Inspection on 16/01/09 for Sotwell Hill House

This inspection was carried out on 16th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sotwell Hill House 26/01/08

Sotwell Hill House 15/01/07

Sotwell Hill House 02/03/06

Sotwell Hill House 30/09/05

Sotwell Hill House 25/01/05

Sotwell Hill House 21/07/04

Sotwell Hill House 20/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report Care homes for older people Name: Address: Sotwell Hill House Sotwell Hill House Brightwell Cum Sotwell Wallingford Oxfordshire OX10 0PS 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: Ruth Lough Date: 1 6 0 1 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. things that people have said are important to them: 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 They reflect the Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Page 3 of 38 Internet address Care Homes for Older People Information about the care home Name of care home: Address: Sotwell Hill House Brightwell Cum Sotwell Wallingford Oxfordshire OX10 0PS Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): old age, not falling within any other category Number of places (if applicable): Under 65 0 Over 65 36 care home 36 Mrs Joy Patricia Butterfield 01491 836685 Additional conditions: The maximum number of service users to be accommodated is 36 The registered person may provide the following category 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 category: Old age, not falling within any other category (OP) Date of last inspection: Brief description of the care home: Sotwell Hill House is a late Victorian converted country house set in attractive and Care Homes for Older People Page 4 of 38 2 6 0 1 2 0 0 8 extensive grounds and provides accommodation for those older people who require day-to-day supervision and care. The home does not provide nursing care. Independence is encouraged and the layout of the grounds enables service users to take exercise in safety. Service users are able to visit the nearby town of Wallingford and other outings are arranged on an occasional basis. Cost of the service provided by Sotwell Hill House is between £570 and £750 each week. Care Homes for Older People Page 5 of 38 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 How we did our inspection: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in January 2008. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the Care Homes for Older People Page 6 of 38 service were assessed. The people who use the service and the staff who provide the support were consulted about their opinion of what is provided, through surveys and on the day of the visit to the service. Of the ten people who are in receipt of support that we contacted through surveys, we received nine responses at the time of writing this report. Five staff were also contacted, again through surveys, of which three responded. A professional who has been involved with visiting the home on a regular basis was also contacted. From this visit it was found that the requirements and recommendations that were made to improve the service during the last inspection process have been met. There were identified areas that will need to improve as to protect the people they support and six requirements were made to reflect this. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. Care Homes for Older People Page 7 of 38 What the care home does well: Comments from residents and their relatives included; The home is warm, friendly and homely. The location is excellent. The staff are caring and obliging. It is a very nice place. I am quite happy. Also This home has a friendly homely ambiance and meets all my care needs. The service provides a very good homely environment, with plenty of communal and private spaces for people to use. The bedrooms are in the majority a very good size and can offer private en suite facilities for the resident to use. The atmosphere of the home and the picturesque views across the countryside from residents bedrooms appear to be enjoyed by the people who live there. The home offers extensive grounds for residents and their relatives to use. What has improved since the last inspection? The service has responded to areas identified as weak at the last inspection they have looked to improving the record keeping for the planning of care and ensured that they have undertaken an assessment of the fire safety of the home through a specialist provider. They have also put some actions in response to this assessment to improve the fire safety they have in place. They have continued to look at developing the activities they have on offer to residents to participate in and have improved the pathways in close proximity of the home for residents to use. They have also implemented sheltered areas for them to sit outside to enjoy views of the garden and surrounding countryside. What they could do better: The documented care planning continues to need further improvement as to assure that staff have detailed instruction of how to support the people they care for. This will make sure that personal choices of how people wish to live will be listened to and acted upon in a consistent way. The systems the home has in place for medication administration do not meet recognised safe practices. The deficits in recording the administration of medicines Care Homes for Older People Page 8 of 38 carried out in the home add additional concerns that residents are at increased risk of not receiving medication as prescribed. The home needs to ensure that staff have the necessary information available to them to safeguard the people in their care from possible harm or abuse and to identify, eliminate or reduce any possible risk to their well being or others. The health, safety, and welfare of people living, and working in the home will be further compromised by some weak areas of practice. These areas are relevant to Control of Substances Hazardous to Health Regulations (COSHH), some fire safety precautions, and recognised good control of infection practices. 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 38 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 38 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 the 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 people who wish to use the service are provided with sufficient information and given the opportunity to visit or stay in the home before they decide to permanently live there. The home ensures that individuals needs are assessed before a decision is taken to admit them. Evidence: The information provided to prospective and new residents about the service were reviewed to see what they are given to assist them to make an informed choice to use the service. Prospective residents are given a portfolio of information that includes a Statement of Purpose and a leaflet outlaying some main topics of interest including mealtimes, hairdresser, telephone, and visits to the home by the local church representatives. Copies of the full complaints and fire procedures are also included with any recent residents newsletter. Care Homes for Older People Page 11 of 38 The Statement of Purpose, which is the legally required document that the service must provide to residents, does include the majority of the necessary information. However, they should ensure that they keep up to date contact details of the regulatory authority, CSCI or other body as and when changes occur. This is with particular reference to the summary of the complaints procedure that is included in the Statement of Purpose document. From reviewing the documents provided during the inspection we have identified there are a small number of good practice recommendations to improve the clarity of the information given. They should show on the documents the date of issue to ensure that residents are aware that they are reading the most recent issue of information. They could also put the detail of the address of the home in larger print and ensure that the telephone contact information is included. These details are in larger print on the homes brochure, but these should be clearly shown, as the Statement of Purpose should be able to be read in its entirety. The care planning records for two new residents were reviewed to see what information is obtained before a decision is made for an individual is admitted to the home. From information available and through discussion with senior staff at the home, prospective residents needs are assessed prior to a decision that the service will be able to accommodate them and provide the support they require. The manager or another senior member of the staff team usually visits the prospective resident either at home or hospital as to obtain key information about their needs. They also involve significant family and other health and social care professionals as to support obtaining the necessary information. Of the nine surveys completed by residents and their relatives, all stated they had enough information about the home before deciding to live there, eight stated that they had received a contract of residency. One survey respondent put that they had not been in receipt of a contract. Contracts of stay in the home were not looked at during this inspection process, however we recommend the registered manager takes the opportunity to consult with Care Homes for Older People Page 12 of 38 residents and their families to ensure that they are confident that they have copies of the terms and conditions of stay and of any contractual agreements made. Some comments from respondents in the survey stated; My son found the home and thought it a welcoming and caring atmosphere and well maintained. I had a two week holiday here before I decided to come here permanently. Care Homes for Older People Page 13 of 38 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 the 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 people in receipt of support cannot be reassured that their needs will be met as the care planning records do not give sufficient information to staff. The medication practices in the home could potentially put residents at risk. Evidence: In regard to the question, Do you receive the care and support you need? one person in the survey wrote: Staff cooperation is good. And to the question, Do the staff listen and act on what you say? they responded with, Very helpful. Another put, Very much so. We looked at the care records for one more recently admitted resident and one person who had been living in the home for sometime. This was to see what information had been obtained as the basis of developing the care plan to meet their needs. The staff are provided with key information about the individual taken from the assessment process. This is mostly about significant health needs, mobility, nutrition, and continence. Additional information is noted about any mental health, such as Care Homes for Older People Page 14 of 38 memory loss. The care plans are provided with an index at the beginning to aid staff to find the relevant documentation, with the daily outcomes now included in these central files. Previously the practice was to keep them separately, which does not ensure that staff are referring to the care plans to identify that they are meeting individuals needs. The content of the care plans reviewed did not give consistent information of how support and care is to be delivered. From the example of the two records reviewed the information of how personal care was to be provided was not outlined in detail. Staff had identified that one persons well-being had deteriorated by noting in the records that becoming more frail, and needing full support but had not put into place what this meant to the person and how they were going to achieve this. This appeared to be a common feature, within all the topics in both care plans that were reviewed. Care plans should give detailed information of the identified needs of the individual, what the intended outcome for the person if they are provided with support, and how staff are going to achieve meeting them. This concern about care planning was identified at the last inspection visit in January 2007 and although staff in the home have implemented some changes to improve the records for care planning, this remains an area of weakness. Insufficient information in the care planning records can result in the person concerned not receiving the care they need, inconsistent support being given, and possibly not in accordance to individuals wishes. However, the consistent staff team in the home does support that they could have a good knowledge of the people they care for although this is not reflected in the care planning. Again as previously highlighted during the last inspection, where the monitoring processes for specific needs such pressure area care and skin integrity had not been carried out, there were a number of gaps in the records reviewed. During this inspection, the records should have included assessment and monitoring tools, such as those for identifying the persons dependency and risks to their well-being,(e.g. Waterlow, Bathols) as to assist planning and delivery of care. This was particularly relevant to the person with diminishing health and increasing frailty. Implementing improvements for care planning were discussed with some of the senior staff in the home and they were advised to carry out research to assist them with changes to develop them further. What was evident that the care records are reviewed regularly and any changes noted Care Homes for Older People Page 15 of 38 in the general comments written by senior staff. However, it was difficult to establish if the key changes identified are reflected in the planned care for staff to follow. The daily records completed by the care staff are written quite well, reflect some of the outcomes of the individuals day, and give a better picture of the person than those in the care planning documents. The staff keep in the individuals room a brief summary of the personal care to be carried out. However, the sample seen had minimal instruction of how the task was to be achieved and there was no record of the persons consent to the personal information being left on display in their room. Senior staff did state that one resident had declined to have the information in their room although they had not recorded this in the persons care plan. Staff note down any consultations with other health care practitioners including any dental, opticians, and chiropody treatments. Residents have access to a private physiotherapist, who can be contacted by the home and treatment arranged with the individual themselves or their family. One health care professional commented about the service, Very personalised service with genuine care for each individual. The processes for medication administration were reviewed as to establish what is in place, if the system protects the people living in the home, and that recommendations made at the last inspection process have listened to and acted upon. The home provides medication that is supplied as part of the services from the local GP practice that has a number of residents under their care. The medications are dispensed on the whole, individually per prescription, only on occasions a nomad box is used if there is a resident in the home on a respite visit and that is their usually method of receiving their prescriptions. Medications are ordered regularly on a two weekly cycle. The home has a dedicated area for storage of medications and clinical items used by the visiting District Nurses. Items are stored and organised on open shelves behind two locked doors. From information given by staff and observation of the medication practices being Care Homes for Older People Page 16 of 38 carried out at 10am in the home during the day of the inspection there are a few areas of concerns raised about the practices carried out. From observation and through discussion with senior staff the keys for the medication storage are kept in an unlocked drawer in a communal staff area. This has been apparently the practice in the home for a long period and a recommendation was made at the last inspection visit in January 2008 to review practices to ensure safety of access. The Annual Quality Assurance Assessment, self-assessment document completed by the Registered Manager returned in October 2008, stated that they have a copy of the The Handling of Medicines in Social Care, by the Royal Pharmaceutical Society of Great Britain. This document clearly states that the safekeeping and security of keys to where medications are stored should have restricted access to those authorised to use them and be carried on a designated person. For the medications administered at 10am staff were seen to pre-dispensing individuals medications into labelled pots with lids, plus open containers with liquid medications onto a tray in preparation to be taken around the home. From discussion with senior staff and the home manager this has been the practice for sometime and that they are confident that this works well and doesnt put residents at risk. They also stated and provided information that the process is only carried out with two staff and they have a method of recording on separate records the medications dispensed and when administered to the person concerned. These practices are clearly identified in the guidance The Handling of Medicines in Social Care, by the Royal Pharmaceutical Society of Great Britain as having the potential for drug errors. The records for administration we sampled to see if the supporting information shows that the current practices work well. They were additionally reviewed as to check that the recommendation made during the last inspection to improve the recording of the reason if medications were omitted or refused. From those records seen there were gaps in the administration to two people on at least two occasions on the 2nd and 13th January where nothing is noted that the person received their medication as prescribed or the reason why they were not given. It was also observed and confirmed by senior staff that any refused medications that have been pre-dispensed by staff and are returned to the medications cupboard are left in an unlabeled food container in preparation to be returned to the dispensing GP practice. From what we observed there were a moderate number of tablets (30 or more) of a variety of different tablets in the container currently in use for this purpose. Care Homes for Older People Page 17 of 38 The medication policy and procedures and any risk assessments in regard to residents self-medicating were not reviewed at this inspection. We were informed that those who do self medicate have been provided with safe storage facilities in their rooms. The home does handle a small amount of controlled drugs, usually those for pain relief, and as good practice keeps some of the night sedation under the same conditions. The records and storage for the management of these medications were reviewed as to see what they have in place and that they are managed safely. What was evident from these records that staff are recording any movement of medications sufficiently. However, the record book did not meet the required standard as the pages were loose leaf and not held securely. This should be a bound book as to assure that pages cannot be lost or removed. Care Homes for Older People Page 18 of 38 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 the 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 people who use the service are given the support to exercise choice over their lives and to maintain their interests. Meals and menu planning meet their needs and ensure that they are an enjoyable part of living at the home. Evidence: The recorded information about residents choices of how they wish to live, interests and social activities was minimal in the care plans sampled. Their particular hobbies and interests are indicated in the brief summary about the person, although there is nothing in the records to support how the staff are going to enable them to continue with them. The staff in the home do not routinely provide with the care records a personal and social history of the person concerned. If this was carried out, with permission of the individual or their representative, this would give added information for staff to be able to support them to continue with life as they choose, assist with staff providing any reminiscence activity, and make staff aware of any particular interest or significant event in their lives that is important to them. Several comments from residents or their representatives included: The organisation of activities has greatly improved and are fun to join in. Care Homes for Older People Page 19 of 38 One relative wrote, My relative is not a joiner so does not do things despite the efforts of the home. Another wrote on behalf of their relative living in the home, I have enjoyed the poetry afternoons, also the trips to look at snowdrops, and on a regular basis, going to the church coffee mornings and the Sunday service. Information provided by the home indicated that there was a regular programme of events, including small groups of residents attending seasonal activities in the community, church and community groups coming into the home, and special events such as a cheese and wine party just before Christmas. Recently, Race Day videos have been obtained to provide entertainment and activities together. What was apparent that although there is not specific member of staff employed to take the lead in providing activities, the majority of the staff get involved in putting events in place for all to join in. A member of the senior staff provided information that they have started looking at more formal process of planning for activities and for identify the goals and involvement of the people living in the home. This has not yet been implemented and they were urged to put this in place parallel with improving the personal planning for activities for individuals, as soon as possible. The residents we spoke to expressed their enjoyment of the mid- day meal provided on the day of the inspection visit. They stated, the fish and chips was nice and the pudding was good. Other comments about the meals given in the surveys were; The food is usually very well prepared and plentiful. There is a lot of variety and choice and I have gained weight since being in the home. A relative commented, Mums food is good and they always make sure there is something she will eat. The food is mostly very good, and especially good at the moment. The chef provided information about how the meals and menu planning is carried out. The staff give information to the chef as to any specific dietary needs and personal choices when a new resident is admitted to the home. Additionally, regular questionnaires are given out as to seek their opinion, their dislikes, and preferences as Care Homes for Older People Page 20 of 38 to assist with the development of the menu. The menus reviewed during the day show that there is mainly traditional English fare on offer for the main meal of the day. The chef indicated that by popular demand from the residents they were provided with two roast dinners a week, traditional fish on Fridays and for a treat full English breakfast, twice a week. Where individuals have a particular preference to meals, which generally are not on the regular meal plans, the chef substitutes the individuals choices if they so wish. Staff make sure that the dining room is presented well at meal times and encourage the residents to attend the midday meal together. From information given by staff there are only two residents who choose not to eat in the main dining room and only one who needs extra support to eat their meals. Staff also support some of the residents religious observances to eat their meals by creating more of a private space in the dining room. Residents are supported to have family or friends to have meals with them, an additional charge is only made if there are more than two guests invited. Staff are able to provide snacks and hot drinks for individuals at other times than the planned mealtimes should they express they would like something to eat. Care Homes for Older People Page 21 of 38 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 the 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 people who use the service cannot be confident that staff and managers have a good understanding of how to ensure that they are protected from possible abuse or be able to manage any concerns should they arise. Evidence: Residents are provided with information of how to make a complaint through the accompanying documents given with the Statement of Purpose and Service User Guide. As previously noted the contact details for the commission need to be amended to ensure that the reader is given the most up to date information. The policy gives an outline of the expected timescales of response to people concerns and who would be responsible to investigate a more serious concern. The home provided information that they had not received any concerns or complaints during the last twelve months. All the respondents to the survey confirmed that they knew how to and who to make a complaint to. The commission has also not been in receipt of any concerns or complaints about the service during that period. The training, information, and support for safeguarding the residents from possible harm or abuse were reviewed. This was to see if staff are provided with sufficient training to identify and prevent possible abuse or harm to the people they support. Additionally, the structures in place for managing any concerns should the arise were Care Homes for Older People Page 22 of 38 also assess as to see if the homes senior management have the skills and knowledge to handle and concerns should they arise. During the previous inspection visits it was identified that the service did not have the relevant information about the local inter agency safeguarding procedure. This was despite the policies and procedures in place referring to them as instruction of how to manage any concerns. Also it was identified that the staff spoken to at this time did not appear to be knowledgeable about protection and the local policy. From the information available in regard to training, the senior staff stated that the topic of safeguarding is not identified as a core subject for all staff to have. From the records available there was evidence that not all the staff had had training and the home were not able to provide an up to training list of what staff had obtained over the last year. Although they did state that staff were provided with a training video periodically. The two members of care staff we spoke to at midday, declined to answer any questions about the training they had had for safeguarding adults and deferred the question to the member of staff who lead in the organisation of training. So it was difficult to ascertain the staffs comprehension of their responsibilities or what they must do, if they have concerns. Members of the management team confirmed that none of the senior staff had attended a training course appropriate to their roles in regard to protection. If this was undertaken they would have the skills and knowledge of how to manage a serious concern should it arise. They also confirmed that they had not obtained a copy of the local inter agency policy and procedure for safeguarding as advised at the last inspection process. Care Homes for Older People Page 23 of 38 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 the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable spacious well-maintained environment for people to live in. The facilities on offer are good and enable people to continue their lives in a pleasant and homely establishment where they enjoy and can remain part of the local community. Evidence: The home is not purpose built but has been adapted for its current use and therefore retains many of the period features, with larger than average communal spaces, entrance hall and staircase. The newer extension to the home provides most of the larger personal spaces, where a small number of these bedrooms are able to accommodate couples should they wish to stay in the home. All bedrooms have en suite facilities, some including baths. The majority of the bedrooms are very spacious and can offer better facilities for the residents to furnish the rooms with their own personal possessions. Throughout the home it was apparent that it is maintained well and in very good order. There is a regular programme of refurbishment and redecoration carried out and prospective residents choices and wishes are listened to make changes to the facilities in their rooms before they move into the home. Most of the residents are provided with good views from their bedrooms over the countryside and the spacious gardens. They can also enjoy the pleasant outdoors spaces in close proximity to the house with pathways and sheltered areas to sit and look over the views. The home is currently in process of planting new trees in the Care Homes for Older People Page 24 of 38 parklands. Comments in regard to the cleanliness of the home that were included in the surveys returned to the commission were My room is kept clean and my bed changed regularly. A relative commented; Very high standard and my Mums room is kept well even if she is unhappy about letting them clean. The home has a good sized laundry area and has the necessary equipment to manage the volume of linen and personal laundry that the service produces. Care Homes for Older People Page 25 of 38 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 the 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 homes staffing levels meet the current needs of the people who live there. The records to support that robust recruitment and employment practices are carried out do not give sufficient evidence that the people living in the home can have confidence that they are protected from inappropriate people providing their care. Evidence: One resident wrote in the survey about the home and staff: The home is warm, friendly and homely. The location is excellent. The staff are caring and obliging. The senior staff provided information that the staff team were consistent and that they did not need to use the services of an agency when shortages occurred. Gaps occurring through sickness, staff holidays or training are usually accommodated by the regular employees. The service has recently put a key worker system in place as to improve the delivery of care to individuals, and has a large senior team of managers and administrators to run the home. From information given by the senior staff there is usually a member of the management team on duty during the day and at weekends. At night they are contactable by phone and would be quickly on the premises as most live in the grounds of the home. Care Homes for Older People Page 26 of 38 Through discussion it was established that there is not a designated leader on each shift of care staff to lead the hands on delivery of care, take responsibility for the medication keys, fire safety, and decision-making if there is an emergency situation. This is unusual as most care establishments have a designated person responsible in this role who has been identified and trained to be competent to make the necessary decision making needed at the time. This is particular relevant to night-time when management are not on the premises. A sample of recruitment and employment records were reviewed to see if practices are thorough and protect the people in support from the possible inappropriate staff providing support. During the previous inspection in January 2008 it was identified that the records held then, although disorganised, were robust. The records reviewed at this inspection did not support this. A member of staff who had been re-employed in the home in January 2008 was not requested to complete a new application with up to date work history even though she had left working in the home on several occasions and returned at least once before. From some of the documentation in the file she had worked at other care establishments in the intervening periods, but there was not a record of checks or references being carried out before starting again in the home. Therefore the employee had not provided supporting evidence of their full work history and the Registered Provider had not ensured that they were suitable for their role. Both records did not show that the individuals identity had been checked. However, the Registered Manager was able to provide proof of an appropriate Criminal Records Bureau checks being carried out. Any interview or decision making to employ the new members of staff had not been recorded. In one record there was a copy of an offer letter for employment, but this was not relevant to the current period of working in the home. Neither records had evidence that the employee had provided a statement or declaration of their health status as there are required to do. The records seen did not support that the individuals had had a full induction to the roles they were employed for. The current practice is to record down in a booklet the topics identified and discussed but this does not show the depth of the training or an analysis of their understanding. This has already been identified as an area in need of improvement and the member of care staff who has been designated responsibility to take the lead for induction and training has already obtained a copy of the most recent recognised good practice training programme in preparation for the next occasion a new member of staff is employed. The concerns about the recruitment records available were discussed with a senior member of staff during the day. They were asked to revisit the current practices to ensure that they are compliant to their requirements as an employer. It was also recommended that they improve the employment checklist they have in place more Care Homes for Older People Page 27 of 38 effectively to assist with obtaining the necessary information they need to keep. Some copies of the training and qualification certificates of the individual staff member are taken, but it was difficult to establish from these and other information given that they had had the necessary training for safe working practices. A training needs analysis of staff, had been carried out last year by an independent provider, on behalf of the home as to establish any gaps in knowledge and training the staff have. However, the results from this have not been updated to what staff have achieved since then or use individually for personal development of the member of staff. We were informed in the Annual Quality Assurance Assessment, self-assessment document completed by the Registered Manager that staff receive the supervision they require on a regular basis. However, the records to support this, although requested during the day, were not provided. Details of supervision and appraisal are not routinely kept in the employment records. Of the three staff who responded in the surveys returned to the commission, two indicated that they had regular meetings to discuss their work practices with the manager, one noted sometimes. Care Homes for Older People Page 28 of 38 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 the 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 continues to be run the interests of residents experiences and quality of life. The practices and management of the home do not support that some the required checks and safety measure to protect those who live and work in the home are carried out effectively. Evidence: Comments from residents about the home and the support provided included, It is a very nice place. I am quite happy. Also This home has a friendly homely ambiance and meets all my care needs. The management of the home has not changed since the last inspection process. The Responsible Individual continues to hold the Registered Manager position and is supported by a team of family members for the overall implementation and development of the service. From information provided by the senior staff of the home, each family member has a lead area of responsibility such as care delivery, administration, and the maintenance and safety of the home. They are supported by a Care Homes for Older People Page 29 of 38 small team of administrators who carry out various tasks for the implementation of care, the recruitment and employment of staff, and the financial processes for the home. The Registered Manager has not undertaken any training during the last twelve months to develop her role in the home. During the previous inspection of January 2007 a good practice recommendation was made for the manager to attain a qualification of NVQ 4 or equivalent to enhance her role. Again it was identified January 2008 that the manager had not responded to this recommendation but had submitted the intention was for the manager who leads in the care delivery in the home to do this instead. However, from information provided during the day of this inspection, this still has not been implemented. The home has a number of processes in place for consulting with the residents, their relatives, and the staff about the quality of the services provided. The home has carried out the second annual audit of individuals opinions through surveys several months ago. They appear to have had a good response from this process and senior staff verbally confirmed that a summary of the findings was made into a report. However, a copy of this was not available to view on the day of inspection or submitted to the commission before this report was completed. The staff continue to provide regular meetings where residents are given the opportunity to comment about what is provided. There is also a monthly newsletter called Newsround which gives a little summary of information about changes with residents and staff, seasonal news and planned events outside and inside of the home. The processes for monitoring the administration and practices for the care home and service continue to require further development. The main areas of improvement should be in the auditing of medication practices and those associated with the recruitment, employment and training of staff. The administrators of the home stated that they continue to have difficulty with the internet connection in the home which limited communication to outside bodies, such as the commission, the local authority, and the GP practice that supports the residents living there. This is particularly limiting, as the home do not currently have fax facilities in the home as an alternative method of communication to the telephone. The present practice is to fax from one of the management teams own home in the grounds. The service was reminded that they have a legal requirement to provide a communication Care Homes for Older People Page 30 of 38 link via fax on the registered premises for the purpose of managing the service. A sample of the policies and procedures were reviewed to see what they have in place. From the information seen there appears to be a wide variety in place that cover the main topics required. However, through closer examination it was apparent that some of them do not necessarily match what the service provide or the practices carried out. Areas that need to be addressed were medication, recruitment, and some of the topics for safe working practices. The records for fire safety and emergency lighting show that there is a regular programme of checks carried out including fire drills. From the records seen the home uses the services of a fire safety company to carry out an audit of the home and of the equipment and systems in place. From this a fire risk assessment of the home is carried out. The records we examined showed that if changes are required to protect the residents, these are implemented. However, through observation during the day, a small number of resident prefer to leave their doors partially open during the day whilst resting in their rooms. These doors are not fitted with automatic door closures should a fire alarm sound. They were strongly advised to seek professional advice to ensure that they meet the necessary legal requirements for fire safety and carry out risk assessments during the interim period. Concerns were raised during the day in regard to their practices in place for Control of Substances Hazardous to Health Regulations (COSHH). During the day it was identified that items that should be stored safely under these regulations were not being cared for appropriately or that the home had the necessary information nearby to deal with accidents or injuries through coming into contact with them. Items of cleaning solutions, such as washing liquids, stain removers, and cream cleansers where left in the open in the laundry area. Additionally, the maintenance staff were keeping large bottles of white spirit, and containers of pest killers in the same room unsecured. These should be kept securely. The laundry room was left unlocked at the time and could of been accessible to residents if they choose to enter. This information was passed back to the management during the day who stated they would take action to secure the room to prevent any accidents occurring. Practices for controlling the spread of infection were also identified as to need some improvement. Staff were seen to leave soiled linen on the floor of the laundry and outside one bedroom. The Department of Healths Infection Control Guidance for Care Homes 2006, specifically identifies practices such as this as a high potential for the spread of infection around the home. This was discussed with the management team as Care Homes for Older People Page 31 of 38 to ensure that staff adhere to practices to minimize the risk. Staff are not checking to see if personal toiletries have been removed from the shared bathrooms after a resident has finished using them, as these again provide the opportunity for infection to spread around the home. From information given by senior managers it was apparent that those carrying out any risk assessment processes had not received recent training to carry out this role. They were able to provide evidence that they had the necessary information from the Health and Safety Executive as to guide them to carry these out. However, the copies of the risk assessments examined during the day, both those for individuals and generally for the tasks and activities in the home where very brief and did not provide sufficient detailed information for them to reduce or eliminate potential risks. The Annual Quality Assurance Assessment, self-assessment document submitted prior to this inspection process had been completed in greater depth than previously seen. The necessary information had been included and the document gave a better picture of what the service has done to consult with the people living there. It also gave a clearer picture of what improvements they intend to carry out to develop the service. Care Homes for Older People Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes 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 Care Homes for Older People Page 33 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That the registered person 31/03/2009 should prepare a written plan of how the assessed needs of the person in respect of their health and welfare are to be met. The care plan should not only identify what the health and welfare needs are proposed to be met they should provide good instruction to staff of how the are do this as to ensure continuity of care. 2 9 13 The registered person should 06/03/2009 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home ensuring that they meet the required standards and protect the people living there. Care Homes for Older People Page 34 of 38 The Royal Pharmaceutical Society of Great Britain guidance states that secondary dispensing prior to administrating medications provides a greater risk of errors occurring. This could put the people you support at risk of harm and not receiving the treatments and medications they require. There is also specific guidance as to the safekeeping of the keys for the security of medication as to ensure they are not accessible to people who do not have direct responsibility for medication administration. 3 18 13 The registered person should 16/04/2009 make arrangements, by training of staff and other measures, to prevent the people they support from possible harm or abuse or being placed at risk or harm or abuse. You have a responsibility to have robust training, information and support measures in place to ensure that staff are confident and capable of protecting the people they care for from possible abuse or harm. 4 29 19 The registered provided should not employ a person to work at the care home unless they have ensured that they are fit to work there. You should ensure that you obtain the necessary information to evidence that the staff that work in the Care Homes for Older People Page 35 of 38 31/03/2009 home are fit to work with the vulnerable people you support. 5 31 16 You are required to provide 31/03/2009 in the premises of the home appropriate facilities(fax) as to be able to communicate effectively other than by telephone in order to operate the service. The staff in the home are not provided with alternative forms of communication other by the telephone as to communicate effectively to GP’s and other health care professionals specific information and support for the people living in the home. The use of a facsimile machine off the premises does not provide a secure of confidential process. 6 38 13 The registered person is 31/03/2009 responsible for protection the health, safety, and welfare of the people living and working in the home. You should ensure that you have robust systems in place to protect people who live and work in the home through safe working practices such as COSHH, Fire Safety, and Control of Infection. There should also be an effective method of assessing any potential risks to the people living and working in the home carried out by an appropriately trained member of staff. Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 36 of 38 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 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!