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Inspection on 10/12/09 for Stowlangtoft Hall Nursing Home

Also see our care home review for Stowlangtoft Hall Nursing Home for more information

This inspection was carried out on 10th 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff we spoke to talked positively about people living in the home and showed a good understanding of their needs. Interaction between the staff and residents was observed to be open and friendly. The residents of Stowlangtoft told us that they enjoyed living in the home, which is an attractive building with large, light rooms that are pleasantly decorated and furnished to a high standard. Some of the bedrooms are large enough for the resident to furnish with their own belongings and they can be made to resemble a domestic bed-sit. The activities coordinator offers a good activities program, which people said they enjoyed. However when she is not at work the programme is cancelled. The home stands in it`s own extensive grounds in a rural area with outside facilities so that people can have free access to the gardens.

What has improved since the last inspection?

It has been made possible for the residents to purchase digital television packages from Sky for their personal use. In the AQAA the manager told us that, "More staff have achieved NVQ qualifications. This had been achieved by using an additional external assessor to assist the in house assessor with some of the assessment work." The AQAA also told us that, "The catering manager oversees the menu choices and offers further training to staff within the catering environment. Qualifications for catering staff have been ongoing to upgrade their skills and develop opportunities."

What the care home could do better:

We identified some health and safety issues that could endanger the wellbeing of people who live in the home. The providers were slow to take action, people must not be left at risk once a safety issue has been identified. Care plans and other records have been neglected resulting in updates to people`s care needs being overlooked. We found that staffing levels were insufficient to ensure that the needs of the residents were fully meet, staff reductions have been made in line with the number of residents at the home yet the layout of the building made the situation difficult for the staff to manage. The lack of effective leadership and management in the home has led to residents expressing concern about their future care and staff raising concerns about lack of supervision and job security.

Key inspection report Care homes for older people Name: Address: Stowlangtoft Hall Nursing Home Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY     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: Ann Wiseman     Date: 1 0 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 36 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 36 Information about the care home Name of care home: Address: Stowlangtoft Hall Nursing Home Stowlangtoft Hall Nursing Home Stowlangtoft Bury St Edmunds Suffolk IP31 3JY 01359230216 01359233346 iain@stowlangtofthall.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Hilary Anne MacDonald,Mr Hector Iain MacDonald care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home The present Stowlangtoft Hall was built in 1859 for the Maitland Wilson family and stands in seven acres of garden and woodland. In 1939 the property was let to London County Council as an evacuation centre for mothers and babies from the East End of London. The Hall has been used as a nursing home since 1969. Many of the original features of the hall have been retained for the enjoyment of the residents and visitors, including an Orangery with a glazed dome roof where residents may sit in the warmer weather. The home has established strong links with the local community and the larger grounds around the home are often used for community events. Care Homes for Older People Page 4 of 36 Over 65 37 0 0 37 2 4 1 1 2 0 0 8 Brief description of the care home The home is currently registered for 37 places for older people or those with physical disabilities and are admitted for either short or long term care. The home actively encourages prospective residents and their relatives to visit and talk to management and residents about the services provided and to attend for trial visits. Consult with the Manager for details of current fees. Care Homes for Older People Page 5 of 36 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: This was an unannounced inspection, which was carried out by two inspectors, we arrived at 10.00am in the morning and stayed for eight hours. The home is run by Mr and Mrs MacDonald and Mrs MacDonald is the registered manager. Neither were at the home when we arrived, the nurse on duty informed them we were there and they came in to participate in the inspection. Prior to this inspection we had carried out two random inspections, one to investigate information given to us anonymously and the second was to check that agreed actions had been carried out. Both of these inspections will be referred to in this report and the full reports can be downloaded from our web site at www.cqc.org.uk During the day we had a look around the home and observed interaction between the staff and people living there. We also had opportunities to meet with all of the Care Homes for Older People Page 6 of 36 residents and some of their visitors to get their opinion of the care they get. Before the inspection we had sent surveys to the residents and staff but only four people responded. They gave a positive response about the home but some commented that they thought that at times the staff were very busy which effected their quality of care. We looked at information belonging to three people living in the home and three of the staff files. We also assessed some of the homes policies and procedures and sampled a random selection of the health and safety files and records. The manager had sent us the Annual Quality Assurance Assessment (AQAA) she had completed prior to the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. Care Homes for Older People Page 7 of 36 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. Care Homes for Older People Page 8 of 36 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 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information given to people of thinking of moving into Stowlangtoft Hall is detailed enough to allow people to make an informed choice about the home and everyones needs are assessed. Evidence: We saw that Stowlangtoft Hall has good quality information which is given to people thinking of moving into the home. It contains a statement of purpose, the homes complaints procedure and other required information including the terms and conditions of residence and services that are included in the fees. The manager told us that the pre-admission documentation is sent to the person making the enquiry and if possible the prospective resident is invited to visit the home and to stay for a meal so that they can get a feel of the home. However the majority of people moving into the home are in hospital and will move in from there and are not able to visit before the move, but families normally visit on their behalf. Care Homes for Older People Page 11 of 36 Evidence: The manager told us in the AQAA that Before admission an information pack, including fees charged, is sent to the potential resident and their family outlining the environment and the services offered. To make sure the manager is able to collect information that is up to date and current, she told us that she always makes an appointment to visit people at the hospital so she can speak to the their named nurse who will be present when the assessment is carried out, she will also talk to as many family members as she can as well as the prospective resident to ensure she gathers as much information as possible. We examined the files of three people during this inspection and saw that they each contained pre-admission assessments completed by the home as well as their local authoritys community care assessment. The assessments contained a lot of good information and covered a wide range of the persons needs including their diet, continence, skin integrity, mental state and any known allergies. Details of their preferred leisure and social activities were recorded and notes were also made of their home situation and some life history. Unfortunately we saw evidence that the work carried out at assessment stage has not always been followed through to develop good quality care plans. One relatively new resident didnt have a care plan in place after several weeks of staying at the home. Information given to us in the AQAA says that the home intends to review their assessments process and incorporate relevant forms and documentation from the department of health and local health care partners. Stowlangtoft Hall doesnt offer an intermediate care service. Care Homes for Older People Page 12 of 36 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. Not everyone has a care plan in place and those that are, have not been reviewed or updated recently. This could lead to people not having their needs met, which could effect their wellbeing. Evidence: At this inspection three care plans were examined, during our second random inspection on 28th October 2009 after the special care needs of two people were bought to our attention we asked to see their care plans so that we could assess whether those needs were reflected in the plans. We identified shortfalls in the care planning process.Both the care plans failed to mention the areas that had raised our concern. Also the weight records of both people showed that they had lost weight recently but there had been no review of their nutritional needs or evidence that any action had been taken to ascertain why they had lost weight. One of the care plans highlighted an area of concern, which was highlighted with red stars so that it was not overlooked, but that information had not been taken into account when this person was moved to a new room recently. A Care Homes for Older People Page 13 of 36 Evidence: requirement was made that care plans must reflect the current needs of the people using the service and that they must be reviewed and updated as peoples needs change. During this key inspection we re-examined the two care plans we looked at during the random inspection on the 28th October 2009. They had not been updated and were as they were when we first saw them. One person had developed behaviours that meant it was no longer safe to leave them on the top floor of the home and was moved to the lower floor close to the nurses station so they could keep a eye on them. Staff told us that the resident had been leaving their room unaided for some time and was unstable on their feet, but that the move had been carried out only after they where found at the bottom of a flight of stairs and it was assumed they had fallen, we were also told that no planning or risk assessment had taken place prior to the move. We examined their care file and found that the recent changes to their behaviour was not reflected in the care plan, which still recorded that the person was not independently mobile. The care plan identified some aspects of their behaviour that put the resident in danger and these had not been considered or taken into account when choosing what room they should move to. The new room contained the same features that had been identified as being dangerous and had been dealt with in their previous room. Thus the home removed them from one danger only to expose them to another one. When we had visited another resident, we witnessed that there were aspects of their behaviour and personal preferences that could compromise their dignity. Their care plan failed to mention their preference and gave no guidance about how staff could help to preserve their dignity. A third care file we asked to see during this inspection was that of a resident who had moved in several weeks earlier, a proper care plan had not been completed since the resident had moved in, the only information carers had about this person was that which the manager had transfered onto a single information sheet she had completed from the initial information collected during the assessment, this sheet is designed as a quick reference aid for the initial few days while the care plans is being put together. The nurse on duty is the nurse who held the responsibility of developing new care plans and reviewing all the care plans, she acknowledged that she had not carried out the work and said that she had not been given the time to do the job properly. The Care Homes for Older People Page 14 of 36 Evidence: recent events concerning the service have meant that the usual running of the home had been disrupted and tasks have been left undone. We saw evidence that peoples health care needs are sometimes met, there were copies of specialist reports such as speech and language and psychology on file. Doctors and other health care professional visits are recorded along with any treatment given so that staff can be made aware and can monitor any changes. However one relative we spoke to told us that their relative had lost several teeth due to a lack of care and that they had to take them to the dentist themselves as the home had not taken appropriate action. The same resident has been waiting for a hearing test for over a year despite the home repeatedly reassuring the relative that the referral has been made by the doctor. We examined the medication and the way it was managed and stored. We found that all the medications including the controlled drugs were stored as required. While checking the medication we examined the controlled drugs book and the medication to see if they both corresponded with each other. We found that the drugs were correct and that they were recorded properly. Induction training includes preserving peoples dignity, but this was not reflected in their care of some people, we witnessed their failure to protect their dignity of at least one resident. We did see however, that when staff interacted with the residents they did so in a caring and supportive manner, we also witnessed them offer people choices with their food and noted that when not in use private information is stored in a locked cupboard and is not left lying around in communal areas. Care Homes for Older People Page 15 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home cannot be assured that they will have sufficient opportunities to enjoy and take part in meaningful activities. Evidence: When we first visited the home on 7th October 2009 people were in the communal areas, interacting and joining in activities and we judged the activities programme as good, but on subsequent visits the outcome has deteriorated. While going about the home during this key inspection we had an opportunity to meet all of the residents and those that were able to voice an opinion told us that they were happy with the activities they had been offered until recently, but told us that when the activities coordinator is on annual leave no activities took place. During this inspection the coordinator was on emergency annual leave and lack of staff meant that no activities took place and that people stayed in their bedrooms and couldnt eat in the dining room, so everyone ate in their rooms. The manager told us that when the proposed sale of the home was made public knowledge by people not involved in the matter, fewer people have chosen to move into Stowlangtoft, as resident numbers have dropped staff levels have been reduced in Care Homes for Older People Page 16 of 36 Evidence: line with their numbers, but the layout of the home makes it difficult for the reduced number of staff to carry out their duties and they told us that much of their time is taken up with rushing from one end of the home to the other answering call bells, which we witnessed. One staff member had to miss her break so that the nursing station could be manned, the the personal care done and all the call bells answered. This was because two carers had gone off duty at 12 noon leaving three carers and a nurse in the home. It had been a similar situation during our second random visit on 28th October 2009, there had been no activities on offer and all the residents were again in their bedrooms, the dining room was not used. However when we first visited the home on 7th October 2009, there were several residents eating in the dining room and people were interacting with each other and the staff, there was a congenial atmosphere and we had an opportunity to sit and chat with people as they waited for the minister to arrive to administer holy communion. Later we met people again as they had tea in the lounge. Staff and relatives told us that they felt that staffing levels have been reduced too far and there are no longer sufficient staff on duty to ensure that the needs of the residents are being met fully, which severely impacts on peoples social activities. There is evidence that activities are sometimes done, the home has an activities room where several vintage objects are on display, the room has its original floorboards, large windows and wooden tables and has the smell and feel of an old school room and is very evocative of past times. There are displays of art and craft work in the hallway by the dining room and photographs of outings and activities attended by the residents. While some people told us that they are happy to stay in their rooms, some of which are large and furnished with their own belongings, others and some of their relatives have told us that they feel lonely, isolated and that they dont have many opportunities to interact with people other than the staff who are often busy and unable to stop and spend uninterrupted time with them. The home is set in its own attractive grounds and there are areas for people to sit and enjoy the gardens, including an orangery where, in good weather, people enjoy the view while they have tea. People often eat in their rooms out of necessity due to insufficient staff numbers, ill health or personal choice, but the home has a pleasant Care Homes for Older People Page 17 of 36 Evidence: dining room with views over the garden and countryside. The one time we observed it in use the tables were attractively set and each table had serviettes, condiments and fresh drinks. The home employs a chef who produces meals that were well prepared and looked and smelt appetising, the menu was varied and nutritionally well balanced, people told us that they enjoyed their food. However while we were at the home we saw that a meal was left with one person who was unable to eat without assistance, it was left by their bedside for twenty minutes before a staff member was free to help them. When residents eat in their rooms the meals are plated in the kitchen and kept in a heated trolley, people would be able to enjoy their food better if the meal was left in the trolley until a carer was available to support them to eat it. Care Homes for Older People Page 18 of 36 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. People can be assured that complaints and concerns are managed in line with the homes policies and procedures and that action would be taken to investigate any complaints. Staff training and procedures help to protect people from abuse. Evidence: In the Annual Quality Assurance Assessment (AQAA) the manager told us that, All residents, potential residents and their families receive a clear copy of our companies complaints procedure. This is also displayed in the entrance hall of the home. If any complaints are received they are recorded and handled in accordance with our published procedure. The homes records show there has been one complaint in the last year, which has been resolved. People told us that they knew how to make a complaint and that they felt confident that it would be taken seriously and dealt with properly. We received an anonymous complaint, raising concerns that the residents were being neglected due to staffing levels being cut and that food was low due to financial difficulties. No evidence was found to substantiate the complaint when we undertook a random inspection on 7th October 2009. The manger told us in the AQAA that if people want to take part in the political process and vote, she will make arrangements to enable them to have a postal vote. Care Homes for Older People Page 19 of 36 Evidence: The home does not manage peoples finances; families are expected to help people manage their money. Small, everyday expenses, such as the hairdresser, will be covered by the home and the family would be invoiced if residents dont hold their own money. People are protected from abuse by staff training, we saw that the training files showed evidence that staff have undertaken safeguarding of vulnerable adults training and there are policies in place around recognising and reporting abuse. Care Homes for Older People Page 20 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home offers a clean and comfortable environment but some serious health and safety issues need to be addressed so that the people living there can be confident that they will be kept safe. Evidence: Stowlangtoft Hall was originally built in 1859 and was formally a large family estate and then was used as an evacuation centre for mothers and babies from London during the second world war. In 1969 it was developed as a nursing home and one has operated from this site ever since. The large rambling building is not ideal for the purpose as the accommodation is spread over three floors and means that the staff, at present staffing levels, are thinly spread. However during a tour of the building we noted that the home was clean, well maintained, considering its age, and is furnished comfortably. There is a mixture of bedroom sizes, ranging from a typical nursing home sized room to those that are large enough for the resident to establish a home from home feel to their room. They are able to have a double bed, three piece suite and other occasional furniture without the room being crowded. The AQAA says that. The building is spacious allowing residents a choice of areas, both indoors and outdoor, when not in their rooms. Their bedrooms are also spacious Care Homes for Older People Page 21 of 36 Evidence: allowing them to bring items of furniture should they wish. The home has a domestic team that work hard to keep the large building clean and free of cobwebs, the home has very high ceilings. The kitchen is large and appropriately appointed for a home of this size and has recently been refurbished. The chef is responsible for maintaining hygiene standards in the kitchen and has a cleaning schedule and keeps records of the cleaning undertaken and other health and safety checks. The bathrooms and toilets are sufficient in number and were clean but have not been refitted in recent years and are looking tired and dated, with water stains in the baths and sinks and chipped enamel. They have specialist equipment and adaptations to meet the needs of the people living in the home and to prolong independence. The adaptations include specialist seating, hoists, stand aids, pressure reliving mattresses and grab rails. Personal protective equipment was available for staff use to enable them to maintain good infection control. The home is set in attractive grounds within a rural area and all of the bedrooms have views of the gardens, which are easily accessible to enable people to have free and safe access to a garden where there is outdoor furniture for them to use and enjoy the gardens. During the first random inspection on 7th October 2009 we identified that electric wall heaters in all areas of the home were dangerously hot to the touch and were placed in positions that would put the people living at the home at risk from receiving serious burns if they came in contact with them. When we placed our hand on the surface it was too hot for it to remain there from more than a few seconds. We also noted that the hot water in one of the bedrooms was very hot to the touch and that there was no regulator on the pipes to keep the water at safe levels, a staff member told us that the hot water supply was erratic in all areas of the home. They told us that in some of the bedrooms the hot water flow was no more than a trickle and cold, while in others the water was excessively hot. We discussed both issues with the manager who undertook to draw up risk assessments and to take steps to protect the residents from harm. When we returned to the home on our further random inspection on 28th October 2009 neither issues had been properly addressed, no risk assessments had been done or changes made to minimise the risks to the residents. We were shown a quote for Care Homes for Older People Page 22 of 36 Evidence: the cost of covers for the heaters, but there was no evidence they had been ordered. Further checks on the hot water identified that the problem was widespread, the temperature ranged from cold to very hot, some were too hot for us to be able to keep our hand under the flow for more than a few seconds. We issued an immediate requirement that risk assessments must be done and that intermediate steps should be taken to keep people safe until a permanent fix could be completed. Despite the manger assuring us in writing that the heater covers and water regulators had been ordered and that they planned to fix them as soon as they arrived, when we carried out this scheduled, unannounced key inspection we found that the work still had not be completed. The home didnt have their own thermometer to carry out their own checks, so we used our own thermometer and checked three hot water taps and found that two were over the permitted temperature of 43 degrees centigrade, at this stage we issued a code B notice under the police and criminal evidence (PACE) procedures informing the responsible person that we would be collecting evidence that would be used in the event of any forthcoming enforcement action. We systematically checked all the water temperatures to all of the bedrooms and some of the bathrooms and found that the temperature ranged from 39 to 53.7 degrees centigrade, as we went from room to room we established whether the resident used the water independently and therefore could be at risk from scalding. In the rooms that were over the permitted limit, only two people used the water independently and they confirmed that although the water was hot, they were confident that they were in no danger. On the day after the key inspection and on the following day the manager provided us with sufficient evidence that they had made proper arrangements to have the heater covers and the water temperature regulators fitted, so we didnt proceed with taking enforcement action. They produced a list, which prioritised the rooms that posed the greater risk, which they intended to have done first. We examined a sample of health and safety records and found that the majority were in order, but the fire extinguishers had not been recorded as being serviced since August 2008, they have not been services leaving the residents at risk. Care Homes for Older People Page 23 of 36 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. People can be confident that staff are aware of their roles and responsibilities and are qualified, however they cannot be assured that there are sufficient members of staff on duty at all times to meet their needs. Evidence: When we arrived at the home we found that there were five care staff on duty and one registered nurse, who was leading the shift, we also noted that the people on duty corresponded to the rota, there was one person off sick and their shift had not been covered. Staff told us that it was not unusual for sickness and annual leave not to be covered and we were also told that because they were short of staff people would receive personal care but would not be brought down to the lounge and would not go to the dining room for their meals, they would be served in their rooms, this was not an unusual practise and was happening more often recently. The manager told us that they had not be recruiting recently and didnt intend filling vacancies as staff leave, because the number of residents have dropped so less staff are needed on duty. However, staff told us that the size and layout of the building means that the drop in staffing levels has lead to staff being stretched and having to walk long distances, they felt that people may be neglected as they couldnt get all their work done. Care Homes for Older People Page 24 of 36 Evidence: The day of the key inspection was a day that it had been decided to let people stay in their rooms and we noticed that the call bell was constantly ringing and the care staff were rushing from one call to another, which meant that they were unable to spend meaningful time with each resident and those that were unable to use there call bell didnt get as much attention as those who could. The carers told us that they felt rushed and demoralised by not being able to carry out their job to the standard they wanted to. We discussed the issue with the provider who said that they felt the staffing levels were adequate. Comments in the surveys returned to us and from the residents and visitors we met at the home told us that people feel isolated and cut off and missed the activities and meeting up with others staying in the home. We were clearly told by several people that this was happening more and more often and that staff were rushed and were unable to Just pass the time of day. Four surveys were returned to us and we had the opportunity, while checking all of the hot water taps in the bedrooms, to meet all of the residents during this key inspection and a couple of visitors. Everyone without exception said that they loved living in the home and that their rooms were comfortable and clean. The said that the staff were thoughtful and helpful, but they also talked about the staff being rushed and unable to carry out all their duties, especially when carers were on leave or off sick. None of the surveys were critical of the quality of care people were given only that at times there didnt seem to be enough staff on duty, the comments were supportive of the staff and showed concern for them. Staff personnel files are kept at the home and we examined three of them in detail. They held all the information and documents that are required. Staff members we spoke to confirmed that all the checks that safeguard people are carried out before people start working at the home and that they took part in induction training when they first joined the workforce. The care staff we spoke with displayed a good knowledge of the people in the home and understood their needs, information given to us in the AQAA told us that the home has met the minimum of 50 of its staff having attained the NVQ 2 in care or its equivalent. The staff records show evidence that the home offers the mandatory training, and that staff have had access to specialist training suitable for the assessed needs of the people living in the home. Care Homes for Older People Page 25 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that the home will be constantly and effectively managed in the best interests of the people living in there. Evidence: The manager was not at the home when we arrived to start the key inspection, she was unwell and was on sick leave, the deputy manager was also off. The nurse contacted the manager to inform her that we were at the home and both she and Mr MacDonald arrived to facilitate the inspection. Meanwhile the nurse on duty made us welcome and provided the information and documents she had access to. Staff, residents and relatives we spoke with told us that the manager or her husband had spent very little time at the home for several months and that it was wasnt noted on the rota when they would be in, so it could not be predicted when they would be at the home if someone requested to see them. The providers told us they had been in the process of selling the home during the Care Homes for Older People Page 26 of 36 Evidence: summer and the sale came very close to completion and they has started to step back from the service to allow the new owners to take up the reins. People at the home told us that they hadnt been told about the proposed sale nor that it wasnt going ahead, but they had heard rumours and speculation. This was worrying for the residents and demoralising for the staff as none where sure of what would happen in the future. Staff told us they felt unsupported. Since the manager has become unable to work due to ill health she has appointed a deputy manager. When we spoke to him on our second random inspection on 28th October 2009, it was evident from our discussions that he had not been given the authority to carry out work with the home to bring it up to standard and that the manager had retained responsibility for some tasks within the home such as doing the rotas and meeting prospective residents or carrying out their assessments, making it difficult for him to run the home from day to day. The deputy manager told us that he had not been made aware of the future plans for the home so was unable to offer reassurance to the staff and residents. He also told us that as he was new to the home he was still getting to know people and assessing the situation, he was also kept busy supporting the staff with the care needs of the residents and was often allocated to work shifts when the staffing levels were low, which all meant that he hadnt been able to take up a management role effectively. Resident numbers had dropped from 37 to 24 and staffing levels have been reduced in line with the residents at the home, but the size and layout of the building had not been taken into consideration. We witnessed that staff were constantly on the go, rushing from one call to another and that important records, such as care plans, were not kept up to date which indicates that the staffing levels are insufficient to ensure that the needs of residents are fully met. Before our first random inspection an anonymous person called us and told us that the home was being run down, that the residents were being neglected and that there was no food in the cupboard. We had been made aware of the sale and that it had not progressed to completion and had been given other indications that the home may be failing financially so we decided to carry out the random inspection to test the truth of the information passed onto us. We found evidence that the residents and staff were confused over what was Care Homes for Older People Page 27 of 36 Evidence: happening with the home and the staff were under stress, but didnt find evidence that people were being neglected or that they were going hungry. There was plenty of food in the kitchen, there were cleaning materials in stock and the home was warm and clean. During the first random inspection on 7th October 2009 we noted electric heaters and the hot water were both too hot, we raised these issues with the manager she agreed to risk assess the situation and to take steps to keep people safe immediately. When we returned to the home for the second random inspection on 28th October the manager was absent and the deputy manager facilitated the inspection. Neither of the issues had been properly addressed, no risk assessments had been done or changes made to minimise the risks to the residents. We issued an immediate requirement that risk assessments must be done and that intermediate steps should be taken to keep people safe until a permanent fix could be completed. Despite the provider assuring us in writing that the heater covers and water regulators had been ordered and that they planned to fix them as soon as they arrived, when we carried out this key inspection we found that the work still had not be completed, we issued a code B notice under the police and criminal evidence (PACE) procedures informing the responsible person that we would be collecting evidence that would be used in the event of any forthcoming enforcement action. Throughout this time residents were at risk of being burn or scalded and it was not until we started to take enforcement action that the providers made firm arrangements to have the work completed. It has to be acknowledged that until recently this service had delivered good quality outcomes for the residents over a number of years, but the standard had been allowed drop over the last year and there has been a lack of leadership and support. The management had withdrawn from the service and had not maintained control of its day to day running and had allowed health and safety checks to lapse, such as the fire safety equipment. They had not monitored the performance of the staff or ensured that the standards of the records had been maintained. We found no evidence that quality assurance checks had been carried out and staff and residents told us that they had not been consulted on what was happening at the Care Homes for Older People Page 28 of 36 Evidence: home and people felt this had caused them undue stress and uncertainty. During the inspection on resident asked us, unprompted, if they were going to have to move and became very distressed. Their visitor comforted them and said that they were cross that they had not been informed of the providers plans for the home and that the uncertainty had caused their relative worry and confusion. The providers failed to pay our fees for two years and at the time of the inspection had part paid them after a warning letter was issued. Care Homes for Older People Page 29 of 36 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 7 15 All care plans must be 16/12/2009 reviewed to ensure that they reflect peoples assessed needs. Care plans that are not reviewed and updated as peoples needs change put them in danger of not receiving the proper care they need. 2 19 13 The provider must assess the 06/11/2009 risks posed by the hot water being unregulated in some areas of the home and of people being exposed to heaters that have an unacceptably hot surface temperature. To safeguard people remedial action must be taken to minimise the risks of scalding from hot water or heating in all areas of the home. 3 19 23 The provider must ensure 26/02/2010 that the hot water supply to all areas of the home is maintained within a safe temperature range and that all the rooms have access to a reliable water supply. The health and safety of people cant be maintained if Care Homes for Older People Page 30 of 36 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 there is not a regular supply of hot water that is maintained within a safe temperature range. Care Homes for Older People Page 31 of 36 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 7 15 It is required that all the residents have care plans in place as soon as practically possible once they have moved in to the home. If comprehensive care plans are not in place people cannot be confident that they will have their care needs meet, which may effect their health and wellbeing. 15/02/2010 2 8 12 Steps must be taken to ensure that where health care issues have been identified that residents are supported to access appropriate care and support. By being proactive in meeting basic health care needs and ensuring people are supported to improve oral and personal hygiene, a home 15/03/2010 Care Homes for Older People Page 32 of 36 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 will enable people to retain healthy and independence. Proposed actions undertaken by outside health professionals should be monitored and followed up if the appointment is not forthcoming. 3 19 23 All fire prevention 15/03/2010 equipment in the home must be serviced at regular intervals. It is important that people can be confident that all safety equipments is safe and ready to use, failure to keep it properly maintained can lead to people being seriously hurt. 4 19 12 Steps must be taken to 15/02/2010 ensure that residents are protected from the hot surfaces of the electric wall heaters by providing covers. Not all of the residents at this home are aware of the danger of touching hot surfaces and they must be safeguarded against being burnt. Care Homes for Older People Page 33 of 36 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 5 19 12 The hot water temperatures throughout the home must be regulated so that the water does not exceed permitted levels. Not all of the residents at this home are aware of the danger of hot water and they must be protected against scalds. 15/02/2010 6 27 18 Having regard to the size of 01/03/2010 the home, the statement of purpose and the number and needs of the people living in the home, ensure that all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of the residents. Without sufficient staff on duty residents are put at risk and can become isolated as they are left to spend long periods of time on their own in their bedrooms. 7 36 18 The manager must spend 15/02/2010 sufficient time at the service to ensure that the staff is properly supervised and guided. Care Homes for Older People Page 34 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will give the residents more confidence that their needs will be met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The presence of the activities coordinator in this home plays a large part in enabling the residents to keep active and to mix with other people in the home, it is recommended that someone is appointed to replace her when she is on annual leave or absent for other reasons. To enable residents to make full use of the communal areas of the home, sufficient numbers of staff should be on duty to facilitate them If staff are on annual leave or go sick their shift should be covered. It is recommended that food is stored in the heated food trolley until staff are available to assist people to eat. 2 12 3 15 Care Homes for Older People Page 35 of 36 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. 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