Inspection on 14/09/09 for Springfields Residential Home

This inspection was carried out on 14th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 29 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Springfields Residential Home 28/09/09

Springfields Residential Home 12/05/08

Springfields Residential Home 07/12/07

Springfields Residential Home 27/07/07

Springfields Residential Home 21/08/06

Springfields Residential Home 12/09/05

Springfields Residential Home 05/02/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Springfields Residential Home Hengist Road Westgate On Sea Westgate Kent CT8 8LP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jo Griffiths     Date: 1 4 0 9 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 40 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 40 Information about the care home Name of care home: Address: Springfields Residential Home Hengist Road Westgate On Sea Westgate Kent CT8 8LP 01843831169 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: barbararicketts@tiscali.co.uk Macari Homes Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Springfield is a detached three-storey property, which provides personal care and support for up to twenty older people, who may also have mental health needs. Accommodation is provided in both single and double bedrooms. There are two lounges and a dining room. Communal areas are large and furnished in a domestic nature. There are gardens to the front, side and rear of property. The home is Care Homes for Older People Page 4 of 40 Over 65 0 20 20 0 Brief description of the care home located within a short walk from the sea front and local amenities. £328.00 - £500.00 per week. Fees range from Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of Springfields residential home carried out on 14th September 2009 between 10.30am and 6.30pm. There is a new manager appointed as being in charge of the home, but she is not yet registered with the Commission. The assistant manager was available during the inspection and the appointed manager joined the inspection later in the afternoon. Prior to the inspection visit information received about the service since the last key inspection was examined. This included the Annual Quality Assurance Assessment (AQAA), completed by the manager and information received from stakeholders and other parties. During the inspection visit the inspector had a look around the home and a number of records and documents used for the running of the home were examined. Five people that use the service were involved in the inspection and five staff members were Care Homes for Older People Page 6 of 40 spoken with. Enforcement action is being taken by the Care Quality Commission in respect of breaches of regulation found through this inspection. Care Homes for Older People Page 7 of 40 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 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 Care Homes for Older People Page 8 of 40 order line 0870 240 7535. Care Homes for Older People Page 9 of 40 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 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service are provided with information about the home, but the provider does not clearly communicate within this the range of needs the service is able to meet. People do not always have a sufficiently detailed assessment of their needs and some people are admitted to the home without assurances that the service has the skills and resources to meet their needs. Evidence: The Statement of Purpose and Service User Guide have been reviewed since the last inspection of the home. The Statement of Purpose does not clearly state the range of needs that the home is able to meet. The Service User Guide is appropriate to the needs of most of the people living in the home and a copy is given to each person to keep in their room. The manager said that the home does not currently have the facilities to produce the Service User Guide in any other formats, such as large print, Care Homes for Older People Page 11 of 40 Evidence: alternative languages or braille. The assessment documentation was seen for three people using the service. Two people had a full assessment of their needs completed by social services on their file. The other person has recently moved to the home and did not have a social services assessment of their need on file. The assistant manager said she had been to visit the person in their previous home and had completed an assessment of their needs. This assessment was not on the persons care plan file, but was produced from the office for the inspector to see. It includes information about some areas of the persons needs, including mental health and personal care, but has not been completed in sufficient detail to ensure a full care plan can be developed to meet their needs in all areas of their life, for example social, nutritional and physical health needs. The assessment does not include seeking the views of the individual or their advocate about their needs. The assessment was written on A4 paper, rather than any formal assessment tool being used. The assessment for the person notes a number of areas of need, including mental health needs and some difficult and aggressive behaviours, that require specialist staff training and that may impact on other residents in the home. It was agreed by the registered provider that the person would move in, but it has since been found by the manager that the home cannot meet the persons needs. The staff have not been trained in managing aggression or working with people with mental health needs. The care plan states that the individual requires two carers to provide all personal care due to aggression and additional staffing arrangements for this have not been made. The compatibility of the individual with other resdients in the home has not been considered or assessed. The social services assessments that were seen for the two other people show that they had a diagnosis of dementia when they were admitted to the home. Inspections carried out by former regulatory bodies since 2005, under the Care Standards Act 2000, have found that the registered provider has continued to admit people to the home that are out of the registration category and that staff have not been trained to meet their specific needs. Some of the staff team have recently completed a suitable distance learning course in Dementia and the manager said it is planned the remainder of the staff will do this to ensure they can meet the needs of these people. The service does not provide intermediate or rehabilitative services and therefore standard six is not applicable. Care Homes for Older People Page 12 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service do not have a care plan that ensures their assessed needs are met. They are risk from poor recording and reporting procedures and their health needs are not always followed up to ensure they are met. People are not consulted on their preferences regarding their daily routines and their personal care and some institutional practices are in place that limit individual choice. The privacy and dignity of people using the service is not fully upheld. Evidence: The care plans were seen for four people currently using the service. One of the care plans had been updated and reviewed in August 2009. Two care plans had not been reviewed since May 2009. At the time of the inspection one person did not yet have a working care plan in place, but the care plan from the previous care home was being used. The assistant manager produced the new care plan, which had been written in draft form, and was waiting to be agreed by the care manager. Care Homes for Older People Page 13 of 40 Evidence: The care plans give staff basic instruction for meeting peoples health and personal care needs. They have not been completed in a person centred way and do not include peoples preferences, for example, times they like to get up, go to bed or have their meals. The care plans do not evidence that people living in the home have been consulted on when they would like a bath or shower. The staff spoken with said that there is a weekly rota for baths and everyone gets a bath and their bed changed once a week. This is institutional practice and does not promote individual choice. There is a record sheet in the care plans to show when people have baths and this confirmed the practice of weekly baths. The records for one person show no bath between 31st August 2009 and the date of the inspection, which was two weeks. The inspector spoke with four people living in the home to gather their views of the support provided for personal care. They confirmed that they have a weekly bath and said that many people in the home, particularly those who have higher needs, are taken to bed straight after tea, sometimes as early as 6pm. They said that if you are more independent you can take yourself to bed when you want to. One of the toilets downstairs does not have a lock on the door. This does not promote the privacy and dignity of people living in the home. Where individual health needs have been identified there is not always a record to show that these have been followed up. Examples of this include one persons care plan that states that they often refuse meals and drinks. The weight record shows that the persons weight has not been consistently monitored and the record shows a loss of 8kg in weight across a period of two months. Any follow up action taken to address this issue has not been recorded in the GP/health record, although staff did confirm that the person was now prescribed nutritional supplements. A fluid chart is in place for this person, but this has not been completed properly. The records show that on a number of occasions there were no fluids given after 5pm and on one occasion there is no record of any fluids given before 4.30pm. Poor record keeping was found in all four of the care plans inspected. Other examples include care plans that state a person requires turning every two hours at night, but the records show this happening every three hours on some occasions. The manager has not monitored these records and taken action to address these matters. The assistant manager said that the more recent records are kept in the file and then when the file is full they are transferred to files in the office. The daily notes for one person showed that care staff have been applying dry dressings to a pressure wound. It is stated in the daily notes that this is under instruction of the district nurse and the manager confirmed that the district nurse has Care Homes for Older People Page 14 of 40 Evidence: agreed to this practice. The care plan does not tell staff what dressings to use or how to apply these. Staff have not received any training in wound care or dressings. Staff spoken with confirmed that they have been changing medical dressings, but that the person no longer requires these and therefore this is not currently happening. There was also an entry in the records that the district nurse was concerned about incorrect use of pressure relieving equipment in the home that may be causing pressure wounds. The Primary Care Trust provides any required equipment, such as air mattresses and cushions, but care staff in the home have not been provided with any training in using this equipment. The care plan for one person states that they may display some behaviour that would compromise their own dignity in public areas of the home. Entries on the daily record show eight occasions during August 2009 where the persons behaviours resulted in a loss of their privacy and dignity. There is also an entry in the daily notes that states that the individual was found during the night in the bedroom of a person with dementia, which is invasive and intimidating for the other person. The home is clearly unable to meet the needs of this individual and the manager agreed with this and is working with the care manager to review the placement. However, the assessment, completed before the person moved in, shows these behaviours are likely to occur and the home should not have admitted the person if they were unable to meet their needs. Two entries seen on the care plan records show people had a fall and one record states unexplained bruising had been found on one person. There were no entries in the accident book for these and the manager said that she had examined the area and did not feel that it required reporting under safeguarding procedures. Three of the care plans do not include a pressure area assessment or a nutritional assessment, although the manager did say that they ask people about their food preferences when they move in. One care plan has a nutritional assessment and a pressure care assessment, but neither have been reviewed since August 2008. One of the care plans viewed refers to the persons need to wear a hearing aid. The person was seen to be wearing the aid during the inspection. The medication that people require is administered by care staff that have completed a training course and have been observed in their practice by the assistant manager. The administration of the evening medication was seen. The medication was dispensed into pots at the medication trolley and taken to the person elsewhere in the home, rather than the trolley taken to the person to dispense directly to them. The registered person must ensure that there is no risk of error in this practice, particularly if the staff member gets distracted whilst carry medicines to service users. The records of Care Homes for Older People Page 15 of 40 Evidence: medication were complete and accurate. Care Homes for Older People Page 16 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered person has not ensured that effective systems are in place for monitoring whether individuals social needs are met and whether they are appropriately occupied during the day. The routines in the home do not promote or respect individuals choice. People are supported to receive visitors when they wish to and to maintain contact with their local community. People are not provided with sufficient variety and choice of meals and have not been consulted on their views of the quality of food. The nutritional needs of some individuals are not being monitored or met. People are at risk of malnutrition due to long periods without meals or drinks. Evidence: As described in the previous section of this report some of the routines of the home are institutional and do not allow for individual choice and needs. This includes the practice of a weekly bathing rota and people being supported to bed at 6pm. The care plans have not been completed in a way that explores individual preferences and Care Homes for Older People Page 17 of 40 Evidence: ensures these are respected and met. There is an activity worker employed in the home who is rotad to work two days a week. The manager said that some weeks the activity worker is only available one day as she is also employed in the other homes owned by the registered provider. There is an activity programme on the notice board in the hallway. This includes visits from the PAT dogs, quizzes, hand massage, hairdresser and moving to music. The activity worker was at the home during the inspection, but had been required to undertake the cooking duties that day as the cook had gone home unwell. The activity worker said she is planning to start networking with other homes in the area to share activities and to promote social contact. She has also made arrangements for the community warden to visit people in the home and has made contact with a local college for befriending sessions. The activity worker said the home is working toward the benchmark for the NAPA standards (accredited activities for older people). She said that when on duty she will take people out for walks and do various 1-1 activities with as many people as she can. The activity worker has completed a social care plan for each person and sends out twice yearly surveys to people in the home to get their ideas for activities. There is a monthly record of each persons involvement in activities that the activity worker arranges. The social care plan and records are not kept in the care plan and the activity worker said she had spoken with the manager and plans to change this. There are no records in the care plan to evidence if the activity programme is carried out when the activity worker is not there. There were no activities happening on the day of the inspection due to staff sickness. People using the service said they can have visitors when they wish to and can see them either in one of the lounges or in their own rooms. There is a pay phone in the hallway for people to use. People using the service said that breakfast is usually served between 7am and 9am and that there is a choice of cereal or toast. Some days there is also a choice of a cooked breakfast. Lunch is served at 12pm and tea at 4.30pm. Feedback from people living in the home was that they felt the meals are served too early and that tea can sometimes be as early as 4.15pm. They said that they do not have anything else to eat in the evening, but that staff will get them a cup of tea if they request it. This means that people are at risk of not having any food or drink for periods of fourteen hours. Some people said that if you are not able to ask for a drink in the evening you would not get one. Some people living in the home would not be able to communicate this request. As previously reported one persons fluid charts show occasions where no Care Homes for Older People Page 18 of 40 Evidence: fluids were given after 5pm. Two people spoken with said they would like to be able to make their own tea and coffee when they want to, but that there are no facilities for them to do this. There is a four week menu with a choice of three dishes for lunch. A record is kept of the choice each person makes, although these records have not always been dated so it would be difficult for the manager to monitor individuals nutritional intake. Two people spoken with said they felt that the quality of the meals is poor and the food is bland. Three people spoken with said they were happy with the food. The lunchtime meal was observed. People had been asked in the morning which meal they would prefer. The meals that were served were presented adequately and condiments were available on the tables. Everyone was offered a cold drink with their meal. Some people require support to eat and staff were seen to sit with the person and provide support at an appropriate pace. One person often refuses their meals and the assistant manager advised a new member of staff that the person may accept the meal if you go back and offer this at various intervals. As previously reported nutritional assessments are not completed for people in the home and records of nutritional intake are not consistently maintained to allow adequate monitoring of their wellbeing. The records show that most people are given sandwiches for tea and this usually consists of marmalade, peanut butter or lemon curd sandwiches. The manager said that this is what they choose, but the records do not evidence that a choice of other dishes is offered. One person spoken with said that they do choose to have sandwiches each night, but four people spoken with said they would like more choices for tea. Care Homes for Older People Page 19 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service know how to make a complaint if they need to, but cannot be assured that their concerns will be investigated appropriately under the complaints procedure. People in the home are at risk of harm and abuse due to a lack of understanding of and compliance with safeguarding procedures. Evidence: The home has a complaints procedure, a copy of which is included in the Service User Guide. The procedure states that any complaints will be investigated within 28 days. The manager said that there have been no complaints received in the home. The Commission has received information indicating concerns about the service and these matters were considered as part of this inspection. The manager said that she regularly talks to all the people using the service to check they are happy with the care they are receiving. This is done informally and no records are maintained of this process. Two people were moving out of the home the day after the inspection. They told the inspector that they had been unhappy with the care and service in the home, but did not wish to give further details. The manager said that she has discussed the concerns with the individuals, but that they still wished to leave. There is no record of this complaint in the complaints book. Care Homes for Older People Page 20 of 40 Evidence: One person spoken with said they have raised concerns with the manager about the quality of the food, but that they have not made a formal complaint. They said that nothing has happened to improve the food. The manager said that the menus are currently being reviewed. The manager was aware of the Mental Capacity Act, but has not yet received any training in this and the staff have not been trained in this area. Some of the staff have received training in safeguarding adults and some have not yet undertaken this training, despite working in the home for eight months. The recruitment procedures in the home are not robust and place people at risk. This has been reported under the staffing section of this report. There have been two safeguarding referrals made about the home since the last inspection. The responsible individual told us, following the inspection visit, that she had been alerted about one of the allegations and had already investigated this. The registered provider failed to follow the correct procedures for reporting allegations in this instance. This allegation is now being investigated under the Kent safeguarding procedures. The second allegation is also being investigated under the Kent safeguarding procedures. The manager was not aware of the Kent multi agency safeguarding policy and was not able to locate a copy in the home. The home has its own safeguarding and whistle blowing policies. The daily records for one service user showed unexplained bruising had been found in September 2009. This was not reported under the safeguarding policy and the manager said she checked the person the next day and did not feel it was a large bruise. The manager must familiarise herself with the Kent safeguarding policy and the registered provider must ensure that any unexplained injuries or allegations of abuse in the home are immediately reported to the local authority following the correct procedures. Six members of staff are living in the home. The manager was not able to produce evidence of criminal records disclosures for any of these employees, although the staff files contain evidence of a POVA first check for three of these people. The manager said they would make arrangements for these people to be under supervision when working in the home. This may still leave service users at risk if the employees are living in the home without the appropriate safeguards having been made. Care Homes for Older People Page 21 of 40 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment does not benefit from an ongoing programme to ensure the fabric of the home is maintained. The environment has not been assessed and suitable adaptations made for people with mobility difficulties. People using the service do not have access to sufficient bathroom and toilet facilities to meet their needs and ensure their privacy. Most individuals have bedrooms that meet their needs, but some people would benefit from more space where they require the use of hoists. Service users do not have unrestricted access to the gardens and the gardens are not appropriately maintained. The home would benefit from a deep clean. People using the service are at risk from a lack of systems in place for checking water temperatures in the home. They do not have access to suitable systems for calling for assistance if required. Evidence: The decor of the home is shabby in some areas and requires some redecoration. The home is kept clean on a surface level, but requires some deep cleaning, particularly to Care Homes for Older People Page 22 of 40 Evidence: the bathrooms and toilets. There are cobwebs around some areas of the home and some bedrooms have an unpleasant odour. The housekeeper works five days a week, but was leaving at the end of the week. The manager said that it is planned that a new housekeeper will be recruited, but that this has not happened yet. The manager said the care staff would have to undertake the housekeeping duties until the post is filled. The housekeeper said that there are red dissolve sacks available for handling soiled laundry, but that there is no sluice in the home or sluice facility on the washing machine. Maintenance tasks are recorded in a book for the handyman, but there is no ongoing maintenance or redecoration plan for the home. The handyman was off on long term sick leave at the time of the inspection and a new employee has joined the home to undertake some of the maintenance tasks. Some of the service users spoken with complained of the state of the gardens and said it was a shame as they used to be well maintained and a pleasure to use. The lawns had been mowed, but the flowerbeds were very overgrown. There are three toilets for service users use on the ground floor and one bathroom. One of the toilets has no lock on the door and therefore individuals privacy cannot be maintained. One of the toilets is locked from the outside. The assistant manager said this was to prevent one particular service user from accessing this without staff. The lock is positioned up high preventing any service user from accessing the toilet. There are only two staff on duty in the afternoon and some people require two staff to support them with personal care and mobility. If two staff are supporting a service user then other service users may have to wait for staff to become available before they can use the toilet that is locked. There are a further two bathrooms, one with a shower, and a toilet on the first floor. The home has two lounge areas and one dining room. There is a small quiet room upstairs, but this is currently used for storage. Access to the garden is through a fire exit from a corridor. This has a keypad on it and the assistant manager said that those that are able to use the code are given this so that they can go out in and out of the garden when they wish to. The assistant manager said that some people require staff support to access the garden anyway as the garden is not safe for them to walk in unaccompanied. The environment should be assessed and risks managed to allow everyone in the home access to the garden when they want it. There is a hoist in the home for one person. The layout of the home is not suitable for the safe manoeuvring of hoists and wheelchairs and staff were seen to struggle in areas, particularly some small bedrooms. There has been no formal assessment of the Care Homes for Older People Page 23 of 40 Evidence: premises in relation to adaptations and equipment that may be required. The call bell system was not working effectively as the board on the first floor had a fault and would not sound when a bell was pressed in a bedroom. This was tested in two bedrooms. The board had been taped over and the assistant manager and manager said they were unaware of the board being broken or how long it had been out of action. Two of the bedrooms in the home are registered as shared rooms. People must only share a room if they have made a choice to do so. One of the shared bedrooms is currently occupied by an individual whom the manager said would not be able to make an informed decision to share the room with another person. Therefore the registered person must ensure that this person remains accommodated in a single bedroom. The home had twelve service users at the time of the inspection, accommodating eleven bedrooms. There are seven vacant bedrooms in the home. Six members of staff are currently living in the home and are residing in the vacant bedrooms. They are sharing bathroom facilities with service users which limits the availability of these facilities for the people in the home. Three of the staff members have not yet had a criminal records check and are unsupervised in the home when they are not working. Some bedrooms were seen. The bedroom for one person who had recently moved to the home was very sparsely decorated. The assistant manager said that the person had not arrived with many personal belongings. The person has not yet been supported to choose new items to personalise their bedroom. The majority of bedrooms were personalised with the individuals belongings. Some bedrooms are quite small for people that require help with their mobility. The assistant manager was not sure whether water temperatures were regularly checked in the home. A record of testing was found in the office, but this has not been completed since April 2009. One member of staff was observed to be using a thermometer to check the temperature of a bath she was running. Care Homes for Older People Page 24 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service are not supported by sufficient numbers of trained and competent staff to meet their needs. People that use the service are placed at risk due to poorly managed systems for vetting new employees. Evidence: On the day of the inspection the staff on duty included three care staff, the assistant manager, the cook, housekeeper and the activity worker. The cook was unwell so went home and the activity worker undertook the catering duties for the day. This meant that the planned activities were cancelled. Two of the care staff on shift are new and were working their second shift. The experienced carer was responsible for supervising and inducting these staff members during the morning. The assistant manager was on duty and said she was completing some paperwork delegated by the manager, but assisted with the inspection. The rota was seen for the period 7th September 2009 to 20th September 2009. This showed that three new carers were employed to the home and started work on 9th and 10th September 2009. One carer started their first shift as the second carer on a night duty. There are usually two waking night staff on duty and therefore this arrangement did not allow for the appropriate supervision of this staff member within normal Care Homes for Older People Page 25 of 40 Evidence: staffing numbers. The other two carers started work on a long day (double day shift). They were rotad as the third and fourth carers, again not allowing for appropriate supervision and induction. Some staff work long hours and the rota showed a member of staff due to work a night duty followed by a long day. This means the staff member would be working continuously for twenty four hours. The assistant manager agreed to review the rota to ensure the appropriate deployment of staff and appropriate supervision arrangements of new employees. A housekeeper is employed in the home five days a week, but was due to leave at the end of the week. A new housekeeper has not yet been recruited. The manager said that the staff would be required to cover the housekeeping tasks until the post is filled. The staff files were examined for seven members of staff. This includes the three newly employed carers, three carers employed within the last year and the new handyman. The registered provider recruits staff from overseas using an employment agency. The files do not contain evidence that POVA first checks, Criminal Records Bureau (CRB) checks, or an application form have been obtained. One of the carers was able to produce a copy of her police check from her country of residence when requested by the assistant manager. The other two carers did not produce these documents when requested by the assistant manager. The files for the three carers employed within the last year contained evidence that POVA first checks have been received, but there was no evidence of receipt of the CRB. The manager was asked to locate these, but was unable to do so during the inspection. It was also found that appropriate references have not been taken up in respect of two of these workers. One person has references dated 2007 and the other has references dated 2008, when both staff members were employed into the home in 2009. The references seen on the two files were not addressed to the provider and therefore the provider cannot be sure of their origin and authenticity. The six workers whose files were inspected as above, are all accommodated in the home. As appropriate CRB and POVA checks were not evident at the time of the inspection an immediate requirement was issued to ensure that service users are safeguarded until this is rectified. The last file that was inspected was for the newly appointed maintenance worker. The appropriate documentation and evidence of the required checks was in place. Care Homes for Older People Page 26 of 40 Evidence: The training records were inspected for six staff members. The three new care staff have not yet completed any training. The assistant manager said they would be starting their skills for care induction and registering for their NVQ. One of the new carers was spoken with and confirmed she had not received any training yet. The three carers who had been employed within the last year had completed a skills for care induction and training in first aid, infection control and medication. They have not yet completed any training in Moving and Handling or Safeguarding adults. The assistant manager showed the inspector an invoice for a moving and handling theory course, but this did not contain any practical instruction and did not confirm that the three carers in question had completed the training. The manager said that moving and handling training has been booked, but that the registered provider has instructed that all training be postponed due to financial constraints. The manager said she intended to go ahead with the planned training courses anyway. The three carers who have not yet received training in safeguarding adults or moving and handling have been placed in charge of the new workers on night duties. This practice can not ensure the safety of service users. The manager said approximately half the staff team recently completed a distance learning course in dementia and that the remainder of the team completed an one day training course in dementia. This included the three staff whose files were reviewed by the inspector. There were no certificates or records on file to evidence this training. Staff have not received any training in mental health despite a person being admitted to the home with mental health needs. 50 of the staff team have completed an NVQ or are working toward this. Care Homes for Older People Page 27 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can not be assured that they live in a home that is run by a person that has demonstrated they are fit to be in charge of running the home. The home is not run in the best interests of the service users. The systems for monitoring the quality of the service are ineffective and therefore the registered provider cannot be assured of the quality of care and the safety of service users. Evidence: A new manager has been appointed to the care home since the last inspection. This manager has not yet applied for registration with the Care Quality Commission and must do so immediately in order to demonstrate their fitness to manage the home. The manager holds a number of relevant qualifications in care and management. Since the last inspection of the service the home has not been effectively managed. Some of the care plans and records have not been appropriately reviewed and maintained. There have been a number of incidents that have not been reported properly and allegations not reported under safeguarding procedures. Staff have been Care Homes for Older People Page 28 of 40 Evidence: employed to the home without the proper checks being made to ensure service users are safeguarded. Some staff have received training in health and safety and moving and handling, but a number of staff employed within the last year have not yet completed this. The food hygiene certificate for the cook expired in January 2009. Water temperature checks have not been made since April 2009. The most recent quality audit by the responsible individual was seen. This had been completed by the manager and signed by the responsible individual and the manager confirmed this is standard practice. There is therefore no effective system in place for the responsible individual to monitor the quality of the service and to monitor the day to day management of the home. The audit had not identified any of the issues found in this inspection. The manager said she was unsure when the last annual Quality Assurance audit took place, that included seeking the views of service users, and was not able to produce a report for this. There is no annual development plan for the home. The manager stated that she plans to undertake an audit soon. The manager and assistant manager have recently taken on additional duties of invoicing local authorities and service users for the fees for the home and paying the staff wages. This is taking a lot of their time away from the running of the home and both said they did not feel they were sufficiently trained to do this task. Care Homes for Older People Page 29 of 40 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 30 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must 23/09/2009 ensure that the documentation required under schedule 2 is obtained for all persons employed to work in the home. Appropriate checks must be made for all staff residing in the home and suitable arrangements made for their supervision until such checks have been completed. To safeguard people using the service. 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 4 The statement of purpose must include the range of needs of service users that the service is able to meet. To ensure that people are provided with clear information about the service in order for them to make a decision about using it. 23/10/2009 2 4 14 The registered person must demonstrate that the home is able to meet the assessed needs of individuals before 23/10/2009 Care Homes for Older People Page 31 of 40 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 admitting them to the home. The registered person must not admit service users outside of the registration category. To ensure that people moving to the home are assured that their assessed needs will be met. 3 7 12 Care plans must be 23/10/2009 completed in a person centred way that ensures that indidivuals preferences about their care and support are included and respected. To ensure indidivuals receieve their care and support in the way they prefer. 4 7 15 Individuals must have a care 23/10/2009 plan that ensures their assessed needs are met. The care plan must be regularly reviewed and amended to reflect changes in need. To ensure that individuals needs are monitored and met. 5 8 12 The registered person must ensure that the nutritional needs of people using he service are assessed and monitored. 23/10/2009 Care Homes for Older People Page 32 of 40 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 ensure that people have their nutritional needs met. 6 8 12 Effective systems must be in 23/10/2009 place to monitor the health and welfare of people using the service. Action must be taken and recorded in respect of any health or welfare concerns. To ensure that individuals health and welfare needs are met. 7 10 12 A suitable lock must be fitted to the toilet door. A risk assessment must be completed for the individual who is at risk of breach of privacy and dignity. To ensure that privacy and dignity of people using he service is respected and upheld. 8 12 12 People using the service 23/10/2009 must be consulted on their preferences and routines in the home must be flexible to meet individual needs and preferences. To ensure that people are supported to live their lives in the way they prefer. 9 12 16 Adequate records must be maintained to enable the 23/10/2009 23/10/2009 Care Homes for Older People Page 33 of 40 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 manager to monitor that individuals social needs are being met. The social needs care plan must be included as part of the overall plan of care. To ensure that people have their social needs met. 10 15 17 The registered person must consult with people using the service and provide adequate facilities for them to prepare their own food and drinks if they wish to. To promote and maintain individuals independence. 11 15 16 The registered person must 23/10/2009 ensure that food and drinks are provided at regular intervals and that the quality of meals is monitored. People must be given appropriate choices of foods. Records of meals provided and choices offered must be maintained. To ensure people have their nutritional needs met, have a choice of meals and have wholesome meals that meet their expectations. 23/10/2009 Care Homes for Older People Page 34 of 40 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 12 16 22 The registered person must 23/10/2009 ensure that a record is made of all concerns and complaints raised in respect of the home. To ensure that complaints are fully investigated and resolved. 13 18 13 The registered person must 23/10/2009 ensure that all allegations of abuse are reported following the Kent safeguarding policy. To safeguard service users. 14 18 13 The registered person must 23/10/2009 ensure that the manager and all staff receive training in safeguarding adults and are aware of the correct reporting procedures for any allegations. To ensure that any allegations of abuse are appropriately reported and investigated to safeguard service users. 15 19 23 The registered person must ensure there is an ongoing programme of maintenance and redecoration for the home and external grounds. 23/10/2009 Care Homes for Older People Page 35 of 40 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 ensure a pleasant and safe environment for service users. 16 20 23 Service users must be given unrestricted access to the garden and this must be made safe for them to use. To ensure service users can access the garden when they wish to. 17 21 23 Service users must have access to suitable and sufficient bathroom facilities that meet their needs and maintain their privacy. To ensure service users privacy and dignity are maintained. 18 22 23 The call bell system must be 25/09/2009 repaired. To ensure service users can call for assistance when required. 19 22 23 The registered person must 23/10/2009 ensure that an assessment of the premises has been made, by a suitably qualified person, and adaptations made as required. 23/10/2009 23/10/2009 Care Homes for Older People Page 36 of 40 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 maximise service users independence and ensure the safety of service users and staff. 20 23 23 Service users that require the use of hoists must be accommodated in bedrooms that are of a suitable size to allow the safe use of this equipment. To ensure the safety of service users and staff. 21 25 12 A system must be in place for ensuring safe water temperatures. To ensure the safety of service users. 22 26 16 The registered person must 23/10/2009 ensure that the home is kept clean and free from offensive odours. To provide a pleasant and safe environment for service users. 23 27 18 Sufficient numbers of 23/10/2009 suitably experienced, competent and trained staff must be employed in the home to meet the needs of the people using the service. 25/09/2009 23/10/2009 Care Homes for Older People Page 37 of 40 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 ensure service users needs are met and that they are safeguarded from harm. 24 28 18 All new employees must be registers on an induction programme that meets the requirements of skills for care To ensure new staff are appropriately trained to meet service users needs. 25 30 18 The registered person must 23/10/2009 ensure that a training programme is in place that ensure all staff are trained and competent in their roles. To ensure staff are trained to meet service users needs. 26 31 9 The registered provider 23/10/2009 must ensure the home is run by a person who is competent and assessed as fit to do so. To ensure the home is run effectively and in the interests of the service users. 27 33 24 The registered provider must ensure that effective systems are in place for the monitoring of the quality of the service and that an 23/10/2009 23/10/2009 Care Homes for Older People Page 38 of 40 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 annual development plan is in place. To ensure the home provide quality care and support to service users. 28 37 17 The registered provider must ensure that accurate and detailed records are maintained in respect of the running of the home. To ensure service users health and welfare are monitored and their needs are met. 29 38 12 The registered person must ensure that systems are in place to ensure the health and safety of service users. To ensure service users safety. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 23/10/2009 23/10/2009 1 23 It is recommended that people living in the home be supported to furnish and personalise their bedrooms with items of their choice to make their room more homely and comfortable. Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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