Inspection on 29/06/10 for Shandon House

This inspection was carried out on 29th June 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shandon House 30/09/09

Shandon House 06/05/09

Shandon House 06/10/08

Shandon House 07/05/08

Shandon House 10/05/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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: Shandon House 20 Crescent Road Birkdale Southport Merseyside PR8 4SR     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: Michael Perry     Date: 2 9 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 32 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 32 Information about the care home Name of care home: Address: Shandon House 20 Crescent Road Birkdale Southport Merseyside PR8 4SR 01704564801 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): SBS Care Homes Limited Name of registered manager (if applicable) Miss Sara Jane Fowler Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following categories of service only. Care home only - code 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 - Code OP Date of last inspection Brief description of the care home Shandon House is a care home that is currently registered to provide personal care and support for up to 20 older people. The home is a large detached property situated close to the town centre of Birkdale village and is within easy reach of Southport town centre and all its amenities. Local Care Homes for Older People Page 4 of 32 Over 65 20 0 3 0 0 9 2 0 0 9 Brief description of the care home services such as shops, a post office, bank and public transport are in close proximity to the home. All the 20 bedrooms are for single occupancy and thirteen have en-suite toilets. The home has a pleasant garden and communal areas including a lounge, dining room and conservatory to the side of the building. The building has three floors which are accessible by a passenger lift and the main and side entrance are equipped with ramps to provide disabled access. A small area is provided for off-road parking. The care home fees range from £389.90 to £450.00 per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and was conducted over a period of one day. All day areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. People living in the home were spoken with along with members of staff and the Senior carer in charge. The manager was not available for the duration of the inspection visit. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the visit, which is a detailed document that gives us a lot of information and update about the home and assists in focusing the inspection. During the visit we were able to speak to a visiting care professional. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? The last main [Key] inspection was a year ago when a number of requirments and recommendations were made. These were checked on a random inspection visit in September 2009. All but one of these had been met; the requirement for consistent pre admission assessments being carried over. This requirement has still not been fully Care Homes for Older People Page 7 of 32 met and there has, therefore, not been any improvement since the last visit. What they could do better: Prospective residents do not consistently have their needs assessed before deciding to move into Shandon House. Unless an assessment is undertaken before admission, there is no assurance that care needs will be met. We would recommend that an assessment of mental capacity [reference the Mental capacity Act 2005] is carried out pre admission so that it can be clearly established the persons capacity to make a choice about coming to the home. The long term care planning of people in the home is good but we found the more immidiate care needs such as a person experiencing a number of falls has not been documented on the care plan. This has the potential to put people at risk as care needs may be missed by staff who may not be aware or consistent in their approach. We were very concerned about the medication administration in the home. We have made some requirments to ensure that the handling, receipt, storage, and administration of medication is maintained safely and accurately so that people are able to receive a safe service. We have also made a number of good practice recommendations. We would recommend that the new local safeguarding policy is discussed with staff who can then be updated regarding the wider role of social services and other bodies such as the police who may be involved in an investigation. This helps ensure that staff are more aware so that residents are kept safe in the service. We looked at the way the home is generally maintained and were concerned that some aspects of the homes maintenance were lacking. For example we found the hot water in one bath outlet to be very hot and therefore putting people at risk of scalds. We also found some of the communal bathrooms and toilets lacked necessary hand washing facilities which reduces the homes ability to maintain proper hygiene and infection control. We made an immediate requirement regarding the hot water which has since been actioned and made safe. We have made further requirments to help ensure better maintenance in the home. We found that new staff employed had not had the required pre employment checks made to ensure they are fit to work with vulnerable people. This is important to protect people by ensuring staff are of integrity and good character. We have made specific requirments to ensure this carried out. The financial records for some residents were seen and it was observed that two signatures are not always witnessing individual transactions. Receipts should be given for any money left for safekeeping. Our records show that we have not received any notifications from the service over the past year with respect to some incidents in the home that should be reported through. These notifications tell us about any key events in the home and ensure we, as regulators, are kept informed. We would require the carer in charge to check records and send any outstanding notifications. Care Homes for Older People Page 8 of 32 There remain a lot of inconsistencies at present with some of the management systems needing tightening up and being made more responsive and consistent. 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 32 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 32 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. Prospective residents do not consistently have their needs assessed before deciding to move into Shandon House. Unless an assessment is undertaken before admission, there is no assurance that care needs will be met. Evidence: We looked at two care files for people admitted to the home since the last Key [main] inspection a year ago. We have made a previous requirement that people must be assessed before admission to make sure the home is suitable for them and care needs identified can be met. One person had been assessed prior to admission and the detail of this assessment was appropriate so that care needs could be understood and a clear understanding of the basis for the admission to the home could be established. There was also supporting reference to health care assessments. Care Homes for Older People Page 11 of 32 Evidence: One person reviewed was not assessed prior to the admission date. There were also no other assessments completed before admission as the person was admitted on a private basis. An assessment was completed on the day of admission to the home which clearly outlined care needs around the person being at risk due to wandering and mental confusion. Since admission these issues have exacerbated and the home have made referrals for psychiatric opinion and are now presented with care needs that may be difficult to meet. We discussed the importance of a pre admission assessment given the above scenario as this person may have been better placed in a different care setting had this been the case. We have left the requirement for preadmission assessments to be carried out. We also discussed the implications of the Mental Capacity Act 2005 and assessments completed to ensure that peoples mental capacity is established so that daily life decisions can be made by residents or in their best interests. We would recommend that such an assessment is carried out pre admission so that it can be clearly established the persons capacity to make a choice about coming to the home. Care Homes for Older People Page 12 of 32 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. Some care planning and medication procedures need to be improved so that care is monitored consistently and safely. Evidence: We looked at the care of two people in some depth. Both have care plans which detail the care planned and carried out by staff so that care needs can be met consistently. They evidenced areas of good practice as both where quite detailed and have been drawn up with the involvement of the person concerned or their advocate. The care plan reviews have been carried out monthly and were very detailed so it was easy to keep up to date with the progress of the care in most instances. For example one person had medical needs which involved ongoing investigations by the GP and these were planned in the care plan and reviewed regularly so that it was easy to see the progress to date. We were concerned that this was not consistent in all instances of care needs. More immediate, or acute care needs were not planned in the same detail. For example one person had had many falls since moving into the care home. It was possible to Care Homes for Older People Page 13 of 32 Evidence: follow some progress as the reviews stated that the home had referred the person for further assessments to care professionals. We asked what the staff were doing in terms of monitoring and trying to meet the persons needs with the aim of reducing the risk and were advised of a number of interventions but none of these were planned on the care plan. We discussed the need to update the care plan with current interventions and support so that staff have a consistent reference point to ensure consistent and ongoing monitoring. This is of particular concern given the safety needs of the person concerned. We spoke to people about the way care is carried out in the home and it was clear from the comments that staff are careful to ensure peoples privacy is respected and care is carried out in a dignified manner. The people we observed were all appropriately dressed for example with good attention paid to standards of personal hygiene. A visiting health care professional commented that people where generally looked after and the home were proactive in ensuring that any health care needs were referred for assessment. For example one person had been referred for monitoring due to diabetes. We looked at the way medicines are managed and administered in the home. We found some concerns that need to be reviewed and current practice updated to ensure medications are administered safely. The homes policy and procedure was reviewed. It is very brief and lacking necessary detail. It was written in 2003 and reviewed by the current manager in April 2010 which reads no change to policy. The policy however says that currently two people are self medicating which was not the case [This confirmed by senior carer in charge on the day]. Also, the policy does not contain any reference to correct storage and information on controlled medication [for example] so that staff can have a clear reference guide. We would strongly recommend that the policy is reviewed and updated with greater detail around the receipt, recording, storage, handling, administration and disposal of medicines. The record of medication received and administered to people [mar charts] were reviewed for some people. it was concern that some records were difficult to follow and we were not able to get a clear audit trail of the medicines administered: * Two people had had changes to their medicines but these had not been updated on the medication record. For example one medicine prescribed two times daily had N recorded on the record. This code was not identified. When we asked the carer stated that the GP had changed the prescription to PRN [give when required] but this had not Care Homes for Older People Page 14 of 32 Evidence: been recorded on the administration chart. We advised that the record needs updating for clarity so that all staff administering medicines are aware of the current prescription. Another person had had a prescription for a pain relief medication changed and again this had not been updated on the medication record. * One person had a handwritten record for a medication and enter on mar is code F which means none. We asked about this medication and why it was not [apparently] being given but the senior carer was unsure whether the person was receiving the medicine or not. There was no supporting information in the care notes [carer looked for this]. There was also no signature or date of entry for the handwritten entry on the medication record. We advised to make an immediate check with the GP and update the record accordingly. Failure to maintain up to date medication administration records can cause confusion and put people at risk of receiving incorrect medicines. *We looked at the medication records and tried to check when medicines had been received and how many had been administered so that a current check of the stock could be made. The records did not contain a date when the medications had been received so it was impossible to audit how many should be currently in stock. The routine audit carried out by the manager is simply a count of the medicines in stock but does not include a check on how many should have been administered. This needs to be reviewed and the medication audit needs to show a process whereby medications are accounted for from date of receipt through to administration and the current stock. This will show that medicines in the home are accounted for. * The people who are receiving PRN [give when necessary] medications did not have clear instructions of the circumstances in which this was to be given. This could mean that the medication could be administered for different reasons by different staff. We discussed the importance of a PRN care plan which can be attached to the medication record so that staff are fully aware of the reasons for the medication and indications when it should be given. This will ensure a more consistent approach which can be reviewed in line with other care needs. * We looked at the training staff receive and records indicate that all staff have been on appropriate training. Following the training The manager needs to be sure that staff are competent in the clinical setting and should ensure that they are directly observed and record is made of this. There were no records of this and staff spoken with said that they had been observed but the manager does not make a record. We would recommend that this is completed for all new staff administering medications. This Care Homes for Older People Page 15 of 32 Evidence: ensures that staffs clinical practice is monitored and people are sure that medicines are administered safely. Care Homes for Older People Page 16 of 32 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. The daily life and social care for residents continue to be developed so that residents generally are supported to feel relaxed and at home. Evidence: At the time of the inspection we found the home to be very warm and welcoming. Residents were happy to chat and to tell about life in the home. Staff were seen to actively interacting and supporting people. One person said, Its alright here. The food is nice and my daughter can visit at any time. Anther person commented, Its very good. Staff are friendly without being intrusive. There are some activities planned for people to join in with such as film shows in the lounge and some outside entertainers are booked. These events are advertised in the hallway. There is also access to a garden area which is well maintained and some people spoke about enjoying this facility. People spoken with were all pleased with the meals. The dining room was observed to be pleasant with tables laid and menus displayed. Residents have a choice of where they have meals. One person said, We get some choice at breakfast and tea but not dinner time. Staff do provide something else however if we dont like the main meal. Care Homes for Older People Page 17 of 32 Evidence: Overall this evidences a relaxed feel to the home and shows that people are settled and comfortable with social arrangements. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure available for people in the home. This is displayed in the service user guide. Those spoken with were very relaxed around staff and said that generally they were listened to so that any concerns could be addressed. Evidence: We asked about any complaints made about the service in the last year. One complaint investigated by the manager concerned the ongoing shouting and behavior of a person who was confused and agitated. The managers response was appropriate and she had arranged for reviews to take place of the person concerned and a more suitable placement had been found following this review. This shows that the management are responsive to an concerns raised. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. The previous inspection a year ago raised concerns around staff training and lack of knowledge in this area. We found improvements in that all staff have undergone training and those spoken with could identify different kinds of abuse and displayed an understanding of the importance of alerting people in authority although were unsure as to the wider picture in terms of arrangements for investigating allegations of abuse. For example there was little understanding of the role of the local safeguarding team at social services. Some staff felt that the manager would investigate and did not understand the importance of referring concerns to outside statutory bodies. The deputy manager/ senior staff in charge was Care Homes for Older People Page 19 of 32 Evidence: able show us copies of the homes policies and procedures.These need updating with regard to the new local social service guidance and we discussed this. We would recommend that the new policy is discussed with staff who can then be updated regarding the wider role of social service sand other bodies such as the police who may be involved in an investigation. This helps ensure that residents are kept safe in the service. There has been one incident reported through the the safeguarding team since the last inspection. This occurred in October 2009 where the manager reported a carer for abuse of a resident and this was investigated and the staff member dismissed and reported through appropriate channels to ensure that she can no longer work with vulnerable people. We were concerned at the time that this incident was not reported to the manager by staff for some time and the delay may have compromised a more timely investigation. Currently there is an ongoing safeguarding concern which we are closely monitoring and will follow up in due course. Care Homes for Older People Page 20 of 32 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. The home is generally maintained but there needs to be prompt action in the event of any failings that may put people at risk so that saftey is maintained. Evidence: At the time of the inspection we found the home to be warm and welcoming. Residents were clearly settled and found the surroundings comfortable. The ongoing decorating was commented on by some of those spoken with. All areas seen were clean and generally well maintained [see below for exceptions]. There was no malodour detectable on entering the home and in the lounge. We spoke to residents who said that the home was generally comfortable and clean. We were concerned that some basic monitoring of the environment was lacking. For example there were communal bathrooms and toilets that did not have any hand wash facilities. They were lacking in either liquid soap and/or paper towels which are recommended to maintain good standards of hygiene and infection control. We were very concerned that hot water temperatures tested in one bathroom was recorded at 60C which puts people at risk of scalds. We asked to look at monitoring records and saw that the hot water outlets are routinely tested and some [including the example mentioned] have consistently been recorded as very high but there has been no management action to remedy this. We served an immediate requirement Care Homes for Older People Page 21 of 32 Evidence: notice for all bath and shower hot water outlets to be tested again and thermostatic controls to be fitted and maintained at a safe temperature. [We were advised by the provider the next day that this has been actioned]. It important that the environment is correctly monitored and any risk to peoples saftey is followed up promptly so that they are protected. Care Homes for Older People Page 22 of 32 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. Overall staffing numbers are sufficient to meet care needs but there must be full recruitment checks on file to ensure that staff employed are fit to work with vulnerable people so that they are protected. Evidence: We looked at the duty rota and found that generally staffing was stable and this was supported by staff interviews. There is also ancillary staff support such as domestic staff as well as staff working in the kitchen. Staff described good team work generally. People in the home who were spoken with generally felt that staff were responsive and the pace of the care was relaxed and unhurried. Overall we found evidence that staffing was generally sufficient to meet care needs. Training is ongoing in the home. Staff spoken with said that they felt supported through the training program. Currently nine out of fourteen of the care staff have a National Vocational Qualification [NVQ] which is over 50 percent so that the home can evidence a core of staff who are competent to carry out care. The Senior in charge provided further information on staff training. This shows that the training opportunities and training needs of the staff team have been identified. The staff training program is developing and records seen showed a progressive ongoing program and staff interviewed had attended relevant courses. Care Homes for Older People Page 23 of 32 Evidence: The residents and their relatives gave good feedback about all staff and the manager. Comments included: Staff are lovely and very helpful I like the home and the staff are very nice Staff were observed to be warm and respectful with the residents throughout the course of the inspection. Staff were present in the lounge throughout the inspection and were readily available to meet the needs of the residents. We looked at the staff files for three new members of staff and a staff member who had been employed for over a year in order to assess the staff recruitment and selection procedures at the home. The files were incomplete and it was difficult to get some information such as start dates for people. One file had no evidence of the required check of the register with the Independent Safeguarding Authority [ISA] to ensure the staff was not barred from working with vulnerable people before she had commenced work in the home. Another staff file had no ISA check and also no Criminal record [CRB] check on file. The senior staff could not locate these. We also found that references on file were not robust enough. For example on application form listed two previous care homes worked in but both references where character references and there had been no attempt to get adequate references form the previous care homes. This is important as references from these sources are needed to help ensure the person is OK to work with vulnerable people. This was the same with a second file inspected. Also none of the files had induction training checklists signed off so it was difficult to evidence whether a proper induction had taken place for these new staff. Some files where incomplete because they did not have photographs of staff. We were given the file of a staff member who has been employed for over a year in order to contrast standards over a longer time frame. This staff record was more of a concern as the person had previous convictions recorded which may make the person unsuitable to work in a care setting. There had been no assessment of risk carried out by the manager until the previous inspection visit had picked this up. This questions the managers ability to ensure staff are recruited who are suitable to work with vulnerable people and this may present as a possible risk to people living in the home. Care Homes for Older People Page 24 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a number of key systems in the home that need to be audited and standardised so that standards can be more consistent. Evidence: During the inspection the Registered manager was unavailable and the home is currently being run by a senior carer. We spoke at length about the need to improve and maintain some key areas of management that have arisen from this inspection. These include medication management and recruitment checks for staff. We also looked at some other areas such as the management of residents personal allowance and some good practice principals such as ensuring two signatures for all financial transactions and issuing receipts for money given for safekeeping are not currently being carried out. Other key areas such as maintaining up to date care plans for more acute care needs such as management of falls need further input to maintain consistency. We looked at the health and safety checks carried out in the home. There is Care Homes for Older People Page 25 of 32 Evidence: monitoring evident with many records up to date but again there are areas of inconsistency which are alarming. For example the monitoring of hot water temperatures [previously discussed]. Our records show that we have not received any notifications from the service over the past year with respect to some incidents in the home that should be reported through. These notifications tell us about any key events in the home and ensure we, as regulators, are kept informed. We identified some issues that the home should have informed us about such as the falls experienced by one of the residents for example. We would require the carer in charge to check records and send any outstanding notifications. We spoke with staff who said that the manager has made many improvements over the past year and the home is now better managed overall. The findings of the Random or focused inspection carried out in may 2009 was that the manager had been able to meet many of the outstanding requirements issued earlier. This shows a degree of management response and willingness to work at improving the home. There remain a lot of inconsistencies at present, however, with some of the management systems needing tightening up and being made more responsive and consistent. Care Homes for Older People Page 26 of 32 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 1 3 Assessments of need should be completed for residents living at Shandon House. This will enable the service to identify needs and demonstrate it is able to meet the needs of people living at Shandon House. 29/10/2009 Care Homes for Older People Page 27 of 32 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 25 13 All hot water outlets must be 28/06/2010 maintained at a safe temperature This will reduce the risk of people being scalded. 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 9 13 People receiving PRN [give when required] medication must have this recorded on a PRN care plan. This helps ensure consistency of administration and appropriate review. 19/08/2010 2 9 13 There must be a date recorded [on the MAR sheet?] to say when medicines are received into the home. This ensures that a check can be made of the current stock of medicines and helps ensure no mishandling. 19/08/2010 Care Homes for Older People Page 28 of 32 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 3 9 17 medication records kept in the home must be maintained up to date and accurate. This helps ensure that people are given correct medication. 19/08/2010 4 19 13 All environmental saftey checks are regularly reviewed and any action needed must be prompt and timely. 19/08/2010 This helps ensure that the home is maintained and provides a safe environment. 5 29 19 All staff must receive the 19/08/2010 appropriate pre employment checks and these must be evidenced in the staff files. This includes two written references from appropiate sources and evidence of both CRB and ISA checks. All staff files must be audited against the requirements listed in schedule 2 of the care home regulations. Care Homes for Older People Page 29 of 32 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 This helps ensure that staff employed are fit to work with vulnerable people and they are protected. 6 37 37 All incidents relating to 19/08/2010 regulation 37 notifications must be reported through to the Care Quality Commission [CQC] This ensures that the regulator is fully informed of incidents in the home. Any hazards or risks 19/08/2010 identified in the environment must be acted on to ensure safe standards are maintained. 7 38 13 This ensures residents are protected and are living in a safe environment. 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 1 3 We would recommend that an assessment of mental capacity [reference the Mental capacity Act 2005] is carried out pre admission so that it can be clearly established the persons capacity to make a choice about coming to the home. The medication policy / procedure for the home should be 2 9 Care Homes for Older People Page 30 of 32 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 reviewed and updated to include grater detail on the receipt, recording, storage, handling, administration and disposal of medicines. Staff who have received medication training need also to have their competency assessed by direct observation by the manager and a record made. All handwritten medication records should be signed by two members of staff to ensure greater accuracy and reduce the risk of errors occurring. 3 18 We would recommend that the new local safeguarding policy is discussed with staff who can then be updated regarding the wider role of social services and other bodies such as the police who may be involved in an investigation. This helps ensure that residents are kept safe in the service. All communal baths and toilets should have appropriate hand washing facilities maintained [paper towels and liquid soap]. The financial records for some residents were seen and it was observed that two signatures are not always witnessing individual transactions. Receipts should be given for any money left for safekeeping. 4 26 5 35 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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