Inspection on 29/04/09 for Sea Breeze

This inspection was carried out on 29th April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sea Breeze 21/12/09

Sea Breeze 25/08/09

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Sea Breeze 34 Carnarvon Road Clacton On Sea Essex CO15 6QE Lead Inspector Helen Laker Key Unannounced Inspection 29th April 2009 07.00 DS0000072805.V375205.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.V375205.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.V375205.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 436690 Dr Elsie Damien 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.V375205.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. Not Applicable as (N) new registration 15/12/2008 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 central library and within walking distance of the seafront, town centre and other local amenities. Public transport facilities are good. The property is set back from the road and has off road parking in front of it. Accommodation is available for nineteen people, consisting of 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 staircase and a chairlift. There is no passenger lift. Communal areas consist of a lounge and a dining room. The rear garden, accessed from both rooms, is a small paved area with a detached storage building, raised flower border and garden table and chairs. Kitchen and laundry are located at the rear of the property. A small area for parking is located at the front of the property. The current weekly charge for a room is £390.39. Extra charges are made for dry cleaning, chiropody, toiletries, and hairdressing. Sea Breeze DS0000072805.V375205.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 this service is 0 star. This means the people who use this service experience poor quality outcomes. This key unannounced inspection was carried out as part of the annual inspection programme for this home and looked at all the core standards for care of older people. It took place on a weekday between 07.00 and 16.45. The senior staff were present throughout most of the day and the proprietor also attended later on the day and assisted with the inspection process by supplying documents and information. The inspection focused on all of the core key standards. A tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to the Care Quality Commission (CQC). It was noted that the AQAA was not received when requested and extra time for completion was required and a further six days was agreed to the 12/05/2009. The AQAA was received by us the day after. It was completed adequately, however the content just mirrored the National Minimum Standards for Older People in quite a few areas and did not give a clear picture of how the service was looking to improve and develop the service. The AQAA provides an opportunity for the service to tell us what they do well in detail, and areas they are looking to improve and/or develop. It is anticipated that any improvements, changes or plans be noted as this contributes greatly to the inspection process and indicates the home’s understanding of current requirements, legislative changes and own audited compliance. Six residents, two relatives and five staff were spoken with during the inspection. Feedback survey sheets sent out by the CQC were not utilised by the service and so comments from these cannot be taken into account when writing the report. Due to the care needs of the residents at the home it was not possible to fully obtain all their views. At the time of this inspection one adult protection referral had been notified to the CQC and was under investigation. The home was also being monitored and inspected by an Environmental Health Officer (EHO) and The Local Authority Quality and Development and Contracts Team. A visit by us was therefore scheduled sooner than anticipated as a result of an adult protection strategy meeting, which we attended on the 27/04/09. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 6 It is noted that the management of the home are being co operative with external bodies and stated on the day of inspection that they intend to address the internal shortfalls which have led to the current deterioration in the home. The matter is not yet closed as an adult protection issue and the home currently has an embargo on any new admissions via the local authority. Issues noted are discussed in more detail in the body of this report. What the service does well: The home can generally provides a good overall standard of care to residents with dementia. Residents appear happy living at the home and interact well with staff and observation and discussions with residents’ indicated they were happy, relaxed and generally comfortable. What has improved since the last inspection? What they could do better: The team need to ensure that good records are maintained that relate to the care and services provided. Further developments are needed in relation to assessments, care planning, risk assessments, medication recording, activity provision, food provision, staffing, staff training, supervision, health and safety and quality assurance. Staff recruitment procedures need to be strengthened. The home should have a registered manager. Staff supervisions and staff inductions require much more development and consistency and aspects of record keeping on various subjects could be a lot better. The management team should audit the maintenance of the home and ensure any health and safety matters that would put service users at risk are addressed and appropriately risk assessed. People living in the home must be kept safe by ensuring adequate robust window restrictors on windows on the first floor, are in place or appropriate locks based on an assessment of their vulnerability and the potential risk. This applies to windows in communal areas such as the upstairs bathrooms and individual’s rooms which lead out onto a flat roof. A registered manager should be in post and should obtain a qualification of NVQ level 4 in management and care (or the equivalent). Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 7 The proprietors must review their input into the service to ensure standards are maintained and serious lapses in procedures which on this occasion were health and personal care, complaints and protection, staffing and recruitment and management and administration do not put service users at risk. It is expected that very significant improvements must be made by the next inspection. 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.V375205.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.V375205.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, 2, 3, 4 - Standard 6 does not apply to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an assessment system in place that does not always ensure that they can meet the needs of people they admit to the home. Information available to prospective residents could be developed further to ensure they can make an informed decision about living at the home. EVIDENCE: The home has a pre-admission assessment system in place. The assessment documentation completed generally goes on to form part of the care plan. From previous completed documentation reviewed. We were informed by the provider that the manager or deputy manager with the assistance of the senior carer would be the people to undertake most of the pre-admission Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 10 assessments, however as there is currently no manager in post the provider will be actively involved with this. The admission process offers the opportunity for people to visit the home and sometimes have a package of day care at the home arranged while waiting for a vacancy. The first month’s stay is generally on a trial basis for both parties to ensure the resident settles at the home. The home offers permanent residency or short-term, respite stays. It does not offer intermediate care. The files of two residents were seen, one of which, had entered the home recently and the other had been a resident for some years. There have been no other admissions to the home since the last inspection prior to re registration. The assessments seen covered the required areas and had been completed adequately. Areas of need for physical and mental support were identified under headings such as mobility, continence, personal hygiene, orientation, general health and communication. The person’s weight and any known allergies were not always recorded. If there had been a history of falls this was not always noted together with any ongoing medical condition that may need monitoring such as diabetes. Sufficient detail relating to the physical and social side of care needs required individually was not always clear, however family and social histories were noted to be in place. Information on residents’ personal preferences and their daily routines was only available in part. It was noted that the time and detail involved when documenting the assessment was variable and depended on who had completed the assessment. The assessments seen were not dated or signed and did not evidence that the assessment itself took place prior to the service user being admitted to the home, which is not deemed appropriate. No evidence of family involvement was seen on those assessments. The AQAA states “We will enhance the efficiency of admission process by :“Invite each prospective service user for day visits for more than one occasion and during different days of the week to make sure that we can deliver the care that the prospective service user needs round the clock for seven days”. “Inviting service user’s family and social worker prior to admission a few times to choose rooms and to personalise the room if needed. This will also give the service user and their family and social worker a chance to experience the service and make a decision accordingly. The prospective service user and their family will be given a chance to discuss and comment on the menu. We will include their preferences as alternative choices. The prospective service user and their family will be given a chance to discuss and comment on the ‘daily activity and plan’. Their preferences will also be included.” Additionally the AQAA states “We will improve on the training level of staff to enable them to care for our service users efficiently to improve the level and quality of care and the whole service provided at Sea Breeze to be of highest standard.” Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 11 Information seen in the assessments on the day of inspection did not tally with the actual care plan. For example one service users assessment identified that they had diabetes but this was not mentioned in that person’s care plan. The care team need to ensure that they are aware of the contents of the assessment and attention to dates times and signatures must be given more prominence. Prospective residents and their families are encouraged to visit the home before making a decision about admissions. On admission the staff generally complete an admission checklist to ensure that all areas are covered but this could be further developed to be a more person centred, individual process for the new resident. The home does take a few emergency admissions into its local authority contracted beds, and would generally be assessed by the manager of the service. It is a general trait that some of these residents are happy to become permanent residents at a later stage. Two service users seen had been at the home in excess of 16 years. One service user commented “I didn’t have enough information about the home prior to moving in but am happy now I am here” The contract reviewed for the home’s most recent admission was noted to be the old format used by the previous providers and the format required updating to reflect the changes in ownership or current Local Authority and CQC details. None of the assessments seen contained confirmation from the home that they could meet the prospective service user’s needs upon admission to the home. A service user guide and statement of purpose are available but will also need updating with regard to content and format, in relation to the resident group, respite services and manager/owner changes. It was discussed with the proprietor on the day of inspection the ways of developing the statement of purpose and service user guide in different formats. No service users on the day of inspection could confirm that they had a copy. However copies were noted to be displayed prominently on the wall in the corridor nearest the lounge area. Sea Breeze DS0000072805.V375205.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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users cannot be assured that their identified needs are included in their care plan. Care planning standards in the home are poor and do not ensure that the care of residents is monitored carefully enough. The home needs a much more person centred approach to improve outcomes for residents further. EVIDENCE: There is an existing care planning system in place consisting of an assessment, care plans and risk assessments. A review system is also in place. At the time of this inspection the paperwork was very disorganised. The files and care plans for three residents were seen. The care plans were arranged under three headings, ‘needs’, ‘aims’ and ‘interventions’. The needs covered the areas that the person required support with and the aims described what the outcome should be for the person. The interventions Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 13 explained how the outcome was to be achieved. Some of the areas covered included mobility, personal hygiene, confusion, continence, oral hygiene and foot care. There were also some entries for helping people to maintain independence, looking at their preferred pastimes and managing mental health problems such as depression. Care plans were seen to be in place for most of the residents identified needs. They were adequately informative although they needed to contain much more detail. It was noted that paperwork had been insufficiently completed since January 2009 highlighting a training and support need for staff. More work is required on introducing information on personal preferences and using a more person centred approach concentrating on strengths, rather than needs and putting support in place to optimise residents’ abilities. It was suggested at this inspection that the more dependent residents who have limited interaction with staff, may benefit from assessments for signs of well being and feeling ill being developed. A monthly review system in place had not been consistently fulfilled. This has also deteriorated since January 2009. Those seen show a staff appreciation of residents’ needs and changes, however attention is also required to include dates, times and signatures. There was evidence that care plans were reviewed with the key worker and the resident when possible. One resident spoken with confirmed that they had had a little input into their care plan. A daily needs assessment sheet was maintained for each resident, with headings that covered self-care activities, visits from health professionals, food and fluid intake over the day, physical needs, emotional needs and any changes in planned care during the day. These were noted to be inadequate and comprised of a small box filling in system which reverted to one word in some cases for example ‘Ok’ and ‘toileted’ These daily records were discussed with the new proprietor who stated “We are just using what is here”. The format for these daily recording sheets and expectations were discussed at this inspection as it has been noted previously that these form the basis for a monthly well being report prepared by the resident’s key worker that gave good information and detail about the resident’s life within the home. The areas covered were health, social and well being. These were noted to have ceased in January 2009 Not all the changes on the daily evaluation sheets were noted to have been transferred onto the care plan. This needs to be addressed to ensure the evaluation sheet does not turn into the care plan and potentially information is lost. These should be cross referenced with the care plan to ensure all needs are being met and documented as such and signed and dated with staff designation details clearly stated for each entry. Daily notes relating to the care varied in quality and must reflect residents’ physical and mental wellbeing. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 14 Social care plans could be better and contain more individual information and quite a few of the residents still do not have life histories and completion of this would help to develop a more person centred approach to the care of the residents. Only four out of nine residents currently in residence at the home, were noted to have likes and dislikes recorded. Recordings of social interactions and one to ones were not seen. At the current time more work is still needed to involve residents and their relatives in the holistic care planning process. The proprietor states in her AQAA , in the section which refers to what we could do better, that they will “Document correctly all events. Management to do regular checks and monitoring of these consultations. Management also to arrange for regular supervisions and observations with staff to make sure that they document efficiently. These will also be documented in staff files.” It was noted on the day of inspection that issues relating to choice were also not attended to wholly appropriately with regard to rising times. Upon arrival at 07.00 am in the morning it was noted that four out of the nine residents currently in the home were up and dressed in the lounge. We are informed this is normal practice and that the night staff are told to get up these four residents before the day shift commences. Upon review of the service users care plans there is no indication that this is their choice, and it was noted that one resident whose care plan noted they were depressed, and would lie in bed all day if they did not receive encouragement was still in bed at 11.00 am. Care staff also attended to medication rounds and gave out drinks, and at 11 am an extra member of staff came on duty to do the cooking for lunch. On the day of inspection only two staff were on duty for care duties and to prepare the breakfast and drinks. An agency member of staff was in charge wearing no uniform, and was getting residents washed and dressed and doing medication, whilst another member of staff was preparing breakfast whilst having to deal with soiled pads and residents who required toileting. This member of staff had no separate clothing provided to undertake kitchen duties. Residents who required two people to assist them were put at risk as not enough staff were available to help them. Staff and residents who commented said that generally “Residents are looked after well, however things are not quite the same” and “staff are kind and caring and do their best”. From discussion with the proprietor, it was agreed that the home only had a basic care planning system in place that was and needed to be developed to ensure resident’s individual needs were met. At the time of this inspection a full and accurate assessment of care planning processes was only partially able to be made. The previous manager had left the week before and previous levels of commitment to paperwork had declined. Not all was available to inspect on the day of inspection as we were told it is ‘missing’. The home now needs to address processes such as care Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 15 planning and assessments and it was discussed with the proprietor that their involvement should involve auditing on a regular basis to ensure that care planning is maintained to a good standard. The staff team at the home have experienced a period of instability since the home’s new registration in December 2008 and there is a vacancy for a manager, which in the interim is being overseen by the new provider. Four of the five staff member spoken with stated that overall staffing levels had reduced causing concern about the welfare of residents and that they found difficulty finding time to complete paperwork. This was confirmed by examination of records on the day of inspection where gaps were noted. During the day staff were observed asking residents where they wanted to sit and what they wished to do. One resident said, ‘staff are lovely, so patient but we have lost the best’. Another said ‘The staff do their best but it is hard for them’ One district nurse professional spoken with raised concerns stating “We come and treat the residents but we are not always sure we get told about everything as we can only come when we are asked to come. Things are not as good as they used to be” There was a good deal of friendly chat and banter throughout the day between staff and residents. A member of staff was observed sitting with a resident with a diagnosis of dementia who had become distressed and reassuring them, gently holding their hand. At the time of the inspection there were no residents being cared for in bed. Records did not all record that doctors or district nurses are asked to see residents as on the day of inspection the notes for a resident being seen by the district nurse could not be found and therefore an entry was not made. Residents have access to the chiropodist and an, optician. Residents can be referred to the falls prevention team in order to improve their mobility and regain independence. A range of risk assessments are completed that include manual handling, falls, general, environmental and nutrition. There was little evidence on file to indicate that these are kept under regular review, and most only contained sufficient, or no detail about falls and bedrails. One service user who used a scooter and the stairlift only had basic handwritten risk assessments which did not detail the risk and safeguards required sufficiently. This was signed by her but a relevant format was not available. Staff need to ensure that identified risks are reflected in the care plan so that the management of the risk is clear. Residents’ weights are being monitored but there are still some inconsistencies as to when this is done. The proprietor stated that she will refer service users for deterioration in physical health and records show that care staff ensure that blood tests are arranged, as requested by the doctor and that residents are supported to hospital appointments with escorts where required. Residents are also accessing dental services in the community. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 16 The team use a blister pack – Monitored Dosage system (MDS) system to manage the majority of the residents’ medication. Medication Administration Records (MAR) sheets were neat but there were some missing signatures and too many hand written prescriptions. A signature audit may be of value to keep this issue in check. Staff need to make better use of the omissions code located on the bottom of the MARS sheet. Items are checked into the home and returns systems are in place but an audit trail is not evident. One resident was partially self-administering for which a risk assessment and protocol was not formulated. Controlled drugs (CDs) are secured in an appropriate metal cabinet secured to the wall. The home has one person on Temazepam and one on Buprenorphine at present so no other CDs or Schedule 3 drugs were being stored. No evidence was seen of any medication reviews. One resident was also noted to be on antibiotics and these were not stored appropriately in a fridge at the appropriate temperature following opening. This was addressed on the day of inspection but a medication fridge is not available so the domestic fridge was used. The medication management policy was seen and has not been updated since June 2006. It gave guidance on ordering, administering and disposing of medicines. It needs to be expanded to include procedures for administering ‘homely’ remedies, giving medicines covertly and altering medicines from the format licensed by the manufacturers. The proprietor was advised to consult current Royal Pharmaceutical Guidelines to ensure the home’s compliance. It was also concerning to note that the agency staff member in charge on the day of inspection had no personnel or training records within the home and current medication training could not be evidenced. With the further development of the care plans and the introduction of a more person centred approach this will allow the team to evidence that they have an appreciation of the diversity of the residents in the home. Staff approach to privacy is generally good; staff were seen knocking on doors and relatives confirmed this too on the day. Interaction between staff and residents was seen and heard to be friendly, caring and respectful. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social care standards at the home need to improve to ensure that residents’ individual and group needs are met and their strengths and choice and control in their daily lives are optimised. The meal service at the home is not satisfactory and service users cannot be assured they will receive a balanced diet. EVIDENCE: The home has employed an activities co-ordinator and devised a weekly programme of activities that cover games, puzzles, exercises, bingo and reminiscence sessions. Parties are arranged to celebrate special occasions and birthdays and outings organised for shopping, going to the seaside or theatre. One resident was seen knitting during the day and another had their daily newspaper delivered. Social care plans are not in place for all residents, outlining resident choices regarding daily routine and life choices. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 18 Records demonstrate a lack of one to one sessions with the emphasis on group or task activities. This possibly relates to the fact that the care staff sometimes have the primary responsibility for social care alone. and the activities coordinator being more prominent in the home may enhance the work that they do. An activities co ordinator is also of value in terms of quality assurance as they are often in a position to obtain individual feedback on services. The management need to review how they provide appropriate activities that meet the needs, wishes and interests of service users, as there are shortfalls in the social care of residents in the home The AQAA acknowledges that “We could do more by evidencing more details in the activities in the residents plan of care. To take the service users out more frequently and include more activities.” Records of staff meetings and activity sheets were not available at this inspection. Service users spoken with stated that “The programme does not always happen”. Assessments, care plans and an individualised approach need to improve. The resident’s files seen contained some details of their preferred pastimes and how they would like to socialise. One file had some detailed life history work but staff said that it was sometimes difficult to engage relatives to do this. All the files had contact details of the resident’s next of kin and a few visitors came and went during the day. One visitor spoken with said, “I have been visiting for years and am generally made welcome, but it would be nice if they had more stimulation and outings”. The monthly well-being report which had not been completed since January 2009, did include some brief information about the activities residents participated in and whether they had had visitors or been taken out with friends. Discussion with staff indicated that no one in the home at the present time wished to attend any religious services but one resident did receive regular visits from active church members. On the day of inspection there were no activities taking place and a plan was not on display. Service users were seen sitting in the lounge and their rooms with very little stimulation apart from the television and the odd conversation with a care worker. Staff reported on the day of inspection. “There are not enough staff to do activities” and the activities co-ordinator who was also a carer, was off. The proprietor stated that external entertainers visit the home but no evidence was available to support this on the day of inspection. Relatives spoken with said that the home had a friendly atmosphere and they are made welcome however one stated “It would be nice if they went out more”. The menus seen were handwritten and only showed that the main meal of the day was at lunchtime. No other meals were documented. We were told these were the menus developed prior to the new providers taking over. Upon inspection of the food stocks, we found milk frozen in one freezer and consequently thrown away. Limited fresh fruit and vegetables were available consisting of some apples and carrots. Prior to this inspection there had been Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 19 complaints about the food and portion sizes and that value foods are being used and are not in sufficient quantities for residents. Residents spoken with confirmed that the quality of food had deteriorated since December 2008 and that some improvements had been made in the last week since the safeguarding alert was made. The provider stated that she was in the process of developing a new four week rolling menu. These had not been completed on the day of inspection. On the dining room wall is a large notice board headed ‘food for thought’. It has pictures of items of food and meals so residents who cannot understand written menus can identify meals by picture. This did not tally at all with the handwritten menu in the kitchen. On the day of inspection the cook who was also a carer arrived on shift for two hours from 11 am to 1 pm and then went on to complete a care shift. During the morning care staff had prepared breakfast and drinks for residents with no changes of clothing. Lunch on the day was omelette or fishcakes with ‘pots’ and beans followed by rice pudding. The inspector was told by one carer “that is if we have any eggs?” Most residents said they enjoyed the meal however some residents spoken with said, “An omelette is a snack not a main meal.” Another stated “The food could be better at times.” The AQAA submitted makes no reference to the menu’s or issues surrounding food or anticipated improvements in the light of recent complaints regarding the same. The kitchen was visited and looked generally clean and tidy, however all doors and windows to the kitchen were open. An EHO inspection on the 9th April 2009 had highlighted that the kitchen should be fully secured at all times when not attended by staff and that carers undertaking care and cooking duties were incompatible with infection control principles. On the day of this inspection 29th April 2009 this had not been addressed. The knives kept on an open magnetic holder had been moved and were placed in the larder store but again this was unlocked. We are informed by the proprietor that the dry goods are purchased at large outlets, but other ingredients come from local suppliers, and that shopping takes place weekly on a Thursday or a Friday. Although food stocks were only adequate on the day of inspection due to the inspection being on a Wednesday, staff spoken to stated that this was an improvement also within the last week. The temperatures of refrigerators and freezers are monitored and recorded to ensure they are functioning within safe limits for food storage. Mealtimes are generally arranged well and care staff sit with the residents and are therefore able to help those requiring assistance sensitively and maintain their dignity. The tables are nicely laid, condiments are available and residents have choices at mealtimes. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that their complaints will be handled appropriately at all times, and that they are protected by the home’s approach to complaints and adult protection matters. EVIDENCE: A complaints procedure is in place and displayed in the home and within the service users guide. It needs updating to reflect the new address and contact details for the Care Quality Commission. The complaints procedure is not available in different formats for instance large print. The new proprietor is new to running a care home and the need for a very open and objective approach to complaints was discussed. At the time of this inspection one POVA safeguarding issue was under investigation. A full and accurate assessment of complaints and POVA processes was only partially able to be made as records were not available to inspect on the day of inspection as the previous complaints recording system could not be located. We are informed that no complaints have been made since the new providers Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 21 took over and although there had been no direct complaints to the Care Quality Commission one resident spoken with stated they had had discussions with the proprietor about several issues mainly related to food but upon inspection these had not been recorded. This also did not tally with the AQAA which stated that at the time of completion no complaints and no safeguarding referrals had been made. This was clearly not the case as a safeguarding issue was being investigated at the time of this inspection. Staff spoken with also highlighted that they felt some of their concerns had been dismissed with regard to staffing numbers and food provision. It was discussed with the proprietor that there needs to be a robust system in place that includes their involvement auditing complaints on a regular basis. This will ensure that complaints and safeguarding issues are kept to a minimum. The AQAA states the home intends to “Document in detail all complaints and record the outcome. To make sure that all staff are trained and been on relevant courses. To keep all staff updated with the complaints and protection procedures and policies.” The home currently does not have a manager and the current proprietor feels that they have inherited some issues however it was discussed that the current situation required action to ensure correct systems are in place. It is anticipated that the current shortfalls in safeguarding procedures, complaints policy and practice are given more prominence and that outcomes for residents improve. Relatives commented that they knew how to make a complaint and who they would raise issues with. The AQAA stated that “We have a complaints procedure in place. If a complaint is made it is written in the complaint book which is then dealt with promptly and effectively. All staff are trained and been on relevant courses regarding abuse and understand the policies and procedures that are in place.” This could not be evidenced on the day of inspection. Some residents also spoken to could not confirm they were aware of the complaints procedure and had not had sight of it, but most knew who to direct concerns to. The home needs a proactive approach to adult protection and must actively refer any concerns that relate to the residents care as current legislative policies direct. The home has a protection of vulnerable adults (POVA) policy and a whistle blowing policy to protect staff who raise concerns. Staff files showed that staff had received instruction in POVA issues and staff spoken with said abuse was covered again during NVQ training. They were clear about their duty of care and could identify different examples of abusive behaviour. Some updates were noted to be required. Most staff spoken with showed they had a good knowledge on the subject. One staff member stated “We did do regular training with the last manager” As noted the home has had one adult protection referral since its new registration in December 2008 which is currently under investigation. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 22 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, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a pleasant welcoming environment but are not fully assured at times that it is well-maintained to ensure their safety. EVIDENCE: A tour of the home was undertaken with a senior carer and most areas were revisited later. The home was generally clean and tidy with no unpleasant odours noted. Domestic staff hours were noted to cover only from 11 am to 1 pm on the day of inspection. We are told this is arranged so that rooms are empty for cleaning. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 23 The AQAA states “Recently a lot of maintenance work has been carried out. Gas, electricity, chair lift safety certification. Faulty light fittings repaired. Disease prevention and hygiene measures carried out. Service users have sufficient and suitable lavatories and washing facilities.” Residents’ bedrooms were seen to be personalised with small items of their own furniture, photographs, ornaments and linen, and work has been done to make them homely for residents. Residents spoken with liked their rooms. One resident said they had been consulted about the decoration of their room and one of their relatives had been helped to decide on new bed linen to match the décor. In some shared rooms there were privacy curtains on rails from the ceiling and staff said there were folding screens available when required. The home does not have any room that could be used for residents to meet people in private. Staff spoken with said that if required one of the offices could be made available but the downstairs office is very small and has no natural light and to use either office could potentially breach confidentiality because of the documents stored there. Residents could always use their own rooms but it may not be appropriate for some visitors or, in the case of a shared room, not convenient for the other person. The maintenance records showed that a number of tasks around the home had been completed, however an inspection by the EHO on the 9th April 2009 identified fifteen areas of concern regarding the environment ranging from repairs required to electrical fittings and sockets, unlagged hot water cylinders in the linen room, emergency lighting not working and a lack of window restrictors. A number of double glazed window panels were clouded with condensation due to the seal having perished. This meant the view was obscured and the panel would not be functioning correctly. The proprietor informed us that an estimate for repair for this was being sought, however window restrictors were noted to be entirely inadequate consisting of a weak piece of chain secured with two screws. These can easily be broken and some already had so a much more secure alternative must be provided to ensure residents are safe as a number of upstairs rooms have windows which open on to a flat roof. This was discussed with the proprietor on the day of inspection and we were told that this will be addressed. In the bathroom upstairs there were large cracks around the windows and the décor was in need of redecoration. The laundry was visited and staff explained how laundry was managed. The carers were responsible for doing the washing and night staff completed the ironing. New machines had been installed prior to the new providers taking over and the washing machines had an automated product feed system. Soiled linen was handled appropriately with protective clothing available for the task. There was provision of liquid soap and paper towels in the laundry and hand gels were seen throughout the areas of the home where staff should practice hand washing to prevent cross infection. Only one box of gloves was Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 24 left on the day of inspection and we were informed by the proprietor that an order was being made that day to replenish the stock. A discussion was held regarding the need for an infection control audit to be undertaken to ensure that the correct facilities were in place at all times. Training records still show a shortfall with regard to infection control training amongst the staff team. The proprietor states training requirements will be addressed. The date for the last recorded infection control training could not be evidenced on the day of inspection however staff were noted to be using gloves and aprons correctly when undertaking procedures such as personal care and disposal of soiled pads. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 25 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment processes of the home do not have sufficient safeguards in place to ensure residents are protected. Improvements in training will help to develop the staff team, which should enhance the care of residents and improve outcomes for them. EVIDENCE: Recent staffing rotas for the last four weeks were inspected. These were confusing and did not show the person in charge or the designation of staff working. On the day of inspection at 07.00 am only two staff were on duty for care duties and to prepare the breakfast and drinks. An agency member of staff was in charge with no uniform and was getting residents washed and dressed and doing medication, whilst another member of staff was preparing breakfast whilst having to deal with soiled pads and residents who required toileting. Residents who required two people to assist them were put at risk as not enough staff were available to help them. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 26 This is not seen as good or safe practice and potential issues arising from this were discussed with the proprietor on the day of inspection. Staff spoken with stated they did not feel staffing levels were sufficient to care for the residents and complete all the tasks required. One stated “Our hours have been cut to save money since the new provider has taken over” Residents spoken with also confirmed that tasks took longer and one stated “There are not as many staff to help us now” An immediate requirement was left with the home to address the inadequate staffing shortfalls which affected the overall care of residents with effect from the day of inspection. A minimum of two carers to undertake care duties is required on morning and afternoon shifts and additional separate staff for designated cooking and cleaning tasks must be available. We have subsequently been informed that staffing levels have increased to the required levels from the 29/04/2009. This was confirmed by the inspector, checking, on the 08/05/2009, and the 12/05/2009. We are also informed, by the EHO and Quality and Development Team that their checks indicate the same and that relatives who have liaised with them confirm that there are more staff in the home now. A response to the immediate requirement was delayed but subsequently received by the CQC on the 13/05/2009 confirming the same. The AQAA states “Recently we have employed dedicated staff to cook all meals, in addition to domestic and more than one carers at any one time for the service of 9 service users.” It was discussed at the inspection with the provider that staffing levels and deployment must be kept under regular review. Relatives who commented said that ‘staff are generally quick to attend to my relatives needs’, ‘I think the carers do their best for the residents and they are always very kind.” The management of the home hope to actively encourage the staff to undertake NVQ qualifications to ensure the home meets the 50 of care staff achieving a recognised qualification. Five recruitment files were checked and were not all generally sound with all the required checks and documentation in place. One staff member who was working as a bank member of staff had no records in the home at all and we are informed by the proprietor that these were ‘at her house’ on the day of inspection. Some records had inappropriate references and some CRB checks could not all be evidenced. It is acknowledged that most of these records were in place prior to the new providers taking over but that a full audit of all files would ensure they were all legislatively sound. CRB checks from previous homes are not wholly acceptable and any identifying convictions should be discussed prior to making a decision about employment. This had not been done in one case were three separate incidents of caution were recorded. One other member of staff who had been suspended and subsequently left also had no documentation to support this. Interview records were also not kept for all the staff records inspected. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 27 Staff for the home should have a good understanding/appreciation of the resident group and be willing to undertake ongoing training. We discussed the Skills for Care induction programme being introduced into the home. The AQAA recognises this as an area for improvement but for the most recently recruited staff no adequate inductions were evidenced on the day of inspection. The home has a training programme in place and identifies training through staff appraisals. These have been piecemeal and an improved staff supervision system would provide a more up to date picture of staff needs in the home. Training records reviewed showed overall that the majority of staff are up to date with their mandatory training and there are plans to maintain ongoing updates which is staggered for staff. There are some gaps that still need to be addressed and these were discussed with the provider on the day of inspection. There is a need for compliance with health and safety training and food hygiene updates. The AQAA submitted briefly states the home intends to “Maintain an adequate number of experienced staff at all times. Maintain and increase staff training Increase one-to-one, monitoring, and supervisions. All new staff will be interviewed; 2 references will be sought; one will be the current employer; CRB AND POVA check will be done prior to commencing work; All new staff should complete induction in the first few weeks and they will be supervised, monitored and observed. The home will operate a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users.” This will be followed up at subsequent inspections by the CQC. The provider stated additional training that relates to the specialist needs of residents can be undertaken. For example training in the care of people with dementia and in relation to subjects such as diabetes, the promotion of continence, and the care of pressure areas to help them to improve the standards of care offered to residents. One staff member spoken to stated “We have not done much training since the new providers took over” another stated “Yes we do training but probably some updates are needed” If the training of staff steadily improves in this home, this should allow for significant positive development of the staff team and therefore services in the home and care outcomes for residents. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 28 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, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is not stable enough and people who use the service cannot be adequately protected at this time EVIDENCE: The previous manager for the home had left the week before this key unannounced inspection and consequently the home does not have the stability of a manager. A deputy manager is in post but was not on duty on the day of inspection. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 29 The home was taken over by new providers on the 15th December 2008 and upon discussion with the proprietor it was confirmed that this is the first experience they had had in running their own home. In the four months since registration and with reference to the overall management and running of the home, four areas of this report state poor outcomes are noted and this has contributed to a deterioration and a period of instability in the home which must now be addressed. This indicates that the proprietors of the home must monitor and be more aware of the management of the home as an integral daily component. Some progression in the development of the staff team and services offered are recognised and the care of residents is maintained and is steadily improving with the recent increase in staff levels. There have been some setbacks with the POVA issues noted in the four poor sections of this report which are currently under investigation. The proprietor showed a willingness to take advice and is keen to ensure that the standards of care improve. The lack of stable management has not helped the home with the continuum of development. The AQAA provided by the home disappointingly does not give a clear picture of the homes current issues but mirrors the wording in the National Minimum Standards in a lot of areas and no reference to the stability or development of the management was noted. This indicates a lack of understanding about the purpose of the AQAA. Two service users spoken to gave different names for the new providers of the home and weren’t sure who they were. There was no evidence of regular staff meetings and and minutes were not seen at this inspection. Staff supervision and appraisal has commenced but has not been consistent. All staff have regular meetings with senior staff and records are kept of the discussions. Staff practice is evaluated and training needs identified. This again was noted to have ceased from January 2009. There are no current quality monitoring or assurance systems within the home. Residents and relative questionnaires were discussed and the team should focus on different areas to obtain feedback, for example menus as these were recently being changed. The AQAA submitted does not make reference to any quality systems but does state “I have to be involved more in the day-to-day running of the home to work with the authorities to produce an enhanced and good quality service.” A more consistent approach to audit and quality assurance methods is required. The development of a policy may help the management focus on what they need to do over the course of a year. The management of residents’ personal monies was explained and two balances were checked against records. Neither matched, one contained too little and the other too much. The safe is in the downstairs office with the proprietor and deputy manager both having keys to it. The money is kept in Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 30 flimsy plastic pouches or envelopes and transactions are recorded on paper before being transferred to records that are kept with residents’ files in the upstairs office. In discussion with the proprietor it was agreed a more robust procedure needed to be established to protect residents’ and staff interests as she stated she was ‘Not really involved in the service user’s money’. This also highlights an auditing need Advice was given about obtaining some advice regarding the depositing of the monies in order that residents can earn interest and have choices regarding their finances. Accruing large sums of money to hold in house is not best practice and this was discussed with the proprietor on the day of inspection. Where residents are able to manage their own personal/financial affairs the home supports them to do this. Health and safety practices currently require attention with fifteen requirements being highlighted by an inspection by the EHO on the 9th April 2009. Environmental and safe working practice risk assessments were not available to inspect. The AQAA states that all inspections and safety certifications are now up to date and that all policies and procedures have been reviewed after the inspection in May 2009. This will be followed up at the homes next inspection. Hot water temperatures are monitored randomly. One service users door was noted to be wedged open and the last fire inspection could not be evidenced The home does not currently ensure regular fire drills are undertaken by all staff and they must record the date, time and names of all staff attending. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 31 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 2 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 X X X X X 2 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 2 2 1 Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N/A 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 Requirement Timescale for action 30/06/09 2 OP3 3 OP7 Reg 4, 5 & The service user guide and 6 statement of purpose must be reviewed and updated and consideration given to the format/presentation. It must be accessible to residents so that service users can make an informed decision about living at the home. Reg 14 Full and detailed pre admission (1) & (2) assessments by the home must be undertaken prior to a service user moving in so that service user’s individual needs can be met. Reg 15 Staff must ensure that where possible residents and/or their representatives have input into the care planning system. Staff need to ensure that changes identified at the time of review are updated on the residents care plan. Residents care plans must reflect their individual preferences and choices regarding their care and be more person centred to evidence that staff appreciate the diversity of individual residents. DS0000072805.V375205.R01.S.doc 30/06/09 30/06/09 Sea Breeze Version 5.2 Page 33 4 OP8 Reg 13 5 OP9 Reg 13 6 OP12 16 m & n 7 OP15 16 (2) g, h, i & j 8 OP16 Reg 22 9 OP18 Reg 13 10 OP25 13(4) (c ) Appropriate risk assessments must be in place for more dependant residents especially where service users are at risk of falls, and staff must maintain detailed records of such and review appropriately so that service users are safe at all times. An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets must be in place so that other possible medication issues can be monitored and good practice is always adhered to. Through assessment and consultation, the team at the home must ensure that residents’ individual social care needs are met and that their independence and self worth is promoted. Social histories of residents should be completed with staff being aware of the content. Residents must receive a varied appealing, wholesome and nutritious diet, which is suited to the individual assessed and recorded requirements and in sufficient quantities to meet residents nutritional needs. The home’s complaints procedures must be followed and the recording and format of the complaints procedure should be developed to make it accessible to more residents in the home. The home must ensure that safeguarding policies and procedures are followed at all times. People living in the home must be kept safe by ensuring window restrictors are in place or appropriate locks based on an DS0000072805.V375205.R01.S.doc 30/06/09 30/06/09 30/06/09 30/06/09 30/06/09 30/06/09 30/06/09 Sea Breeze Version 5.2 Page 34 11 OP27 Reg 18 assessment of their vulnerability and the potential risk. This applies to windows in communal areas such as the upstairs bathrooms and bedrooms. Staff rotas and staff numbers should be representative of the home staffing requirements and dependency levels, showing contracted hours worked, names and designations, person in charge and NVQ qualifications should continue to be encouraged amongst staff. An immediate requirement was left for this on the 29th April 2009 effective immediately. 29/04/09 12 OP29 Reg 13 & 18 13 OP30 Reg 18 14 OP35 Reg 20 15 OP36 Reg 18 (2) Reg 24 & 26 16 OP38 The home’s recruitment procedures must be robust and all staff must have an appropriate POVA first or CRB check in place before they start work, so that residents are protected. The staff-training programme needs to ensure that staff are fully able to meet the needs of residents. This relates to a consistent approach to training being developed and inductions being completed fully with all new staff. The home must manage service users monies appropriately. This with specific reference to amounts of cash being held in the home. Staff must have regular supervision and the staff supervision system needs to be developed further. The home must ensure that ongoing quality audit systems are in place and that systems within the home protect and DS0000072805.V375205.R01.S.doc 30/06/09 30/06/09 30/06/09 30/06/09 30/06/09 Sea Breeze Version 5.2 Page 35 safeguard service users. This also with reference to regular fire drills being undertaken and recorded 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 2 3 Refer to Standard OP2 OP4 OP7 Good Practice Recommendations Each service user should have an up to date contract and terms and conditions Service users should be assured that the home can meet their needs upon admission The management team should develop daily evaluation records in conjunction with care plans and risk assessments so that they contain more details about all aspects of people’s health, personal and social care needs in a similar way to the plans in place around people’s morning routines. The storage facilities for medication should be reviewed to ensure that the home has appropriate facilities to store medications that may be prescribed for people living in the home, specifically medications that need to be stored at a controlled temperature. A drug storage system should comply with the Misuse of Drugs (Safe Custody) Regulations 1973. Consideration should be given to the appointment of a full time activities officer to help ensure that residents individual and group social needs are met. The recruitment of specifically skilled maintenance personnel would ensure the environment for residents was kept regularly well maintained and this should be given consideration. A training matrix and plan would ensure that further development is consistent and maintained. The home should have a registered manager The registered manager should obtain a qualification of NVQ level 4 in management and care (or the equivalent). This would ensure people living in the home benefit from a robust management structure in which the manager has obtained the qualifications needed to meet the National DS0000072805.V375205.R01.S.doc Version 5.2 Page 36 4 OP9 5 6 OP12 OP19 7 8 9 OP30 OP31 OP31 Sea Breeze 10 11 12 13 OP36 OP37 OP38 OP38 Minimum Standard. The home should implement an appropriate supervision and appraisal structure for all staff and ensure appropriate records are kept. Dates times and signatures on documentation must be given more prominence on all documentation, so an audit trail is in place for the home The home must ensure regular fire drills are undertaken by all staff and record the date, time and names of all staff attending. The management team should continue to audit the maintenance of the home and ensure any health and safety matters that would put service users at risk are addressed and appropriately risk assessed. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 37 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Sea Breeze DS0000072805.V375205.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!