Inspection on 02/12/09 for Stoneham House

This inspection was carried out on 2nd December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stoneham House 28/11/08

Stoneham House 05/12/07

Stoneham House 25/05/07

Stoneham House 15/01/07

Stoneham House 28/04/06

Stoneham House 01/09/05

Stoneham House 13/04/05

Stoneham House 19/10/04

Stoneham House 12/05/04

Stoneham House 14/01/04

Stoneham House 11/07/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Stoneham House 4 Bracken Place Chilworth Southampton Hampshire SO16 3NG     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: Chris Johnson     Date: 0 2 1 2 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 32 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 32 Information about the care home Name of care home: Address: Stoneham House 4 Bracken Place Chilworth Southampton Hampshire SO16 3NG 02380760112 02380768585 stonehamhouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs W L Bellett care home 37 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 to be accommodated is 37. The registered person may provide the following category/ies of service only: Care home only - (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 (OP) Dementia (DE). Date of last inspection Brief description of the care home The home is located on the outskirts of Southampton with easy vehicular access to local amenities. The home was opened in 1995 and is a large detached property standing in extensive grounds. There is a car parking area at the front and the side of the building. The building stands on a slight hill, so has three floor levels, which can be accessed with a shaft lift. The home has some shared bedrooms, but the present philosophy of the home is to operate at less than full capacity, thus ensuring that current service users have a single room. Communal space is provided by way of a Care Homes for Older People Page 4 of 32 2 8 1 1 2 0 0 8 37 0 Over 65 0 37 Brief description of the care home large lounge, a dining room and a conservatory area. There are also two patio areas, with some furniture. 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 purpose of this inspection was to assess how well the home is doing in complying with regulations, compliance with previous requirements and to assess what the outcomes are for people who live at his home. The findings of this report are based on a number of different sources of evidence. These included: An unannounced visit to the home, which was carried out by two inspectors over one day on 2 December 2009. We arrived at the home at 09:30 and completed the visit at 19:10. During the visit we looked at all key standards and followed up on requirements that were outstanding from the previous inspection. Any regulatory activity since the last inspection was reviewed and taken into account including any notifications sent to the Care Quality Commission and the predecessor organisation the Commission for Social Care Inspection. We requested that the manager complete an Annual Quality Assurance Assessment (AQAA) prior to this inspection and this document forms part of the evidence for this Care Homes for Older People Page 6 of 32 report. During this visit we looked at the physical environment including, peoples bedrooms and all communal areas of the home. We examined records, policies and procedures. We talked to people who live at the home and some members of staff. We observed staff during their day-to-day interactions with people living at the home. We also gave out surveys to staff and people living at the home. During the inspection it was brought to the attention of the person managing the service that statutory powers under sections 31 and 32 of the Care standards Act 2000 were in use and a notice was left identifying failures that led the inspectors to believe that an offence may have been committed. The commission is considering the action to be taken as a result of this non-compliance and following a management review of the situation they will be informed of the action agreed. The manager was on leave the day of the visit. However he voluntarily came into the home to provide the inspectors with information and to give them access to documents and was present for some of the visit. The provider was present throughout the visit to answer questions and discuss issues and verbal feedback was provided to her at the end of the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home on a permanent basis have their needs assessed prior to moving in. This enables the home to determine whether they can meet the persons needs. The assessment process for people coming on a respite basis is less robust and does not provide assurances that needs can be met. Evidence: At the last inspection of this home carried out on 28 November 2008 this outcome area was judged to be good. The annual quality assurance assessment (AQAA) completed by the manager prior to the visit stated, We use a Department of Health recognised single assessment process tool, which cover the elements, required by standards to assess the residents before they are admitted. The AQAA also told us that, The Home will assess all care needs of residents before admission and confirms to the resident/representative in writing that the Home is able to meet their needs. Care Homes for Older People Page 10 of 32 Evidence: During the visit to the home we looked at the care records of four people and this included someone who had moved into the home since our last visit. At the time of this visit the home was accommodating fourteen people. One of whom was in hospital. We looked at the records and assessment documentation for the most recent admission to the home. This person had undergone an initial assessment as described in the homes AQQA and as has been found at previous visits. When looking at the assessment of someone who had been admitted to the home for respite care it was noted that although they had undergone an initial assessment for their first stay at the home, the home had not carried out a re- assessment of their needs for any subsequent stays. Neither had their care plan been reviewed. Records provided evidence that their needs were changing and that they were likely to continue to change. Care Homes for Older People Page 11 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. While some parts of the care plans provide sufficient detail, information in some care plans is contradictory and inaccurate. This means that care plans can not be relied on to provide correct information to staff to carry out their care duties. Medication procedures within the home are unsafe and poor recording practices mean that staff can not be clear whether people have received their medication as prescribed or not. The practice of providing accommodation to staff within the home is an intrusion into the dignity and respect of those living in the home. Evidence: On the last two occasions that we have inspected this home this outcome area has been judged as adequate. During our visit to the home we looked at the care plans and associated documents such as risk assessments and medication records, in respect of four people. In order Care Homes for Older People Page 12 of 32 Evidence: to gain the opinion of the standard of health and personal care that people received, we talked to people who live at the home and some people completed a survey. We also had the opportunity to talk with a relative of someone living at the home. People have told us that they are happy with the care and support that they receive and staff who completed a survey were all of the opinion that they received up to date information about the needs of the people who live at the home. Some information within care plans contradicted with other parts. We could not determine if all care plans were appropriate for the person. There were several contradictions within care plans and it appeared that information had been cut and pasted from other care plans. This meant that care plans could not be relied upon to provide accurate information and in at least one case appeared to be a mixture of two persons care plans, with them being referred to as both He and She. The following text from a care plan of a male resident regarding their personal care needs provides an example of this. He would like a bath normally once a week, which requires a hoist into the bath. Carer needs to wash all body and legs and feet. Would like to wash her face, hands and arms if a flannel is handed to her with soap on it. He does not like to be forced to have a bath ,she thinks it is better to have a bath when she is in the right frame of mind. She likes to have bubble bath and lots of nice smells. When she has had a bath she enjoys being told how nice she looks. She does not like her hair washed or her head touched it upsets her. She likes her hair washed once a week with her hairdresser after she has had her hair done. We discussed the information recorded in the care plan with the person concerned and although they said that some parts were accurate it was clear that other parts were not. Three of the care plans looked at were of people who were permanent residents of the home and we saw evidence that these had been kept under regular review. This was not the case for the care plan of a person staying at the home for respite care. Records showed that this person had stayed at the home on several occasions and that they had originally been assessed by the home in March 2009. There was a care plan dated 7 April 2009 and this had not been reviewed or updated since. This was despite the fact that they had stayed at the home as a respite resident on at least two further occasions. Care Homes for Older People Page 13 of 32 Evidence: There was no evidence that they had been reassessed prior to being readmitted since the original assessment despite the fact that this person had dementia care needs that may well have changed over time. The care plan was not reflective of this persons needs. It stated that they slept well however this conflicted with information recorded in the daily records. In discussion with staff it was found that they do not use the care plans to inform them how to carry out care. Current practice is that they record in the daily notes a description of the care provided. They are not involved in care plan reviews as the manager takes responsibility for this. Discussion and observation however of staff practises was that they had a good understanding of peoples individual care needs and that their contribution and input into the care planning process would prove beneficial. The manager stated in the annual quality assurance assessment (AQAA) that the home used Dementia Care Mapping,to indicate what different activities may help engagement with some service users. In discussion with the manager we asked which people he had assessed using this technique. The manager had not used this technique on any individual person currently living at the home. Evidence showed that the last time this had been undertaken on an individual was in March 2009, in respect of someone who had since left the home. The manager stated that he had undertaken generalised mapping involving many people during meal periods, and during activities. The level and frequency of information recorded in the daily records needs to be improved. Examination of the daily records for one person would indicate that they had not had a bath in November. Daily notes were not numbered and staff had only recorded the persons first name in some cases which could lead to confusion. Whilst some daily records provided evidence that concerns were being monitored others did not. It was noted for instance that staff on the day shift recorded that someone had not passed urine all day and that this needed to be monitored. There was no recorded evidence that this had been monitored throughout the night and the next entry made the following day did not refer to this. In contrast to the above concerns, some care plans did provide some detailed information regarding peoples personal care and support needs. Care plans were written in the first person and all care plans examined referred to the importance of Care Homes for Older People Page 14 of 32 Evidence: maintaining privacy and dignity. During the visit we became aware that the home was providing accommodation to a staff member within an empty bedroom at the home. We explained to the provider that this was unacceptable practice as it was an intrusion into the dignity and respect of those living in the home. The provider Mrs Bellet confirmed to us during the visit that the staff member would be found alternative accommodation with immediate effect and we witnessed the staff member to move her belongings from the room. We have written to the provider and the manager to reinforce this and have received a response confirming that there will not be any further occurrences. Risk assessments and associated risk management plans were in place for all identified risks. Where possible the home had developed a memories of my life document. This provided a life story of the person in some cases this information had been provided by relatives and in others the person themselves. We also saw that where someone had refused to provide this information their choice had been respected. We saw records during our visit to the home that people had access to a range of services such as GPs, Dentists, Chiropodists and District nurses. This was supported through conversations with people. During the visit to the home we observed a senior member of staff administer people their medication. We examined the medication administration records and it was found that staff were not recording the administration of medication appropriately or correctly. It was noted that there were errors on at least six peoples medication administration recording charts. There were lots of gaps on the medication administration records (MAR) and it was not clear if people had received their medication as prescribed or not. We brought this to the attention of the provider and explained our concerns. Overall our findings regarding the management and administration of medication was not in keeping with the information supplied by the manager in the annual quality assurance assessment (AQAA) which stated, We have a robust medication policy, procedure that is followed by the staff. Staff all have access to the written information and understand their role and responsibilities with regard to medication. The medication is reviewed regularly by medical staff. Medication records are accurate. Records clearly were not accurate apart from the gaps in recording as described above there were several other anomalies. Care Homes for Older People Page 15 of 32 Evidence: One persons record indicated that they had missed a dose. When queried with staff we were told that they no longer took this medication. However the record still stated that the medication should be administered. This put the person at risk of receiving medication which according to verbal feedback was discontinued. One bottle of medication had been opened for a person however no record had been recorded of the date that it had been opened. Medication was found in the medication trolley prescribed for someone who no longer lived at the home. The dosage on a bottle of medication for someone else had been altered in pen from 4mls twice daily to 2mls twice daily. Staff were however administering from another bottle that stated 4mls twice daily and the MAR stated 2mls twice daily. It could not therefore be established what dosage the person should have been receiving. This person could therefore have received double the stated dosed or only half of the dose required. The storage of medicines were found to be safe with all current medication being stored within a dedicated locked trolley. Staff stated that the manager was responsible for ordering and dealing with medication and other than administering they did not get involved in other aspects. We asked staff to describe the medication administration training that they had received. They told us that they had watched a video, taken a test following the video, they had then observed medication being administered and been observed themselves prior to being issued with a certificate. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a healthy diet. People requiring pureed diets are not as well catered for as those who do not. People can make their own decisions about how they spend their day and can receive visitors as and when they wish. Evidence: We asked people who live at the home whether there were activities that they could take part in. Although they did not answer with a direct yes or no they were able to name some activities that they had enjoyed taking part in. One person told us, We went out in summer to the forest , Another person said that they had taken part in Christmas card making and that they chose not to go out, another person had made Christmas cards and said that they went out in the summer and enjoyed sitting in the garden during the summer. People were generally happy with the meals at the home and told us that they Usually liked the food. Comments from people included,Suits me. This person thought that the home would provide an alternative if they didnt want menu item. Someone else commented Lovely and said that some people had seconds. Another Care Homes for Older People Page 17 of 32 Evidence: person said that if you ask they will give you something different. Someone else commented that the food was pretty good they did not think that there was a choice and said that they accepted what they were given. Care plans highlighted any support needs associated with eating, drinking and diet. The manager told us that they had kept the menus under constant review and that they had a menu system whereby no two weeks of the year were the same and that they had maintained this for the last two years. We saw examples of menus and it was noted that these were only available in written format. Due to the communication needs of many of the people who live at the home alternative formats such as pictorial menus would seem more appropriate. We observed the midday meal and noted that people ate in a calm and unhurried manner. The home employs a cook and they were on duty the day of our visit. The cook confirmed that they had information regarding any special dietary requirements required by people such as those associated with diabetes. We observed one person to be provided a pureed meal. It was noted that the meal had been pureed together and served in a breakfast bowl. We spoke with the person concerned and they stated that there needs were such that they needed to have a pureed diet. We asked if they had ever been offered the purred diet as separate components of the meal and they told us that this had never been offered. Staff stated that it was the persons choice to have the whole meal pureed together. However the person was not aware that any alternative was possible. In discussion with the cook it was evident that they had not considered presenting the meal in any other way. We saw computer records of the minutes of residents meetings and these showed that people are consulted about the menu. The home had a visitors policy and did not place any restrictions on the frequency or times that people could receive visitors. All visitors to the home are requested to sign a visitors book and examination of this provided evidence that people could receive visitors as often as they wished. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory systems are in place for people to address any concerns or complaints that they may have. Evidence: The last inspection carried out 28 November 2008 found this outcome area to be Good. The judgement on that occasion was that there were satisfactory systems in place for people to address any concerns or complaints that they had. People were protected by the homes policies and procedures and staff received related training. The annual quality assurance assessment (AQAA) stated, We have clear complaints procedure that highlights the importance of complaining or making suggestions for improvement. It is made available in all the languages of the present residents and in tape form and large print so that everyone who is in the home and relatives understand how to complain or make suggestions. Everyone has a copy of the complaints procedure given to them either before or on admission and a copy is on the notice board. We saw that a copy of the complaint procedure was on display in the home. In discussion with people living at the home they told us that they would report any concerns that they may have. Comments included, If necessary I would say, I would say if I had any complaints but there is no need to make a complaint and I would say if I had any concerns. Care Homes for Older People Page 19 of 32 Evidence: Staff told us that they knew the procedure to follow if someone was to raise a concern about the home. Data recorded in the AQAA told us that the home had not received any complaints in the last twelve months. When looking at staff training records we could not see any evidence that they had received specific Protection of Vulnerable Adults training. They had however covered this area as part the common induction training that they had all undertaken. All staff had received copies of codes of practice and are made aware of relevant policies during their induction period. We know that there have been some ongoing safeguarding investigations instigated by local authorities. At the time of this visit these were ongoing and we are therefore unable to comment any further. Following our visit we made a safeguarding referral to the local authority due to concerns that we had regarding the lack of assessment and the care plan not being reflective of the persons needs. This has been discussed in the Choice of home and Health and personal care sections of this report. 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. The home provides a safe clean environment to live in. Improvements to some communal areas would provide a more homely feel to the home as at present these are quite bare. Evidence: On the last two occasions that we have inspected this home this outcome area has been judged as adequate. The last inspection of the home carried out on 28 November 2009 found that, The home provides a safe clean environment to live in. Improvements to some communal areas would provide a more homely feel to the home as at present these are quite bare. During this most recent visit we saw all communal areas and some bedrooms. On arrival, the home was found to be clean and tidy and there were not any unpleasant odours. A cleaner is employed to work at the home and a housekeeper who has responsibility for laundering clothing. People spoken with during the visit were in agreement that the home was kept clean. The home had systems in place for infection control and staff receive training in this. We saw evidence that the home had sufficient supplies of gloves and aprons for staff. Staff were observed to use these during our visit. It was noted that there were not any supplies of gloves or aprons in the laundry room and this room is also used for sluicing. We were assured however that these were used by the housekeeper when dealing with laundry or by staff when using the Care Homes for Older People Page 21 of 32 Evidence: sluice. Paper towels, and or, hot air dryers and liquid soap were present in all bathrooms and toilets. It was noted that an upstairs bath was very discoloured. We have since been informed that this was due to damage to the plastic coating caused by lime-scale remover. The bath seat handles were also found to be dusty and sticky. Staff told us that this had not been used for a long time. At the time of this visit there were only fourteen people resident at the home leaving twenty three bedrooms unoccupied. The Annual Quality Assurance Assessment (AQAA) asked the home to tell us what they could do better with regard to physical environment. The manager responded that, We were proposing that six of the bedrooms would have new furniture, but we have been unable to do this and it has become unnecessary as we have twenty three empty rooms. The Annual Quality Assurance Assessment (AQAA) listed a number of areas of improvement since our last visit and provided the following evidence, Several parts of the home have been refurbished. A number of bedrooms have been re-carpeted. Three sets of new bedroom furniture have been purchased. The AQAA also stated that they planned to make the garden more secure with a gate. This had been completed by the time of this visit. We saw evidence that maintenance issues are dealt with promptly and on arrival at the home a trades-person was present carrying out repairs to door frames. During the visit we became aware that the home was providing accommodation to a staff member within an empty bedroom at the home. The implications of this have been discussed in the Health and personal care section of this report. We did not find any significant change to the standard of the communal areas of the home since our last visit in November 2009. The staff had however decorated the home with Christmas decorations and the home did look very seasonal and more homely. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient numbers to meet the current needs of people living at the home. The homes recruitment procedure is not robust and puts people at risk. Staff feel that they have sufficient training to carry out their role. However current medication practices suggest that people require re- training in some areas. People living at the home are happy with the staff. Evidence: On the last two occasions that we have inspected this home this outcome area has been judged as adequate. At the time of this most recent visit there was one outstanding requirement in this outcome area from the last inspection of the home. This was that, Staffing levels must be adjusted accordingly to ensure that peoples needs can be met at all times of the day. We looked at the staff rota for the day of the visit and this proved to be a true reflection of the actual staff on duty. We also saw that the staff rota had been planned for the forthcoming weeks and that arrangements had been made to cover staff leave.Staff were asked whether there were enough staff to meet the individual needs Care Homes for Older People Page 23 of 32 Evidence: of all the people who live at the home and they all said that there were. Evidence from the rota, observation and discussion of peoples needs would suggest that staffing levels were sufficient for the number and needs of the people currently living at the home. The manager has told us that there was not currently anyone requiring the assistance of two members of staff for their care needs and this was substantiated through discussion with staff. All staff were of the opinion that they received training appropriate to their role, that helped them meet peoples needs, kept them up to date with new ways of working and provided them with enough knowledge about health care and medication. Staff records showed that staff receive training in core areas such as health and safety,medication, first aid, food hygiene, infection control and moving and handling. Many of the training courses are facilitated by the homes manager and involve the staff member watching a DVD, followed by the completion of a questionnaire and having completed this the home had then issued staff with a certificate. We cannot say this level of training is or is not sufficient and it is the role of the manager and provider to determine this. What is apparent is that staff require further medication training, the reasons for the this have been discussed in the Health and Personal care section of this report. The Annual quality Assurance Assessment (AQAA) told us that four members of staff were undertaking National Vocational Qualification (NVQ) at level 2 and two members of staff were working toward NVQ3. The home has continued to provide staff with induction training and we saw evidence from all staff files that we looked at that they had completed this. There was only one person currently working at the home who had been employed since the last inspection. We looked at the recruitment records for this person. We were concerned that not all satisfactory checks had been completed prior to the person commencing work at the home. From examination of their records they had completed an application form. There were not two written references. There was one faxed reference however the second reference appeared to have been completed by the manager. The manager stated that he had probably taken the reference verbally over the phone. However there was nothing to substantiate this. Neither had this been followed up in writing. This was despite the fact that according to the application form this had been the persons last place of employment. People spoken with or whom completed a survey told us that they were happy with the staff. We observed staff to spend time chatting with people on an individual basis Care Homes for Older People Page 24 of 32 Evidence: and to be patient and friendly and supportive toward the people that they were caring for. Care Homes for Older People Page 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in auditing of records and overall quality assurance mean that people are put at greater risk than is necessary and this reflective of the management of the home. Peoples finances are safely managed and staff are now receiving regular supervision. The failure of staff to follow all procedures such as the safe storage of cleaning materials put people at unnecessary risk. Evidence: On the last two occasions that we have inspected this home this outcome area has been judged as adequate. There were three outstanding requirements from the previous inspection. Evidence gathered during this most recent inspection demonstrated that two of these had been met. The Annual Quality Assurance Assessment (AQAA) completed by the manager prior to Care Homes for Older People Page 26 of 32 Evidence: the inspection was inaccurate and did not portray a true reflection of the home. This report has provided evidence that the service is not being monitored satisfactorily to ensure compliance with all standards and regulations. This report has shown that recruitment practices are unsafe as are medication procedures. Requirements have been made as a result of this inspection regarding, assessments, care plans, medication, staff recruitment, the storage of hazardous substances and quality monitoring. For these reasons the home can not demonstrate that they are effectively monitoring the quality of service or that the service is being managed appropriately and effectively. We made a requirement following the last inspection that the registered provider must visit the home in accordance with regulations and keep a completed report of each visit at the home for inspection at all times. In discussion with the provider she stated that she had not completed these reports. The manager was not present during this conversation and has since contacted us to say that these reports had been completed. We also made a requirement following the last inspection that staff must receive regular supervision. Records examined during the visit showed that this requirement had been met. The home has the facility to look after peoples money on their behalf. We looked at the records for three people and checked the that the amounts held balanced with the records held at the home. They were found to be correct and records of transactions had been maintained. The manager oversees this process as set out within the homes written policy. It was noted that none of the people had signed themselves to say that they had received their money although the manager had signed on each occasion. We raised this at the last inspection. The manager said that one person refused to sign. The manager was advised that where appropriate people should also sign the records. The annual quality assurance assessment (AQAA) provided us with evidence that policies and procedures are kept under review and that equipment used within the home is regularly serviced and checked.We saw documented evidence during our visit to the home that maintenance checks, tests and servicing of equipment are carried out regularly. Generally the home was found to be safe the exception to this was that cleaning materials were not being stored as per the homes policy. An unlocked cupboard contained several household cleaning products that would prove extremely harmful should they be ingested. This was brought to the attention of staff and the Care Homes for Older People Page 27 of 32 Evidence: provider and dealt with. Care Homes for Older People Page 28 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 33 26 The registered provider must 26/02/2009 visit the home in accordance with this regulation and keep a completed report of each visit at the home for inspection at all times. At present the provider cannot demonstrate that they are adequately monitoring the quality of the service. Care Homes for Older People Page 29 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 3 14 Pre admission assessments 08/02/2010 must be carried out on all people prior to them moving into the home. Assessments must be kept under review and revised when necessary. This is to make sure that someone does not move into the home whose needs cannot be met. 2 7 15 All care plans must be reviewed and the registered person must ensure that they accurately reflect peoples care and support needs. Care plans need to contain accurate information so that staff are provided with the right information and that peoples care needs are addressed. 08/02/2010 Care Homes for Older People Page 30 of 32 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 3 9 13 All medication must be administered as prescribed. Administration records must be accurately maintained. This is to make sure that people receive their medication safely. 08/02/2010 4 29 19 Staff must not commence 08/02/2010 work at the home until all satisfactory checks have been completed. Any outstanding references must be obtained. By undertaking a robust recruitment procedure people will be better protected. 5 38 13 The manager must ensure that people living at the home are not put at risk from the unsafe storage of hazardous materials. Cleaning materials pose a risk to people especially those with dementia care needs. 08/02/2010 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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