Inspection on 16/12/09 for St Lukes Care Home

This inspection was carried out on 16th December 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Lukes Care Home 11/12/07

St Lukes Care Home 04/07/06

St Lukes Care Home 23/09/05

St Lukes Care Home 24/05/05

St Lukes Care Home 11/10/04

St Lukes Care Home 26/04/04

St Lukes Care Home 09/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: St Lukes Care Home Palace Fields Avenue Palacefields Runcorn Cheshire WA7 2SU     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: Phil McConnell     Date: 1 5 0 1 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: St Lukes Care Home Palace Fields Avenue Palacefields Runcorn Cheshire WA7 2SU 01928791552 01928759244 stlukes@c-i-c.co.uk www.c-i-c.co.uk Community Integrated Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 60 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: Dementia Code DE Date of last inspection Brief description of the care home St. Lukes is a purpose built establishment for the provision of nursing care for up to sixty residents diagnosed with dementia inclusive of 2 places registered for physical disability. This service is provided within four separate suites located over two floors, each unit has its own lounge, dining room, utility kitchen and staff team. Each unit provides accommodation for a maximum of 15 residents. The design features include passenger lifts, safety alarmed exit doors, single level flooring with external access, Care Homes for Older People Page 4 of 29 Over 65 0 60 Brief description of the care home grab rails, and adaptations in all communal areas, bathrooms and toilets. Externally there is a central patio area and sensory garden accessible to all residents. St Lukes is located in a large residential area on the outskirts of Runcorn. The home is on a main bus route and rail links are within two miles of the home at Runcorn East station. The service is provided by Community Integrated Care, a not for profit organisation. Care Homes for Older People Page 5 of 29 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: An unannounced visit to St Lukes took place on the 16th of December 2009, which was carried out by three inspectors from the Care Quality Commission, another visit was carried out on the 17th of December by one inspector and a subsequent unannounced night inspection was carried out by one inspector on the 14th January 2010. In total the visits lasted approximately 19 hours. St Lukes wasnt due to have an inspection visit until 2011, however because of a recent situation, involving a police investigation, it was decided to carry out an unannounced inspection. Other information was also gathered in order to be able to assess the National Minimum Standards for Care Homes for Older People. Throughout the inspection visits, there was the opportunity to speak to some of the Care Homes for Older People Page 6 of 29 people who use the service in private, speak to some visitors and discussions also took place with some of the staff team, both during the day and at night. Peoples files were examined, with all relevant documentation being in place including, initial assessment documentation and care plans. Seven of the staff files were examined and they also contained all of the necessary documentation needed for inspection purposes including, recruitment information and evidence of various training that has been provided. Throughout the site visits there was the chance to observe the support and care that was being provided to individuals, which was done in a caring, appropriate and professional manner. The organisations policies, procedures and the health and safety documentation were examined and they were found to be up to date and satisfactory. A tour of the premises was carried out and it was found to be clean, safe, hygienic, comfortable and very well decorated throughout. Care Homes for Older People Page 7 of 29 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 order line 0870 240 7535. Care Homes for Older People Page 8 of 29 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 29 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. People are assessed and admitted to the home appropriately so that their care needs can be effectively planned. Evidence: We were advised by the managers that the home completes detailed assessments prior to people being admitted to St Lukes, so that the home are sure that any assessed care needs can be met. We saw some assessments, which had been carried out on people, who had been admitted to the home [including a recent admission] and these were generally very thorough. They were supported by further information and assessments from professionals such as social workers and health care professionals so that a full picture of the person could be built up. From this information a care plan can be drawn up. Some of the assessments seen were not always dated. This is important so that accurate records are maintained and the assessments can be placed in context. Care Homes for Older People Page 10 of 29 Evidence: We also had some discussion with reference to one person who has had decisions made around end of life care and, although discussions had been inclusive and good practice generally maintained, we did not see any mental capacity assessments on file. General admission assessments do not contain any capacity assessments and staff spoken with had not received training around the Mental Capacity Act and were also unaware of issues relating to peoples restrictions on liberty and care managed in their best interests [recent law on Deprivation of Liberty for example]. We would strongly recommend that assessments reflect current good practice so that decisions made on behalf of people supported in the home are based on their capacity which has been assessed. We have made some training recommendations under the staffing section of the report. We saw that information is made available to people. There are notice boards in all parts of the home and these contain information about the home and activities and daily life. We also saw key policies available such as the complaints procedure. There is a service user guide and the home have also produced their own booklet on dementia and also on infection control so that relatives and people living in the home can be made more aware. This helps people to orientate and settle into the home. Care Homes for Older People Page 11 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health care needs are very well monitored, helping to ensure that peoples personal care, privacy and dignity are maintained. Evidence: We looked at the care records for three of the people in the home. These were fairly comprehensive and we were able to follow the care of the people concerned. The care records include a care plan which details the care needed for each person so that staff can carry out the care with some consistency. These were completed well and included reference to a diverse range of peoples individual needs. For example one person had a pressure sore which was being well monitored and treated using a range of good practice. There were clear records of care staff interventions including dressings and routine pressure relief. There were also good notes showing that the tissue viability nurse had been involved at various times. This shows that the home are liaising with external health care professionals. We visited the person who was being cared for in bed. They looked comfortable and there was good attention paid to personal hygiene. The care staff were able to give an update on the care and it was Care Homes for Older People Page 12 of 29 Evidence: clear that there was good communication between the nurse and care staff. The care plans are evaluated monthly and these were generally written so that we could get an understanding of the persons progress and contained good detail.We could not find a lot of evidence that relatives are kept up to date and have input into the care planning process. Evaluations did not contain any reference to relatives input and we would recommend that this is a good time to include relatives [at various times] so that they can have a full discussion about care needs and be kept up to date and included in the care. Some of the comments from relatives regarding the care provided were, Its excellent here, the staff are so obliging I am always kept informed about mums health and Any problems with mum and they are on the phone right away. One of the comments from one of the nurses was, People are totally dependent on us, we need to protect their dignity. We need to be their hands and eyes. To become the extended person, because they cant do it themselves. The care records contained very good references to peoples health care needs. A visiting professional spoken to, made their own entries in the care files, which demonstrates effective communication regarding peoples health care needs. We saw references in care files of input by chiropody, district nurses, dietitians and GPs. We were informed that people are regularly monitored by a consultant psychiatrist who attends the home for reviews. We looked at the care of one person who is currently exhibiting behaviors that are of a challenging nature and staff have an observation chart to monitor this. Part of the monitoring is to assess whether there are any triggers in the environment that may be causing the behaviors but the information recorded is not thorough enough to evaluate this. We would recommend that such charts are completed in detail so that full evaluation and monitoring by the care staff can inform the care planning process. We saw staff assisting people to walk and also encouraging people with their diet. Staff also used moving and handling skills to assist some residents. We observed varying levels of staff interaction but none of these were negative or adverse. Staff supported people well on these occasions and clearly recognised people as individuals. People observed were appropriately dressed and there was generally good attention paid to personal hygiene needs, although one person was observed to have toe nails that needed attention and this was discussed with the managers. One carer was observed assisting a person to eat her lunch. This was done in a caring, respectful and dignified manner. The person was informed of what was happening and Care Homes for Older People Page 13 of 29 Evidence: what they were going to do. This helped to show that people are treated with dignity and respect. The medication procedures were examined in the Rowan and Laurel units. It was evident that generally the recording, storage and administration of medication was correctly carried out. We saw that all medication was stored in locked trolleys and in cupboards in each of the units clinical rooms. The stock control in the Rowan unit was very good. Each persons Medication Administration Record (MAR) contained a photograph of the person. This helps to assist with the identification of individuals. However, we discovered some concerns in the Laurel unit. These were, the recording of the administration of medication was not as robust as in the Rowan unit, particularly regarding controlled drugs and some medicine items were overstocked and not always accurately recorded. There is a need to ensure that the recording of all medication is robust. These concerns were raised with the management, with an assurance being given that the medication procedures in all units would be closely looked at and any identified shortfalls would be promptly addressed. Care Homes for Older People Page 14 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social life of people living in the home continues to be developed so that they feel relaxed and engaged in their daily lives. Evidence: There are activities organised for residents on a daily basis. These are organised on the four units in rotation. The home has two committed staff who are employed to coordinate activities. We spoke to these members of staff and they said, the homes manager had supported them well in their role and that both had attended training around provision of activities for people. They have an ongoing programme which includes in house events and activities, with some of these being advertised on each unit. During our visit to the home some people had been escorted out on a local trip [shopping] and during the afternoon we observed some one to one work with people who were having hand massages. The interaction and level of engagement by people was good during these sessions. We saw that each person had activities recorded and there are also very good pen portraits of the people in the home [memory books] which are the result of a recent Care Homes for Older People Page 15 of 29 Evidence: project so that staff can become aware of peoples history and preferences regarding social activities. We spoke to staff who were very knowledgeable about the people they were supporting. One member of staff said, this lady grew up where Im from and I know her family and the area well. This sort of knowledge helps staff to understand behaviours and communication needs of people. Staff reported that there are a lot of care tasks to perform in the morning but good staffing levels ensure that care is not hurried. We observed one person getting up after a lie in bed showing that routines, as much as possible, are organised around peoples care needs. Staff reported that there is time in the afternoons particular to sit and spend time with people. People responded positively to staff attention and interventions during the day. We observed the lunchtime meal on one of the units and this was a well organised social event that was well paced and relaxed so that people were observed to be enjoying this time. One person commented,the food is lovely and plenty of it and one visitor said, the food here wasnt up to much, but over the last six / eight months, it has become excellent. I taste the food myself. The food was well presented and appetising. We saw that dining tables on the units were well presented and tables were laid appropriately so that people with dementia can be clearly orientated. There was a menu available and this was also posted on a board in the dining room. The ground floor units have easy access to an enclosed garden and the units are designed so that people with dementia can be orientated with level access to bedrooms for example. There is also good use of assisted technology with sensors in peoples bedrooms that can be activated if people are at risk of falls for example. This shows that care is organised around trying to remove any barriers for people with disability [dementia] so that they can make decisions about their daily life. Care Homes for Older People Page 16 of 29 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. The safeguarding procedures at St Lukes have failed to give the assurance that vulnerable people are protected from harm or abuse. Evidence: St Lukes had a comprehensive complaints policy and procedure in place. The complaints procedure was clearly displayed on the homes notice board, with a suggestion box in the entrance to the home, where any concerns or complaints could be placed (anonymously if needed). In discussion with some relatives it was apparent that people knew who to raise any concerns or complaints with and that they would have the confidence to raise any concerns or complaints that they may have. One relative said, We had a problem a short while ago. Someone from head office came and they dealt with it immediately. There was a thorough policy in place to deal with a suspicion or allegation of abuse. However, in October 2009 it was discovered that serious allegations of abuse had been made. The allegation was made about one member of staff. A police investigation followed, which has resulted in the alleged perpetrator being charged with verbal and physical abuse of eight service users. This has raised a number of concerns, with regard to the protection and safeguarding of vulnerable people. It appears that the alleged abuse has been happening for a considerable amount of time, with some members of staff being aware of the alleged abuse and failing initially to Whistleblow, although relevant safeguarding training has been provided by the organisation. Care Homes for Older People Page 17 of 29 Evidence: During the three inspection visits to the home a number staff were asked about their understanding of safeguarding issues and particularly about raising the alarm, if there was any suspicion of abuse. Some people were quite clear about safeguarding issues, although there was a vague mixed response from other people, for example, Not had safeguarding training for nine years (although this person was able to demonstrate an awareness of abuse issues) other comments were, I did abuse training at my induction, thats challenging behaviour isnt it? (some confusion about safeguarding and the management of challenging behaviour) I did my abuse training by watching a DVD (This person couldnt give an account of what to do if they suspected abuse) and Never heard of No Secrets ( No Secrets is Government guidance about abuse issues. This is the foundation for providing abuse training at St Lukes). Following the inspection visits we have been made aware that the organisation had immediately implemented more in depth Safeguarding training, with a programme of training that will ensure all of the staff team receive safeguarding training as soon as possible. This helps to give some assurance, with the increased and improved training that vulnerable people will be better protected in the future from harm or abuse. Care Homes for Older People Page 18 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and clean so that people living there enjoy comfortable surroundings. Evidence: A full tour of the premises was carried out and throughout it was found to be of a very good standard. It was found to be clean and hygienic, with anti bacterial hand gels strategically situated around the home. This is regarded as good practice, helping with the management of cross infection. The decor and furnishings within the home are maintained to a very good standard. A good range of aids and adaptations in each of the units in the home were observed including, wheelchairs, walking frames, specialised chairs, specialised beds and fully equipped bathrooms and toilets. This helps to show that the organistaion provides care and support for people with varying diverse needs and disabilities. The day areas are bright and there are plenty of visual stimuli with art projects and pictures and photos displayed. The bedrooms observed were highly personalised, displaying evidence of peoples individual lifestyles and past histories. There is a sensory room (Snoozelen) which is adequately equipped to provide Care Homes for Older People Page 19 of 29 Evidence: stimulation, relaxation and calmness for service users. It was commented, this room is used a lot and people really enjoy coming in here. The kitchen was observed to be clean and hygienic with sufficient equipment in place, with cleaning rotas displayed, however the kitchen would benefit from being updated, for example the backs of the ovens, the grill and the fryer had exposed pipes. This could potentially be a safety risk. In discussion with the management, an assurance was given that improvements to the main kitchen are already planned to take place. There are smaller kitchens on each of the four units that have facilities for making drinks and snacks. The laundry was seen to be very well organised, with adequate machinery to cater for the needs of the people living at St Lukes. The feedback received was very positive regarding, the cleanliness, comfort and decor of the home. For example, the home is really well decorated and well maintained. Care Homes for Older People Page 20 of 29 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. It is evident that the provision of safeguarding training is presently inadequate. The present training fails to give full assurance that vulnerable people are protected, especially in relation to whistleblowing. Evidence: Seven of the staff files were examined and they were well organised, with all of the necessary recruitment documentation being in place including, application forms, two written references for each person, Criminal Record Bureau (CRB) checks, Protection of Vulnerable Adults (POVA), contracts of employment and job descriptions. This helps to demonstrate that the recruitment of staff is thoroughly carried out. During the three inspection visits to the home it was observed that there were sufficient numbers of staff on duty including, nursing staff and carers. During the visits there was no evidence to suggest that people are not being safeguarded from harm. However, recent events demonstrate that vulnerable people have allegedly been placed at risk of harm and abuse. As previously mentioned the safeguarding and whistleblowing procedures have not been satisfactorily followed, raising serious concerns about whether vulnerable people are in safe hands at all times Care Homes for Older People Page 21 of 29 Evidence: Some of the feedback from relatives regarding the staff team were, the staff have been excellent the staff are very nice and the girls do a great job. Some of the comments from staff were, I have really enjoyed working here at St Lukes I wouldnt hesitate to come and live here myself and I love working here, if not happy I would leave. There was evidence that relevant and satisfactory training is being provided by the organisation. Some of the training provided included, Dementia awareness, infection control, safeguarding adults, first aid, nutrition, fire training, crisis prevention intervention (CPI), moving and handling and the management of challenging behavior. It was discovered that much of the training is provided via e-learning and then competency tests carried out. E - learning (on line) is probably adequate enough training, for many subjects, however, safeguarding training including whistleblowing would be better received if provided in a traditional training environment. As previously mentioned, some members of staff were a little vague about whether they had received certain training or not. Some of the comments from the staff were, The training is really good we have elearning refresher courses and I did abuse training on my induction. Thats the same as challenging behaviour isnt it ? Overall with the feedback received, it appears that there are some inconsistencies regarding, what people actually learn with the present e-learning system. Care Homes for Older People Page 22 of 29 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. At the present time, there is a lack of assurance that peoples safety and welfare is actively promoted. Evidence: The Registered manager has been in post at St Lukes for over four years, and from the feedback received it appears that she has made some very positive changes during this period. Some comments regarding the manager from relatives were, The manager has made some good changes and the manager is really good, very approachable. Some of the staff comments were, the manager has made many changes for the better she drives St Lukes with such passion and is open with everyoneand she is extremely approachable. Other staff comments were, I know the manager is bogged down with paperwork, she tries to get on to the units as much as possible and I meet with the manager at monthly meetings. I know she has been in once on nights, but I have never seen her, but I have every confidence in her. Another comment Care Homes for Older People Page 23 of 29 Evidence: from the night visit was, we are like two different homes, we feel like we are just left to get on with it. During the three inspection visits, the general feedback regarding the management was very positive, however it was evident that there has been a limited presence of the homes manager during the night. During the night inspection it was reported that since the allegations were made, there has been no management presence at night, other than the nurses on duty. We have (CQC) been informed that since our night inspection of the 14th/15th January, senior management (CIC) have carried out an unannounced night visit. There were procedures in place, regarding service users finances, with appropriate and adequate records being maintained. This helps to ensure that peoples finances are safeguarded. There was documented evidence to show that staff supervisions take place and minutes of recent staff meetings were also observed. There were some inconsistencies regarding formal supervision sessions, with some staff indicating that they happen every 8 to 12 weeks and with other people saying, I think supervisions are every six months and my last supervision was six months ago The provision of supervisions should be regularly provided to all staff. This will help the staff team feel valued and appreciated. It would also give people the opportunity to raise any concerns or issues they may have. The health and safety policy and procedures were examined and they were found to be up to date and all of the homes health and safety inspection certificates were also observed including, electricity, gas, fire extinguishers, portable appliances (PAT), hoists and the passenger lift inspection certificate. The inspection certificates were all up to date and correct. The alleged incidents of abuse that were recently investigated, raise concerns as to whether the safety and welfare of service users has been adequately promoted and maintained. The senior management of CIC have already been proactive in addressing a number of the issues that have been identified in this report. For example, an action plan has been submitted, which includes the provision of more in depth safeguarding training, a programme of more regular supervision sessions and as already mentioned, more of a management presence at night. Care Homes for Older People Page 24 of 29 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 25 of 29 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 18 12 The registered person shall 30/01/2010 ensure that the care home is conducted so as- to promote and make proper provision for the heath and welfare of service users. Service users should not be subject to any form of abuse. The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Regular substantial safeguarding training is needed, with competency demonstrated by all staff in this area 28/02/2010 2 18 13 3 30 14 The registered person shall, ensure that persons employed by the registered 31/03/2010 Care Homes for Older People Page 26 of 29 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 person to work at the care home receive - training appropriate to the work they are to perfom. The provision of safeguarding training needs to be more robust and thorough. 4 38 13 The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The safety and protection of vulnerable adults is paramount , therefore the present culture, systems and training are not sufficient to give the assurance that people are safe from abuse. 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 28/02/2010 1 3 All assessments should be dated to ensure accurate records are maintained. We would strongly recommend that current good practice around assessment of mental capacity is included in the standard admission assessments and is also reflected Care Homes for Older People Page 27 of 29 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 throughout further assessments used in the home. 2 7 Evaluations did not contain any reference to relatives input and we would recommend that this is a good time to include relatives [at various times] so that they can have a full discussion about care needs and be kept up to date and included in the care. We also discussed the need to ensure that care needs that have been discontinued as peoples needs change are filed outside of the main care plan notes. This is good housekeeping to ensure that the care plan is current and easier to follow. 3 8 We would recommend that behavior monitoring charts in use are completed in detail so that full evaluation and monitoring by the care staff can inform the care planning process. The medication procedures in all of the units should be robust. The same process that is now in place in the Rowan unit, should be adopted for all units. This will ensure consistency throughout the home. There was generally good attention paid to personal hygiene needs although one person was observed to have toe nails that needed attention and this was discussed with the managers. The organisation need to promote and develop further confidence with the staff team, in order that any concerns or suspicions are quickly brought to the attention of the relevant bodies. (Whistleblowing). The main kitchen would benefit from being updated. This would promote the safety and maintenance of this area. We recommend that staff are given training in the Mental Capacity and deprivation of liberty safeguards so that they can be fully aware of good practice in supporting people in their daily lives. It is recommended that there is a more frequent presence of the registered manager on nights. This will help give an assurance of management consistency and promote a unity between the staff on days and nights. 4 9 5 10 6 18 7 8 19 30 9 31 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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