Inspection on 07/07/09 for Southbourne Residential Care Home

This inspection was carried out on 7th July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Southbourne Residential Care Home 29/10/08

Southbourne Residential Care Home 21/08/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Southbourne Residential Care Home Cary Avenue Babbacombe Torquay Devon TQ1 3QT Lead Inspector Michelle Finniear Key Unannounced Inspection 08:25 7 and 28th July 2009 th DS0000069861.V376532.R01.S.do c Version 5.2 Page 1 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. 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. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 2 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 Internet address Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southbourne Residential Care Home Address Cary Avenue Babbacombe Torquay Devon TQ1 3QT 01803 323502 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) southbournecarehome@btconnect.com Rosepost Healthcare Limited Mrs Kay Lorraine Allen Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21), of places Physical disability over 65 years of age (21) Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 categories: Old age, not falling within any other category (Code OP) - maximum 21 places Dementia, aged 65 and over (Code DE(E) - maximum 21 places Physical disability, aged 65 and over (Code PD(E) - maximum 21 places The maximum number of service users who can be accommodated is 21. 29th October 2008 2. Date of last inspection Brief Description of the Service: Southbourne Residential Care Home is a detached residence that stands in its own grounds, it provides 24-hour residential care for persons in the category of Old Age, not falling into any other category, Dementia over the age of 65 years and Physical disability over the age of 65 years. The home’s accommodation is set over two floors, there are 17 single bedrooms, and two for shared occupancy. All rooms have en-suite facilities. A large comfortable lounge is available, meals are taken in a separate dining room at small tables seating up to four persons. A stair lift is provided for people who have mobility issues. At the front of the building there is a large hard standing car park, which has the capacity to take several vehicles. There are gardens with a large lawn area to the rear and sides of the home. Southbourne is situated in the Babbacombe area of Torquay and is within level walking distance of local amenities and the Babbacombe downs. The weekly cost of care at Southbourne is between, lowest £325.00 and the highest £360.000 . Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This report reflects a summary of a cycle of Inspection activity at Southbourne since the last Key inspection visit to the home in October 2008. To help us make decisions about the home the manager and owner gave us information in writing about how the home is run in an Annual quality Assurance Document (AQAA); information received since the last inspection was seen along with the records of what was found at that time; Questionnaires were sent to people staying at the home about what it was like to live at Southbourne; two site visits were carried out with no prior notice being given to the home as to the specific date and timing of the visits; discussions were held with the manager and the staff on duty; various records were sampled, such as care plans and assessments; time was spent sitting in the lounge of the home watching how people spent their time and how well staff interacted and supported them; Discussions were held with the homes activities organiser; a tour was made of the home; and time was spent individually with some of the people who were living at the home. This approach hopes to gather as much information about what the experience of being at Southbourne is really like, and make sure that people’s experiences of the home form the basis of this report. What the service does well: Southbourne provides a comfortable environment in an attractive location close to a local park, church, shops and sea front. The home provides en-suite accommodation for people in mainly single occupancy rooms, although there are rooms available for a couple to share if they wish. The accommodation is being well maintained, and there is an attractive enclosed garden with seating areas. The home have completed some risk assessments since the last inspection about the environment and some staff tasks. The staff group seen communicated well between themselves and were knowledgeable about the people they were caring for. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 6 People receive a full assessment and opportunities to visit the home before making a decision about whether to move there. Some people at the home have previously visited the home for day and respite care before making a decision about moving in. What has improved since the last inspection? What they could do better: All staff must receive training to meet the assessed needs of people living at the home. The registered person’s must make sure that staff working at the home receive a comprehensive induction, that accords with the Sector Skills council Induction standards. This is to ensure people are working consistently and in accordance with good practice. All staff expected to administer medication should receive updated and appropriate training to make them safe to do so. Registered persons must report to CQC without delay any incidence of allegation of misconduct by a person working at the home and any incident which affects the health and well being of any person living at the home. These may also need to be reported to the local Safeguarding team as appropriate. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 7 This helps to ensure incidents of concern are shared and appropriate action can be taken to protect people. Full records must be kept of all medication returned to the supplying pharmacist. This is particularly important in relation to controlled medication so that a full audit trail may be completed. The home must provide a system for reviewing and improving the quality of care at the care home. Prescription dressings no longer required by that person must be returned to the pharmacy and not used for other people. The registered person shall not employ a person to work in a care home unless - he has obtained in respect of that person the information and documents specified in - (i) paragraphs 1 to 7 of Schedule 2.This includes references and criminal records bureau checks. This is to ensure that people are being cared for by staff who are suitable to be working with potentially vulnerable people. Not doing so leaves people at risk. Staff should receive supervision to enable them to carry out their job consistently and to their full potential. An annual development plan should be produced by the home to include information gathered during the home’s quality assurance processes. This helps to ensure people living at the home can have a say in the way the home is run. The home’s Annual quality assurance assessment should include more information about how the home is being run and improvements they plan to make. Staff recruited should provide a full employment history, not just their last employer. This is so that any gaps in their employment can be explored. Free standing radiators should be risk assessed to ensure they are safe to be used by people living at the home. Their use should be discussed with the fire officer and environmental health officer. The hot water supply should be maintained at a safe temperature at outlets where people living at the home have access. This is to reduce any risk of scalding. Lighting in the bathroom should be bright enough to ensure people’s safety and experience of bathing is pleasurable. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 8 Information on complaints made about the home should be shared amongst the management team so that they can be addressed and monitored by all people responsible to do so. The complaints procedure needs to be updated to reflect changing policies in the way complaints are managed. Choices should be available for the evening meal, to ensure people do not eat the same thing every day. People’s care plans should include information on interests and activities they enjoy and how the home aims to support them to maintain these. Information about an individuals capacity to make decisions and the homes procedures to support them with decision making should be included in each person’s file. Decisions about active treatment need to be subjected to the legal framework available. The First aid kits at the home need re-stocking. Personal profile forms in the care plans should be completed to ensure the home has information on people’s histories and lifestyle choices. Staff working at the home would benefit from training in communicating with people who have memory loss. People living at the home or their representatives should be involved in the drawing up of their care plans. This is to ensure they reflect their needs, wishes and aspirations. Contracts for people living at the home should be updated to ensure they accurately reflect the situation at the home. 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. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6. 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. People thinking about moving to Southbourne have opportunities to visit the home and have a full assessment to make sure the home can meet their needs. EVIDENCE: During the first site visit we looked at the information available about the home, and how the home decides whether they can meet peoples needs before they are admitted to the home. The home has a user guide available, which contains information about the home and the services it provides. The guide seen needed some updating, for example with changes to the homes complaints procedure and the address of Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 11 Commission. The manager agreed to do this, and by the second visit she said she had done so. We looked at the last admission that had been undertaken to the home. This involved a person who had previously visited the home once a week for a day care service. They then came into the home for a period of respite care and decided to stay. Information that had been provided in the form of an assessment by the local authority prior to the respite care placement was seen in the persons file, along with an updated assessment and care plan drawn up when the person came in to stay. This helps to ensure that the home can meet people’s needs and have any equipment or specialist services needed available before people move in. We spoke to a person who had been recently admitted to the home. They told us that they had initially visited for a short period, but had decided to stay after having lived at the home for a while. They said they had support from the local Authority to help make the move. Contracts of residency are available, although many people who are funded by the local authority have a contract with them. We saw a blank contract, which needed some updating to make sure the information it contained was accurate. Contracts help people be clear about what they can expect to receive for their fees and information about their rights. The home does not cater for intermediate care. This means that they do not provide a specialist intensive rehabilitation service with the aim of returning the person to the own home. The home does provide respite care, and the manager confirmed that provides some limited day care. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. 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. People’s day to day healthcare needs were being met, but errors with medication administration had put people at risk. EVIDENCE: On the first visit to the home we looked at a number of care plans for people recently admitted, and also those who have been there a long period of time. The care plans seen had not been drawn up with the involvement of the person concerned or their relatives, and had not been signed by them. The manager said this was because some people at home could not participate in this process, however this had also not been undertaken by those who would have had the capacity. Care plans contain information on the support people need and how they wish that support to be given. They also contain information on risks and how they are managed. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 13 The care plans seen had a reasonable amount of information about the people being cared for, the support they needed and a record of when this care was given is kept in a separate Kardex system. The files also contained some personal profile forms, which had not been completed in some of the files seen. This information is important as it helps staff understand the lives people have led and information about their past. This can be particularly important where people have memory loss and need additional support to make sense of the world around them. The plans seen also focused on the problems people had rather than their strengths and the desired outcomes of any interventions. However the records were being completed to show daily input and reviews were being undertaken at least monthly, although some of these were brief. People spoken to said the staff were kind and their needs were being met. Not all of the people at the home were able to hold a conversation about their care, so some time was spent sitting in the lounge on the second visit looking at how well people were being supported and staff were identifying their needs. This showed staff may benefit from additional training on communication with people who have memory loss. The medication systems were examined. The home uses a blister pack system for the administration of medication which helps to reduce the risk of errors being made. No people living in the home self administer any medication. Senior staff have been trained to give medication. Controlled drugs -- which are those that need special storage control due to their strength or effects were being stored safely, and the balance was checked and found to be correct. However when medication was being returned to the pharmacy the amount was not always being recorded. This means that a full audit could not be completed and it is not clear where unused medication had gone. An examination of the care files on the second visit showed one person had on at least two occasions received an overdose of medication which had not been reported to us or addressed properly within the home. The medication is now being administered differently which appears to have solved the problem. The home must ensure that staff receive updated training in Medication administration. The CQC pharmacist will be asked to visit the home and complete an audit and advise the home on medication procedures and good practice. The first aid kit needed restocking, and expired dressings or those no longer in use for people at the home were being kept for general use. This was also identified at the previous inspection. The home has equipment available for the moving and handling of people with limited mobility, including four specialist beds. There are also specialist bathing facilities and mattresses to relieve pressure for people who spend considerable time in bed or immobile. Other aids such as raised toilet seats and grab rails are provided as required. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 14 Files contain information on the medical and paramedical supporting that people receive at the home. The home also has book which identifies visits from community healthcare professionals, such as GP’s, District nurses and occupational therapists. Discussion was held on capacity issues. During the first visit a file sampled showed that a person’s relatives had requested the home adopt a policy of non intervention should the person become critically ill. Due to changes in recent legislation there are now formal legal avenues for people to appoint people to act on their behalf to make decisions about their health should they become incapacitated, and the home was advised to seek guidance on this. By the second visit the home had taken advice and provided a policy on supporting people who lack capacity and decision making. The manager said she had checked their policy with issued guidance and local agencies to make sure that it was correct. This policy also relates to supporting people in making day to day decisions when they were not able to do so themselves. Some information on this needs to be included in people’s files to record individual issues. One lady was discussed with the manager as her nails needed cleaning. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. 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. People living at the home have opportunities to take part in organised activities. People’s care plans should include more information on how they like to spend their time and any interests they have. EVIDENCE: Time was spent on the inspection talking to the homes activities organiser, who visits once a week to provide professional activity services to people. She is a qualified occupational therapist. She works hard to ensure that everybody whatever their disability has opportunities to have either one-to-one support or take part in group activities. On the day of the first inspection visit people were making lavender bags, and evidence of previous craft work can be seen. On the second visit people were taking part in a quiz and word games. One person spoken to said they liked to watch the activities going on even if they didn’t want to take part themselves. Others were clearly enjoying the stimulation and being involved. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 16 When the activities organiser is not visiting the home’s staff try to provide some activity and stimulation for people and a record of this is kept. For some people with memory loss it is difficult to organise themselves to undertake activity without a lot of support, including 1:1 support. This would also include time outside of the home. One person spoken to said they enjoyed their television and went out into the garden when they could and the weather was fine. But they didn’t get taken out unless their relatives came. The home manager said that they had offered trips out but people did not want to go on them. People may benefit from having their daily lifestyle choices and interests recorded in their care plans. This helps as far as possible people to carry on with their comfortable patterns of activity from before they went into the home. This might for instance include when they liked to get up and how they spent their day. On the day of the first inspection the meal being served was ham and parsley sauce with boiled potatoes carrots and peas. On the second visit the meal was sausage patties, fried egg, parsley sauce, swede, peas and mashed potatoes with jelly and ice cream for dessert. On the second visit we spoke to the chef. He said that he was responsible for the food ordering and was able to order the food he wished within reason. Food is delivered regularly throughout the week including fruit and vegetables. Some concerns were expressed before the second visit about the food at weekends and the manager confirmed there had been some issues and these were being addressed. On the second inspection visit the chef said the meals in the evening were mainly sandwiches and soup which he prepared before he went off duty. This was said to be what people enjoyed but the manager should make sure that other options are available for people to avoid them having to eat the same thing every day. One person spoken to said they enjoyed the food, but would really like a steak and chips. They said they had been told they could ‘send out’ for this if they wished. Another person buys food from outside for extra treats. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. 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 home’s policies and practice do not protect people from potentially being cared for by staff who may be unsuitable to work with vulnerable people. Safeguarding issues are not being reported to the appropriate authorities for investigation. EVIDENCE: The home has a complaints procedure which is in the service user guide. The complaints procedure tells people how and to whom to make a complaint and what they can expect when they do. The procedure needs updating to ensure it reflects recent changes in legislation for safeguarding investigations and the response of CQC to complaints made about service delivery. Two complaints had been made since the last Key Inspection, one of which was discussed with the home and investigated on the second visit. The first complaint concerned staff shortages, wages not being paid on time and the owner’s attitude to staff. These were passed to the responsible individual of the company for investigation and action as necessary. However the manager said she had not been informed of the complaint, so had not included it in the homes Annual Quality Assurance document. As the manager is registered and Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 18 responsible for the home it is important that any concerns are also discussed with her, so she can make sure any problems are put right. Some staff at the home and the manager have received training on the Mental Capacity Act and Deprivation of liberty safeguards, and a new policy has been provided by the home in relation to this. This helps to ensure people’s rights can be protected. Discussion with the manager and examination of staff files indicated that staff are still working before a criminal records bureau or Protection of vulnerable adults register check is undertaken. These help to ensure that people who work at the home have not been barred from working with people who may be vulnerable. Not doing these checks could put people at risk from being cared for by people who are unsuitable. This was a requirement of the last inspection and has not been complied with, despite the manager telling us in an improvement plan from 2008 that it had. In addition during the inspection it became clear that a person living at the home had been assaulted by another person at the home, however no referral to safeguarding had been made. Two other potential referrals were also identified during the second visit that had not been referred to the appropriate agencies. This indicates that the home are not following proper safeguarding procedures or their own policy to protect people who may be vulnerable. The first issue was the subject of an immediate requirement made following the first visit and within 48 hours the owner confirmed it had been addressed. Other issues identified at the second visit were discussed with the manager who agreed to report them without delay. This included reporting them to CQC. Not reporting allegations or concerns for full investigation puts people living at the home at risk of being subjected to abuse or abusive practices. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. 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. Accommodation offered to people was clean warm and comfortable. EVIDENCE: During the second visit a tour was made of all areas of the home, looking at the accommodation available for people to live in and the service areas such as the kitchen and laundry. A few bedrooms were not seen as people were in them receiving care. Southbourne provides comfortable accommodation for older people many of whom have memory problems. The home is a converted and extended residential property set in a residential area of Torquay, near to the beach at Babbacombe. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 20 The property has an enclosed garden with seating areas and plentiful parking to the front. The home is opposite a church and close to a local park and shops. The rooms seen were comfortable and homely, with en-suite facilities ranging from full bathrooms to just toilet and basins. Rooms vary in size with some being small and others spacious with lounge and bedroom space. Some rooms have en-suites that have very small wash hand basins. The manager said that in these rooms people have to wash using a bowl of water or use the communal bathroom. There are communal bathrooms on each floor, with hoists as needed. The lighting in one of these rooms was rather low which made the room feel dark as there is no external window. The hot water supply to one wash hand basin was tested and found to be at 46 degrees, which is above the recommended safety level to prevent people being scalded. The bath water tested was at an appropriate temperature to ensure people’s safety. Discussion was held with staff and the manager concerning locks on people’s doors. Some rooms had a key outside the door. Staff and the manager confirmed this was to allow staff access in the night as people locked their doors because a male service user was known to wander into their rooms. Discussion was held on having a device available that alerted staff on night duty to his having left his room so that he could be diverted before disturbing other people. There were some free standing oil radiators in the lower part of the home which the manager said were used as some parts of the home could get very cold in winter. These devices do not have a regulated or protected surface temperature and so present a risk to people coming into contact with hot surfaces for long periods. Other radiators are said to be covered. The home’s laundry was clean and equipment is available to prevent the spread of infection at the home. The laundry is said to be suitable for achieving a sluicing cycle which means that laundry can be properly disinfected. Sheets are cleaned by an external professional laundry service. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. 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 staffing arrangements could put people at the home at risk. Staff seen working with people were conscientious and confident. EVIDENCE: Considerable time on the first visit was spent looking at the staffing arrangements at the home. This was in particular in relation to 2 complaints made during the year which included concerns about the staffing arrangements at the home. The staffing levels seen on the day of the first visit indicated that a trainee carer on their first week was included on the rota. As full employment checks had not been completed for this person they should have been working only in a fully supervised role. Files seen on this visit for two newly employed members of staff were incomplete, including in one case only one reference, and in another one reference provided by family member. Their induction programmes had not been completed, and Criminal records bureau checks had not been carried out when they started. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 22 Full employment histories were not available for staff so it was unclear what their employment history had been. By the second visit a staff member seen previously had already left the home’s employment, but two other new staff had been recruited. One of these was on duty and was being supervised directly by the manager, who was working as a carer. No criminal records bureau check, protection of vulnerable adults check or references had been obtained for this person, although they had apparently been requested. For staff who may work at the home there is no formal system for risk assessing or verifying any declared convictions. These arrangements do not protect staff people living at the home from being cared for by people who may be unsuitable to work with potentially vulnerable people. Training charts had been provided for most people, however not the newly appointed staff, showing what training staff have undertaken and what they need to do. However there is no plan to complete the gaps in this plan. No one at the moment is undertaking National Vocational Qualifications, which are a national award reflecting the competency of a carer in their working role. The induction programme seen needs to be ratified with the Sector Skills council approved Induction, as it is not clear how well it addresses the required areas. Training provided by the home includes watching DVDs and completing a following quiz or hand out. On the day of the first visit the manager was due to do some Fire and health and safety training for one staff member. Since the last inspection staff have been given contracts of employment by the owner, however it is understood that they have refused to sign them because they consider the terms unacceptable. Evidence was not clear as to the turnover of staff of the home. The manager felt that between three and four staff would have left since the last inspection, however people at the home spoken to indicated the turnover had been considerably higher. We checked the rotas against rotas supplied to us in December which indicated that at least 10 staff employed in December were no longer working at the home. This indicates there is still a high turnover of staff at the home. People spoken to said the staff were kind and caring with them. Staff observed during the inspection visits had good relationships with people living at the home and discussion with them indicated they had a great deal of affection for the people they were caring for. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 23 Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. 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. Some of the management systems at the home remain outstanding despite being discussed at the previous Inspection last year. Some systems leave people at risk. EVIDENCE: The manager of the home is Mrs Kay Allan. She has been a registered manager other homes and has extensive experience in care. There are other senior care staff, care and domestic staff working at the home. The owner of the home is a company Rosepost Healthcare Ltd, who also own and operate another home Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 25 next to Southbourne. The responsible individual or representative from the company who oversees the care at the home is Mr Vaughan Owen. Since the last inspection the home have completed a number of risk assessments, some of which we sampled on the first visit. A heavily pregnant member of staff was working on the first visit with no risk assessment having been documented or completed to safeguard their health or the health of the people being cared for. By the second visit this had been attended to but by this time the person had left to go on maternity leave. The homes quality assurance systems were discussed and the manager confirmed that questionnaires have been issued to people living at the home and these have been audited and a report made. However this has not been incorporated into an annual development plan including information from internal and external audits which was required at the last inspection. The Annual Quality Assurance document returned to us was very brief and did not give us all of the information we needed. Portable appliance testing was due in July, and evidence of other regular health and safety contracts testing was also requested and seen, some of which was overdue. This included according to the manager adding ventilation to a gas boiler which is understood has not been completed. Servicing for the boiler, the chairlift and hoist was overdue. The Fire system has been serviced recently. By the second visit arrangements had been made for much of the servicing to be attended to. For this inspection the manager completed an annual quality assurance assessment. There was very little information in this document, despite this having been discussed at the last Inspection. This document gives us information about how the home is being run and is their opportunity to tell us about the improvements they have made or plan to make in the coming year. Discussion was held on staff supervision systems. Supervision is a system comprising staff development and performance management and should help to ensure staff are working to their full potential and in a consistent fashion to support people living in the home. It is recommended that this be completed six times a year with each member of staff. Evidence can be seen of some people having had two supervision sessions this year, with others having none. Some concerns were expressed that staff at the home had been given a small amount of money to share between them by a person living at the home’s relatives, but that this money had not been given to staff by the responsible individual. The manager said she had reminded him. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement The registered person shall not employ a person to work in a care home unless - he has obtained in respect of that person the information and documents specified in - (i) paragraphs 1 to 7 of Schedule 2. This includes references and criminal records bureau checks. Previous timescale of 30/09/08 not met. 2. OP9 13 Prescription dressings no longer required by that person must be returned to the pharmacy and not used for other people. Previous timescale of 03/12/08 not met. 3. OP33 24 The home must provide a system for reviewing and improving the quality of care at the care home. Previous timescale of 03/02/09 not met. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 28 Timescale for action 30/07/09 30/08/09 30/09/09 4. OP9 13 (2) 5. OP37 37 13 6. OP9 13 (2) 7. OP30 18 8. OP30 18 Full records must be kept of all medication returned to the supplying pharmacist. This is particularly important in relation to controlled medication so that a full audit trail may be completed. Registered persons must report to CQC without delay any incidence of allegation of misconduct by a person working at the home and any incident which affects the health and well being of any person living at the home. These may also need to be reported to the local Safeguarding team as appropriate. All staff expected to administer medication should receive updated and appropriate training to make them safe to do so. The registered person’s must make sure that staff working at the home receive a comprehensive induction, that accords with the Sector Skills council Induction standards. All staff must receive training to meet the assessed needs of people living at the home. 30/07/09 30/07/09 30/07/09 30/08/09 30/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP2 OP7 Good Practice Recommendations Contracts for people living at the home should be updated to ensure they accurately reflect the situation at the home. People living at the home or their representatives should be involved in the drawing up of their care plans. This is to DS0000069861.V376532.R01.S.doc Version 5.2 Page 29 Southbourne Residential Care Home 3. 4. 5. 6. OP30 OP7 OP38 OP14 7. 8. 9. 10. OP12 OP15 OP16 OP16 11. 12. 13. OP20 OP19 OP25 14. 15 OP29 OP33 ensure they reflect their needs, wishes and aspirations. Staff working at the home would benefit from training in communicating with people who have memory loss. Personal profiles forms in the care plans should be completed to ensure the home has information on people’s histories and lifestyle choices. The First aid kits at the home need re-stocking. Information about an individuals capacity to make decisions and the homes procedures to support them with decision making should be included in each person’s file. Decisions about active treatment need to be subjected to the legal framework available. People’s care plans should include information on interests and activities they enjoy and how the home aims to support them to maintain these. Choices should be available for the evening meal, to ensure people do not eat the same thing every day. The complaints procedure needs to be updated to reflect changing policies in the way complaints are managed. Information on complaints made about the home should be shared amongst the management team so that they can be addressed and monitored by all people responsible to do so. Lighting in the bathroom should be bright enough to ensure people’s safety and experience of bathing is pleasurable. Hot water supply should be maintained at a safe temperature at outlets where people living at the home have access. This is to reduce any risk of scalding. Free standing radiators should be risk assessed to ensure they are safe to be used by people living at the home. Their use should be discussed with the fire officer and environmental health officer Staff recruited should provide a full employment history, not just their last employer. An annual development plan should be developed by the home to include information gathered during the home’s quality assurance processes. The home’s Annual quality assurance assessment should include information about how the home is being run and improvements they plan to make. Staff should receive supervision to enable them to carry out their job consistently and to their full potential. 16. OP36 Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Southbourne Residential Care Home DS0000069861.V376532.R01.S.doc Version 5.2 Page 31 - 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!