Inspection on 18/01/10 for Shire House

This inspection was carried out on 18th January 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shire House 13/05/10

Shire House 22/03/10

Shire House 18/01/10

Shire House 15/12/09

Shire House 29/05/09

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Fairfields Country Rest Home

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Queensmount

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Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Random inspection report Care homes for older people Name: Address: Shire House Sidmouth Road Lyme Regis Dorset DT7 3ES zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susan Hale Date: 0 2 0 2 2 0 1 0 Information about the care home Name of care home: Address: Shire House Sidmouth Road Lyme Regis Dorset DT7 3ES 01297442483 01297442483 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sentry Care Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 22 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Shire House is established in a large detached house set in its own grounds on the western outskirts of Lyme Regis. The home is accessed by a driveway and is surrounded by mature grounds and gardens there is level access to most parts of the gardens. There are large parking areas at the side of the house for visitors Care Homes for Older People Page 2 of 21 Brief description of the care home convenience. The original Edwardian house has been extended to provide additional bedrooms. There are two communal lounges and a separate dining room on the ground floor. People who live at the home are accommodated on the ground, first and second floors of the home and a passenger lift is available to the first floor for less ambulant residents. There are eighteen single and two double bedroomsuites, all of which are decorated to a good standard. Of the twenty bedrooms, eighteen have ensuite facilities. There are sufficient communal bathrooms and WC s to meet the needs of residents, including an assisted bath. Shire House provides 24-hour personal care, all meals, laundry and domestic services. Care Homes for Older People Page 3 of 21 What we found: The inspection took place over the course of one day in January 2010. It was undertaken by two inspectors. The purpose of the visit was to check if the home had complied with the statutory requirement notice issued on 11 January 2010. The notice was issued as the home had breached the Care Home Regulations 2001 in relation to the recruitment of staff. We looked at the two staff files that on the previous visit did not contain the necessary documentation and checks that must be in place before people start working at the home. We noted that the staff files , including Criminal Records Bureau checks were not kept securely in the managers office and could have been accessed by any member of staff. Information about staff was kept collectively rather than on individual files. On the first file looked at a satisfactory Criminal Records Bureau and Independent Safeguarding Authority check was on file. There was some evidence of proof of identity but this did not include an up-to-date photograph of the person. An application form had been completed but the last employer was not included on the persons CV and the person had not put down their last employer as a reference. Two references were on file, one from a previous employer and one was a character reference. However, one reference was dated the same date as the person had started employment and one reference was dated one month after they had started working at the home. There was no evidence in the file that the person had undertaken health and safety, fire safety or infection control training and this was confirmed by checking the training matrix. On the second staff file looked at the Criminal Records Bureau and Independent Safeguarding Authority check had been obtained. An application form was on file but this had been completed after the safeguarding check had arrived. The file contained proof of identity but in common with other files checked did not contain interview records, job description or a contract of employment. There was no evidence that the person had undertaken in induction or any training relating to health and safety or fire safety and this was confirmed by checking the training matrix supplied by the home. On the third file looked at we saw that a satisfactory Independent Safeguarding Authority and Criminal Records Bureau check was in place. An application form was on file but it was unclear and the deputy manager was not able to tell us, if the member of staff whose first language was not English had completed the application form themselves. In common with other files looked at the file did not contain a record of the interview, any evidence of any induction training, a job description or a contract of employment. The deputy manager told us that the person did not have a training file although they had been working at the homes since 12th December 2009. The member of staff concerned had not undertaken any training relevant to their specific role or other mandatory training such as health and safety and fire safety. On the fourth file we checked we saw an application form, two references and proof of identity. However, this person had also started work before the Criminal Records Bureau check had been received and that was no evidence that they had been supervised during Care Homes for Older People Page 4 of 21 this time. In common with other files there was no interview record, contract of employment or a job description. A Skills for Care common induction standard booklet was on file but this lacks detail and the deputy manager could not evidence the work undertaken with the person to ensure that they have completed and understood the work booklet. The person had not undertaken any health and safety training but the deputy manager told us they had completed two out of three training sessions on fire safety although this could not be evidenced. On the fifth staff file checked we saw that the person had had a staff appraisal in 2009. However, the appraisal consisted of a tick box and did not contain enough detail of the discussion that had taken place or how it had been decided that the persons performance was satisfactory. There was no evidence on any of the staff files looked at that staff had been supervised from the time of a satisfactory Independent Safeguarding Authority check was received and starting work until a satisfactory Criminal Records Bureau check has been obtained. The staff application form asks applicants if they have any health problems but states that if they have no health problems they have to provide details. The staff application form asks applicants to provide details that may not be within the current employment legislation. The staff recruitment policy and procedure contained contradictory information and needs to be updated in line with the national minimum standards and current employment legislation. There was no evidence that new staff routinely undertook the Skills for Care common induction standards training. The deputy manager did not have the necessary managers guidance on induction training to be able to support staff and make a professional judgment as to their competency during the induction period. The deputy manager gave us a copy of what we were told was the current staff training matrix. This showed that none of the care staff are qualified to NVQ two or above.Dementia training was taking place for some members of staff and the registered person on the day of the visit. The training matrix recorded that eleven members of staff including the deputy manager have not undertaking any training in adult protection. Seventeen members of staff have not undertaking any training in infection control. Thirteen members of staff have not completed any health and safety training and ten members of staff have not completed training in moving and handling. The deputy manager told us that some members of staff had undertaken manual handling training on the previous day but was not able to evidence how many or which staff had done this. The deputy manager told us that they undertook staff supervision with assistance from a senior member of staff. The deputy manager told us that neither of them had received any information or training in how to formally supervise staff. We looked at two supervision records in detail. Supervision was brief and not in line with the recommendations in the national minimum standards. Records had not been signed by the supervisor or supervisee and it was unclear if staff were given their own copy. Supervision did not take place on a regular basis and certainly not at least six times year in line with the national minimum standards. Care Homes for Older People Page 5 of 21 We saw that there were two supervision records on the managers desk. These have been written by a senior member of staff and had been completed before they had even met with the member of staff which is clearly inappropriate. The supervision records referred to above was seen on the managers desk amongst paperwork that included unfilled prescriptions and application forms. We undertook a very brief tour of the premises and noted that there was an unpleasant odour on the first floor. We observed that one bed had been made although the bottom sheet was clearly dirty and should have been changed. We saw that a used continence product had been set aside to be used again (due to the residents choice) but this showed a significant lack of knowledge of staff in infection control issues. We saw one private bathroom but although it had been cleaned since our last visit , it was still not clean to an acceptable standard. There was plaster missing from the wall behind the toilet cistern and the toilet is mounted on a wooden platform with significant gaps posing a possible infection control risk. The lid of the waste bin was on the table on top of unused wound dressings. The hot water temperature in all outlets remains very high and poses a significant risk of scalding and burns to residents and staff. The deputy manager told us that work to address this will start on 9th February 2010. We noted that there were fingerprints and hand prints on the back of several doors indicating that they had not been cleaned since the last inspection. It was clear from looking at one residents feet and from talking to two residents that the chiropodist had not been to the home since the last inspection. This is despite the poor condition of peoples feet being drawn to the deputy managers attention on 18th January 2010. We looked briefly at one medication administration record (MAR) . We saw that handwritten entries had not been checked and signed by a second member of staff. There was no rationale for medication that was prescribed as required ( P.R.N.) and in relation to this particular person who was prescribed more than one painkiller there was no rationale as to which should be given in a particular circumstance. What the care home does well: What they could do better: Significant improvements are still needed in the way that people are recruited to work at the home. This is to ensure that the home have undertaken the necessary checks and people who work there are suitable. All members of staff should be given their own copy Care Homes for Older People Page 6 of 21 of the General Social Care Council code of conduct to make sure that they are aware of the expectations relating to their conduct. The staff recruitment policy and procedure must be updated to make sure it reflects current good practice and current employment law. All staff must receive training in mandatory topics including health and safety, infection control, moving and handling and fire safety. All staff must receive training in adult protection to make sure they are aware of how to keep people living in the home safe from the risk of harm. Significant efforts need to be made to ensure that staff are offered the opportunity to undertake NVQ training to make sure they have the skills and knowledge to meet residents needs. A supervision policy should be developed and supervision should take place in line with the national minimum standards to make sure that staff are working to the standard expected by the home and are offered appropriate support and guidance. Significant efforts need to be made to ensure that all areas of the home are clean and that staff are aware of infection control issues and how to keep people safe from the risk of cross infection. All records in the home must be stored securely and in line with the requirements of the Data Protection Act 1998 to make sure that confidentiality about personal information relating to staff is maintained. Improvements are still needed in the way that medication records are maintained to make sure they are in line with good practice advice and gave clear information and guidance to staff. 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 set out on page 2. Care Homes for Older People Page 7 of 21 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered manager must ensure that those staff carrying out initial assessments the assessor has had the necessary training to interprete the results of the assessment tools used. To ensure that peoples needs are met and they are not at risk of harm 15/01/2010 2 3 14 The registered manager must ensure that all people who are to reside at the home have their needs assessed. To ensure that peoples needs are met and they are not at risk of harm 15/01/2010 3 7 15 The registered manager 17/07/2009 must ensure that all care plans and reviews accurately reflect the needs of the person and give enough detail to guide and inform staff as to how to met the agreed needs (Previous timescale of 17/07/2009 and 15th January 2010 not met). Care Homes for Older People Page 8 of 21 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Not looked at during this inspection. 4 7 15 The registered manager must ensure that people are consulted with regards the contents of their care plans To ensure that peoples needs are met in a way that suits the individual 15/01/2010 5 9 13 The registered manager 15/01/2010 must ensure that the receiving, administration, recording of and returning of medication is carried out in accordance with the National Pharmaceutical Guidence so as not to put people at risk of harm. To ensure that people are not put at risk 6 9 13 The registered manager 07/07/2009 must ensure that the receiving, administration, recording of and returning of medication is carried out in accordance with the National Pharmaceutical requirements so as not to put people at risk of harm. (Previous timescale of 07/07/2009 and 15/01/2010 not met) 7 26 13 The registered manager must ensure that infection control policies are adhered 07/07/2009 Care Homes for Older People Page 9 of 21 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action too so as to promote the well being of those at the home. ( Previous timescale of 07/07/2009 not met). 8 29 19 The registered manager must ensure that your recruitment systems demonstrate that you are satisfied that all staff members are appropriately and safely recruited. To ensure the protection of those who live at the home 26/01/2010 9 29 19 The registered manager 07/07/2009 must ensure that any prospective staff member has their fitness to work with vulnerable people established in order to protect those who live at the home. ( Previous timescale of 07/07/2009 and 24/01/2010 not met). 10 30 18 The registered manager 17/07/2009 must ensure that all staff under a formal recorded induction into the work they are going to perform to ensure people are not put at risk ( Previous timescale of 17/07/2009 not met). 11 30 18 The registered manager 01/08/2009 Page 10 of 21 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action must ensure that all staff have the necessary statutory training to ensure that peoples needs can be met in a safe manner. ( Previous timescale of 01/08/2009 not met). 12 37 13 The registered manager must ensure that all accidents are recorded and evaluated to maintain the safety of those who live at the home. (Previous timescale of 07/07/2009 not met). Not looked at during this inspection. 07/07/2009 13 38 38 The registered manager must ensure that the hot water temperature does not poise a significant risk of injury. ( Previous timescale of 18/06/2009 and 15/12/2009 not met). 18/06/2009 14 38 13 The registered manager 17/07/2009 must ensure that all risk assessments demonstrate how the safety of the people who use the service or work at the home is being maintained. ( Previous timescale of Care Homes for Older People Page 11 of 21 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 17/07/2009 not met). Not looked at during this inspection. Care Homes for Older People Page 12 of 21 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 3 14 The registered person must ensure that all people who are to reside at the home have their needs assessed. (Previous timescale of 15/01/2010). Not looked at during this inspection. To ensure that peoples needs fully assessed in the home is confident that they can be met. 02/03/2010 2 3 14 The registered person must 02/03/2010 ensure that staff carrying out pre-admission assessment have had the necessary training to interpret the assessment findings. Previous timescale 15/01/2010 Not looked at during this inspection. To ensure that peoples needs are appropriately Care Homes for Older People Page 13 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 assessed. 3 7 14 The registered person shall ensure that the assessment of service users needs is kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. Not looked at during this inspection. To ensure that records reflect peoples current needs and staff have accurate information to be able to meet peoples needs. 4 8 13 The registered person shall 02/03/2010 make arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. 02/03/2010 To ensure that all service users have access to timely chiropody services. 5 12 16 The registered person must 30/03/2010 ensure that there are opportunities for all residents to be involved in meaningful activities based on peoples assessed needs and aspirations. (Previous timescale of 12/02/2010 not met). Care Homes for Older People Page 14 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Not looked at during this inspection. To ensure the well-being of the people who live at the home. 6 15 18 The registered person must 30/03/2010 ensure that the catering staff receive training appropriate to their role to ensure that they are able to meet residents assessed needs. Not looked at during this inspection. To ensure peoples nutritional needs are met and cooks are aware of how to provide specialist diets. 7 15 13 The registered person must ensure that all unnecessary risks to residents are identified and as far as possible eliminated. (Previous timescale 02/03/2010). Not looked at during this inspection. This refers to staff including catering staff having sufficient knowledge about food allergies and how to keep people safe. 8 18 13 The registered person shall make arrangements by training staff to prevent service users being harmed or suffering abuse or being 30/03/2010 02/03/2010 Care Homes for Older People Page 15 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 placed at risk of harm or abuse. To keep people living the home safe. 9 19 13 The registered person must 02/03/2010 ensure that the hot water temperature does not pose a significant risk of harm to those who use the service. Immediate requirement given on 27th of December 2010. (Previous time scale of 01/02/2010 not met). To ensure that people who live and work in the home are not at risk of harm. 10 19 13 The registered person must 02/03/2010 consult with environmental health officers and take action if required to ensure that the lift meets the current regulations governing the use of passenger lifts. (Previous timescale 05/02/2010). Not looked at during this inspection. To ensure that those who live at the home are safe from harm. 11 19 13 The registered person must ensure that all windows that are not restricted in their opening do not pose a 02/03/2010 Care Homes for Older People Page 16 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 significant risk of harm to service users and are risk assessed. Not looked at during this inspection. To ensure that people are not at risk of harm. 12 26 16 The registered person shall keep the home free from offensive odours. 02/03/2010 To ensure the residents live and pleasant environment. 13 29 19 The registered person must 02/03/2010 ensure that a recent photograph is on file for each member of staff. To ensure that the home has accurate and up-to-date proof of peoples identity. 14 29 19 The registered person must 02/03/2010 ensure that recruitment systems demonstrate that staff have been appropriately and safely recruited. ( Previous timescale of 18/01/2010 not met). To ensure the safety of people who live in the home. Care Homes for Older People Page 17 of 21 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 7 All care planning documentation including risk assessments should be fully completed, dated and signed. First recommended in the inspection report 18th of January 2010. Not looked at during this inspection. 2 7 Urgent consideration should be given to developing a care plan relating to foot care for all residents. First recommended in inspection report 18th of January 2010. Not looked at during this inspection. 3 8 Full information should be obtained in relation to the use of the Waterlow (pressure sore) and MUST (nutritional) risk assessment tools. This should include all the relevant guidance and give clear instruction and guidance to staff on what to do with the assessment outcome. First recommended in the inspection report 18th of January 2010. Not looked at during this inspection. 4 8 Risk assessment should be in place in relation to use and storage of dental tablets. First recommended in the inspection report 18th of January 2010. Not looked at during this inspection. 5 19 Serious consideration should be given to providing signage for the shower room. The light bulb should be replaced. First recommended in inspection report 18th of January 2010. Not looked at during this inspection. 6 24 Beds should not be made with stained sheets. Bedlinen should be changed at least weekly. Care Homes for Older People Page 18 of 21 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 First recommended in inspection report 18th January 2010. 7 25 All radiator temperatures should be able to be adjusted individually and covers fitted should accommodate this. First recommended in inspection report 18th of January 2010. Not looked at during this inspection. 8 27 The registered person should consider if there are sufficient numbers of staff available at lunchtime to meet the needs of those who live in the home. First recommended in inspection report 15th of December 2009. Not looked at during this inspection. 9 10 28 29 Urgent consideration should be given to offering NVQ training to all members of care staff. All staff records should be stored securely to ensure confidentiality. Consideration should be given to creating individual staff files to ensure confidentiality of information. 11 29 The recruitment policy should be revised to make sure that it complies with the national minimum standards, Care Home Regulations 2001 and current employment legislation. The registered person should make sure that the staff application form complies with employment legislation. A record of interviews should be kept. All members of staff should be given a contract of employment and job description. All applicants should put their last employer as a reference. All members of staff should be given their own copy of the General Social Care Council code of conduct. 12 29 Care Homes for Older People Page 19 of 21 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 13 14 30 30 All new staff should complete the Skills for Care common induction standard training. Urgent consideration should be given to obtaining the managers guidance from Skills for Care in how to support staff to complete the common induction standards. All staff should be given a copy of their supervision record. All supervision records should be signed by the supervisor and supervisee. 15 36 16 36 A supervision policy in line with the national minimum standards should be developed as soon as possible. All staff should be supervised at least six times a year in line with the national minimum standards. 17 38 The accident book should be checked and signed by the deputy manager and evaluated to identify any trends to enable measures to be put in place to reduce accidents. First recommended in inspection report 18th of January 2010. Not looked at during this inspection. Care Homes for Older People Page 20 of 21 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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