Inspection on 16/01/09 for Strawberry Bank

This inspection was carried out on 16th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Strawberry Bank 04/02/10

Strawberry Bank 17/09/09

Strawberry Bank 07/08/09

Strawberry Bank 08/07/09

Strawberry Bank 24/01/08

Strawberry Bank 26/09/07

Strawberry Bank 15/05/07

Strawberry Bank 04/07/06

Strawberry Bank 19/10/05

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Strawberry Bank 17 Strawberry Bank Liversedge West Yorkshire WF15 6JT     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynda Jones     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Strawberry Bank 17 Strawberry Bank Liversedge West Yorkshire WF15 6JT 01924410471 01924405070 info@strawberrybankcarehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Prince Edward Anojan Joseph Name of registered manager (if applicable) Miss Claire L Allen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To complete Schedule 1 of the Fire Safety Officers report To forward a Statement of Purpose and Service User Guide within three months of becoming the registered provider. Date of last inspection Brief description of the care home Strawberry Bank provides personal care and support for 24 older people. The home is located at the head of a quiet cul-de-sac, off the main Halifax road into Liversedge. Accommodation is on three floors, with a lounge, and a dining area on the middle floor. A passenger lift serves all floors. There is a mixture of both single and shared bedrooms. There is also a patio to the rear of the property, where people can sit out in the warmer months of the year. In addition to the weekly fee there are additional charges for hairdressing, Care Homes for Older People Page 4 of 33 care home 24 Over 65 24 0 Brief description of the care home newspapers, and magazines. Information about the home and the services provided is available from the home in the statement of purpose and service user guide. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The home was last inspected in January 2008 when it was assessed as being adequate. Care Homes for Older People Page 6 of 33 This inspection was carried out to assess the quality of care provided to people living at the home. The inspection process included looking at the information we have received about the home since the last key inspection as well as two visits to the home. The first took place on 16 January 2009 and lasted 4:5 hours. The manager was not present on that occasion. The second visit took place on 9 February 2009 because we were concerned that the home was not appropriately staffed at all times to meet peoples needs. We also wanted to check that the home was receiving a regular supply of food. During the visit we spoke to people who live in the home and to the staff on duty. We observed care staff delivering care, looked at various records and looked around the home. We sent surveys to people who live and work at the home and to health care providers who visit. Information received in this way is shared with the home without identifying who has provided it. We received 13 completed surveys and we have used comments from them in this report. What the care home does well: What has improved since the last inspection? What they could do better: The provider must take action to make sure that the home is run and managed in the best interests of the people who live there. This must include: Making sure that the health, safety and well being of people is protected and promoted. Making sure that peoples care plans tell staff everything they need to do to support that person. Making sure that the plans are reviewed regularly and reflect the care that people need. Making sure the daily records are improved so that they reflect the care people actually receive. Making sure that medications are stored safely, in hygienic conditions, and that people are given their medications regularly as prescribed their doctors. Making sure that they do not admit anyone to the home unless they have enough staff to meet their needs. Making sure that there are always enough staff on duty to look after people properly. Making sure that peoples personal appearance is good. That people get to see the hairdresser regularly and men are shaved (unless they are growing a beard). Making sure that staff receive the training they need to equip them to do their job properly, understand peoples needs and how to meet them. Making sure that there are stimulating activities for people to take part in if they want to. Making sure the home is kept clean at all times so that it is a pleasant place for people to live. Making sure that adequate finances are available for essential supplies. Making sure that people can always access their own money that is held for safekeeping. Care Homes for Older People Page 8 of 33 Making sure that the home is being managed properly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is available for people to look at before they move in and they can visit to see if they think the service can meet their needs. Evidence: The statement of purpose and service user guide is available from the home. These documents give people lots of information about the home. We saw some of them in the bedrooms we looked at. The manager assesses people before they move in to make sure that their needs can be met at the home however, there have been no new admissions to the home in recent months. The home does not provide intermediate care. Care Homes for Older People Page 11 of 33 Care Homes for Older People Page 12 of 33 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. Care plans are not up to date and instructions in the plans are not always followed. This means there is a risk that staff may not fully or consistently meet health and personal care needs. Evidence: We looked at a selection of care plans because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. The quality of information in the plans varies greatly. Out of four plans we looked at only one contained a good life history; three out of four contained a completed section about personal preferences. From observing and talking to staff it is evident that they know each individuals likes, dislikes, and needs but this information is not always written in the care plan. Overall, the plans we looked were poor and lacked detail, they are not being reviewed regularly and they do not contain up to date information about the care and support Care Homes for Older People Page 13 of 33 Evidence: that people require. This means that peoples health is placed at risk because they may not be receiving the care that they need. These are some of the points we fed back to the person in charge at the end of the visit: The records suggest that people do not routinely see opticians, chiropodists and dentists. We saw that need for someone to be referred to a specialist health care provider had been highlighted in the care plans but we were unable to tell whether this had been followed up. In one plan we read that an individual was waiting for an audiology appointment when they moved into the home in 2008. There was nothing on the audiology record sheet to indicate whether this had been followed up. We looked at a plan for a person who moved into the home in 2004 and we could not find any evidence of this person seeing an optician, dentist or a chiropodist. According to the records, another person who moved into the home in 2006 has not been assessed by an optician or chiropodist. We could find no evidence that this person has seen a dentist since admission. When the care plan was last reviewed on 9/1/09 the notes indicate that action needs to be taken to register this individual with a dentist, we could not tell from the records whether this has been arranged. Records of contact with health care providers are not up to date. The records for one person show that on 5/12/08 staff were concerned that this individual could have a urine infection. The records state unable to get a GP - get a sample, the reason for being unable to get a GP to visit was not recorded. The next entry on the record of GP visits was made more than a month later, on 12/1/09 when antibiotics were prescribed. We could not ascertain from the records whether a urine sample had been obtained and tested. We asked staff why there had been a months gap before this person had a visit from a GP and we were told the doctor visited but it must not have been recorded. People are at risk of not receiving the health care that they need because the plans are not being reviewed regularly. We looked at a plan for an individual who moved into the home in April 2008. Their pressure ulcer risk assessment showed a score of 25, indicating high risk. This means that weekly assessments need to be carried out and a referral made to GP and district nurse. These instructions have not been followed, the only entries on the records were for May, June, July and August 2008. Care Homes for Older People Page 14 of 33 Evidence: Peoples personal hygiene is being neglected because people are not being offered a bath regularly. We saw a notice pinned up in the office reminding staff could everyone look at their baths please because some have been missed. In one plan we saw that one person had a full body wash on 14/10/08, the next entry in the records was 9/1/09. There was no other record of a bath or wash between these dates. The records show that another person last had a bath on 11/11/08 and has had six strip washes since then. There was no indication in the records as to why a bath had not been offered. People did not look particularly well cared for. Some people did not look as if they had had their hair combed since they got out of bed, some of the men were unshaved and the majority of the women sitting in the lounge were not wearing stockings or tights. Records are not always updated to reflect the changes in individual needs. We looked at a continence plan which told us about the needs of one person. An important change was made to the plan indicating that this person needed assistance from staff. The entry was not signed and dated, there was no information about what had brought about the change and what assistance should be provided. In addition, the type of continence pad specified on the plan was different to the supply of pads in this persons room. This means that it would not be possible to deliver consistent personal care to this person based on the content of the care plan. The information we received from the home before the inspection said nutritional screening is carried out on everyone when they move into the home and is repeated for people at risk of malnutrition. We were told six members of staff have received training in malnutrition care and assistance with eating. We looked at nutritional risk assessments in the care plans which specified that some people need to be weighed weekly. According to the records this is not being done. Staff need to be more vigilant at meal times to make sure that people are comfortable and are encouraged to eat their meals. At lunch time, one person who is at risk of malnutrition was sat at the table in a wheelchair, she did not seem to be in a comfortable position to eat. Her pudding was placed on the table before she had finished her main course. Trying to be helpful, other people at the table then moved the main course away and gave her the pudding to eat. No one asked whether she had finished her main course. The care plan for one person who is diabetic and dependent on insulin does not contain Care Homes for Older People Page 15 of 33 Evidence: any information about what staff must do if this persons blood sugar is either very high or very low. This person has been noted to be agressive at times but staff have not looked at the possibility that this could be linked to blood sugar levels. A health care provider who visits the home told us basic needs appear to be met but staff appear to have limited knowledge about specialised areas such as diabetes and I feel poor communication skills compromise patient care. The daily records do not contain any evidence of the care that the staff deliver.The records are repetitive; they say very little about the quality of care provided and little about the lives of the people living there. Many of them simply say All personal hygiene maintained and nightime records say in bed,checked every two hours The same comments are often repeated day after day. We are concerned that personal information about peoples health care is being recorded in the office diary and not in individual care plans. For example we saw blood sugar levels for one person recorded in the diary but not in the care plan. Important information about peoples care must be written in their care plan so that it is possible to track changes in their health and the treatment they need. We looked at a sample of medication administration records. The records show that medication is booked in correctly and staff are signing the records to show that people are getting their medication at the right time. On one set of records we looked at staff had written completed next to one item of prescribed medication. A note in the diary indicated that a member of staff had reordered this medication. We could not tell from the records whether the home had run out of this item or whether it had been stopped by the GP. When we asked staff about this they were not sure. One of the visiting health care providers told us that medications are sometimes missed when people return to the home from hospital and there is a delay in collecting prescriptions from the GP. The fridge in the office which is used to store fortified drinks is dirty and unhygienic. Insside, the bottom of the fridge was sticky and covered in hairs. It also needs to be de -frosted. One of the visiting health care providers told us that medication is often not locked away safely, sometimes the medications are in boxes or in plastic pots with loose tablets inside. Care Homes for Older People Page 16 of 33 Evidence: On our second visit to the home we found racks of medication in monitored dose packs, left in boxes on the floor in an unlocked office. Inside the office the key safe had been left wide open. This is unsafe practice and we fed our concerns about this to the manager and owner during our visit. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of stimulating activity within the home. People can be left for long periods without moving about, some people are left without anyone talking to them. Evidence: From talking to staff it is clear that they have a good understanding of peoples likes and dislikes, although this information is not always recorded in the plans. If the regular staff were not available to cover a shift and temporary staff were needed, it would not be possible to ensure that people follow their preferred daily routine based on the records alone. The records that we looked at show that some people are asked about what they would like to do. We could not find any of this information on the plans for people with dementia that we looked at. Some of the responses we saw included going to the zoo and the seaside but we couldnt tell whether any of these outings have taken place or whether they are likely. A note in the office reminds staff that an activity must take place each day and a record kept of who takes part. It goes on to say that staff must record any reason for Care Homes for Older People Page 18 of 33 Evidence: activities not taking place. We could not find any recent records of activities and nothing took place on the day of our visit. The records in the activities folder started on 10/9/08 and the last entry was made on 18/10/08. In the morning most people sat in the lounge; there was very little contact with staff except when they provided drinks mid morning or took people to the toilet and to the dining room at lunch time. In the afternoon a couple of people sat talking to staff as they wrote thier daily reports in the dining room. The staff were pleasant with people, they reminded people if they had had visitors and talked to them about their relatives. The atmosphere was calm and relaxed. People told us they loved the meals that are provided. One person said the foods lovely here and another comment after lunch was I couldnt have made that better myself. The lunch time meal was nicely presented. At lunchtime people were drinking juice out of disposable plastic cups, the type often found next to water dispensers. We thought they were difficult for some people to hold when full. We were told that these are used because there are not enough drinking glasses to go round. The food delivery arrived while we were there and there was plenty of fresh fruit and veg available. In the week following this visit we were told that food stocks were very low and as the home did not have funds to buy food, the manager contacted the owner to get him to authorise an order. We visited the home again three weeks later because we were concerned about this. We found some tinned food, some frozen meat and frozen vegetables and dry goods in stock. The cook said she is unable to plan the menu in advance, she makes a meal for the day from what is in stock. We were told an order was due to be placed the following day and the owner who was present, confirmed that funds are available for food. Once again people told us they enjoyed the food, they had home made soup, followed by pork, yorkshire puddings and a selection of vegetables and a choice of desserts. Care Homes for Older People Page 19 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff need more training on their role in safeguarding people so that they can ensure that people living there are safe. Evidence: In the information the home sent to us before the inspection they told us We have a clear and easy to read complaints policy which is give to all clients upon admittance. We investigate complaints immediately upon receipt and inform the complainant of progress and outcomes throughout. We had limited acess to records because the manager was not available when we visited. The last record of a complaint we found was from December 2007. According to the AQAA a complaint received during the last twelve months has been investigated and upheld. We do not have any information about this. The AQAA told us there have been no adult protection referrals in the last twelve months and we have been told that staff have had adult protection training but we cannot be sure that procedures are being followed. We read a note in the diary about one person complaining of being dragged to bed after she fell in the toilet. There was nothing in the daily records about this and none of the staff knew whether this had been investiagetd. We also read about someone who was sometimes agressive towards other people living and working in the home. We could find no evidence of a Care Homes for Older People Page 20 of 33 Evidence: risk assessment regarding this behaviour and no evidence of any strategy for staff to use to diffuse situations. Care Homes for Older People Page 21 of 33 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. People are living in a dirty, untidy and poorly maintained home. Evidence: The home is not clean and it is not well maintained. The lack of care and investment in the home indicates a lack of respect for the people who live there. While we were there we had a look round most parts of the home. We did not see all of the bedrooms. These are some of the things we found: The carpet in the lounge is stained. The chairs are worn and dirty, many of them have food stuck on them, some of the base cushions have collapsed. The legs on some of the trays are encrusted with food. The paintwork on the walls is marked and there are cobwebs hanging from the ceiling. Fingerprints are visible in the thick dust on the bookcase. Dead flowers were sitting in a vase of murky, brown water on the mantlepiece. A box of christmas decorations was stored behind one of the chairs and the christmas tree stand was still on the fireplace. At one end of the lounge where a ceiling light fitting had been removed, taped up wires were left exposed. There was no tube in the fluorescent light near the fire escape at the other end of lounge. In the main, bedrooms are personalised and people have lots of their own possessions Care Homes for Older People Page 22 of 33 Evidence: around them but the rooms are not well maintained. The windows are dirty and look as if they have not been cleaned for some time, some of the bed linen looked worn and was unironed. The carpets in the hallways and on the stairs are heavily stained. The paintwork and wallpaper on the corridors is marked and torn in places. The bathrooms are functional and do not provide an atmosphere conducive to having a relaxing bath. There is an extremely large deposit of cigarette ends on the patio,outside the door to the dining room. They have been left on the floor and brimming over onto the floor from a large ashtray which stands outside. Another pile of cigarette ends have been left in a bucket under the fire escape. These leave an unfavourable impression to visitors to the home and judging by the amount, they must have been there for some time yet no one has bothered to clean them away. We pointed this out to staff on our first visit to the home and during our second visit some of these were cleared away. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels were reduced without any regard for the needs of people living at the home. This means there is no guarantee that peoples needs will be met. Evidence: On our first visit to the home we were informed that there are three care staff on duty during the day from 7:30am to 9:30pm plus a cook, domestic and laundry person. There are two care staff on duty throughout the night. We were subsequently contacted by a visitor to the home who told us that there had only been two people on duty during an evening visit they made. We contacted the home by phone and were able to confirm that there had been occassions when only two care staff had been on duty. The manager told us she had been asked very recently by the owner to reduce the number of care staff on duty. According to the information provided to us by the home before the inspection took place there are 16 people living there who need help dressing/undressing; 19 people need help with bathing; 8 people have continence problems and need help to go to the toilet and 8 people have dementia. Reducing staffing levels is not acceptable, it is unsafe because it places people living at the home at risk and means that there is no guarantee that their needs will be met. We contacted the owner with our concerns and Care Homes for Older People Page 24 of 33 Evidence: we were assured that staffing levels would be immediately restored to three care staff on duty. On our second visit to the home we met with the owner and manager and they confirmed that there would be three care staff on duty during the day. We will continue to monitor staffing levels. We could not access all the staff records because the manager was not present. In the information we received before the inspection the home told us they have recruitment policies and procedures to ensure that staff receive appropriate checks before commencing work. We looked at the records we found relating to two member of staff. We could see that references had been taken up and appropriate checks had been carried out before new staff start work at the home. We could see that some staff have completed parts of the homes own induction package. We were unable to tell exactly what information this covered. We could not find any evidence of induction training that meets Skills for Care common induction standards. In the information that we received before the inspection, we were told that 11 out of 18 staff have NVQ level 2 or above. Care Homes for Older People Page 25 of 33 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. The home is not being managed properly and the owner is not making sure it is being run in the best interests of people living there. People are not adequately protected or safe in the home. Evidence: The registered manager is planning to leave to take up other employment early in March 2009. When we visted for the second time, the owner was interviewing for the managers position. It is important that the person appointed is a competent, skilled manager because we have identified a number of shortfalls in the service that must be addressed. The AQAA was returned to us when we asked for it. It did not include any information about the servicing of equipment, and it did not contain any information about the review of policies and procedures. Although we were given some information about the Care Homes for Older People Page 26 of 33 Evidence: service provided there is only minimal evidence to support any of the claims made within it. The fire test records we looked at are incomplete. We found a record of daily checks from 9/12/08 to 22/12/08 containing only 8 entries, the rest of the records were blank and no one could tell us about fire safety checks. This means that peoples health and safety is not adequately protected. We are not being routinely notified about any incidents that affect the well being of people living at the home. We must be notified so that we can monitor the welfare of people living there. We wanted to check the money that is held by the home on behalf of people living there. The manager was not available on the day we visited and the senior on duty did not have access to the key to personal monies. We asked what would happen if someone wanted some of their own money and we were told that a member of staff would probably lend them some of their own money. People should have access to their own funds whenever they need to. On the second visit to the home they had run out of bread. We were told they had also run out at the weekend. In both cases, a member of staff paid for the bread out of her own money and had to ask for a refund from the manager because staff do not have access to a float. Evidence indicates that the home is not well resourced, there is no plan for the future development of the home. There is no budget or plan for refurbishment and there is no evidence of any strategic planning. Recent events suggest the home may be in financial difficulty. We will be asking for the homes accounts to check that it remains finacially viable. The owner of the home does not live in the area. He should visit the home once a month and complete a report on the conduct of the home. We were unable to find any of these reports and staff could not recall how often he actually vists. In one of the staff surveys we were told I feel the owner has lost interest in the home as he never seems to be around anymore another said he used to come twice a month now he doesnt come at all. Care Homes for Older People Page 27 of 33 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 28 of 33 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 Care plans and risk assessments must be kept up to date and reviewed regularly. This is an outstanding requirement from 24 January 2008. This is to make sure that people receive the care and support they require. 20/03/2009 2 7 12 People must be weighed regularly and food and fluid intake must be monitored regularly. This is an outstanding requirement from 24 January 2008. This is to prevent the risk of people being malnourished. 20/03/2009 3 7 15 Care plans must be in place that address peoples ongoing health care needs. This will make sure they get the treatment they need. 20/03/2009 Care Homes for Older People Page 29 of 33 4 7 15 People and/or their 20/03/2009 representatives must be involved in the care planning process. This will make sure people are consulted about their care and support. 5 9 13 Medication must be stored securely at all times. This is an outstanding requirement from 24 January 2008. This reduces the risk of it being tampered with and makes sure it is safe to use. 20/03/2009 6 12 16 Activities must be provided 20/03/2009 that meet the range of needs and abilities of the people who live there. Wherever possible people must be consulted about the sort of activities they wish to be involved in. This will enable people to take part in activities of their choice. 7 16 17 A record must be kept of all complaints received, together with details of any investigation and action taken. This will help highlight any common themes and improve the service. 20/03/2009 8 18 13 All allegations of abuse must 20/03/2009 be recorded and promptly followed up. To protect people and keep them safe. Care Homes for Older People Page 30 of 33 9 18 13 Staff must receive appropriate training to ensure that they are aware of their responsibility to safeguard people in their care. To ensure that people using the service are safe and protected from abuse. 20/03/2009 10 26 16 All parts of the home must be kept clean and hygienic. To reduce the risk of infection and to protect the health and welfare of people who use the service. 20/03/2009 11 27 18 The staffing levels in the home must be kept under review. There must be enough staff on duty at all times to make sure that peoples needs are met consistently. This will make sure people get the care that they need. 20/03/2009 12 33 26 Arrangements must be 20/03/2009 made to carry out monthly visits to the home and make monthly reports available about the conduct of the home. To ensure the home is being run in the best interests of the people living there. 13 38 23 Arrangements must be made to ensure that fire safety checks are conducted and recorded on a regular basis. 20/03/2009 Care Homes for Older People Page 31 of 33 To make sure that peoples health and safety is protected and people are not placed at unnecessary risk. 14 38 37 Arrangements must be in place to notify us about any incidents that affect the well being of people living at the home. This is so that we can monitor the welfare of people living at the home. 20/03/2009 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 35 People should always have access to the money that is held in safekeeping for them. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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