Inspection on 24/10/08 for Stallingborough Lodge Care Home

This inspection was carried out on 24th October 2008.

CSCI 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stallingborough Lodge Care Home 21/04/09

Stallingborough Lodge Care Home 07/01/09

Stallingborough Lodge Care Home 16/07/07

Stallingborough Lodge Care Home 18/07/06

Stallingborough Lodge Care Home 07/02/06

Stallingborough Lodge Care Home 12/08/05

Stallingborough Lodge Care Home 12/08/04

Stallingborough Lodge Care Home 16/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stallingborough Lodge Care Home Station Road Stallingborough Grimsby North East Lincs DN41 8AF     The quality rating for this care home is:   zero star poor service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Theresa Bryson     Date: 2 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Stallingborough Lodge Care Home Station Road Stallingborough Grimsby North East Lincs DN41 8AF 01472280210 F/P01472280210 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shire Care (Nursing and Residential Homes) Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 44 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 admssion to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD and PD(E) Date of last inspection Brief description of the care home Stallingborough Lodge Care Home is a purpose built establishment that is registered for 44 service users with problems of old age, physical disability over 65 years of age and under and also has a nursing registration for service users. The accommodation is set on the outskirts of a small village, near the larger town of Grimsby. It has some local amenities for service users to visit and the home is near a regular bus route into the town. The home is set in enclosed gardens, which are all accessible to wheelchair users. The home is part of a small group of homes, Shire Care Ltd, and is supported by Care Homes for Older People Page 4 of 32 Over 65 44 20 0 20 Brief description of the care home a head office team and a visiting Director of Operations. It has the benefit of also having service users visiting from other local homes. The home has several groups of staff employed including; - professionally trained nurses, care assistants, domestic and laundry staff, kitchen staff, administrator, handyman and activities organiser. The weekly fees are reviewed annaully .Extra charges are made for hairdressing and chiropody depending on treatments. This is also reviewed annually. The provider makes available to all prospective service users and current service users, the service user guide, which is also available and on display in the main entrance hall. Care Homes for Older People Page 5 of 32 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 the people who use this service experience poor quality outcomes. This was an urgent key inspection site visit as information had been passed to us from a number of sources that people may be at risk of harm. Prior to the visit we were able to speak to some relatives by telephone and some stakeholders by telephone and at a meeting. We were also able to review the service history of the home through records kept by us. The Acting Manager was present through the two days of the visit and the owner of the home was spoken to by telephone on the second day. On the first day we were Care Homes for Older People Page 6 of 32 accompanied by a member of the local Safe Guarding Adults Team. We have reviewed our practise 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 considereed 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. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 32 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should only be living in the home who fall within the category the home is Registered for and this could result in their needs being unable to be met and put them at risk. Evidence: This site visit was the result of The Commission working with the local Safe Guarding Adults Team of North East Lincolsnhire, where it had been brought to our notice that the home possibly had people living there who did not come under the category it is Registered for. During the course of tracking several case files the assessments completed by the home suggested that they did have people outside their category area living there. One person was currently being assessed, at the instigation of the Acting Manager, who had contacted the local Social Services Department. The names were later passed Care Homes for Older People Page 11 of 32 Evidence: to the local Social Services Department to enable them to re-assess those persons and establish whether they were suitably placed in the home. There has been a failure in the home of not keeping care plans up to date and where necessary contacting other bodies to re-assesses that persons needs and in some cases possibly suggesting they needed to be moved to an establishment better suited to meet their needs. This failure could result in people not having their needs met and being put at risk of harm. The assessments are usually completed by the Acting Manager or the Quality Control Nurse, working for the Company. The last documentation for the most recently admitted person was seen and showed how an holistic assessment tool had been used to confirm the persons needs. On this occasion the persons needs appeared to meet the criteria for the category the home is registered for. As there had been a change of manager since the last inspection we asked to see the homes Statement of Purpose and Service Users Guide. This gave all the latest information about the home and stated it could be produced in large print and other languages. It gave clear information about the home and the services it can provide to enable people to make informed choices about living there. The home does not give intermediate care and therefore Standard 6 is not applicable. Care Homes for Older People Page 12 of 32 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. Poor evaluation of care and a failure to deliver appropriate care when identified will result in peoples being put at risk of harm. Evidence: This site visit was in response to issues being brought to our notice which could affect the safety of the people living in the home. There was no time to send out survey forms but several relatives were spoken to by telephone and other stakeholders, during a meeting, prior to the visit. 8 people were spoken to on the day who live in the home, plus 11 staff. 3 care plans were tracked in depth and found to be of a poor standard. There had been little evaluation for some months and in some cases the notes were inaccurate. For example care plans stated where there should be bed rail assessments in place yet the assessments were not completed until after they were in place on the persons bed. The new management team have now addressed this issue and written evidence was seen that these are now in place and the old bed rails which do not meet new Care Homes for Older People Page 13 of 32 Evidence: standards were seen to be in storage waiting for disposal. We had been informed that the staff in the home had not responded to the care needs of one individual recently, despite having received the relevant training to use the apparatus required to assist this persons medical needs. This had resulted in the person becoming very distressed and having an emergency hospital admission. The care plan notes stated where instruction had been given to staff and also the failures of staff to respond when the person needed them. The input by the Community Nursing Staff was very intensive, yet the homes staff appeared not to respond to the identified needs of this person. Information had been received prior to this visit of the failure of staff to respond to the needs of those with diabetes and this had also resulted, according to the care plans seen, of a hospital admission, due to staff not monitoring the needs efficiently. In several cases it had been identified in the care plans that peoples blood sugar reading needed to be monitored regularly, yet the records seen had been spasmodically written. There were also indications in the care plan notes that some people needed to have their weights monitored on a weekly basis. This the home cannot do as there is only one set of scales between 4 homes in the group and each home only has the scales for a week at a time. This could result in an unacceptable weight change, with negative consequences for health, in this client group. Especially as the need for more frequent monitoring is identified in the homes assessment. The recent copy of the management audit of care plans also showed that few had been evaluated and this had been fed back to the staff through a minuted staff meeting which was seen. A failure to evaluate and deliver the appropriate care to people living in the home will put them at considerable risk of harm. Written evidence was also seen that there is a possibility that the home has people resident who fall outside the category the home is Registered for. For example one persons care plan identified some degrees of memory loss and challenging behavior. We were also given a list by staff in the home of twelve people who have dementia. 3 were listed as only having dementia and 9 with dementia and other multi medical problems. At a meal time we asked a member of staff to identify people who could make informed decision to speak to us and 3 were identified who staff stated have dementia. The names of those people were passed to the Care Management Team of the local authority to be reassessed. People admitted without an in depth assessment and without care plan evaluations who are later found to be outside the homes category of Registration could result in those people being put at risk from an ill equipped home and staff not trained to look after their needs. Whilst touring the home there was some equipment which was not fit for use. For example some beds appeared to be very small and 2 people were observed who were having difficulty in moving whilst in bed. A bath hoist had to be taken out of use, with immediate effect, as it was in a poor state of repair and could have harmed a person Care Homes for Older People Page 14 of 32 Evidence: using it. Some people spoken to stated that they were having difficulties in getting staff to allow them to exercise their independence, whilst they can. For example one person is able to use a urine bottle yet frequently has to ask staff to empty it as it makes my room smell. Several people also stated that some staff were difficult to understand, especially those whose first language was not English. One person stated I have to repeat myself so many times and then I get muddled. there were 7 permanent members of staff working in the home whose first language is not English but there was no indication on their personal records that the home was assisting them to improve their language skills. One staff member spoken to had difficulty answering simple questions put to them by ourselves and could not read a simple notice of instruction in the home. This person was identified to the management team during the course of the visit. Recently the new management team have ensured that an appropriate contract is in place to ensure the safe disposal of controlled drugs, as this had expired. There was also a new pharmacy supplier. Since the last inspection the drug storage area has been enlarged to make a better working area for staff. We had been notified prior to this visit that there had been a drug error which had been passed to the local Safe Guarding Adults Team. Some staff had gone through the homes disciplinary process and copies of letters and action taken where seen on their files. On this visit the drug administration sheets were, in some cases incomplete but this had been picked up by the homes own new auditing process. This was seen and detailed action taken by management staff to correct errors. 2 people were being fed by artificial means but when questioned a staff member, when questioned failed to be able to give an answer to the recent regime of one person and was referring to documentation which was a year old. The persons care regime had been reviewed a few weeks previously. The staff members name was given to the management team during the visit. People visiting the home had stated to us that some staff appeared not to be able to follow instructions which could people at risk,for example: in positioning a person in bed to aid their breathing.Staff were observed giving personal care and assisting at meals, which was completed in a relaxed manner. Staff stated to us that at times the amount of care they can deliver is impaired by not enough staff being on duty and the skill mix of staff was not always good as we do not have appropriate staff to actually care. A failure to ensure peoples assessed needs are being met and that they are cared for by appropriately trained staff could put them at risk. Care Homes for Older People Page 15 of 32 Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social, cultural and religious needs and expectations are not being met and will result in them becoming isolated in the home. Evidence: There has been an outstanding requirement since the last inspection that insufficient social activities are being provided in the home. The documentation on this visit showed that there was still insufficient written evidence to support a variety of social activities taking place. When assessments had been completed they were not often followed through to actual events taking place. For example one person showed a need to socialize more outside the home. There was no supporting evidence to suggest this takes place and the person spoken to said time was limited due to insufficient staff being on duty. The home currently did not have a staff member allocated to facilitate activities and events, which staff stated was making their job difficult as it took them away from other care tasks. This could result in peoples expectations not being met and people becoming isolated at the home. People themselves stated to us that they were at times bored and we dont do much at all, you have to make your own enjoyment. Care Homes for Older People Page 17 of 32 Evidence: Only a brief tour of the kitchen took place as the Environmental Health Officer had visited in the last few weeks and left requirements for the home to complete to ensure food could be prepared in a clean and safe environment. There is still a system in place to ensure people are being observed, where necessary, to ensure they eat a balanced diet. These records showed the percentages of food eaten at each meal. There was no documented evidence to support how this information was passed on to care staff to ensure people are not put at risk from having an inadequate diet to keep them well. Care Homes for Older People Page 18 of 32 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 should be able to raise concerns knowing they will be looked into promptly with out any fear of reprisals. Evidence: This site visit was in response to allegations which had been made that people in the home were not being looked after and their needs were not being met. On this site visit we were accompanied by a member of the local Safe Guarding Adults Team who focused on the concerns raised to them. This is the third safe guarding adults referral which had been made to the local team in 3 months. One of those referrals the team asked the home to look into themselves. On the complaints log seen the home had also dealt with 3 concerns raised to them and recorded the outcomes.People spoken to said they felt more confident in the present management team and would not be worried about raising issues. This has altered from previous management where people stated I was told to find another place to live. Another person said that the issue they had brought to the current managements notice had been dealt with promptly and in confidence. There was also written evidence seen that all policies adhering to complaints and safe guarding issues had been reviewed. Some safe guarding adults training had also taken place earlier this month. Care Homes for Older People Page 19 of 32 Evidence: People need to feel confident that any concerns raised will be dealt with promptly and in confidence so they can live in a relaxed atmosphere. Care Homes for Older People Page 20 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should be able to live in an environment which is safe and comfortable, free from hazards and smells. Evidence: We were accompanied for one of the days of the site visit on tour of the home, by a member of the Safe Guarding Adults Team. For part of the visit we also walked around the home alone. There were several trip hazards in the home, which could cause any one to fall. These included furniture used to prop open doors, thresholds of doors with uneven surfaces and trolleys left in corridors making it difficult for those in self propelling wheelchairs and using zimmer frames to walk to negotiate their way around. Parts of the home had an odorous smell not only near bedroom areas but also near a lounge and the main dining room. This made for an unpleasant environment in which to live. All communal areas, toilets, bathrooms and a selection of bedrooms were inspected. Some parts of the home looked tired in the choice of decoration used. Some equipment was also not fit for purpose and the manager asked to address these items as a priority to safe guard people and ensure they were living in a safe and comfortable environment. This included ensuring that all beds were of a size to allow Care Homes for Older People Page 21 of 32 Evidence: people to rest in comfort. Two people were seen who were having difficulty in turning over in the their beds. Some commodes were in a poor state of repair and could cause damage to peoples legs. A bath hoist was asked to be taken out of service as it was in such a poor state of repair it could cause damage and discomfort to people using it. The smokers lounge was being redecorated during the site visit. And we were also able to see what other maintenance work had been completed prior to our visit. This included small jobs like replacing light bulbs to redecorating a bed room. Since the last visit a new activities room had been built, but was currently not used to its full potential due to a lack of planned activities taking place. The gardens were neat and tidy. There is open access to all main roads and the car park. Staff must ensure they are vigilant when people whose memory is impaired are close to exit doors. An incident form was handed to us, which The Commission had never seen before, concerning a missing person in the home in August 2008. Staff had failed to tell the management team and The Commission. The person was found a short distance away from the home and was cold as the incident happened at night. Measures have now been put in place to try and ensure staff are more diligent, especially at night, as to the whereabouts of people living in the home, especially if they can not make decisions about their own safety. Several people spoken to said they had been comforted by being able to bring a few belongings and some furniture in with them on admission. There was ample evidence that this was so and people spoken to seemed delighted to talk about their favorite pieces of furniture or paintings or ornaments. Some people said they were disappointed that on occasions their beds were not made until late afternoon or they had to ask for them to be made. Also that on several occasions over a period of time they also had to ask for clean towels. A couple of people said even though we put dirty towels on the floor it can be a day or more before they are taken away. Generally the home was tidy and was clean, but people were feeling dissatisfied with the speed some things were completed and some issues of safety had not been checked for sometime. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been no robust systems in place to recruit staff and ensure they are safe to work with people in the home and are trained to do their jobs. Evidence: When speaking to stakeholders prior to going on the site visit and also to relatives, concerns were raised to us about the competence of some staff. The poor care plans documentation, poor delivery of care to some people and poor administration of medication to some people has caused a great deal of concern in the home. We were presented at the site visit with an incident report concerning the disciplinary of an ex-staff member who allegedly did not care for a person well. This was the first time The Commission had seen this report. It was not refereed to the Safe Guarding Team which will prove difficult to track this persons future employment. Staff and people living in the home expressed their concerns to us about the sometimes lack of staff in the home and the skill mix of those staff. One person said we have too many chiefs and not enough Indians to do the work. Others stated their concern that some staff did not appear to know what was asked of them like ensuring people were dressed appropriately or about specific nursing tasks like changing wound dressings and using pieces of equipment. A selection of rotas were seen. Some days Care Homes for Older People Page 23 of 32 Evidence: there appeared to be less staff on duty than others, but recently the level of sick leave had been reduced and also the numbers of agency staff used. The management team also needed to ensure they were using the correct matrix to ascertain the numbers of staff required to ensure peoples needs were being met. Concern had also been raised by stakeholders and people resident in the home of how little some staff could understand English being spoken, when it wasnt their first language. There were 7 permanent staff whose first language was not English. One spoken to during the visit found answering simple questions difficult and also found it difficult to read a simple instruction notice. This person was identified to the management team the same day. On checking the staff files there was no evidence to support that the home was taking measures to ensure these staff could be enabled to improve their understanding of English. The personal files of all the 7 trained nursing staff and some other grades were tracked in depth. There was no evidence to show that any nurse had been challenged on their abilities to maintain a valid Registration with the Nursing and Midwifery Council. 3 Registrations had to be checked on the first day of the site visit as we could not find any evidence of current fitness to practice documentation. This was later produced. All work permits were now in place, but documentation was seen of one person, no longer employed, who has been reported to the Home Office for an invalid work permit. This had been discovered by the current management team. The current team have also ensured that each staff member has completed safety checks prior to continuing their employment and are safe to work with people in the home. Documentation was seen to verify this statement. The training of staff has been spasmodically recorded in the last year. Even when staff have been given instruction to use equipment there was documented evidence to show that they have failed to adhere to this and put at least one person at risk of harm. This person has now said they are concerned what would happen if their health deteriorated more. The current management team were preparing a training and skills matrix during the course of the visit and have also commenced a new clinical procedures manual. This will help to ensure staff have something to refer to and be able to give the correct care to those living in the home. A failure to ensure sufficient staff are on duty, that they have received adequate safety checks and then trained to do their jobs could people at risk of harm and make them feel unsure of how well they are being looked after. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People should be able to live in safe and comfortable home, run for their benefit and to suit their individual needs. Evidence: The current management team are beginning to put auditing tools together to ensure that the home is run for the benefit of people living there. They had already identified, when minutes of meetings were seen and audits completed, certain major areas of concern and had begun action plans. This included testing the competence of all trained nurses, health and safety audit, surveys to people using the home and their relatives and reviewing all the policy and procedure manuals. The team spoke of how they are now asking for the assistance of other health care professionals and looking to appoint a person specifically to monitor nursing tasks. The main file of peoples personal allowances appeared to be correct and there is now a checking system in place. The home is currently looking into the management of the Care Homes for Older People Page 25 of 32 Evidence: Residents Fund as there appeared to be no written records of what was held and where this money is kept. This could result in there being a fraudulent use of this fund if it is not checked regularly. All the safety certificates were seen to be in place and new auditing methods in place to ensure the home is safe to live and work in. These were seen during the site visit. Supervision records could not be found of sessions completed since the last inspection, but staff stated they had completed discussion sessions. These had apparently been spasmodic and did not include any observational supervising. The new management team have completed a first set of appraisals with all staff and will continue to monitor their progress through discussion and observation. Each appraisal was seen to have action planning attached. This will ensure staff are safely being monitored and can do their jobs, if failures occur action plans will be put in place. Care Homes for Older People Page 26 of 32 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 12 16.2.m. The registered person must 24/01/2009 ensure that all aspects of service users recreational, social, cultural, religious and other needs can be met. And that the activities organiser has received training in caring for those with memory loss. (This time scale has been adjusted, as this aspect was not checked on this occasion of 16/04/07. Now the original time scale of 16/05/07 has not been met). Care Homes for Older People Page 27 of 32 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 2 4 There are people living in the home who fall outside of the category the home is Registered for. People must not live in the home who do not come into the category of Registration of the home. A failure to do so could result in them being put at risk from staff who have not been trained to look after their needs. 24/12/2008 2 3 18 Assessments on people prior 24/12/2008 to them coming into the home must be accurate. A failure to make the correct assessments on people will result in them being resident in the home when the home cannot meet their needs. 3 7 15 Peoples assessed needs must be evaluated on a regular basis. 24/12/2008 Care Homes for Older People Page 28 of 32 A failure to ensure needs are regularly reviewed will result in people being put at risk of harm. 4 8 13 The assistance of health care professionals must be sought and their advice followed when required. A failure to respond to care needs and seek assistance will result in people being placed at risk. 5 12 16 Arrangements must be made to ensure peoples social, cultural and religious needs are met. A failure to ensure peoples expectations are being met will result in them becoming isolated. 6 13 16 Peoples must be allowed to have contact with the local community and maintain contact with family and friends. A failure to meet peoples expectations will result in them becoming isolated and unfulfilled. 7 27 18 There must be sufficient staff to enable peoples needs to be met. A suitable matrix to determine dependency levels must be used. 24/12/2008 24/01/2009 24/01/2009 24/12/2008 Care Homes for Older People Page 29 of 32 A failure to ensure sufficient staff are on duty will lead to peoples needs not being met. 8 29 18 Robust recruitment systems must be in place to ensure staff are safe to work with people in the home. Safety checks must be completed on all staff to ensure they are suitable of working with people in the home. 9 30 18 Staff must have sufficient training to enable them to do their jobs. Staff must have sufficient training to understand the needs of people they are looking after and not put them at risk. 10 35 25 Funds raised for use of 24/12/2008 people living in the home must be accurately recorded and checked. A failure to do so could result in a fraudulent use of those funds. 11 36 18 Staff must be supervised to ensure they can do their jobs. A failure to monitor staff could result in people being put at risk from unsafe practice being used. 24/01/2009 24/01/2009 24/12/2008 Recommendations Care Homes for Older People Page 30 of 32 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 2 3 7 9 15 A system should be in place to monitor the progress of each persons care plan and ensure it is kept up to date. Staff should use a safe system of administering medication and be supervised to ensure they are safe practitioners. Staff must be aware of the requirements set out by other statutory bodies and ensure relevant information about people living in the home is passed to the correct staff. Staff should be trained to respond to safe guarding needs and concerns raised by people living in the home and do so promptly and without fear of reprisal of those people. A full maintenance program should be in place to ensure the home is safe and comfortable to live. All staff recruited should be able to have a sufficient command of the English language to have themselves understood and be able to under others. And where it is valid for their job role to be able to read English. A good auditing system should be in place to ensure the home is run to meet the needs of people living there. 4 18 5 6 19 29 7 33 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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