Inspection on 18/02/09 for Sceats Memorial Home

This inspection was carried out on 18th February 2009.

CSCI 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sceats Memorial Home 12/08/09

Sceats Memorial Home 16/01/08

Sceats Memorial Home 17/08/07

Sceats Memorial Home 06/09/06

Sceats Memorial Home 15/11/05

Sceats Memorial Home 03/03/05

Sceats Memorial Home 18/06/04

Sceats Memorial Home 19/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives 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, 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: Sharon Hayward-Wright     Date: 2 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: 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): Sceats Memorial Housing Association Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 31 Number of places (if applicable): Under 65 Over 65 31 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 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. Care Homes for Older People Page 4 of 33 Brief description of the care home 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 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by one inspector over a three day period. Before we visited the home we sent surveys to the home in order to get views from the people who use the service and the staff. We received six back from people who use the service and one from staff. The results of these have been used in the report. We did not request a Annual Quality Assurance Assessment (AQAA) prior to this inspection. We also look at any 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 wellbeing 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 6 of 33 activities, complaints, staff training and recruitment, menus and the ongoing maintenance of the home. We also spoke to people who use the service, staff and any visitors and their comments have been used in the report. Since the last inspection the Registered Manager has retired and a new Registered Provider has taken over the management and administration of the home. 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 33 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the home, however this is out of date and does not help people make an informed decision about the services being offered. There is a system in place to ensure peoples needs are assessed prior to admission but staff are unable to always demonstrate sufficient skill and knowledge to be able to meet these needs. Evidence: Following the change in the Registered Provider the home has yet to update their Statement of Purpose and Service Users Guide. Following the completion of the recent building work to the main entrance the home must add to these guides the two rooms that have been effected by this work. Both of these rooms now look onto brick walls and have limited natural light. The home no longer has a Registered Manager as they have retired since the last inspection. Care Homes for Older People Page 11 of 33 Evidence: A pre admission assessment of a person who has been admitted to the home since the last inspection was examined. The home has obtained information from the hospital about this person. The assessment was brief but did contain details about this persons care needs. A copy of the letter that the home sends to people confirming their needs can be met was seen. This inspection has highlighted a number of concerns about how the service meets the needs of people. These concerns relate to the knowledge and skills of the staff, to be able to recognise when they are using unsafe practices, resulting in placing people at risk of harm or injury. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 and unsafe practices by the staff are potentially placing people at risk. The principles of respect, dignity and privacy are not put into practice. Evidence: Two people were randomly selected at the inspection to have their care examined in detail. This included examining care records, speaking to the person if able, observing staff interacting with them and speaking to staff. One person had been living at the home for a number of years and the other person was a recent admission. Both people had ongoing assessments of their needs in place, but these were not always updated when a change in their condition had taken place. One person did not have care plans in place for all their assessed needs therefore staff are not being provided with clear directions or information about peoples care needs and choices. This person needs to be hoisted for all transfers but there was not a clearly documented care plan or assessment to determine the equipment required. When staff were asked about this they said there were only 2 slings and 2 hoists in the home. One of these is a standCare Homes for Older People Page 13 of 33 Evidence: aid hoist, which is not a full hoist and can only be used for people who can support their body weight. Staff were not able to demonstrate that they know how to assess a person for a sling. We observed 2 members of staff lift this person up under their arms and drag them into a wheelchair. This is unsafe and poor practice as this person is not able to stand and staff placed the person and themselves at risk of injury. Neither members of staff explained or spoke to this person whilst undertaking this unsafe manoeuvre again this is poor practice. This person is taken back to their bed after mealtimes and has been provided with a hospital bed. We visited this person in their room and found that a chair was placed against the bed. Staff confirmed they do this to prevent this person from falling out. This is a form of restraint and must not be used as it places the person at greater risk. Another person was also found to have a chair placed against their bed despite in the past a person having fallen out of their bed and getting caught between the chair and the bed. The deputy manager was advised to contact the community nurse as a matter of urgency for both people and request they are reviewed. This did take place. One person has a care plan in place for prn or as required pain relief medication as the staff feel this person is in pain and they can become distressed. The staff had not considered administering this medication before any personal care or moving and handling task to see if it helped to reduce their distress and pain. This care plan lacked details about how and when this should be given. The staff had written statements in care plans that are not measurable for example does not drink enough, when a member of staff was asked how they monitor this, they did not know as no fluid chart was in place to determine if this was the case. It was also found in this persons daily records that on one night they had not passed any urine but there were no other records to see if the home had acted on this and contacted the GP or community nurse for advice. One care plan was found to contain detailed information about how the staff should manage one persons dentures, which is good practice. Risk assessments were in place for some of the assessed risks but most contained limited details. Moving and handling assessments had been completed for both people but one was not dated and if the staff have not had training in how to assess people for the correct moving and handling procedure then they could contain wrong information. The home also needs to urgently review their moving and handling equipment to make sure it meets the needs of people who use the service as one hoist is very old and there were only 2 slings. Evidence was seen that people do have access to external professionals to include their GP, community nurses and chiropody. Community nurses were visiting the home during the inspection. Several people have equipment provided by the community nurses to include profiling bed and pressure relieving mattresses and seat cushions. Care Homes for Older People Page 14 of 33 Evidence: We asked people in the surveys we sent to them do you receive the care and support you need, 3 people said always and 3 people said usually. The Medication systems used by the home were examined. Records were in place for medications received into the home and administered to people but there were gaps in this and for medication that was returned to the local pharmacy. Gaps were found in the recording of administration of medication and this includes creams. One tablet was found not to have been given but no reason as to why was recorded. One person was prescribed antibiotics but the staff were not administering them as per the directions. This must be addressed. The home has several people who are prescribed controlled medication. After the last inspection a number of controlled medication were found to be missing and the Police were contacted. The controlled medication was checked and it was found that an adding up error had taken place resulting in an incorrect balance of tablets. Auditing of this medication must take place on a frequent basis. The home must also make sure they have a safe system in place for the management of controlled medication. A large amount of out of date stock was found in the medication cupboard and the home returned this to the local pharmacy on the second day of the inspection. Dates of opening were found on the majority of boxed medication and eye drops. All staff that administer medication have completed a safe handling of medication course. The systems in place for people to self medicate were not examined at this inspection. As mentioned previously care plans that were examined for prn or as required medication lacked specific information about how and when staff should be giving this type of medication. When staff administer prn medication they should record the actual time that it was given to make sure they meet the directions issued. During the tour of parts of the environment, it was found that seat covers were being placed on nearly all the seating in the communal areas. This is institutional practice and must be discontinued. At one mealtime a person wanted to move seats but a member of staff was heard to say they could not move seats without the agreement of the deputy manager. A seating plan was also found on the wall in the dining area. People must be given a choice of where they wish to sit and not be dictated to by the staff. The managers of the home expect people who use the service and staff to address them formally but they are able to address people by their Christan names. In the majority of care services this is viewed as outdated practice. However the deputy managers said they are looking to change this. A staff noticeboard is on display in the dining area and this needs to be moved as this room is for people who use the service. These are examples of poor practice and gives the impression that the home is run for the staff and not people who use the service. People spoken to felt that staff respect their privacy and dignity. Care Homes for Older People Page 15 of 33 Evidence: Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor 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 can make choices about their daily life but at times the routine of the home restricts these. The home does not provide people with recreational activities that meets their expectations, needs and choices. Evidence: During the days of the inspection no activities were seen to be taking place. There was no planned programme of activities available. The staff are responsible for any activities that may take place. People were observed to be sleeping in the communal rooms. One person said they were waiting for their newspaper to arrive, otherwise the television was on. Some people said they are able to make their own activities and one person is able to go out alone and helps out at a local club, which is excellent. People were asked in their surveys if there are activities arranged by the home that they can take part in, 2 people said always and 4 people said sometimes. Comments include A trip into the country to see the bluebells or daffodils and have a cup of tea out I think would be much appreciated by many residents, I still go to the day center I used to go to before I came here, so I have bingo, quizzes etc. I could join in the bingo here if I wanted to. There are sometimes concerts and sales of clothing that I attend. One person asked that the reception of the television is looked at in the Care Homes for Older People Page 17 of 33 Evidence: lounge as it is not very good and they enjoy watching the TV. Visiting to the home is not restricted and this was confirmed by a number of visitors to the home that were spoken with. The hairdresser was visiting the home during one of the days of the inspection. People spoken with said that they are able to make choices about their daily lives, however the routines of the home may restrict this, for example a member of staff sounds a gong when it is mealtimes and when drinks are provided in the dining area, again this is institutional practice. People are expected to go to the dining room when hot drinks are being served. We did not see any members of staff offer to take drinks to the people in the lounge. People did say they are able to chose where they have their meal in the dining room or their own room and there is a choice for each meal. Peoples personal belongings were seen on display in their rooms. The deputy manager said the home has just implemented a new 4 week menu that has included asking people who use the service for their input. Choices were seen being offered at each mealtime. Since the last inspection the deputy manager said that there are now flexible times for breakfast and people can request a full English breakfast on a Sunday. On other days people can request cooked options such as a fried or scrambled egg. The cook confirmed that they are able to cater for people on special diets. We joined people for lunch on one of the days and we found the meal to be very tasty. People asked said they enjoyed the food, however on the second day of the inspection concerns were raised about one of the choices for the main meal and this was fed back to the cook by the deputy manager. A tour of the kitchen took place and the health and safety checks were examined. Despite the home obtaining 3 stars from the local Environmental Health Department gaps were found in the recording of these checks and we found issues with the cleanliness of the kitchen and this is discussed further in the Environment outcome group of this report. We asked people in the surveys whether they like the meals in the home, 3 said always, 1 said usually and 2 people said sometimes. Comments included The meals should include more fresh vegetables, e.g. new potatoes. Last year (2008) we did not have them once, not even as a special treat. The meals are not well cookedmain meals others are adequate, I like the breakfasts and the main meals and vegetables. I do not like things on toast for tea and Meals at the weekend are especially good. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns and have access to a complaints procedure. The systems the home has in place are not protecting people from possible harm or risk of abuse. Evidence: The home has a book where all the complaints they receive are documented, however there were no copies of any other correspondence or investigation findings which are required. The new Registered Providers are aware of what information is required and what must be stored in the home. They had received an anonymous complaint but this was not stored at the home but they were able to obtain details we asked for. A new complaints procedure is displayed on the noticeboard. We asked people in their surveys if they knew who to speak to if they were unhappy and if they know how to make a complaint and all 6 people said yes. The home has new policies in place for the protection of vulnerable people, whistle blowing and bullying and harassment. Certificates were seen of enhanced adult protection training for both of the deputy managers and all staff except for one has completed the Alerters guide training. The local Council provides this training. Despite this training and the access to policies, it appears that staff are not able to recognize when some of their practices may cause harm to people and place them at risk of possible abuse. Care Homes for Older People Page 19 of 33 Evidence: We referred one person who uses the service to the local Adult Protection Unit due to our concerns about their care and we felt the home were not able to meet this persons assessed needs. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the building is not a purpose built environment. However with the continued planned improvements will help to provide people with a comfortable place to live. Evidence: A tour of parts of the environment took place with a number of rooms belonging to people being seen. People are able to display their personal belongings in their rooms. Since the last key inspection a new entrance hall has been completed and this has extended one of the communal lounges. This new part of the home has greatly improved the entrance area but it has compromised the natural light of two bedrooms belonging to people. They both now look out on to a brick wall. The relatives of one of these people said they did discuss this with the previous Registered Manager but they feel at the present time it is not an issue for their relative. Since the new Registered Providers took over several bedrooms have been refurbished to include new furniture and carpets, this has greatly improved these rooms. Plans are in place to continue with this refurbishment. In parts of the home the decor is tired and needs to be refreshed. Storage of some equipment is also an issue as a stand aid hoist is stored in one of the communal lounges and needs to be stored elsewhere. The home should look to store the medication trolley in another area other that the dining area. In the main entrance hall a noticeboard provides visitors and people who use the service with useful Care Homes for Older People Page 21 of 33 Evidence: information to include advocacy. In room 12A the carpet needs to be replaced as matter of urgency as it is heavily stained. Damage was found to the ceiling in room 17. The kitchen area was examined and the standard of cleanliness was poor. There were also concerns about the storage of some foods. The local Environmental Health Department were contacted following this inspection. Since the last inspection the new Registered Providers have set up a clinical waste contract to dispose of incontinence products safely. Staff have access to protective clothing to include gloves and aprons and staff were observed to use them when required. The laundry was not examined in detail as repair work was taking place to the washing machine but we were told verbally that the home has a procedure for managing soiled linen. The notice on the door of room 6, regarding laundry arrangements, must be moved to a more private area so that visitors to the home cannot read it. People were asked in their surveys if they felt the home was always clean and fresh, five people said always and one person said usually. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is confident that there is sufficient numbers of staff to meet the needs of people who use the service. However not all the staff were able to demonstrate they have the skills and knowledge to safely meet peoples needs. Evidence: From discussion with the deputy manager on duty the needs of people who use the service are being met by the numbers of care staff on duty. Ancillary staff are employed but some of these tasks have to be undertaken by the care staff when they are on duty. We were concerned about some of the care practices we witnessed during the inspection as they were unsafe. Of the fifteen care staff employed thirteen have an NVQ 2 or above in Health and Social Care which is excellent. However, we did not see this training being put into practice by the care staff. From discussions with some staff morale is low but they felt they worked well as a team. There was no evidence of appropriate supervision of staff taking place by the deputy managers. They were not seen to be working alongside staff in the home, instead locating themselves in the office. People spoken with praised the staff in the home and the majority of them were very happy with the care they receive. We asked people in the surveys whether the staff listen and act on what you say, all six people said yes. We also asked them if staff are available when you need them, two people said always and four people said usually. Care Homes for Older People Page 23 of 33 Evidence: The personnel files of two staff appointed since the last inspection were examined. All had the required recruitment checks in place before they started work at the home, except that one member of staff did not have a full employment history. This meant that employment gaps could not be explored in detail as required by the Care home Regulations 2001. Both members of staff had Criminal Records Bureau Disclosures in place that include the Protection of Vulnerable Adults (POVA )check. One of the deputy managers said that the home is looking to review their induction training and ongoing training for all staff now they have a new Registered Provider. They are aware that this is an area they need address urgently, especially following the staff practices we observed during this inspection. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Without effective management and administration of this home it has meant that the service is not run in the best interests of people who use the service and people are being put at risk. Evidence: Since the last key inspection the Registered Manager has retired and the new Registered Provider is looking to appoint a new manager. The home has two deputy managers in post who are overseeing the running of the home. A number of serious concerns have been highlighted at this inspection and these were fed back to the Operations Manager for the home. They were already aware of many of these issues and are looking to address these as a matter of urgency. Since the last inspection auditing has stopped and needs to be re-started. It appears that the last time the home sent surveys to people who use the service and their relatives/representatives was in 2007 as the results are displayed on the noticeboard Care Homes for Older People Page 25 of 33 Evidence: in the main entrance. This means that there is not an effective quality assurance system in place. Regulation 26 visits where a representative of the Registered Provider undertakes a monthly unannounced auditing visit are taking place and these have identified areas that need improvement. Information is handed over to staff at the beginning of each shift but these are done by the deputy managers and does not include the staff from the previous shift, therefore important information may not be shared between each shift. We observed one of these and it appeared that staff are given tasks to undertake and minimal information about people is exchanged. The system the home has in place for managing peoples monies was examined. On checking one persons money an error was found with the adding up. Also the staff are not recording correctly monies received on behalf of people. Safe systems for managing peoples monies must be adopted as soon as possible. The new Registered Provider is looking to implement a new staff supervision system, which will be constructive to helpful to the staff member receiving this. Currently a blame culture exists which is destructive and demoralising. There is no recorded staff supervision sessions since the end of last year. Maintenance records and some monthly checks for health and safety were seen. The new Registered Provider will need to make sure that all the required checks on equipment and services to the home are in place. The fire risk assessment needs to be reviewed and an fire evacuation procedure devised as a matter of urgency. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24(1) The registered person must 30/10/2008 devise a quality assurance system to ensure the home is run in the best interests of the people who use the service. This requirement has been outstanding since the last three inspections. Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 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 8 13 The registered person must make sure that the actions of staff are not putting people at unnecessary risk of injury or harm. This will help to make sure 29/05/2009 Care Homes for Older People Page 28 of 33 that staff are not using unsafe moving and handling practices that place people at risk. 4 8 23 The registered person must make sure that the equipment in the home for moving and handling people meets their needs. This will help to make sure that if people who use the service require moving and handling by the staff they are not put at unnecessary risk. 5 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. 6 9 13 The registered person must make sure that there is a safe system in place for the management of medications and to make sure they are administered as per the directions of the GP. This will help to make sure people are receiving their medications are per the directions issued by the GP. And a safe system is in place for the administration of controlled medication. 7 10 12 The registered person must make sure that people who use the service are treated 29/05/2009 29/05/2009 29/05/2009 Care Homes for Older People Page 29 of 33 with respect and their dignity and privacy is maintained. This particularly relates to the institutional practice. That staff will treat people who use the service with respect and maintain their privacy and dignity. 8 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. 9 18 13 The registered person must make sure that people who use the service are not put at risk of harm or abuse by the actions of staff. The registered person needs to make arrangements to provide staff with the skills and knowledge to know when their actions are placing people at risk of possible harm or abuse. 10 31 8 The registered provider 20/07/2009 must appoint a suitably qualified and competent person to undertake the management and administration of this home. This person must apply to us 29/05/2009 Care Homes for Older People Page 30 of 33 to be considered for registration. This will help to make sure the home is run in the best interests of people who use the service. 11 33 24 The registered person must devise a system for evaluating the quality of the services provided at this home. This will help to make sure that people who use the service have a say in how the home is run and to make sure it is run in their best interests. 12 36 18 The registered person must devise a system to make sure staff are appropriately supervised. This will help to make sure that the needs of people are being met by staff skilled. 13 38 23 The registered person must make sure that the fire regulations are being met to prevent people from being put at risk. This will help to make sure that people who use the service are kept safe and procedures are in place in case a fire was to happen. 29/05/2009 29/05/2009 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 Care Homes for Older People Page 31 of 33 improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The home should consider putting more detail into their pre admission assessments as well as using their dependence tool. Staff should record the actually time that any prn or as and when required medication is administered. The systems the home has in place to manage peoples monies needs to be reviewed to make sure it is safe and free from errors. 2 3 9 35 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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