Inspection on 22/04/09 for Sandhurst Lodge

This inspection was carried out on 22nd April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 01/04/10

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 23/04/08

Sandhurst Lodge 30/04/07

Sandhurst Lodge 20/09/06

Sandhurst Lodge 27/06/06

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Claremont House

Sun Court Nursing Home

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Dolphin Court

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Wakes Hall

165 Putnoe Lane

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sandhurst Lodge 58 Ampthill Road Bedford Bedfordshire MK42 9HL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Geary     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 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): Type of registration: Number of places registered: Dr Surinder Kumar Gulati 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 accomodate 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, amenities including transport links. The accommodation is set out over three floors - accessible via a staircase and a shaft lift. 0 0 0 Over 65 10 10 10 Care Homes for Older People Page 4 of 35 Brief description of the care home All bedrooms are single occupancy and communal facilities include a small lounge and dining room on the ground floor. There is one assisted bath and one shower, which would not be accessible for people with a physical disability. There are no ensuite facilties and there is limited outside space. At the time of writing, work had begun to extend the home to create a further 7 bedrooms and more communal space. It is hoped that this will also include a small sensory garden. 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. Fee information within the SoP and SUG differs with the SoP stating that fees start from £457.06 per week and the SUG records fees as starting from £425 per week. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: 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 inspection of this service on 23rd April 2008. This included surveys which we sent to the home to give out to the people living there, their representatives, staff and health professionals. We received 4 back from people living at the home, 3 from relatives, 5 from members of staff and 1 from a health professional. We looked at notifications that we have received about 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 and following Care Homes for Older People Page 6 of 35 our visit. We carried out an unannounced visit to the home on 22nd April 2009 which lasted about 8.5 hours. During the visit to the home we met most of the people who 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 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. What the care home does well: 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 35 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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 in order to give people the information they need to make an informed choice about where they live. Evidence: Information about the home has been produced in the form of a Service User Guide (SUG) and a Statement of Purpose (SoP). Both are available within the home along with a copy of the most recent inspection report for this service. Although both the SoP and SUG contain some useful information for prospective service users and their representatives, evidence from this inspection showed that some of the information within these documents is not completely accurate. For example statements about the home offering a wide range of menus and about the environment being a good decorated home. The SUG also does not contain all the required information at the current time. Care Homes for Older People Page 11 of 35 Evidence: There was nothing specific in the SoP about how the home provides for the needs of the people that it is registered to look after. Sandhurst Lodge is registered to provide personal care and accomodation for up to 10 people whose primary care needs on admission fall within one of the following categories: old age, mental disorder, dementia and physical disabilities. If a home says it provides for the needs of people in any of these categories, it should make clear in the SoP exactly how this is done. It should also make clear about the arrangements for accomodating people who dont have dementia with people who do. Many people with dementia can be properly cared for in an older persons care home however, providers need to show they have thought about the possibility of conflicting needs and how these are to be managed. To date, the SUG and SoP have only been produced in a standard format. The manager said that large print could be arranged. and that they are also aiming to produce information in different languages. 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 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are treated with respect and dignity, but the homes medication practices are not satisfactory and could result in people being placed at risk. Evidence: Service user files were organised and care plans were in place which recorded the health, personal and social needs of each person. The homes approach was person centred with reminders for peoples birthdays seen and important information about peoples lives before they came to live at the home, known. A key worker system was also in place. There was no photograph on file for one person, but the manager said that this was being arranged. Care plans did not always link to other information held on file. For example the care plan for one person did not include specific information about their aggressive outbursts, but these were referred to in other paperwork that was found. The home Care Homes for Older People Page 13 of 35 Evidence: must make sure that care plans sign post staff to the most up to date information to ensure that this is available quickly, and also to ensure consistency of care is provided. The manager said that people read and sign their care plans if they are able to do so. Otherwise their representatives are involved. The manager had only worked at the home for about 7 months but there was evidence that she had made a number of referrals to health professionals since coming into post, on behalf of people at the home. During the inspection one person was supported to go to a routine appointment. Another person spoke about the manager spending time with them looking up information on the Internet. This was to try to support them in coming to terms with a recent diagnosis following a referral concerning their health. Staff were observed to support this person in a gentle and dignified manner when they became upset. Due to a lack of storage, there are no sit on scales in the home, so it has not been possible for the home to monitor the weight of one service user who has a physical disability. The manager said that sit on scales will be purchased once the building works are complete (an extension is in the process of being built). There was evidence that risk assessments are carried out when things happen in the home and that appropriate actions are taken regarding health care concerns. One person was being supervised by staff when drinking hot drinks incase of an injury caused by a spillage. The person in question was able to say that they were happy with this arrangement and that it did not infringe on their right to privacy. Medication recording (MAR) sheets were seen for the previous month which showed several gaps in medication administration. There was no evidence of advice/action being taken for some of the apparently missed doses. Sometimes reasons for the gaps were not recorded at all. It was not always clear what was PRN (as required) medication on the sheets, so it could appear as if some medications were not being given as prescribed. In addition, information about the purpose of medication was not included in care plans so administering staff may not be fully aware of the reasons and importance of giving each medication. When asked about the gaps on the MAR sheet, the manager said that the medication Care Homes for Older People Page 14 of 35 Evidence: had been administered, but that further action including training, was to be taken with regard to the staff involved. The manager also said that she regularly checks medication records and that this was the first time that this has occurred. However as the errors had occurred on several occasions over different days there was little evidence of there being sufficient systems in place to prevent a re occurrence. Care Homes for Older People Page 15 of 35 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. People living at the home are supported to maintain contact with their friends and families, and are given opportunities to participate in recreational activities. However the home needs to make sure that the activities provided suit the needs, preferences and capacities of the people living there - particularly those with dementia. Evidence: During the inspection, one person living at the home was out at day care, another was visited by a relative and another had a meeting with a local advocacy service arranged by the manager. On arrival at the home, a number of people were sitting in the lounge. The television was on but most were not engaged with this. The majority of people living at the home have dementia. The care staff on duty were observed trying to do their best to provide activities for people during the day, but they also had to provide personal care, maintain records and prepare all meals and drinks. The manager supported the staff as much as she could. Care Homes for Older People Page 16 of 35 Evidence: The manager said that she was planning to take some of the people who live at the home out clothes shopping, and wanted to organise further trips out from the home in the future. Some people do go out regularly, but this tends to be with friends and/or family. The manager also said that she was looking at increasing the amount of entertainment that is provided in-house (currently every 3 months) including visits from local places of worship. And she hopes to employ an activity organiser and provide a separate activity room once the building works are complete (see environmental section of this report). Newspapers are purchased for service users as requested. Some of the activities provided in-house are not particularly tailored for people with dementia. For example the activity chart for the week included arm chair exercises, dominoes, news of the day, bingo and jigsaw puzzles. Although reminiscence sessions were also included, there was little evidence of activities designed to provide people with a real purpose. People were observed during the inspection not wanting to join in with the table top games provided. No activities are planned at the weekends. Records showed that some people are encouraged to help fold away laundry but there is limited access to the kitchen for people wanting to prepare food and drink. The activity records for one person recorded: exercises as per physio instructions. There was limited evidence that any other activities had been carried out in that week and as this is more of a health need, it cannot really be described as an activity. Another persons activity chart recorded their weekly activities as: arm chair exercises once, reminiscence twice, day centre and folding laundry once. Little consideration had been given to the people living in the home for the duration of the building works. For example the noise caused by the builders was loud and constant for almost 4.5 hours on the day of the inspection. We were told that this was not the first time that the noise had been at this level. Some of the people living in the home were visibly distressed, and those able to, said how noisy it had been. The homes Statement of Purpose (which was reviewed in March 2009) sets out with regard to the building of the extension: No disruption to Sandhurst Lodge itself until at the last stage, which should be in approx. 5 months time. The Management will keep everyone updated regularly. This was clearly not the case on the day of the inspection with the noise levels seriously impacting on the home and its users. It is not clear what updates from the management regarding the disruption will achieve given the needs of some of the people living there. No arrangements were in place to Care Homes for Older People Page 17 of 35 Evidence: take people out if they wanted to get away from it all. This is a significant oversight particularly given the detrimental effect that noise can have for some people with dementia. One person was heard asking to go out during the inspection. After the inspection the manager said that the noise levels had since decreased, and that she had spoken to the builders about carrying out noisy work for short periods of time only. She also said that the homes owners had agreed to provide an additional member of staff for 2 hours at such times, to take some of the people living at the home away from the home for short breaks. Contact with families and representatives is encouraged, and findings from this inspection shows that this hapens in a number of ways. These include meetings at the home, notice board information and verbal communication. The manager said she hopes to start a newsletter for the home in the future. There was a large wipeboard in the dining room which had the menu for the day written on it. Copies of previous menus were requested but not provided as the home does not appear to keep paper records. It is a regulatory requirement to keep records of the food provided. The menu for the day was mashed potatoes, mixed vegetables, chicken in gravy and fruits in jelly for pudding. There was no choice and there was nothing on the board for tea. We were told that people choose what they would like to have for tea. At tea time the manager went round and gave people a choice of sandwich. The home does not employ a cook, and care staff prepare all meals and drinks. The manager said that she hopes to employ a cook once the building works are complete as there will then be up to 17 people to cater for. She also hopes to provide a choice of meal in the future. Some new example menus were seen during the inspection that she had already begun to work on. Care Homes for Older People Page 18 of 35 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. Systems are in place regarding complaints and protection. But some of the homes practices need to be improved to demonstrate that peoples legal rights are being considered and upheld. Evidence: The homes complaints procedure is set out in the Service User Guide and Statement of Purpose. The manager told us that no complaints had been receieved by the home since the last inspection. A number of compliments have been received. A suggestions and comments box is located by the front door for people to use as they wish. On arrival at the home, the front door was locked and one of the people living at the home was trying to open it but couldnt. We were told that the door was locked because of the building works going on outside and the fact that the home is situated on a busy road. The back door is unlocked sometimes, but this is accessed through the kitchen, and if staff are not in the vicinity, then the kitchen door is also locked meaning that people living at the home cannot come and go freely. Although this standard (about peoples legal rights) was not inspected in detail on this occasion, there was insufficient evidence in the care plans seen, to show that all restrictions of liberty were being recorded. If a care home thinks they need to deprive Care Homes for Older People Page 19 of 35 Evidence: a person of their liberty they need to follow an assessment and decision-making process that meets the Mental Capacity Act Code of Practice Guidelines, and ensure that this is recorded in the persons care plan. Disciplinary proceedings were underway regarding an allegation made about a member of staff and their behaviour towards someone living at the home. Appropriate action had been taken in response to the allegation, however there had been a delay in the incident being reported in the first place. The manager said that additional training regarding safeguarding of vulnerable adults (SOVA) was to be provided to the staff members in question. Care Homes for Older People Page 20 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home do not live in a safe and well-maintained environment. Evidence: At the time of the inspection, work had begun to extend the home to include 7 more bedrooms and a 2nd lounge. The manager said she hoped to also provide a sensory garden, an activity room and more storage for the home. It was said that all of the new bedrooms would have ensuite facilities including showers. The existing bedrooms only have handbasins. There are 2 bedrooms currently on the ground floor but there are no bathing facilities at this level. There is one bathroom, with a small assisted bath on the first floor and a shower, not suited for people with a physical disability, on the 2nd floor. The bathing facilities were not homely or inviting - with mops being stored in the bathroom and stained flooring, mould, and a missing tile seen. In addition, a separate staff toilet had no hand towels - presenting a number of potential infection control issues overall. One person living at the home had not had a bath or shower since they had moved in a few months earlier. The person had a physical disability and it was said that there were no bathing facilities at the current time that could meet this persons needs. When spoken to, the person said that they would like to have a shower. It was not clear why this had not been provided as a priority. Care Homes for Older People Page 21 of 35 Evidence: The existing part of the building had seen better days with regard to the decor, fabrics and furnishings. The manager said that there were plans to revamp this part of the home once the work to the extension had been completed. She also said that the people currently living at the home would be given first choice of the new bedrooms. For this reason, a complete environmental audit was not undertaken, but things seen during a tour of the building included: damaged/broken window fixtures, mould, stained toilet/bathroom flooring, urine odour in 1 bedroom, 1 bedroom with no lampshade, linoleum flooring covered with drips of paint, a jug under the sink and incomplete boxing in of pipework, a lack of adequate communal space, lack of useable space in bathrooms for people with poor mobility or a physical disability, a missing headboard in 1 bedroom, small fluorescent type lights over beds - not all of which worked, and carpet coming away on the stairs - presenting a tripping hazard. In addition, there were no window restrictors in place for one bedroom on the first floor. The room was vacant and when it was suggested that the door be locked because of the risk posed, it was not possible to do so because the key could not be found. The door did not close properly, presenting a further potential fire risk. As stated above, there was limited available communal space for people living in the home with only a small lounge and a dining room provided. There was no garden as such - just a small area to the side of the home which people could use if the exits for the home were not locked. This area was not enclosed and opened out onto a busy road. One service user with a hearing impairment, was seen trying to listen to music in the dining room, but due to a lack of available space, there were several other people in the room at the same time. A phone had been placed directly in front of the person in question, which was heard to ring. The dining room was not at all homely with storage for paperwork and medication in situ. The purpose of the room was therefore not clear and could potentially cause confusion for someone with dementia. The manager said that new storage for the home would be created when the building work was complete. Aside from some laminated pictures on internal doors, no environmental adaptations had been made for people with dementia. And there were plans to increase the size of the building. Care Homes for Older People Page 22 of 35 Evidence: The building would have taken some time to deteriorate to the level described here so it is clear that money has not been invested in the maintenance and upkeep of the home as is required. The was also no evidence that the registered provider was visiting the home to inspect the premises. This is a legal requirement (see management section of this report). The home does not have a designated smoking area, so people are asked to smoke outside. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff team are clearly committed to meeting the needs of the people living at Sandhurst Lodge and a number of improvements have been made in this area. More needs to be done however to make sure that there are sufficient numbers of staff who are trained to meet the assessed needs of the people living at the home, at all times. Evidence: At night, there is currently 1 waking member of staff on duty and 1 sleeping in member of staff. During the day there are 2 care staff in the morning and afternoon, and a domestic member of staff (morning only). The manager is supernumerary for the majority of her hours. The home does not currently employ a deputy manager, cook or activities person. The manager hopes that this will change once the building works are complete. Evidence from this inspection highlighted a need for the staffing levels/arrangements at the home to be reviewed. Some of the things that we found that call for such a review include: an incident which happened at night where a member of staff took inappropriate action to prevent a person living at the home from wandering, the records for 1 person with a physical disability which state that they need 2 people for personal care - day and night, the lack of appropriate meaningful activities for people with dementia - in and out of the home, the noise levels from the current building Care Homes for Older People Page 24 of 35 Evidence: work and the effect of this on the people living at the home, the needs of the service users (the majority of the 9 people living at the home at the time of the inspection had dementia), the layout of the home (arranged over 3 storeys), the fact that care staff have to provide personal care, activities and all meals/drinks, and during the inspection one of the builders was heard to raise the alert that a person from the home was trying to escape . The management section of this report also makes reference to the homes fire risk assessment and staffing levels. Feedback from one of the surveys that we received included a comment about the staff group not being representative of the current group of people living at the home - with regard to race/ethnic origin. This was confirmed by the manager. However, during the inspection there was some good evidence to show that the manager and staff team are very committed to each other and the people living at the home. Feedback received from other sources including a social worker and the district nurse team, confirmed that the care provided in the home has improved since the manager came into post. Staff files were organised and there was evidence that recruitment checks, staff training, staff supervision and appraisals had improved since the manager had come into post. The manager had provided some in-house training and was intending to provide more. She spoke about empowering staff through training so that they could take on more responsibility within the home. Training records were being maintained for staff, but some needed updating. There was limited evidence of training for all staff around the assessed needs of the people living at the home. For example Bi Polar, Parkinsons and Dementia. The manager said that some information was available in the home for staff to read, but there was no evidence that this had happened. One example of this was that although some staff had received basic dementia care training, they did not have sufficient knowledge about providing appropriate activities for people with dementia. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A number of improvements have been made with regard to the management and administration of the home since the new manager came into post. However this inspection has highlighted that there is still work to be done to make all the required improvements. Evidence: The current manager has been working at the home since September 2008. She had not applied for registration with the CQC at the time of the inspection but was in the process of doing so. The manager said that she had completed an NVQ 4 in Care qualification and had started to do the new Leadership and Management Award. It was evident that the manager had been working hard with the staff team to improve standards in the home. New paperwork and systems had been introduced along with staff training, health referrals for people living at the home and improved care practices. Observation showed positive interations between the manager, the staff and the people living at the home. Care Homes for Older People Page 26 of 35 Evidence: Although the manager was busy on the day of the inspection, she remained in control and made time for people as needed. Findings from this inspection show that there is still a lot of work to be done to make all the required improvements, but there is evidence that this is being managed appropriately by the new manager who is working through tasks in a priority order. A number of things appear to be outside of her control and will need to be dealt with by the owners of the home. At the time of the inspection there was no annual development plan for the home. But the manager was in the process of organising satisfaction questionnaires for people at the home as part of the homes quality assurance system. She said that if people were able to, they could complete the questionnaires themselves, otherwise staff would help them to complete these. It was not clear how an independent view of the service could be achieved doing it in this way. However, the manager did submit a completed annual quality assurance assessment (AQAA) to the CQC prior to the inspection which provided some important information about the home. And a number of surveys were sent to the home to be distributed to the people living there, their representatives and the staff. A good number of these were sent back to us. We also looked at some written compliments that had been sent to the home recently. One of these was from a relative of a person living at the home - thanking the manager for keeping the lines of communication open and for showing a good understanding of their relatives needs. Another from the district nurse team noted improvements in the running of the home including a reduction in pressure sores. A person who had originally come to the home for respite care but had since moved in on a permanent basis wrote: You did everything possible to make my stay enjoyable and comfortable. During the inspection one person living at the home offered lots of praise for the manager saying how quick and efficient she was and that she had had a positive impact on them. It was said that they had decided to move into the home after meeting her. A social worker wrote: The level of commitment shown whilst caring for the residents I have placed with you has ensured that some of our most vulnerable older people have been able to regain a sense of purpose and well being. I believe the approach you and your staff use is truly person centred. The manager said that she was carrying out regulation 26 visits. However the Care Homes for Older People Page 27 of 35 Evidence: regulations state that these should be carried out by the registered provider and is a legal requirement. There was no evidence therefore that the registered provider was undertaking checks to ensure that the home was being run in the best interests of the people living there. The managers own checks included the environment, water temperatures and flooring. A number of deficits in these areas have been highlighted within this report. Any repairs to the building are arranged through the owners. At the time of the inspection, monies for 3 of the people living at the home, were being held on their behalf by the home. We looked at the records for one person. We were told that the persons family gives money to the homes owners to manage on their behalf. Records were being maintained on the home computer for this money but although it was said that the money had been deposited into a bank account, there were no copies of any bank records available. Therefore there was no evidence for us or the person living at the home, about any interest that they may have accrued, or any evidence that the money was being managed separately from the homes own bank account. There was no money available in the home for the person in question on the day of the inspection, despite a considerable amount being held on their behalf (according to the computer records). The manager said that the homes petty cash float could be used if required and the owners would then arrange for the money to be repaid at a later date. There was only £40 petty cash however available on the day of the inspection to sub up to 3 service users and cover any purchases required for the home. The manager did not appear to have any control over the homes budget or monies being held on behalf of the people living there. If a person wanted to get hold of their money then arrangements would need to be made through the owners. It was not clear how easy this would be. There was evidence that staff supervision and support had improved since the manager had come into post, and records of meetings were being maintained. Daily records were being maintained and entries that were read were very positive and demonstrated a genuine warmth towards the people living at the home. Risk assessments were being completed. One seen for the use of bed rails did not include the need for regular maintenance checks. but daily records indicated that these did take place. Another risk assessment seen was for the challenging behaviour of one person living at the home. It didnt identify main triggers or de-escalation techniques. A statement had been included about restraint and that under the homes policy it was to be avoided at all times, though at the risk of injury towards staff/other Care Homes for Older People Page 28 of 35 Evidence: residents - staff must ensure safety for themselves and other residents. Records did not make clear if all the staff had been trained properly to do this and what techniques should be used. The manager said that the behaviours had subsided in the past few months. And a behaviour recording chart supported this. The manager said that she had updated the homes fire risk assessment. There was evidence that the fire authority had been consulted as they had replied to query whether there were sufficient numbers of staff available to complete an evacuation of the premises, given the identification of the residents diabilities. There was evidence that regular fire alarm and emergency lighting checks were taking place. Water temperature charts that were seen had not been completed on a regular basis. The most recent entry was for December 2008. Temperatures had been recorded between 30 and 34 degrees celcius. The manager said that this was for the shower as people living at the home did not use the bath. A test carried out on the day of the inspection showed that water temperatures were closer to the required 43 degrees celcius, so it was not clear if there was a problem with the water or the way in which the tests had been carried out. The AQAA stated that products which might be harmful to people living at the home were now being locked away and that regular audits for medication and infection control were being carried out. However, evidence from this inspection shows that some improvements are needed in both medication and infection control. A new accident book had been purchased for the home but it did not meet regulatory requirements. This was discussed with the manager who understood the need for additional information to be recorded. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13(2), 12(1)(a) Care must be taken that medication procedures are followed and that there is documentation to support the procedure. 01/05/2008 Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must make sure that medication records are maintained and up to date for all medication administered by staff at the home. To ensure that service users are protected and not placed at risk. 29/05/2009 2 12 16 Activities provided by the home should suit the needs, preferences and capacities of the people living there. To ensure that people, particularly those with dementia, are given meaningful opportunities for stimulation. 23/06/2009 3 15 17 Records of the food provided 29/05/2009 for people living at the home should be kept. Care Homes for Older People Page 31 of 35 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 To make sure that the diet provided, in relation to nutrition and any special diets, is satisfactory. 4 19 23 The home must provide the commission (CQC) with written information, including timescales, to say how each of the environmental deficits recorded in this report is to be remedied. To ensure that the home is suitable for its stated purpose and meets the individual and collective needs of the people living there. 5 30 18 Training must be provided for all staff working at the home around the assessed needs of the service users. To ensure that people living at the home have their needs met and are in safe hands at all times. 6 31 9 The manager must apply for registration with the CQC. To ensure that she meets the fitness criteria for managing a registered care home. 05/06/2009 14/08/2009 05/06/2009 Care Homes for Older People Page 32 of 35 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 7 33 26 The registered provider 12/06/2009 must carry out visits in accordance with this regulation and supply a copy of reports made from these visits to the CQC until further notice. To promote the well-being of the people living at the home. 8 35 17 Up to date records for monies held on behalf of people living at the home must be maintained within the home. This should include any bank accounts and all incoming and outgoing payments. To ensure that service users monies are safeguarded. 29/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Information for service users and their representatives should be accurate and include all the information set out in this standard. It should also include specific information about how the home provides for the needs of the people that it is registered to look after. 2 8 Nutritional screening should be undertaken on admission and subsequently on a periodic basis, with a record maintained for everybody living at the home which records Page 33 of 35 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations weight gain or loss, and appropriate action taken. 3 4 5 15 17 27 People living at the home should be offered a choice of meals. All restrictions of liberty must meet the Mental Capacity Act Code of Practice Guidelines and be recorded. Given the layout of the home and the needs of the service users, the numbers of staff on duty should be reviewed. 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