Inspection on 16/02/09 for Southcrest Nursing Home

This inspection was carried out on 16th February 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southcrest Nursing Home 23/06/10

Southcrest Nursing Home 14/07/09

Southcrest Nursing Home 23/05/08

Southcrest Nursing Home 22/02/07

Southcrest Nursing Home 14/09/05

Southcrest Nursing Home 18/04/05

Southcrest Nursing Home 03/11/04

Southcrest Nursing Home 02/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Rumble     Date: 2 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Southcrest Nursing Home 215 Mount Pleasant Southcrest Redditch Worcestershire B97 4JG 01527550720 01527550738 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Kalpana Ananthram,Dr Sabarathnam Ananthram care home 40 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: All persons admitted within category PD must be at least 55 years of age and on a named basis, with the prior agreement of the registration authority The Home to allow 1 named resident between the age of 61-65 years of age. Date of last inspection Brief description of the care home Southcrest Nursing home is a forty-bedded care home providing general nursing care for older people. Accommodation is provided over three floors in both single and shared occupancy bedrooms. Some bedrooms have ensuite toilets and wash band basin. The home has a passenger lift so that people using the service can access all Care Homes for Older People Page 4 of 38 Over 65 40 40 0 3 Brief description of the care home parts of the home. There is a variety of aids and equipment available to help people to move about more independently and ramped access to the rear of the building. There are a number of toilets and bathrooms available placed close to peoples bedrooms and the lounges on each floor. There is a small car park available for visitors and staff . The home is near to the town of Redditch and local shops are within walking distance. The home is on a bus route and also in walking distance of Redditch railway station.The weekly fees are not published in the service user guide but are available upon request from the manager. Copies of the most recent inspection reports are availble in the home for people to read if they wish. 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 Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the homes second key inspection for the year and this report should be read with the report of the inspection of May 23rd 2008. This inspection was carried out over two days by one inspector and a pharmacist inspector visited on the second day of inspection. The home did not know we were going to visit. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection . This included notifications received from the home. These are reports about things that have happened in the home that they have Care Homes for Older People Page 6 of 38 to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there . Three people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them , observing the care they receive , discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. We spoke to the general manager , acting manager, four care staff and a visiting professional. Because the people living here are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experiences. We call this the Short Observational Framework for Inspection ,SOFI. This involved us observing five people who use services for 2 hours and recording their experiences at regular intervals. The last key inspection of this service took place on the 23rd May 2008 . An unannounced random inspection took place on the 12th August 2008. What the care home does well: What has improved since the last inspection? What they could do better: Information available about the home and the services it offers could be in alternative formats so that it is easier to understand. Pre admission assessments and care plans should be in more detail so that staff have Care Homes for Older People Page 8 of 38 all the information they need to meet peoples needs in a way they need, expect and prefer. Staff need more training so that they have all the skills and knowledge they need to be able to meet peoples individual and collective needs in a safe and dignified way. Records of any complaints or concerns received need to be in more detail so any one looking at the record can see that the complaint has been investigated and responded to in a timely way. More storage space is needed in the home so that the equipment used to move people does not get in peoples way . More staff are needed so that people do not have to wait excessively long periods to receive the care or treatment they need at times that meets their needs and expectations. The activities available need to be improved so that people can lead interesting and stimulating lifestyles that reflect their gender, personal taste and interest. The arrangements for mealtimes need to be improved so that people receive their meals in away that promotes the social aspects of mealtimes and maintains their dignity. People should have the opportunity to attend religious services of their choice to ensure their spiritual needs are met. Consideration should be given to finding out about and implementing the research that has been done about colour schemes and signage so that people with confusion , memory loss or dementia can more easily orientate themselves around the home and maintain their independent. The garden must be made safe and secure so that people have the option of using this in the warmer weather. The handover period should be included in staffs paid working hours so that the home is not reliant on their good will to arrive early or stay late for their shift . The arrangements for responding to the fire alarm need to be improved so that all staff have clear guidance and training they need and will follow in the event of a fire . Evidence that all health and safety checks have been conducted in a timely manner should be available in the home so people can be confident that the home and all the equipment is safe and well maintained. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 9 of 38 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 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 11 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to make an informed decision if they want to live there .The lack of detail in pre admission assessments means there is a risk that people will not have all their needs met consistently upon admission. Evidence: There is a service user guide and statement of purpose available. These documents give prospective residents and their families information about the home , what it can offer and what they can expect if they decide to live there.We were told that both of these documents are being updated so that they contained accurate information about the service , including the details of the fees payable . These documents are not available in alternative formats such as large print , audio visual formats or include pictures so that the information is easier for some people to understand. Contracts of residence are given to people once they come to live at the home, copies Care Homes for Older People Page 12 of 38 Evidence: of these were seen on the care files we looked at .This means the people know what to expect from the home and how much it will cost to live there. Pre admission assessment are completed before some one comes to live at the home.However,the pre admission assessments looked at lacked detail. For example, one persons assessment stated needs help with hygiene, but did not say what help was needed or how the person preferred the help to be given . They had not been completed to include details about peoples social history or cultural needs so that staff have the information they need to know about the things the person is interested in and important to them .People most recently admitted to the home were unable to talk to the inspector about their experiences of their admission to the home because of their poor memory. The language used within the pre admission forms refers to marital status and may discourage some people from feeling comfortable about disclosing relationships that are important to them. 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 this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can not be confident that all their health and personal care needs will be met consistently which may place them at risk of harm. Evidence: Each person has a written care plan. This is an individualized plan about what the person is able to do for themselves and what assistance they need from staff so that their needs will be met. Following the last inspection we were worried that care plans were not available for people so that staff were not aware of what peoples needs were so they could meet them. So after the inspection we sent the home a Statutory Requirement Notice . This is a legal notice that requires them to write care plans so that staff have the information they need to meet peoples needs. We looked at three peoples care plans and care records in detail. We found that with the exception of one person not having a care plan for one medical condition people now have care plans. This should mean staff know what their needs are. Care Homes for Older People Page 14 of 38 Evidence: However, some care plans for people provided conflicting information. For example one persons care plan gave conflicting information about their dietary needs .One care plans said they needed a high protein diet , another said they needed a low calorie and high fibre diet . A nutritional risk assessment for this person stated she needed a fortified diet to provide extra calories . Care staff spoken to said she she had a normal diet and she was observed to be given a soft diet during the visit.This means that staff are not meeting her needs and will mean there is a risk that to her health and well being . Some care plans lacked detail so that staff do not have the information they needed to meet people needs in the way they expect, need or prefer. For example peoples likes and dislikes were not consistently recorded and the size of pads or slings that people used was not documented . Some care plans lacked detail about how to meet the persons needs .For example, needs assistance with hygiene ,without saying what assistance is required or how it is given.This may mean that there is a risk that people do not get the help they need in a way that they prefer. Staff spoken to were unaware of the content of some care plans . One person had a care plan for Epilepsy but three staff spoken to did not know that this person has Epilepsy. This means that they were not monitoring her for possible seizures and in the event of a seizure staff would not know how to respond which may place her health at risk of harm. Staff have recently started to complete person centered plans for people . These are individualized care records that should describe the things people like to do, as well as what help they need to stay healthy. At the time of this visit these had not been completed for all the people living at the home. There are risk assessments in place for nutrition, sore skin, moving and handling and the use of bed rails . This should mean that staff have information they need to help keep people safe .Throughout our observations we saw that people were helped to move by staff in a safe way. There is evidence in the records that people are seen by the GP, optician , tissue viability nurse and dentist . On the second day of the inspection a dentist was visiting the home . There is a range of pressure relieving equipment available in the home to help stop people getting sore skin .This should mean that people receive the right care to help stop them getting sore skin. During the visit we were able to speak to a visiting health care professional who commented that the home are good at looking after peoples Care Homes for Older People Page 15 of 38 Evidence: skin and that if people were admitted with wounds these improved once they came to live at the home . We saw from records for one of the people we case tracked who had a wound that this was the case .She also commented that staff sought medical advice where it was needed and any omissions she had noted in care plans were addressed quickly once she brought it to the attention of nursing staff . During the visit we observed that people were wearing clothing that was appropriate to their gender , age and reflected individual choices .However on the first day of inspection that a number of people were not wearing tights or socks despite the cold weather. This means that peoples dignity is not been maintained and there is a risk that they will be cold. We saw one person ask to use the toilet and was told to wait a minute . It was over an hour later before staff came back to take him to the toilet. This does not show that peoples wishes are listened to. Nursing staff allocate care staff to bath or shower people twice a week . However, from talking to care and nursing staff and looking at records there does not appear to be any consideration of peoples dependency or evidence that people are consulted about how often they prefer to bathe. This may mean some people do not have a bath or shower at least twice a week or as often as they would want or need. The pharmacist inspection took place on the second day of inspection and lasted three hours. Six peoples medicines were looked at together with the Medicine Administration Record (MAR) chart, care plans and daily records. The medicine management had improved since the last inspection. The managerial staff had worked hard to implement robust systems to improve the service and this is commended. Three medicine trolleys were in use, one on each floor where the majority of the medication was kept. All surplus medication and Controlled Drugs were kept in a dedicated medication room in the home. The trolleys were not taken to the people in the home but are used to store and prepare the medication. Prepared medication was placed in small open medi-pots. The nurse then walked throughout the unit to the person receiving the medication. There would be no where to securely hold this loose medication if an emergency occurred. Concern was raised that the morning medication round was not completed until 11:45am in the morning even though the nurse had started to administer medicines since 8am. She was constantly interrupted during the medication round. This may lead Care Homes for Older People Page 16 of 38 Evidence: to errors in drug administration. All nursing staff should have dedicated time to handle medicines to safeguard the people who live in the home. The home sees all the prescriptions prior to dispensing and takes a copy of these. They are then used to check the medicines and MAR charts received into the home and kept alongside the MAR charts for reference. This is considered good practise as any discrepancies can be easily seen and addressed. The quantities of all medicines received are recorded. This enables audits to take place to check whether the medicines have been administered as prescribed. Audits indicated that the majority of medicines had been administered as prescribed and records reflected practise. A few errors were seen where some medicines had been recorded as administered when they had not been. All controlled drug (CD) balances were correct and the records in the CD register reflected those on the MAR chart. They were securely stored in a cabinet that complied with current regulations. The care plans did include some clinical information about the residents but these had not been regularly updated so it was not possible to track all new medicines prescribed or why some had been discontinued or even why some residents were prescribed a particular medicine. It is expected that the nursing care plans would include all the clinical conditions and support plans are put in place to ensure that all the nurses have access to up to date information about the clinical conditions of the residents they look after. Reliance on nutritional supplements was evident. Many people had been prescribed supplements. A dietitian has not been involved in supporting the care home to improve the diet to avoid using these supplements.It was also observed that many of the people living at the home are a slim build and may benefit from fortified food. Records of food provided to people are kept but there is no records of the quantities of food eaten. This means that some peoples nutritional intake is not been well monitored. Care Homes for Older People Page 17 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities available do not meet the needs or preferences of the people who live at the home or ensure that they lead a stimulating lifestyle .People do not receive support with their meals in a way that provides a pleasant and sociable experience or maintains their dignity. Evidence: Care plans looked at do not show that staff have placed sufficient emphasis on finding out peoples past interest , religious beliefs, cultural needs and life experiences so that staff have the information they need to provide stimulating activities that met peoples individual needs. An activity coordinator has been employed part time ,Monday to Friday and does some activities with people. However, we observed and spoke to staff who said that the normal practice is that the activity coordinator assists people with mid morning drinks and feed people who require assistance at lunch time .This leaves limited time available to engage people in doing thinks that they enjoy. We observed the care five people received over a two hour period in the lounge, on the middle unit. Throughout this time we saw that the television was on with the sound turned down and the radio was tuned into a pop music station. This does not show that people had been asked or their wishes considered when staff select what Care Homes for Older People Page 18 of 38 Evidence: they listen to. During our observations we saw that people were doing things with the activity coordinator to keep busy. However, most people were not given a choice of activity. The activity was manipulating a ball and later looking at reminiscence cards. These activities were decided by staff not the people living at the home.We also observed that the activity coordinator was trying to get a number people to engage with a ball at the same time rather than giving individual attention which may have made the activity more enjoyable for people.We observed that people who have better verbal communication skills received more staff attention than those people who were more dependent . This means for some people there is a risk of them being isolated. There are a few external entertainers who visit the home for example, exercise to movement . A local school visited over Christmas to sing carols and there are photos in the home showing people enjoying this activity. A hairdresser visits regularly which means people can maintain their personal appearance if they wish. Discussions with staff and looking at records show that opportunities for people to do things or attend activities in the community are extremely limited. Discussions and observations of care staff showed that they have very little time available to do activities with or talk to the people living at the home . One person told us that there is not a lot to do, the television is the main activity. Records showed and staff told us that there are few activities available for people. The homes Annual Quality Assurance Assessment (AQAA) acknowledges that they need to get better at providing activities for people and the activities coordinator said she is planning to gather more information about peoples previous interest so that she can provide activities that will interest them. Religious services no longer happen in the home so that peoples spiritual needs are not been met . People do not have the opportunity to attend services outside the home unless their family support them. A member of staff said that some people using the service used to enjoy this opportunity . The home has an open visiting policy , which enables people to see their visitors as they choose and maintain relationships that are important to them . On the day of the visit the main meal was a choice of chicken casserole or beef stew with mash and four vegetables. The meal looked and smelt nice and was well presented. People told us that they generally enjoyed the food provided. People received their meals on small tables in front of them. We observed staff Care Homes for Older People Page 19 of 38 Evidence: assisting people with their meals .We saw that no condiments , sauces or napkins were offered. The assistance given was not always in a dignified or discreet manner . Some staff were seen to be stood over people while feeding or giving them a drink and in same cases people were left part way through the meal with no explanation to do other task before returning to continue feeding them. We observed one person not being given the diet the care plan said that they needed to keep them well. We spoke to the Chef who told us menus are not planned in advance but are done on a daily basis depending on the food stocks available .There is no active monitoring of the meals provided to ensure that people receive a varied diet. Records of food provided also show that some times the choice of meals available does not provide a real choice, for example fried fish or baked fish.The AQAA states and the general manager told us that they are developing a four week menu to ensure that people get a varied diet and that they will have real choices of food available daily.It was pleasing to see that fruit juices and squashes were freely available in the lounge areas so that people can help themselves. Care Homes for Older People Page 20 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further staff training is needed so that people can be confident that all staff have the skills and knowledge to protect them from harm. Evidence: Information about how to complain is displayed in the entrance hall and is also included in the service user guide . Both of these documents are written in small type print . This may mean the information is hard to understand for some people using the service .The complaints procedure displayed does not include contact details for the Commission, so that if people are not happy about how their complaints has been managed they can let us know. Since the last inspection the home has received two complaints. Both of these complaints were upheld and are recorded in the complaints log together with the outcome . However, there is no written record of how these were investigated and no evidence that the complainant was responded to in writing, letting them know what was going to change as a result of their complaint . The AQAA states that the home are aware that they need to improve how they record complaints and their response to them . CSCI have not received any complaints about the home since the last inspection. One person spoken to said that if they were unhappy about something they would tell the staff and they would sort it out. Care Homes for Older People Page 21 of 38 Evidence: Two of three staff spoken to had received training in the protection of vulnerable adults ,the other person said that they had covered some basic information about abuse in their induction training . Staff were able to give adequate answers to questions about what is abuse and what they would do in the event of or suspicion of some one being abused. Training records show that less than 50 of the care staff have received training in recognizing and responding to abuse which may mean that they do not have the knowledge or skills to recognize and respond to abuse. Care Homes for Older People Page 22 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed in the home so that it is provides a pleasant place for people to live and meets their needs. Evidence: The home provides accommodation over three floors with lounges and an adequate number of bathrooms and toilets available on each floor. There is a passenger lift available so that people can access all parts of the home.There are thirteen single rooms and nine shared rooms . Screening is provided in the shared rooms so peoples privacy can be maintained. Some of these rooms have en suite toilets and wash hand basins. Peoples bedrooms contained personal items and photographs so that they were more homely and reflected peoples tastes and interests. We saw that call bells were placed in reach of peoples beds so that they could summon assistance if they required it . We looked at some areas of the home which were all clean and tidy. Lounge and dinning room space is available on each floor. During our observations we noticed that there is not enough dinning space so that all the people living at the home can eat at a dinning table. Sixteen people live on the middle floor yet there is only seating at dinning tables for seven people.We observed that people in the middle lounge were fed their meals on small tables in front of them. There was very limited space Care Homes for Older People Page 23 of 38 Evidence: available between chairs for staff to support them in a way that would promote their dignity and ensure that meals times are a sociable and pleasant experience. Some of the furnishings in the home look tired and are in need of replacement to improve the environment for the people living there. Some carpets are rucked and present a trip hazard and are in need of refitting or replacement. The floor covering in the shower room was in need of replacement .The general manager said that there is an ongoing program of refurbishment in the home that will address these matters. It was evident during the inspection that some vacant bedrooms were being redecorated and the AQAA states that they are planning in the next twelve months to buy some new furniture and replace window frames . The home has a range of equipment available to assist people to keep safe and maintain their independence including hoists , raised toilet seats ,wheelchairs ,pressure reducing mattresses , bed rails and bumpers .The equipment used to move people had been serviced so that people know that it is safe to use.There is limited storage space within the home , this means that equipment is stored in communal areas of the home and may get in peoples way. The home is not decorated in a way that people with dementia and memory loss will find easy to find their way way around themselves. Consideration should be given to signage and using colour schemes so that people are able to orientate themselves easily and be more independent in the home . The home has a laundry in the basement that provides a laundry service for the people living at the home . At the last inspection we required that hand wash facilities were provided in the laundry to help reduce the risk of cross infection .At this visit a hand wash basin had still not been installed but the general manager was able to show an email confirming funds to complete the work have been made available. Given that this requirement was made some time ago the home should let the Commission know when this work has been completed . The home is situated on a busy road.There is a small car park to the rear of the building for staff and visitors. There is a small garden to the front of the home that is partly accessible to people who use a wheelchair .The garden is nicely planted but is not enclosed which means that it is not suitable for people to use in the warmer weather without direct supervision as they can easily access the road. This places them at risk of harm. Care Homes for Older People Page 24 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 this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not supported by suitably trained and qualified staff in the right numbers to meet their needs. Evidence: In addition to care and nursing staff the home employs an administrator ,cleaners , laundresses and cooks to provide support to people using the home . On both days of the visit there was a nurse and six care staff on duty. We do not think that this is enough staff to support the number and dependency of the people living in the home . For example on both days the morning medication round was not completed until nearly lunchtime. This means that people are not having a long enough gap between their tablets which might mean they receive an overdose of medication placing them at risk of harm. We saw that people on the middle floor did not finish receiving help with their morning personal care routines until lunch time.One person had to wait for over an hour to use the toilet as staff were busy. In the morning we saw that there were no care staff based in the lounge to supervise people as they were busy undertaking personal care task with people .People are not bathed as often as they need or would prefer. Care staff spoken to stated that they did not think that there was enough staff on duty and that they did not have enough time to spend with people . One person said that staff do not have time to talk to you, they are very busy. In addition care and nursing staff Care Homes for Older People Page 25 of 38 Evidence: are working long days from 8am to 8pm. This means that staff may be tired and are not at their best when caring for people and this may place people at risk. There are currently only three registered nurses employed in the home to provide round the clock nursing care . The home is using using agency staff to ensure that a nurse is always on duty but this does not ensure that people are been looked after by people who know them well. We were told that more nurses are being recruited, but the home was waiting for their recruitment checks to be completed before they started work . It is good that people have been asked about if they want a male or female carer to support them with their personal care. However consideration should be given to the staff rosters to ensure that staff are available across all shifts so that their preferences can be respected. Staff receive a handover at the start of their shift so that they know what they are expected to do for that shift and who they are looking after. However, staff have to come in early or stay late to have this handover and are not paid for this time.This means that the home is relying on staffs good will, and does not demonstrate that sufficient emphasis is placed on this importance of this handover to ensure all staff have all the information they need. As stated in the health care section of this report staff did not know about all the needs of the people they were looking after which means that people may not get all the care they need. The home has started to update their records of the staff training provided. Staff training records and discussions with staff do not show that they have all the training they need. All staff have not received all the mandatory training they need such as food hygiene , first aid , protecting vulnerable people , manual handling, health and safety or infection control . Very few staff have received any training in looking after people with dementia even though a lot of people living at the home have dementia or memory loss. Care staff have not received training in looking after people with sore skin or epilepsy. Approximately 50 of staff have completed or are working to wards their NVQ qualification which should mean they have the basic skills they need to care for people. During our observations in the home we watched how staff interacted with the people they were looking after . Only 23 of interactions we saw were positive,34 were neutral and 43 were negative. This means that staff need more training to enable them engage with people in a way that promotes their self esteem and personal wellbeing. Staff told us that when they start work in the home have an induction booklet to work through , so that they have some basic information about what they need to do.We Care Homes for Older People Page 26 of 38 Evidence: saw some of these booklets showing what information and training staff were being given. However, there was no record of any induction training on the homes training records.The homes AQAA tells us that they need to provide more staff training and keep better records of the induction training provided. Following the last inspection the home received a Statutory Enforcement Notice. This is a legal notice requiring them to improve their recruitment practices so that people are people looked after by staff who are suitable to work with vulnerable adults.The homes AQAA tells us that they have improved their recruitment practice. We looked at the records for three people who had recently started to work at the home and we were able to see that robust recruitment checks were now in place and the home has complied with legal requirements . Care Homes for Older People Page 27 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 this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not benefit from living in a home that is well run with their best interests at heart. Evidence: Since the last key inspection the registered manager has left the home. The home has recruited a general manager who is responsible for none care related things and an acting care manager who is responsible for the clinical care .She is well qualified and has worked at the home for a number of years . The acting manager stated that she will be making an application to become the registered manager in the near future. The Annual Quality Assurance Assessment (AQAA) returned to us was brief but showed some insight and recognition into what they need to do to improved the service provided. It did lack detail about how they planned to achieved this. The home has previously not had any meetings with residents or relatives to give them an opportunity to have a say in how they want the home to be run , what they Care Homes for Older People Page 28 of 38 Evidence: like and what they would like more of. However they were planning to have their first meeting with residents a few days after the inspection. Posters were in place in the reception area of the home advertising this, but it was not clear what other steps had been taken to let people know about the meeting and the purpose of it. Surveys were sent by the home to people who live there and their relatives in July 2008 to ask them what they thought about the service provided. From the responses received a brief report has been written identifying what they do well and what could be done better. There is some evidence that these views have been acted upon . For example people had commented that the food was an issue.As a response the home has recruited new chefs and during the inspection our observations and peoples comments showed that the meals provided were nice.It was evident that care staff had supported people using the service to complete the surveys . It is not clear how comfortable people would be to raise any concerns about the staff or the service in this way . Therefore any feedback given may not be objective. Consideration should be given to seeking their views in a more independent way. The frequency of visits to the home by the owner or their representative to the service to look at the quality of the service offered and how well the home is running have improved. These should help improve the quality of care provided. As stated earlier in this report the staff do not have all the training they need to meet peoples needs and our observations are that there are not enough staff available on each shift to help people in the way they prefer in a timely way. The home does not manage peoples personal finances but does hold some money on behalf of some of the people using the service. This money was stored securely and accurate records kept of the balance of money held and expenditure, with receipts available to verify expenditure. Staff do not receive appropriate supervision to ensure that people using the service benefit from well supervised and supported staff.A formal system of supervising staff was introduced in January 2009 but records and discussions with staff confirm that all staff still have not received the supervision they need .As discussed earlier in this report staff did not have all the information they needed to meet peoples needs and the manager was unaware of the gaps in the staffs knowledge. The AQAA and records available in the home to show that further work is needed to ensure that the health and safety of people is being promoted. For example the most recent visit by the fire officer required that a number of improvements were made. Care Homes for Older People Page 29 of 38 Evidence: While many of these have been achieved there was no evidence available in the home to show that the fire detection equipment had been upgraded as recommended. While fire fighting and detection equipment checks are been made records show that this is not undertaken as consistently as required .The last fire drill took place in August 2008 but records seen does not show which staff had attended so the manager is aware which staff have received training . During the second day of the visit the fire alarm went off.This was a false alarm . However we observed the evacuation procedures used during this incident did not reflect the written actions the homes fire policy said should be taken . Potentially this could place staff and people using the service at risk .It is important that all staff know what to do in the event of a fire to make sure people are safe . Equipment used to move people had been serviced so that it was safe to use, but a recent certificate of electrical worthiness could not be found in the home to evidence that it was well maintained and safe to use . Care Homes for Older People Page 30 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R 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 31 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 12 Care plans must be in sufficient detail and periodically reviewed. So that staff have all the information they need to meet peoples health and personal care needs. 16/04/2009 2 9 13 The medicine chart must be referred to before the preparation of the service users medicines at all times and be signed directly after the transaction and accurately record what has occurred. 31/03/2009 This is to ensure that the right medicine is administered to the right service user at the right time Care Homes for Older People Page 32 of 38 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 and at the right dose as prescribed and records must reflect practise 3 16 17 Arrangements must be in 31/03/2009 place so that records of all complaints made about the service and their investigation are in sufficient detail So that people can be confident that complaints are taken seriously, listened and responded to. Arrangements must be made so that the external grounds are suitable So that people can use the garden and be safe 5 30 18 Arrangements must be in place to ensure that all staff receive all the training they need So that staff have the skills and knowledge they need to be able to meet the individual and collective needs of the people living there. 6 30 18 Arrangements must be in place to ensure that all times people using the service are supported by suitably qualified and 30/03/2009 01/05/2009 01/06/2009 4 20 23 Care Homes for Older People Page 33 of 38 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 competent staff in sufficient numbers So that the health and welfare needs of people using the service are met in a timely way. 7 36 18 Arrangements must be in place to ensure that all times people using the service are supported by suitably qualified and competent staff in sufficient numbers So that the health and welfare needs of people using the service are met in a timely way. Evidence of the worthiness of the electrical hard wiring must be available in the home . So that people can be confident that they live in a safe well maintained home 9 36 23 Arrangements must be in place so that all staff are aware of the agreed procedures for detecting of fire and the safe maintenance of equipment. 11/03/2009 30/03/2009 8 36 13 01/04/2009 Care Homes for Older People Page 34 of 38 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 so that in the event of a fire people are not placed at risk of harm 10 36 18 Arrangements must be in place to ensure that all staff receive all the training they need So that staff have the skills and knowledge they need to be able to meet the individual and collective needs of the people living there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/03/2009 1 1 Consideration should be given to providing information to people, including the statement of purpose ,service user guide and complaints procedure in accessible formats so that the information it is easier to understand . The Pre admission assessment should be completed in sufficient detail so that people can be confident that their health personal and social care needs will be met upon admission to the home . It is recommended that a dietician is involved in the care of the people with low body mass index to look for alternative means of maintaining peoples nutrition without the trend of reliance on nutritional supplements. That at least four hours elapses between medication rounds to reduce the risk of potential overdose of medication. A suitable and safe method of transporting medicines to the 2 3 3 8 4 5 9 9 Care Homes for Older People Page 35 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations people who use the service is implemented so that they can be held securely inthe event of an emergency. 6 9 A quality assurance system is implemented to assess individual nurse competence in the handling of medicines so that people can be confident all nurses have the knowledge , skills and competence to administer medication as prescribed. Arrangements must be in place so that the dignity of people using the service is maintained at all times. Consideration should be given to ensuring the activities coordinator is able to focus on providing opportunities for people to take part in leisure and recerational activities rather than assisting people with drinks and meals . People using the service should have the opportunity to attend religious services of their choice so that their spiritual needs are met. People using the service should be consulted about their social and recreational activities and arrangements made to enable them take part in social and community activities that reflect their taste , interest and gender. The arrangements for mealtimes should be reviewed so that people can receive support in a way that promotes their dignity and enhances the social aspects of mealtimes. Arrangements should be in place so that the quantity of food eaten by people who use the home is been monitored and staff take appropriate action if people are not eating enough to maintain their health and well being. Consideration should be given to providing information about how to complain is in an accessible formats so that the information it is easier to understand . Arrangements should be in place so that all staff have the knowledge and skills to be able to recognize and respond to allegations of abuse so that people in the home can be confident that they are safeguarded from harm. Consideration should be given to creating additional dinning space so that all people living at the home can choose to eat at a dinning table if they wish. Consideration should be given to finding out about and implementing the research that has been Page 36 of 38 7 8 10 12 9 14 10 14 11 15 12 15 13 16 14 18 15 20 16 20 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations done about color schemes and signage so that people with confusion , memory loss or dementia can more easily orientate themselves around the home and maintain their independent. 17 20 Consideration should be given to providing alternative and adequate storage space for equipment in the home so that it does not get in peoples way. All staff working in the home must receive adequate supervision so that they receive feedback on their performance and further training needs are identified 18 36 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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