Inspection on 23/11/09 for Spencefield Grange

This inspection was carried out on 23rd November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Spencefield Grange 04/03/10

Spencefield Grange 16/02/09

Spencefield Grange 06/03/07

Spencefield Grange 13/12/05

Spencefield Grange 26/05/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: Spencefield Grange Davenport Road Leicester LE5 6SD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ruth Wood     Date: 2 3 1 1 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: Spencefield Grange Davenport Road Leicester LE5 6SD 01162418118 01162418118 Debbie@hicare.co.uk www.hicare.co.uk HiCare Limited care home 63 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: 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 physical disability Additional conditions: The maximum number of service users who can be accommodated is 63 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Mental Disorder, excluding learning disability or dementia - Code MD Old age, not falling within any other category - Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home The home provides accommodation for up to 63 people and is owned by Hicare Limited. It is located in a quiet suburb on the outskirts of the city of Leicester and has access to a regular bus service. The building is a modern purpose built service offering accommodation on ground and first floor level. Bedrooms on the first floor are Care Homes for Older People Page 4 of 33 Over 65 0 0 63 0 63 63 0 63 1 6 0 2 2 0 0 9 Brief description of the care home accessed by a shaft lift. There is ample car parking facilities to the front and side of the home. At the rear of the home there is an extended patio terrace with garden furniture and ornate water fountain. The garden has level access for people with impaired mobility. There are suitable facilities to support people with physical disabilities such as handrails. Specialist equipment for the prevention of pressure sores is also available through the district nursing service. A copy of the most recent inspection report is available in the reception area. The fees for 2009 to 2010 are from £430 to £470. 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: one star adequate 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 inspection took place on a weekday between 09:30 and 17:00 and was undertaken by two inspectors. Before the inspection visit we looked at information from the following sources: The services Annual Quality Assurance Assessment (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Information about incidents that have occurred in the home that the registered manager has told us about. These are called notifications. Some of the people who live at Spencefield Grange have dementia. Because people with dementia are not always able to tell us about their experiences, a formal way to observe people was used to try and understand this. Four people with dementia were Care Homes for Older People Page 6 of 33 observed to ascertain their general state of well-being and how they interacted with staff members, other people who live in the home, and the environment. The observation took place in the main lounge between 10:45 and 12:40. We looked at how peoples care needs are met by examining their care plans, speaking to people directly and speaking to staff members about how they meet peoples needs. We also observed how staff supported people during breakfast and at lunchtime and observed how staff moved and transferred people. We spoke to staff members about their experiences of training and recruitment in the home and about their understanding of how to keep people safe. We also looked at a sample of staff training and recruitment records. How medication is administered and managed was observed and discussed with senior staff members and we looked at arrangements in place for storing medication. We looked at all communal areas of the home and one persons bedroom. Fire maintenance and testing records were also looked at. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 33 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service Users Guide needs updating to make sure that people have accurate information about the home before they move in. Evidence: Each person living at Spencefield Grange has a copy of the Service Users Guide and these are also given to people thinking of coming to live in the home. Some information in the Service Users Guide is not accurate (such as the number of bedrooms in the home) and information about the assessment process is not written clearly. The registered person must update this document and keep it under regular review to ensure that it accurately reflects the services and facilities within the home. Peoples needs are assessed before they move into the home and they are offered the opportunity to visit Spencefield Grange for a days trial. Assessments from social workers and other commissioning workers are also obtained and we saw copies of these for the people whose care that we looked at in detail. Care Homes for Older People Page 11 of 33 Evidence: The information gathered for the homes in-house assessment could be improved. The assessment and care plan for one person who had come to live in the care home this year did not record details of the persons mental health diagnosis. The assessments of other people who have lived in the home for some time have not been updated to reflect the changes in their needs. Assessment is an important process as it enables the managers of the service to ensure that the service is able to meet the ongoing needs of the people living in the home. Spencefield Grange does not provide intermediate care, therefore Standard 6 is not applicable. Care Homes for Older People Page 12 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. Peoples care plans do not give staff clear information about how to meet peoples needs and how to manage identified risks. Evidence: We looked at five peoples care plans; some of these people were part of a specialist observational study. We also spoke directly to two of the people, observed their care and spoke to staff about how they deliver care. Although a sheet within the care plan indicates that plans are reviewed every month, only brief notes are made, primarily in relation to visits from health care professionals. Assessments and care plan documents are not always updated and therefore peoples plans contain information that is out of date and it is not always possible to ascertain what a persons current needs are or how staff should meet them. For one person with particular dietary needs it was unclear from their plan just what they could and could not eat because old information was mixed up with more recent information. Information in their plan did show however that appropriate intervention from specialists such as Speech and Language Therapists had been sought to meet this persons needs. Care Homes for Older People Page 13 of 33 Evidence: Risk assessments, particularly in relation to the management and prevention of falls are not sufficiently detailed and do not give staff sufficient information and guidance. For one person the staff response to the risk of falls is documented as, for staff to monitor and assist with all mobilising where possible. The assessment does not specify just how staff are to assist, and there were insufficient staff at the home on the day of the inspection to allow staff to follow this instruction. We observed that when this person needed to go to the dining room for lunch they got up themselves, unaided and held on to doors and walls to assist their walking. Discussion with the registered manager at the end of the inspection identified that this person had been referred to a specialist falls advisor by the hospital, following one of their hospital admissions. This was not clearly documented, neither were recommendations by the specialist nurse for the use of hip protectors and pressure sensors documented. These recommendations have not yet been implemented. Equally, risk assessments in relation to eating for this person do not give staff sufficient direction about how to meet the persons needs. The entry X eats well when sitting, sometimes needs feeding gives no guidance as to when and how staff should support this person to eat. Records did indicate that health care support from General Practitioners and other professionals is sought. People also have access to chiropody and optical services. One person with a physical disability told us that they used a specialist bed and chair to make sure that their skin did not become sore and that staff checked their skin. This was also recorded in daily records. They also said that they enjoyed having a bath once a week but hadnt had one for some time. We observed the medication being administered. One senior staff member was responsible for the medication round and we observed that they were also attempting to monitor the serving of breakfast in the dining room. They told us that the round had started at 08:30am that morning. We observed that the morning medication round was not completed until 11:30am. The lunchtime medication round commenced at 12:40pm. The senior said that they had receive appropriate training and we observed that their practice was good; they asked people if they required pain medication before giving it and always signed the Medication Administration Register (MAR) after they had observed the person had taken the medication. We were concerned however with the number of distractions that the staff member had to deal with during the administering of medication, and would strongly recommend that the service review practice in this area to ensure that the person giving out medication can focus solely Care Homes for Older People Page 14 of 33 Evidence: on this task. This may also ensure that there is a more appropriate interval between when some people recieve their morning and lunchtime medication. We looked at the arrangements for the storage and monitoring of medication. The service now has appropriate storage for controlled medication, although we noted that money is also kept in here before being transferred to the safe. The Controlled Drugs cabinet should only be used for the storage of controlled medication. Records of controlled medication were accurate. Following the theft of medication by a staff member during the summer, a system of daily audits was implemented. As there have been no further incidents this audit has been reduced to three times per week. Two peoples MAR showed that they had been prescribed a sedative on an as required basis but that this was being given regularly on a daily basis. The registered manager said that the peoples GP had directed this but there was no documentary evidence for this. We asked the manager to obtain this evidence and forward a copy to the Commission. Because people with dementia are not always able to tell us about their experiences, a formal way to observe people was used to help understand this. Four people with dementia were observed, to ascertain their general state of well-being, and how they interacted with staff members, other people who live in the home, and the environment. The observation took place in the main lounge between 10:45 am and 12:40 pm. Outside of the specialist study we also directly observed how staff interacted with other people in the dining room. The specialist observation showed that for 70 of the time, staff engagement with people was neutral and was mostly focused on specific tasks, primarily handing out coffee and tea. Staff did not use this opportunity to speak at any length to people living in the home. Biscuits were served to people from a very large tub and for one resident who liked plain biscuits these were taken out by staff members and two given to them. Good interaction was observed between staff members and one resident who was being hoisted from their wheelchair to an armchair. The person appeared frightened but staff were able to re-assure them and make them laugh. One person was seen by their GP in the lounge and staff did not have time to reassure the person before the examination took place. This caused the person distress and staff had to spend time with them after the consultation and told them to keep their hand on their shoulder. It was unclear why the staff member had told the person to do this (the instruction had not been given by the doctor) and the staff member did not come back to check or offer any further advice to the person. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor management of mealtimes detracts from the good quality of the food served and means that some people do not have an enjoyable mealtime or one that consistently ensures they receive adequate nutrition. Evidence: Because people with dementia are not always able to tell us about their experiences, a formal way to observe people was used to help understand this. Four people with dementia were observed, to ascertain their general state of well-being, and how they interacted with staff members, other people who live in the home, and the environment. The observation took place in the main lounge between 10:45 am and 12:40 pm. We found that none of the people we observed were in a withdrawn state of being, and as a group people during this period spent only 6 of their time in a negative state of being. The four people we observed were in a positive or passive state of being for the majority of the observation period. Staff interaction with people was focused almost exclusively on giving out tea and coffee and there was a 45 minute period when there was no contact with staff at all. There were no formal activities arranged for the morning of the inspection; the registered manager said that staff may arrange some activities in the afternoon. We Care Homes for Older People Page 16 of 33 Evidence: did raise the issue that for some people the afternoon may not be their most receptive period. The home does have a separate activities room, which contains a large TV screen, computer with internet connection and other equipment. We observed one person using this facility on the day of the inspection to watch a recording of the 1966 world cup match. Another person that we spoke with said that they used the computer to go on Face Book to keep in contact with their family and friends. The activities coordinator works three days per week and the manager said that a wider range of activities is available on these days. During the warmer months the home arranges outings, using its own transport. During the inspection a minister came to see one resident to recite scripture. For those people who can access and use the facilities in the activities room, the home would seem to provide sufficient activity, however for people with higher dependency needs and particularly for those with dementia, more pro-active interaction from staff would improve the quality of their day to day lives. One person summed up their daily experience by saying, We have dinner, come back here [the lounge] until we go to bed. Another person said that the staff were very kind but there hasnt been much conversation. We spoke to three relatives visiting the home; all said that they are made welcome when they come to visit. One person visits regularly and has their meals with their relative. Another relative said that they were phoned straight away by staff if there were any concerns about their mother. Food is freshly cooked on the premises and people spoke positively about the quality of the food, the food is beautiful. The menu for the day is written up by one of the people living in the home and displayed on a board in the dining room. On the day of the inspection, the choice of main course was Cornish Pasty or Beef Casserole. It would be a good idea if people with dementia were shown these options to help them make a decision about which dish to choose. The atmosphere in the dining room and the way that food was served both during breakfast and lunch did not create a relaxed and enjoyable experience for people and detracted from the good quality of the food being served. One person was observed asleep sitting in their wheelchair at the breakfast table at 10:30; there was toast and juice in front of them. Staff members and managers had been in the dining room but the person was still in the same position at 11am. The senior carer informed us that this person had been brought to the table at 08:30 and that they were having some problems eating. We asked that the person be given the choice of being helped to eat Care Homes for Older People Page 17 of 33 Evidence: their breakfast or being asked if they wished to leave the table. We noted that two other people were sat in their wheelchairs for extended periods at the breakfast table without eating or drinking. One person was wheeled out of the dining room at 11:15 and then wheeled back into the dining room at 12 noon although they did not start to receive their lunch until 12:30. None of these people appeared to have any choice about the time that they came into the dining room or left it. We observed another person at breakfast time who had been sat at the dining room for over half an hour with a plate of toast in front of them; they were then assisted to eat by a staff member. The staff member stood to the side of their wheelchair and was putting toast into their mouths without communicating to the person or observing the persons response. We asked a senior staff member to intervene. This same staff member was later observed helping another person eat their soup at lunchtime. Again the staff member did not communicate with the person and did not observe that the person was becoming distressed as they were not being allowed sufficient time to swallow between spoonfuls. We stopped the staff member and asked the assistant manager, who was stood nearby, to intervene and supervise the staff member. The staff member told us that this was their first day at work. The atmosphere in the dining room, particularly during breakfast was chaotic and no one seemed sure when people had eaten, if they required help or if they wanted to leave the table. There appeared to be no overall management of what was going on and the only person monitoring peoples food intake was the senior carer who was trying to administer medication. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current observed practice does not always ensure that people are protected. Evidence: Two people that we spoke with said that they would feel able to speak to the manager or a staff member if they were not happy with anything and a visiting relative told us that they were always informed straight away if there were any issues regarding their relative who lived in the home. The Complaints Procedure is outlined in the Statement of Purpose and a record of complaints received and the response to them is kept. The staff members that we spoke with said that they had received training in safeguarding vulnerable adults and the documentation that we saw supported this. One staff member did not know about whistle blowing; we are aware that this is part of the safeguarding training so this indicates that additional supervision may be required to ensure that all staff have fully assimilated and understood the training they have received. Not all staff have received training in the implications of the Mental Capacity Act or in the Deprivation of Liberty Standards. Given that people with dementia and mental ill health live in the home, care staff should have an understanding of these two areas. In an earlier outcome group (Health and Personal Care) we highlighted that ways to manage potential risks to people are not always documented clearly and that staff Care Homes for Older People Page 19 of 33 Evidence: practice in this area is not always consistent. In the Daily Life and Social Activities outcome group we outlined our observations that some people in the dining room at breakfast time had been left in their wheelchairs at the table for excessive periods, in one case in excess of two hours after they had finished eating. We also observed two people being assisted to eat by a new staff member who was clearly not competent in this area and was not being appropriately supervised. Care Homes for Older People Page 20 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. Systems of monitoring the physical environment need improving to ensure that all areas of the home are clean and comfortable and pleasant to live in. Evidence: Spencefield Grange has been undergoing a period of refurbishment and currently a new reception area is being created in the Entrance Hall. The registered manager also informed us that the laundry area was to be extended. There was a smell of urine in the downstairs corridor but all other areas of the home were clean and fresh smelling, including the bathrooms and toilets. We noted that all bathrooms in use have suitable, safe heating but that some do not have curtains or blinds at the windows to ensure that people can bathe in private. We looked in one persons room, at random on the first floor. The room was very bare with no personlisation; the mattress and base of the bed were stained and the headboard was dirty and torn. Packs of continence pads were piled into the corner of the room and the drawers in the chest were off their runners, resulting in clothes spilling out. The pillow had been placed into a cover that was too small, was lumpy and looked uncomfortable to sleep on. We pointed these issues out to the manager who said that she had not been made Care Homes for Older People Page 21 of 33 Evidence: aware of them. The rota shows that there are between three and four housekeepers on duty in the morning so it is concerning that none of the housekeepers or carers had reported these concerns or ensured that the persons room was comfortable and pleasant to sleep in. Steps were taken to address these issues before we left the home. The manager said that they were looking to replace some of the beds, but until that time they arranged for a valance to be fitted. The drawers had been repaired but the pillow case still needed changing. The service should also look at additional storage for continence supplies to help maintain peoples privacy and dignity. The upstairs lounge/activity room is nicely furnished, with home entertainment area, computer, and new chairs. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are insufficient to ensure that the needs of all the people living in the home are met consistently. Evidence: We observed that people had to wait a long time (sometimes for over two hours) before they were helped to return to the lounge from the dining room following breakfast. We also observed that staffs interaction during our specialist observation of people with dementia was limited to specific tasks and that for 45 minutes of that two hour period there was no interaction with staff at all. Staff we spoke with said that people did get their personal care needs met, but it had to be done quickly. One person living in the home told us the most common response they hear from staff is, In a minute. People living at Spencefield Grange have a wide range of complex needs. At the time of the inspection this included people with physical disabilities, people with dementia and people with serious mental health conditions. On the morning of the inspection there were four care staff on duty and three seniors, for one senior it was their first day at work and they were acting in a direct care role. One senior was observed to be carrying out the majority of supervisory tasks as well as administering medication. Although it was their first day the new senior was given a task to help people to eat and was not supervised. The inspector had to intervene to ensure that two service Care Homes for Older People Page 23 of 33 Evidence: users were not placed at risk as the senior did not appear competent in this area. We looked at two recently appointed staff members recruitment records. Both peoples names had been checked against the Protection of Vulnerable Adults register before they started work in the home and two references were on file, although for one person these were both from the same company. Criminal Records Bureau enhanced checks had been applied for both people and received for one. Although the home has copies of the Skills for Care Common Induction Framework, this system is not being used for the induction of new staff. We looked at one persons induction record which was recorded as starting on 06/07/09 and was signed off as completed on 07/07/09. The manager said that the induction period took place over 5 days and that there had been a mistake in recording. The persons file also had a form asking what they had thought of their induction; this had not been completed. We spoke to the person about their experience of induction and they said that they had been shadowed for two weeks. They had been given a week to fill in induction booklets. They had not had formal supervision from the manager but had received support from colleagues. Staff have the opportunity to complete National Vocational Qualifications; one person that we spoke with said that they had just completed their NVQ at level 3. Staff also said that they had received training in areas such as moving and handling, first aid and dementia care but the staff member that we spoke to was unclear how the latter training had informed their practice. Staff have not received training in working with people with mental ill health and not all staff have received training in the Mental Capacity Act and Deprivation of Liberty Standards. Given that there are people with mental ill health and dementia living in the home, all staff should receive training in each of these three areas. We also recommend that staffs training in dementia care is consolidated through supervision and discussion as from our observations they appeared to be unaware of the importance of effective communication with people with dementia. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current management does not always ensure that the home is run in the best interests of the people living there. Evidence: The registered manager holds National Vocational Qualifications in care and the Registered Managers Award. As yet she has not received any appropriate training in meeting the needs of people with mental ill health conditions. Given that people in this registration category are living at Spencefield Grange the manager should arrange to receive this training alongside her staff team. Evidence outlined in previous outcome groups suggests that the management and deployment of staff in the home does not always ensure that all people living in the home enjoy good quality outcomes consistently. Direct observation in particular demonstrated that some people were left without staff contact for extended periods and that there are no clear systems in place to ensure that all people receive adequate nutrition and hydration in a timely fashion. Observations detailed in previous outcome Care Homes for Older People Page 25 of 33 Evidence: groups also indicate that new staff are not always correctly supervised. The service sends surveys to people living in the home and their relatives to find out their views about the quality of care. We looked at some of the responses received this year and these were mostly positive. We reminded the registered manager and provider that the information that they forward to the Commission in their Annual Quality Assurance Assessment must be accurate and say what is actually happening in the service. We noted that the assessment told us that booklets with menu choices were available for people living in the home so that they could study what they would like to eat. The registered manager confirmed that such booklets have never been available. The three staff that we spoke to said that they had received training in moving and handling and documentation confirmed that all staff receive this training. We observed staff moving and transferring people safely and giving appropriate reassurance to one person who appeared frightened of the hoist. Documentation and discussion with staff also confirmed that training is given in statutory areas such as first aid, fire safety and infection control. We asked to see the record of fire equipment tests and the fire risk assessment for the home. The fire risk assessment initially could not be found but was eventually located but was not fully completed. The document had been sent through from the parent companys head office in June partially completed but the registered manager had not been made aware that she had to complete the document. The registered manager had not checked the document at this time to make sure that it was a valid assessment. A representative of the organisation visits at least every month to ensure that home is being correctly managed. At least five such visits had been made to the home but the incomplete fire risk assessment had not been highlighted with the manager. The registered manager said that she would complete this straight away; the completed assessment was forwarded by e-mail to the Commission, later on the day of the inspection. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 31/03/2009 ensure that how to meet each aspect of a persons health and personal care is outlined in detail in their care plan This is to ensure that all of a persons needs are met consistently by the staff team. Care Homes for Older People Page 27 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 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 1 5 The registered person must 31/01/2010 update the service users guide to ensure that it is an accurate reflection of the accommodation and services provided at Spencefield Grange. This is to make sure that people have accurate information about the home to enable them to make an informed decision about whether the service can meet their needs. 2 7 13 The registered person must ensure that clear and detailed information is recorded about how risks to service users health and safety should be managed This is to ensure that staff know what action they should take to ensure the safety and well-being of service users. 01/03/2010 Care Homes for Older People Page 28 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 3 7 15 The registered person must ensure that care plans give detailed information about how each service users identified needs should be met. This is to ensure that each service users individual needs are met consistently 15/03/2010 4 7 14 The registered person must 15/03/2010 ensure that each service users written assessment of need is kept under review and updated when their needs change This is to ensure that staff have access to an accurate and up to date record of a service users current needs 5 12 16 The registered person 31/03/2010 should review the opportunities for activity and social interaction available for service users with dementia in the home. This is to ensure that suitable opportunities for social interaction and activity are available for all people living in the home and to ensure no service user becomes socially isolated. Care Homes for Older People Page 29 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 6 15 12 The registered person must 15/01/2010 ensure that those service users who need support with eating and drinking receive this from a suitably trained and competent staff member at a time of their choosing. This is to ensure that all service users receive adequate nutrition and hydration. 7 19 16 The registered person must ensure that all bathrooms have suitable window coverings. This is to ensure the privacy and dignity of the people living in the home. 31/01/2010 8 27 18 The registered person must 31/01/2010 review staffing levels in the home and ensure that having regard to the size of the care home, the statement of purpose and the number and needs of service users there are at all times suitably qualified, competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of service users. Care Homes for Older People Page 30 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 This is to ensure that the needs of all people living at Spencefield Grange are met consistently and safely. 9 30 18 The registered person must 31/03/2010 make suitable arrangements to ensure that all staff receive training related to the implementation of the Mental Capacity Act and the Deprivation of Liberty Standards. This is to ensure the privacy and dignity of the people living in the home. The registered person must 30/04/2010 make suitable arrangements to ensure that all staff receive training in the conditions associated with mental ill health This is to ensure that all staff have the necessary knowledge and understanding to meet peoples needs 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 10 30 18 1 9 How medication is administered in the home should be reviewed to ensure that the staff member responsible for Care Homes for Older People Page 31 of 33 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 this process is able to carry it out in an efficient way, with the least possible distraction, so that all service users receive their medication at the appropriate time. 2 3 10 12 Medical examinations and/or treatment should be provided in the service users own room. For some service users, actual examples of the meal choice on offer should be shown to help them when they are trying to decide what to eat. Alternatively, photographs of the food on offer could be used. We strongly recommend that the registered person reviews how meals are served in the home to ensure that all service users who require assistance receive it in a timely fashion from appropriately trained and competent staff and that for all service users mealtimes are a relaxed and enjoyable event. Suitable storage should be provided for the storage of continence aids so that these are not on display in peoples room. The registered manager should ensure that a robust system is in place to report any dirty or damaged furniture and or equipment in service users rooms. Any issues identified should be remedied as quickly as possible to ensure that all service users rooms provide a clean and comfortable place to sleep in. 4 15 5 24 6 24 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. 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