Inspection on 01/03/10 for St Michael`s View

This inspection was carried out on 1st March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michael`s View 15/07/10

St Michael`s View 17/06/10

St Michael`s View 02/06/10

St Michael`s View 13/04/10

St Michael`s View 13/07/09

St Michael`s View 23/07/08

St Michael`s View 31/07/07

St Michael`s View 16/06/06

St Michael`s View 15/09/05

St Michael`s View 19/05/05

St Michael`s View 20/01/05

St Michael`s View 28/07/04

St Michael`s View 26/02/04

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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 Michael`s View St. Michaels Avenue North South Shields Tyne And Wear NE33 3BP     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: Irene Bowater     Date: 0 1 0 3 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 37 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 37 Information about the care home Name of care home: Address: St Michael`s View St. Michaels Avenue North South Shields Tyne And Wear NE33 3BP 01914551215 01914551238 stmichaels@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Sonia Pharoah Type of registration: Number of places registered: care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 64 The registered person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 31 Dementia Code DE, maximum number of places 33 Physical Disability - Code PD, maximum number of places 2 Date of last inspection Brief description of the care home St Michaels View Care home is owned by the Southern Cross, which was first registered in November 1994 and now accommodates 32 older people of mix gender Care Homes for Older People Page 4 of 37 Over 65 0 31 0 33 0 2 Brief description of the care home for general nursing care and another 32 persons with mental ill health, 16 of who may also have a physical disability. The home does not provide intermediate care services. It is situated in a residential area and convenient for the town centre of South Shields. It is close to local train and bus transport. The seaside, shopping outlets, local theatres and social amenities are close by. The local shops and a post office are within easy walking distance of the care home. St Michaels View is a modern single storey care home, custom designed and built to provide facilities and services in 2 distinct separate units. There are in total 4 lounges, 2 dining areas and bedrooms with en-suite facilities. There are 2 internal courtyards both with wheel-chair access. The home is decorated and furnished to a good standard, and in keeping with the age, character and style of the building. Care Homes for Older People Page 5 of 37 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: Before the visit we looked at information we have received since the last visit on the 23 July 2008;how the service dealt with any complaints and concerns since the last visit; any changes to how the home is run;the providers view of how well they care for people; the views of people who use the service,their relatives,staff and other professionals. We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. The Visit. An unannounced visit was made on the 1 March 2010.This visit was carried out by two inspectors and took nine and a half hours to complete. Care Homes for Older People Page 6 of 37 During the visit we: Talked with people who use the service,staff,relatives and the manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Each person must have an initial care plan on admission to the home. All care plans must be detailed about all aspects of peoples health,including mental health, and social care needs.Advice must be sought from other professionals about falls risk,nutrition and behaviours that may be difficult to manage. Access to medical services must be sought so that peoples health care can be monitored. The storage and management of medication must be reviewed. People living in the home need to be sure that their choices are supported and recognised. All concerns and complaints need to be listened to and all actions and outcomes clearly recorded. The premises must have a plan of refurbishment and renewal and risk assessments put in place when the radiators are renewed. Ensure that the furniture and fittings in the communal areas are of good quality and suitable for the needs of the people using them. Ensure that there there is an accessible alarm facility in all rooms including bathrooms and toilets. Ensure the bathroom flooring is repaired. All areas of the home must be kept clean,safe and free from unpleasant odours.Ensure that a cleaning programme is introduced and ensure that sluices are kept locked. All staff employed in the home must complete thorough recruitment and selection processes including checking references, proof of identity and enhanced CRB checks. Quality assurance and quality monitoring systems must be reintroduced. A programme of regular,formal supervision must be implemented to ensure all grades of staff are clear about their roles and responsibilities. All records must be kept safe and up to date. Care Homes for Older People Page 8 of 37 The registered manager should ensure that she is in day to day control of the service. Visits by a representative of the provider must be carried out at least once a month and a written report completed regarding all aspects of the service. Advice from the Fire Authority must be sought regarding the practice of keeping bedroom doors open by artificial means.And ensure that fire training is up to the required standard. 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 9 of 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Without consistent and comprehensive assessments people cannot be sure that the home will meet their needs and they may be placed at risk. Evidence: The Company have detailed admission policies and procedures for staff to use.Information was not available from the care manager in the form of a care plan,discharge information from the hospital or other care centre.Neither was a full assessment carried out by the home manager or a senior member of staff. The four peoples care that was case tracked from admission showed that information was not always completed in detail. Where health care information was provided this was not fully implemented by the staff in the home. For example, one person had been identified at risk of falls and a care plan was not completed.Another person had two infections on admission but there was no care plan and medical advice was not sought following completion of a course of antibiotics. Care Homes for Older People Page 11 of 37 Evidence: Two people recently admitted were not referred to their GP on admission, and although there was a detailed care plan from the care manager for another person, a care plan was not completed leaving the person at risk, as staff did not have the required information to care for that person properly. None of the assessments have information about life history,current aspirations and cultural needs. Without this information a person centred approach to care will not happen and peoples needs will not be fully met. Care Homes for Older People Page 12 of 37 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. Without comprehensive care planning and recording of care,people cannot be sure that all their health care needs with be met which puts them at risk of harm. Evidence: Four care plans were examined.The assessment tools include information about,pressure ulcer risk,using the Braden Scoring Tool,dependency,moving and handling,nutritional assessments using the Malnutrition Universal Screening Tool (MUST),continence and falls risk assessments.This information is to help the staff understand the level of risk and assist them complete care plans based on individual needs. The care plans on both units focus on a medical model of care and a person centred approach has not been developed. The care plans differed on the two units.In two plans there was clear information about pressure ulcer care,diet including weight loss and gain, moving and handling and falls risk assessments. Short term problems such as chest infection are recorded with actions and Care Homes for Older People Page 13 of 37 Evidence: outcomes.As well as daily progress notes, two plans had weekly summaries of events.Some of the terminology was difficult to understand with staff using abbreviations.In one plan, the author could not easily remember what the abbreviation meant. Two other plans were incomplete and progress records were not detailed about daily care and events.Information in one plan shows that a person had a urinary tract infection on admission and was prescribed antibiotics.The Medicine Administration Record(MAR) records show that the antibiotics were given and signed but there was no care plan or check to see if the infection had cleared as requested in the discharge notes. One person had a pressure ulcer and MRSA on admission but there was no care plan to show how the pressure ulcer and infection were being managed. Records from two care plans show people could be vocal and abusive at intervention. There is no information or care plan to show how this is it be managed by staff so that any anxiety or distress is minimised. Also there is no indication of what triggered the outburst and it is not clear what interventions were taking place. Information about diet and fluids have not been recorded and there was no care plan to inform staff regarding difficulty with swallowing, poor diet and the need for pureed diet as there was an aspiration,choking risk. Another plan shows that the admission assessments had not been completed.The care plan from the care manager was specific about risk of absconding but no care plan had been written.Personal care details regarding distinguishing marks,or photographs were not available should an incident occur. There are no specific records of behavioural episodes that might indicate particular triggers or patterns. There are no risk assessment documents to show how staff manage this area of care or how they can ensure that no one is at at risk of injury due to the behavioural needs of some people who live in the home. Social care assessments were not detailed and social care plans are not completed. This means that peoples likes,dislikes and previous lifestyles are not always taken into account when planning care. Food and fluid charts are available but are not always completed in detail.This means no one can be sure what anyone who is at risk nutritionally has had to eat and drink Care Homes for Older People Page 14 of 37 Evidence: over a twenty four hour period. There is no evidence to show that staff are seeking specialist advice about Mental Capacity assessments and resuscitation (DNAR). There is evidence that people have access to all NHS services.However when one person had three falls in a short period of time the falls specialist was not contacted.Another person did not have a review of health needs on discharge from hospital and although a referral to the dietician was made for another person, the recommendations were not put into a plan of care. The Company have comprehensive medication policies and procedures for staff to follow. There is a separate treatment room on the Marsden Unit to store medication.There were many boxes of Fortisip stored haphazardly on the floor and shelves.None were stored in date or name order. The treatment room was messy and disorganised. The medicine trolley was locked and secured but this was also disorganised and bottles of liquid medication were sticky and some labels were difficult to read as there has been spillage when dispensing. All of the medication in the Cleadon unit is stored in the nurses station which is used daily for general nursing duties and storage. There is a register of staff authorised to dispense medication. Medication Administration Records (MAR) show the amount of medication received with two witness signatures. Not everyone has a photograph and not all handwritten directions have two signatures.The Controlled Drug check was correct. The drug fridge temperature and room temperatures are recorded and were within recommended limits although the fridge was not locked. There is a new BP machine and suction machine have been recently been provided. Temperatures are recorded by Timpatic Automatic machine. Staff use red tabards when dispensing medication to make sue they are not disturbed although this does not always happen in practice. Staff were seen to make sure care was delivered in private.The practice of keeping bedroom doors open whilst people are sleeping compromised their dignity and privacy. Care Homes for Older People Page 15 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are limited and this prevents people from living full and active lives Evidence: There is an activity organiser who plans events in and outside of the home.She is enthusiastic but her time is very limited given the hours she works. There are records of the activities that have been arranged but these are difficult to follow as a coding system is in use. These records are kept separately and social care plans have not been completed about previous lifestyles and current aspirations. The nursing and care staff are very busy with the routines of the day and they have little or no time for one to one, or other social care. During the visit the activities organiser was supporting people on the Dementia Care Unit to make some Easter cakes. A bread maker was provided and several people enjoyed making bread in the afternoon. Other people did nothing apart from walk up and down the corridor or were in their room watching television. One person was sat in the room most of the day and Care Homes for Older People Page 16 of 37 Evidence: became very anxious as the door was shut. Although shouts of help could be heard along the corridor nothing happened until the inspector went to find out what was wrong.The person was sat in an armchair, unable to reach anything including the televising, which was blaring out.The shouting was normal according to staff. Visitors were seen to come and go throughout the day.Some came at mealtimes and supported their relative with their meals. Many bedrooms have been made homely with small personal items reflecting their lifestyle.There were some rooms that looked sparse with little in the way of personal memorabilia and photographs. Many people especially on the Marsden Unit stayed in their rooms with the lounges unused, some were watching television,reading a paper or were listening to music. Menus were not available in dining rooms, although there were clear instructions about peoples individual needs, such as who needed thickened fluids,soft and pureed diets.This information on show for anyone to see does not respect peoples right to privacy and dignity. Pictures of food, to help people with dementia choose meals were not available. Breakfast was served after nine am.The majority of people on both units had breakfast in their bedrooms. Choices included various cereals,porridge,bread,toast and marmalade with a choice of hot and cold drinks. There was no butter,only margarine, although full fat milk was available.The breakfast was prepared in the dining rooms by the care staff who took peoples individual choices from a menu sheet which was completed the day before. Staff said there was a cooked breakfast twice a week ,but if anyone requested a hot choice such as bacon sandwich and eggs this would be provided. There were various choices for the tea time meal including curry, salad,sandwiches,soup, omelettes and jacket potatoes with various fillings.There was also a selection of fresh fruit ,cheese and biscuits and yoghurts. Again,most of the people in the Marsden Unit had their meal in their rooms although a few did have a meal in the dining room.Support was given discreetly and service users spoken to said the meal was nice. Care Homes for Older People Page 17 of 37 Evidence: Tea time in the Cleadon Unit was managed reasonably well although trying to make sure everyone had their meal without getting up and walking away or making sure there were enough staff available to support everyone have a hot meal was difficult.Staff said it was sometimes hard but they managed . Care Homes for Older People Page 18 of 37 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. Complaints and safeguarding issues have not been well managed and leave people at risk of harm. Evidence: The Company have clear complaints and safeguarding policies and procedures.These are displayed and are available in the Service User Guide.Given that there is a designated unit which cares for people with a dementia,the information is not provided in any other style such as pictures. There is a complaints record and two complaints have been recorded since the last inspection.There is also a monthly complaints monitoring form, which states that there had been three complaints in October 2009, and an anonymous complaint in December 2009,however there there was no record of them in the main complaints record. The manager could not remember the details and it was unclear what action had been taken and if the complaints had been dealt with and resolved within timescales. The staff have had Safeguarding training with Future Strategies and said they would know what to do should there be a suspicion of abuse.Training that links into the Local Authority Procedural Framework is to be sought. Care Homes for Older People Page 19 of 37 Evidence: There is currently one safeguarding alert which is being investigated by external agencies. Care Homes for Older People Page 20 of 37 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. There are ineffective cleaning and hygiene measures in place and further investment is needed so that people live in a comfortable,pleasant and safe home. Evidence: This is a single storey purpose build home which has two separate units.One is called the Marsden Unit and the other is the Cleadon Unit. In the Marsden Unit dining room there are notices about peoples dietary needs including who has to have pureed soft and thickened fluids.There was food debris down the walls and the crockery cupboard door was missing and the surface is heat damaged. The tiles around the sink unit were ingrained with dirt and badly stained. Inside the cupboard the pipes are broken and water is then draining into a brown stained bowl.The shelf is broken and the dirty water has been left to stagnate in the bowl. The lounges are also tired and worn.One armchair was turned on its side as one of the legs were broken,the furniture would not be suitable should any one have mobility problems and the carpets are stained. One lounge had suitable furniture but there were no ornaments or audio equipment to Care Homes for Older People Page 21 of 37 Evidence: make it homely.Many of the people living in this unit mainly stayed in their rooms with the communal areas underused. In the Cleadon Unit there are lots of memorabilia on walls including items that people can touch . The relaxation room could not be used as it was being used to store portable radiators. One communal area has been decorated as as pub and photographs of the history of the area are displayed.All of this work was done over two years ago and the decoration is starting to look worn and shabby as is the general decoration and fabric of the communal areas. There again is damage to the sink units and cupboards in the dining room.And there is food debris down the walls.Information about peoples diet and fluid intake is again displayed for anyone to see. Bedrooms on both units are for single occupancy and although the majority have been made homely some are scantly personalised. There was a pervading odour of stale urine throughout the home despite the domestics continually cleaning.Sluices were not kept locked and some of the light cords were knotted and grimy and call cords in showers were wrapped around the shower rail. The bathroom flooring opposite room 27 had small holes in the floor, the call cord did not reach floor level and there was no shower curtain to maintain privacy.A rusty and dirty commode chair is being used as a shower chair. There is a problem with all of the radiators in the home and all have been checked in the last two months.There is a plan to renew the heating system and portable radiators have been provided. Some are unsuitable for use and they do not guarantee low surface temperatures and are not flush with the walls therefore causing a tripping and burn hazard.This was discussed with the manager and the Company representative and it was agreed that these would not be used.The manager also confirmed that the heating system would not be replaced until the warmer weather arrived. Care Homes for Older People Page 22 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although staffing levels are adequete the lack of comprehensive recruitment,training and supervision places people at risk of harm. Evidence: Each unit is staffed separately.One the day of the visit there were five care staff and one nurse allocated to the Marsden Unit and there were two nurses and five carers allocated to the Cleadon Unit. The nurse on the Marsden Unit had telephoned in sick and so one nurse from the Cleadon Unit was then re allocated to the Marsden Unit.The manager is supernumerary and there is a deputy who also manages one of the units. In addition to the qualified nursing and care staff the home employs an activity organiser cook,kitchen assistants,domestic and laundry staff,an administrator and maintainence person. Two care staff on each unit start the morning shift at seven am to help those who wish to get up early.On the Marsden Unit this support is either to assist people to get washed and dressed or assist people to sit up in bed ready for breakfast. The majority of people on this unit have breakfast served in their bedrooms. This was Care Homes for Older People Page 23 of 37 Evidence: not until nine am and it was unclear what this acheived apart from fitting in with staff routines as there was no observational evidence of service users being enpowered to make choices. More people were up and about in the Cleadon Unit but again the focus was about getting everyone ready before breakfast was served at ten past nine. Staff on both units said there was enough of them to manage but this means a number of people wait for some time for support and assistance. Five staff files were examined.In general there was no evidence that gaps in work history had been explored in every case and not all files had a recent ,clear photograph of the person. There were no supervision ,appraisal or up to date training records in individual files.Records show that staff have not had yearly appraisals and there was no evidence that specialist training had been provided. The Criminal Record Bureau(CRB) tracking form stated that the CRB for one person had been applied for but it was not clear if it had been returned and the application form had details of three referees but the addresses were peoples home address and not their place of work. Another record showed a completed application form,two references,proof of identity and POVA first check.There was no recent photograph and the interview checklist was incomplete.There was no completed induction,training and no supervision or appraisal records. Care Homes for Older People Page 24 of 37 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. Without direct ,consistent leadership and management people have not received a quality service and they are at risk of harm. Evidence: The manager is registered with the Commission and is qualified and experienced to manage the service.She has been taken out of the home by senior management several times over the last year to assist in other homes belonging to the Company. One period of time was from October 2009 to January 2010 and another was in 2009 when she was also managing a home which did not have a manager and then assisting and supporting a manager through induction.This means that she has been unable to fully carry out her role of management,supervision and leadership of the staff and the service. The Company have clear quality assurance and quality monitoring systems,however there has been a lack of quality monitoring,day to day supervision and visits under Care Homes for Older People Page 25 of 37 Evidence: Regulation 26 have not been completed since October 2009 and prior to that the visit was June 2009. The reports were brief and no issues were highlighted. There has been a lack of support and direction from senior members of the organisation during this period which reflects in the lack of formal supervision and training of all grades of staff. The supervision records showed that most staff had not received individual formal supervision since March 2009. The manager had a training file,however this was not up to date and it was difficult to see what up to date mandatory training had been completed during the last year. Other records belonging to service users were not kept safe.In the Cleadon Unit many food and fluid charts and other information about individuals were haphazardly stored in the bar area and on the floor.Some were dating back to 7 January 2010. In house maintenance and service certificates were available and up to date. There is a problem with all of the radiators in the home and all have been checked in the last two months.There is a plan to renew the heating system and portable radiators have been provided. Accidents are recorded and there is a high incidents of falls recorded.As the manager has been out of the home on a regular basis no analysis to track incidents and trends has been carried out although she said she is planning to start this. Fire drills should be carried out twice monthly but they were only recorded on 28 January and 24 February 2010. It was unclear whether they need to carry out fire instruction and the manager was advised to contact the Local Fire Brigade.CQC shared information about the practice of keeping bedroom doors open by using chairs,bedtables and other items with the Fire Officer. Care Homes for Older People Page 26 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 37 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 3 14 Each person must have a comprehensive assessment of their health and social care needs which is then implemented into a plan of care for the person. This will ensure that staff know how to care for people and people can be confident that their needs will be met. 30/04/2010 2 7 15 The care plans must be up to date,detailed,reviewed at least monthly,be person centred and reflect how current and changing needs will be met. This is to make sure that staff plan and review peoples care so that people receive a good quality care. 26/04/2010 3 8 12 Ensure clear information is available and expert advice is sought to show how staff are to support people 03/05/2010 Care Homes for Older People Page 28 of 37 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 who have behaviours that may challenge. This will make sure people receive consistent care and their individual needs are met. 4 8 13 Risk assessmensts and incidents of falls must be accurately recorded and those at risk referred to specialist services. This is to make sure people receive appropraite treatment and they are protected from harm. 5 8 12 Wound and pressure ulcer care must be recorded and any deterioration or improvement recorded and reviewed on a continual basis. This is to make sure people receive the apporopraite treatment. 6 8 13 Ensure that medical advice is sought before making decisions regarding Mental Health and DNAR status. This is to make sure peoples rights are protected. 7 8 12 Nutritional screening must be completed and a record 26/04/2010 26/04/2010 26/04/2010 03/05/2010 Care Homes for Older People Page 29 of 37 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 of maintained of food and fliud intake kept.Advice from specialists must be implemented into a plan of care. This will make sure that people at risk are protected and have a good nutritional intake. 8 9 13 Ensure all handwritten 12/04/2010 directions have two witness signatures.And ensure there is identification of the person on each MAR chart. This will make sure there are no errors and people receive their mediaction safely. 9 9 13 Ensure that medicine 03/05/2010 storage facilities on the Cleadon Unit are reviewed and updated in line with best practice guidance. Medicines must be stored safely and securely at the correct temperature recommended by the This will make sure that the home complies with legislation and people are protected. Care Homes for Older People Page 30 of 37 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 10 12 16 Ensure that everyone living in the home has the opportunity to enjoy social activity which is recorded in a plan of care. This will make sure people are able to make decisions about their daily routines. 03/05/2010 11 14 12 Ensure that people living at the home are properly assisted to make choices and decisions in daily living and how their care is planned and provided. This will make sure people can exercise choice and control over their lives. 26/04/2010 12 15 16 Ensure that people are 26/04/2010 supported and offered varied meals at flexible times which they have been supported to choose. This will make sure people are provided with choice of meals that meets their requirements. 13 16 22 All concerns and complaints must be recorded and details of actions and outcomes recorded and responded to within a 28 day timescale. 05/04/2010 Care Homes for Older People Page 31 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure that people will be confident that their views are listened to,recorded and acted upon. 14 18 18 All grades of staff must 07/05/2010 complete safeguarding training which links into the Local Authority Procedural Framework. This will ensure people living in the home are protected from harm. 15 19 23 Provide a programme of maintenance and renewal of the fabric and decoration of the home. This will make sue that the home is kept in a good state of repair and isa safe and pleasant place to live. 16 20 16 Ensure that the furniture 07/05/2010 and fittings in the communal areas are of good quality and suitable for the needs of the people using them. This will ensure that people have access to safe and pleasant facilities. 17 21 23 Ensure that the bathroom and shower is repaired and an appropriate privacy curtain and shower chair provided. 30/04/2010 26/04/2010 Care Homes for Older People Page 32 of 37 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 make sure people have appropriate facilities for bathing. 18 22 12 Ensure that there there is an 31/03/2010 accessible alarm facility in all rooms including bathrooms and toilets. This is to make sure people are able to access help at all times and they are protected as far as possible. 19 25 13 Ensure that the heating system is renewed following clear risk assessments and ensure that any portable radiator is guarded or has low surface temperatures. This is make sure people are kept safe. 20 26 23 Ensure that a cleaning programme is in place so that the odours can be eliminated.And ensure that the dirty call cords and light cords are replaced. Ensure that sluices are kept locked when not in use. This is to ensure people have a safe, clean, odour free place to live. 05/04/2010 03/05/2010 Care Homes for Older People Page 33 of 37 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 21 27 18 Ensure that staffing levels are based on the dependency levels of the people living in the home . This will ensure that iindividuals needs are met and they are kept as safe as possible. 19/04/2010 22 29 19 All staff employed in the 05/04/2010 home must complete thorough recruitment and selection processes including checking proof of identity and enhanced CRB checks. This will make sure staff are properly vetted and people living in the home are protected from harm. 23 30 18 All staff must be provided 03/05/2010 with opportunities to receive training that is appropriate to the work they are to perform. This will ensure people living at the home are cared for by suitably skilled and trained staff. 24 33 26 Visits by a representative of 30/04/2010 the provider must be carried out at least once a month and a written report Care Homes for Older People Page 34 of 37 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 completed regarding all aspects of the service. This will make sure that the home is run in the best interests of service users. 25 33 24 Quality monitoring and quality assurance systems must be fully implemented. This will make sure that the quality of the service is regularly reviewed taking account of peoples views. 26 36 18 All staff must receive formal supervision at least 6 times a year with records kept. All staff must be supervised and directed as part of everyday practice. This will ensure people receive consistent care delivered by trained experienced staff. 27 37 17 All information and records belonging to service users must be kept secure and in good order. This will make sure peoples best interests are safeguarded. 28 38 23 There must be safe alternative heating provided when the system is changed including risk assessments. 05/04/2010 30/04/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 35 of 37 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 make sure people are protected from harm. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Develop a person centred approach to care planning.Use plain English and do not use nursing jargon and abbreviations. The treatment room on the Marsden Unit should been cleaned and organised ,including the medicine trolley, and all supplement food be stored properly. Staff should make sure that any spillage on medicine bottles is cleaned straight away. The practice of keeping bedroom doors open when people are sleeping should be reveiwed. Menus should be on display and pictures of food should be available to help people with dementia actively choose their meals It is recommended that the complaints procedures are made available in alternative formats. More than fifty percent of staff should complete National Vocational Training in Care level 2 or above. The registered manager should ensure that she is in day to day control of the service. It is recommended that advice from the fire officer is sought regarding the use of door guards that link into the fire alarm system.And to check when fire instruction is needed. 2 9 3 4 10 15 5 6 7 8 16 28 31 38 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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