Inspection on 25/11/09 for Seagull Rest Home

This inspection was carried out on 25th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seagull Rest Home 03/12/08

Seagull Rest Home 11/10/06

Seagull Rest Home 22/11/05

Seagull Rest Home 29/04/05

Seagull Rest Home 12/10/04

Seagull Rest Home 26/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Seagull Rest Home 131 Stocks Lane Bracklesham Bay Chichester West Sussex PO20 8NY     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Sevier     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Seagull Rest Home 131 Stocks Lane Bracklesham Bay Chichester West Sussex PO20 8NY 01243670883 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Maniben Odedra Name of registered manager (if applicable) Mrs Sarah Louise Christopher Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 23 The registered person may provide the following category(ies) of service only: Care Home only (PC) to users of the following gender:Either Whose primary needs on admission to the home are within the following categories : Dementia (DE ) Mental disorder ,excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Seagull Rest Home is a care home able to provide care and support for up to 23 residents who may have dementia or another related mental disorder. It is situated next to a main road close to the village of Bracklesham Bay near Chichester. Local shops and other community facilities are within walking distance. Care Homes for Older People Page 4 of 35 Over 65 0 0 23 23 0 3 1 2 2 0 0 8 Brief description of the care home The accommodation is a single story building with a car park area to the front of the building and paved areas to the rear. Communal areas include a lounge and a dining area. There are twenty one single bedrooms and one double bedroom. Two bedrooms have en suite facilities. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service O star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 25th November 2009 between the hours of 10:00 and 4:45 pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in 3rd December 2008. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Older People Page 6 of 35 meeting the needs of people who live at the home. We met with the registered manager, registered provider, two staff, one visitor and there were three people who use the service involved in the inspection visit. There were 18 people living in the home on the day of our visit. We looked at three pre admission assessments, three care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had fifteen surveys returned. Several requirements for action were made following the visit to the home in December 2008. It is not considered that all of these requirements have been met and action is being considered outside of this report. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Where an individual is deemed at risk an assessment must be in place and this must be reviewed regularly and in the event of something happening. Medication must be administered, stored and managed safely. The activities must be appropriate to the needs wishes and abilities of those living at the home. One comment in a survey said that there could be more entertainment to stimulate the people living at the home. Thought must be given to the environment to be homely. Also that it assists people who live at the home to find their way round in relation to their mental health issues. There must always be adequate bathing facilities to meet the needs and numbers of people living at the home. Furniture must be fit for purpose and meet peoples needs. Thorough recruitment of staff must be carried out and checks must be in place before staff commence employment. Staff must received mandatory training to enable them to care for the people using the service, this must be given in a timely way to protect them and people living at the home. Accurate records must be kept of staff training in fire safety. Care Homes for Older People Page 8 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. The current assessment record would prove more beneficial to the assessment and care plan process for the individual if the information is used as a basis for the care plan to meet identified needs. Evidence: The AQAA for the home said:All pre admission assessments are undertaken by two senior members of staff to ensure suitability to Seagulls, liaising with relatives where possible, we encourage potential service users to spend time with us prior to admission. There have been several admission since we last visited in 2008 we looked at three of them. We saw that there was information on individual needs based on their present Care Homes for Older People Page 11 of 35 Evidence: and past medical history for example, nutrition and food likes and dislikes. We saw that the assessment is reviewed after admission and six monthly thereafter. The assessment noted where individuals had particular needs such as weight and mental well being. We also saw examples on how staff are to offer support at night, whether the light is to be left on or the door open. The assessments had spaces for additional comments we saw that these had been used in some areas of the assessment in two cases. We saw that there was information from other health professionals to assist the manager in making the assessment as to whether Seagull rest home can meet the individuals needs. The manager also told us that one person had come from hospital and no information had been given to staff that the person was an insulin dependent diabetic, and this only came to light when staff were unpacking the persons bags. We could see from daily records that the staff had contacted the duty GP for advice and what action they had taken to protect the individual until the nurse came to the home the next day. Visitors spoken to on the day and comments received in surveys said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. One comment we received in a survey said; the staff at Seagull have played a vital role in enabling my mother to make a successful transition from her previous home to living at Seagull rest home. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans do not always detail the needs of the individual and support staff are to give. The lack of training in some areas places people who use the service at risk when staff are trying to meet their needs. The medication records and administration within the home do not always show that this is carried out in a safe manner to protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that: Personalised care plans promoting independence wherever possible. We collate all information gathered and incorporate into care plans; mental capacity is also now incorporated into care plans. We looked at three care plans where the individual had moved to the home in the past year. The first care plan was for an individual who was admitted as an emergency to the home. The first documents in the care plan were an end of life plan and further assessment tools. We saw that those for nutrition and pressure areas had been Care Homes for Older People Page 13 of 35 Evidence: completed. There were two assessments regarding risks for falls and environmental both of which were blank. The manager said these were new documents however we could see that these were completed for the other two people whose care plans we looked at. We saw personal information about night care which included ability to use call bell, what drinks or food they may want at night and preferred lighting and carer support whether male or female. We saw care plans for medication administration, oral health, memory loss with the aim that the individual would become familiar with the surroundings, familiar with location of room and possessions, staff support to offer reassurance. There were also plans of care for activities, personal care and continence. Whilst there was some information for staff there was a lack of detail of individual needs and choice and how staff would support these. We have explored further under the section for the environment, how this does not support individuals in finding their own room or to become familiar with their surroundings. On the second care plan we saw that the GP was consulted regularly about the care of the individuals catheter and that the home was supported by the district nurse with the care of the catheter and with the individuals diabetes and insulin. We did see that the GP had been called two days prior to our visit when the individual had complained about pain in the right side the GP felt that this may be due to a fall. We saw in the accident records that this person has had several falls and we have not been notified. We saw that the home had completed a falls risk assessment however this had not been reviewed following each fall. We saw information that the individual has breathing difficulties and that staff are to give inhalers for this, also that the home had acquired information on hypoglycemia and hyperglycemia. For the third care plan we saw the daily notes, and noted that the individual has had several chest infections this year. We also noted that there are references to sore areas and skin tears, the last record seen said that there was a skin tear on left forearm 28th October 2009, bruise on nose 18th October 2009 and sores 25th October 2009. There was no information about action taken or whether these were still issues. We saw that the individual had fallen out of their wheelchair on 6th July 2009. We looked at the accident record and there was no information on what had been happening at the time, who was on duty or that a review had taken place to ensure this did not happen again. We saw that the individual has contracted legs and is unable to weight bear, and they need the assistance of two staff for all daily living activities, with the exception of eating and drinking. As the individual is cared for in bed 18 hours a day, we asked Care Homes for Older People Page 14 of 35 Evidence: how they assist them into the communal areas. The manager told us that a wheelchair is used and that they have looked into having a hoist, however with the hallways of the home being so narrow this is proving problematic. We asked how the individual is assisted out of bed into the wheelchair, from wheelchair to armchair and vice versa and were told that two staff lift the individual manually. We also noted that the individual has epilepsy and we did not see what action staff were to take when this occurs. We also saw that the individual is prescribed Fentanyl patches for pain and that they often become agitated the day before it is to be renewed, we did not see a plan of care for the management of pain and use of analgesia, we asked the manager what happens if the individual becomes agitated the day before the patch is to be changed and we were told that the person is prescribed Paracetamol. We saw risk assessments for bedroom doors and fire and that nutritional and physical needs assessment had been completed. We asked about two mattresses we saw in two bedrooms. The manager said that one person had fallen out of bed, when reviewing what action the home could take they consulted a nurse who said that bed rails could also cause problems they advised a mattress on the floor beside the bed. We looked at the medication storage and administration records. We saw the medication records for 27th of October 2009 to the day of the visit. The medication trolley was attached to the wall inside the staff office. The home has Fentanyl patches stored as a controlled medication and this was kept locked inside a double safe bolted to the floor in the office. We looked at the Controlled Medication record book and saw the total number of patches written in the book did not match the stock. We asked the manager and deputy manager to check our findings and they also found that the CD record book and stock did not match. We asked the manager what she felt she should do and what the homes medication policy stated. After some discussion, and checking of the CD record book and the safe the manager rang the police. We looked at the medication policies and saw guidance on: dispensing, administering, refusal, surplus, deceased persons, self medication and managing errors. Also how to accept medication into the home, and that refrigerated medication is to be kept in a secure fridge designated only for the purpose of storing medication. There were no policies for staff on how to manage Controlled Medication, its storage recording and how to accept it into the home and disposal. Whilst we were looking around the home and speaking with people using the service the deputy came and told us that a mistake had been made when the home accepted stock from the local chemist. Instead of five that had been recorded two had been sent to the home, the chemist confirmed what they had sent, the home had not checked. We asked how the patches are disposed of as there is no policy on this and we were told that the patches are thrown away in the clinical waste bags with incontinence pads. This was discussed with the manager and a Care Homes for Older People Page 15 of 35 Evidence: requirement has been made. We saw in the medication records kept by staff there were three gaps where medication was prescribed to be given and there was nothing to indicate if the medication had been offered, refused or destroyed. We saw that where there is a choice of dosage to be given for example one or two Paracetamol, there was not always a record of how many tablets had been given. Where a medication was as required there was no record of why it had been given and outcome for the individual. We saw that there were examples of was medication that was as required which had been given daily one had been given three times a day for the preceding 27 days. There is a fridge in the kitchen for storing medication that needs to be refrigerated and this is not locked. The manager said that they have just changed chemist and the new chemist has ordered them a new lockable fridge and trolley. All surveys returned by staff indicated that they are given up to date information about the support they are to give people that live at the home. Surveys for people who use the service have been completed by their relative or advocate. One respondent said that that their relative is usually dressed well with make up and jewellery, which they normally would have worn when able to do so themselves. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of evidence that people who use the service participate in activities appropriate to their age, peer group and cultural beliefs or as part of the local community; and that dietary needs are well catered for, or that food available meets individual dietary requirements and choices. Evidence: The AQAA for the home said that: We have no restrictions on visiting times and encourage relatives and friends to stay for meals. We exercise service users choices re activities , food likes and dislikes and social interests. A requirement was made following our last visit regarding a programme of activities for people who use the service enabling people to have a choice in their lifetsyle. It is not considered that this requirement has not been fully met although the home has gone some way in their action and the home must show what action they are taking in this area. One survey we received commented that there is a policy that residents must feed themselves as much as possible this inidvdual expressed concern that on days they do not visit and feed their loved one they do not receive enough food. Another Care Homes for Older People Page 17 of 35 Evidence: commented that activities were improving and should continue to do so. A third person said they had found the meals satisfactory. One person who was able to comment said that the food was lovely and staff were nice however they lacked company to talk to. The manager told us that one member of care staff has just completed their qualification as an activity coordinator. There is no programme of what activities are available or who has participated, the manager said that they are working on this and have begun buying equipment, such as ball games and reminiscence. We saw some sensory equipment in the main lounge area which was projecting images onto the ceiling and playing music, this was near the television which was on with the sound turned down. We saw one person who appeared mesmerized by the lights and movement although we did not see any staff using the equipment with the person inviting interaction. We looked at the menus in the kitchen and saw that there was no choice available. The manager said when the people are told what is on offer they can ask for something else if they do not like it. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process however people may be at risk through a lack of staff knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said: We try to minimise complaints by encouraging service users and families to talk to nurse in charge to resolve any misunderstandings and dissatisfactions before they arise. All staff receive POVA training and SVA policies folders are available. The home has a complaints procedure, which is outlined in the Statement of Purpose and Service User Guide and on display in on a notice board above the visitors signing in book. It includes the timescale of response and the address and phone number of CQC. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. The manager has attended safeguarding update and attended a session on the Mental Capacity Act in April 2009. We saw that the manager had purchased information relating to this Act and guidance on Deprivation of Liberty. We saw that some staff at the home have had training in safeguarding in September Care Homes for Older People Page 19 of 35 Evidence: 2009 however we could not see that all staff have received training. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a living environment which is having redecoration and refurbishment to improve it. However some areas are not homely or clean and the refurbishment plan has left the home without adequate facilities for the people that live there. Evidence: The AQAA for the home said:We provide a safe and secure environment, encourage service users to personalise their rooms with their own belongings and have an input into decoration, to have a development programme of works and progress. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. We could see that many people who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. We saw that two bathrooms were in the process of being refurbished, one bathroom had only just been completed. On the day of our visit there was one bathroom to accommodate the needs of 18 people; the home is registered for 23. The manager has written to us following the visit to say that the refurbishment of the second bathroom is completed. Also that one person has their own en suite facility. Care Homes for Older People Page 21 of 35 Evidence: We told the provider and manager to contact us about their plans to have adequate bathing and toilet facilities available for the 18 people who live at the home by the end of the week of the inspection. We received an email dated 28th November 2009 stating that the shower room may be completed at the end of the next week, no dates were given. In the surveys we received there were some comments about the environment, it would be nice if the refurbishment programme could complete the bathrooms and lavatories as a matter of priority and that the residents and their families are advised of a completion date for the rest of the work. It would be nice if a plan is developed to enhance the living experience and environment by the provision of mirrors, colourful pictures, variations in the colour scheme and different types of lighting etc. The home was beige in all areas with the exception of one bedroom. There were several rooms with a malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered with the exception of a toilet. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. We noted that two bedrooms had large floor tiles with rubber backed mats which were rotting away. These rooms felt cold. We were told that the occupants of these rooms had difficulty using the commode. The manager has written to us to say that these tiles are non slip clay tiles and that the mats have been replaced. In another bedroom we saw that there was a freestanding heater attached to an electric socket. The manager said this individual had asked to keep this after the heating had broken down last year. We also noted that at the end of two corridors there were wooden gates. One secured with nylon string the other with a metal chain. The manager said that these gates were to protect the personal space for two individuals whose rooms were behind the gates; and that these gates were open at night. We saw that most of the beds at the home are of the divan type, we saw that on many of the bases the material covering it was either not there or torn. The individual who requires to be lifted although they had a nursing type mattress the bed was a divan which did not enable staff to care for them safely. Whilst looking around we saw the kitchen staff outside the kitchen door smoking we asked the manager about this and we were told that the staff have to be a certain distance away from the kitchen to smoke. They did not appear to be the asked Care Homes for Older People Page 22 of 35 Evidence: distance. The issues of the kitchen are being addressed by the Environmental Health Officer. Laundry facilities are sited away from areas where food is prepared and stored. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices at the home do not protect the people who use the service. Staff have not received all the mandatory training that is expected at induction or each year, or training to meet specific needs. This places the people at the home at risk. Evidence: The AQAA for the home said: We employ good quality staff and continue to train to a high standard via induction and NVQ. Continued training inhouse and through outside agencies, covered rota with mix of senior and junior staff to ensure continuation of care. Two requirements had been made following the last inspection visit in this section of the report. One regarding employment checks and the second that staff must be trained in the care of people with dementia. It is not considered that these requirements have been met and action is being considered outside of this report. At the time of the visit there were eighteen people living at the home. The staffing structure at the home consists of the responsible individual, the registered manager staff, care staff and kitchen staff. We were told that a domestic will be starting at the home soon. There are two night staff and someone on call each night. The manager works five days a week and this can include weekends. When the manager is on duty Care Homes for Older People Page 24 of 35 Evidence: there are five staff including her which drops to four in the afternoon. These staffing numbers are four and three respectively when she is not on duty and one of these staff is usually the deputy manager. There have been a few people employed by the home since our last visit and we looked at five of these files. We saw that in three cases there were two references, there was evidence that a CRB had been received or applied for and that a POVA First check had been carried out and they were dated before the employee commenced work at the home. However for the other two we saw that in one case the references were dated after the employee had commenced work, in the second there were two verbal references with one followed up in writing. We saw that the individuals had commenced or completed a basic induction into the how the home runs and they had started the Skills for Life induction pack. We saw evidence that these five staff had had some training for example; all five have had infection control; four safeguarding adults; two training in dementia a two hour introduction; two food hygiene; two first aid; one fire and one moving and handling. When we looked at the certificate for the moving and handling it was signed by the deputy manager. We asked if he was a trained moving and handling instructor and we were told he is not. All staff information is kept at the home locked in the managers office. We discussed with the manager concerns about the level of need of one individual living at the home, with regards to safety, staff training, staff numbers and equipment. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures for example; recruitment, training, care planning and risk assessments do not promote the safety and welfare of those living and working in the home. The environment is not homely, and does not meet the needs of people living at the home. Evidence: The AQAA for the home said: We create an open, positive approach in the running of the home which is reflected in the atmosphere, we ensure that the home is run in the best interests of the service users and involve all in the care planning process. All training arranged and completed in mandatory courses. There registered manager for this home has worked there for several years and became the registered manager a year ago. She is currently working towards the Registered Managers Award. The manager Mrs Christopher had completed the AQAA and returned this to us in the timescales. The document did not have a lot written describing the homes compliance with the regulations in the specific outcome groups. Care Homes for Older People Page 26 of 35 Evidence: We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that the manager has undertaken staff meetings. We saw that the employers liability insurance was due to run out the day after our visit the manager said she had spoke to the provider about this and the provider said it was in the post. We asked for confirmation that the certificate had arrived. The home has written to us to say that the certificate arrived shortly after our visit. The home looks after what it describes as pocket money for people who live at the home. We saw that the home keeps records of spending and that the records matched the money available for three that we sampled. The registered provider carries out Regulation 26 visits each month and completes a report. We looked at the reports and noted that from January to October there were nine reports, two were not dated, and we noted that several reports had the same information. We asked the provider how they carried out their visits for the report and they said that they do what the report says. However following discussion and showing the provider the Regulation in the Care Standards Act they agreed that they were not carrying out the visit as per regulation. The manager carries out an audit each month based on Regulation 26 she looks at the areas of the homes management speaks with staff and visitors, this used to request improvements or new equipment for example. The home does not use a survey or questionnaire to seek information although Mrs Christopher did say that she wanted to produce a newsletter for people coming to Seagulls. The local Environmental Health Officer visited the home in June 2009 with several requirements for action made following that visit; as a result the home has a brand new kitchen. The EHO had been to the home the day before our visit to monitor the work in the kitchen. There are some areas that are yet to be completed satisfactorily. We spoke to the manager about Regulation 37 notifications as in preparing for our visit we had noted that we had not received many, given that the home had had several new admission it seemed likely that several people had left the home. The manager explained that she had been told in the past that a Regulation 37 needed only to be completed when a person went to accident and emergency. We discussed Care Homes for Older People Page 27 of 35 Evidence: the regulation with the manager and as a result we require notification of all issues that fall under this regulation and for a monthly report on all slips, trips and falls and what action is taken at the home. We looked at the records for fire safety training and monitoring of equipment. We saw fire training records that listed staff names but there was no date so the home was unable to confirm when staff had had training. The records for testing the equipment had been completed weekly up until 10th November 2009. We saw that the records for the monthly checks on emergency lighting were last completed in April 2009. There were no records to say that the home checked the safety and availability of the fire safety equipment such as fire extinguishers. We did see that an external company visits the home every three months to service and maintain the fire safety equipment they are next due in December 2009. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 Staff must not begin work 31/01/2009 until gaps in their employment have been explored and references and Criminal Record Bureau checks have been received in order to protect people living in the home 2 30 18 Staff must be provided with 31/01/2009 training in the care of people who have a dementia so that they have the knowledge and skills they need to do their job. 3 31 26 Regulation 26 visits must be 31/01/2009 carried out by the registered provider each month and a written report provided to make sure that the quality of the service is kept under review and improvements made where necessary 4 33 24 A system of quality 31/01/2009 assurance must be developed and reports made of the Regulation 26 visits carried out by the provider so that the quality of the service is kept under review and people who live in the home and their advocates Care Homes for Older People Page 29 of 35 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action contribute to the development of the service. Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15 Sch 3 The registered person must ensure that there are care plans supporting individuals needs for analgesia and other specific issues such as epilepsy. To ensure that staff are aware of individual pain relief needs and what action they should take in the event of the individual having an epileptic fit. 25/01/2010 2 8 13 13 (4)(b) The registered provider must ensure that risk assessments are reviewed following an incident or when needs change. To ensure that staff are aware of needs and risks of the indivdual. 25/01/2010 3 9 13 13 (2) The registered person must ensure that a record is kept 25/01/2010 Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action of the amount of medication that is given where there is a variable dosage and why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 4 9 13 13 (2) The registered person must ensure that there is a system in place for the control of stock, administration and safe disposal of controlled medication. This will ensure the safe administration of medication. 5 12 16 16 (2) The registered person must ensure that people who use the service are enabled to make choices, about their daily lives which includes food and activities. This will enhance peoples lives. 25/01/2010 25/01/2010 Care Homes for Older People Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 18 13 13 (6) The registered person must ensure that all staff receive training in safe guarding adults. This will help to protect people using the service. 25/02/2010 7 19 23 23 (2) (a) (d) (g) (j) (n) (p) 25/12/2009 The registered person must ensure that there are suitable beds to meet the needs of people, that these beds can be maintained to assist with the prevention of cross infection. That there are adequate bathing and toilet facilities to meet the needs of people at the service. That all pipe work and radiators are covered to protect people using the service. That all areas are kept clean and free from malodour To enhance peoples lives and protect the environment they live in. 8 38 23 23 (4)(d) The registered person must ensure that fire training is undertaken regularly by all staff. 25/01/2010 Care Homes for Older People Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To protect those that use the service and staff. 9 38 23 23 4(c) (v) 25/12/2009 The registered person must ensure that records are kept of tests and checks on fire fighting and warning equipment. To protect those that use the service and staff. 10 38 13 13 (5) 25/01/2010 The reregistered person must ensure that all staff receive training in: moving and handling, first aid, food hygiene and infection control To protect those that use the service and staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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