Inspection on 13/04/10 for St Michael`s View

This inspection was carried out on 13th April 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 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 01/03/10

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 29/06/2010.

Random inspection report Care homes for older people Name: Address: St Michael`s View St. Michaels Avenue North South Shields Tyne And Wear NE33 3BP zero star poor service 01/03/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Irene Bowater Date: 2 3 0 4 2 0 1 0 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): Name of registered manager (if applicable) Sonia Pharoah Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne Homes Ltd care home 64 Number of places (if applicable): Under 65 Over 65 0 31 0 dementia old age, not falling within any other category physical disability Conditions of registration: 33 0 2 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 0 1 0 3 2 0 1 0 Care Homes for Older People Page 2 of 34 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 for general nursing care and another 32 persons with mental ill health, 2 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 coast, 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 3 of 34 What we found: We carried out this inspection to check whether the provider had complied with requirements made in a report issued following the key inspection of 1 March 2010 when the service had been assessed as poor. Before the visit we looked at the providers improvement plan and any changes to how the home was being operated. We also checked information which had been shared with us by other professionals and external agencies with an interest in the service. The inspection commenced with an unannounced visit on 13 April 2010, followed by further visits on 14, 15, 16, 22 and 23 April 2010 all made by two regulatory inspectors with 2 days input from a pharmacist inspector from the Commission. 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. During the visit we: Talked with people who use the service, staff, relatives, senior staff from the organisation and staff from external agencies. 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 at the home. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe and comfortable. We told various support managers and a members of the senior operational staff from the organisation what we found. Care records and care planning: We examined the care records of five service users in detail and various other care plans as we examined specific aspects of individual care delivery. We found that care plans failed to identify how each individual service users health and welfare needs were to be met. Also that not all care plans had been reviewed at least monthly or sooner as dictated by changes in individual service users needs. We found many examples where service users care plans had not been revised to reflect their changing health and welfare needs. Also, we found evidence that consultations with the service users or their representatives had not taken place. We found that the standard of written information varied but was generally poor with out of date and contradictory information. Care plan entries were inconsistent and important details regarding service users health and welfare had been omitted. There was inadequate emphasis on service users strengths and abilities and a lack of information and guidance for staff to follow. Care Homes for Older People Page 4 of 34 For example, a service user who was assessed at high risk of falls had recently experienced numerous falls and sustained injuries. However, there was no care plan in place to demonstrate how staff planned to reduce further falls and minimise injury. Despite the amount of falls staff had not sought support and advice from the specialist falls nurse. Several examples were found where assessments had been carried out by dieticians and speech and language therapists but their advice and instructions had not been added to the relevant nutritional care plan. The specific and complex care needs of service users who were at risk of weight loss, who required specialist diets and who were at risk of aspirations and choking were inadequately detailed in care plans. This placed them at risk particularly at a time when the majority of the staff were new to the home. The recording of care record charts such as food and fluid intake and continence monitoring charts was inadequate and could not be cross referenced to care plans. It was impossible to assess and reconcile food and drink intake for individuals over a 24 hour period. Written information regarding the prevention of pressure damage was scant with varying and conflicting instructions for staff. For example, it was unclear if a service user was to have 2 or 4 hourly positional changes and the type of pressure relieving mattress and setting was not recorded. Short term care plans were not in place where service users experienced acute problems such as chest infections or wounds. There were no care plan instructions to help staff deal with and understand service users with dementia who exhibited difficult and challenging behaviours. In view of the ongoing failure to meet previous requirements relating to the provision of service users care plans a Statutory Requirement Notice has been issued. Care delivery: We found evidence that staff had failed to promote and monitor individual service users bowel actions and take prompt remedial action where problems had been identified. This included some unexplained periods of 3 weeks plus where prescribed aperients had not been given and where service users, identified at risk of constipation, had gone for periods of up to one week without a bowel action. The nurses on duty were unaware of these situations and there was no evidence of any staff intervention. We found that all of the service users on the Cleadon Unit and 17 out of 24 service users on the Marsden Unit had no access to a call bell. No risk assessments were in place where it would be considered unsafe for a service user to have access to a call bell. The inspectors spoke with service users who said that they wanted and needed access to a call bell to summon staff and staff comments included she needs one and it has been reported probably a few weeks ago, we are now having to complete close observation records to prove that we have been in to check that the residents are okay. Care Homes for Older People Page 5 of 34 Staff on both units told inspectors that they had not been provided with appropriate handover information about the conditions and care needs of service users in their care at the start of each shift. Examples were identified on each unit where agency and new staff were unaware of service users specific care needs such how to administer their medications, nutritional and special dietary requirements, how to transfer and lift service users and individual hygiene needs and preferences. We observed care staff transferring service users out of their wheelchairs into dining chairs. However this caused distress to some service users and staff expressed concern over the fact that they had not been given sufficient information regarding moving and handling techniques. Staff had failed to ensure that the personal hygiene needs of individual service users had been met. For example, one service user had dirty, smeared spectacles and unpleasant smelling, soiled hands on two separate occasions. It was identified that pressure area care was not being provided according to service users individual needs with particular lack of attention to those service users who remained in bed. Staff were not aware of individual service users skin conditions with particular regard to any pressure damage. The inspector identified a wound dressing which the staff on duty were not aware of and had no knowledge that it was covering a sacral pressure ulcer. Service users were not kept adequately warm and comfortable. Examples were found by the inspectors and nurses from the PCT where services users on both units were unacceptably cold. Duvets were missing from the majority of beds and there were problems with the homes heating system. Action to warm service users and monitor their body temperatures had to be prompted by the inspectors. Serious concerns were identified over the confirmed use of oral and naso pharyngeal suction which had been undertaken on individual service users without multidisciplinary agreement, where individual service user risk assessments, care plans and in house procedural guidance were not in place and by nurses who were not accredited to carry out this invasive,high risk procedure. Guidance and instruction provided by multi disciplinary professionals about the care and treatment of service users, in particular dieticians and speech and language therapists, had not been relayed to all staff and was not being followed. Staff, including those who prepared food, were unaware of individual service users nutritional needs and failed to ensure that food provided to service users met their individual nutritional needs. The understanding of what individual dietary requirements were varied between catering, care and nursing staff with further variances apparent within care plans. The catering team was not made aware of individuals who were at nutritional risk and took no part in supplementing or fortifying individual diets. Appropriate professional advice had not been taken prior to the addition of medicines and Care Homes for Older People Page 6 of 34 supplements to service users meals and drinks in order to ensure that these remained palatable in terms of texture and flavour. Five liquid medicines were being regularly added to one service users cereals without any knowledge or information as to how this would taste. Staff did not adequately support and assist individual service users identified as needing assistance with their food intake so that service users received a nutritious diet that was appropriate to their individual needs. Many examples were seen in service users bedrooms and communal dining areas where service users were left unattended and were unable to access or manage their meals. This led to meals going cold and food not being eaten. Staff failed to offer alternatives when uneaten food was removed. Accurate records of the food and drink provided to individual service users were not maintained and did not contain sufficient detail to demonstrate whether the diet provided to each service user met their individual needs. Many examples were seen of nutrition intake records which contained meaningless information which provided no specific details of exactly what or how much individuals had eaten. In addition there was nothing to confirm that any drinks had been thickened, for example, entries on one record read 1 in the cereal and porridge column, 200mls in the drink column plus 1 in the supplement column.The lunch meal was described as 1/2 with 200mls in the drink column and 1 in the supplement column. In view of the ongoing failure to meet previous requirements to provide proper care and treatment to service users a Statutory Requirement Notice has been issued. Medication: We looked at a sample of the current Medication Administration records (MARs) on both units and all the completed MARs from the previous month. We found 45 gaps on the previous months MARs, relating to the treatment of 14 service users where the administration of medication had not been recorded and no non administration code had been added. A system to record the quantity of medication remaining after administration has been recently introduced but had not prevented the home running out of seven medications over the last few days of the monthly treatment cycle. In addition,some doses of medication were not administered because care staff could not readily locate the prescribed medication in the trolley. Facilities for the storage of medicines on the Cleadon Unit were poor and were located within the cramped nurses station which is not appropriate for the storage and preparation of medicines. We were informed that provision of a single treatment room was being investigated. The treatment room on the Marsden Unit was adequate although the fridges were not locked at the time of the inspection and some creams were stored in an unlocked cupboard underneath the workbench. The homes handyman had a master key to the treatment room and was able to open the door to the treatment room for the pharmacist inspector. Medication guidance for staff was not up to date and there were no copies of the Care Homes for Older People Page 7 of 34 providers detailed medicine policy and procedures readily accessible in the treatment rooms. This was particularly important during a time when new or agency staff were working in the home and were handling medication. The two units shared one controlled drug cupboard on the Marsden unit which was not large enough and some stocks of Temazepam liquid could not be stored securely within the controlled drug cupboard at the time of the inspection. The list of staff authorised to administer medicines was not up to date which would make it difficult to identify who was involved in administration of medicines if an error or discrepancy arose. We noted that the blood glucose results for service users receiving insulin were not always regularly recorded on the diabetic and urine record sheet. For example, the record sheet for one service user had no recorded results for an eight day period. We were informed that a record of the blood glucose was made on the handover sheet which was subsequently stored in the managers office after 24 hours. This meant that staff did not have an adequate daily record of the service users blood glucose readily available when managing their dietary intake and insulin administration. A number of service users were prescribed thickening agents to help them overcome swallowing difficulties. Although professional advice had been obtained to assess the individuals swallowing difficulties medication had not always been provided in liquid form. In addition, there was no guidance in the care plan or with the MARs to indicate whether the service user could be given solid dose medication safely or if not, whether medication was to be crushed before administration and whether advice from a pharmacist had been obtained to ensure that it was safe to do so. We noted that three service users were identified as being poorly compliant with medication and medicines were being secreted in liquids or food to improve compliance. The care plans for these service users included risk assessments for non compliance and listed the medicines to be given in this way. The GP, unit manager and service users relative had consented to medication being administered in this way. However, there was no evidence of input from a pharmacist and no practical advice for the nurses as to how the medicines, supplied in liquid form, should be provided to the service user. On the day of the inspection a nurse confirmed to the inspector that she had mixed all the medications together for one service user in a glass of water but had not observed the service user consuming the whole contents of the glass. Another service user was receiving nutritional requirements through a Percutaneous Endoscopic Gastrostomy (PEG) tube and all medication was being given this way. We noted that two of the medicines were in tablet form and asked the nurse how they had administered the morning dose of Perindopril, supplied as 4mg tablets. We were informed that they had crushed the tablet and mixed it with water. However there was no guidance in the care plan or with the MAR to indicate that professional advice had been sought from a pharmacist to ensure that this was safe and appropriate. In view of the extent and serious nature of the failings to make suitable medications arrangements a Statutory Requirement Notice has been issued. Care Homes for Older People Page 8 of 34 Daily life and social activities: Staff confirmed our findings that there were no social care plans in place. This meant that service users previous lifestyles and current aspirations had not been taken into account when planning and delivering care. Several service users on the Marsden Unit spent most of their time either in bed or in their rooms but staff were unable to confirm if this was by choice or due to an established practice which had become routine. One service user was always in bed apart from an hour in the evening. However, there was no provision of social care intervention or any stimulation such as music or one to one interaction with the staff. The provision and organisiation of group social events and activities in communal areas appeared well co-ordinated and involved good numbers of service users and their visitors and relatives. Regular sessions were maintained throughout a difficult time at the home and appeared to bring a lot of fun and pleasure to both service users and the staff. The mealtime experience varied in the home. Service users were offered choices for their meals and a list was completed the day before and then sent to the kitchen. However, this list remained in the kitchen which meant care staff were unable to check service users preferences and choice of meal when it was being served. Several meals were observed during the visits and the food was observed to smell and look very appetising. Ample sized portions were well presented and service users reported that food was tasty and enjoyable. Complaints and protection: Some progress had been made to update the homes complaints register since the key inspection of 1 March 2010. However during these visits it became apparent that complaints and safeguarding issues had not been well managed or handled in accordance with both the providers and Local Authority guidance regarding safeguarding protocols. Premises: Continuing shortfalls in the environment, in many instances created additional infection control hazards and risks to service users and staff on both units. These included: Broken, damaged and dirty call bell and light pull cords in communal and individual toilets and bathing areas which posed an accident and infection risk to staff and service users. For example,a toilet and shower room opposite bedroom 8, bedroom 3 en suite, a communal toilet adjacent to bedroom 12, and bedroom 13 en suite on the Marsden unit and a communal toilet opposite bedroom 27 and the bathroom opposite bedroom 23 on the Cleadon unit. There were holes in the flooring and no shower curtain in the bathroom opposite bedroom 27 on the Marsden unit and a rusty and dirty commode chair was being used as a shower chair in this room. The Cleadon unit was extremely malodorous with a strong smell of stale urine at each visit and certain bedrooms on both units smelled particularly unpleasant and were not fit for use by service users, staff or visitors. For example bedrooms 12 and 31 on the Marsden unit and bedrooms 30, 31 and 23 on the Cleadon unit. Care Homes for Older People Page 9 of 34 Soap dispensers in bedrooms without en suites had leaked causing damage and stains to the wall beneath for example bedrooms 1, 11 and 16 on the Cleadon Unit and bedroom 32 on the Marsden Unit. Several vanity units were broken, cracked and dirty which posed an accident and infection control risk for service users and domestic staff for example, bedrooms 11 and 16 on the Cleadon Unit and bedroom 32 on the Marsden unit. Exposed metal pipes were accessible in a shower room opposite the dining room on the Cleadon Unit where a radiator had been changed. The practice of storing unpackaged incontinence pads on top of en suite WC cisterns was widespread on the Marsden unit. Apart from the issues of service user privacy and dignity this posed an infection risk. A significant amount of major refurbishment work was underway throughout the inspection. In particular, following replacement of the boilers last year the entire heating system,to include all radiators,was being replaced. Redecoration was ongoing in communal and bedroom areas together with carpet replacement. Servery areas within dining rooms were being upgraded and the garden areas were being improved with new lawns and flower beds. The level of upgrading work activity on the Marsden Unit led to considerable noise levels and disruption at times and on 22 April 2010 the inspectors requested sight of the schedule of works and associated risk assessments which were provided by the estates manager the following day. These were produced and detailed the work schedules and the assessed risks. There was a significant problem with inadequate storage space. Several empty bedrooms on the Marsden Unit were being used as work areas, paint stores, equipment maintenance areas and for storage of out of use items together with boxes of archived records. Immediate requirements were issued ion 14 April in respect of these findings. Bedrooms on the Cleadon Unit were also being used as store rooms but the doors to these areas were locked shut and appropriately signed. The inspectors found despite the ongoing works that standards of cleanliness and general housekeeping had improved since the previous inspection. Staffing: The registered manager, the entire regular nursing staff team including bank staff and several care assistants were under suspension pending the outcomes of police and safeguarding investigations. The subsequent, significant shortfalls in staffing were being covered by staff from other care homes within the Southern Cross group of companies and agency staff together with some support from the Local Authority and PCT. An interim management team was in place which included an acting support manager and various clinical lead nurses who were overseeing care management and delivery on each unit. The regular ancillary team remained in place and there was additional support Care Homes for Older People Page 10 of 34 for the homes regular administrator. Social care staff were providing extra support with care delivery. There were problems where nursing and care staff had not received adequate hand overs between shifts. Otherwise staff of all designations appeared to be working well together and helping each other and the service users and their relatives to cope in difficult circumstances at the home. The inspectors spoke with several care staff on both units who described a poor provision of staff training and supervision and a regime where they had been excluded from involvement in care planning and evaluation of care delivery by the deputy managers and nursing team. For example, they knew very little about service users diagnoses and medical conditions and appeared to follow a task orientated approach to care where emphasis was on achieving workload targets and signing documents to say what they had done. However, they had established a good working knowledge of service users care needs and individual preferences and much evidence of close and supportive relationships between staff and the service users and their families was apparent on both units. Evidence of failure to ensure that regularly employed nurses working at St Michaels View had received training appropriate to their work was identified from the individual staff training files and general training records held at the home. It was established that accurate records of all training provided to individual members of staff and assessments of training needs for each member of staff to identify their training needs were not in place. It was identified from information held within the nurses records and a staff training matrix overview of training, that the training provision in understanding dementia, managing challenging behaviour, safeguarding adults, the Mental Capacity Act and Deprivation of Liberties safeguarding and the administration of medications was inadequate. In addition there was no available evidence to confirm that newly employed and current staff had received structured induction training that had included training in moving and handling, fire safety, safeguarding adults, health and safety and food hygiene. There were insufficient staff employed at the home who were trained in first aid to ensure that at all times there was a minimum of one person on duty who has received first aid training. In view of the ongoing failure to provide staff with suitable training a Statutory Requirement Notice has been issued. Recent selection and recruitment practices were not examined. Management and administration: A senior management team were overseeing the day to day operation of the home in the absence of the registered manager. The inspectors found that the efficiency of these arrangements varied depending on who was in charge and the degree of other demands, such as attendance at safeguarding meetings away from the home, which effected the consistency of communications and attention to areas Care Homes for Older People Page 11 of 34 of concern. For example, immediate requirements which were made by the inspectors in relation to unsafe and insecure storage arrangements on 14 April 2010 had not been addressed within the deadline requirement timescales of 16 April 2010. In relation to health and safety it was identified that individual risk assessments in areas such as falls, weight loss and choking had not been updated to reflect service users changing health care needs. Specific concerns were identified on the Cleadon unit about the amount and management of falls and subsequent injuries sustained by certain service users where evidence of the assessed risk, incidence and subsequent management review was either absent or inadequately recorded. Examples of service users who were at significant risk were identified and it was confirmed that referrals had not been made to the PCT Falls Specialists until after the PCT nurses had commenced their own individual assessments of service users care needs. The Commission was aware of proposals to replace the entire heating system throughout the home and had made a previous requirement to ensure that the heating system was renewed following clear risk assessments and to ensure that any portable radiator was guarded or had low surface temperatures. However, several examples of the use of supplementary heaters in service users bedrooms which were unsafe and a risk to service users were found. These heaters were found to be in use on both units and when fully heated became red hot to touch posing a serious burns risk to service users. Following examination of various service users care plans and care records it was established that no risk assessments were in place for the use of these heaters. The inspectors also identified that existing bedroom radiators, which were in use on both units, and which were hot to touch were broken and damaged to such a degree that hot and unsafe surface temperatures were visible and accessible to service users. The supervision records for the registered manager and the regularly employed nursing team all of whom were under suspension were examined and it was observed that these staff had not been regularly or appropriately supervised during formal supervision sessions and that supervision records which had been made were inadequate. Examples included most recent appraisals in November 2007 and most recent supervision sessions in January 2009 where the only content was sickness notification. Another supervision record covered medications guidance only and was dated 4 June 2009. There were no supervision records at all for at least four of the nurses. Supervision entries made by a deputy manager and dated March 2009 for one nurse contained inappropriate language and instruction which indicated that this had been a disciplinary session. The requirement for monthly visits to the home by a suitable person had not been met in that the only records provided to the inspectors were for visits in June and October 2009. Care Homes for Older People Page 12 of 34 It was identified that the registered manager had been absent from the home for considerable periods of time since 2009 while she had been working at another care home within the Southern Cross group of companies. However this key and notifiable event had not been brought to the Commissions attention. During a review of exactly what notifications had been received since January 2009 it was found that the home had failed to notify the Commission of service user deaths in the home and the circumstances of those deaths, of events which have occurred in the home that have adversely affected the well being and safety of service users and of allegations of misconduct by persons working at the home. In summary it was established that the deaths of 22 service users who had resided at the home since January 1 2009 had not been reported to the Commission. In addition five recent serious safeguarding alerts and seven staff suspensions had not been notified to the Commission. The acting support manager and current management team were unable to provide any reasons for these serious omissions. In view of the ongoing failure to notify the Commission of service users deaths and other key events a Statutory Requirement Notice has been issued. What the care home does well: What they could do better: The continuation of previously identified and several new and serious concerns over inadequate standards of care delivery, care planning, medication arrangements and management and notification of serious events effecting service users have led to the service of six statutory requirement notices. These clearly set out what the home must do and by when. Regular unannounced inspection visits will follow in order to look for compliance. Any continuing failure to meet Care Homes for Older People Page 13 of 34 requirements will lead to further enforcement action. Steps must be taken to improve and maintain the standards of care delivery, the safety and well being of service users and the day to day efficiency and smooth and safe operation of the home. It is essential that all concerns, requirements and recommendations raised within this report are addressed within the specified timescales. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 14 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. 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 26/04/2010 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. 3 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. 26/04/2010 4 8 12 Ensure clear information is 03/05/2010 available and expert advice is Page 15 of 34 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action sought to show how staff are to support people who have behaviours that may challenge. This will make sure people receive consistent care and their individual needs are met. 5 8 12 Nutritional screening must be 26/04/2010 completed and a record 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. 6 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. 7 8 13 Ensure that medical advice is 26/04/2010 sought before making decisions regarding Mental Health and DNAR status. This is to make sure peoples rights are protected. 8 9 13 Ensure all handwritten directions have two witness 12/04/2010 03/05/2010 Care Homes for Older People Page 16 of 34 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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 storage 03/05/2010 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. 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. 11 14 12 Ensure that people living at 26/04/2010 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. 12 15 16 Ensure that people are 26/04/2010 Page 17 of 34 03/05/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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 05/04/2010 must be recorded and details of actions and outcomes recorded and responded to within a 28 day timescale. 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 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 and 07/05/2010 fittings in the communal areas are of good quality and Page 18 of 34 07/05/2010 26/04/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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. 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 05/04/2010 03/05/2010 30/04/2010 Care Homes for Older People Page 19 of 34 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action when not in use. This is to ensure people have a safe, clean, odour free place to live. 21 27 18 Ensure that staffing levels 19/04/2010 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. 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 completed regarding all Page 20 of 34 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 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 30/04/2010 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. This is to make sure people are protected from harm. 05/04/2010 30/04/2010 30/04/2010 Care Homes for Older People Page 21 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 37 17 Ensure bedroom 6 (Marsden Unit) which was full of confidential service users care and financial records is secured by 5 pm on Thursday 15 April 2010. This is to ensure all service user records are kept securely. 16/04/2010 2 38 13 Ensure that five bedrooms 16/04/2010 namely numbers 6,11,24,26 and 29 on the Marsden Unit were secured by 5 pm on Thursday 15 April 2010. As they were not secured and therefore accessible posing a fire and health and safety hazard to service users. This is to ensure that unnecessary risks to the health and safety to service users were eliminated. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure that all service users 02/07/2010 plans clearly identify how each individual service users health and welfare needs are to be met. Put in place effective Care Homes for Older People Page 22 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 arrangements to ensure that all service users care plans are reviewed at least monthly or sooner as dictated by changes in individual service users needs. Put in place effective arrangements to ensure that where appropriate, service user care plans are revised to reflect individual service users changing health and welfare needs after consultation with the service user or a representative of his. This is to make sure that staff plan and review how they work with people so that everyone works in the same way to ensure peoples needs are being met. 2 8 12 Put in place effective 24/05/2010 arrangements to ensure that all staff, including those who prepare food, are aware of individual service users nutritional needs and to ensure that food provided to service users meets their individual nutritional needs. Ensure that appropriate professional advice is taken prior to the addition of medicines and supplements to service users meals and drinks to ensure these remain palatable in terms of Care Homes for Older People Page 23 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 texture and flavour. Ensure that staff adequately support and assist individual service users identified as needing assistance with their food intake so that service users receive a nutritious diet that is appropriate to their individual needs. Ensure that an accurate record of the food and drink provided to individual service users is maintained and contains sufficient detail to demonstrate whether the diet provided to each service user meets their individual needs. This is to make adequate,proper and prompt provision for the care and treatment of service users generally and in accordance with specific requirements. 3 8 12 Make arrangements to 24/05/2010 promote and monitor individual service user bowel actions and take prompt remedial action where problems are identified. Ensure that all service users have access to call bells unless a thorough and robust risk assessment indicates that a service user should not be provided with access to a call bell. Care Homes for Older People Page 24 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Ensure that all staff are provided with appropriate handover information about the conditions and care needs of service users in their care at the start of each shift. Ensure that the personal hygiene needs of individual service users are met. Undertake a review of the pressure area care provided to each individual service user and implement any necessary changes in order to ensure that pressure area care is provided to all service users according to their individual needs paying particular attention to those service users who remain in bed. This review should involve consultation with each service user and their representative. Put in place effective arrangements to ensure all staff are made aware of individual service users skin conditions having particular regard to pressure damage. Ensure that service users are kept adequately warm and comfortable at all times. Ensure that oral and nasopharyngeal suction is only undertaken on individual service users in accordance with multidisciplinary Care Homes for Older People Page 25 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 agreement, where individual service user risk assessments are in place and by nurses accredited to do so. Put in place effective arrangements to ensure that guidance and instruction provided by the multidisciplinary professionals about care and treatment of service users, in particular dieticians and speech and language therapists is relayed to all staff and followed at all times. This is to make adequate, proper and prompt provision for the care and treatment of service users generally and in accordance with specific requirements. 4 8 13 Ensure that individual service 02/07/2010 user risk assessments are reviewed and updated to reflect their changing health needs. This is to ensure service users are protected from risks of harm. 5 9 13 Ensure that the reasons for 21/05/2010 non -administration of medication to service users are recorded by the timely entry of an appropriate code or entry on the medication administration record relating to each service user. Page 26 of 34 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Ensure that the meanings of all codes used on service user medication administration records are clearly explained on each service users medication administration record. Ensure that any person that administers medication to service users makes a full and accurate record of the administration of that medication in the individual service users medication administration record at the time of administration. Ensure that appropriate professional advice is obtained and provided to all staff handling medication in sufficient detail to ensure that when medication is given to service users with swallowing difficulties or is given via a PEG tube it is done in a safe and appropriate way, taking account of individual service user needs. Ensure that the list of staff authorised to administer medication to service users is kept up to date at all times. Ensure that service user blood glucose readings are fully recorded on the diabetic/urine record sheet in line with the monitoring requirements detailed in the Care Homes for Older People Page 27 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 individual persons care plan to ensure that the correct doses of insulin can be given to that person. This is to make sure that there are arrangements in place to ensure the recording and safe administration of medication. 6 9 12 Ensure that an effective 21/05/2010 system is in place to request, obtain and retain adequate supplies of prescribed medicines for service users to ensure that medicines can be given to them in accordance with the prescribers instructions at all times. This is to make sure that service users receive their medication as prescribed. 7 26 13 Replace all broken, damaged 02/07/2010 and dirty call bell and light pull cords. Repair the flooring and replace the rusty and dirty commode chair in Marsden bathroom 27. Eradicate unpleasant odours. Clean and redecorate areas damaged by leaking soap dispensers. Repair or replace damaged vanity units to ensure that they can be cleaned Care Homes for Older People Page 28 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 effectively. Ensure incontinence pads are stored in their packaging. This is to ensure that all areas to which service users and staff have access are kept free from hazards and cross infection risks. 8 30 18 Undertake a comprehensive 31/07/2010 review of the training provided to current staff at the home and produce an accurate record of all training provided to individual members of staff. Produce an assessment of training needs for each member of staff to identify the training needed to enable each member of staff to meet service users health and welfare needs. Ensure that as a minimum each member of staff receives training in Understanding Dementia Managing challenging behaviour Safeguarding Adults Mental Capacity Act and Deprivation of Liberties safeguarding Ensure that all nurses with responsibility for administering medication are trained to do so. Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Put in place effective arrangements to ensure that all newly employed and current staff receive structured induction training that as a minimum includes Moving and Handling training Fire safety training Safeguarding adults Health and safety training Food Hygiene Ensure there are sufficient staff employed at the home that are trained in first aid so that there is at all times a minimum of one person on duty who has received first aid training. This is to ensure that the staff receive training appropriate to their work in order to meet the health and welfare needs of the service users accommodated at the home. 9 31 39 Give written notice to the 04/06/2010 Commission when someone, other than the registered manager, manages the home and when the registered manager ceases to manage the home. This is to ensure that the home is being run by a fit person who is able to fully discharge their responsibilities. 10 33 26 Carry out and provide adequate evidence of 04/06/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 appropriate monthly visits to the home on behalf of the registered provider. This is to ensure that the home is being operated in the best interests of service users and that they are receiving good quality care. 11 36 18 Ensure that the staff receive formal and appropriate supervision. This will ensure that staff are appropriately supervised and supported in their work. 12 38 37 Put in place effective 21/05/2010 arrangements to ensure that prompt written notification is made to the Commission of the death of any service user and the circumstances of that death. Put in place effective arrangements to ensure that prompt written notification is made to the Commission of the occurrence of any event in the care home which adversely affects the wellbeing or safety of any service user. Put in place effective arrangements to ensure that prompt written notification is made to the Commission of any allegation of misconduct by the registered person or any person who works at the care home. Care Homes for Older People Page 31 of 34 31/07/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that service users health, safety and welfare is being actively promoted and protected 13 38 13 Ensure that any 24/05/2010 supplementary heaters used during renewal of the heating system are appropriately guarded or provide low surface temperatures. Ensure that individual risk assessments are in place when any supplementary heaters are in use. Identify and take action to prevent any burns risk from existing broken radiators. This is to prevent the risk of burns to service users. 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 9 Consideration should be given to relocating medication stored on the Cleadon Unit, preferably into a single treatment room facility for the home. A copy of the providers current medication policy and up to date copies of other professional medication guidance should be put in the treatment room. Stocks of controlled drugs should be maintained at appropriate levels to ensure that they can all be accommodated in the Controlled Drugs cupboard. Care Homes for Older People Page 32 of 34 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 The medicines fridge in the Marsden treatment room should be replaced with one incorporating an integral thermometer. A record should be made in the disposal book to confirm when medication is removed from the home by the waste contractor. Details of how to mix medication with thickening agents should be recorded on the MAR of individual service users. 2 18 Staff need to be aware of and follow the homes own policy and procedural guidance together with Local Authority safeguarding protocols when handling complaints and issues of service user protection and well being. Storage arrangements and the management of out of use items and archived records should be reviewed. The development of any new storage areas should be discussed with the fire safety officer. 3 22 Care Homes for Older People Page 33 of 34 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!