Inspection on 30/06/10 for Shakespeare House

This inspection was carried out on 30th June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shakespeare House 17/05/10

Shakespeare House 27/05/09

Shakespeare House 27/05/08

Shakespeare House 10/05/07

Shakespeare House 13/06/06

Shakespeare House 22/11/05

Shakespeare House 10/05/05

Shakespeare House 22/12/04

Shakespeare House 18/05/04

Shakespeare House 15/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Shakespeare House 19 Shakespeare Road Bedford Bedfordshire MK40 2DZ     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: Nicky Hone     Date: 3 0 0 6 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Shakespeare House 19 Shakespeare Road Bedford Bedfordshire MK40 2DZ 01234359224 F/P01234359224 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Sada Camiah,Mrs Vijama Camiah Name of registered manager (if applicable) Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Shakespeare House is registered to provide care for eighteen people who are 65 years of age or over who may also have physical disabilities and/or dementia. Mr and Mrs Camiah have owned the home for a number of years and participated in the operation of the home as financial manager and care practice advisor. The home is located on a busy road in Bedford within walking distance of the towns amenities including bus and train links. The physical environment has been adapted internally to meet the needs of older people, although some of the bedrooms are Care Homes for Older People Page 4 of 30 Over 65 18 18 18 0 0 0 1 7 0 5 2 0 1 0 Brief description of the care home rather small for people who need equipment to assist them to move. Accommodation is arranged over three floors with seventeen bedrooms, one of which could be used for two people. Access is provided to the upper floors via a shaft lift. The lounge and conservatory/dining room are on the ground floor. There are bathrooms and toilets on all floors, although not all bathrooms are used, and there is a main kitchen, laundry and office. There is a small, enclosed garden to the rear of the home, and 2/3 parking spaces at the front. Meter parking is available in the road opposite the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of Shakespeare House was carried out as the result of a safeguarding incident. Due to the level of concerns the inspection type was changed from a random (focused) inspection into a key inspection so that a full review of key standards and outcomes for the people who live here could be undertaken. Two inspectors visited the home on 30 June 2010, and the inspection was completed on 01 July 2010. We inspected some areas of the building, and spoke with the manager, and operations manager. We also spoke briefly with 3 of the people who live here, and 4 of the staff. We read documents the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. As part of the safeguarding procedure, a number of staff had been suspended from duty. This meant there were several agency staff on duty. As the safeguarding Care Homes for Older People Page 6 of 30 investigation was still ongoing we did not investigate that incident. Staff from the local authority/PCT had visited the home prior to our inspection and assessed that the home did not have suitable equipment to meet peoples moving and handling needs. Equipment for people who needed it was delivered during our inspection, and staff were trained by the local authority/PCT staff in how to use the hoists and beds. At the time of this inspection the manager, Donna Masters, had not applied to CQC to become registered, even though she had been employed as manager at the home for almost 18 months. We carried out a random inspection of this service in May 2010. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Mr and Mrs Camiah, the registered proprietors must urgently take action to ensure that the people who live here get the quality of service they need and deserve. CQC is so concerned about the shortfalls at Shakespeare House that it is invoking management systems to place this service on CQCs improvement agenda. We do this so that outcomes for people living at Shakespeare House are closely monitored to ensure that the improvements are undertaken and sustained at the home. Enforcement action will be considered if the requirements made as a consequence of these visits are not met and if the overall quality of the service is not improved. Things the home must do better include: - a manager must be employed who has the qualifications, skills and experience necessary to manage a care home effectively and competently; - the provider must take full responsibility for ensuring the home is managed well, including carrying out visits as required by regulation 26 and leaving a report of the visit at the home; Care Homes for Older People Page 8 of 30 - medication must be recorded, handled, stored, administered and disposed of safely; - information to confirm that the required checks have been carried out on agency staff must be obtained before each agency staff member works at the home; - each person who lives here must have a care plan that accurately reflects their current care needs; - assessments of peoples needs must be carried out; - safeguarding procedures and protocols must be followed; - all staff must receive training in safeguarding vulnerable adults; - the home must produce a complaints procedure that is accessible, and that has up to date information about how people can raise concerns if they want to; - staff must receive training from trainers who are competent to train; - there must be a first aider on duty at all times; and - up to date, correct information about the home must be available. Currently there is no registered manager and the provider must address this as soon as possible. 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 30 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 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information available about the home was not up to date, and some of it was misleading. Assessments of peoples changing needs were not carried out well, and the home was not equipped to meet the needs of some of the people who live here. Evidence: Shakespeare House has produced a statement of purpose and we found a copy in the hallway with the visitors book. However, on the first page, it said Welcome to Waterloo House. The manager said this was because she had used the sister homes template to create the statement of purpose for Shakespeare House. We did not read the statement of purpose in detail, however we did note that there was some information in it that simply was not true. For example, the statement of purpose stated that 96 of the staff have a National Vocational Qualification (NVQ) in care: the actual figure for this home is very much lower. Also the statement of purpose had not been updated for some considerable time, and did not contain all the information required by the regulations. Care Homes for Older People Page 11 of 30 Evidence: The manager showed us the Service User Guide which is a single page leaflet. This gave some information about the home, but should include more detail so that people who are thinking about moving here know what to expect. This also included misleading information. For example, it stated that Donna Masters is the registered manager, but she has not yet applied to CQC to be registered. It also said that 24 hour nurse care, medical and other facilities are available, but this is not a nursing home. The certificate on display in the entrance of the home cited a registered manager that had left the position at least 18 months previously. Most of the people living at Shakespeare House have lived here for some time, so we did not look for pre-admission assessments. We saw that care plans are reviewed and evaluated each month which should be, effectively, a re-assessment of peoples needs. We noted that in the folders we looked at, most months staff had written no change. However, the manager told us, and we read in peoples daily records, that there had been changes to peoples needs. For example, one person had suffered a deterioration in their mental health and when we visited needed a member of staff with them at all times. Yet the care plan, last reviewed only 4 days before our visit, said no change. It was apparent that staff did not have the necessary training to care for the needs of some of the people living at the home such as those with complex behaviour problems, including mental health problems. The staff from the local authority had found that the home did not have the equipment needed, in particular equipment for moving and handling people, that was needed for a number of the people who live here. Intermediate care is a service offered by some homes, which gives short-term, intensive rehabilitation for people leaving hospital before they return to their own homes. This service is not offered at Shakespeare House therefore standard 6 is not applicable. Care Homes for Older People Page 12 of 30 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. Care plans did not give sufficient up to date information and guidance for staff to be able to meet peoples needs. Medicines were not handled safely. Evidence: We looked at care records for 2 people. The folders contained quite a lot of paperwork, but it was difficult to find what was meant to be the current care plan. Some evaluation had been done monthly which indicated the plan was current, but no change had been written month after month. This did not concur with our observations, nor with what we were told by the manager. The number of agency staff currently working at this care home means it is even more important that care plans accurately reflect each persons needs. Some risk assessments had been carried out, but again these had not been updated to reflect the current situation, and no change written in the monthly reviews. For example, the manager told us that one persons mobility had deteriorated, and we found a reference in the daily records about needing to use a hoist. However, the risk assessment and moving plan indicated this person only needed the use of a turn-table Care Homes for Older People Page 13 of 30 Evidence: and a wheelchair. Following an incident involving poor moving and handling techniques the local authority had secured the advice of a moving and handling expert and an occupational therapist. The evening before our inspection they had assessed all the residents regarding their moving and handling needs, and had ordered the correct equipment to ensure people could be transferred safely. The new equipment included an electric hoist for each floor, appropriate slings for each person and beds that would ensure the hoists could be used correctly and safely. This equipment arrived during our visit. We looked at the way the home manages medication. On one persons file we noted that Medication Administration Record (MAR) charts had been photocopied and sent with the person when they were admitted to hospital, which is good practice. In some cases, staff had completed the MAR charts well. However, we found a number of errors in the recording, handling, safe-keeping, safe administration and disposal of medicines received into the care home. We were not able to carry out a full audit of medication, as the records were so poor. We served an immediate requirement, giving the home 48 hours to rectify the failures, and we followed this with a letter to the provider advising him of our serious concerns about the medication. Issues included: Medication had not always been given as prescribed. For one person the entry on the MAR chart read give one a day, the one had been crossed out and two written in, but the instructions on the packet of tablets read give one three times a day when required. Hand-written entries on the MAR chart did not always reflect the prescription. Alterations to the MAR charts were not signed or dated. Variable doses were not always recorded. For example, one person was prescribed Senna one or two tablets: for most of the days in the current cycle we did not know whether one or two had been given. There were no brought forward quantities of medicines, so we were unable to carry out an audit to ensure that the number of tablets recorded as being given was the same as the number of tablets actually given. In one case we could audit one medication, because staff told us they had run out of this medication and started a new pack from the chemist on a particular date. We could therefore count the number of tablets left and the number signed as given. There were 2 more tablets in the packet than should have been there, so on 2 occasions staff had signed to say the medication had been given, but it had not. The home does not routinely audit medication. Care Homes for Older People Page 14 of 30 Evidence: There were some gaps in recording, so we did not know on those occasions whether the medication had been administered. On one persons MAR chart, staff had signed on the day after the day we were there, to say the medication had been given (one staff member did tell us this was her mistake). There was no evidence that staff had addressed contradictory instructions: one person had been prescribed two medicines which had clear instructions that they should not be taken together, but staff had signed that both had been given at 08:00. We found some medicines no longer in use which had not been disposed of. For one person, on several occasions staff had entered a code on the MAR chart to show they had not given the medication as the person was asleep. One example was a medicine to be given in the morning: staff had not attempted to give the medicine at a later time. For another persons medication, staff had entered the code for destroyed on a number of occasions. The staff told us the person spits the tablet out. They said the doctor was aware, and they had requested this medicine as a liquid, but there were no records to show that any of this had been done, or when. Throughout the inspection we observed good interaction between staff and residents, and staff spoke to residents in a respectful manner. We did however witness a visiting community nurse changing a dressing in the main lounge while the resident involved was having lunch. We discussed the reason for this with the community nurse and the manager, and both agreed to find a way of resolving this. Care Homes for Older People Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a range of things to keep them entertained, and are offered a choice of nutritious meals. Evidence: The home employs a part-time activity co-ordinator. On the day of the inspection she was working in the main lounge with the majority of the residents. She was doing reminiscence work that involved talking with the group and some music. This appeared to stimulate many of the residents and we overheard conversations about rabbit pies and how to make pastry. On our second visit, a flute player had come to the home and residents were singing along to the music. Residents who were mobile were able to walk out into the secured garden, where there are tables and chairs for people to sit with their visitors if they wish to. Staff were accompanying one resident who told us she liked to go wandering round the garden. The first day of the inspection spanned lunchtime and teatime. We saw that the residents were enjoying their lunch which was meat and vegetables followed by sponge pudding and custard. We did not see how people were asked to choose their Care Homes for Older People Page 16 of 30 Evidence: meal and noted that the meals were served plated from the kitchen, including the custard already added to the pudding. Although the conservatory was prepared for lunch, and windows and doors were opened to make the room cool, none of the residents moved from their seats in the lounge. The meal was served to them on over-lap tables. The cook went off duty at 2pm and he told us he had prepared the evening meal in advance. People were offered regular hot and cold drinks during the day. On the second day we arrived at 1:45p.m. and lunch, usually served at 12:30 had only just been served. The manager told us the cook had rung in sick, so one of the senior carers had come in on her day off to do the cooking. Nevertheless, people were enjoying their meal of sausage, egg and chips, followed by fruit and ice cream. Again, the ice cream was added to the fruit in the kitchen, so we could not see that people had been given a choice. In the kitchen we looked at menus which showed that there is always a choice of 2 main meals at lunchtime. The senior carer told us that the cook goes round in the mornings to ask people what they would like for lunch: if they do not like either of the choices, alternatives are offered. However, we noted that on the 2 days we visited, people had been served meals that were not on the menu. The manager said cooked breakfasts are available if anyone wants one, or there is a choice of cereals, porridge and toast. She said there is a good budget for food. Occasionally the residents ask for a take-away meal, which they can have, and the manager said that snacks, sweets and fresh fruit are always available. On the second day, sandwiches had been prepared for tea and put in the fridge. We noted they were uncovered. We also saw that there were some items of opened foods in the fridge, for example a bowl of tinned fruit, that had been covered but not dated. The kitchen looked rather shabby: for example, there was a split in the vinyl flooring; plastic covering on the shelves was peeling away; and laminate had come off the units, exposing the chipboard. We asked the environmental health officer for advice and they agreed to visit the home to check that everything meets Food Safety requirements. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that the manager and staff have a good enough understanding of practices and procedures around safeguarding so that they will be kept safe. Evidence: The complaints procedure was in a holder on the wall in the hallway, with the statement of purpose and other information. It was not up to date, with CQC still shown as CSCI with a Cambridge office address and telephone number. We did not see any information on the procedure to let people know they could contact the local authority if they had concerns they felt unable to raise with the manager or the provider. The manager showed us that there is a complaints log. She said there had only been one complaint from families and that had been about the carpets. These have been replaced. We saw that there were no other recent complaints in the log. Our visit had been prompted by a safeguarding issue. CQC had received a notification from the home about an incident, however the staff had failed to refer the matter to the SOVA (Safeguarding of Vulnerable Adults) team. There was a copy of the local protocol (drawn up by the Council) in the office, but it had not been followed. According to the manager, a group of staff had received SOVA training in February 2009. There were 7 staff on the training matrix for whom there was no evidence that Care Homes for Older People Page 18 of 30 Evidence: they had had SOVA training at all. The manager said either she or the manager from Waterloo House are on call at all times, so staff know they can be contacted if they have any concerns. The manager had a poor understanding of her responsibility to keep people living here safe as she had failed to ensure that the agency staff working in the home had the necessary checks and training to do so (see Staffing section of this report). Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shakespeare House provides a reasonably comfortable home for people to live in. Evidence: During the inspection we made a partial tour of the building. Carpets on the stairs and in hallways had been replaced and some redecoration had taken place but on the whole the bedrooms looked worn. The bedrooms were all different and although some were considered small, some were larger and airy. Bathroom facilities were poor. We were told that the bathroom on the ground floor is not used, although there are bedrooms on this floor. The bathrooms on the first and second floor were very institutionalised and basic and did not include showering facilities which would have been needed by the residents with higher needs. The home was reasonably clean and smelt fresh, other than a faint odour of stale urine in one of the bedrooms near the front door. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that all the staff working at the home have been recruited well enough to ensure they are suitable to work with vulnerable people. There was no evidence that staff training is carried out by people trained and competent to train others. Evidence: The manager had produced a staff rota up until 11th July 2010 that confirmed that at least one permanent member of staff was on duty during each shift, working with 3 agency staff, so that there were four care staff on duty during the day. This number did not include the manager, the cleaner or the cook. At night there was one permanent member of staff and one agency staff. Agency staff were sourced from one of two recruitment agencies used by the home. The manager showed us a list of staff that one of the agencies is sending to Shakespeare House for the first 10 days in July. We noted there were only 8 different names, with some of the agency staff working almost every day, which gives reasonable continuity of care to the residents. We also checked to make sure that permanent staff are having some time off so they are not working too many hours. On the day of the inspection we observed that staff were taking breaks, and did not seem too rushed. Care Homes for Older People Page 21 of 30 Evidence: We asked to look at the personnel and training files for all the care staff on duty on the day of the inspection. Files for the permanent staff indicated that the manager had correctly recruited new staff and ensured that pre-employment checks were in place. The manager told us that staff did not commence employment until all preemployment checks had been received although we did see evidence that in the past staff had commenced induction training while full Criminal Record Bureau (CRB) checks were being waited for. The manager was not able to produce any information relating to the three staff on duty who had been provided by an agency. When asked for the information the manager told us it was the responsibility of the agency to carry out all the checks. This is a breach of Regulation 19 of the Care Homes Regulations 2001 that requires that the registered person obtains the information and documents specified in Schedule 2 in respect of persons working in the care home. We told the manager to obtain information about the staff immediately, especially evidence of a Criminal Record Bureau (CRB) check, in respect of the agency staff working in the home during the inspection and for the following 24 hours. This information was obtained and shown to us. The required information must be obtained before any agency staff are allowed to work in the home. We wrote to the provider immediately following this inspection, requiring him to ensure with immediate effect that no staff work in the home until evidence of their fitness to do so has been obtained. Staff files included certificates that confirmed staff had undertaken some of the necessary training to carry out their roles. The information was also part of a training matrix that the manager used to inform herself of training needs. However it was not possible to confirm that the trainers responsible for the training had the necessary qualifications to be accredited trainers and award certificates of competency. For example the manager said that the the moving and handling training had been undertaken by the deputy manager, but she could provide no evidence of the deputys competence and knowledge to do this. She also said that some training had been done by a company that provided some of the equipment used by the home. The manager told us that staff were promoted to the position of senior carer when they had experience, and not necessarily because they had been awarded an NVQ qualification. We did however note that one carer who had been away from caring for a number of years was promoted to senior carer after only 7 weeks as a carer. Care Homes for Older People Page 22 of 30 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. This home is not managed well enough to ensure that the people who live here have good quality, safe lives. Evidence: The manager (not yet registered), Donna Masters, had been in post for more than 17 months and told us she had only recently started the process to become the registered manager. We were aware that this was a very difficult time for everyone, and the manager was working hard to keep the home running and keep staff morale up. The manager had a poor understanding of her responsibility to keep people using the service safe by ensuring that the staff working in the home had the necessary checks and training to do so. She was not aware that training provided to staff must be provided by a person trained to do so. The manager did not routinely audit the situation on the floor. For example she did not routinely audit medications or care plans. Care Homes for Older People Page 23 of 30 Evidence: The manager told us that the provider visits the home, however she was not able to produce copies of the reports following Regulation 26 visits that the provider is required to carry out monthly. The manager told us that she had never had supervision. A small amount of cash is kept in the safe for people who prefer not to look after it themselves, or cannot do so. Staff complete transaction records to show what the money is spent on. We checked the records for 2 people and found that everything was correct, including the written balance matching up with the amount of cash. On the whole records had been completed but it was clear that staff were not careful how they completed forms and did not update records as peoples needs changed. We saw that care plan reviews had no change for months on end even when changes had been identified in the daily notes. We looked at fire records. Tests of the fire alarm system and emergency lighting had been done as required, a number of other checks of fire equipment are done and fire drills take place. The fire officer inspected the home in May 2010, and was satisfied with what he found. The manager showed us that risk assessments relating to the environment had been completed and reviewed recently. Staff have received some training in some of the topics relating to health and safety (fire safety; infection control; moving and handling; food hygiene). Only one of the staff has a current certificate in first aid, so there is not a first aider on duty at all times. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 25 of 30 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 1 9 13 Medication must be recorded, handled, stored, administered and disposed of, safely. So that peoples health is maintained and they are kept safe. 02/07/2010 2 29 19 Information about the checks 01/07/2010 required before a staff member can start to work at the home must be obtained for all staff working in the home, including staff supplied by an agency. So that the home is sure that staff are suitable to work with vulnerable older people. This requirement is repeated: the previous timescale of 31/07/09 had not been met. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 Information about the home must be up to date and must reflect what the home offers. 31/07/2010 Care Homes for Older People Page 26 of 30 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 So that people who are thinking of moving here know what to expect. 2 3 14 Full assessments of peoples needs must be carried out. So that people can be assured that their needs will be met. 3 7 15 Care plans must give sufficient information and guidance for staff. So that people can be sure their individual needs will be met. This requirement is repeated: the previous timescale of 31/07/09 had not been met. 4 16 22 The complaints procedure must be up to date, and available to people. So that people know how and to whom they can raise any concerns. 5 18 13 Safeguarding procedures and protocols must be followed. To make sure people who live here are kept safe from harm. 31/07/2010 31/07/2010 31/07/2010 31/07/2010 Care Homes for Older People Page 27 of 30 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 Evidence must be available to show that all staff have undergone training in safeguarding adults. So that the people who live here are protected from harm or abuse. 31/08/2010 7 30 18 Staff must receive sufficient 30/09/2010 training from people who are qualified to train others. So that training is of good quality so that staff can do their jobs well. This requirement is repeated: the previous timescale of 31/07/09 had not been met. 8 31 9 A person who is fit to do so must be employed to manage the home. So that the people who live here have good quality, safe lives. 31/07/2010 9 33 26 The provider must visit the 31/07/2010 home at least monthly and write a report of that visit, in accordance with this regulation. So that the provider is assured that the home is being run well, in accordance with all the Care Homes for Older People Page 28 of 30 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 standards and regulations which apply. 10 38 13 There must be a person 31/08/2010 trained in first aid on duty at all times. So that first aid can be given quickly when needed. 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 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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