Inspection on 27/03/09 for Springdene

This inspection was carried out on 27th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Springdene 01/06/09

Springdene 16/01/07

Springdene 04/11/05

Springdene 03/05/05

Springdene 14/12/04

Springdene 20/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Springdene 55 Oakleigh Park North Whetstone London N20 9AT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Duncan Paterson     Date: 3 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Springdene 55 Oakleigh Park North Whetstone London N20 9AT 02084462117 02084462110 gaye.summers@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Springdene Nursing & Care Homes Limited care home 56 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 56 The registered person may provide the following category of service only: Care Home with nursing - Code N 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Springdene is a purpose built care home registered to provide nursing care for 56 elderly people, some of whom may also have dementia. A short stay rehabilitation service for people between hospital and home is also provided. The stated aim of the home is to provide a service that is safe, sociable, comfortable and healthy to live Care Homes for Older People Page 4 of 35 Over 65 0 56 56 0 Brief description of the care home in. The home is owned by a company called Springdene Nursing and Care Homes Ltd. The company also has three other care homes in London. The company is led by a board of directors. The home is built on four levels and there are two shaft lifts. On the lower floor there is the kitchen and laundry as well as some bedrooms overlooking the garden. On the ground floor there is the main lounge area and bedrooms. The first floor has a small lounge and the main dining area. The second floor provides a designated service to people who have a higher range of needs and includes a lounge and dining area for these service users. The top floor provides a large activity room and hairdressing room. There are 55 single bedrooms and these all have en suite shower rooms. There are also four assisted bathrooms. The staff team consists of a manager, two deputy managers, nursing staff and a team of carers. There is a team of ancillary staff including catering staff, laundry assistant, cleaning staff a handyman and reception staff. The current scale of charges are £895 -£995 per week. Care Homes for Older People Page 5 of 35 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: This key inspection took place on 27th March and 30th March 2009. On the first day of the inspection two inspectors visited and spent the day checking care records and talking with residents, relatives, staff, the manager, the Operations Manager and Administrator. The second inspector is an inspector with nursing experience who looked specifically at nursing care, health matters and medication arrangements. The second day of the inspection was carried out to complete checks of staff records. A standard form, the Annual Quality Assurance Assessment (AQAA), was returned to us and this was taken into consideration. Returned surveys from earlier in the year, when we had carried out an Annual Service Review, were also considered. The inspection also involved an assessment of the homes records, procedures and forms as well as observation and a view of a sample of bedrooms. Care Homes for Older People Page 6 of 35 What the care home does well: What has improved since the last inspection? What they could do better: This inspection has found evidence of a fall in standards since the last key inspection of January 2007. There is a need to modernise, streamline and have clearer care plans for residents. The care plans need to include specific plans on all aspects of health care. Specific risk assessments such as for bedrails, manual handling and pain management need to be either drawn up or made clearer. The wishes of residents and their representatives need to be identified so that wishes can be clear and respected. The wishes for residents in terms of end of life care also need to be discussed and recorded to ensure that these needs are met. Auditing of the medication arrangements needs to be carried out on a regular basis and remedial action is needed in a number of medication areas to ensure that medication practice is safely and consistently managed. There is a current safeguarding investigation at the service. When this is completed the home owners will need to draw up an action plan to address any arising matters. The complaints records seen during the inspection provided evidence of competent complaint management but we became aware of complaints subsequently made to the home which will need further work to ensure they are fully investigated. Further, feedback from relatives is that there are matters of concern, such as communication with the home and waiting times for meals, which need to be captured by the homes quality assurance system so that they are speedily resolved. We found a number of staffing matters which have affected the smooth running of the home. Staff handover, communication and staff supervision arrangements were not Care Homes for Older People Page 7 of 35 well organised and were not effective. These need to be amended so that staff have up to date information about residents needs and so that staff are monitored as to how they provide care. Formal and informal supervision arrangements are poor and need to be strengthened. Staff training records were poorly kept leaving a knowledge gap about staff training needs and no clear or reliable method of planning for future training. Staff recruitment, although generally thorough, needs more regular auditing to make sure that staff are not allowed to work before all the recruitment checks have taken place. The overall management arrangements for the monitoring, supervision and quality control of the home need a review. The owners had not identified problems with staff supervision, staff training and recruitment or with staff handover arrangements. This type of issue should be identified through regular monitoring of the home. In addition, increased quality assurance initiatives are needed so that relatives and residents views are obtained and responded to in relation to mealtime arrangements and communication about residents needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 35 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 9 of 35 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 good standard of information available about the service can be improved by providing more detail about the rehabilitation service provided. Assessments are completed and arranged well. The rehabilitation service is well organised and equipped and provides a good standard of care. Evidence: There is a range of information available for people considering moving in to the home or placing a relative here. This includes a brochure and a statement of purpose. A number of services are provided at this home including a short stay rehabilitation service for people who have been in hospital, an outpatient service as well as the more traditional nursing home service. The statement of purpose clearly sets out details about the home and what people can expect. However, there needs to be more detail about the other services provided particularly the rehabilitation service. Details about the provision of end of life care is also needed as the service is providing care in that area. This will assist people when they consider using the service. A Care Homes for Older People Page 10 of 35 Evidence: recommendation is given about this. Contracts were not viewed at this inspection. However, the manager advised that there were a number of residents who had arranged their care privately as well as a number who were being supported by local authorities. Eight residents case files were inspected as part of the inspection. A sample of files were examined on each floor of the home with residents care provision case tracked. There are detailed case files for each resident with a lot of information obtained at the assessment period. We found some problems with how this information was translated into care plans and more detail about that is given in the next section. However, in terms of obtaining information about residents assessed needs the home was either obtaining that information or was receiving relevant information from local authorities. The rehabilitation unit, or clinic, as it is known at the home, is on the lower floor with additional space on the ground floor if needed. It was set up almost two years ago and provides a short stay service for people who have been in hospital before they return to their own homes. There were four people staying during the inspection. There is a dedicated unit leader running the unit as well as a dedicated space within the home on the lower floor. There are bedrooms as well as a pool, a gym and a dining room. There are physiotherapists and occupational therapists in the staff team able to provide such services to residents. One resident spoken with during the inspection expressed great satisfaction with the service. She said that, the service was great, and had helped her tremendously. Care Homes for Older People Page 11 of 35 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 need for some updating and modernisation of care plans to ensure that residents care needs are being met and individual needs monitored. Medication arrangements need to be regularly audited and steps need to be taken to make sure that the practice followed is in line with legislation and correctly recorded. More work is needed to make sure that residents end of life wishes are identified so that steps can be taken to meet these wishes. Evidence: We inspected eight residents care plans during the inspection within the nursing home part of the home as well as an additional two care plans in the rehabilitation unit. Care plans had been formulated for most needs. However, in some instances the information was general and needed personalising, and for one resident the care plan was not available for all identified needs such as nutritional and social needs. There was also some conflicting information in respect of mobility needs in one care plan and the documentation needed updating to clearly reflect the current status of the resident. Care Homes for Older People Page 12 of 35 Evidence: Risk assessments for falls had been completed. However, in one instance the care plan documentation had not been updated promptly following a fall and no mention of the fall was found in the daily record. Although for another resident a fall had been clearly documented. The accident book had recorded 25 falls from 7 January 2009 to the day of the inspection which indicates a need to review falls and update care plans accordingly. Bedrails were seen in use and were referred to in some documentation viewed. However, it was not always clear if bedrails were in use and risk assessments for the use of bedrails had not been completed. A signed consent for use was seen for one resident and the manager said that written consents are obtained for all residents for whom bedrails are in use. Between the first and second day of the inspection the manager had drawn up a bedrails use risk assessment. This must now be used for occasions when bedrails are in use. Correction fluid had been used on some documentation viewed. This is unacceptable practice. A medical term had been used to describe the position a resident needed to be in for a particular procedure. The need for all staff to be aware and understand what is meant by such a term was discussed with the manager. Care plans had not always been been formulated for specific medical conditions. There was no evidence of involvement from residents and their representatives in the formulation and review of care plans. This was borne out in discussion with relatives a number of whom told us that it was difficult to get information about their relative from staff. Such input from residents and representatives should assist in gaining a clear picture of each residents individual needs and how these are most effectively to be met. Wound care documentation was viewed. Some of the information needed updating to reflect a change in the dressing regime and this was done at the time of the inspection. Assessments for pressure risk were in place. However, some updates were required to accurately reflect the residents condition. No photographs of wounds were seen so it was difficult to assess the progress of wound healing. Pressure relieving equipment was seen in use in the home. For one resident with moving and handling needs the assessment had not been completed and this was done at the time of the inspection. The actual equipment to be used for each resident had not always been identified and the home does have different hoists so this needs to be clearly recorded for each individual. Nutritional assessments had been carried out. We were informed that care plans are reviewed monthly and assessments three monthly. However, in some instances assessments had not been reviewed in these timescales and updates were required. In addition, some of the records, such as Care Homes for Older People Page 13 of 35 Evidence: weight records and health care appointment records, are kept separately. This is potentially confusing and requires all records to be brought together to gain an overall picture of each residents needs. The need to carry out an audit of all care plans and take appropriate action to bring them up to date was discussed with the manager and a requirement about this is given. The rehabilitation unit keeps records of care provided. Two case files here were examined. These were well ordered and contained a great deal of information. The record of physiotherapy and occupational therapy provided was particularly detailed. Each stay at the home is rounded up by a discharge letter setting out future care needs. We sampled medication management and records for all nursing floors and the rehabilitation unit. A front sheet was available for each resident and provided clear relevant information. Photographs were available for some residents and the need to obtain a photo for each resident for identification purposes was discussed. Medication receipts had been recorded and administration records had been fully completed on the medication administration record (MAR) charts viewed for the ground and first floors. Some gaps in signing were noted on MAR charts viewed for the second floor. Where a variable dose had been prescribed, the actual dose being given was not being recorded. For one medication where the dosage was made up of different strength tablets , the overall dose given was being signed for. Liquid medications had not been dated when opened, and in one instance the date of dispensing was four months previously. However, it was not possible to tell when the medication was actually opened. In some instances when a medication had been omitted, the reason for omission had not been recorded. Handwritten entries on the MAR charts had been signed by the GP in some instances but there were some entries that were not signed. If nursing staff are making a handwritten entry on the MAR this should be checked and signed by two nurses as good practice. The home uses a 28 day monitored dosage system and we viewed some from each floor. The stocks were correct. We also did a stock balance check for two boxed medications and these were also correct. For residents on medication to control pain, no pain assessments were seen. A care plan for pain was seen. However, there was no evidence of how the pain control was being monitored. The controlled drugs register was up to date and stocks checked were correct. We found that the controlled drugs were being stored in a small wooden cupboard in the medication room, even though an approved controlled drugs cupboard was available in the same room. It was explained that due to the code to the safe being lost the controlled drugs cupboard was being used to store residents money. This was addressed at the time of the inspection. However, it was concerning to note that staff were not aware of the storage requirements for controlled drugs. The home Care Homes for Older People Page 14 of 35 Evidence: was sending medications back to the dispensing chemist for disposal and the need to arrange correct disposal in line with current legislation for nursing homes was discussed. Medication arrangements for the rehabilitation unit were discussed with the nurse in charge of the unit and a sample of records viewed. Medication arrangements here are complex as they involve residents bringing with them medication for short stays and therefore changes in a short space of time. There had been a recent medication error in this unit which had been reported to us. Action had been taken and the relevant consultant spoken with. The error had taken place when the unit leader was on leave and was not identified immediately. The unit leader said that two staff now check medication into the home. This is good practice. However, there is a need for more regular monitoring and auditing of medication and a requirement is given about this. There was some very positive staff interactions with residents observed during the inspection and a number of residents said positive things about the care they received. Less positive were some of the comments from relatives, some of whom felt that communication was poor with difficulties experienced with getting information from staff. There was also feedback that to get things done, such as minor repairs, involved constant talking to staff rather than staff at the home taking action spontaneously. We found that the handover information and communication amongst staff was not effective and more information about this is given in the staffing section. After the inspection we were informed about complaints which included issues of dignity. These are being addressed by the homes management. The care plans did not contain any information regarding the wishes of residents and their families in respect of health deterioration and end of life care. This needs to be addressed so that all residents are offered the opportunity to discuss their wishes, which can be recorded and then actioned should the health of the resident deteriorate. It is acknowledged that this is a sensitive topic and where a resident or their family does not wish to discuss it then this should be recorded. As described above, the statement of purpose should include details about end of life care provided at the home. The manager advised that a number of referrals were received for such care. Care Homes for Older People Page 15 of 35 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. Changes to activities personnel have led to a lack of consistency in activity provision. More needs to be done to make sure that residents wishes about activities are understood and planned for. Better communication with relatives is needed. Mealtime arrangements need review to address peoples concerns about waiting times. Evidence: The service has been affected in recent months by the loss of two of the activities staff. This has meant that care staff have taken the lead for some activities and an activities organiser from one of the other homes in the group has spent time at this home. The owner advises that new activities staff will be appointed and the plan is to resume activities in a similar style as before. Formally, there was a good standard of activities provided and the home was well resourced with a separate activities area and dedicated staff. Feedback we received from relatives included some dissatisfaction with the current arrangements and the feeling that relatives, particularly those who have relatives with dementia, were not getting the support and involvement from staff they were used to. We did see activities sessions both in the morning and afternoon of the inspection which were attended by approximately 12 residents at each session. In addition, care Care Homes for Older People Page 16 of 35 Evidence: staff were observed to be working on a one-to-one basis with residents. There were also a number of relatives visiting throughout the day. However, there were some residents seen in the second floor lounge just sitting or sleeping in the period before lunch. In addition, we have already mentioned that care plans were not capturing residents and representatives wishes. The section about activities on one care plan seen was blank. When the care plans are reviewed the activities sections will need to be included in the review and brought up to date where required. There is very good contact with the local community. Many of the residents have visitors on a regular, and in some cases daily, basis. We spoke with a number of relatives on the day. Feedback was not positive in a number of cases. Concerns were raised about communication with them and some examples were given of not being able to get up to date information about their relatives condition. Another example was raising matters with staff and then later finding that the matters had not been passed on to the manager or deputy manager. There were additional worries about staffing levels and the speed with which minor repairs were carried out. These concerns indicate an overall poor level of staff communication, management and supervision and are discussed further in the staffing section. We observed lunch being served on two of the units, sampled the meal and spoke to residents, relatives and staff about the arrangements. The meal looked and tasted good. The food was well presented and there is an effective means of getting meals from the kitchen to the dining table quickly. A dumb waiter links the kitchen with the homes dining rooms. Staff were helping residents to eat where needed and were observed to be assisting in a kindly manner. There was an open atmosphere with one relative observed to join a dining table to eat lunch with residents. However, there was feedback to the homes March 2009 survey from residents which included residents reporting that they had to wait a long time for meals. Further, the recent safeguarding issues include some expressed concerns about the serving of meals and length of time residents have to wait. This needs to be carefully examined by the home owners and manager so that they can be confident there are no underlying issues of concern. A requirement is given that the arrangements for serving meals are reviewed which covers residents wishes, staff deployment, waiting times and supervision of staff. Care Homes for Older People Page 17 of 35 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. Ensuring that all complaints received are fully investigated and establishing a system for the quick resolution of relatives and residents concerns will bring additional confidence in the service for residents and relatives. Similarly, setting out an action plan addressing arising matters from the safeguarding investigation will enable any arising matters to be actioned. Evidence: The complaints records were inspected. There had been six recorded complaints since September 2009. The records kept relating to these were clear and gave an account of the complaint issue, how investigated and what action was taken as a result. There is information about how to raise a complaint within the home. However, from the feedback from relatives we received it is clear that there are concerns that relatives may have that are not being addressed. For example, day-to-day matters such as minor repairs or communication issues could be easily resolved on the day. There needs to be a more effective quality assurance system to capture these matters and resolve them quickly. Following our inspection we were advised of two complaints that had subsequently been made. One still required further work to make sure that all matters were investigated and it was unclear as to the second how that had been responded to. All complaints must be fully investigated. Care Homes for Older People Page 18 of 35 Evidence: There has been a recent safeguarding issue at this home which is currently being investigated through the local authority safeguarding protocols. Following the outcome of the safeguarding matter the home will need to draw up an action plan to include any agreed arising actions. An overall requirement about this is given at this stage. Care Homes for Older People Page 19 of 35 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 excellent 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, clean home which is kept to a good standard. Residents have the freedom to personalise their rooms. Relatives would welcome more information about the carrying out of minor repairs. Evidence: Overall, a very good standard of accommodation is provided. The home is purpose built to a good standard with single bedrooms provided all with en suite facilities. There is a range of communal space as well as separate activity rooms. The lower ground floor, which contains the rehabilitation unit, has a separate gym area as well as a therapy pool. There is an attractive landscaped garden to the rear. A number of bedrooms were visited during the inspection and each was comfortably furnished and had residents individual items such as photographs and keepsakes. The home was clean and tidy and the design bright and welcoming. We were shown records of regular health and safety meetings where matters relating to repairs and other health and safety matters were discussed. There are maintenance staff available. We were shown paperwork relating to the regular servicing and maintenance of the home. We noted that some sections of the corridor carpets, such as outside sluice rooms, were marked. Re-carpeting was discussed with the manager and the homes Care Homes for Older People Page 20 of 35 Evidence: administrator who advised that action was to be taken at a future date after budget discussions. As described above, there was some concern expressed from relatives about the speed of completing minor repairs. This type of matter should be addressed through more effective quality assurance and communication systems with relatives. There was also concern expressed about the security of the home and the danger of some vulnerable residents wandering outside the home. There had been one recorded incident of this and precautions taken as a result such as locking the front door. The manager will need to address this matter on an individual basis through resident risk assessments. Again, this can be completed during the review of care plans. Care Homes for Older People Page 21 of 35 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. Residents will receive a clearer service from more informed staff if staff handover and staff monitoring arrangements are improved. This should also lead to better communication with relatives. Recruitment checks need to be improved to make sure that all staff are properly vetted. Staff training is poorly recorded and needs improvement. Evidence: The staffing rota was inspected, discussions were held with the manager and a number of staff on duty and records were viewed of staff recruitment and training. Feedback from relatives and residents was obtained and observations were made. On the day of the inspection there were adequate numbers of staff on duty. There were both nursing and care staff assigned to each floor. However, feedback was received from a care staff and two relatives that in the recent past staffing levels had been low. The manager said that staffing levels had been affected by sickness in November 2008 but had got back to normal in December 2008. She also said that staffing levels had increased a few months before when the numbers of residents at the home increased. Handover arrangements between staff and shifts as well as staff supervision and monitoring were discussed. Records relating to handovers were viewed. There were a Care Homes for Older People Page 22 of 35 Evidence: number of records including a communication book, an allocation book and an exercise pad used to record arising matters. The manager said there were three shift handovers throughout the day but that the manager was only present for the afternoon handover and the manager said that no specific records of handovers were kept. The records seen were not detailed. The communication book provided a range of information on arising issues but not about each resident. The allocation book listed the staff on duty and who was in charge of medication but no detailed information about current matters relating to each resident. The manager said that the book was meant to include details about escorts for residents but that that information was not there for that day. This lack of staff handover information was backed up through comments received from relatives about poor communication experienced when they asked about their relative. Similarly, a member of staff spoken to was not clear how many other people were on duty with him on the afternoon of the inspection. The manager said that between 1 -3pm on the second floor there was no nurse present. This may be having an impact on communication with relatives and should be reviewed. We found that formal staff supervision was not happening as regularly as is required. This is described in the next section. Informal supervision is not effective either. The manager described how she monitored staff on a day-to-day basis by walking through the home and observing practice taking up issues with staff accordingly. She said that she had completed two staff supervision sessions that day but had not recorded them. To be effective the staff monitoring and supervision system needs to be more systematic with records kept. A management presence at handover meetings is needed with records kept of those meetings. Staff training records were inspected. It was clear that staff have received a range of relevant training as training certificates were seen either in the training records or on individual staff files. However, the training records were poorly organized and it was impossible to tell what training each member of staff had received without a lengthy trawl through paper records. The current system of recording is not effective and needs reorganisation. A computer system should be used to record, audit and monitor training. When this audit has taken place the manager will be able to plan required training for staff for the year ahead. A sample of recruitment records were inspected. On the whole, recruitment practice is thorough. However, the system needs to be carefully checked to make sure that all checks are made before staff start work at the home. One staff members reference needed further checking with the last employer and a second member of staff was Care Homes for Older People Page 23 of 35 Evidence: allowed to start working at the home without having been properly vetted. A Criminal Records Bureau (CRB) check or POVA First check had not been obtained for the staff member. The manager stopped the worker from working until the check had been obtained but more monitoring of the system is needed to make sure that all checks are received. Care Homes for Older People Page 24 of 35 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. The owners need to take a more proactive role in managing and running the home. Systems such as staff supervision, staff recruitment and the recording of staff training have not been identified by the owners as ineffective. And more detailed quality assurance initiatives will bring benefits by involving more residents and relatives and addressing their concerns. The manager may need further training and support to be fully effective. Evidence: Shortfalls in staff communication, handover arrangements and informal staff supervision have already been identified. The formal staff supervision arrangements were also found to be lacking and needing to be developed. Staff supervision records were seen but not all the staff had received supervision and the manager had not always recorded supervision. Annual appraisals were being carried out and recorded but more frequent, detailed staff supervision is required. This will enable staff to receive motivation and space to address any training or development matters. The manager has clearly worked hard to manage the home but, on the evidence of this Care Homes for Older People Page 25 of 35 Evidence: inspection, requires more help, support and guidance. There should be a review of her training and support needs and assistance given as required. The home owners will need to introduce a greater range of monitoring, quality assurance and supervisory initiatives. The poor communication experienced by relatives and poor organisation of staff handover information risks affecting the smooth running of the home. As discussed earlier in the report, the quality assurance initiatives, although able to capture peoples views, needs to be extended so that relatives can express concerns and so that concerns can be resolved quickly and efficiently. The lack of progress with staff supervision should have been addressed through the routine monitoring of the home by the home owners as should the staff training issues. The system for looking after residents money was examined. This is a relatively simple system whereby small amounts of money are looked after to pay for hairdressing and other expenses such as toiletries. Records are kept and the money is held securely. Care Homes for Older People Page 26 of 35 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 27 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 An audit of all care plans must be carried out to bring care plans up to date and to have all care information about each person in one place. Having all care plan information in one place and up to date will assist staff to provide care and brief relatives. 01/07/2009 2 7 15 Before bedrails are used a bedrail risk assessment must be carried out to ensure that the use of bedrails is the most appropriate method of ensuring the residents safety. To ensure that the risks associated with use of bedrails have been assessed before use. 01/05/2009 3 7 15 Input from the resident and / or their representative 15/05/2009 Care Homes for Older People Page 28 of 35 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 must be sought for the formulaton and review of the care plans, unless it is impracticable to carry out such consultation. This will ensure the needs and wishes of the resident are clear and can be respected. 4 7 15 Care plans must be individualised, up to date and identify all the needs of the resident. This will ensure that all a residents needs can be met. 5 7 15 Following a fall the falls risk assessment and all related documentation must be reviewed and updated. To ensure that any increased risk of falls is identified. 6 8 15 Wound care documentation must be up to date and evidence the wound management of each wound. To ensure that the correct information is recorded and available for each wound. 15/05/2009 01/05/2009 15/05/2009 Care Homes for Older People Page 29 of 35 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 7 8 13 The equipment to be used for the moving and handling of each resident must be clearly identified in the individuals care plan. To ensure that the correct equipment is used in each case. 15/05/2009 8 9 13 All medications must be stored and disposed of in line with current legislation. To ensure that medications are properly disposed of. 01/05/2009 9 9 13 Where a medication is omitted, the reason for omission must be clearly recorded. To provide a safe system for administration of medication. 15/05/2009 10 9 13 Liquid medications must be dated when opened. To assist in the management of medication practice. 01/05/2009 11 9 13 Where a resident is on medication for pain control, a pain assessment and system for monitoring the effectiveness of the pain control must be in place. 01/05/2009 Care Homes for Older People Page 30 of 35 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 To provide an effective means of planning individual care. 12 9 13 Where a variable dose of 01/05/2009 medication is prescribed, the actual dose administered must be individually signed for. To ensure effective medication practice. 13 9 13 Where a medication dosage 01/05/2009 is made up of more than one strength of tablet, each tablet administered must be individually signed for. To ensure effective medication practice. 14 9 13 The receipt, administration 01/05/2009 and disposal of medication must be monitored through regular auditing with records kept and remedial action taken as indicated. To ensure that there is consistent good practice and that any errors are identified in a timely manner. 15 9 13 All medications must be signed for at the time of administration. To ensure effective medication practice. 01/05/2009 Care Homes for Older People Page 31 of 35 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 16 11 12 The wishes of residents and 01/06/2009 their families in respect of health deterioration and end of life care must be discussed and clearly recorded. To ensure that residents and families wishes about end of life care are met. 17 15 16 A review of mealtime arrangements must be carried out. To ensure that residents wishes are addressed and that meals are served in a timely manner. 01/07/2009 18 16 22 All complaints received must 01/05/2009 be fully investigated. This will ensure that people can have confidence that their concerns will be listened to and addressed. 19 27 18 Staff handover 01/05/2009 arrangements must be reviewed with more effective handover, staff communication and staff monitoring procedures put in place. Records must be kept. Care Homes for Older People Page 32 of 35 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 will enable the effective communication of information between the staff team. 20 29 18 Staff training records must be audited with records drawn up for each member of staff. A training plan for the home must be put in place. This will allow the manager to be clear as to the training needs for each member of staff and to plan accordingly. 21 29 19 Staff must not be offered work at the home until all information in respect to Schedule 2 of The Care Homes Regulations 2001 has been obtained. This will ensure that staff are properly vetted before working with residents. 22 31 10 A review of the managers training and support needs must be carried out. Training and support should be provided as indicated. This will enable the manager to receive training and support relevant to the role. 01/07/2009 01/05/2009 01/07/2009 Care Homes for Older People Page 33 of 35 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 23 33 24 More effective monitoring, quality assuarnce and supervisory initiatves must be introduced by the home owners. This will allow the owners to plan the service and address arising matters effectively. 01/07/2009 24 36 18 All staff must be provided with regular supervision. To ensure that staff are supported and monitored in their work with residents. 01/05/2009 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 1 1 More detail about the rehabilitation service and other services provided at the home should be included in the statement of purpose. Handwritten entries on the medication administration records (MAR) not signed by the GP should be checked and signed by two nurses. For the purposes of medication management, unless a resident refuses, a photograph should be available of each resident for ease of identification. Replacement of corridor carpets should be considered within the current financial year. The absence of a nurse between 1-3pm on the second floor should be reviewed. 2 8 3 9 4 5 19 27 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!