Inspection on 15/03/10 for Shakti Lodge

This inspection was carried out on 15th March 2010.

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

Other inspections for this house

Shakti Lodge 06/05/09

Shakti Lodge 30/05/07

Shakti Lodge 19/07/06

Shakti Lodge 06/02/06

Shakti Lodge 24/08/05

Shakti Lodge 22/11/04

Shakti Lodge 18/10/04

Shakti Lodge 09/08/04

Shakti Lodge 15/07/04

Shakti Lodge 18/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Shakti Lodge 208-212 Princes Road Dartford Kent DA1 3HR     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: Sarah Montgomery     Date: 1 5 0 3 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 34 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 34 Information about the care home Name of care home: Address: Shakti Lodge 208-212 Princes Road Dartford Kent DA1 3HR 01322288070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shakti Lodge Limited Name of registered manager (if applicable) Ms Chan Teeluck Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Shakti Lodge is registered to provide care and accommodation for twenty-six older people. Accommodation is provided on two floors, which can be accessed via a shaft lift. The home has fourteen single and six double rooms, one of which has an en-suite facility. All bedrooms have a staff call system, washbasin and television aerial point. Copies of inspection reports and the homes Statement of Purpose are made available Care Homes for Older People Page 4 of 34 Over 65 0 0 0 0 Brief description of the care home on request. Off road parking is available to the front of the building. Intermediate care is not provided. Residents have access to a pay phone or can use the homes cordless phone. Please contact the home for current up to date information regarding fees. Care Homes for Older People Page 5 of 34 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 key inspection was conducted by Sarah Montgomery, Regulatory Inspector, and Sandra Meadows, Heath Care Assessor. They were in Shakti Lodge care home on March 15th 2010 from 10:30am until 7pm. During the inspection they spoke with representatives from Shakti Lodge including the registered manager, the owner, senior staff, care staff, service users, relatives, and visiting professionals. Several records including care plans, assessments, and staff files were assessed. Time was also spent observing working practice. The Commission received a completed annual quality assurance assessment from the home. Information from this document was used to inform the inspection process. All outcome areas have been assessed as poor. There are 23 requirements (10 of these are immediate requirements). The quality rating for this service is 0 stars. This means that people who use this service experience poor quality outcomes. Care Homes for Older People Page 6 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 34 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 8 of 34 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 9 of 34 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 statement of purpose is misleading and does not accurately describe services or facilities at the home. Prospective service users are not competently assessed prior to admission, and their support needs are not recorded. Evidence: Standards 1, 3, 4 and 6 were assessed. To assess these standards we looked at records which told us how prospective service users are supported in their choice of home. These records included the statement of purpose and pre admission assessments. We spoke with members of the management team about these processes and documents, and spoke with some residents about their experiences of moving into the home. We also looked at information sent to us from the home in their annual quality assurance assessment. Standard 6 does not apply as the home does not offer intermediate care. The homes statement of purpose was inspected. It was then cross referenced with all Care Homes for Older People Page 10 of 34 Evidence: evidence gathered throughout the inspection. This is because the statement of purpose tells prospective and current service users, and their representatives what services are provided at the home. It is important that these documents are up to date and relevant as they serve as a benchmark for all service provision. Our assessment of the statement of purpose evidenced a number of inconsistencies with information gathered during our inspection. For example, the statement of purpose says every resident will have an individual care plan including full assessment of physical and emotional needs, risk assessment and progress plan. Residents will be included in formatting their care plan. We assessed seven care plans in detail. None of the care plans contained any adequate assessment of need, none contained any risk assessments, there were no progress plans, and there was no evidence that residents had been consulted or involved. Pre admission assessments were inspected. We found that the quality of information gathered at pre assessment stage was poor, and did not address or explore the health and personal care support needs of the individual. For example, on one pre admission assessment it stated that the service user required help with mobility, had a pressure area, required assistance with personal hygiene and had a poor appetite. No further details were recorded with regard to the level and frequency of support required, nor was the personal preferences or wishes of the service user recorded. Although risks had been identified within this assessessment, there was no record within the assessment of what support was required to eliminate or reduce the risk. For example, mobility: Although the form recorded support was required with mobility, a falls risk assessment had not been undertaken either at pre assessment or upon admission to the home. We looked at a pre admission assessment of a service user recently admitted to the home. Information on this assessment was poor, and did not contain any detail. For example, it stated needs supervision in the bath, but does not give any further details. Under social it stated close to family, but gave no information about how to meet the social needs of this individual, or any record of hobbies or interests. When we cross referenced the information on the pre assessment with care plans and risk assessments we saw that the home had not developed any, and had placed the risk assessments and care plans from the previous home (dated March 2009) on file. These had not been updated or reviewed. We saw information on these care plans which had not been identified by the home at pre assessment. For example reluctant to wash or change clothes and can become agitated. The home had not developed any care plans which addressed or met these needs. Care Homes for Older People Page 11 of 34 Evidence: A further pre admission assessment stated the service user had a history of falls. No other information was recorded, a falls assessment was not undertaken, and there is no record that a risk assessment was put into place to prevent or minimise falls. Our overall findings from inspection of pre admission assessments is the home has failed to gathered sufficient information at pre assessment, and care plans and risk assessments generated from the homes assessment information do not include robust information which is necessary to provide appropriate support to individuals. This may mean that service users could be at risk of harm as their needs will not be known, recorded or met. Care Homes for Older People Page 12 of 34 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. Service users health and personal care needs are not assessed or met. Evidence: Standards 7, 8, 9 and 10 were assessed. To assess these standards we looked at records which told us how the care home meets the health and personal care needs of service users. These records included care plans, risk assessments, daily notes, and medication records. We spoke to members of staff about how these records are used, and asked staff about how they used care plans in their day to day work with individuals. We wanted to see how the home ensures service users are treated with dignity and respect, and spent some time observing working practice. We also looked at information the home had sent to us in their annual quality assurance assessment. Seven health care plans were inspected. They all lacked sufficient detail to be considered effective documents, and staff would be unable to ascertain what support needs the individual had. None of the care plans recorded any personal wishes or preferences of the individual. This means the home has not sought the views of the service user or their representative. Care Homes for Older People Page 13 of 34 Evidence: We looked closely at how the home responds to and manages the health concerns of residents. During the inspection we spoke with healthcare professionals who were visiting the home. They told us that communication with the home is poor, and they have only been made aware of significant health concerns (for example pressure areas) when the condition has become acute. This has led to a delay in meeting the health care needs of some residents. Further information from health care professionals indicated that staff at the home are not ensuring service users with pressure areas are regularly turned, and this is having a detrimental impact on management of the pressure area and pain. When assessing health care records, we found evidence to support information supplied by the healthcare professionals. Notes in one care file assessed stated sore right hip. There was no referral to the community nursing team, no risk assessment for pressure area care, no action plans and no specialised equipment in place. This file also identified that the service user had continued weight loss and from the date of admission had been steadily losing weight. There was no evidence of referral to a dietician, and no nutritional needs assessment or food and fluid charts in place. We assessed the file of a service user who has significant health needs including an open wound. There was no care plan in place for managing the changes in wound care. The personal care support plan had not been updated, and when spoken with, staff had no idea how to support this service user with personal care in a way which minimised pain or discomfort and ensured needs were met. For this same service user the nursing team informed us that home had failed to collect a prescription for specialised wound dressings and painkillers. This meant that the correct equipment was not available at the home and the nursing team had to make do with what they could find at the home. We found evidence that the home is making poor judgements about residents who are unwell or who have had accidents. For example, when we looked at accident records we saw there has been a high number of falls at the home resulting in head injuries. In all cases no medical treatment was sought, the homes response was to give wet flannels to service users to place on their heads. None of the accidents were followed up by a falls risk assessment, or a mobility assessment. None of the care plans we assessed had been updated or reviewed following a fall. File notes of another resident indicated that they had been attacked by a service user and had sustained significant injuries including open cuts and wounds. No medical attention was sought and when staff found the service user laying on the floor Care Homes for Older People Page 14 of 34 Evidence: bleeding from wounds, they just assisted them back to bed. When we looked at the file of the service user who perpetrated the attack, we saw that their had been no update to the care plan or risk assessment, and current support plans did not provide information or support guidelines for staff around challenging behaviour or keeping other service users safe. We looked at how the home ensures the privacy and dignity of service users. Evidence gathered demonstrates that service users are not treated with dignity and respect at all times. Some examples of this include the following: Our inspection of the environment evidenced that all bedroom doors are kept open. There are no curtains on windows, and service users dignity could be compromised. Furthermore, personal information about service users is selotaped to wardrobe doors. This is inappropriate and indicates a lack of respect and privacy. During the inspection we found that some staff interacted well with service users, but also observed that other staff ignored service users and spoke amongst themselves. Discussion with staff and other professionals indicated that on occasions service users experience verbal abuse and are shouted at by a senior manager of the home. We were also told that this senior manager frequently shouts at staff in front of service users. We noted that zimmer frames were in the service users bedrooms or stored in a corridor by the lounge. None of the service users had walking aids with them to assist in their freedom of mobility. This is considered restraint. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users cannot be confident they will be supported in their lifestyle choices, or be supported to exercise control over their lives. Service users would benefit from robust nutritional screening. Evidence: Standards 12, 13, 14 and 15 were assessed. To assess these standards we looked at records which told us how the home ensures service users are given social opportunities, and can make choices and decisions about their lives. We also looked at how the home supports service users to maintain contact with family and friends, and looked at records which told us how the home ensures service users receive a wholesome and nutritious diet. We spent time talking with service users about their life at the home, and talked to staff about how they support service users with their lifestyle choices. We referred to the homes annual quality assurance assessment and cross referenced this with evidence gathered. We looked at how the home ensures service users have opportunites and choices in their everyday lives. Files assessed evidenced that the home had not sought information about hobbies and interests either at pre admission assessment, or at any time following this. Care Homes for Older People Page 16 of 34 Evidence: All activities take place in the lounge. The home does not have a person centred approach to activites and they are conducted as a group. Service users who do not wish to participate are not offered alternatives. The home is welcoming to family and friends and has an open door policy. A relative spoken with during the inspection told us she is always made to feel welcome and that staff are friendly and helpful. Our inspection of service users files evidenced that none of the service users at the home are weighed frequently, and none have had a nutritional assessment. No record is made of what service users eat or drink, and daily notes read demonstrated that the most information recorded by staff consists of occasionally noting that a service user has enjoyed a meal. This absence of recording means that service users who may be at risk of malnutrition and are losing weight, are at risk of having these health needs unknown due to the homes failure to keep appropriate and necessary records. We were unable to assess whether service users nutritional needs are being met in respect of diet as no records of food prepared at the home were available. On the day of inspection work was being carried out in the dining room (flooring being replaced). We observed service users being given hot beverages by staff and having to balance them on their laps. Service users were at risk injury. We requested that tables were made available and that staff ensured the safety of service users by providing suitable equipment to minimise the risk of accidents while eating and drinking. Care Homes for Older People Page 17 of 34 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. Service users are not protected from harm Evidence: Standards 16 and 18 were assessed. To assess these standards we looked records which told us how the home ensures service users are protected from harm and abuse, and records which demonstrated that the home listens and responds to service users concerns or complaints. We spoke with service users about how they make a complaint, and talked with staff about how they respond to complaints and protection. We also looked at information provided in the statement of purpose, and information told to us by the home in their annual quality assurance assessment. There are significant shortfalls in how the home responds to complaints and protection of service users. There are no systems in place to ensure service users are protected, and no systems in place to report concerns or significant events to the Commission and other agencies. The current management team at the home have limited understanding of recognising adult protection issues, and none were aware of the protocols around reporting incidents. There have been a high number of safeguarding concerns at this home for the past few months. None have been reported to us by the home, and we have learnt of the concerns from the safeguarding teams. As evidenced in the Personal and Healthcare outcome area in this report, a number of service users have experienced falls, injuries and significant health concerns which not been appropriately responded to either in terms of treatment or reporting information. This Care Homes for Older People Page 18 of 34 Evidence: tells us that service users at this home are at risk of neglect and at risk of harm. The homes statement of purpose states that a clear and accessible complaints procedure is in place. Our inspection of the complaints procedure found it did not meet the needs of the service users living at the home, is not clear and accessible, and has not been adapted to ensure that service users can understand how to complain. The complaints procedure gives the wrong information regarding contact details for the Commission, and service users or their representatives would be unable to contact us if they so wished. Lack of leadership, poor training and communication, and an inadequate complaints procedure lead the Commission to have significant concerns about how service users at the home have a voice, and are able to communicate when they are unhappy or concerned. We could not find any evidence that the home has consulted with service users about their care or lives at the home. Care Homes for Older People Page 19 of 34 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. Service users do not live in a safe or homely environment. Evidence: Standards 19, 21, 24 and 26 were assessed. To assess these standards we looked the communal areas in the home, and a number of bedrooms. We also looked at records which told us how the home ensures service users are kept safe, for example, certificates of electrical equipment testing. In addition, we looked at systems the home has in place to ensure the home is clean and hygienic, and looked at information supplied in the statement of purpose and annual quality assurance assessment. We assessed some communal areas and the majority of service users bedrooms. Our assessment of the environment evidenced significant shortfalls and hazards which included poor infection control, absence of necessary safety equipment, a disregard of privacy due to inadequate curtains, and an overall lack of cleanliness. Some examples are: All bathrooms and toilets were inspected and found to have major shortfalls. None of them contained any soap or paper towels. Healthcare professionals told us there is never any infection control equipment in the home, and in the absence of any soap or paper towels they have had to use washing up liquid for hand washing. In one toilet there was some paper towels left on top of the cistern. However, these were dirty, wet Care Homes for Older People Page 20 of 34 Evidence: and stained. In a first floor toilet the window was wide open and had no window restrictor fitted. In another upstairs toilet there was an overwhelming odour of urine. The light switch in this toilet was behind the door and is not easily accessible. A plastic gravy granule container was being used as a bin. Lino floor covering in all toilets and bathrooms had heavy urine staining around the toilet area. Some of the lino was ripped and coming away from the floor. The upstairs shower room contained three wheelchairs, a seated weighing machine, a carpet cleaner and industrial cleaning materials. This room was not locked. An upstairs bathroom had several items on the floor which were considered both trip hazards and infection control hazards. They consisted of bowls with cat food and water, a cat bed and a large scratch toy. In addition, the bath had no panel. The majority of the bedrooms inspected were considered poor. None of the upstairs bedrooms had window restrictors. All windows were wide open. In two of these rooms the windows could not be closed at all as the lock was broken. Most of the bedrooms did not have net curtains. The bedrooms at the front are overlooked by a main road, and the bedrooms at the back are overlooked by other houses. In one bedroom, instead of the curtains hanging from a curtain pole, copper gas piping had been attached to the wall, and the curtains were hung from this. Many bedrooms had paint peeling off the walls and contained broken furniture such as broken wardrobes and drawers, and headboards broken and coming away from the wall. Some bedlinen was stained and dirty. Under one set of drawers we found a walking stick propped under to steady the broken drawers. In another bedroom the nurse call bell was wrapped around an electric light. In one bedroom we found that a used catheter bag on a stand had been left by a radiator with the connection end exposed and laying on the carpet. In another bedroom we found a soiled incontinence pad in the sink. We observed that a fire door at the front of the building on the ground floor was tied with a leather belt to a hand rail. On release of the belt we found that the fire door was not locked and as it swung open no alarm could be heard. We found the access corridor to a fire door restricted by furniture and zimmer frames. The fire door to the area where hairdressing is undertaken would not open and the exit area in the yard was restricted with rubbish. Care Homes for Older People Page 21 of 34 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. Service users are not supported by competent and trained staff Evidence: Standards 27, 28, 29 and 30 were assessed. To assess these standards we looked at records which told us about the skills and competencies of staff. These records included recruitment processes, staff training and the homes rota. We also looked at information provided in the statement of purpose and at what the home has told us about in their annual quality assurance assessment. We found significant weaknesses in staff competencies. This has had a major impact on service users. We looked at the individual training records of seven staff members. These records demonstrated that training provided at the home is poor, and staff have not received regular training or updated training in key areas such as adult protection, infection control and moving and handling. When spoken with, staff (including senior staff) had little or no knowledge of adult protection, risk assessment, care planning, dementia, infection control, upholding privacy and dignity, or knowledge of how to keep people safe from harm. We witnessed staff assisting a service user to mobilise using unsafe practices. Staff roles and responsibilities were not clearly defined, and were at odds with the management and staffing structure. The deputy manager was mainly based in the Care Homes for Older People Page 22 of 34 Evidence: kitchen and undertakes the majority of cooking duties. A senior carer was responsible for care planning and notifications of significant events, but had not received training in either and was unable to tell us what the care home were required to notify the Commission about, and unable to tell us how to develop individual care plans for service users. Assessment of staff files evidenced that not all staff had job descriptions, none had received appraisals or supervision, and one file did not have a criminal record bureau check. However, we did see that references, photo identifification and evidence of induction were on file. Care Homes for Older People Page 23 of 34 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 home is not being managed well. This has resulted in practices that do not promote and safeguard the health, safety and welfare of the people using the service. Evidence: Standards 31, 32, 33, 36 and 38 were assessed. To assess these standards we looked at information and records which tell us how well the home is run, and records which tells us how the home self-monitors their performance. These records include the experience and qualifications of the manager, the homes annual quality assurance assessment, systems in place for supervising staff, and all records relating to meeting support needs of service users, for example care plans. The homes statement of purpose indicates the home is competently run by an manager experienced in the care of older people. Evidence gathered at todays inspection demonstrates this is not the case, and there are significant shortfalls in how this home is being managed. Care Homes for Older People Page 24 of 34 Evidence: Our inspection today evidences that service users needs are not being met in any outcome area assessed. Poor pre admission assessment, poor care planning and risk assessment, and poor management of service users health care needs, have led to service users being neglected and suffering harm. When we identified concerns with the manager, she did not demonstrate insight or acknowledge responsibility into the failings of the home, and felt that they were meeting service users needs well. This lack of insight into evidenced significant shortfalls continues to place service users at risk of harm. Staff told us that the manager is not approachable, that she sometimes shouts at them and has been known to flick a wet tea towel at them. They said her management style affects the running of the home, and staff and service users are sometimes intimidated by her. We were informed by health professionals that the manager has refused to communicate with them, and has instructed her staff not to speak with them or pass on information about service users. We spoke with the owner regarding his responsibility regarding the home. We could see that Regulation 26 visits had taken place, and some shortfalls had been identified. However, the owner informed us that the manager was resistant to change, and did not agree with the Regulation 26 visit findings. At times, she had refused to allow senior managment from the Company to enter the home to undertake a Regulation 26 visit. Discussion with the owner demonstrated he has an awareness of the shortfalls at the home, and has given a committment to ensuring improvements are made without delay. Care Homes for Older People Page 25 of 34 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 30 18(1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users- (a) Ensure that at all times suitably qualified, competent and experienced persons are working at the care home and that they receive training appropriate to the work they are to perform. To ensure that residents are supported with their needs by suitably trained staff 06/11/2009 Care Homes for Older People Page 26 of 34 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 7 15 The registered person must 16/03/2010 ensure the care plan and risk assessment of a service user (name given to you at the inspection) is updated immediately. To ensure the service users care needs and health needs are met. 2 7 13 The registered person must 16/03/2010 ensure a cotside risk assessment is undertaken for all service users. To ensure the health, safety and welfare of service users is met. 3 7 13 The registered person must 16/03/2010 ensure a falls risk assessment is undertaken for all service users in the home. To ensure the health, safety and welfare of service users. 4 7 13 The registered person must ensure a moving and handling risk assessment is undertaken for all service users in the home. To ensure the health, safety and welfare of service users. 16/03/2010 5 8 17 The registered person must 16/03/2010 ensure all service users have a weight chart, are weighed regularly, and apporpriate action is taken with regard to any concerns about their Page 27 of 34 Care Homes for Older People 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 weight. To ensure the health, safety and welfare of service users. 6 18 13 The registered person must ensure the home ceases removing mobility aids from service users. To ensure the health, welfare and safety of service users. 7 24 23 The registered person must ensure curtains are fitted to all bedrooms. To ensure the privacy and dignity of service users is upheld. 8 26 16 The registered person must ensure infection control equipment is in place in toilets, bathrooms and bedrooms. To ensure the health, welfare and safety of service users, staff and visitors. 9 38 23 The registered person must contact the fire service and arrange an urgent assessment of all fire doors. To ensure the health, safety and welfare of service users, staff and visitors. 10 38 23 The registered person must ensure that window restrictors are fitted to all windows in the home. To ensure the health, safety Care Homes for Older People Page 28 of 34 16/03/2010 16/03/2010 16/03/2010 16/03/2010 16/03/2010 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 and welfare of service users. 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 4 The registered person must ensure the statement of purpose is up to date and reflects the services and facilities at the home. To ensure prospective service users have correct information to make an informed choice about where to live. 14/05/2010 2 3 14 The registered person must ensure that prospective service users are competently and thoroughly assessed prior to admission to the home. this includes demonstrating that appropriate consultation with the service user and their representative has taken place. Prospective service users are not currently being competently assessed prior to being offered a place at the home: therefore support 30/04/2010 Care Homes for Older People Page 29 of 34 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 needs are not being identified or met. 3 7 12 The registered person must 31/05/2010 develop comprehensive care plans and risk assessments which detail support needs of individuals. The home must demonstrate they have consulted with service users, and have taken into account their wishes and feeling. Current care plans are inadequate and do not contain support needs of individuals. The registered person must 18/03/2010 ensure that they respond, without delay, to health concerns, including accidents, and that service users are given access to health care professionals for medical treatment. This includes seeking advice from district nurses to make sure the right support is given and that specialist advice is sought and followed when conditions change. Current systems do not promote or maintain proper provision for the health and welfare of service users. 4 8 13 Care Homes for Older People Page 30 of 34 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 5 10 12 The registered person must ensure that service users are treated with respect and dignity at all times. . 17/03/2010 6 12 16 The registered person must ensure that service users are consulted about activities and further ensure that activities meet service users individual needs. . 05/04/2010 7 15 16 The registered person must ensure that the nutritional needs of service users are met. This includes ensuring all food intake is recorded. To ensure the health and welfare of service users is met. 01/04/2010 8 16 22 The registered person must ensure a suitable and accessible complaints procedure is developed. To ensure service users are able to communicate concerns and complaints. 12/04/2010 9 17 37 The registered person must ensure they inform the Commission, without delay, of all significant events at the home that are outlined in this regulation. 22/03/2010 Care Homes for Older People Page 31 of 34 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 ensure the health, welfare and safety of service users is met. 10 18 13 The registered person must ensure that all staff receive accredited sufficient and effective training in adult protection (recognising and responding to signs of abuse) and that they are competent to use this knowledge. To ensure the health, welfare and safety of service users is met. 11 24 23 The registered person must 15/04/2010 ensure the environment is safe and clean and meets all service users assessed needs. To ensure the health, welfare and safety of service users, staff and visitors. 12 27 18 The registered person must ensure that staff employed at the home are competent to carry out their duties. This includes ensuring staff receive necessary training. To ensure the health, welfare and safety of service users. 30/04/2010 05/04/2010 Care Homes for Older People Page 32 of 34 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 13 31 10 The registered person must 19/03/2010 ensure that the home is well run, and there are robust systems in place which safeguard service users and ensure appropriate care and support is given. To ensure the health, welfare and safety of service users. 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 33 of 34 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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