Inspection on 02/11/09 for Stainton Way Care Home

This inspection was carried out on 2nd November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stainton Way Care Home 15/03/10

Stainton Way Care Home 19/02/09

Stainton Way Care Home 10/03/08

Stainton Way Care Home 26/02/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

Key inspection report Care homes for older people Name: Address: Stainton Way Care Home Stainton Way Hemlington Middlesbrough TS8 9LX     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: Katherine Acheson     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Stainton Way Care Home Stainton Way Hemlington Middlesbrough TS8 9LX 01642599157 01642596481 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): North East Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 67 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 49 Dementia - Code DE, maximum number of places: 18 over age of 55 years Date of last inspection Brief description of the care home Stainton Way is a purpose built care home in the village of Stainton on the outskirts of Middlesbrough. The home is registered to provide care to a maximum number of 67 older people, 18 of whom may have a dementia.The home is divided into four units. Each unit has lounge, dining facilites, toilets and bathing facilities. Bedrooms are single Care Homes for Older People Page 4 of 33 Over 65 0 49 18 0 1 9 0 2 2 0 0 9 Brief description of the care home in nature and have ensuite toilet facilities.A Passenger lift enables accesss to the first floor. The cost of care at the time of the inspection visit ranged from £428 to £435 a week. Care Homes for Older People Page 5 of 33 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: The Quality rating for this service is 0 star. This means that people who use the service experience poor quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspections reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. The group manager completed and returned an Annual Quality Assurance Assessment, (AQAA). The AQAA is the services self assessment on how they think that they are meeting National Minimum standards. This information was received before the inspection and was used as part of the inspection process. Care Homes for Older People Page 6 of 33 Before this inspection visit we looked at all of the information that we have received since the last inspection of the service on 19th February 2009. Some safeguarding issues highlighted the need to carry out an inspection sooner than originally planned. This key inspection took place over two days, the 2nd and 18th November 2009. The first day of the inspection was unannounced, the second day was announced. A pharmacy inspection of the service also took place on the 2nd November 2009. The pharmacy inspection looked at the homes systems and procedures for receipt, recording, storage, handling, administration and disposal of medicines. The reason for the inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff records. We looked around parts of the home to make sure that it was clean, safe and comfortable. Requirements and recommendations highlighted at the last inspection were revisited to see if improvements had been made. During the visit we talked with people who use the service, their relatives, the new manager and staff. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Medication administration and recording practises are not robust enough to ensure that people will always receive their medicines accurately as prescribed. Record keeping is poor and some handwritten entries on Medication Administration Records (MAR) are incorrect. Hand written entries and changes to MAR charts should be accurately recorded and detailed. The prescriber or community pharmacist should be asked to Care Homes for Older People Page 8 of 33 provide information when medication has a dose of when required or as directed. A current photograph of each person should be attached to their MAR charts. This helps to reduce the risk of medication being given to the wrong person. The temperature of the rooms in which medication was stored was inconsistent. The temperature needs to be regularly monitored to make sure that medicines are stored at a temperature recommended by the manufacturers. Medication carried over from one month to another should be recorded on the MAR to enable auditing. Care staff responsible for the administration of medication should have their competency assessed on a regular basis to make sure that they administer medication correctly and safely. Care plans need to be developed to ensure that they are individual and specific to the person. This will help to promote Independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Care plans for those people who have dementia should be updated to include the level of the persons dementia and the impact of dementia on life. Care plans for those people identified as aggressive should detail in what way they can be aggressive, what the triggers are to the aggression and what measures are in place to manage the aggression. All Care Plans should be reviewed and evaluated on a monthly basis or more often as needed to ensure that care needs are being met. Risk assessments for people should be reviewed and updated to detail clear and specific action that should be taken to prevent the person coming to harm. Moving and handling assessments need to be updated to include details of the persons mobility, assistance needed and equipment required to assist the person to ensure safety. Guidance should be available for staff who are completing nutritional risk assessments Nutritional risk assessments should be reviewed and updated to include details of why a person is at risk of malnutrition or why their risk has increased so that appropriate action and treatment can be taken to ensure the wellbeing of the person. Formal agreements should be made regarding the arrangements and expenditure for those people who use the service and are receiving one to one social hours. The homes complaint procedure needs to be updated to include names and contact details of who to complain to. The homes adult protection procedure needs to be updated to include clear action for staff to follow if abuse is suspected. Adult protection training should be provided to all staff on a regular basis to safeguard people that use the service. The homes recruitment procedure is not as robust as it should be. Gaps in employment are not always explored and appropriate references are not always obtained for prospective staff. The homes induction does not meet standards as set by Skills for Care. Mandatory training for many staff working at the home is out of date. Quality assurance monitoring is not happening as often as it should be to make sure that the home is being run in the best interest of people who use the service. Care Homes for Older People Page 9 of 33 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 10 of 33 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 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of people who are to use the service take place before they move into the home to ensure all needs can be met. Evidence: People who are to use the service are assessed before coming into the home. They firstly receive an assessment from a social worker. This assessment is sent to the home for review. Once this assessment has been reviewed the manager then visits the person at home or in hospital to carry out a further assessment. The manager uses these assessments to decide whether the home can meet their needs. If a person is funding their own care an assessment is usually only undertaken by the manager or senior staff working at Stainton Way. People are encouraged to visit the home before they move in. Care Homes for Older People Page 12 of 33 Evidence: People are offered a trial period of up to six weeks. At the end of the trial period a review takes place to make sure that the placement is both successful for the person using the service and the home. Care Homes for Older People Page 13 of 33 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. Care plans and assessments for people that use the service are insufficiently detailed and on some occasions incomplete. Medication administration and recording practices are not robust enough to ensure that people will always receive their medicines accurately as prescribed. This means that the treatment of their medical condition could be affected. Evidence: Last inspection of the service in February 2009 highlighted that care plans needed to be developed to include more detail and be reviewed/evaluated on a monthly basis or more often if needed. Care plans are records that are used by care services to show what sort of help each person needs and how staff will provide that care. The files of four people that use the service were looked at during the inspection, two from the dementia unit and two from the older persons unit. A basic assessment of needs is obtained prior to people moving into the home, this could be enhanced once the person has moved in to include more personal detail. Files looked at during the visit contained numerous other assessments an example being, nutritional, moving Care Homes for Older People Page 14 of 33 Evidence: and handling, and continence. Some of the assessments were incomplete or had not been updated on a regular basis. One file looked at during the visit contained a nutritional assessment. The purpose of the assessment was to identify if the person was malnourished or at risk of malnourishment. No guidance was available on files looked at for staff completing assessments. The homes group manager was asked to explain the nutritional assessment tool and scoring system, however was unable to do so fully. The nutritional assessment score for this person had increased. The higher the score the more at risk of malnutrition the person was. Although scores reflected that the persons risk of malnutrition was increasing there was no information on file to see why. Moving and handling assessments were insufficiently detailed. One completed assessment informed of the persons body shape and possibility of losing their balance, but did not detail how mobile the person was or help needed. One file looked at during the inspection contained a detailed history of the person including childhood, family, working years and interests. This is particularly useful when caring for a person with dementia. Evidence was available to confirm that care plans had been re-written and updated, however still did not include sufficient detail. One file looked at during the visit was that of a person who needed help to wash and dress. The care plan stated Offer bath, shower or strip wash twice weekly. One plan of care for a person on the dementia unit details that they can be aggressive. The plan of care does not detail in what way they can be aggressive, what the triggers are to the aggression or what measures are in place or action that staff should take to manage the aggression. Care plans did not include the level of the persons dementia or the impact of the dementia on life. One care file looked at during the visit contained a risk assessment which identified that the person would try to get out of the home and when they did they were at risk. The risk assessments did not clearly detail specific action to take to prevent the person coming to harm. Two of the four care files looked at during the visit contained evidence to confirm that care plans had been reviewed and updated on a monthly basis and two did not. There is clear evidence of the involvement of GPs, District Nurses and other healthcare professionals such as chiropodists. People living at the home confirmed that if they were feeling unwell, the GP would be called. During the inspection visit the manager and staff were observed to interact well with people that use the service and visitors. Staff approached people in a supportive and Care Homes for Older People Page 15 of 33 Evidence: respectful way. People spoken to during the visit were in general complimentary about life in the home and care received. Comments made included, The girls are nice and it is comfortable I am happy with the care she is getting The home is lovely and the staff are good. You can have a lie in if you like, but I am an early bird Its pretty good here really. Most of the staff are very good During the inspection arrangements for receiving, storing, administering, recording and disposing of medication were observed and examined. Medication administration and recording practices in the home are not robust enough to ensure that people will always receive their medication as prescribed. The record keeping of medicine administration was poor. A Medication Administration Record (MAR) is a chart that details prescribed medication and is signed by staff to say medication has been given. MAR charts looked at during the visit contained very few gaps meaning that staff had signed to say that medication had been given. When medicines were audited very few could be balanced. An example of this was twenty eight tablets were received for a person that uses the service. Staff had signed on twelve occasions to say that they had given the medication which would mean that there should be sixteen tablets left. A count of this medication highlighted that there were actually nineteen left. A number of MAR charts were handwritten. The MAR charts had been written by one person and signed as checked by another yet many of the MAR charts contained errors. Photographs were not within the medication files for a number of people that use the service. Medication was stored within each unit of the home. There were inconsistent records of room temperature in each storage area. Not all medication was stored securely. Creams were stored in peoples bathrooms and bedrooms some medicines were stored Care Homes for Older People Page 16 of 33 Evidence: in unlocked cupboards. The date of opening was not always added to eye drops, liquids and medicines with a limited use once open. This means that medication could be used beyond the expiry date. Staff responsible for the administration of medicines had received training, however would benefit from updates to make sure their training follows current best practice guidelines. Care staff should have their competency assessed to make sure that they follow safe practice. Care Homes for Older People Page 17 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service lead fulfilling lifestyles through exercising choice and control over how they spend their day. Food provided is enjoyed, which helps to maintain wellbeing. Evidence: The home employs three activity co-ordinators to plan, arrange and take part in activities for people that use the service. Some people who use the service have been assessed as needing individual activities and outings on a one to one basis. One of the activity co-ordinators has been appointed to provide this service, however people receive additional funding from the local authority for social hours. Activities and outings taking place include going to the pictures, shopping, eating out, doing jigsaws and word searches. A discussion took place with the home manager and office administrator regarding the need to make formal arrangements and agreements regarding expenditure. The two other activity co-ordinators work Monday to Friday with one or both being on duty from nine in the morning until four in the afternoon. Care Homes for Older People Page 18 of 33 Evidence: Activities taking place on a daily basis include, bingo, armchair exercise, flower arranging, scrabble and hand massages. The home had a summer fayre in August and have regular entertainers coming into the home to sing to people that use the service. The home were busy planning for Christmas. The Salvation Army are coming into the home on the 22nd December a Christmas carol concert is to be held on 13th December and the homes Christmas party is on 20th December. The mobile library bus visits on a monthly basis and leaves a plentiful supply of books. The manager said that there are monthly visits from representatives of the local Church of England and Methodist Churches. Visitors are welcome at any time. There was a plentiful supply of visitors on both inspection days. During the inspection a discussion took place with one of the homes activity coordinators. The activity co-ordinator spoke of a flexible and varied plan of activities. She said that activities also take place on a one to one basis with people who prefer to spend time in their own room as well as group activities. She said, This is a good place to work. I enjoy it. Comments made in respect of activities from people spoken to during the inspection included, It is pretty good here really. I enjoyed the musical bingo. There is enough going on if you want it and There is plenty to do. The lunchtime of people that use the service was observed. The lunch time menu of the day was beef casserole, mash potato, green beans, diced carrots and peas. There was an alternative of gammon available. For dessert there was ice cream with butterscotch sauce or coconut tart and custard. Lunch time was relaxed with people enjoying the food served. Tables were nicely set. People were given a glass of juice or water and a cup of tea. People spoken to during the inspection said that they liked the food, comments made included, The meals are good, there is always choice and The food is lovely. The AQAA advises that the home are in the process of issuing questionnaires to people that use the service to seek their views on food provided and to see if they would like any changes made to the current menu. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service are confident that their complaints would be listened to and acted upon, however the complaints procedure needs to be updated to include names and contact details of who to complain to. This will ensure that complaints are dealt with promptly. Adult protection procedures do not include clear action for staff to follow is abuse is suspected. Adult protection training is out of date and as such could impact on safeguarding people. Evidence: The last inspection of the service highlighted that the homes complaint procedure should be updated to include names and contact details of who to complain to, this had not been actioned. The complaints procedure advises of peoples rights to contact funding authorities if they want to make a complaint, however does not give any contact details. Since last inspection the homes system for recording of complaints has improved. The AQAA advises that the home have received seventeen complaints in the last twelve months. It was also highlighted at the last inspection that the homes adult protection procedure should be updated to include clear action for staff to follow if abuse is suspected, this has not been actioned. The procedure needs to be updated to ensure that any allegation of abuse is reported to the local authority prior to any investigation Care Homes for Older People Page 20 of 33 Evidence: taking place. The group manager advised that since last inspection adult protection training had been provided to some staff but not all. People living at the home said that they felt safe. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment is good providing people that live there with an attractive, homely and comfortable place to live. Evidence: Stainton Way is a purpose built care home, which is situated in the village of Stainton on the outskirts of Middlesbrough. The home is registered to provide care to a maximum number of sixty seven people eighteen of who have dementia. The home is divided into four units. The ground floor of the home has two units named Daisy Chain and Memory Lane. Daisy Chain can accommodate a maximum number of seventeen older people. There are fifteen single bedrooms and one double bedroom all of which have ensuite toilet facilities. Communal space consists of a lounge and a dining room. Memory Lane can accommodate a maximum number of sixteen older people. All bedrooms are single and have ensuite toilet facilities. Communal space consists of a combined lounge diner. On the first floor of the home there is a further two units named Lavender and Peace Haven. Care Homes for Older People Page 22 of 33 Evidence: Lavender can accommodate a maximum number of eighteen people with dementia. There are sixteen single bedrooms and one double bedroom all of which have ensuite toilet facilities. Communal space consists of a lounge and dining room. Peace Haven can accommodate maximum number of sixteen older people. All bedrooms are single and have ensuite toilet facilities. Communal space consists of a combined lounge diner. Toilet and bathing facilities are available on each unit. A passenger lift enables people to access the first floor. There is an enclosed garden area for people to use. There is a designated lounge on the ground floor of the home for people who wish to smoke. During the visit the Inspector walked around the home with the manager. In addition to communal lounge areas a number of people choose to sit on comfortable chairs in the wide corridors and ground floor reception area of the home. One person said, I like to sit in reception watching people come and go. Communal areas were beautifully decorated and well maintained. Since last inspection the homes hairdressing room has been refurbished. Bedrooms of people that use the service that were looked were nicely decorated, had appropriate furniture and were personalised. The last inspection highlighted that the home had a key pad locking system, which allowed people to gain access and leave the building by entering a code. The code had been shared freely with visitors, staff and visiting professionals. A recommendation was made that the homes security arrangements should be reviewed. On the first day of the inspection it became apparent that security had not been reviewed, the postman, representative from the chemist and others were freely able to enter and leave the home without staff being aware. A discussion took place with the manager regarding poor security who said that she would take immediate action to address the situation. On the second day of the inspection security arrangements had been reviewed. The code to enter the home and leave the building had been changed so that they were different to each other. The manager said that only people who had been given the code to enter the home were staff and district nurses. Appropriate laundry facilities are in place. Staff said that there was a plentiful supply of protective clothing. On the day of the inspection the home was clean and odour free. Care Homes for Older People Page 23 of 33 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. The homes recruitment procedure is not as robust as it should be. Gaps in employment are not always explored and appropriate references are not always obtained for prospective staff. The homes induction does not meet standards as set by Skills for Care. Mandatory training for many staff is out of date and as such does not ensure that they have the appropriate knowledge and skills to carry out their work. Evidence: At the time of the inspection there were sixty one people who were using the service, sixteen people on Peace Haven, fifteen people on Memory Lane, thirteen people on Daisy Chain and seventeen people on Lavender. Duty rotas looked at informed that there are three care staff on duty during the day on each unit, one of which is a senior care assistant. On night duty for all units there are six care staff on duty two of who are senior carers. In addition to care staff on duty the manager works full time Monday to Friday. People spoken to during the visit said that they felt there was enough staff on duty. A Care Homes for Older People Page 24 of 33 Evidence: relative spoken to during the visit said, I generally believe there is enough staff on duty. I feel that staff have the knowledge, skills and experience to meet mums needs. Nineteen out of thirty four care staff at the home have achieved a minimum qualification of NVQ level 2 in Care or equivalent. The remainder of the care staff are working towards achieving the qualification. Three files of staff working at the home were looked at during the visit. Files looked at identified that the homes recruitment procedure is not as robust as it should be. All three care files looked at during the visit contained evidence to confirm that a Criminal Record Bureau Check had been received prior to starting working at the home, however only one contained appropriate references. Gaps in employment had not been explored for any of the staff. Records were available to confirm that staff working at the home receive induction, however this did not meet with the standard as set by Skills for Care. This was highlighted at last inspection of the service. Examination of records highlighted that mandatory training for staff was out of date. The manager confirmed that staff were not up to date with their mandatory training and that she was in the process of arranging this and prioritising staff to attend. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance monitoring is not happening as often as it should be to ensure that the home is run in the best interest of people that use the service. Evidence: Since last inspection of the home a new manager has been appointed. The manager started working at the home in October 2009. She has many years of experience in working in social care and has achieved an NVQ level 4 in Care and Management. The manager is aware of the need to apply for registration with the Care Quality Commission. Long discussions took place with the new manager regarding concerns identified at this inspection of the service. The manager was efficient throughout the inspection process and demonstrated willingness and commitment to improve. The Responsible Individual was available at the home on the first day of the inspection. A long discussion took place with the Responsible Individual to inform him Care Homes for Older People Page 26 of 33 Evidence: of areas of concern. Quality assurance monitoring has not been happening as often as it should be. General surveys for people that use the service were last sent out in July 2008 to make sure that they were happy at the home and with the care they are receiving. Surveys asking people to comment on food have recently been sent out, however results were not available. Following last inspection of the home and as the result of a number of issues during the course of the year, the group manager and provider had informed the Care Quality Commission and Local Authority that they were to undertake numerous visits to the home to monitor the quality of the service at the home. The homes group manager was unable to provide evidence that these visits had taken place. The home looks after money for people who use the service. Since last inspection improvements have been made in record keeping. Each person has an individual record which details money held and transactions. A sample of health and safety records were examined and in general found to be in order. Records were available to confirm that the homes gas boilers, fire alarm and portable appliances had been serviced in the last twelve months. Water temperatures are taken and recorded on a weekly basis to ensure that they are within safe limits. The last inspection highlighted that on occasions water temperatures had been cooler than they should be. The manager said that this problem had been resolved. Records were available to confirm that on average weekly tests of the fire alarm system take place. Fire drills involving staff also take place on a regular basis. Records examined suggested that on occasions fire tests and drills were taking place at the same time with the same staff attending. It was pointed out to the manager that she should make a written record of the drill including effectiveness, how long it took and if any improvements or safety measures could be improved. Care Homes for Older People Page 27 of 33 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 28 of 33 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 9 13 Medication must be stored safely and securely. A system must be in place to check expiry dates of medicines and to add a date of opening when necessary. This makes sure that medication is safe to administer. 01/12/2009 2 9 13 Additional training that reflects best practice guidelines must be provided to all staff responsible for the administration of medication. Having well trained staff helps to reduce the risk of errors. 01/12/2009 3 9 13 Medication must be given as 02/11/2009 prescribed and a record made at the time that it is given. This will ensure that people receive their medications Care Homes for Older People Page 29 of 33 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 correctly and the treatment to their medical condition is not affected. 4 29 19 The Registered Person must ensure that a robust recruitment procedure is followed. To safeguard people who use the service. 5 30 18 The Registered Person must 30/12/2009 ensure that staff working at the home receive mandatory training. To ensure that they have the appropriate knowledge and skills to carry out their work. 6 31 8 The manager must apply for 31/03/2010 registration with the Care Quality Commission and undergo fit person interview. To make sure that she is competent and experienced to manage the home. 7 33 26 The Registered Person must 30/12/2009 ensure that appropriate quality assurance monitoring systems are in place. Visits as required under Regulation 26 of the Care Homes Regulations 2001 must be made on a monthly basis. 18/11/2009 Care Homes for Older People Page 30 of 33 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 help to ensure that the home is run in the best interest of people who use the service. 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 Risk assessments for people that use the service should be reviewed and updated to detail clear and specific action that should be taken to prevent the person coming to harm. Care Plans should be reviewed and evaluated on a monthly basis or more often as needed to ensure that care needs are being met. Care plans for those people who have dementia should be updated to include the level of the persons dementia and the impact of dementia on life. Care plans for those people identified as aggressive should detail in what way they can be aggressive, what the triggers are to the aggression are or what measures are in place or to be used to manage the aggression. Care plans should be individual and specific to the person. Care plans should be developed to include what the person can do for themselves, assistance needed, likes, dislikes, evidence of personal choice and preferences. This will help to promote Independence, ensure that care needs are met and that care is delivered in such a way that is acceptable to the person. Guidance should be available for staff who are completing nutritional risk assessments for people who use the service. Nutritional risk assessments should be reviewed and updated to include details of why a person is at risk of malnutrition or their risk has increased so that appropriate action and treatment can be taken to ensure the wellbeing of the person. 2 7 3 7 4 7 5 8 Care Homes for Older People Page 31 of 33 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 6 8 Moving and handling assessments need to be updated to include details of the persons mobility, assistance needed and equipment required to assist the person to ensure safety. Care staff responsible for the administration of medication should have their competency assessed on a regular basis to make sure that they administer medication correctly and safely. Medication carried over from one month to another should be recorded on the MAR to enable auditing. The temperature of the medication rooms should be regularly monitored. This makes sure that medicines are stored at a temperature recommended by the manufacturers. Hand written entries and changes to MAR charts should be accurately recorded and detailed. The prescriber or community pharmacist should be asked to provide information when medication has a dose of when required or as directed. This makes sure that medication is given correctly. A current photograph of each person should be attached to their MAR charts. This helps to reduce the risk of medication being given to the wrong person. Formal agreements should be made regarding the arrangements and expenditure for those people who use the service and are receiving one to one social hours. this helps to safeguard people that use the service and staff. The Registered Person should ensure that all care staff who have not achieved an NVQ level 2 in Care complete and induction that meets standards as set by Skills for Care. A written record of the homes fire drill including effectiveness, how long it took and if any improvements or safety measures could be improved should be kept. 7 9 8 9 9 9 10 9 11 9 12 12 13 30 14 38 Care Homes for Older People Page 32 of 33 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. 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