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Inspection on 18/05/10 for Stowlangtoft Hall Nursing Home

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

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, friendly and respectful. Residents told us that they thought the carers looked after them well and that they worked hard at giving them a good life. The residents also told us that they enjoyed living in the home, which is an attractive building with large, light communal 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 furniture and personal belongings. They are comfortable and homelike. The activities coordinator offers a good activities programme, which people said they enjoyed taking part in. 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?

During the random inspection we noted that the requirements made at the previous key inspection had been complied with, the electric heaters had been covered and the hot water had been regulated, we had carried out random checks on the water and found it to be within the safe temperature range, none were hotter that 43 degrees Centigrade. However further requirements were made after the random inspection. Since February 2010 the service has been inspected by the Fire Officer, the Environmental Health Officer, Suffolk County Council`s Health and Safety Adviser and their Outcome and Monitoring team. All of which have made requirements and recommendations that must be complied with. We have seen copies of the reports which ask for improvements in care planning and health and safety in the home. Healthcare Management Solutions are aware of the seriousness of the shortcomings and have implemented an action plan and have carried out most of the work asked of them. An activities coordinator has been appointed who has set up an activities plan. She keeps records the activities that take place and has surveyed the residents to get their preferences. On this occasion the communal areas of the home were warm and several people have started coming down to the dinning room for their lunch and then to take part in some organised activities. Bi Monthly relatives meeting have been introduced into the home and we were advised that the room was full for the first meeting. The maintenance person is spending more time at the home and has taken on the responsibility of carrying out health and safety checks. Colour coded mops are now being used by the domestic staff, this ensures that cross infection is minimised as different mops are used in different areas of the home, there are now different mops for general use, for cleaning the kitchen and moping the toilet floors.

What the care home could do better:

Several attempts have been made to improve the care plans, but there are still gaps and omissions and they must be completely reviewed and changed to properly reflect the people living in the home, their assessed needs and how they will be met. The management, recording and administration of the medication has been found to be in need of improvement and staff need medication training. The individual needs of the residents must be reassessed to ensure that there are sufficient staff on duty at all times. The environment needs improvement, the bathrooms and toilets need updating and renewing. Some areas of the home need to be decorated, the water supply must be improved and a heating system must be installed that ensures the home is kept within a comfortable temperature range .

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 8 0 5 2 0 1 0 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 38 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 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): Mrs Hilary Anne MacDonald,Mr Hector Iain MacDonald Name of registered manager (if applicable) Mrs Hilary Anne MacDonald Type of registration: Number of places registered: 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. Care Homes for Older People Page 4 of 38 Over 65 37 0 0 37 1 0 1 2 2 0 0 9 Brief description of the care home The home has established strong links with the local community and the larger grounds around the home are often used for community events. 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 was taken into administration during February 2010 and is being managed by Healthcare Management Solutions whilst decisions are made about the future of the service. During this period of change, please contact the Manager for details of current fees. Care Homes for Older People Page 5 of 38 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 key inspection, which was carried out by two inspectors, we arrived at 9.30 in the morning and stayed for a little over six hours. The home was taken into administration in February 2010 and Healthcare Management Solutions have been asked by the administrators to manage the home until its future has been decided. Debi Baron is a consultant in the company and is overseeing the running of the home on their behalf and is assessing the present situation, she works there two days a week and was at the home when we arrived and facilitated the inspection, which she did in an open and helpful manner. When the home went into administration the assistant manager left and the management company have appointed the senior nurse as the acting manager. She has worked at the home for many years and has a good knowledge of the residents and their needs. The assistant manager runs the home in the absence of the Care Homes for Older People Page 6 of 38 management companys representative and is supernumerary to the rota. Whatever files and documents we asked to see were produced quickly. 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 talk with some of the residents to ask their opinion of the care they get. On the 23rd February 2010 we carried out a random inspection to check compliance of requirements made during the last key inspection in December 2009. The requirements were focused on care planning, health and safety in the home, meeting peoples health care needs, staffing levels and the management of the home. We will refer to that inspection and its outcomes in this report. Before this key inspection, we sent surveys to the home to be distributed among the residents and staff. Three residents returned their completed surveys, two were assisted by their relatives who also added their comments and three staff members returned theirs. All the surveys gave some positive responses about the home but all commented that they thought that, at times, the the staff were very busy which effected the quality of care people received. We looked at information belonging to four people and some of the 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. We were sent the Annual Quality Assurance Assessment (AQAA) completed by the acting manager 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. The AQAA was very detailed in places but there were several areas that were not completed, which means that it didnt fully reflect the homes present position. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? During the random inspection we noted that the requirements made at the previous key inspection had been complied with, the electric heaters had been covered and the hot water had been regulated, we had carried out random checks on the water and found it to be within the safe temperature range, none were hotter that 43 degrees Centigrade. However further requirements were made after the random inspection. Since February 2010 the service has been inspected by the Fire Officer, the Environmental Health Officer, Suffolk County Councils Health and Safety Adviser and their Outcome and Monitoring team. All of which have made requirements and recommendations that must be complied with. We have seen copies of the reports which ask for improvements in care planning and health and safety in the home. Healthcare Management Solutions are aware of the seriousness of the shortcomings and have implemented an action plan and have carried out most of the work asked of them. An activities coordinator has been appointed who has set up an activities plan. She keeps records the activities that take place and has surveyed the residents to get their preferences. On this occasion the communal areas of the home were warm and several people have started coming down to the dinning room for their lunch and then to take part in some organised activities. Bi Monthly relatives meeting have been introduced into the home and we were advised that the room was full for the first meeting. The maintenance person is spending more time at the home and has taken on the responsibility of carrying out health and safety checks. Colour coded mops are now being used by the domestic staff, this ensures that cross infection is minimised as different mops are used in different areas of the home, there are now different mops for general use, for cleaning the kitchen and moping the toilet floors. Care Homes for Older People Page 8 of 38 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 38 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 38 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 them to make an informed choice about the home and everyones needs will be assessed before they move in. Evidence: The home has a statement of purpose and a service users guide which have been rewritten by the management consultant since she has taken over the running of the home. At the time of the inspection there were 21 residents living at the home and due to a voluntary suspension of admissions, there hasnt been any new admissions since the service was taken into administration. Therefore we were unable to test their present admission procedures. In the AQAA the acting manager told us that, All service users, prior to admission, will undergo a pre-admission assessment, in a place of their choice either at home or another setting. This is carried out by a suitably qualified nurse or the homes Care Homes for Older People Page 11 of 38 Evidence: manager. A full medical and social history is taken. The social workers or nursing assessment is taken into account and we encourage the relatives to be present at the assessment. As new residents are admitted in the future the acting manager tells us that they need to, Consider that some people will not be able to read or fully understand the terms and conditions, which we have tended to direct toward the relatives in the past. This practice needs to be improved as it is the resident who it relates to so we need to take time to sit and read it to them and ensure it is understood by them. If necessary we should help people access an advocacy service. This service does not offer intermediate care. Care Homes for Older People Page 12 of 38 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 good quality care plan in place that properly reflects their assessed needs. This could lead to people not having their needs met, which may have a detrimental effect on their wellbeing. Evidence: We looked at the way in which people living in the home are cared for. We spoke with seven residents and they told us that the carers were very good and attended to their needs well. One resident said that staff were under pressure and were very hurried now. However, this resident was satisfied with the care provided. Another resident we visited in their room was still in their dressing gown at 11.30, they had been given their breakfast on a tray and had been waiting for assistance to get washed and dressed. The resident told us that staff have little time to spare these days and that they were often late in coming to help them in the morning, but At least I can get up and get about my room. They also said, I know that if I ring the bell they will come to me, but I know they are rushed off their feet and may be helping someone who needs it more that I do. Care Homes for Older People Page 13 of 38 Evidence: We examined the care plans relating to three people in detail and looked at a random selection of others. The acting manager told us that the home was introducing a new care plan format as they recognised the one being used at present was not good. The acting manager also said the paperwork in general was not good. When we looked at the care records we found that there were shortfalls in the assessment of peoples health and care needs and care plans setting out how those needs should be met. For example, for one resident the daily progress notes show some problems with swallowing and recent nausea. Another entry in May shows that a pureed diet is being given and this was much better for the person. However, there was no nutritional screening to determine the risks to this persons nutritional intake due to the changes in health or what action should be taken. There was a care plan for eating and drinking but this was written on the 4th February 2010 and had not been updated to reflect current and changed needs. For the same person a weight record shows only one entry on the 13th January 2010. In addition, a waterlow assessment used to determine the likelihood of pressure sores had been completed on the 12th May 2010. The waterlow score was 23, which indicates the person is at high risk of developing a pressure sore but there was no care plan setting out what steps should be taken to minimise the risk of pressure sores. In the care file relating to another resident we found that records showed the person has dementia. The medication administration records showed that all medicines had been refused for at least one month. When we spoke to the acting manager about this we were told that the person had refused medicines for the last two months. We looked at the GP contact notes and could find no record of contact in relation to this. The acting manager said the GP had been contacted but a record had not been made. Some of the medicines being refused relate to a heart condition and not having prescribed medicines could be harmful. Other medicines relate to other conditions and not taking medicines could have an impact on the persons health and care needs. We looked for care plans and risk assessments in relation to the omission of the medicines but they were not present in the file. We looked for assessments in relation to the persons mental capacity but there were non present in the file. It was not clear if the person fully understood the risks of not taking medicines and whether the home had considered or properly consulted with other professionals as to whether it was in the persons best interest not to have all or some of the medicines. In addition, the medication records did not show what steps had been taken to encourage the person to take the medicines before they refused. Care Homes for Older People Page 14 of 38 Evidence: In the care file relating to another resident a falls risk assessment tool had been used. The assessment determined the risk of falls was high, however there was no care plan setting out what action should be taken to minimise the risk of falls. We spoke to a care assistant who told us the person was falling frequently. We observed the person in their room and saw a dressing to their arm and an injury to the head. The risk assessment stated use pressure mat but this not an adequate method of preventing falls, it is used to draw attention to the persons movements. There was a care plan for mobilising but there was no mention of falls. This care plan had been last up dated on the 4th February 2010 but the person had a fall on the 7th May 2010 and there was no evidence of review of the care plan at this time. In the three care plans we looked at in detail and those we sampled, there were numerous similar examples to those given above where care files did not contain risk assessments and action plans or care plans that covered all the needs of the individual. Care plans are not being regularly reviewed, it is considered good practice to review them monthly and as peoples needs change. In addition, it was not clear in the records that peoples health needs were being properly addressed through consultation with appropriate health professionals. We also looked in brief at the homes medicine management practice. The home maintains Medicine Administration Record (MAR) charts for each individual. The charts are stored in a folder each separated by a laminated card with a photograph of the resident and other relevant information such as name, date of birth and allergies. This is good practise. The home has a secure lockable room in which to store all medicines and has purchased a new fridge specifically for storing medicines requiring low temperatures. We examined the charts of three residents and looked at a random selection of others. We found that in the main the charts were being completed to show that peoples medicines were being administered correctly. However, we did see some gaps in the recordings where it could not be determined if medicines had been given or not. In addition, we saw that some of the administration boxes had been ticked and not signed by the person administering the medicine. We spoke with the acting manager about this and were told that these were the occasions when care staff had administered medicines such as prescribed creams and informed the nurse on duty that it had been done, therefore they ticked the box. We informed the home that the person administering prescribed medicines must be trained to do so and they have the responsibility to sign the charts when medicines are administered. Care Homes for Older People Page 15 of 38 Evidence: We were not provided evidence that the care plans contain guidance about assessing peoples need for medicines prescribed on a when required basis. In addition, we found no records (usually kept along side charts or on the reverse) to explain why medicines had not been given, for example when refused. We observed the medicine administration practice of the nurse on duty during the lunchtime medicines round and saw that the nurse dispensed medicines into individual pots for three people and appeared to sign the charts before taking them to residents. This is poor practice and could lead to errors in medication administration. We also found a tablet on the floor in a residents room and when we asked the resident what happened with the tablet, they replied they dropped it when taking their medicines in the morning. This suggests that the person administering the medicines did not observe them being taken. Again this is poor practise. When entering the rooms of two people we saw unsecured prescribed medicines, one of which should have been stored in a refrigerator. We spoke with a carer and asked if prescribed creams were always stored in peoples rooms and they said they were. All prescribed medicines should be stored securely and at the correct temperature. Care Homes for Older People Page 16 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be assured that they will offered opportunities to enjoy and take part in meaningful activities and enjoy good meals in attractive surroundings. Evidence: While going about the home we were able to talk to many 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, an new activities coordinator has been appointed. She has made the activities room more accessible by clearing away much of the clutter and arranging the tables so that wheelchairs can move about the room easier. A programme of activities has been developed and she has canvassed the residents to get a better understanding of their preferences. When we spoke to her at our random visit she had just been appointed and was very enthusiastic about her new job and told us about her plans to spend time individually with each resident to develop a life history, to talk about how they want to spent their time and how she can make the activities she offers fit with their expectations. We were also told that she is planned to do training in planning and organising activities for older people. During this inspection we found that the activities room, with its vintage objects and Care Homes for Older People Page 17 of 38 Evidence: memorabilia on display, was comfortably warm and during the afternoon several people were in the room listening to music and taking part in a craft session. Around the home there was evidence of peoples handiwork and plants and vegetables in tubs that the residents have planted. We also saw recent photographs of people taking part in other activities. News papers are delivered to the home daily. Some of the residents and their relatives have told us that they felt that staffing levels are too low and there are not sufficient staff on duty to enable them to just sit and spend time with the residents. One residents survey said, Staff are lovely, we could do with a few more though. another person told us, Staff are kind and help is given subject to very limited staffing. A relative we spoke to on the phone told us that that their relative was fairly active but didnt leave their room often and has said that they were lonely sometimes and felt cut off from the world. The staff will come to their room if they ring the bell but are often so rushed they cant stay for more than a couple of minutes. Some of the residents prefer to stay in their own rooms and others arent able to leave them as they are very frail. The activities coordinator told us that she tries to spend time with everyone in their rooms and told us how she will read the news paper or a book to people if they wanted it. The acting manager told us that visitors are welcomed at any reasonable time and are invited to attend special events such as birthdays and other celebrations. The home is set in its own attractive grounds and there are areas for people to sit and enjoy the gardens, in the AQAA we were told that the home is considering improving and developing further external pathways to enable the residents to fully assess the estate grounds and gardens. During our previous visits we saw that the residents were in the habit of eating all their meals in their rooms, often out of necessity due to insufficient staff numbers, ill health or personal choice, but the home has a pleasant dining room with views over the garden and countryside. Since the last inspection people have been encouraged to go down to the dinning room to eat their main meal. We saw that the tables were attractively set and each table had serviettes, condiments and fresh drinks. Fresh bread was available and people were offered wine with their meal. The home has made changes in the kitchen, the chef now manages the kitchen. He is planning new menus and visits the residents to get their opinion of the food and has asked for ideas for the menu. We saw that the meals were well prepared and looked and smelt appetising, the current menu is varied and nutritionally well balanced, Care Homes for Older People Page 18 of 38 Evidence: people told us that they enjoyed their food. Suffolk County Councils health and safety advisers audit had identified that people who need assistance with eating had their meals taken to their room early so they can be assisted before everyone else is served, however the meals were taken upstairs on a tray and remained unheated until staff become available to assist people to eat them. During this inspection we were able to confirm that a heated trolley had been purchased and was now being used to keep peoples meals warm until they were ready to eat it. Care Homes for Older People Page 19 of 38 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: We were told by the acting manager that a new complaints folder has been set up and staff have been shown how to register them and have been reminded of the complaints procedures. In the Annual Quality Assurance Assessment (AQAA) the acting manager told us that, All complaints are logged, investigated and responded to by management within the stated 28 day response time. Staff on the nursing floor have been informed regarding the complaints procedure and forms are available to all staff so, in the absence of a manager all complaints can be recorded correctly and dealt with on my return. The AQAA shows that three complaints have been made since the last inspection, two have been has been resolved to the satisfaction of complainant. The other one is still being dealt with, all were seen to be properly recorded in the complaints log. The people we asked said that they knew how to make a complaint and that they felt confident that it would be taken seriously and dealt with properly. The acting manager told us that if people want to take part in the political process and Care Homes for Older People Page 20 of 38 Evidence: vote, she will make arrangements to enable them to have a postal vote. 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 21 of 38 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. The water supply in this home is not reliable and the lack of sufficient heating needs to be addressed. Evidence: During a tour of the building we noted that the home was clean and is furnished comfortably. There is a mixture of bedroom sizes, some are large enough for the resident to establish a home from home feel with many of their possessions about them. The larger rooms are able to have a double bed, three piece suite and other occasional furniture without the room being crowded. Not all the rooms are occupied and some of the smaller rooms have been closed and people have moved into the bigger rooms. We were told that they were consulted about the move and were happy to change. Overall the whole of the upper part of the home; the bedrooms, the corridors and bathrooms are in need of redecoration. The walls are scuffed, wallpaper is torn and the paint is discoloured and chipped. The rooms and bathrooms have specialist equipment and adaptations to meet the needs of the people living in the home and to prolong their independence. The adaptations include specialist seating, hoists, stand aids, pressure reliving mattresses Care Homes for Older People Page 22 of 38 Evidence: and grab rails. Personal protective equipment was available for staff to use to enable them to maintain good infection control and we saw them use it appropriately. The bathrooms and toilets are sufficient in number and were clean, but we noted that the bathrooms were old and in need of refurbishment. many of the suits are chipped, stained with lime scale and the water seals are stained with black mould. They are unattractive, uninviting and some of the flooring is in need of repair, making it difficult to keep it hygienic. For example one bathroom, number 81, has had a new toilet fitted at some time that does not match the colour of the bath and sink. The lino around the toilet no longer fits, but rather than new lino being refitted a patch of a different colour has been laid to fill the gap, which is poorly fitting and has not been sealed. This is unhygienic as it will allow urine and other spills to get under the lino and to soak into the floorboards, making it impossible to wash the floor properly. The bath, although clean is stained with lime scale which has then been stained by the rust coloured water that initially runs from the taps when they are first turned on. The waterproofing seal around the bath is stained and has shrunk away at the edges. The taps in the sink did not have running water at all. We identified that there is a problem with the water pressure during earlier inspections, there are several rooms and bathrooms with poor water pressure. The other bathrooms and toilets are in a similar position. The residents do not have en-suite facilities so only have access to the communal bathrooms. The AQAA says that. Stowlangtoft Hall needs extensive improvement due to the issues highlighted in various inspections and audits. The communal areas are acceptable, welcoming and comfortable. However the bedrooms are in need of upgrading....The laundry is poor and needs a full upgrade. it also told us, The communal bathing facilities are very poor and require a full upgrade. When talking to the acting manager and management company representative, they both agreed that all the bathrooms need replacing. It was also agreed that the whole water system needs to be reviewed and possibly re-plumbed to ensure that all areas of the home has access to a constant and reliable water supply. When we visited the home during the winter months we found that the home was very Care Homes for Older People Page 23 of 38 Evidence: cold. The local authoritys quality monitoring team also found it cold when they visited in February 2010 and again in April 2010. Residents and their families told us that their rooms are cold at times, one relative told us in a survey that, There are insufficient heating arrangements, my relatives bedroom is cold on winter days. In the past the home was not been heating the communal rooms when they werent in use, which led to the ground floor to be very cold and we have previously made requirements that steps must be taken to maintain the ambient temperature throughout the home at a level that is safe and comfortable for the residents. During this inspection, which was carried out on a mild day in May, we found that all the heaters on the ground floor have been left on, which kept it a lot warmer than when we last visited. However the stairways were still cold indicating that the heating was still not sufficient to keep the home warm throughout. 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. During their visit in February 2010, the Environmental Health Officer found that food wasnt being stored properly and that raw food was being stored above cooked food in the fridges, increasing the chances of cross contamination. The officer also noted that there were areas of the kitchen that were dirty and not properly maintained, which made it difficult to maintain good hygiene levels as they couldnt be cleaned thoroughly. He also asked for regular reviews to be carried out on their hygiene control measures. During this inspection we were informed that the home has complied with all of these requirements and have carried out a deep clean of the kitchen, developed a cleaning programme, bought new fridges and freezers, a hot food trolley and a floor cleaner. Care Homes for Older People Page 24 of 38 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 living in this home benefit from a staff team that are dedicated to giving good quality care, but the management company has to reassess the residents needs to ensure that there are sufficient staff on duty. Evidence: When we arrived at the home we were told by the management consultant that there should be one nurse on duty and four carers that morning. One staff member had gone sick, only informing the home early that morning meaning it was too late to get cover before 9am when one of the people who normally works at night came in to help out. This meant that between 8 and 9am there was only two care staff on duty. In addition, when we spoke with the carer who had come in to help out, she said that she was due to leave at 2pm but she had been asked if she could stay longer and she agreed to stay until 3pm. This again meant that only two care staff would be available until the next shift started. During the morning we visited residents in their rooms and found that several had still not received personal care at 11.30. Staff were busy all morning tending to the residents and answering the call bell. Now that residents are using the dining room for lunch this means that a carer is allocated to supervise the meal, normally leaving three care staff to serve the rest of Care Homes for Older People Page 25 of 38 Evidence: the residents meals in their rooms. Six people need assistance to dine. 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 people that were unable to use their 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. Staff also passed on the same sentiments in the surveys they sent us, one person said, We need more staff during the day so that more time can be spent with the residents. another staff member said, Things could be better if we had more staff, especially to cover when anyone goes off sick. Comments in the surveys returned to us and from the residents and their relatives on the day, told us that people felt that there werent enough staff on duty, that staff were rushed and were unable to spend time with the residents. None of the comments made to us about the staff were critical of the quality of care people were given, only that at times there didnt seem to be enough staff on duty, the remarks were supportive of the staff and showed concern for them. During the inspection it was noted that the interaction between staff and the people the residents was friendly, caring and professional. Staff were attentive to the peoples needs and requests for assistance were attended to promptly. The recruitment records of three staff members were viewed and it was noted that appropriate checks had been made to ensure that people were safeguarded. The checks included Criminal Records Bureau (CRB) checks, identification, two written references and their work history which was included in their application form. When the management company first took over the running of the home they found that the recruitment files were in disarray and they have dedicated time to auditing the files and getting them in order, the files are now tidy and the information can be easily accessed. The AQAA stated told us that, Complete staff files are available for inspection and individual staff training files have been developed. An electronic matrix is in place for the easy auditing of training needs. The three staff records that were viewed including training certificates, which included Care Homes for Older People Page 26 of 38 Evidence: an appropriate induction course, manual handling and safeguarding. A training matrix was viewed which clearly identified training needs and we were shown the homes future training programme, training planned for April, May and June included moving and handling, safeguarding, fire marshal, COSHH, first aid, health and safety, food awareness and infection control. 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. They also told us that they believed they had been provided with the training that they needed to do their jobs. The two staff surveys we received said that they were provided with training which kept them up to date with new ways of working and provided them with enough knowledge about managing peoples health care needs. Care Homes for Older People Page 27 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Healthcare Management Solutions are making improvements to the management of this home, but attention needs to be paid to the the people living in the home, their needs and their comfort. Evidence: As soon as the management company took over the running of the home they carried out an audit of all the homes policies and procedures, care practises, staffing arrangements, equipment and the maintenance of the building and an action plan was developed, which we have been given a copy of. It clearly identifies areas that need addressing such as the staffing files, training needs, maintenance of the home and the replacement of equipment. Many of the improvements that were needed have been implemented and action has been taken to improve outcomes for people living in the home. They include the reinstatement of relative and resident meetings, staff meetings have been have taken place and staff supervision is again underway. A selection of surveys have been given Care Homes for Older People Page 28 of 38 Evidence: to the residents so the management company can get an idea of what changes they would like to see and the staff have had a similar survey. Bi Monthly relatives meeting have been introduced to the home and the first one had a very good turnout, the lounge was full, and the relatives, although apprehensive about what was going to happen to their family members home, were happy that they were being kept informed and where being consulted. The Consultant from the management company works at the home two days a week and the acting manager is available five days a week. She has posted a notice around the home saying that she will make herself available every Wednesday to meet with anyone who would like to speak to her, including the residents, their relatives and staff members. The acting manager told us that she is on call when she isnt at the home and is happy to offer advice if staff need to call her. However, none of the managers work at the home during the weekend and one of the staff surveys told us that it has sometimes been difficult for staff to contact a manager for advice during the evenings and at the weekend and suggested that more formal arrangements could be put in place to ensure there is always a manager on call. The staff member said they feel uncomfortable and unsafe not knowing if there will be a manager around if they are needed. It has been made clear to us during this inspection that the staff, the residents and their families feel that there need to be more staff on duty during the day, it was evident on the day of the inspection that the staff were kept busy and we saw that people were still in their night cloths at 11.30 in the morning. A full assessment of the needs of the residents must be undertaken so that the home can ensure that, having regard to the size of the home, the statement of purpose and the number and needs of the residents, at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are reasonable to meet their needs. However this cant be done unless the residents have full and detailed care plans and needs assessments in place, which is not the position at the moment as identified in an earlier section of this report. The maintenance person is spending more time at the home and has taken on the responsibility of carrying out health and safety checks. We checked the health and safety records and found that the safety checks had been carried out and the records Care Homes for Older People Page 29 of 38 Evidence: had been completed. We were shown a comprehensive list of what equipment needs servicing, when it is next due and who has the service contract. The management found that some were overdue and steps have been taken to have the services done and to renew servicing contracts so that they will not be missed again. The fire safety equipment was professionally serviced on 3rd February 2010 and some of the extinguishers were replaced. We were told that the occasion turned into an impromptu training session when the old extinguishers were used to give the staff an opportunity to discharge them and were shown how to use them. Portable Appliance Tests (PAT) had been completed in March 2010. We noticed that there was a multi plug extension attached to the wall that had been PAT tested and had failed the safety check as there was a crack in the casing, but it was still in use. When asked why the unsafe equipment was still being used the maintenance person explained that it was supplying power to the homes call system, which is very old and was no longer being manufactured. To replace the multi plug the call system would have to be disconnected from the power, which the company responsible for servicing the system advised against as there was a question as to whether the backup battery would be able to support the system, if it didnt the call system would be out of action until the servicing company could get out to reset it. It was decided that it would be better not to disconnect the system until the company was at the home so it could be reset without delay if needed. This couldnt be arranged immediately so a risk assessment was undertaken to decide if the removal of the damaged plug could be delayed. The risk assessment found that the plug was in an area of the home that was not normally accessed by residents unaccompanied and that it was not constantly having things plugged in and out as it only serviced the call system, so it was decided that it was safe to leave until the service company could be present when the system was disconnected. The plug was rendered safer by insulation tape being placed over the split in the casing and a notice was attached close to the plug to alert staff not to touch it. A date has been arranged when the service company would be available to ensure the call system continued working once it had been disconnects and the plug replaced. Colour coded mops are now being used by the domestic staff, this ensures that cross infection is minimised as different mops are used in different areas of the home, there are now different mops for general use, for cleaning the kitchen and moping the toilet floors. Care Homes for Older People Page 30 of 38 Evidence: In the past the residents were reluctant to use the passenger lift as it was unreliable and prone to breaking down, the service lift can be used by residents but it doesnt go to all the areas of the home and some people cant get downstairs at all when the passenger lift is out of action. Since the home has gone into administration the lift has been given a major refit and we have been assured that is in full working order and hasnt broken down again since the refit. Since February the home it has been inspected by the Fire Officer, the Environmental Health Officer, the Suffolk County Councils Health and Safety Adviser and their Outcome and Monitoring Team. All of which have made requirements and recommendations that must be complied with. We have seen copies of the reports which all ask for improvements in health and safety in the home. Healthcare Management Solutions are aware of the seriousness of the shortcomings and has already started making the improvements. During his visit the Fire Officer issued an enforcement notice in respect of infringements to fire safety legislation that had been identified at a previous visit, before the home was taken into administration, and had not been attended to. Time scales have been set and the fire officer said that he would return to the home to determine whether the work has been carried out. The main concern was the lack of door closures on the residents bedroom doors. The Fire Officer contacted us early in May to inform us that he had revisited the home and that he was satisfied that self closers, of an appropriate standard, had been obtained and fitted to the bedroom doors. They still need to be wired into the electricity supply, but he is satisfied that work was scheduled and he was confident it would be done. He intends visiting the home again in December to ensure that the remainder of the requirements have been carried out. Care Homes for Older People Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 38 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 13 You must put in place effective arrangements to ensure that unnecessary risks to the health and safety of people living in the home are identified and so far as possible eliminated. Good quality risk assessments enable people to live a fulfilling life while still protecting them from unnecessary harm. 30/07/2010 2 7 15 You must put in place effective arrangements to ensure that care plans are reviewed when appropriate or when peoples needs change and they are up dated to reflect those changes. If care plans are not reviewed regularly staff may miss important changes to the residents care and needs may go unrecognised. 30/07/2010 Care Homes for Older People Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 7 15 You must put in place effective arrangements to ensure people living in the home have all their needs assessed and there is a written plan as to how those needs are to be met. Peoples health and wellbeing can be put at risk if care plans do not properly address their assessed needs. 30/07/2010 4 8 12 You must put in place 30/07/2010 effective arrangements to ensure that you promote and make proper provision for the health and welfare of people living in the home. People must be supported to make decisions that will promote their wellbeing. 5 8 13 You must put effective arrangements in place to ensure that people living in the home receive, where necessary, treatment, advice and other service from any healthcare professional. People must be supported to make decisions that will promote their wellbeing. 30/07/2010 Care Homes for Older People Page 34 of 38 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 6 8 15 You must ensure that where 30/07/2010 risk assessments are carried out peoples mental capacity must be considered and taken into account. If it is felt that someone may lack capacity and may put themselves at risk it should be considered having their capacity tested in accordance with the Mental Capacity Act. 7 9 18 You must ensure that staff involved in the administration of prescribed medicines are provided with suitable training. It is important that staff are suitably trained in all areas the management and use of medication to avoid mistakes that can have serious consequences. 30/07/2010 8 9 13 You must put in place 30/07/2010 effective arrangements for the recording, handling, safe keeping and safe administration of prescribed medicines. This is to protect the people living in the home as mistakes with medication can have serious consequences. Care Homes for Older People Page 35 of 38 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 9 25 23 You must put in place effective arrangements to ensure that all rooms used by people living in the home have a suitable and adequate supply of hot and cold water. To protect the health and welfare of the people living in the home it is essential that there is a clean and reliable water supply to all areas of the home. 30/07/2010 10 25 23 You must put in place 30/07/2010 effective arrangements to ensure that there is suitable and adequate heating provided in all areas used by people living in the home. It is essential for the welfare of the residents that all areas in the home are kept at a comfortable temperature. 11 26 23 Steps must be taken to ensure that all bathrooms and toilets in the home are kept in a good state of repair. The condition of bathroom and toilets in the home do not promote good hygiene. 30/07/2010 Care Homes for Older People Page 36 of 38 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 12 30 18 You must ensure that there 30/07/2010 are sufficient staff on duty at all times to meet peoples assessed needs. It is not sufficient to set staffing levels on comparing the ratio of staff to residents. The size and layout of the building and the residents care needs must also be taken into consideration. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 37 of 38 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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