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Inspection on 12/08/09 for Sceats Memorial Home

Also see our care home review for Sceats Memorial Home for more information

This inspection was carried out on 12th August 2009.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The vast majority of people spoken with during the inspection and the feedback we received from surveys indicated that people are happy with the standard of care they receive. The home offers people a good selection of meals and choices are provided at each mealtime. The home exceeds the recommended 50 percent of care staff trained in NVQ 2 or above in health and social care which is excellent.

What has improved since the last inspection?

We did not witness any armchairs being placed next to people`s beds to prevent them from falling out as this is a form of restraint. A quality assurance system has started to be put into place and the views of people are now actively being sought. Formal staff supervision sessions have commenced and plans are in place to expand this to include supervised practice sessions that will be documented. A review of the moving and handling equipment has taken place and a new hoist is due to be purchased.

What the care home could do better:

Care plans must be in place for all people`s assessed needs and kept under review. These plans must provide staff with clear directions on how to meet peoples assessed needs. They should also contain peoples individual choices. This remains outstanding since the last inspection. The home needs to devise a system so that people can be assessed to determine if they are nutritional at risk and put systems in place to manage this. Care staff must be trained to assess people for moving and handling equipment and be trained to move people safely especially if they are undertaking the moving and handling assessments. This remains outstanding since the last inspection. Some of the medication systems used by the home need to be reviewed and monitored to make sure they are safe and people are not placed at unnecessary risk. The home needs to provide people with an activities prgramme based on their needs, choices and preferences. The home also needs to look at ways of encouraging staff to interact with people other than just when they are assisting them. This remains outstanding since the last inspection. The staff in the home require guidance about how to make sure that the practices they use respect people`s dignity and privacy. This remains outstanding since the last inspection.Staff must receive training pertinent to the tasks they are to perform to make sure they can meet the needs of people who use the service. This remains outstanding since the last inspection but the home has provided some training. The staff in the home need to supervise the communal areas so that they are available when people need them, rather than completing tasks where they cannot be reached by people.

Key inspection report Care homes for older people Name: Address: Sceats Memorial Home 1-3 Kenilworth Avenue Gloucester Gloucestershire GL2 0QJ     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: Sharon Hayward-Wright     Date: 1 3 0 8 2 0 0 9 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 43 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 43 Information about the care home Name of care home: Address: Sceats Memorial Home 1-3 Kenilworth Avenue Gloucester Gloucestershire GL2 0QJ 01452303429 01452303429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sceats Memorial Housing Association Limited care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Sceats is a Care Home, which provides personal care to the older person. It is situated in a residential area on the outskirts of Gloucester City. It offers accommodation over two floors in two, extended Victorian houses. All bedrooms are single occupancy and several have en suite facilities. Communal toilets and bathrooms are near to all bedrooms and main communal rooms. There are two lounges and a dining room. The building is accessible by wheelchair. The first floors are reached by stair lifts, but some bedrooms are not easily accessed unless the individual is confidently mobile and advice would need to be sought from the home as to which bedrooms are affected. The home has a copy of their Statement of Purpose and Service Users Guide on display in the main entrance hall and people who use the service are also provided with a copy of these guides. The fee range for this home is 388 pounds to 450 pounds per week. Additional services that are excluded from the fees include hairdressing, newspapers and chiropody. Care Homes for Older People Page 4 of 43 Over 65 31 0 2 3 0 2 2 0 0 9 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: This inspection was carried out by two inspectors over two days in August 2009. One of the inspectors was a pharmacist who examined the system the home has in place for the management of medications. Before we visited the home we sent surveys to the home in order to get the views from people who use the service, staff and external health and social care professionals. We received seven surveys from people who use the service, three from staff and two from external health care professionals. The results of these have been used in this report. We did not request an Annual Quality Assurance Assessment (AQAA) prior to this inspection. We looked at other information we have received from or about the service from other stakeholders. This includes notifications from the home regarding incidents that may have effected the well being of those who use the service. We looked at a number of systems the service has in place to include care records, Care Homes for Older People Page 5 of 43 activities, complaints, staff training, food provision and ongoing maintenance of the home. We spoke to people who use the service, staff, visitors and external health care professionals that were visiting people during the inspection. Their comments have been used in this report. Since the last key inspection a new manager has been appointed. Care Homes for Older People Page 6 of 43 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be in place for all peoples assessed needs and kept under review. These plans must provide staff with clear directions on how to meet peoples assessed needs. They should also contain peoples individual choices. This remains outstanding since the last inspection. The home needs to devise a system so that people can be assessed to determine if they are nutritional at risk and put systems in place to manage this. Care staff must be trained to assess people for moving and handling equipment and be trained to move people safely especially if they are undertaking the moving and handling assessments. This remains outstanding since the last inspection. Some of the medication systems used by the home need to be reviewed and monitored to make sure they are safe and people are not placed at unnecessary risk. The home needs to provide people with an activities prgramme based on their needs, choices and preferences. The home also needs to look at ways of encouraging staff to interact with people other than just when they are assisting them. This remains outstanding since the last inspection. The staff in the home require guidance about how to make sure that the practices they use respect peoples dignity and privacy. This remains outstanding since the last inspection. Care Homes for Older People Page 7 of 43 Staff must receive training pertinent to the tasks they are to perform to make sure they can meet the needs of people who use the service. This remains outstanding since the last inspection but the home has provided some training. The staff in the home need to supervise the communal areas so that they are available when people need them, rather than completing tasks where they cannot be reached by people. 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 8 of 43 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 9 of 43 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. People who may use the service do not have access to information that would enable them to make a decision about the home. Information that is available is incorrect and describes a service that dictates the regime of the home and does not encourage people to make choices. Evidence: Following this key inspection we requested a copy of the homes revised Statement of Purpose and Service Users Guide. On examination we found that both of these guides did not meet the Care Home Regulations 2001. Schedule One of the Care Home Regulations lists 18 points that are required in the Statement of Purpose and the vast majority of these were not in place or lack sufficient detail. On the front page of the Statement of Purpose the name of the home was also spelt incorrectly. Factual inaccuracies were also found for example it states the home has a conservatory and 3 lounges but in fact they have two lounges and one of these is used a quiet room and no conservatory. At the last inspection we raised concerns about the lack of choices Care Homes for Older People Page 10 of 43 Evidence: for people and that the regime of the home is dictated to people. In both of these guides we found a a daily diary and a list of mealtimes and when drinks are served. Nothing had been included to inform people that they could, for example, request a hot drink at other times of the day than that specified. In agreement form for admission which people have to sign when they move into the home it states The following operational details are accepted by residents, mealtimes as arranged by the management and visiting relatives and friends can visit any time of the day as long as they do not inconvenience residents during mealtimes. Again this indicates that the regime of the home does not encourage personal choice and could be seen as restrictive. We also could not find in the agreement of admission form or the Service Users Guide about how people are able to request additional services and pay for them. The home must demonstrate to us how they are meeting Regulation 5 (1b-bd). Following the last inspection we held a meeting with the a Representative from the Registered Provider to discuss how they planned to improve the service. We were informed that they were not going to admit people to the home, however a misunderstanding took place and the Registered Provider said they were not going to admit people for long stay only respite. We examined the pre admission assessments of three people that were admitted for short term care. Two people were having their placement funded by Community and Adult Care Directorate (CACD) but only one of these people had a care plan in place from a Social Worker. All three people had been assessed prior to admission by the manager or deputy manager. All three assessments had details in place regarding peoples needs and a list of their medications. We also saw a copy of the letter sent to people to confirm their needs can be met. We spoke to two of these people and they said they were both happy at the home. At the last inspection we had concerns about the staff and their skills in meeting peoples needs as we identified unsafe practices. At this inspection we still have the same concerns and some unsafe practices are still taking place by some staff. Sceats does not provide intermediate care therefore Standard 6 does not apply. Care Homes for Older People Page 11 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is not based on their individual needs. Care records lack sufficient details and do not contain peoples individual choices and care plans are not always in place for peoples assessed needs. The principles of respect, privacy and dignity are not put into practice by all staff. CONCLUSION ABOUT MEDICATION Generally there were suitable arrangements in place for the management of medicines but the inspection highlighted particular weaknesses where improvements were needed so as to help protect people living in the home from unnecessary risks with medication. Evidence: At the last key inspection we identified a number of issues with the care plans they had in place for people during a case tracking exercise. Case tracking involves examining care records, speaking to the person if able and staff and observing interaction between staff and the identified person. At this inspection we did not complete a full case tracking exercise. We did however examine a number of care Care Homes for Older People Page 12 of 43 Evidence: records and speak to people whose care records we examined and some staff. We found that care plans still did not provide staff with clear directions on how to meet peoples needs and some people did not have care plans in place for all their assessed needs, for example one person is a diabetic but no care plan was in place to direct staff on how to manage this. Other people who are diabetics had care plans in place but they lacked specific details for example one persons said needs to be monitored and report any concerns immediately and call an ambulance. The care plans did not tell staff what symptoms they need to observe for and when they would require an ambulance being called. Care plans in place for personal care lacked details on how staff would care for their hair, nails and mouth care. Records relating to bathing or showering of people where inconsistent and not alway completed. For example some people had only 2 baths/showers recorded for July where as other people had less. One persons care plan stated they like to have a bath twice weekly but no records were in place to support that this was taking place. On examining a number of care plans there lacked in the vast majority of cases personalised information about peoples individual needs. For example it appeared that in a number of care plans in relation to mobility, all people needed the supervision of staff when mobilising but from our observations and from speaking to people this was not the case. One person that was admitted for respite care and they had a shower every 4 days when at their home and this was recorded in their assessment. This had not been carried on since being at the home and they had only had one shower after they asked for it. Other changes were needed to this persons care plans as when we spoke to them and observed them their care plans did not reflect the care they actually required. Another person was having input from the Community nurses but the instruction on how to care for this person were confusing. The Community nurse said this person requires daily assistance from the staff to wash and cream their legs, however the staff said they do this twice a week before a bath; but the care plan did not contain any information about this. The Community nurses confirmed they visit every day but the care plan stated twice a week despite a list of daily visits being documented in the care records. On the first day of the inspection there was no manager on duty and none of the care staff appeared to be in charge when we asked. We noticed that some people did not look well cared for, for example people were wearing soiled clothing and some people had not had their hair brushed. One person was still in their night wear at 12.30pm and when we asked staff they did not know if they had any personal care and this person was showing distressed behaviour at times. We observed that a member of staff went to assist this person to wash their hands and they were seen to have a bottle of dettol in their hands. When we asked the member of care staff what the Care Homes for Older People Page 13 of 43 Evidence: dettol was for they said they had used a diluted form to wash this person hands. This is unsafe and poor practice as dettol is not to be used to clean people as this person could have reacted to this. Also on the first day of the inspection the staff said that the bathing rota stated that 3 people were due for assistance with bathing, but they had not been able to do this. We asked what would happen and the staff said the staff that come on duty on afternoon shift would have to undertake this. We were unable to ascertain about people choice in relation to bathing or showering and if they could request one on any day. People did confirm they have weekly baths. Risk assessments were in place both in a care plan format and hand written. The hand written risk assessments lacked details about the risk and how it should be managed. Again there appeared to be little individual information as people who were assessed as having the same risk had the same information. One persons moving and handling assessment lacked details about the type of hoist to be used and sling size, which is vital information. At the last inspection we were concerned that the staff did not know how to assess people for moving and handling equipment, at this inspeciton we were not able to gather evidence to suggest this has been met. However for one person the home did contact an Occupational Therapist who assessed the person for equipment and provided the equipment. One person was assessed as being at risk of pressure sores as they had reduced mobility, the risk assessment stated to check regularly and cream on a regular basis. Its doesnt stipulate where staff need to check and cream. On checking this persons Medication Administration Record no cream had been prescribed by the GP for the staff to use. A risk assessment tool was in place to assess peoples risk of developing pressure sores but we are not sure that staff actually understand how to use this tool correctly. The home has no consistent system in place to monitor peoples weight. One persons relative expressed concerns to us that their relative had lost weight. On checking the care records no evidence could be found of any people being weighed. We did find a folder where staff are given a list of people to weigh,but these were inconsistent. One person was weighed on the 20/04/09 and it was recorded at 7 and a half stone, three days later it is recorded they were weighed again and they were 6 and half stone. There is no recored evidence that the staff checked this again as this is a vast amount of weight to lose in three days. The next time this person was weighed was 23/07/09 and it was recorded in kgs therefore no consistency. In another person care plans it states to use food charts but these were not in place. In some peoples care plans it state the staff are to monitor and make sure people drink enough, no fluid charts are in place or information about what is enough for each person. Care Homes for Older People Page 14 of 43 Evidence: People do have access to external health care professionals to include Community nurses, GPs, Chiropodists and Continence advisors. Records are in place of these visits. We spoke to several health care professionals who all expressed concerns about the care of some people. For example the staff were asked to completed a input and output chart for one person as part of some ongoing test. However the information could not be relied upon as it was written that this person was drinking vast quantities of fluids at certain times and the health professional was not sure if this is when they were given a jug of drink for the day or if they had actually drank that amount. Other health care professional expressed concerns about peoples overall care and that instructions they had given were not being followed. We asked people in the surveys we sent them do you receive the care and support you need, four people said always and three people said usually. We also asked does the home make sure you get the medical care you need, six people said always and one person said usually. Comments include They look after after us well and They listen and attend to us. We asked the health care professionals in the surveys we sent them, are peoples social and health care needs properly monitored, reviewed and met by the care service, both said usually. We also asked does the care service seek advice and act on it to meet peoples social and health care needs and improve their well being, one said always and one said usually. Pharmacist inspectors report about arrangements for the handling of medicines inspected on 13th August 2009. As part of this key inspection one of our (the Care Quality Commission) pharmacist inspectors looked at some of the arrangements for the handling of medicines. We examined some stocks and storage arrangements for medicines and various records about medication. We saw how staff administered some medicines to people living in the home and chatted with one person who was looking after some medicines in their bedroom. We spoke to the manager designate, the operations controller for Keychange Charity and a carer who was responsible for medication that morning. We gave full feedback after the inspection to the manager designate about the medication issues we found. The inspection took place during a six and a half hour period on a Thursday. We found basic arrangements for handling and managing medication in this home were in place but we identified some weaknesses and matters for attention that are outlined in this report. At the time of this inspection staff supported a few people living in the home to self medicate and look after some of their medicines where some sort Care Homes for Older People Page 15 of 43 Evidence: of risk assessment indicated this was safe. Most people living in the home however were totally dependent on the staff to deal with and administer all of their medicines. We also spoke to the manager designate about any cultural or equality and diversity issues that could affect the administration of medication for people living in this home and she told us that they have not identified anything. Certain carers who had medication training and assessment were authorised as responsible for handling and administering the medicines for people living in the home. These staff have very recently attended additional medication awareness training. The home is soon changing the medication system and will be receiving the medicines from a different pharmacy. The operations controller told us that additional training will be given to all staff about the new system. During our inspection we saw that staff gave medicines to people living in the home within an acceptable period of the time shown on the medicine directions and followed safe procedures. The carer was very attentive and kind. When we asked about some people s(he) was aware of their individual needs in respect of their medicines. We chatted to one person who looked after and administered some of his or her medicines in their bedroom. There was a locked drawer in the bedroom in which to keep medicines. Staff used a special medicine trolley to take medicines around the home. This is an important part of safe medicine administration and should avoid staff walking around the home just with a cup of tablets or other medicines. There was no shaft lift in the home which has different levels so getting the trolley to all areas was not possible. The manager designate must consider how staff will be enabled to always follow accepted safe medicine administration practices. There were arrangements for keeping records about medication received, administered and leaving the home or disposed of (as no longer needed) for each person in the home. Accurate, clear and complete records about medication are very important in a care home so that people are not at risk from mistakes with their medicines and so that there is a full account of the medicines the home is responsible for on behalf of the people living there. The allergy section of the medicine charts was completed so that this potentially important information was easily seen. Most charts had a photo attached to help staff to recognise that they were giving medicines to the right person but we noted three people where there were no photos and some of the other photos had been copied so were not always clear. We saw that safe systems were in place to manage warfarin treatment according to national guidelines. There were also arrangements to store the medicines safely. Care Homes for Older People Page 16 of 43 Evidence: We identified some weaknesses in the arrangements for managing medication during the inspection. Special consideration is sometimes needed for medicines that have to be given before or after food. One person was taking an antibiotic course that needed to be taken before food. The carer was aware of this and we saw before lunch they came specially to administer the dose before the meal. For another person we pointed out the printed directions for one particular medicine were to take before food but this person was given this at 10.45am which was some time after their breakfast. This can affect the activity of the medication. We also discussed the need for particular care to make sure that for medication containing paracetamol there is always a minimum of four hours between each dose so as to avoid risk of toxic effects. On the day of the inspection staff finished the morning medicines at 11am and began the lunch medicines at 1pm. Nobody was taking regular paracetamol medication on this day but this is an issue which staff need to be very attentive to. Staff told us that on the inspection day medication had taken longer than usual as the main dining room was out of action while a new floor was laid so people were in different areas of the home. We also saw that the carer administering the medicines in the morning had the cordless phone and so was answering the phone whilst administering the medicines. This was poor organisation and practice so we took the phone back to the office and asked for other staff to deal with the phone. It is well accepted that safe practice is for staff not to be interrupted unnecessarily whilst administering medicines as this is often the cause of mistakes. We looked at two risk assessments about the arrangements for self medication for two people. One was quite detailed but needed updating as the cream listed did not agree with what was prescribed on the current medication administration chart. The other risk assessment lacked useful detail. The manager designate said she would review this and any other to the same standard as the first one we looked at. Improvement in other records for people who look after their medicines and self medicate is needed so that there is a record made when staff hand over medicines to people to look after. This should help staff to monitor that the medication is being used correctly. We were concerned that the cream containers in one bedroom had no opening date and were old. This was contrary to the home policy to date all containers and replace after 90 days to reduce risk of contamination. We found that routinely administered medicines were generally signed as administered or an explanation in the form of a code letter was provided if not. This Care Homes for Older People Page 17 of 43 Evidence: indicated that people living in the home were receiving their medicines as prescribed. Our checks of some monitored dose blister packs also helped to confirm this. We did identify three gaps on the records of three medicines for three people in the previous four days. In two cases the tablet in question was not in the blister pack for that day and time so could mean that the dose was taken or perhaps discarded. In the other case the tablet was still in the pack. Gaps in records like this mean that we cannot be sure if people received their medicines correctly and this could be a risk to these people. A code letter was sometimes used on medicine records to indicate a reason if a dose was missed. We saw for one person that a particular the code O (defined as other) had been used a lot for several medicines on a chart dated as starting on 13th July 2009. This does not provide a useful explanation for missed doses. We pointed this out to the manager designate as we wondered if the home had run out of stock of any medicines. We saw another example where the medicine administration records indicated one person was not having their eye treatment according to the doctors directions. This person was prescribed eye drops to use three times a day but since 10th August 2009 no doses were signed at lunchtime and on 12th August in the morning no dose was signed so on this day records indicated as only used once. For the same person an eye gel was prescribed to use in both eyes every night but no doses had been signed for since 10th August 2009. We looked at the records for the previous period starting 13th July 2009 and these were all signed indicating that both these eye drops had been administered correctly. Staff we spoke to could not explain why in recent days these drops were not used in the way the doctor had prescribed or had not been recorded. Both of these medicines were in stock on the medicine trolley. On medicine administration charts we looked at, staff recording to indicate they had applied prescribed creams, ointments or other topical treatments was very variable and there were plenty of gaps with no explanation as to why a particular treatment had not been applied. It may of course have been applied but no record made. We found that some medicine records about using some prescribed creams or ointments did not agree with what was written in the care plans. For example one care plan stated to cream regularly but when we looked at the medicine charts no creams or topical preparations were included. Another care plan mentioned about using a moisturising cream but did not contain sufficient information to guide staff in the intended use. These sort of issues have been raised at previous inspections and after the last key Care Homes for Older People Page 18 of 43 Evidence: inspection in February 2009 a requirement made for action by 29 May 2009 that accurate records are maintained of all medication administered in the home. After this inspection we had received an improvement plan from the home about the actions that would be taken. The evidence from this inspection was that the sufficient action has not yet been taken to meet this and so this requirement remains as outstanding. A more robust audit and checking system of medication is needed. We found that eye drops in use had dates of opening written on them so that they were changed regularly to reduce risks from contamination and staff were aware of this. Directions for using eye drops for one person did not state which eye(s). Two other containers for another person clearly stated both eyes. Many other medicine containers did not have a date of opening written on. This is good practice to help make sure that any specific directions about the length of time to use before discarding can be followed and can help with audit checks that there are the right quantities of medicines in agreement with the records. This is some indication that the medicines have been administered correctly and fully accounted for. Except when medicines were supplied in the monitored dose system packs we were therefore not able to make these checks. It is also good practice to help with stock control if each month when the medicines are changed over and new records put in place a stock count is recorded of any medicine carried forward to use the next month. A number of people needed Olive Oil ear drops but it appeared that staff may not be using one bottle per person. There were more people where records indicated they were using Olive Oil than there were bottles in the medicine trolley and cupboard. Only one bottle had a persons name written on the label. There were two bottles in the trolley but with no persons name and these looked old and very soiled. Arrangements need to be made to use proper Olive Oil ear drops now widely available in 10ml dropper bottles so that there is one bottle named for each person and with a date of opening written on so that stock can be regularly replaced. Records to indicate the drops were being used were not made consistently with plenty of gaps and no explanation. We looked at the additional arrangements in place for handling controlled medicines. These were kept in the right type of cupboard but this was fixed to the wall with screws rather than the rag or rawl bolts as specified in the Misuse of Drugs (Safe Custody Regulations) 1973 with which all care homes now have to comply. There was a record book in which all administration of this group of medicines to people in the home was recorded with stock balances and signatures from two staff. The headings Care Homes for Older People Page 19 of 43 Evidence: on some pages were either not completed or did not contain all the relevant information to fully identify the medicine and person for whom it was used. We had raised both of these points after a random inspection of controlled medicines in 2006. Two staff also record a daily check on a separate record of these but we found this check was only for the tablets and had been missed on two days recently. It would be safest if all controlled medicines were checked daily particularly where the medicine is not used every day so staff may not look at the stock for a week. This would make it difficult to identify when a discrepancy happened should this occur. We also noted that records indicated a patch that should be changed every seven days had been changed after eight days then six days in April 2009 and again in June 2009. Records since then indicated the right interval between the doses. The right dose interval is important so that the person receives a proper level of medication from the patch. If there were daily stock checks this may help to alert staff if the patch was not changed on the right day. A number of people living in the home were prescribed different medicines only to use when required or with a variable dose. Although the carer on duty could give us a good account of how he or she would use these medicines it is important that there is clear written individual guidance to staff about how each medicine is to be used for that person to meet identified needs. We discussed with the manager designate straight forward ways to achieve this. Any consideration of the requirements of the Mental Capacity Act 2005 must be included. We saw that there was a record book listing medicines returned to the pharmacy. It is important that records are kept of any medicines disposed of so that there is a full account of medicines in the home. It was not clear if the envelopes containing individual wasted dose were recorded in the main disposal book, or if not, how they were recorded. Although medicines were stored locked up, the room was very tight for space.This meant it was not easy to arrange the medicines in clear way so as to easily see what was in stock. The room was dirty with cobwebs, the walls and floor were dirty and the window was filthy with black mould. This was not acceptable for what should be regarded as a clean clinical area. We found two bottles of cough mixture that had expired earlier this year and a bottle of peppermint oil with an expiry date of July 2002. These appeared to be homely remedies but we did not see any homely remedy protocol and staff told us they did not give medicines that were not prescribed. We saw some medicine procedures in a file in the office that the manager designate gave to us. Some information was not up to date, for example the guidance document Care Homes for Older People Page 20 of 43 Evidence: from the Royal Pharmaceutical Society of Great Britain about handling medicines was the 2003 version rather than the much more up to date 2007 version. The operations controller told us she had provided the home with a full Keychange Charity policy. This sort of information is important and should clearly set out how the Charity expects staff to manage medication. This information must be specific for this home and be readily available for staff. With the proposed imminent changes with a new pharmacy and system being introduced this is the time to make sure the medication policy and procedures are fully reviewed and that staff are fully aware and trained about these. It would be good practice to give staff access to a standard reference book about medicines (such as the latest edition of the British National Formulary that is published twice a year) so that they have some up to date information about the medicines they use. At the last inspection we identified some concerns in relation to privacy, dignity and respect of people who use the service. At this inspection we found that nearly all the seat covers had been removed from the armchairs in communal rooms as this is out dated practice. As previously mentioned we were concerned that some people did not look well cared for on the first day of the inspection but we did notice an improvement on the second day. We were concerned to see that one persons catheter bag and tap to empty the bag were on display at the bottom of their trouser leg. We also had to request that it was emptied. This is not respectful of peoples privacy and dignity and it is an infection control risk if the tap touches the floor. We also witnessed an incident where two members of staff were talking to each other through a gap in a toilet door whilst one member of staff was in there with the person. This is poor practice and disrespectful to the person. We also observed that one person who was in their room was left without access to the call bell or a drink. The seat cushion they were sat on was dirty. We received several comments from health care professionals that said the staff treat people as individuals and are kind to people. People we spoke with during the inspection expressed no concerns about privacy and dignity. Care Homes for Older People Page 21 of 43 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 are now able to make more choices about their daily life and the routines of the home are less regimented. People still do not have access to a recreational programme that is based on their needs, abilities and choices. Evidence: At the last key inspection we had concerns about the lack of activities and stimulation for people and the feedback from most people also reflected this. Following the last key inspection the Registered People sent in an improvement plan that said they are in the process of employing an activities coordinator. They also had a service users meeting where they had feedback about what people want. Several people spoken with confirmed they attended that meeting. During this two day inspection we did not observe any activities taking place and very little stimulation provide by the staff. The television was on in the main communal room. People were observed sat in this room either talking to other people or asleep. Some people did say they like to watch the television. The hairdresser was visiting on one of the days of the inspection and people said they enjoy having their hair done. A list of Church Services is on display and number of people said they do like to attend those. Some people said they like to stay in their rooms and make their own activities. Several people said they are able to go out with family members or alone which is excellent. The home recently held a fete as Care Homes for Older People Page 22 of 43 Evidence: a letter was seen from the Registered Providers in the managers office about this The homes Service Users Guide states that a range of activities both group and one to one is provided but we were not able to substantiate this from speaking to people. We asked people in the survey we sent them does the home arrange activities that you can take part in, one person said always, three people said usually, two people said sometimes and one person said never. A relative spoken with at the inspection expressed concerns about the lack of activities and stimulation. Comments we received in surveys from staff and health are professional stated, Make more time for service users to do more activities and go out of the home and More social activities are needed. People we spoke with and visitors to the home confirmed that visiting is not restricted but when we asked if they visited at mealtimes they all said they tend not to visit then. We asked visitors to the home this due to the statement found in the accommodation agreement that states relatives and friends can visit any time of the day as long as they do not inconvenience residents during mealtimes. As part of the tour of the environment we viewed a number of rooms belonging to people with their consent. People are able to display their personal belonging. At the last inspection we had concerns that people were only able to make limited choices about their daily lives due to the regime of the home. At this inspection we observed people being offered hot drinks in communal areas and their rooms as at the last inspection people had to attend the dining room. At the time of this inspection the dining room was having new flooring fitted so was out of use and both communal rooms had dining tables in them. People spoken with said they were able to chose what they did each day and where they would like to have their meals and drinks. As mentioned previously the Statement of Purpose and Service Users Guide dictates the regime of the home but from speaking to people they felt this was not the case. One statement in the Service Users Guide says that medication will be given out after each mealtime as appropriate, again this limits peoples choices and some medications must be given before meals. On the first day of the inspection we observed that three people were in the night clothes at 5pm. We asked a member of care staff who explained that they needed to make sure people are washed before they go to bed but these three people have requested this. We did not get the opportunity to ask the three people but we did examine their care records and found this information was not included. At the last key inspection we had concerns regarding the cleanliness of the kitchen and that health and safety checks were not taking place. We contacted the local Care Homes for Older People Page 23 of 43 Evidence: Environmental Health Department. At this inspection the cleanliness was much improved and records were in place of health and safety checks on food and equipment. The cook had a list of people who require a therapeutic diet. The home is operating on a 2 week menu rotation, which we would recommend is reviewed as people will be having less variety. We observed a mealtime that was taking place in the communal rooms because the dining room was closed. Staff served the meals and were wearing protective clothing and meals were covered. On the first day of the inspection we had to follow up on one person who was in their room as none of the care staff knew if they had a meal. We had to inform the kitchen who did prepare a meal for them. Also people were asking for hot drinks following the lunchtime meal as the care staff appeared not to know what to do. Again we had to ask the kitchen staff to arrange this. We asked people at the inspection about the food provision; people confirmed that they are offered choices and the vast majority of people enjoyed the food. One person had told the Representative from the company that they did not enjoy the meals. In the surveys we sent to the home we asked people do you like the meals in the home, two people said always, four said usually and one said sometimes. Care Homes for Older People Page 24 of 43 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. People who use the service and visitors to the home are able to express their concerns and have access to a complaints procedure. Some of the actions of some staff can still place people at risk of harm or possible abuse. Evidence: The new manager said that since she has taken over the home she has not received any complaints. A copy of the homes complaint procedure is on display in the entrance hall but needs to be updated with our Newcastle address and telephone number. This procedure was not available in other formats for example in a large print. People we spoke with during the inspection we happy with care they received. A visitor spoken with said they do speak to the management of the home when they have any concerns. We asked people in the surveys we sent them is there someone you can speak to informally if you are not happy, all seven people said yes. We also asked do you know how to make a formal complaint, five people said yes and two people said no. We asked staff in their surveys do you know what to do if someone has concerns about the home, all three staff replied yes. In the survey we sent to health care professional we asked them did the care service respond appropriately if you, a person using the service or another person raised any concerns, one said always and one said sometimes. Several health care professional expressed concerns to us at the inspection about the care of some people, they have also shared these concerns with Care Homes for Older People Page 25 of 43 Evidence: a Representative from the company who manages this home. All staff have now completed the Alerters guide training provided by the local County Council. Staff have access to policies and procedures relating to safeguarding people. Posters were seen around the home that gave information to people, visitors and staff about abuse. At the last inspection we raised concerns about some of the staff practices. The new manager said that she has spent a lot of time observing staff and addressing any unsafe or poor practice. We feel this needs to continue as we still have concerns as mentioned previously in this report. At this inspection we did not refer any people to the Adult Protection Unit as at the last inspection we had concerns about the care of one person. This person has now been moved to another home as they required nursing care. Some staff spoken with said they would report to the management of the home any practices by other staff that they felt were unsafe or didnt respect peoples privacy or dignity. The home now need to look at all care staff accessing training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. Care Homes for Older People Page 26 of 43 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. The physical design and layout of the building is not a purpose built environment, however with the planned continued improvements this will help to provide people with a pleasant and comfortable place to live. The actions of some staff can potentially place people at risk. Evidence: A tour of the environment took place and a number of bedrooms belonging to people were viewed with their consent. Sceats Memorial Home is not a purpose built care home, it is two houses joined together. Chair lifts provide access to the upper floors on both sides of the home. The recently added new entrance hall has replaced a sun lounge and made one of the communal lounges bigger. At the last key inspection we reported that the entrance hall now compromises two bedrooms in relation to natural light and peoples views. This information must be included in the homes Statement of Purpose. Since the new Registered Providers have taken over the home they have started to refurbish the bedrooms and provide new furniture which is improving the environment. Other parts of the home to include some corridors, toilets and bathrooms need redecorating as the decor is very tired in places. People are able to display their own belonging in their bedrooms. We found that some parts of the home were odorous on both days of the inspection and this included several rooms belonging to people. The carpet in room 12A still has not been replaced despite being heavily stained and we identified this at the last Care Homes for Older People Page 27 of 43 Evidence: inspection. We raised concerns about the window restrictors on the ground floor and the maintenance man was in the process of dealing with this prior to the inspection. The standard of cleanliness was not as good at this inspection but the home did have two domestics off sick. A number of communal toilets were stained and hand towels were not always replenished. The laundry area was examined and a system is in place to manage soiled linen. We were concerned that fabric conditioner was left out on the side and people can have access to this area. Consideration should be given to making sure this is put away when staff are not in the room. One visitor said that at times they have found other people,s clothes in their relatives room that have been put there by the staff. The sluice area was also not locked and we found chemicals covered by the COSHH Regulations in this room. Again people can access this area and these chemicals must be stored in a locked facility for safety. Staff were seen to have access to protective clothing and a new procedure has been put in place for when staff want to access the kitchen area, which is an improvement from the last inspection. Several people spoken with said they were happy with their bedrooms and the cleanliness, one visitor was concerned that the carpet in their relatives room was dirty and they were not sure when it was last deep cleaned. We asked people in the surveys we sent them is the home fresh and clean, six people said always and one person said usually. Comments we received from all surveys include, A lift is needed as stair lifts are available but not suitable for residents with mobility problems, Very small garden area for people to sit outside, needs enlarging and bedrooms need updating. Care Homes for Older People Page 28 of 43 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. Staffing numbers do not always meet the needs of people who use the service and not all staff are able to demonstrate they have the skills and knowledge to do this safely. Evidence: Duty rotas were examined and it was found that at times these did not contain up to date information, for example on the first day of the inspection the duty rota indicated that only one member of staff was working the night shift. However a member of staff on duty said they were working that night. Care staff said the manager arranges duty cover and that she would have made sure cover was arranged for any vacant shifts. Duty rotas must be up to date. The new manager confirmed that the staffing numbers have not altered since the last key inspection and that at times care staff still undertake ancillary tasks. At the last inspection we commented that the care staff do not supervise the communal areas and tend to be undertaking non care tasks for example laundry. At this inspection we also notice that there was limited supervision of the communal areas and very little social interaction between staff and people who use the service. When we were leaving the building on the second day of the inspection with a Representative from the Registered Provider we noticed that one member of staff was sat in the communal room away from people reading a newspaper and the other two members of staff were sat just outside this room, again no interaction with people was taking place. On the first day of the inspection three care staff were on duty and no manager, the new manager came back from the Care Homes for Older People Page 29 of 43 Evidence: training they were attending. Two of the three care staff were due to work the night shift and were needing to leave so they can have a break before the night shift. One member of care staff was due to start work following the training session in the morning, however they never came to work for the afternoon shift. This meant that the two staff had to stay later and then when they had to leave the home was short staffed. The new manager had attended training with this member of staff that morning. The new manager had to call in agency staff. This is poor practice not to show up for a shift and shows a disrespectful behaviour towards people who use the service and other staff. People we spoke with during the inspection all said the staff were very good. In the surveys we sent to people we asked are the staff available when you need them, four people said always and three people said usually. We also asked do the staff listen to you and act on what you say, four people said always and three people said usually. Several members of staff spoken with said they have worked at the home for a number of years and they enjoy working there. In the surveys we sent to staff we asked them are you given up to date information about the needs of the people you support or care for (for example, in the care plans), one member of staff said always, one said usually and one said sometimes. We also asked are there enough staff to meet the individual needs of all people who use the service, two staff members said sometimes and one said never. We asked the staff in the surveys what does the home do well, comments include encourage good relationships between service users and care staff,the home meets most of the residents needs and the food sometimes is good and prepared well. We also asked what could the home do better, comments include, The manager should sort the carers rota out better so that enough carers are at work, This home needs a better manager who knows what they are doing, needs carers that will put the training into practice, I know there are some good carers at Sceats who will do their best for the residents, sort out the carers and get rid of the ones that are not doing their job well and improve communication between service users, staff and the management. The home exceeds the 50 percent of care staff with an NVQ 2 or above in Health and Social Care, which is excellent. However from observations at the last inspection and this inspection we do not feel they are putting what they have learned into practice. The home has not appointed any new staff since the last key inspection therefore we did not assess this standard. The new manager was able to provide evidence that the home is looking to arrange some induction training from training providers that are accredited by the local County Council. This training will be based on the Skills for Care Common Induction Standards. Care Homes for Older People Page 30 of 43 Evidence: An updated training matrix is not as yet in place but we were able to see some certificates of training that has taken place since the last key inspection. Some staff were attending training during the inspection for care planning and medication and other dates were seen for this training in August. The manager said some staff have been booked onto training but have not attended. Staff spoken with said they do have access to ongoing training. We asked staff in the surveys we sent them about training and they all said they receive training relevant to their roles, however one member of staff felt that the training they are given does not help them to meet the individual needs of people. The new manager felt the training of staff is ongoing. Care Homes for Older People Page 31 of 43 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. The lack of effective management and administration of this home it has meant that the service is not being run in the best interests of people who use the service and people are being placed at risk. Evidence: A new manager has been appointed since the last inspection. She has not managed a care home before. She does have experience of working with older people. People and staff spoken with at this inspection all felt she was approachable and they could discuss any concerns with her. The feedback we received in the surveys from staff felt that she lacks management experience. We also received feedback from visiting health care professionals that they felt the service had started to improve but they now feel it has gone the other way. The also expressed concerns about communication between the management of the home and care staff as they feel their instructions are not being relayed. The care plans are written by the management of the home and Care Homes for Older People Page 32 of 43 Evidence: they do not provide staff with clear direction on how to meet peoples needs and care plans were not always in place for all peoples assessed needs. The home has started to devise a quality assurance system as questionnaires have been sent out to people who use the service and other stakeholders. The results of these are due to be collated. A meeting for people who use the service has taken place and two staff meetings. Regulation 26 visits are taking place (this is where a Representative visits the home unannounced each month and completes an assessment of the service). The Representative for the Registered Provider said these have been sent to us and they must continue to be sent to our Newcastle address. Auditing is yet to take place. We did not request an Annual Quality Assurance Assessment (AQAA) for this inspection. At the last key inspection the home was rated as poor and we requested an improvement plan. This was followed up at this inspection. Despite some improvement in the service we still have a number of concerns about how the needs of people are being met. A further improvement plan will be requested following this inspection and then we will consider what action we may take to make sure the outcomes for people are improved. As mentioned in a previous outcome group the home needs to look at accessing Mental Capacity Act 2005 and Deprivation of Liberty training or all care staff and make sure staff are aware of the homes policies and procedures in this area and what impact this could have on people who use the service. The system the home has in place for managing peoples monies was examined. Two peoples records and monies were chosen at random, of these one had an adding up error that would have been identified if auditing of this was taking place. Receipts are kept. We would recommend that two members of staff sign any money in and out to reduce any risks of errors. The new manager was able to provide evidence that each member of staff has received one documented supervision session. She has plans to undertake and document supervised practice on each member of staff. We asked staff in the surveys we sent them does your manager give you enough support and meet you to discuss how you are working, one member of staff said often and two said sometimes. The new manager said that some staff have undertaken training in fire, moving and handling and some certificates were seen. However this area of training is ongoing for all staff. A visitor to the home told us about a recent fire drill where people were evacuated from the home as they had a number of concerns and these were shared with the Representative from the Registered Providers. At the last inspection we saw records of health and safety checks undertaken by the Care Homes for Older People Page 33 of 43 Evidence: maintenance person. We have not seen any evidence as to how the home is reducing the risks of Legionella. Following our last key inspection we asked the local Fire Service to visit and Environmental Health Department and we were told that both agencies were happy with the systems the home has in place. We were told that the fire officer checked their fire risk assessment. An evacuation procedure that includes what help each person would require if a fire was to break out, needs to be devised as a matter of urgency. Care Homes for Older People Page 34 of 43 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 7 15 The registered person must 29/05/2009 make sure that people who use the service have care plans in place for their assessed needs. These must be kept under review and update as necessary. This will provide staff with clear directions on how to meet peoples assessed needs. 2 8 13 The registered person must make sure that people are assessed for moving and handling equipment by staff who are trained to do this. This is will help to make sure people are not put at unecassary risk. 29/05/2009 3 9 13 The registered person must 29/05/2009 make sure that accurate records are maintained of all medication administered in the home. This will provide a detailed records of when people receive their medication. 4 10 12 The registered person must 29/05/2009 make sure that people who use the service are treated with respect and their dignity and privacy is maintained. Page 35 of 43 Care Homes for Older People 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 This particularly relates to the institutional practice. That staff will treat people who use the service with respect and maintain their privacy and dignity. 5 12 16 The registered person must 29/05/2009 make sure that the home provides people who use the service with an activities programme that meets their needs and choices. This will help to make sure people who use the service are provided with meaningful activities to help maintain their life style. 6 30 18 The registered person must make sure that staff receive training pertinent to the tasks they are to perform. This will help to make sure people who use the service are not put at unnecessary risk and the staff have the skills and knowledge to meet peoples needs. 7 31 8 The registered provider must 20/07/2009 appoint a suitably qualified and competent person to undertake the management and administration of this home. This person must apply to us to be considered for registration. This will help to make sure the home is run in the best Care Homes for Older People Page 36 of 43 26/06/2009 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 interests of people who use the service. Care Homes for Older People Page 37 of 43 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 1 5 The registered person must 23/10/2009 devise a Service Users Guide as required by this Regulation. A copy must be sent to our Newcastle address. This will help to provide people with information about home and additional services. 2 1 4 The registered person must devise a Statement of Purpose that meets this Regulation and Schedule 1 of the Care Home Regulations 2001. A copy must be sent to our Newcastle address. This will provide people with information about the services provided by the home. 23/10/2009 3 7 13 The registered person must make sure that risk assessments contain 07/10/2009 Care Homes for Older People Page 38 of 43 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 individual details about the risk and how the home plans to manage this. This will help to make sure that staff have clear directions in place to assist them in managing any risks. 4 8 12 The registered person must make sure that a system is in place to assess and monitor people who are assessed as being nutritionally at risk. This will help to make sure that people health and welfare is assessed and monitored. 5 9 13 Make sure and demonstrate 30/09/2009 that all the arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are safe for everyone in the home by having clear, safe procedures in place with robust checking and auditing at a frequency to prove this and that people are consistently having their medication correctly. This is to particularly address the various weaknesses identified in the report. 07/10/2009 Care Homes for Older People Page 39 of 43 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 This is to help make sure that people living in the home receive the correct levels of medication and are not put at unnecessary risk because of poor practices or recording. 6 9 13 Make sure that when people 30/09/2009 look after and administer any of their medicines themselves there is a full written risk assessment process in place with actions taken to reflect best practice guidance and to make sure this is safe for everyone in the home. Make records when medicines are given to people to look after, as well as regular checks that they are using their medication correctly. This to help make sure that people are taking the correct amounts of medication and that the arrangements are safe for everyone in the home. 7 9 13 Upgrade the wall fixings on the controlled drugs cupboard in order to comply with the Misuse of Drugs (Safe Custody) Regulations 1973. 30/09/2009 Care Homes for Older People Page 40 of 43 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 This is to make sure these medicines are stored securely and in accordance with the law. 8 9 13 Review medicine records 30/09/2009 and care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. 9 26 13 The registered people must make sure that any chemicals covered by the COSHH Regulations are stored securely at all times. This will help to prevent people being placed at risk by the actions of some staff. 11/09/2009 Care Homes for Older People Page 41 of 43 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 The home should review what is written in their Statement of Purpose and Service Users Guide as it dictates the regime of the home to people and does not allow people to make choices. Make sure that people choices are included in their care plans. Make daily recorded stock checks of all controlled drugs so that there is regular assurance that all of this category of medicines are fully accounted for. Make arrangements so that all staff write the date on containers of any medicines when they are first opened to use and record the quantity of any stocks of medicines that are carried forward to the next medication cycle. This is to help with good stock rotation in accordance with the manufacturers or good practice directions and to enable audit checks that medicines are being used correctly and the right quantities remain in stock. Clean thoroughly the medicine storage room so as to maintain a suitable clean and hygienic area in which to store medication. Review and update the medicine policy and local procedures to make sure this includes all aspects for the safe handling of medicines (including any homely remedies) relevant to this home. Make this available to all staff in the home so they have precise direction about the way medicines are safely managed and handled in this home. The home should consider using other formats for their complaints policy to include larger print to make it more accessible to people. The home needs to alter our contact details on their complaints policy to our Newcastle address and telephone number. 2 3 7 9 4 9 5 9 6 9 7 16 8 16 Care Homes for Older People Page 42 of 43 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. 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