to communicate, so we observed the way that the staff were supporting them. We also looked at some of the paperwork that the home has to keep such as care plans, risk assessments, medication charts, staff records, menus and health and safety records. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: People told us in the surveys that the home would be better if it could provide a better and more structured learning and entertainment programme - including some external activities and outings, more movies on the TV, and more dancing. Some people thought there should be more training available for everyone working at the home. In our last inspection report for this home, we said that they had failed to respond swiftly to contractual arrangements and regulatory requirements which had resulted in a significant amount of intervention from us and the Council. We reminded the registered provider that he needed to be fully aware of his legal responsibilities as registered provider and warned that if things did not improve, we would consider taking enforcement action. Despite some improvements being found during this inspection, we still have a number of concerns about the way the registered provider is Care Homes for Older People Page 8 of 33 carrying on the home. For example, there was evidence that the home had registered with Companies House as a limited company but had failed to make an application to the Commission to reflect the fact that another person was carrying on the home. In addition, we were once again concerned about the way in which the home was supporting people to manage their personal finances and made a referral to the Councils Safeguarding of Vulnerable Adults (SOVA) team following the inspection. In the last year the Commission has carried out 7 inspections of the home which have resulted in 3 Immediate Requirement notices being issued and a warning letter being sent to the provider. This amount of intervention raises serious questions about the fitness of the registered provider and we are currently taking further advice regarding possible enforcement options. We will be formally asking the registered provider for Sandhurst Lodge to tell us what he is going to do to address our concerns. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some useful information has been produced for prospective service users, but more detail is required to ensure people have the information they need to make an informed choice about where to live. Evidence: The Statement of Purpose for the home had been updated shortly before this inspection. Once again it provided some useful information, but it still lacked sufficient detail about the specialised services offered by the home to meet the variety of needs of the people that it currently accommodates, and for people that it is registered to provide a service to. This includes people with dementia, mental health needs, people with a physical disability or a learning disability, people with an alcohol dependency or issues associated with ageing and death. Some of the information provided did not reflect current up to date good practice. And although we found evidence during our inspection that the manager had been working Care Homes for Older People Page 11 of 33 Evidence: hard to try to address these concerns, we did not see evidence of the providers commitment in supporting her to achieve this, or to review the type of services to be offered by the home in the future. We wrote about this in our last inspection report for this home and also sent a letter to the registered provider about it in February 2010. Despite this, there was evidence that people living in the home were being well cared for and that staff understood their particular needs well, and were meeting these. It should be noted though that the home is not operating at full capacity as there were only 5 people living in the home at the time of this inspection. The homes Service User Guide had also been updated, and we were provided with a copy during the inspection. In our last inspection report for this service, we said that the Service User Guide contained some useful information. We also said that the Service User Guide had only been produced in a standard format and that it did not contain all the required information. This was still the case on this inspection and some of the information relating to the Commission was factually incorrect. There had been no new admissions since the last key inspection. But there was evidence that peoples needs are assessed prior to moving into the home, and that information gathered through the assessment process is kept under review and updated. Sandhurst Lodge does not provide Intermediate Care at the current time. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and helped to be independent, but where personal and health care support is required, this is provided in a respectful and dignified way. Evidence: A key worker system was in place and there was evidence that care plans had been written recently, and were being reviewed and updated regularly. Plans that were looked at provided some clear information for care staff to help them to meet peoples needs. We spoke to staff who were able to confirm that they understood the needs of the people currently living in the home. There was evidence that people were involved in care planning and review processes whenever capable, and/or their representative(s). Daily records were being maintained and entries were appropriate and respectful detailing information about the personal, health and social care being provided to each person living in the home. Care Homes for Older People Page 13 of 33 Evidence: The was evidence that the manager had supported people living in the home to maintain their health through a number of referrals to specialist health care services and other relevant professionals. Appropriate records regarding health care checks and interventions were being maintained. There was evidence that the home supports people to maintain their independence as far as possible and ultimately their dignity. There has been a notable improvement in the number of notifications about events affecting the wellbeing of people in the home, being received by the Commission, since the manager started working in the home in November 2009. The home was supporting people to monitor their weight but the manager confirmed that at the time of this inspection, they did not have the equipment to monitor the weight of anyone with a physical disability, if they were unable to weight bear. It must be noted that all of the people living in the home at the time of this inspection, were able to weight bear. No significant concerns regarding medication were noted during this inspection. Appropriate storage was in place and administration records were being maintained and were up to date. There was evidence that manager had been discussing arrangements for after death with people living in the home, and that she was making arrangements for a local funeral service to talk to people (particularly those without family) about their preferences should they wish to do so. Care Homes for Older People Page 14 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. Significant improvements have been made in this area. And as the home is not operating at full capacity, people currently living in the home are benefiting from an increase in communal space as well as having the opportunity to spend individual time with staff. Evidence: In the past we have reported concerns about the limited amount of communal space in the home. Since then, the home has been extended providing a new open plan lounge/dining area. At the time of this inspection, the existing lounge was also in use and being used as a TV lounge, and two vacant bedrooms were being utilised to provide a quiet area for people to meet with relatives/friends and an activity room providing four communal rooms in total. We observed the 5 people living in the home using all of these areas - some watching TV, some listening to music and/or taking part in activities. Activities included looking at some 1960s reminiscence cards of famous people/films which were on loan from the local library, folding laundry, playing table top games and spending individual time with staff. People appeared to be enjoying the space and time spent with them and there was a more relaxed atmosphere in the home. Care Homes for Older People Page 15 of 33 Evidence: The manager had started to make arrangements for external entertainers to visits the home, and a singer has already visited and was booked for a further two visits before the end of the year. Records indicated that the first visit had been enjoyed by people living in the home. There was still limited evidence of (everyday) activities being organised for people who have dementia, aside from folding laundry. But the manager had started work on a structured activity timetable and this was discussed with her again. She told us that she was planning to include things such as laundry folding, ball games, gentle exercise, music console, dancing, movie night, reminiscence, board games, painting and reading and writing in activity programme. Surveys sent out to the home and received back by the Commission prior to the inspection, included confirmation that people wanted more dancing and movie nights to be organised. Despite the activity programme not yet being in place, records showed that regular activities such as playing with a soft ball, watching TV, dominoes, drawing, talking to staff, playing cards, reminiscence activities, walking round the garden and listening to music were taking place. Of the two people case tracked during this inspection, one person was taken out almost daily by a relative and the other did not enjoy new activities and this was recorded as such in their care plan. The manager told us that she was making a referral to a befriending service on behalf of someone who did not have any family. Concerns about the person becoming socially isolated had been raised during a recent review of their needs. One person living in the home was attending day care each week and this had recently been increased to 3 days a week. There was evidence that the person benefited from this, and from 1:1 attention with staff as they can become disruptive without appropriate stimulation. During this inspection, staff were able to give the person in question lots of individual attention, so disruption to other people living in the home was minimal. Records indicated that another person sometimes had trouble sleeping. We saw evidence that staff supported the person to sit with them during the night and to have a drink or snack. The person in question was also supported to go back to bed in the morning when they were tired, indicating that the homes routines were flexible around the needs of the people living there. Previous reports for this home have included concerns about the lack of choice at meal times and insufficient recording of the food being prepared and eaten. On this Care Homes for Older People Page 16 of 33 Evidence: occasion we were told that the registered provider did the food shopping for the home on a weekly basis. Four-weekly menus were now in place - providing a choice at each meal. There was evidence that people were being asked each day what they would like to eat and this was being recorded. A record of food actually eaten was also being maintained. Four large bowls of fruit were seen in the new dining area, and drinks were provided throughout the day. We were able to observe the evening meal which consisted of a choice of sandwiches or beans on toast. It was unhurried and people were able to choose where they ate. One person chose not to come to the new dining area at all. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are dealt with appropriately, but systems for managing peoples money and financial affairs are not clear and need to be much more transparent if peoples financial interests are to be protected. Evidence: One complaint had been received from someone living in the home and there was evidence that this had been dealt with positively and appropriately by the manager and staff team. Actions that had been taken as a result, had been clearly recorded. In our report dated 22nd April 2009, we included concerns about the management of one persons personal finances. During this inspection we had similar concerns. There was a lack of up to date information available about another persons financial incomings and outgoings, and we were told that these were being dealt with by the providers wife. The care plan for the person in question confirmed this and stated that records would be kept regarding income and expenditure, but this was not the case. We did see some personal finances for the person in question, which were being kept in the home and included corresponding records and receipts - which all tallied. We also saw a bank statement in the persons name for the period from 30.9.09 to 6.11.09, which showed money being taken out. But there was no money going into this account and there were no records to show what the money had been taken for. This was the most up to date information we found regarding any savings. There was Care Homes for Older People Page 18 of 33 Evidence: an old statement for a building society (2004) and some direct debit information about care and board between the person and the provider for 2008. We were not able to find evidence of the persons benefit entitlements (if any) and if these were being received by them. Nor were we able to establish if they had any other accounts/monies/valuables. The manager told us that she only dealt with personal allowances (monies kept in the home). After the inspection, we made a referral to the Councils safeguarding of vulnerable adults (SOVA) team about our concerns. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this area. And as the home is not operating at full capacity, people currently living in the home are benefiting from an increase in communal space. Evidence: At the time of this inspection, there were only 5 people living in the home. And an extension to add a further 7-8 bedrooms had almost been completed. We saw part of the new extension on this occasion - a new lounge/dining area. It had been completed to a high standard, but there was no evidence that the home had considered good practice guidance in relation to the design and layout of the new extension as a whole - for people who may have dementia. We noted that some of the vacant rooms on the ground floor had been utilised to create some additional communal space. In total there were 4 rooms being used, but we were told that 2 of these rooms were intended to be used as bedrooms eventually. One of the rooms which will remain as a communal room was being used as a lounge/TV room. However this room will also provide access to the new part of the building; so consideration must be given as to how this room will be used in the future, as it is likely to be quite a busy and noisy area if the number of people living in the home increases. Care Homes for Older People Page 20 of 33 Evidence: Improvements regarding outside space were also seen, with an enclosed area to the side of the property for people wishing to smoke or sit outside. Flowers had been planted in at least one of the borders seen and seating was available. Despite the increase of communal space on this occasion, we observed one person who has dementia who came to sit by another person who was trying to watch the TV. The person with dementia was grinding their teeth throughout. The other person told us that this was a constant source of irritation to them but felt that there wasnt any thing that they could do. We wrote about a similar situation in our 1st December 2009 key inspection report. So observations from this inspection once again raise concerns about the compatibility of some of the people living in the home, and the homes ability to meet a variety of needs within the same building. Aside from this, there was evidence that people were benefiting from the additional space due to the current low occupancy rates (see also daily life and social activities section of this report), and we found the home to be warm, comfortable and clean. Care Homes for Older People Page 21 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made with regard to providing training for staff to support them in meeting the needs of the people living in the home. However improvements that had been made with regard to recruitment and vetting checks, have not been maintained - placing people in the home at risk. Evidence: We have previously reported concerns about staffing levels in the home and we asked the provider to risk assess these after our last key inspection in December 2009. The information supplied to us did not take into consideration the future of the service including the building layout, any increase in the number of people living in the home, compatibility of people living in the home and/or the variety of needs that the home caters for. However, at the time of this inspection there were only 5 people living in the home. And rotas showed that there were 2 staff on each morning and afternoon, with 1 waking and 1 sleep in person at night. The manager was not included in these numbers. There was evidence that this was sufficient for meeting the needs of the people living in the home at the current time. During this inspection we observed some very positive interaction between the staff on duty and people living in the home. Staff genuinely seem to care about the people Care Homes for Older People Page 22 of 33 Evidence: they are supporting and have a good understanding of their needs and preferences. The manager confirmed that no new staff had been taken on since our last key inspection in December. However, rotas indicated that family members of the provider were now working some care shifts. There was little or no evidence of recruitment/vetting checks for the family members. We left an immediate requirement about recruitment checks during a random inspection of the service in October 2009. This had been complied with at the time, so it was disappointing to see that standards had slipped again. We were given verbal assurance at the end of the inspection that this deficit would be remedied quickly. However at the time of writing, we had not received confirmation of this. There was evidence that someone providing aromatherapy sessions to the people living in the home had a satisfactory CRB disclosure in place. The manager confirmed that there was still no training matrix at time of this inspection, although progress was being made regarding booking relevant training for staff such as medication administration, SOVA (safeguarding of vulnerable adults), and training regarding dementia care and supporting people who have a learning disability. Mental health training had been found but not yet organised and the manager confirmed she was also looking to provide some training around bereavement issues. Staff who were spoken to were positive about working in the home and the changes being made by the new manager. They were positive too about attending more training. Further training to meet the needs of the current people living in the home is still needed in areas such as alcohol dependency, sensory impairment, and issues associated with ageing. In addition, we looked at training records for 5 staff working in the home at the time of this inspection, and could find no evidence that any of them had received training about the Mental Capacity Act (MCA) 2005, or how the MCA deprivation of liberty safeguards affect their work. Care Homes for Older People Page 23 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although improvements have been made and compliance is eventually achieved, this is reactive and not proactive. Systems that are in place are not adequate to ensure that improvements are sustained or that a consistent level of service for the people who live in the home is maintained - raising serious questions about the fitness of the registered provider. Evidence: In our last inspection report for this home we said that the home had failed to respond swiftly to contractual arrangements and regulatory requirements which had resulted in a significant amount of intervention from us and the Council. We reminded the registered provider that he needed to be fully aware of his legal responsibilities as registered provider and warned that if things did not improve, we would consider taking enforcement action. During this inspection we did see a number of improvements and found that people Care Homes for Older People Page 24 of 33 Evidence: living in the home were being well cared for and that staff understood their particular needs and were meeting these. It was clear that the manager and staff had been working hard to improve care plans and other records, and the amount of communal space and activities on offer had increased because of the current low occupancy rates, the number of vacant rooms and the ratio of staff to people living in the home. There was evidence that the manager had also made progress regarding introducing a quality assurance system and providing more training for staff. She had also begun the process of applying to register as manager of the home. However we have some significant concerns about other things that were mainly outside of the managers control. These included: 1.The registered providers response to our 1st December 2009 key inspection report requirements and our subsequent Improvement Plan request. The information that we received did not provide us with the necessary assurance that the provider had a good understanding of his legal responsibilities and obligations for carrying on a care home. Nor did it convince us that the staff working in the home have sufficient expertise and skills to manage the variety of needs that the home is currently registered to provide for. We have written to the provider about our concerns on more than one occasion now. 2. Evidence that there has been a change of provider (from an individual to a limited company) for the home, without informing the Commission (CQC). This means that potentially, the home is being carried on by an unregistered provider and may not have adequate insurance arrangements in place. It is also a legal requirement that a service is appropriately registered with the Commission. An Immediate Requirement notice was left about this during this inspection. 3. Concerns about the homes financial viability given the fact that there were only 5 people living in the home, and the Councils embargo on further admissions to the home remains in place. Earlier requests for information about the homes financial status have only been met in part, or have failed to provide evidence that the home is financially viable. An Immediate Requirement notice was left about this too. 4. There were insufficient records about the financial incomings and outgoings for 1 person living in the home. After the inspection, we made a referral to the Councils Safeguarding of Vulnerable Adults (SOVA) team about this because we had previously had concerns about the management of peoples monies, which we reported on in our 22nd April 2009 report. Care Homes for Older People Page 25 of 33 Evidence: 5. And there was insufficient evidence of recruitment checks for family members of the registered provider, despite them working some care shifts. We issued an Immediate requirement about the homes recruitment practices in October 2009 (see also staffing section of this report). In the last year the Commission has had a significant amount of input into the home. For example we have carried out 3 key inspections, 4 random inspections, issued 3 Immediate Requirement notices, issued a warning letter, met with the provider to discuss the Commissions concerns and position, sent letters to the unregistered manager and provider about the manager needing to apply for registration, sent a detailed letter to the provider in response to his inadequate response to our requirements from the 1st December 2009 key inspection report, and requested an Improvement Plan. This amount of intervention raises serious questions about the fitness of the registered provider and we are currently taking further advice regarding possible enforcement options. There was evidence that the provider had taken on a consultant to help to improve the home since our last inspection, but they had not stayed long. Since April 2009 the home has had 5 different managers. None of whom have applied to be registered with the CQC. It is an offence under section 11 of the Care Standards Act 2000 for a person to manage an establishment or agency without being registered with the Care Quality Commission (the CQC) in respect of it. We wrote to the registered provider and the current manager who started working at the home on 23.11.09, about this on 17.2.10. During the inspection on 1.4.10, there was evidence that the manager had begun the process of applying to register as manager, but had not yet submitted her application form. The manager confirmed that there was no one subject to a (Mental Capacity Act 2005) deprivation of liberty authorisation at the time of the inspection and no issues of concern in relation to this were noted at the time of this inspection. In our last inspection report for this home we wrote that: We saw 1 person coming and going independently from the home to a local shop. They did not have a key and had to wait to be let out of the home by staff and let back in again. There appeared to be a limited understanding around restraint issues in the home and the practice that we observed was focused on keeping other people in the home safe rather than prioritising the individual human rights of the person wanting to go to the shop. On this occasion the manager confirmed that the person in question had been provided with a key to the home, and that they were also investigating a key-less lock, in consultation with the local fire authority. Care Homes for Older People Page 26 of 33 Evidence: There was evidence that the manager had just started to introduce satisfaction questionnaires for people living in the home and their families. Regular internal audits were also taking place with regarding to checking things such as medication and health and safety matters. We did see some recent correspondence in the home from relatives of people who live, or have lived in the home. One card read: you showed (this person) a lot of love, kindness and patience. A questionnaire about someone else living in the home read: she appears quite settled and content, and another letter said: Im glad mum is looking so well. Thanks for your help. We were able to speak with people living in the home, staff and a relative of one person, during this inspection. A number of positive comments were made about the new manager and people felt that she was making a difference to the home. It was said that things were more stable and changes being made were good changes. Records and discussions with staff confirmed that supervision sessions for staff, and staff meetings, were now taking place on a more regular basis. Although, the manager confirmed that she was not supervising family members of the registered provider who were also working in the home. This situation needs to be regularised to ensure that all staff working in the home are treated equally and that systems such as recruitment checks and training are applied consistently. We saw the homes accident book and noted that appropriate entries had been made and incidents dealt with properly. A new kitchen was in use in the new extended apart of the home. In our last report we wrote that: The local Environmental Health Authority (EHO) had inspected the home on 5.11.09. They had made some recommendations which appeared to be in hand. There were plans for the EHO to revisit the home once the building works had been completed as there were plans to move the kitchen which needed to be reinspected. On this occasion the manager confirmed that the EHO had not been notified about the completion of the works and she was advised to do this as soon as possible. There was evidence that the manager was carrying out monthly audits to promote the health, safety and welfare of people living in the home and the staff. The audits included checks on water temperatures, fridge/freezer temperatures, food temperature monitoring, medication, the homes fire alarm and emergency lighting Care Homes for Older People Page 27 of 33 Evidence: systems and first aid boxes. We also saw risk assessments on file that showed that the manager was assessing the safest way of working with people in the home and assessing potential risks as they occurred. 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 34 25 The homes business and 19/01/2010 financial plan for this, and the next financial year, must be provided to the Commission. To satisfy us that the home is financially viable for the purpose of achieving the aims and objectives as set out in its Statement of Purpose. 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 1 31 7 There was evidence that 17/04/2010 there has been a change of provider for the home from Dr Surinder Kumar Gulati to Care Guru Ltd. There was no evidence that Care Guru Ltd has applied to the CQC for registration, or that you have applied to have your provider registration cancelled. The concerns are that the home is being carried on by an unregistered provider. As well as this being an offence under the Care Standards Act 2000 and associated regulations, the insurance arrangements for the home (including legal liability cover) may be at risk. You must write to the CQC and confirm if/when an application to cancel your registration, and an application for a change of registered provider, has been submitted to the CQC. You must also provide confirmation that there are adequate insurance arrangements in place for the home given the current situation. This verification must be provided by the insurance company in question. To clarify who is carrying on the home and that there are clear lines of accountability in place. Care Homes for Older People Page 30 of 33 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 2 34 25 There are concerns that the 19/04/2010 home may not be financially viable for the purpose of achieving the aims and objectives as set out in its Statement of Purpose. Under the provisions of the Care Standards Act 2000 and associated regulations, you must provide the CQC with the following: The annual accounts for the care home certified by an accountant. These must include everything included in regulation 25 (3) (b) of the Care Homes Regulations 2001. A reference from your bank expressing an opinion as to your financial standing as the current registered provider for the home. Information as to the financing and financial resources of the care home. A certificate of insurance for the (current) registered provider in respect of liability which may be incurred by him in relation to the care home in respect of death, injury, public liability, damage or loss. To ensure people living in the home are safeguarded by the accounting and financial procedures of the home. Care Homes for Older People Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 17 Up to date records for all 19/04/2010 monies and valuables managed on behalf of people living at the home must be maintained and available at all times - to include any bank accounts and all incoming and outgoing payments. To ensure that service users monies and financial interests are safeguarded. People must not be allowed 19/04/2010 to work at the care home unless full and satisfactory information is available for each of the matters specified in Schedule 2 of the care home regulations 2001, before they start working in the home. To ensure that people living in the home are protected and not placed at risk by the homes recruitment policy and practices. 2 29 19 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!