Inspection on 25/08/09 for Sea Breeze

This inspection was carried out on 25th August 2009.

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

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

Other inspections for this house

Sea Breeze 21/12/09

Sea Breeze 29/04/09

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Sea Breeze 34 Carnarvon Road Clacton On Sea Essex CO15 6QE Lead Inspector Ray Finney, Michelle Love and Derek Brown Key Unannounced Inspection 09:00 25th August 2009 DS0000072805.V376670.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sea Breeze Address 34 Carnarvon Road Clacton On Sea Essex CO15 6QE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01255 435515 Dr Elsie Damien Manager post vacant Care Home 19 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (19) of places Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users accommodated in the home must not exceed 19 persons. 29th April 2009 Date of last inspection Brief Description of the Service: Sea Breeze is a care home for older people, situated in a residential area of Clacton, opposite the library and within walking distance of the seafront, town centre shops and amenities. The home is a short walk from the railway station and is also accessible by bus. The property has some off road parking to the front and there is a pay and display car park nearby. The home can accommodate nineteen people; there are seven single rooms and six double rooms, twelve of which have an en-suite facility. Bedrooms, toilets and bathrooms are on the ground and first floor. Access to the first floor is by stairs. There is no passenger lift but there is a chairlift available. Communal areas consist of a lounge and a dining room. The garden to the rear of the property is a small paved area with a detached storage building, raised flower border and garden table and chairs. The home charges £390.39 a week for the service it provides, with additional charges for services such as dry cleaning, chiropody and hairdressing and for personal items including toiletries and newspapers. This information was given to us at the time of the last inspection. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is 0 star. This means people who use this service experience poor quality outcomes. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. We examined the home’s Statement of Purpose and Service User Guide which contain information about the service. A visit to the home by two inspectors took place on 25th August 2009 and included a tour of the premises, discussions with people living in the home and members of staff. Completed surveys were received from members of staff. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. This observation formed a significant part of the inspection and was carried out both informally throughout the day and as a formal process known as SOFI (short observational framework for inspection). Details of this observation process can be found in the sections of this report relating to ‘Health and Personal Care’ and ‘Daily Life and Social Activities’. At the time of the last key inspection the home was judged to provide poor outcomes for people living there, which raised concerns about the quality of the service. Subsequently we met with the registered providers to discuss these concerns and the regulatory requirements made in the inspection report. Following this meeting an improvement plan was received from the providers with information about how the requirements were to be met. On the day of the inspection we were given every assistance from the proprietors who are currently managing the home and staff on duty. A further visit was made on 27th August 2009 by a Pharmacist Inspector to look specifically at the home’s processes around medication. What the service does well: Overall people living at Sea Breeze appear to be happy. People appear to enjoy the food provided. Through the home’s quality assurance processes, relatives who completed surveys have made positive comments about the home and how their relatives are cared for. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Information for prospective residents needs be improved and should accurately reflect the service that is currently being provided. The system of care planning needs to be more detailed and contain accurate information that reflects people’s assessed needs. Care plans need to be devised in a person centred way that is relevant to the individual and takes their wishes into account. People living in the home need to have a range of risk assessments for all areas of risk arising out of their assessed needs and not just manual handling and falls. This includes, amongst other things, risks associated with diabetes, anxiety or aggression, dementia and nutritional needs. Identified healthcare needs must be dealt with robustly and without undue delay to ensure people receive appropriate investigations to ensure any health issues are properly diagnosed and treaded. Some staff practices around how support is provided need to be improved. This includes how people who are unable to eat independently are supported with their food and drink. Manual handling practices need to improve if people are to be supported safely The service needs to make improvements to their processes around medication. Accurate records must be kept when medicines are given to people and people must only be given medication as prescribed. There must be clear guidelines for staff to follow when medicines are given on a ‘when required’ basis so that people are protected from the risk of inappropriate use of medicines. There must be risk assessments in place where people store medicines in their rooms and medicines must always be locked away when not in use. The range of activities available could be improved. In particular activities designed to stimulate and engage people who are becoming increasingly frail, confused or who have been diagnosed with dementia. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 7 The way people’s choices and wishes are be taken into account could be addressed better. This includes listening to people about both what and when they want to eat or drink and when they go to bed. People’s dining experience could be improved if the care and support provided was consistent and all staff followed good practices. The complaints policy and procedure that is in place needs to be followed robustly to ensure people are satisfied with the service provided and all their concerns are addressed. Significant improvements are necessary around safeguarding people. This includes areas such as care planning, risk assessment processes, better care practices and staff’s understanding of their responsibilities around recognising what constitutes poor practice or abuse. Improvements to the environment are necessary if people living in the home are to benefit from a well maintained environment that is appropriate to meet their needs. Specific details of areas of concern can be found in the section of this report relating to the environment. Improvements are necessary in a number of areas relating to staffing in the home. These include staff practices, training and staff supervision. Further details of areas for improvement can be found in the section of this report relating to ‘Staffing’. Day to day management of the home needs to improve and measures need to be taken to address the issues that have been identified throughout this report. 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. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to Sea Breeze cannot be assured they will have accurate and up to date information about the home, so as to make an informed choice about whether it will meet their needs. EVIDENCE: The registered providers have devised a Statement of Purpose and Service User Guide, which give details of the aims and objectives of the home and provide information about the services and facilities provided at Sea Breeze. These documents are essential as they provide vital information about the home to the prospective resident or their representative. Both documents are on display on the wall in the corridor nearest the lounge area. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 10 We noted that the Service User Guide is not compiled in a suitable format for the people for whom the service is intended, including people who are diagnosed with dementia or have poor cognitive ability. While we note that since the last key inspection of the home the document has been written in larger print, further consideration should be made as to what formats would meet the needs of people who may wish to move to the home. These formats could be larger print, simple language, spoken word or pictorial format so as to give people the opportunity to understand the information and make an informed choice about whether the service will meet their needs. In addition the Service User Guide needs to be reviewed as the information it contains is inaccurate. Specifically the document makes reference to the ‘National Care Standards Commission’, which has not existed for a number of years, and not the Care Quality Commission, the independent regulator of all health and adult social care in England. Further amendments are required to be made to the Statement of Purpose as this makes reference to the Commission for Social Care Inspection, the organisation that preceded the Care Quality Commission. In addition these documents contain limited and inaccurate information as to the specific range of needs the service is intended to meet and the criteria used for admissions to the care home. The document states, Sea Breeze is a registered care home offering 24 hour care for adults of any age as long as their needs can be met. The home is registered to provide care for up to 19 older people who may have dementia. The document also makes a brief statement advising that the home will be pleased to accept service users for long term, short term for convalescence or holiday stays or respite care or day care for people including those who suffer from Dementia. Further details are required as to how this range of services will be undertaken and managed and the impact this may have on people who live permanently at the care home. The documents also state that four rooms have a bath, however further clarity is required to ensure that people wishing to use the service are aware that these are not assisted baths and people with mobility difficulties who require hoisting will not be able to use them. The document also states that all rooms have been recently redecorated and refurnished and are equipped to accommodate service users with Dementia. Evidence on the day of the site visit did not support this and further evidence may be found in the Environment section of this report. Since the last key inspection of the home there have been no new admissions. As a result of this there was insufficient evidence to assess fully the services admission process and judge whether it is sufficiently robust. However, there is a formal pre-admission assessment format in place, so as to enable that the management and staff team to assess the needs of anyone wishing to move into the home. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 11 The home does not provide intermediate care therefore national Minimum Standard 6 does not apply. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in care planning, risk assessment, care and medication practices could have an adverse effect on the health and wellbeing of people living in the home. EVIDENCE: Following the last key inspection of the home, the registered provider has reviewed the homes care planning processes and a new care planning system has been introduced and implemented. The registered provider told us that discussions had taken place with staff as to the new formats and the information required to be recorded. As part of this site visit five care files were looked at, three were fully examined and two partially examined in relation to people’s specific healthcare needs. Records showed that each individual person has a care plan. In some Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 13 cases the information recorded was basic and not person centred; there was little evidence to show that the person or their representative had been involved in the care planning process. Not all areas of assessed need were documented within the plan of care and, other than a formal manual handling risk assessment, no other risk assessments were recorded. In addition there was little information recorded detailing individuals strengths, abilities, areas of independence and personal preferences. We were advised by the person in charge of the shift that one person is diabetic. On examination of their care file, no plan of care was devised as to the specific care needs relating to their diabetes and the actions to be taken by care staff to ensure that their needs are met and their condition is monitored proactively. In addition there was no risk assessment relating to the person’s diabetes identifying the specific nature of the risks and the steps to be taken to minimise this so as to ensure the persons safety and wellbeing. During the site visit we witnessed this person calling out please help me on several occasions. The person was observed to become quite distressed and persistent in their calling out as a result of some staff not answering them and appearing to ignore their request. Both the registered provider and staff on duty acknowledged this and stated they always do this. On inspection of the person’s care file, basic reference was made to this behaviour and the recorded action to be taken by staff was always answer! We observed that this did not always happen and we noted that some staff did not take time to listen to the person or to provide appropriate reassurance. One member of staff was observed on several occasions to say, what you want? and what happened [name of resident]?, but did not wait for the person to respond or to check further as to their wishes. We looked at the care file for one person in relation to their Percuitaneous Endoscopic Gastrostomy (Peg) Tube. Whilst it made reference to this appliance being in place, risks relating to a potential number of minor and major complications associated with a Peg Tube were not recorded. During the site visit we witnessed this person displaying signs of anxiety on frequent occasions and requiring a lot of reassurance that ‘everything was alright’. We were advised by the person in charge of the shift that the individual can become anxious and concerned when there are ‘new faces’ at the care home. On inspection of their care file, records showed that the person can exhibit ‘extreme mood swings’ and can be ‘emotional’ on occasions. The care plan did not record how this manifests or provide specific guidance and instructions for staff as to how to deal with this, so as to ensure a positive outcome for the resident. Further development of the homes care planning and risk assessment processes is required to ensure positive outcomes for people and to guarantee consistency in recording. This will also ensure that staff working at the care home, have the necessary information they need in order to meet people’s Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 14 health, personal and social care needs consistently and in ways that the person needs and wishes. As a result of concerns relating to the homes poor care planning processes, a Serious Concern Letter was forwarded to the registered provider. We also left an Immediate Requirement Notice in relation to the fact that no risk assessments other than for manual handling and falls were in place. However, the latter have yet to be completed for people who currently live at Sea Breeze. The daily care records for one person showed that in July 2009 they experienced pain and discomfort to one of their limbs. Records showed that initially the GP was called, a speculative diagnosis was made and forms left with the care home for an x-ray and scan to be undertaken following referral to the hospital. However, records showed that following the GPs visit the person continued to experience pain and to have pain relief medication administered. There was nothing in the care records to indicate the outcome of the appointment. We discussed this with the person in charge of the shift and were advised that the appointment had not taken place. In addition there was no evidence to show that care staff contacted the GP to make them aware as to the persons continued discomfort and pain or to request that the appointment be brought forward. We were advised that the GP had been contacted; however it was acknowledged that this may not have been recorded. On inspection of the homes accident records, there was no evidence to indicate that the person had sustained a fall or had an accident. This was confirmed by both staff and the registered provider. There was no plan of care was in place in relation to the management of pain for this person. As a result of these concerns a safeguarding referral has been made to the Local Authority Safeguarding Team. Records also showed that this person could be aggressive on occasions and incidents were recorded whereby they had become agitated or had exhibited aggression towards staff. Records did not always include evidence of staffs interventions or what support was provided and there was no care plan or risk assessment completed. On inspection of the persons Medication Administration Record, this showed that the person is prescribed medication for their agitation and aggressive behaviours to be administered as and when required (referred to as PRN medication). However, no protocol was in place detailing the rationale for when this medication should be administered and what signs should be looked for that would indicate the person needed the medication. In some instances it was unclear as to why the medication had been administered. On inspection of the staff training matrix and from looking at a random sample of staffs training records, there was no evidence to show that staff had received training relating to dealing with challenging behaviours. This was confirmed by staff spoken with at the time of the inspection visit. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 15 Records showed that people living at Sea Breeze have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include District Nursing Services, GP, attendance at hospital appointments, Optician and the Mental Health Team. Some people with dementia or poor cognitive ability are not always able to tell us about their experiences and what it is like to live in a care home. Therefore, as part of the inspection process, we have used a formal way to observe people to help us understand what life is like for them. We call this a Short Observational Framework for Inspection (SOFI). This involved us carrying out an intense and detailed observation of three people living in the home for a period of 1.5 hours and recording their experiences at regular intervals. This included their state of well being, how they interacted with care staff and others and what they did during this period. From our case tracking of the people we were observing we noted that individuals care plans make little or no reference to their dementia or poor cognitive ability and how this impacts on their quality of life or activities of daily living. The formal observation was undertaken in the afternoon however we also spent a considerable amount of time during the morning sitting in the lounge and dining room and observing staff practices. These observations highlighted inconsistencies in staff interactions and how they engaged with people living in the home. The majority of interactions by staff were solely centred around providing people with a drink or biscuit and undertaking manual handling procedures. The most positive interactions throughout the day were by the person in charge of the shift however they appeared reticent to instruct others whose practice was observed to be poor until we pointed this out. The tea rounds during the morning and afternoon were times when the interaction was the most positive as it was a sustained period of time that staff and residents engaged. However we noted that although there was a choice of tea or coffee available, only orange squash was provided and apart from one occasion where residents were asked if they wanted a drink, these refreshments are provided at set times during the day. During the observation one person was observed over a 30 minute period to ask repeatedly for a sandwich. It was positive that the request was always answered by the senior person in charge of the shift, however there were several occasions whereby the person was told that a sandwich would be provided but no action was taken to produce it. The resident became anxious on several occasions and on three occasions asked, are you going to get me a sandwich or not? On one occasion the resident was asked, what about a biscuit? and replied I dont want no biscuit just a sandwich. The sandwich was provided 30 minutes after the persons initial request. The same person was also observed to repeatedly ask, can I go to bed in a minute and I want to go to bed, why dont you want me to go to bed? The senior person in Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 16 charge of the shift responded sensitively by advising that it was too early and they had not yet had their teatime meal. On four occasions during the day poor manual handling procedures were seen to be adopted by staff, which could potentially place people at risk of harm. On only one occasion did the senior in charge of the shift advise the resident as to what was happening prior to undertaking the manual handling procedure. One member of staff was observed on more that one occasion to use inappropriate manual handling techniques. We advised the person in charge of the shift of our observations and they stated, Yes, I did notice, I guess I should have spoken to them. As a result of our concerns, a Serious Concern Letter was forwarded to the registered provider. Practices and procedures for the safe handling and use of medicines were examined by a pharmacist inspector on 27th August 2009 as part of this key inspection. Some concerns were noted in relation to the storage of medication. The majority of medicines were stored securely in a trolley in the dining area of the home, but there were some medicines awaiting return to the supplying pharmacist which were in an office area but the door was unlocked. In one person’s room we found a prescribed cream which was not locked away. This increases the risk that medicines may be accessed by unauthorised people or people they are not prescribed for and a requirement has been made about this. We also found medication in a person’s room which was labelled with someone else’s name. The temperature of the area where the medication is stored is not monitored or recorded regularly. The failure to store medicines at the correct temperature could result in people receiving medication that is ineffective. The cupboard used to store controlled drugs is not fixed to the wall in the way required by the regulations. Records are kept when medicines are received into the home, when they are given to people and when they are disposed of and, in general these records account for the medicines in use. However, we found number of worrying discrepancies in the records made when medicines are given to people. These discrepancies included, but were not limited to, the date that medication was given to people was inaccurate; medication prescribed to be used three times a day but recorded as being used only once a day without any record made that this change in dosage had been agreed with the health care professional who prescribed the medication; duplicated records that might indicate medication was used twice in the morning not once, as it was prescribed; unexplained gaps in the records giving no indication of whether medication was administered or not; medication prescribed in variable doses not indicating how much medication was given and so this could result in people receiving too much or too little medication. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 17 Additionally where people are prescribed medication on a ‘when required’ basis (sometimes referred to as PRN medication), for example to control behaviour or for pain relief, care plans did not provide guidance on the circumstances the medication should be used and care records did not justify their reasons for use. Where people stored medicines in their own rooms, the risk to themselves or other people in the home had not been assessed. Medication is only given to people by trained staff but the training in many cases was done some years ago. We were told that future training is planned in September 2009, and because of this we have not made a requirement on this occasion. However, the lead inspector carrying out the inspection on 25th August 2009 noted in staff supervision records that all staff had a record of an observation of their competency in administering medication. The assessments stated, for example, that the person administering the medication ‘wore gloves’, which should not be necessary as medication is not touched if appropriate practices are followed. The assessor did not appear to be aware of this. The assessments also stated that no errors were observed and all were judged by the assessor as being competent. It was further noted that the assessor has not had updated medication training for a number of years. In order to be competent in assessing other people’s abilities it is essential that an assessor has up to date knowledge and skills and is aware of appropriate practices around the storage, handling, administration and recording of medication. These guidelines are available from the Royal Pharmaceutical Society of Great Britain. The home carries out regular checks of the medication records and the requirement made on the last inspection about this has therefore been met. Overall, it was evident from our observations that many of the staff team treated people living in the home with respect. As noted elsewhere in this report, the most positive interactions were from the senior member of staff in charge of the shift. The cook was also observed to interact well with people. Evidence examined in the home’s complaints log indicated that someone had complained that when they visited they had noticed that their relative’s clothing was being worn by another resident. More care must be taken by staff to ensure people’s personal possessions are not misused. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Sea Breeze can not be confident their social and dietary needs wishes are met. EVIDENCE: One of the senior care staff is responsible for co-ordinating activities. however the expectation is that all staff working at the care home support and enable people to have the opportunity to engage in personal interests and activities. A copy of the planned activity programme was noted to be displayed in the main lounge. Although this is in a written and pictorial format, consideration should be made to devise the activity programme in a larger format so that people know what is happening and planned each day. On inspection of the activity programme, activities available include bingo, dominoes, reminiscence, gentle exercise, interactive chat, puzzles and snakes and ladders. An activity folder depicting activities undertaken each day with residents is kept in the staff room. Records showed that in addition to the above there is skittles, card Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 19 games, looking at magazines, listening to music, watching television or films and religious observance. Of those care files case tracked, there was limited evidence to show that the social care needs of individuals were recorded. Records showed for those people who have limited communication or poor cognitive ability, there is a lack of appropriate social stimulation available. The majority of people who live at the home are unable to give a view as to whether or not there are sufficient activities provided at the home, however two people stated, not a lot I like and not for me. During the site visit efforts were made by the senior person in charge of the shift during the afternoon to engage a small number of people in social activities. Whilst two people refused to participate, two people were observed to enjoy a few games of snap and two people were given a soft dice to hold. In addition the member of staff was observed to dance with a resident to some rock and roll music. Whilst this is seen to be positive, we are concerned about the actions of one member of staff throughout the day. We observed the member of staff consistently did not verbally or physically interact with people unless instructed by the senior person in charge. On one occasion the member of staff was observed to sit down next to a resident and to look at a magazine for over five minutes, without involving the resident or speaking to them. On another occasion the member of staff was seen to pick up a pack of cards and to play a game of patience independently and it was not until we intervened that the senior member of staff, instructed the carer to play cards with a resident. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. There is a rolling four week menu in place and from inspection of this, showed that people within the home are provided with a varied diet throughout the day. From discussions with the cook we were advised that alternatives to the main meal are available, however on the day of the site visit everyone had chosen to have the same choice. Consideration should be made to devise the menu in larger print and/or pictorial format so as to ensure that people living at the care home are able to make an informed choice. Tables were observed to be attractively laid with tablecloths, placemats and glasses. The quality and quantity of food provided to people was observed to be appropriate and looked appetising. The cook was seen to ask people if their meal was satisfactory and positive comments were provided by residents. These included yes and fine thank you. A choice of drinks was not readily available and everyone was provided with orange squash. During the observation of the lunchtime meal, one person was seen to be assisted to eat their meal by a member of staff. We noted that throughout the entire meal (main meal and dessert) the member of staff did not talk to the resident (approximate period of 40 minutes). During this time the member of Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 20 staff was seen to outpace the resident by not giving them sufficient time to swallow their food before another spoonful of food was provided. This was also evident when the member of staff gave the resident a drink. In addition no attempt was made to advise the resident as to the meal choice provided for both the main course and dessert. Another two people were assisted by staff to eat their meal and in general terms this was seen to be undertaken positively. However the senior person in charge of the shift whilst providing assistance to one person to eat their meal got up and administered medication to another person. The person was not advised of this and was left waiting for the member of staff to finish providing assistance. During this time the resident was observed to call out on three occasions please help me, however no staff responded. After lunch one person remained in the dining room. We had observed this person struggling to manage using cutlery and was consequently only able to eat very slowly. The proprietor later explained that this person preferred to manage independently wherever possible and chose not to have assistance with eating. A member of staff returned to the dining room as the resident began to cough as though food had ‘gone down the wrong way’. The member of staff patted the resident on the back a few times without speaking to them and then lifted the spoon and attempted to give the person a spoonful of food. Up to this point there had been no attempt at verbal interaction with the resident, who then indicated that they did not want the offered food. The member of staff asked if they were finished and proceeded to remove the dinner without further comment, placed a bowl of banana and custard in front of the person and left the room without speaking. It was evident that the member of staff was not aware of this person’s wish to remain independent around eating. It was also evident that the support offered was inadequate when the person was coughing and the lack of communication throughout the incident indicated poor practice. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor practices mean that people living in Sea Breeze cannot be confident that they will be safeguarded. EVIDENCE: The home’s Statement of Purpose states, ‘In order to attain a high standard of care and satisfaction in our home, we wish to provide an effective means of recording, dealing and resolving of complaints from both residents and their relatives or carers. Complaints should be seen as an opportunity to improve the delivery of quality care’. The complaints procedure specifies that all complaints, however trivial, are to be investigated, will be acknowledged within 24 hours and the complainant will be advised of the outcome in writing within 28 days. On the day of the inspection we examined the home’s complaints log. The records contained evidence of two recorded complaints, which were acknowledged, investigated and written responses sent of the outcomes. One of the complaints related to someone in the home who had been admitted to hospital. Relatives had expressed concerns that the person’s underwear was missing or in a poor state. They also expressed concerns that another resident was seen to be wearing their relative’s dressing gown when they had visited Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 22 the home. Although the response to the complainant dealt with the missing or spoiled underwear, it did not acknowledge the other issue of someone else wearing their relative’s clothes. There were no records of discussions with staff around good practices with laundry or how a resident came to be wearing someone else’s personal clothing. If, as stated in the Statement of Purpose, the home is to attain a high standard of satisfaction through an effective complaints process, then all aspects of a complaint must be dealt with robustly. This includes keeping a full and detailed record of the investigation and what measures have been put in place to address all the issues raised by the complainant. On the day of the inspection we observed that interactions between staff and people living in the home varied, with some staff displaying an open and friendly attitude whilst others demonstrated poor practices such as ignoring people or carrying out tasks without speaking to the person. Further details of these issues are recorded in the sections of this report relating to ‘Health and Personal Care’ and ‘Daily Life and Social Activities’. Poor practices in response to signs of distress or requests for assistance do not ensure that people can be confident they are adequately safeguarded. Additionally, we observed poor practices around moving and handling throughout the course of the inspection. A pharmacy inspector who visited the home found evidence of poor practices around the storage and recording of medication. Details can be found in the section of this report relating to ‘Health and Personal Care’. These poor practices have a significant impact on increasing the risks to people living in the home. As reported in the staffing section of this report safeguarding training is currently being rolled out across the staff team. Some members of staff have already completed the training and others are booked to do it. Throughout the day of the inspection, it was evident from our observations that staff did not fully understand their responsibilities around recognising signs of abuse or poor practice and reporting concerns. This is an unacceptable risk to vulnerable people directly related both to poor staff practices and staff’s failure to recognise and deal with other people’s poor practices. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Currently people living in Sea Breeze do not benefit from living in a safe, homely environment. EVIDENCE: On the day of the inspection we undertook a full tour of the premises which included all communal areas including the lounge and dining rooms, laundry room, kitchen, bathrooms, toilets and residents’ bedrooms. Overall we observed the home to be tidy and odour free. The bedrooms that were occupied all were seen to be individualised and contained a range of personal items such as ornaments, photographs and memorabilia. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 24 One person’s room had two locked cupboards to store PEG (Percuitaneous Endoscopic Gastrostomy) feed equipment, which had peeling labels on the doors stating what was in the cupboards. The senior carer explained that these items were not all used any more. It was pointed out that labels stuck on doors and padlocks screwed to the front of the furniture did not enhance the homely feel and made the room appear institutional. We also noted broken handles on a drawer and wardrobe, which added to the poor appearance of the room. The provider stated in the Statement of Purpose, “all rooms are connected to the nurse call system for the benefit and safety of the residents”. We noted during the tour of the premises that call bells are situated on the walls near the beds in individual rooms but these were not accessible to anyone sitting in a chair. This is a particular risk to anyone with mobility difficulties who would not be able to reach the alarm if they required assistance. The Statement of Purpose states all rooms have been recently redecorated and refurnished recently and are equipped to accommodate service users with dementia and all communal social rooms are arranged in a way to facilitate for service users suffering from dementia. This did not concur with our findings and it is unclear as to how the environment has been designed or arranged to meet the needs of people with dementia. There were no pictures on individual doors to distinguish one room from another which would assist people who may be becoming confused or forgetful as a result of the aging process. Similarly there was inadequate signage on bathrooms, toilets or communal areas to assist peoples orientation. This falls short of the standards expected in a service that is registered to care for older people or those who have dementia. Overall the evidence does not support the providers statement that the premises are arranged in a way help people with dementia. It was reported at the last inspection that the provider stated in the home’s Annual Quality Assurance Assessment (AQAA), “Recently a lot of maintenance work has been carried out. Disease prevention and hygiene measures carried out”. It was evident during a tour of the premises that there were a number of areas where maintenance was poor. One room has wallpaper peeling away from the walls in the corners of the en-suite; another room had an en-suite with a toilet that was badly stained with a build up of limescale in the toilet bowl and bad staining in the corner of the flooring. This does not support the information provided in the AQAA or the statement in the Service User Guide that states “our luxury 13 bed-roomed accommodation, 12 en-suite, offers all the facilities to ensure comfort and care”. A number of concerns relating to health and safety or infection control issues were raised during this inspection. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 25 One issue relates to the Control of Substances Hazardous to Health (COSHH). The cupboard in the laundry containing cleaning materials was noted to be unlocked. When this was brought to the attention of the cleaner the cupboard was then locked and we observed that the small padlock was ineffectual and did not hold the doors securely closed. The COSHH products in the cupboard could easily have been accessed by vulnerable people living in the home. This is a particular risk for people with dementia or cognitive impairment. It was further noted in the laundry room that there were some damaged tiled and a worktop with a damaged surface. The proprietor explained that this was caused by previous staff who no longer worked in the home using the worktop to iron clothes instead of using the ironing board. These damaged surfaces pose an infection control risk in an area used for laundering soiled clothing and steps need to be taken to reduce the risk if people living in the home are to be safeguarded. One improvement that was noted is that radiator covers have been installed since the last inspection. However we observed that several of these radiator covers were loose and had not been fixed securely to the walls. This is a potential hazard for elderly people who are frail and who could be at risk either from falls by leaning for support on a loose radiator cover or from burns from being able to access the hot radiators. Some individual rooms have floor tiles in the en-suite facilities that are raised to a different level to the flooring in the bedroom area. This creates a potential trip hazard, particularly for elderly people who are unsteady on their feet or who have poor vision. At the time of the last inspection it was reported that window restrictors were inadequate and consisted of a weak piece of chain secured with two screws. It was advised that a more secure alternative must be provided to safeguard people, as a number of upstairs rooms open on to a flat roof or there is a steep drop to the ground outside. Through discussion the provider explained that these had been replaced with a heavier type of chain which was safer than the previous window restrictors. However, we noted that in one room the chain was broken and, although the chains had been replaced, they were still inadequate and posed a risk should anyone fall against an open window. The provider informed us that replacement windows were planned to be installed soon. We noted that communal toiletries, including bars of soap, comb, razor, shampoo and conditioner, shaving foam and ‘zinc and castor oil cream’ for a named person who is no longer resident in the home, were located in the shower room on the ground floor. Some of the toilets had terry towels for hand drying, which can create a risk to infection control. The downstairs toilet did not have paper towels for hand drying. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 26 We inspected the main kitchen and found some items of food that had not been covered properly and were not marked with the date when opened and placed in the fridge. We also observed the seal on one of the fridges was broken. Whilst we accept that a new fridge is to be purchased as advised by the senior person in charge of the shift, at the time of the inspection the fridge may not have maintained an appropriate temperature for the storage of food, posing a potential health and safety risk to people in the home. Fire records for the home were examined and these showed that the fire alarms are tested weekly. However the homes emergency lighting was last tested in May 2009 and should be undertaken more regularly to ensure it is in working order. There is a fire risk assessment in place and fire drills (including a full evacuation) are undertaken frequently. The registered provider was advised to ensure that the names of all staff who participate in fire drills should be recorded so that they can identify any member of staff who needs to be updated on this procedure. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Sea Breeze cannot be confident that their needs will be met by a competent staff team with the skills and competencies to provide good quality care. EVIDENCE: From our observations on the day of the inspection and from staff rotas examined, it was evident that there were regularly two carers on duty per shift with additional support to cover kitchen duties and domestic tasks. Although there were sufficient numbers of staff on duty to meet people’s care needs, the quality of support was variable. We observed that some staff interactions were caring, whilst others were poor. Similarly some staff practices were seen to be appropriate, whilst others were poor. This particularly applies to practices around moving and handling and assisting people with their meals. We discussed staff qualifications with the provider, who explained that all members of staff have completed a National Vocational Qualification (NVQ) at level 2 and many staff have completed or are in the process of doing level 3. Four personnel files examined on the day of the inspection contained evidence of completed NVQ awards. However, it was noted that although the majority Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 28 of staff have achieved the qualification, as evidenced throughout this report, some practices did not reflect an understanding of what constitutes good care. Staff who completed surveys told us that what the home does well is, “Care for the service users”, “respects people, individuality, privacy, human rights and we care for the service users well” and “we care for our service users and their well being [is] our main priority”. If people living in Sea Breeze are to be confident their needs will be met appropriately, staff must demonstrate a greater knowledge and understanding of their responsibilities around recognising poor practice and keeping people safe. The new providers have put an improved recruitment process in place. They have devised a checklist to assess candidates and have devised an improved application form. The proprietor explained that they are currently not recruiting staff and there are only seven residents in the home and they have twelve vacancies. A sample of three personnel files was examined and it was evident that the proprietor was making progress with getting the files in order. Not all documents as required by regulation were place, such as two written references; however, we accept that some members of staff have been employed at the home for many years and the missing paperwork does not necessarily reflect the current recruitment process. The providers were able to demonstrate an understanding of their responsibilities when employing new staff. We discussed staff training with the providers who explained that they have now put a training matrix together to plan training by identifying what training people have had and what needs to be updated. Safeguarding training is being rolled out across the staff team. The first three members of staff have completed the training and another three are booked to start. The training is delivered over a period of five weeks and staff complete an ‘activities and assessment’ workbook. An assessor comes to the home on a weekly basis to assess the work the member of staff has completed. The training records of four members of staff were examined and the evidence of training was variable. Only one of the four members of staff had evidence of a range of training, including health and safety, fire safety, safeguarding adults, care of medicines and safe handling of cleaning products and use of chemicals. Three of the four files examined contained evidence of moving and handling training and all four contained evidence of food safety training. In the file of one senior carer examined the majority of training certificates were out of date; there was no up to date training around medication and this was the member of staff who had responsibility for carrying out medication observation assessments on other staff. The proprietor explained that staff are now taking on new ways of working and are now expected to complete paperwork, which was not previously seen to be their responsibility. The proprietor further explained that they are being given in-house training on completing paperwork such as care plans. Staff spoken with on the day of the inspection said they had not had training on care Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 29 planning and it was evident that there was a lack of understanding about what constitutes training and improving practice by learning from informal training. It is essential that staff understand the importance of developing their skills and knowledge and using this to develop good care practices. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Sea Breeze cannot be confident that the current management arrangements ensure the home is being run in their best interests. EVIDENCE: At the time of the last key inspection in April 2009, the manager had recently left the service. The providers explained that in the three months between June and August they had placed advertisements locally for the post of manager. They told us they were disappointed with the calibre of applicants and had decided that they would continue to manage the home themselves on a full time basis until the necessary improvements were achieved. Neither of Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 31 the providers have a background in care but they explained that the deputy manager works three days a week and concentrates on care management as well as carrying out staff supervisions. As documented throughout this report, there are a significant number of areas of concern that will need to be managed appropriately and robustly if the service is to improve sufficiently to ensure the home is run in the best interests of the people living there. Details of those areas of concern can be found in the various outcome groups throughout this report. The providers have now put a staff supervision process in place. Personnel records examined confirm that all members of staff have had a formal appraisal over the past few months. However, it was evident that some of the supervision process was being carried out by senior staff whose training was not up to date. We noted in the Health and Personal Care section of this report that all staff had a record of an observation of their competency in administering medication but this was carried out by a senior member of staff who did not have up to date medication training. There was a recorded ‘observational supervision’ of a member of staff getting a service user ready for bed. This described the actions taken in a task orientated way. There was only one reference to communication, which stated, “[Name of member of staff] then explained to the service user that [they were] taking them to the toilet to get ready for bed”. There was no recorded information as to whether the care or communication was appropriate. Our observations on the day of the inspection were of poor communication and poor practices from this member of staff. Although the proprietors have put a process in place for the formal supervision of staff, the poor practices are not being recognised, picked up and dealt with to ensure practices improve so that people’s wellbeing and safety are safeguarded. We discussed to process of quality assurance with the providers, who have devised a service user satisfaction questionnaire. Many of the questions require a ‘yes’ or ‘no’ tick response. Questions include, ‘Do you feel happy at Sea Breeze?’ and ‘Do you feel the staff are always close at hand at all times to help you?’. The yes or no choice does not always give people the opportunity to choose a response that matches their experience. Responses such as ‘sometimes’, ‘often’ or ‘never’ may be more appropriate than the choice of yes or no. The proprietors also distributed surveys to visitors and relatives; nine of these were returned and contained a number of positive comments about the service. Comments included, “Exceptional friendly staff at all times. Always helpful staff to answer queries and pass messages”, “The girls are very helpful, nothing is too much trouble for them. They are all very kind to service users”, “No complaints”, “Meals look good”, “overall my impressions are good”, “Garden requires attention. Colourful plants would benefit clients by stimulation and show the seasons” and “The home has a lovely atmosphere and is very clean and tidy”. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 32 At the time of the last inspection there was no quality assurance process in place and we acknowledge that the providers have demonstrated a commitment to improving the service. Further development of the quality assurance process will contribute to this improvement. It is evident that staff recognise that changes are taking place in the home and the new providers are taking some steps towards improving the service. Staff who completed surveys made positive comments about how they felt the management of the home had improved. One person told us, “The home seems to be running better now. Staff [are] more happy with changes that have been made” and another stated, “I think the home under new management has improved in the last 2 months after a bad start”. Another member of staff said, “After the changes made, everything has settled down and is an enjoyable home to work in”. A sample of health and safety documentation and maintenance certificates examined was found to be in order and up to date. These included the electrical installation certificate, the stair lift maintenance document, the home’s gas certificate, portable appliance testing certificate (PAT), hoists maintenance and the employer’s liability insurance. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 1 X 2 Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement Timescale for action 01/10/09 2. OP3 14 3. OP7 14 Ensure that the Statement of Purpose is accurate and detailed, depicting the homes aims and objectives, facilities and services. This will ensure that people wishing to use the service have the information they need about the home. This issue was highlighted in the last inspection report. 01/10/09 Full and detailed pre admission assessments by the home must be undertaken prior to a service user moving in so that service user’s individual needs can be met. There have been no recent admissions to the home therefore we were unable to judge if this requirement has been met. There is a plan of care, clearly 25/09/09 identifying all aspects of the persons care needs and how these are to be met by staff. This will ensure that staff have the information they need so as to provide appropriate care to meet the individuals care needs. DS0000072805.V376670.R01.S.doc Version 5.2 Sea Breeze Page 35 4. OP7 15 5. OP7 6. OP8 7. OP8 8. OP8 9. OP9 Where the persons care needs have changed, the plan of care must be regularly updated and reviewed to reflect the most up to date information. This will ensure that staff have the most up to date information and can provide appropriate care to meet their needs. This is a repeat requirement 13(4)(b) Risk assessments must be and (c) devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps taken to reduce the risk. This issue was highlighted in the last inspection report 12(1)(a), Make proper provision for the (2)(3) and health and welfare of people in (4)(a) the care home. This refers specifically to ensuring that people have their care needs met and that staff engage with people regularly. So as to ensure peoples safety, health and welfare. 13(6) All staff who work with people who have challenging behaviour are suitably trained. This will ensure that people will not be placed at risk and that staff have the skills and competence to manage difficult situations proactively. 13(5) Ensure that suitable arrangements are in place to provide a safe system for moving and handling service users. So as to ensure peoples safety and wellbeing. 13(2) Medicines must be stored securely at all times when not in use and in line with legal requirements. This will ensure medicines are DS0000072805.V376670.R01.S.doc 25/09/09 28/08/09 25/09/09 01/11/09 25/09/09 15/09/09 Sea Breeze Version 5.2 Page 36 10. OP9 13(2) not accessible to unauthorised people. Medicines must be stored under suitable environmental conditions and records must be kept to demonstrate this. This will ensure the quality of medicines in use. Records made when medicines are given to people must be accurate and complete. This will demonstrate people receive their medication as prescribed. 15/09/09 11. OP9 13(2) 15/09/09 12. OP9 13(2) 13. OP9 13(2) 14. OP9 13 People must only be given 15/09/09 medication prescribed and any variation to labelled instructions must be justified with documented agreement of the prescriber. This will protect people from harm and ensure medication is given as prescribed. Where people are prescribed 15/09/09 medication on a ‘when required’ basis, there must be clear written guidance for their use. This will protect people from harm and ensure appropriate use of medicines. Where medicines are stored in 15/09/09 people’s rooms, there must be appropriate risk assessment and risk management plans in place. This will protect people from harm. All people who live at the care 21/09/09 home must be given the opportunity to engage in a varied programme of activities which meets their needs. This refers specifically to those people who have poor cognitive ability and/or dementia and who find it DS0000072805.V376670.R01.S.doc Version 5.2 Page 37 15. OP12 16(2)(m) and (n) Sea Breeze 16. OP15 16 17. OP16 22(3) 18. OP18 13(6) 19. OP19 23(2) 20. OP19 13(4) 21. OP19 13(4) difficult to communicate effectively. So as to ensure that people are enabled to maximise their potential. This is a repeat requirement Ensure people are regularly provided with adequate fluids. To meet residents needs and promote their health and well being. All aspects of complaints must be fully investigated. This will ensure people can be confident their concerns are taken seriously and acted upon. This is a repeat requirement Staff must be aware of and follow safeguarding policies and procedures. This refers to staff being able to recognise abuse or poor practice and taking appropriate action. This will ensure people are protected from harm. This is a repeat requirement Ensure that the home environment meets the needs of the people it is intended for. This refers specifically to people who have dementia. Ensure that all areas of the home are as far as possible free from hazards to individuals safety. This refers specifically to the homes COSHH cupboard. So as to ensure peoples safety and wellbeing. Ensure that all areas of the home are as far as possible free from hazards to people’s safety. This refers specifically to ensuring risks from open windows are prevented and if window restrictors are fitted they must be fit for purpose. So as to ensure people’s safety and wellbeing. This issue was highlighted at DS0000072805.V376670.R01.S.doc 25/08/09 01/12/09 21/09/09 01/12/09 01/09/09 01/09/09 Sea Breeze Version 5.2 Page 38 22. OP27 18(1) 23. OP29 19 24. OP30 18 25. OP31 10(1) the last inspection Ensure staff working in the home are suitably competent and have the skills and knowledge to provide people with appropriate care. This will ensure people’s safety and wellbeing is safeguarded. Procedures to recruit new staff must be robust and ensure that all relevant checks on their suitably to work with vulnerable people are carried out. This will ensure people’s safety and wellbeing is safeguarded. This issue was highlighted at the last inspection Staff working in the home must receive the training they need to ensure they have the skills and knowledge to meet the needs of people living in the home. This will ensure people’s safety and wellbeing is safeguarded. This is a repeat requirement Ensure that the service is managed with sufficient care, competence and skill. To promote good quality care in the best interests of people living in the home. 21/09/09 01/11/09 01/01/10 01/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Consider devising the Service Users Guide in an appropriate format for the people for whom the service is intended e.g. simple language, pictorial and/or larger print. The providers should continue to develop the home’s DS0000072805.V376670.R01.S.doc Version 5.2 Page 39 2. OP33 Sea Breeze Quality Assurance system so that when they seek the views of people living in the home and other interested parties, the information is used to form a development plan, which demonstrates that people’s views are being acted upon. Sea Breeze DS0000072805.V376670.R01.S.doc Version 5.2 Page 40 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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