Inspection on 17/06/09 for Stoneleigh House

This inspection was carried out on 17th June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stoneleigh House 23/01/08

Stoneleigh House 03/09/07

Stoneleigh House 28/07/07

Stoneleigh House 18/05/06

Stoneleigh House 13/10/05

Stoneleigh House 09/06/05

Stoneleigh House 24/11/04

Stoneleigh House 06/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Stoneleigh House Cooper Street Springhead Oldham OL4 4QS Lead Inspector Helen Dempster Key Unannounced Inspection 11:30 17th June and 22nd June 2009 DS0000005521.V376360.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 2 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 Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoneleigh House Address Cooper Street Springhead Oldham OL4 4QS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 624 5983 0161 678 2158 stoneleighhouse@masterpalm.co.uk Masterpalm Properties Limited Miss Diane Riley Care Home 31 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (23) of places Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP, (maximum number of places: 23) Dementia over 65 years of age - Code DE (E) (maximum number of places: 8) The maximum number of people who can be accommodated is: 31 Date of last inspection 23rd January 2008 Brief Description of the Service: Stoneleigh House is a detached property in a semi-rural location. It is situated close to public transport and local amenities. To access the property, people have to manage a small incline from the main road. The outside of the property is well maintained, with landscaped gardens and views over the local area. Accommodation is provided in 27 single rooms, 26 of which have en-suite facilities. There are two shared rooms, both of which have en-suite facilities. Communal areas include three large lounges, one of which is an allocated smoking area, and a large dining room. Information about the home can be obtained from the Service Users Guide, which is a booklet which contains details of what people could expect from the service. Alternatively, information can be obtained from the manager, in person or by telephone. Fees charged are £390.00 per week. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means that people who use the service experience poor outcomes. This key unannounced inspection, which included two visits to the home, took place on Wednesday 17 June 2009 and Monday 22 June 2009. The manager and staff did not know that these visits were going to take place. Prior to the inspection, we sent surveys out to people who use the service and staff to ask what they thought about the service. Three members of staff returned surveys, but we did not receive any completed surveys from people who use the service. Comments from these surveys are included in the report. We asked the manager of the service to complete a form called an Annual Quality Assurance Assessment (AQAA). This form gave the manager the opportunity to tell us what they felt they do well and what they need to do better. The AQAA was not completed in enough detail to help us to determine if the management of the service see the service they provided in the same way that we saw it. All of the key inspection standards were assessed at the site visit and information was taken from various sources. This included observing care practices, talking with people who use the service, their relatives, the provider, the manager, the deputy manager, the activities organiser, the cook, and other members of the staff team. The care of three people was looked at in detail to learn about their experience of the service from when they first used it to the present-day. A selection of records were also looked at, including medication records, training records and care records. What the service does well: People’s needs were assessed before they moved in. This meant that they knew that their needs could be met. All the people and their relatives spoken to were pleased with the standard of care at the home. Comments included that the manager and staff were, “good about health care”, and were, good about privacy and dignity. We saw that visitors were made welcome at the home. One person’s relative said, I come in every day, the carers are very nice with me, they make me more than welcome and always offer a drink. Another persons relative said, you feel at home, they say the residents can do what they want. This is good as it enables people to maintain an ongoing relationship with their relatives and friends. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 6 People were happy with the staff. Comments included that staff were, very friendly, “approachable whenever, “very nice, theyve always got time to speak to you, “lovely, always laughing, “so lovely, so helpful. One persons relative concluded, I can only give it praise the carers are so good, Ive recommended the home to a few people. People and their relatives were also happy with the manager. One persons relatives said that the manager was, very helpful, and, “down to earth. Another person’s relative said, Im positive I would trust the manager to deal with any concern, I trust them. What has improved since the last inspection? What they could do better: While the manager was committed to improvement and had improved some outcomes for people using the service, the things that the service could do better did have the potential to put people at risk of harm and were of concern to us. These included the following: Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 7 The manager needed to make sure that risk assessments, especially risk assessments concerning the risk of falls, always contained detailed information about what the staff needed to do to support and safeguard people in order that risks can be reduced or eliminated. Recruitment procedures for staff were not robust enough to protect people from harm. This included the failure to obtain Criminal Records Bureau (CRB) checks consistently, not consistently verifying references, and not consistently checking any gaps in potential staffs employment history before they worked unsupervised with vulnerable people. This means that the management of the service are not properly keeping people safe from unsuitable staff. We were particularly concerned about the lack of response of the organisation to the registered manager regularly contacting the company head office to find out whether CRB checks she had requested had been returned. Under no circumstances, should staff who have not been appropriately checked out be employed to work at the home. 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. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the 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 have their needs assessed before moving into the home, so they know that their needs can be met. EVIDENCE: In the AQAA the manager stated that what they do well was, pre admission assessments. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to three people from Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 10 the point of their admission to the present time. We also talked to people using the service, their relatives and staff. A new manager had been registered since the last inspection. It was evident to us that the manager had been working hard to improve the way that peoples needs were assessed and met at the home. When we looked at the assessments for three of the people who use the service, we saw that the care plans did mirror the information in the assessments made by social workers prior to admission of each person, and that this was achieved by using the same headings on the care plans as were used on the local authority assessments. Three members of staff who completed a survey said that they were always (2), or sometimes (1), given up-to-date information about the needs of the people they cared for. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were met with respect for their privacy and dignity. Limited information in risk assessments did not always enable staff to minimise known risks to people. EVIDENCE: In the AQAA the manager stated that what they do well was, care planning to identify the service user’s needs. The manager acknowledged that, recordkeeping, was something that the service could do better. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to three people from the point of their admission to the Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 12 present time. We also talked to people using the service, their relatives and staff. When looking at the care plans of three people using the service, we saw that the manager had improved the level of detail in care plans, which were written from the point of view of the person receiving the care. We saw that care plans were based on key areas of need, which also formed the basis of the assessment made by each persons social worker prior to admission. This was helpful as it meant that the care plan did reflect the assessment of needs for each person. These areas of need included a safe environment, communication, breathing, eating and drinking, body temperature, perception of health status, medication, mental health, religion, family/advocate involvement, mobility, personal hygiene, personal care, sleeping/night routines, continence promotion and risk assessments. The three care plans we saw provided staff with the information they needed to care for people in the way that they wished to be cared for. We saw evidence which demonstrated that the service used body mapping, which are diagrams which note any injuries/vulnerable areas of skin which enabled staff to monitor the health of people’s skin. We also saw clear records of peoples weight and nutritional needs. One persons relative was pleased with communication about any health care problems. This relative said, “the staff let you know if there is any problem, theyve called me in a few times and told me they are concerned about my relatives weight. This relative was pleased with the way this concern was being dealt with and we saw that the manager sought support from relevant professionals when there was any concern about nutrition/body weight. Risk assessments were in place concerning some areas of risk. However, the risk assessments did not cover all known areas of risk, and information in the care plans did not always link with the risk assessments. One example was that the risk assessment concerning skin integrity for one person did not mention the fact that this person had diabetes and the implications for the person of this. We were also concerned that risk assessments concerning falls did not contain sufficient information to enable staff to minimise risk to the person. One example was a person who had previously fallen onto a knee, and for whom this had resulted in a history of falls onto the same knee. This information was not mentioned in the falls risk assessment. In addition, the persons medical conditions/previous operations, including a hip replacement and high blood pressure, which may have implications for the risk of falls, were not mentioned in the falls risk assessments. Another example was a person who experienced breathing problems on exertion, had painful legs due to arthritis, a previous inability to weight bear, used manual handling equipment and had received physiotherapist input, yet these issues were not noted on the falls risk assessment, nor was there any cross-reference in the falls risk assessment to vital information in the assessment/care plan. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 13 Falls risk assessments also contained statements including, requires one carer to assist when mobilising around the home. More specific detail of the level of assistance and the reason why assistance was needed was required. Falls risk assessments also lacked details of practical considerations e.g. appropriate footwear etc. Some reviews of risk assessments were in place. However, in many cases there were no details of the outcome of the review, and review records consisted of the date of the review and the next planned review date. A requirement was made about these issues. On the occasion of the second visit to the home, the manager provided evidence to demonstrate that she was already working on developing and improving the risk assessment process and records. People who use the service and their relatives were pleased with the care received. One relative said that staff were, “good about health care”, and had organised a podiatrist visit to their relative. One persons relative was pleased about the level of support their relative received and added, when my relative rings, they come straight away. Another relative talked about staff being good about privacy and dignity. Medication was dispensed from a monitored dosage system, which was secured in a locked cabinet, within a locked room. One member of staff who completed a survey had raised concerns about medication practice, including the recording process for controlled drugs. We found that the balances of controlled drugs and the records were accurate. We also found clear evidence of monitoring by the manager and deputy manager to ensure accuracy in the administration of medication to people. Some good practice was also noted, including a file which provided staff with information about what medication was prescribed for and some of the known side effects, and having a pharmacy communication book to evidence all communication with the pharmacy. It was recommended that some improvements to storage arrangements for equipment used by community nurses, and creams held in peoples bedrooms were made. By the time of the second visit to the home, the manager had completed risk assessments concerning peoples prescribed creams being left in their unlocked rooms. The manager said that she was also committed to providing a secure cupboard for the community nurses’ equipment (as the locked room in which it was stored, did act as a passageway into the medication storage room) and individual safe storage units in peoples rooms to store prescribed creams. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the 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 benefit from choices to enable them to exercise day to day control over their lives and enjoy the food of their choice. EVIDENCE: In the AQAA the manager stated that what the service does well was, activities. The manager added that improvements in activities have been made in the last 12 months by using, talking newspapers, daily newspapers, talking books, and a rotating library. Planned improvements for the next 12 months included, to arrange weekly trips out. To find out whether this was the case, we talked to people, their relatives and staff, tasted the food provided and looked at the programme of activities. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 15 Some information about people’s social needs were recorded on care plans, but this information was not always detailed. It was recommended that the manager ensured that a detailed personal history was taken for each person on admission, including religious needs, to enable staff to understand what had been, and what was, important to each individual. The manager agreed to implement this and had started this process on the occasion of the second visit to the home. The service employs an activities organiser for 10 hours each week. This person coordinates some one-to-one activities and a range of planned activities that people can join in. We talked to the activities organiser, who explained that the service provided a range of activities, including reminiscence. The activities organiser added that people were asked for their ideas and preferences concerning activities and that people had particularly enjoyed using a games console. The activities organiser concluded that traditional activities were provided alongside some more, modern things. We tasted the lunch of cottage pie and two vegetables followed by crumble and custard, provided to people who use the service. We saw that people were offered alternatives to the main menu and could make specific requests. The meal was hot and tasty and well presented and people said that they had enjoyed it. The atmosphere in the dining room was relaxed and unhurried, some people choose to eat in their own room and this choice was respected. We talked to the cook who provided a copy of a four week rotating menu. The cook explained that people are provided with choices and that a full cooked breakfast is provided to people every day. We found that the cook was committed to providing people with the food they liked, cooked in a clean kitchen, to ensure peoples health and safety. The manager said that the cook had made positive changes to the menu and had greatly improved the quality of food offered to people. All the people we spoke to and their relatives said that visitors to the home are made welcome. We witnessed visitors being greeted by the manager and staff and saw that they were friendly and welcoming in their approach. One persons relative said, I come in every day, the carers are very nice with me, they make me more than welcome and always offer a drink. Another persons relative said, you feel at home, they say the residents can do what they want, and added that staff say, “if you need anything just ask. This is good as it enables people to maintain an ongoing relationship with their relatives and friends. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the 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 were confident that the manager and staff would listen to their concerns and staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. However, recruitment practice did not fully safeguard people. EVIDENCE: In the AQAA, the manager stated that, the complaints procedure is well displayed for all to view, complaints forms are easily accessible to enable people to voice their concerns and all staff have received, or are due to attend, training sessions on the protection of vulnerable adults”. To see if this was the case, we looked at policies, procedures and records and talked to people, their relatives and the staff. We saw that the complaints procedure was displayed at the home and that there was a complaints record which demonstrated that the manager deals with complaints positively and that the outcomes were clearly recorded. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 17 People who use the service were positive about the complaints process. One persons relative said, I feel confident I could come in and voice concerns, Im sure they would try to solve it and help us. Another persons relative said, Im positive I would trust the manager to deal with any concern, I trust them We saw evidence which demonstrated that the manager and 12 other staff had received training in the protection of vulnerable adults in June 2009. Seven staff, including the manager, had also attended training provided by the local council concerning the protection of vulnerable adults. It was clear that training in this matter was prioritised by the manager. In addition , all three staff who had filled in a survey said that they knew what to do if people raised any concerns. We assessed staffs understanding of the protection of vulnerable adults by providing two members of staff with an example of a scenario they may face, and asking how they would deal with this. One senior carer demonstrated an excellent grasp of the practical steps they needed to take to support a person who was alleging abuse and how to respond to, and report on, this matter in the best interests of the person. The other member of care staff was less clear on the reporting process. The manager agreed with the recommendation that staff understanding of the protection of vulnerable adults would be discussed with them in staff meetings and on a one-to-one basis. One member of staff talked about the managers commitment to the safety and well-being of people using the service. This member of staff said, “if staff are concerned about a resident, the manager goes to that resident to observe and assess and make her own judgement”. This is good for people using the service. The relative of one person concluded, Im sure (people) are safe here, no doubt about this. Staff recruitment procedures were not robust enough to fully protect people. (See staffing for details). Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people benefited from a comfortable, clean and well maintained environment. EVIDENCE: In the AQAA the manager stated that what they do well was to, encourage service users to personalise their rooms. The manager also described improvements made in the last 12 months and plans for improvements in the next 12 months. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 19 The manager provided a copy of the refurbishment plan to demonstrate what work had been completed since the last inspection. This included some double glazing of windows, redecoration of communal areas and bedrooms, replacement of some carpets and soft furnishings and improvements to fire safety, including work on fire doors. We saw that the manager was already working through the refurbishment plan for 2009/2010. We completed a tour of the premises, including communal areas, some bedrooms, some bathrooms and some toilets. Overall, it was evident that the premises was well maintained. For example, we saw that radiators which may pose risks were covered. However, this was not the case in one bedroom. By the occasion of the second visit to the home, this radiator had been fitted with safety cover. Although quite a number of the carpets had been replaced since the last inspection, one stair carpet was found to be frayed on the edges and could pose a tripping hazard. By the occasion of the second visit to the home, arrangements had been made to replace the carpet. Overall, hygiene arrangements at the home were good. Liquid soap and paper towels were provided in some rooms, but not in others. It was recommended that these were provided in all toilets and bathrooms. It was recommended that the cause of a smell from a drain in one shower room was investigated and resolved, that a suitable shower chair was provided in one shower to maintain the safety of people and that toilet frames/commodes which were damaged and could injure people’s skin were repaired/replaced. On the occasion of the second visit to the home, these issues had been addressed. At the last inspection, was recommended that ways of preventing smoke from the smoking lounge infiltrating into non-smoking areas were sought, so that good air quality was maintained. This had not been addressed and the recommendation has been repeated. One persons relatives talked about improvements to the premises which were, fine, and added, theyve put new carpets in, they’re making an effort. This persons relatives concluded that the home, isnt pretty, and is, not posh, but that the staff and standards were good. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the 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 benefited from support from well-trained staff, in sufficient numbers. However, recruitment practice had the potential to put people who use the service at risk of harm. EVIDENCE: In the AQAA the manager stated that, staffing levels are sufficient to meet the needs of service users”. The manager added that, “staff training is provided relevant to their roles and more than 50 of staff have achieved National Vocational Qualification (NVQ) Level II and are progressing to Level 3”. The manager indicated that what they could do better was to complete the training induction booklet quicker with new starters as some booklets still needed completing. To see if this was the case we looked at the recruitment procedure, staff files and training records and we talked to people, their relatives, the manager, and the staff. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 21 We saw that the recruitment procedure includes potential staff completing an application form, being interviewed and providing references. Two of the staff who completed a survey said that their employer did carry out checks, including a Criminal Records Bureau (CRB) check, but one member of staff said that they did not. We saw from staff records that a CRB check was undertaken in a timely manner for some staff. However, the manager explained that there have been delays in receiving these checks despite her constantly contacting the company head office to ask whether CRB checks had been returned. We looked at the staff files for two members of staff. One of these members of staff had been employed for a year at the service and had been providing care on a one-to-one basis to people using the service for this length of time without a CRB check being in place. In addition, when looking at staff files, we saw that a full employment history wasnt always taken to identify any gaps in employment and that verification of the identity of referees was not always clear. A requirement was made to the effect that the recruitment procedure must be made more robust in order that people are protected. On the occasion of the second visit to the home, the manager said that she had arranged for the umbrella organisation who processed the CRB checks for the home to be changed to improve efficiency. At the time of the visit, staffing levels had been reduced in line with the reduced occupancy of the home. We saw from staffing rotas that the minimum staffing levels were a senior carer and two staff during the day to care for 18 people using the service. Minimum levels at busy times, e.g. in the morning, were greater than this, and also included management cover from the manager and deputy manager. The manager stated that there was enough staff to care for residents and that there was also on call arrangements in place . Two of the staff who completed a survey said that there were always, or usually, enough staff to meet the individual needs of the people who use the service. One member of staff said that there never were. At the time of the visits, we saw that there were enough staff to meet peoples needs, people and their relatives did not raise any concerns about staffing levels, and one persons relatives talked about the rapid response of staff when their relative called. The manager provided a copy of the training matrix, which demonstrated that staff were offered a range of relevant training. All three staff who completed a survey said that they were being given training that was relevant to their role. Two of the staff said that they were being given training that helped them to understand and meet the individual needs of people, kept them up to date with new ways of working and gave them enough knowledge about health care and medication. Staff we spoke to were very positive about working at the home. Comments included that they, love the job, get on with the residents so well, have monthly staff meetings and have good access to training, including, lots of inhouse training. One member of staff said that the manager had, really, really Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 22 tried to make improvements in training for the staff, which is really good. Staff said that they did not get regular supervision and it was recommended that this was addressed. People and their relatives were happy with the staff. Comments included that staff were, very friendly, “approachable whenever, “very nice, theyve always got time to speak to you, lovely, always laughing, and, “so lovely, so helpful. One persons relatives concluded, I can only give it praise the carers are so good, Ive recommended the home to a few people. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the manager had improved some outcomes for people and demonstrated commitment to further improvement, the safety and welfare of people was undermined by poor recruitment practice. EVIDENCE: Stoneleigh House has been owned by the current providers for many years. In recent years, the providers have had to recruit several times to the position of registered manager which has had an impact on the home’s ability to drive Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 24 forward improvements. The succession of managers has led to some instability within the home which has been reflected in previous reports. This instability means that each time a new manager is recruited they have many improvements to make. The current manager was registered in January 2009 and has made significant improvements in many areas. Throughout the inspection, the manager demonstrated her openness, and commitment to making improvements to the home. We saw that the manager had strengths. One example was the rapid response to issues raised with her on the occasion of the first inspection visit to the home. In particular, the manager forwarded, in writing, information as to how she was going to address all the issues raised. We received this information prior to the second visit to the home. However, whilst we could see that she has tried hard to move the service on and provide good outcomes for people living at the home, the poor recruitment of staff has influenced our rating. It is not acceptable to have staff working at the home without the proper checks having been made before they commence work. Whilst management arrangements had improved, the impending planned long term maternity leave of the manager meant that we had some concerns as to whether continuity of management, and improvements made, would be maintained. We were also concerned that the shortfalls we found, especially recruitment procedure needed to be consistently addressed by the organisation, manager, and proposed acting manager. In the AQAA, the manager stated that, what they do well was to, safeguard service users finances. The manager stated that improvements had been made to documentation in the last 12 months and that plans for improvement in the next 12 months included, consistent management to maintain positive outcomes for the service users. To see if this was the case we looked at records and spoke to people and their relatives, the manager and staff. People using the service, their relatives and staff were positive about the manager. One persons relatives said that the manager was, very helpful, and, “down to earth. Another persons relative talked about asking the manager some questions about their relative’s finances. This person expressed their satisfaction with the managers response which included providing a list of all appointments, costs and expenditure. This relative stated, they didnt need to do this as I trust them anyway, I only asked them about money and they did this, I didnt ask for it, it was very kind. This relative concluded, Im positive I would trust the manager to deal with any concern, I trust them. Staff comments about the manager included that she was a, “really good manager, “was firm, but makes sure that the job is done properly, doesnt cut any corners, totally respects the staff, was approachable, and, I cant fault her with the residents. One member of staff concluded, “I trust the manager, I can tell her anything. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 25 We saw that the manager obtained peoples views at residents meetings and through more informal chats with people. We recommended that quality assurance audits were undertaken annually to ensure that the manager has information from all relevant parties which would allow her to develop the service. People using the service were billed individually for their care. Most people using the service were supported by their family to manage their finances. The manager recorded information in the AQAA which demonstrated that health and safety procedures and checks were carried out at the home. Some aspects of fire safety practice needed to improve. This included ensuring that an up-to-date fire risk assessment was always in place and regular checks of the means of escape were completed and the outcomes recorded. Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 X 2 Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Risk assessments, including those concerning the risk of falls, must contain more detail to support staff to minimise risks, especially the risk of falls. This is necessary to enable staff to have sufficient information to protect people from risks. The manager must make sure that the staff recruitment procedure is robust. This includes consistently obtaining a Criminal Records Bureau (CRB) check in a timely manner and always obtaining a detailed employment history and appropriate references. This is necessary to ensure that people who use the service are supported by staff who are being vetted to ensure the protection of people. The provider must provide the Commission, in writing, with a proposal as to the management arrangements for the service during the absence of the registered manager. Timescale for action 25/07/09 2. OP29 19 25/07/09 3. OP31 38 25/07/09 Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is strongly recommended that a secure cupboard is provided for the community nurses’ equipment and that individual safe storage units are provided in peoples rooms to store prescribed creams. This is necessary to minimise risks to people. It is strongly recommended that a detailed personal history is taken for each person to enable staff to understand what had been, and what was, important to each individual. It is strongly recommended that staff understanding of the protection of vulnerable adults is discussed with them in staff meetings and on a one-to-one basis. This is necessary to ensure that staff were always confident in the use of the policy for the protection of vulnerable adults. It is strongly recommended that ways of preventing smoke from the smoking lounge infiltrating into non-smoking areas are sought, so that good air quality is maintained. It is strongly recommended that carpets are always in good repair, radiators that could pose risks are always covered, and that an appropriate shower chair is always provided in assisted showers to maintain people’s safety. It is strongly recommended that liquid soap and paper towels are provided in all bathrooms and toilets. This is necessary to protect against the risk of cross infection. It is strongly recommended that the manager undertakes quality assurance audits annually, which are based on seeking the views of people who use the service, their family and friends, staff and stakeholders within the community and publishing the outcome of the audits. This is necessary to ensure that the manager has information from all relevant parties which will allow her to develop the DS0000005521.V376360.R01.S.doc Version 5.2 Page 29 2. OP12 3. OP16 4. OP19 5. OP19 5. OP26 6. OP33 Stoneleigh House service. 7. 8. OP36 OP38 It is strongly recommended that staff receive regular supervision to enable them to develop their practice. It is strongly recommended that the fire safety checks of the means of escape are recorded alongside other fire safety checks in the fire log book and that the fire risk assessment is kept under constant review. This is necessary to ensure people’s safety Stoneleigh House DS0000005521.V376360.R01.S.doc Version 5.2 Page 30 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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