Inspection on 16/06/09 for Southlands

This inspection was carried out on 16th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southlands 12/06/07

Southlands 10/10/05

Southlands 11/07/05

Southlands 23/09/04

Southlands 08/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Southlands Southlands 7 Linkfield Lane Redhill Surrey RH1 1JF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 1 6 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Southlands Southlands 7 Linkfield Lane Redhill Surrey RH1 1JF 01737769146 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: southlandsresthome@hotmail.com Mr Ravind Sohun,Mrs Angela Sohun care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Southlands Rest Home is registered to provided residential care for up to nineteen people whos primary needs is elderly or have a past and present mental health condition. The home has been owned and operated by joint providers once of which is Care Homes for Older People Page 4 of 33 19 19 0 Over 65 0 0 19 Brief description of the care home the registered manager since 1996. The home is situated in a residential street close to Redhill town centre and all amenities including shops, post office, theatre cinema and good transport links to London and the southeast. The house is a large converted domestic detached property, set in its own grounds and is presented across three floors with a passenger lift providing access to each floor. Communal space consists of a dining and large living room situated on the ground floor, which leads out onto a raised balcony patio area that overlooks a rear garden that is set to lawn with some flowerbeds. Residents accommodation consists of fifteen single and two shared bedrooms, four of which now provide en-suite facilities. The home can provide transport for the people how use the service Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment form and the information contained in this document has been used to inform the inspection process. The inspection was facilitated by the Mrs Angela Sobun (registered provider/ manager) and in part by Mr Ravind Sohun (registered provider). The inspection consisted of looking around the building including all the communal areas and the majority of residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff. Six residents, three staff and five relatives were consulted as part of the inspection process, residents were also observed in their interactions with staff. Care Homes for Older People Page 6 of 33 Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided. Sixteen were returned in total, eleven from residents, four from staff and one from health care professionals. Their feedback is included in this report. There were nineteen residents living at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there. Residents were observed in their interactions with staff and in their daily routines and their body language noted in order to make judgments about residents experiences and wellbeing. Care Homes for Older People Page 7 of 33 What the care home does well: Residents live in a comfortable, homely environment with their private accommodation personalised and with parts of the home decorated and furnished to a high standard. Consistent feedback was received regarding the comfortable relaxed nature of the home. Residents clearly benefit from the relaxed gentle lifestyle offered at the home. A sample of comments made by residents regarding their experiences of the home included provide good support and a good daily basic day to day living It is a very nice home I would not want to live anywhere else altogether it is a nice place to live and I like living at Southlands as its comfortable and the staff are very kind to me. Residents were observed being relaxed around staff with many signs of positive body language in those residents not able to vocalise their experiences about the home. A relative commented on the improvements to their relatives wellbeing since being at the home and felt that this was due to the staffs understanding of people who have dementia and the calming environment. The health needs of residents are well met with evidence of regular input from a range of health care professionals. A relative feedback very impressed with how quickly they sought medical attention Flexibility in the daily routines is an integral part of the home with a resident commenting I have the freedom to do what I like. The vast majority of the homes practices promotes and encourages choices for residents and where they do not the manager has agreed to review. Residents lives are enriched by the home providing various opportunities for activities and occupation. Links with families and friends are valued and supported by the home. A relative commented we can visit whenever we want there are no restrictions always offered refreshments. Much positive consistent feedback was received regarding the personal qualities of the provider/ manager and included such comments as very nice manager was good, friendly and responsive and manager nicest person, you can tell her anything very hands on very good and works very hard , is very open. The meals are good offering both choice and variety and catering for special dietary needs. Two relatives spoke about their relative eating well and putting on weight that had previously lost before they were at the home and how well diabetics are catered for. Residents clearly benefit from a stable, trained staff team that know them. Consistent feedback was received regarding the kindness of staff. Relatives comments about staff included staff seem very knowledgeable about dementia and are kind to my mum when she gets muddled and anxious as to what she is doing at the home and consistency of staff I am particularly impressed with. Staff very stable there seems to be little turnover the same faces all the time. Care Homes for Older People Page 8 of 33 What has improved since the last inspection? What they could do better: There are several areas of shortfall noted at this inspection which have resulted in requirements being made in order that they be addressed. Serious concern is raised regarding the poor management of residents safety, which relates to a number of shortfalls . This is from the risk of unrestricted windows, which the manager had failed to address from the previous inspection. Lack of robust recruitment practices which resulted in staff being employed without all of the necessary checks being undertaken to ensure they are safe to work with vulnerable people. Risk assessments not being in place for all residents to ensure that any risk faced and posed by them are promptly identified. Medication practices which do not always evidence if medication is being administered in accordance with the prescribed instructions. There is a care planning system in place which provides staff with most of the information they need to be able to meet residents needs, however further work is required to ensure that staff have clear guidance on all residents assessed needs with particular reference to managing challenging behaviour so they can provide consistent and individual support. There must be a more effective management of practices at the home in order to address the concerns noted at this inspection, improve residents safety and ensure that improvements are sustained. In order to ensure a pleasant environment in which to live, visit and work there must be a more robust management of unpleasant odours. Staff undertake cleaning as part of their duties and sufficient staff must be employed as is necessary to ensure residents health and safety Some further works is still needed towards the overall upgrade of the building which the providers are in the process of addressing. It is recommended that some of the information provided about the home be produced in a format intended to make this information accessible to residents. Care Homes for Older People Page 9 of 33 The use of a residents bedroom as a communal hairdressing room did not promote the privacy of the occupant of this bedroom. The manager agreed to address this immediate. Where there are restrictions on residents freedoms, namely in the management and control of tobacco this must be based on a clear process of establishing how this restrictions are decided agreed and managed in the best interest of the individual. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 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 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides both prospective and existing residents, with information about what services are provided and what to expect when living at the home with some further work recommended to provide some of this information in a easy read format. The way in which prospective residents are assessed ensures that the home admits only those residents whose needs can be met by living at the home. Residents benefit from a relaxed and quiet lifestyle. Evidence: The homes statement of purpose, which is a book that tells people who the home is for, The service users guide, which is the book that tells people how the home works, has been updated in accordance with the shortfalls noted at the previous inspection. The manager confirmed that this information would be sent to prospective residents and their representatives to help them make informed choice about the homes Care Homes for Older People Page 12 of 33 Evidence: suitability. Two relatives confirmed that although they could not recall receiving information about the home in advance they felt they had sufficient information through visiting the home and being able to ask as many questions as they liked to find out about the home. The information produced by the home is currently in a written format and it is recommended that the service user guide be in a format intended to make this information accessible to some residents who use the service. Namely easy read and the use of pictures. The assessment documentation was examined for recent admissions and this showed that the home ensures that prospective residents are accommodated only following an assessment of their needs by the placement authority and the manager. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. A resident spoke of the manager assessing them whilst they were in another home and was able to ask the manager many questions about the home. The manager demonstrated a clear understanding of the range of needs the home is able to meet. Residents are provided with a written contract of terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. In the vast majority of cases a signed copy of the contract is retained in residents files. An example was noted whereby a resident who had been admitted for a month had not yet been issued with a contract and the manager agreed to rectify this promptly. There is a range of needs being accommodated at the home this includes older people who have long term enduring mental health needs, some residents who have dementia and several residents who live independent lifestyles. The majority of residents are assessed as having low to medium assessed needs. Through observation, looking at records and speaking to residents, staff and relatives, there was evidence that residents, clearly benefit from the quite and relaxed lifestyle offered by the home. However, some further work is needed in the care planning process to ensure that staff can provide support in a consistent way. This is discussed under standard 6 of this report. Residents spoke positively about their lives at the home with a sample of comments including provide good support and a good daily basic day to day living It is a very nice home I would not want to live anywhere else altogether it is a nice place to live I like living at Southlands as its comfortable and the staff are very kind to me. Residents were observed being relaxed around staff residents showing signs of smiling, eye contact and touching. A relative commented on the improvements to their relatives wellbeing since being at the home and felt that this Care Homes for Older People Page 13 of 33 Evidence: was due to the staffs understanding of people who have dementia and the calming environment. Residents and relatives consulted with all spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Consistent feedback was received that when residents or their families visited they were made very welcome and any queries were answered knowledgeable, with a residents saying looked around the home before I made my mind up to come and staff Care Homes for Older People Page 14 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a care planning system in place which provides staff with most of the information they need to be able to meet residents needs, however further work is required to ensure that staff have clear guidance on all residents assessed needs so they can provide consistent and individual support. The health needs of residents are well met with evidence of regular input from a range of health care professionals. Not all of the homes medication practices safeguarded residents and promoted residents privacy. Evidence: Four individual plans of care were examined and these showed that a range of information is generally gathered about each resident which provided staff with most of the guidance they needed on the needs and preferences of each resident. However for a resident who had been admitted for four weeks information about their assessed needs and the risks they faced was limited, which did not provide sufficient guidance Care Homes for Older People Page 15 of 33 Evidence: for staff on being able to provide consistent support or ensure their safety. In line with previous requirement the manager reported that residents files have been reorganized to enable the easier retrieval of information. Residents consulted with expressed little interest in being involved in the development and review of their care plans, but felt able to ask to see them and most care plans had been signed by the resident or their representative to indicate that they were aware of its contents. Care plans did not provide clear guidance for staff on managing the challenging behaviour presented by some residents. An example was noted whereby staff were observed providing inconsistent approaches to a resident when faced with their challenging behaviour. It has been required that care plans provide this guidance to promote continuity and risk assessment in order to promote residents safety. The manager reported that they review care plans every three months, however an example was noted whereby not all of the information contained in care plans and risk assessments had been reviewed to reflect the changes in a residents needs. The manager agreed to review the care plans more frequently in light of the complex changing nature of some residents needs. Records of medical intervention showed that the home works closely with a range of health care professionals including GPs, district and specialist nurses, dieticians , speech and language therapists, chiropodists, opticians and dentists to ensure residents receive a range of health care intervention. Residents consulted said that when they have asked to see a Doctor then this has been sought promptly. A relative also feedback very impressed with how quickly they sought medical attention when he began to loose weight. Currently no residents are assessed as wishing to self medicate. The system for the administration of medication did not always provide for a clear audit trail of medication, therefore it was not always possible to ensure that medication was being accurately administered or accounted for. Examples were noted whereby staff had not followed the homes medication procedures in signing for all medications administered, ensuring clear and accurate records of controlled drugs were maintained and that all As Directed medication had clear guidance for their individual administration. This highlighted that medication practices were not being regularly monitored by the manager and placed residents at potential risk. Variable standards of medication recording were also noted at the last inspection. The manager reported that all staff had undergone training in medication. Care Homes for Older People Page 16 of 33 Evidence: Staff consulted with showed an understanding of good practices in preserving residents rights to privacy and dignity, with residents confirming that staff knocked on their bedroom door before entering. Several relatives commented on how well dressed their relatives were in accordance with their personalities and always wore their own clothes. However a ground floor residents bedroom was used as the communal hairdressing room which did not preserve the privacy of the occupant of this bedroom. The manager agreed to cease this practice immediately and find an alternative location for the hairdresser. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Flexibility in the daily routines is an integral part of the home. The vast majority of the homes practices promotes and encourages choices for residents and where they do not the manager has agreed to review. Residents lives are enriched by the home providing various opportunities for activities and occupation. Links with families and friends are valued and supported by the home. Evidence: Residents views regarding activities varied between those who enjoyed socialising and others who were not so interested but all confirmed that there wishes were respected. An activities co-ordinator is employed twice a week to undertake a variety of plan and spontaneous activities. The activities co-ordinator was knowledgeable about suitable activities for people who have dementia and mental health conditions and residents who participated in the activity of baking cakes were observed to be engaged and appeared to be enjoying the activity. Residents spoke of undertaking exercise lessons, quizzes, external entertainers and celebrating birthdays and special events. As the Care Homes for Older People Page 18 of 33 Evidence: weather was very nice on the day of the inspection a group of residents went for a short work with the activities co-ordinator. Upon their return a resident spoke of how much they enjoyed this event. A group of residents clearly enjoying the company of a young visitor. Staff were knowledgeable about residents individual cultural or religious beliefs. A relative fedback that they were very impressed with the activities that now goes on and how their relative is taken out for walks and although their relative likes to remain in their bedroom how staff pop in regularly to talk to them. A staff member did feel that due to the recent raise in residents numbers they did not always have the opportunity to be able to spend individually time with residents in order to provide stimulation and occupation. Without exception all residents and relatives commented positively on how welcome they or their visitors were made to feel when visiting. A relative commented we can visit whenever we want there are no restrictions always offered refreshments. Observation of the daily routines and discussion with residents confirm that staff accommodate residents personal wishes with regard to meal times, going to bed, rising and bathing. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy with a resident saying I have the freedom to do what I like. Staff showed an understanding of how they promote choice for residents and were able to give examples of how they do this in their daily practice. However where restrictions had been placed on residents freedom namely in the management and control of cigarettes there was no evidence to establish whether the resident had capacity to consent to this or had consented to this. The manager agreed to discuss this with the placement authority with a view to establishing whether a best interest decision needs to be undertaken regarding this issue. It was not clear whether those residents who share bedrooms have chosen to do so and therefore the manager agreed to ensure that agreements be implemented to confirm that they have chosen to do so. The inspector observed part of lunch time with the meal served being presented well with residents individual preferences respected. Discrete and sensitive support was provided to those residents who needed assistance. Care staff now undertake the cooking as part of their daily duties. Although there is a planned menu staff spoke about also being able to provide flexibility and spontaneity in the menu to reflect residents needs at the time. A sample of residents comments made about the food included not bad at all and Since the chef left is has been ok. Two relatives spoke about their relative eating well and putting on weight that had previously lost before Care Homes for Older People Page 19 of 33 Evidence: they were at the home and how well diabetics are catered for. Specialist input has been sought from a dietician for a resident in order to promote weight gain. Care Homes for Older People Page 20 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an effective complaints system with evidence that residents and relatives feel that their views would be listened to. Staff have the guidance and training necessary to show them what to do if abuse is suspected. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. In line with the shortfall noted at the last inspection the complaints procedure has been updated to make it more accessible. All residents, staff and relatives consulted with said that they felt able to share any concerns they had with the manager. The manager reported that there have been no formal complaints made since the previous inspection. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with said that they had undertaken the necessary training in safeguarding adults and prevention of abuse and showed an understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Older People Page 21 of 33 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. Residents live in a comfortable, homely environment with their private accommodation personalised and with parts of the home decorated and furnished to a high standard. However not all parts of the home are safe for residents or appropriate standards of odour management maintained. Evidence: The provider reported that the premises are a grade II listed building which places some restrictions on them being able to sometimes promptly respond to maintenance issues while permission is sought to undertake certain upgrades. Despite this the home continues to undergo a gradual refurbishment and upgrade with parts of the building decorated to a high standard. The shortfalls noted in the previous inspection to address areas in need of redecoration has now been undertaken with further bedrooms due to be redecorated in the near future and replacement of some windows. Communal space consists of a dining room and large lounge that opens out onto a raised patio area. This contains seats and overlooks a well maintained garden with residents actively involved in planting up flower containers and creates a very attractive area for residents and their visitors to enjoy. Much effort is made to create a homely feel to the environment in the decor and furnishings. Consistent feedback was received regarding how comfortable the home felt however variable comments were made about the overall standard of accommodation needing a slight upgrade to parts Care Homes for Older People Page 22 of 33 Evidence: of the home being a little dated. Residents bedrooms had been individualised with all residents consulted saying that there bedrooms provided everything they needed. Locks are provided on residents bedrooms with many residents opting to lock their bedrooms when they are not occupied. It was previously required that all windows are fitted with restrictors. At inspection this had not been undertaken and placed residents at significant risk and is discussed under health and safety standard 38 of this report. There is sufficient number of toilets and bathrooms located around the home, including a shower and assisted bathing facilities. There was a range of individual aids and adaptations to assist residents mobility and independence, including raised toilet seats, walking aids, hoist ramps and grab rails. Variable standards of hygiene was noted around the home with some unpleasant odours confined to a few bedrooms, this was also noted at the previous inspection. In line with the previous requirement an alternative flooring has been fitted in one bedroom to help with continence management. A relative commented there is occasionally unpleasant odours which is a little depressing sometimes but they seem to do there best to cope with any accidents quickly. Currently care staff undertake cleaning duties as part of their role. The manager confirmed that they now plan to employ more staff to help ensure that standards can be improved, in the meantime it is required that more robust procedures are put into place to help manage odours more effective. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although residents clearly benefit from a stable, trained staff team , they are placed a potential risk by poor recruitment practices and insufficient staff to be able to ensure appropriate hygiene standards. Evidence: Consistent positive feedback was received regarding staff with particular reference to their kindness and friendliness. Residents were all clearly comfortable in staffs presence with humour often being used to effectively communicate with residents. Staff were observed using sensitive diversion techniques in helping to alleviate a residents anxiety and were knowledgeable about residents and there preferences, with the majority of staff having worked at the home for some time. Residents feedback about staff included Staff listen to me and are always here when I need them and the staff are wonderful. A sample of comments made by relatives included the staff know him very well and he is relaxed around them and they know how to support him staff seem very knowledgeable about dementia and are kind to my mum when she gets muddled and anxious as to what she is doing at the home and consistency of staff I am particularly impressed with. Staff very stable there seems to be little turnover the same faces all the time. As part of care staff duties staff also undertake cooking, domestic and laundry duties and with the increase in residents numbers a staff member felt that they currently do Care Homes for Older People Page 24 of 33 Evidence: not always have enough time to spend individually with residents. They felt that this had sometimes impacted on the quality of occupation opportunities they are able to provide. The standard of hygiene was variable with staff commenting that residents needs came before their cleaning duties. The manager said that they were in the process of further recruiting staff. It has been required that staff are employed in sufficient numbers to ensure the health and welfare of residents. The home has been proactive in ensuring that the majority of staff have completed a National Vocational Qualification in care. The personal files of the two staff were inspected and although these showed that some recruitment checks had been undertaken which includes the use of an application form, interviews and written references prior to employment commencing up to date accurate Criminal Records Bureau checks (CRB) had not been undertaken. This placed residents at potential risk as the manager was unable to confirm that these staff were safe to work with vulnerable people. An immediate requirement notice was issued which required the manager to take action in order to safeguard residents. Staff consulted with confirmed that they have undertaken all of the mandatory areas of training needed to promote residents safely. A staff member fedback I find that the home is doing very good and there had been a lot of improvements concerning the infrastructure and we are having a lot of study days so we are always up to date. The manager spoke about the areas of specialist training also undertaken by staff, including cognitive impairments, dementia and mental health conditions. Although certificates of attending training is maintained the manager had compiled lists of all the training undertaken and due to be undertaken for each staff, this could not be located at the time of inspection to confirm a consistent planned approach to training and development. Care Homes for Older People Page 25 of 33 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. The home is not being managed effectively in ensuring that residents are safe and their wellbeing is protected, as born out by the number of concerns noted at inspection. Evidence: The manager who is also the provider has many years experiences in the care of older people and whom residents clearly responded to. They reported that they have undertaken the recommended qualification in management. Consistent positive feedback was received regarding their approachability and their hands on nature. A residents fedback that the manager was very nice. A relative commented that the manager was good, friendly and responsive with a staff member saying manager nicest person, you can tell her anything very hands on very good and works very hard , is very open. The manager said they undertake the same training as staff and recognised the need to undertake training in changes in legislation effecting people with impaired mental capacity in order to help improve decision for residents. However Care Homes for Older People Page 26 of 33 Evidence: they had failed to ensure residents safety through robust recruitment practices and to address all of the previous requirements, which highlighted the need for more effective management of the home. There are several mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. This includes annual feedback surveys sent to residents and stakeholders involved in residents care with the last set of surveys specifically seeking feedback on celebrations and events at the home. As a result of this feedback, changes to menus, the environment have been undertaken in order to further enhance services at the home. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. Care staff spoke of receiving regular formal supervision and some direct supervision when working with the manager and felt well supported by them to undertake their role. However, closure supervision of staff undertaking medication practices at the home is needed to ensure that the homes medication practices are being followed and residents safeguarded. Written guidance is available on issues related to health and safety. Records submitted by the home stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. the manager reported that a fire risk assessment had been completed by a fire safety expert, which recorded any significant findings and the actions taken to ensure adequate fire safety precautions in the home. The manager reported that recommendations made as a result of this fire risk assessment have been completed. It was previously required that all windows be fitted with restrictors. This had not been undertaken and it was noted at inspection that at least three bedrooms and staff sleep over bedroom windows, above ground level did not provide sufficient restrictors on them in order to safeguard residents. An incident involving a resident falling out of one of these windows occurred the day before the inspection which did no result in serious injury. An immediate requirement was made at inspection to address those windows not suitable restricted as a matter of priority. During the course of the inspection the provider stated that they undertook a check of all but two windows and either mended or fitted restrictors, with assurances that the remaining two bedrooms Care Homes for Older People Page 27 of 33 Evidence: would be checked upon the occupants returning to the home in order to gain entry into their bedrooms. This highlighted that regular health and safety checks of the building and facilities was not effective which the manager must address in order to further promote residents safety. Care Homes for Older People Page 28 of 33 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 That only staff who have 16/06/2009 undergone all of the required recruitment checks are employed by the home including obtaining up to date Criminal Record Bureau checks, prior to commencing employment. To ensure that only staff who are safe to work with vulnerable people are employed 2 38 13 That residents are safeguarded from the risk of falls from windows In order to ensure that residents health and safety is being protected at all times. 16/06/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That care plans provide clear 27/07/2009 guidance for staff on all aspects of the health, personal, challenging behaviour and social care needs of service users and which make explicit the actions needed to meet these needs and which Page 30 of 33 Care Homes for Older People 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 include personal risk assessments for all service users, which are reviewed regularly and records the actions to manage or reduce any identified risks. To ensure that staff provide a consistent support to residents and that any risks residents face and posed are managed or reduced. 2 9 13 That there are arrangements 10/07/2009 in place for the adequate recording, handling, safekeeping and safe administration of medicines at the home To ensure that service users receive medication in accordance with their prescribed instructions and are not placed at risk by poor medication practices. 3 23 16 That robust procedures are put into place to ensure the effective management and eradication of offensive odours throughout the home, To provide a pleasant dignified environment in which to live. 29/07/2009 Care Homes for Older People Page 31 of 33 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 4 27 18 That staff are employed in sufficient numbers at all times to ensure the health and welfare of residents. 29/07/2009 To ensure the health and safety of residents and standards of hygiene can be improved and maintained. 5 31 10 That the registered provider and the registered manager shall having regard to the size of the home, the statement of purpose, and the number and needs of service users carry on or manage the care home with sufficient care, competence and skill. In order to ensure residents safety 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 06/08/2009 1 1 That the service user guide be in a format intended to make the information about how the home works more accessible to some residents who use the service. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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. 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