Inspection on 24/11/09 for Summer Court Hall Residential Home

This inspection was carried out on 24th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Summer Court Hall Residential... 23/02/10

Summer Court Hall Residential... 16/06/09

Summer Court Hall Residential... 27/02/07

Summer Court Hall Residential... 06/02/06

Summer Court Hall Residential... 30/08/05

Summer Court Hall Residential... 05/01/05

Summer Court Hall Residential... 11/08/04

Summer Court Hall Residential... 13/02/04

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

Key inspection report Care homes for older people Name: Address: Summer Court Hall Residential Home Football Green Hornsea East Yorkshire HU18 1RA     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: Beverly Hill     Date: 2 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Summer Court Hall Residential Home Football Green Hornsea East Yorkshire HU18 1RA 01964532042 01964532042 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hexon Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Home may admit up to 37 service users when the building works are completed and a Certificate of Completion issued under the Building Act 1984 Building Regulations Date of last inspection Brief description of the care home Summer Court Hall is located in the seaside town of Hornsea on the coast of the East Riding of Yorkshire, close to all local amenities. It has parking facilities for several vehicles. The home is registered for thirty-seven older people, a maximum of twelve may have dementia and are cared for in a separate area of the home. The home does not provide nursing care. Currently the service is without a manager. Care Homes for Older People Page 4 of 40 Over 65 12 25 0 0 Brief description of the care home The bedrooms are arranged on both the ground and first floor, with a lift and stairs providing access for residents. The home has a lounge with a conservatory, and a separate dining room in the main part, and a connecting lounge and conservatory in the dementia care unit. There are bathrooms and toilets on each of the floors. The current fees for residents range from £342 to £390 a week and are primarily based on their assessed needs. This was correct on 16th June 2009. Information is available in the statement of purpose and service users guide. Care Homes for Older People Page 5 of 40 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 that the people that use this service experience poor quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 26th June 2008, the annual service review on 16th June 2009 and a site visit to the home, which lasted approximately ten hours. The local authority had received a safeguarding alert about the physical and psychological abuse of some residents and, jointly with the police, began an investigation. The initial findings of the investigation prompted us to carry out an unannounced inspection. We explained to the person in charge, and later the provider, that the visit would entail collecting evidence under the police and criminal evidence act (PACE) that could be used for enforcement action against the home if regulations Care Homes for Older People Page 6 of 40 had been breached. We ensured they were fully aware of the procedure and gave them a list of any documents we copied. The provider, management and staff team were helpful and provided us with the documentation we required to complete our inspection. The provider is now fully aware of the findings of our inspection and is anxious to put right the shortfalls and improve the home for the residents living there. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Summer Court Hall. We also had discussions with the provider, the acting manager, staff members, a health professional and two relatives. Comments from the discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were, medication practices, risk management, activities organised, nutrition, complaints, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked to see how residents were consulted with in how the home was run and how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We completed a short observation in the dementia care unit to check out how staff interacted with residents and how they supported them. The provider had returned their annual quality assurance assessment (AQAA) within the required timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Summer Court Hall, the staff team and management for their hospitality during the visit, and also thank the people who had discussions with us. 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 the 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. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to be managed more effectively so that residents health needs are met promptly and their personal hygiene needs are more closely monitored and carried out. Staff members need to be more vigilent and proactive when caring for people to ensure all their needs are fully met and privacy and dignity maintained. There has been incidents in the home between residents that has led to some people being harmed. Any incidents like this affecting the welfare of residents must be reported to the local authority quickly so they can be investigated and addressed. The Care Quality Commission must also be informed so we can monitor how the home is managing the incidents. Documentation needs to improve and assessments, care plans and risk assessments need to be much more thorough to ensure they contain sufficient information for staff to meet peoples needs. Monitoring charts need to be completed thoroughly and accurately. People must not be allowed to run out of medication as this could have a serious effect on their health. The way medication is recorded also needs to improve so that staff have full and accurate information about the medicines they administer to people. There could be more activities for people to participate in. There was evidence of some stimulation but this was not consistent throughout the home. The provision of more activities/stimulation and outings, and a second option at the main meal would improve Care Homes for Older People Page 8 of 40 the choices and decisions people are able to make. Complaints are recorded and investigated but documentation could record evidence that the complainant is satisfied with the outcome. Some parts of the environment needed attention to ensure the home was a safe and clean place for people to live. The dementia care unit could be made to look more homely. Some equipment and furniture was in need of replacement. We noticed that some residents bedrooms were untidy and their wardrobes had clothes thrown in the bottom rather than hung up neatly on hangers. This showed a lack of respect for peoples clothes and belongings and needs to be improved. The hot water outlets had very hot water and this could potentially scald people with fragile skin. There is a limit for safe water temperature but those recorded in some bedrooms and bathrooms were much too high. A health and safety officer visited the home after our inspection and told the home what they had to do to rectify the problem. The staff team were described as polite and caring but we were not assured they had the skills to care for vulnerable people. The training matrix had gaps in mandatory training and conditions affecting older people. There needs to be a training plan developed that meets staff training needs identified from observations, staff supervision and appraisals. More staff need to be encouraged to undertake national vocational training. Staff need to be confident in management and be supervised effectively so that they feel able to tell them about any concerns they may have in the knowledge that they will be addressed. The way the home is monitored regarding the quality of the service it provides needs to improve. Audits are carried out but if these were effective the auditor would have picked up some of the issues and shortfalls that we found during the inspection. The manager needs to ensure that health and safety is promoted by ensuring staff follow policies and procedures and use moving and handling equipment 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 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 40 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 40 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. The assessments of needs completed prior to admission do not fully reflect peoples needs. This means that care could be overlooked. Evidence: We examined three care files in detail, one of which was for a person recently admitted to the home. We wanted to check the assessment processes and how the home made the decision that the persons needs could be met. There was evidence that the home obtained assessment of needs and care plans completed by the local authority when it funded the placement. The home completes in house assessment documentation as well, to be assured that needs have not changed. The one seen was completed the day after the person was admitted to the home. The same document is completed for people privately funding their care. Although the document had scope for staff to comment on all areas of need Care Homes for Older People Page 11 of 40 Evidence: the one seen had been filled in with only very basic information. For example under a section on breathing the staff had put, OK, when the person had actually been admitted from hospital after a two week stay for shortness of breath due to a diagnosis of chronic obstructive airways disease. The, what is health usually like section stated, 1 carer possibly 2 and usual sleep pattern was described as, likes sleeping. Other sections were not completed at all. To improve, the assessment needs to be comprehensive about peoples needs and what impact they have on their activities of daily living. This will help staff be able to plan for their care more thoroughly. The home should write to people following assessment to formally state that their needs can be met in the home. The home does not provide intermediate care services so standard 6 does not apply. Care Homes for Older People Page 12 of 40 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. Peoples health and personal care needs were not adequately planned for and met and dignity not consistently promoted. This means that staff would not have full information about how to care for people and care will be missed. People did not consistently receive the medicines they had been prescribed by their doctor. This means that their health and welfare will be affected. Evidence: We examined three care plans in detail but also looked at other information such as risk assessments, monitoring charts, health input and medication records. Each resident had a care plan but they were basic and lacked details about their full needs and how these were to be met. For example, the care plans used general terms like, carers to offer assistance with personal care at all times and carers to assist to the toilet at regular intervals. This was not specific about what assistance was actually required, what the person was able to do for themselves, what preferences they had about their care needs and what, regular actually meant. The same person had needs Care Homes for Older People Page 13 of 40 Evidence: associated with nutritional intake and the care plan stated, carers to be aware that dietary supplements have been prescribed. The care plan did not detail what these were, when the person was to have them and whether they were to be provided only if the person declined to eat all their meals. Similarly another residents care plan for, continence, reminded staff the person was doubly incontinent and stated, correct incontinence aids to be used but did not state what these were. The care plans did not always reflect the persons actual needs. For example, one care plan for tissue viability states, at present they have no problems with pressure areas and skin is intact. However, the persons assessment on admission states that there were some red areas but the skin was intact. The risk assessment states there is a risk of tissue damage and the persons nutritional intake is being supplemented. The care plan need to be thorough regarding how staff are to ensure prevention of tissue damage. The care plans were not signed by the resident or their representative to evidence they had contributed to them and agreed to the contents. One care plan examined was completed eighteen days after admission. Care staff need information about the tasks they need to complete to meet peoples needs in a much more timely way. There was some evidence that care plans were updated when needs changed but this was not evident in some of the plans examined. For example the daily recording for one resident was clear about changes in health needs but the information had not been forwarded to the care plan. Risk assessments were completed for skin condition, falls, moving and handling, mobilising in a wheelchair and the use of bed rails. We also saw individual risk assessments for issues such as smoking and behaviours that could be challenging to others. The risk assessments did not always fully link to care plans and were not consistently kept under review. For example, one risk assessment told staff that a specific resident liked to smoke but this had to be supervised and staff needed to cover the persons knees to protect from burning ash. The care plan did state the resident liked to smoke and this had to be supervised to prevent burns but the information was minimal. There was no plan about frequency of cigarettes, where the resident was able to smoke and whether the cigarettes and lighter were held by staff. One resident did not have a nutritional risk assessment yet they were on dietary supplements and had a low weight. Staff had weighed the person though and there was evidence of a small increase in weight since admission. There were gaps in daily recording noticed in some of the care files. One resident admitted for respite care had a full days recording of care missing from the file and Care Homes for Older People Page 14 of 40 Evidence: another care file had several days missing that related to an accident they had when they spilled a cup of tea over themselves. We were not confident that staff were proactive in obtaining medical attention quickly for people. For example, one resident suffered a burn from a hot cup of tea at lunchtime, and although a cold compress was applied, they did not receive any attention from health professionals until 8pm. This is currently being investigated by the safeguarding team. There were also two other incidents noted from examination of daily recordings where health professional advice should have been sought but the GP had not been contacted. We had a discussion with a health professional during the visit and they expressed concerns that one residents diet was not not being monitored as robustly as it should be and this was affecting their diabetes. We checked the food monitoring chart and there were gaps in the recording. Health monitoring and prompt access to health professionals was discussed with the manager and provider to address. During the day we noted several residents had dirty fingernails. One resident in particular had a brown substance ingrained under the nail bed and in the cuticles, their teeth were dirty and their clothes had remnants of the meals served during the day. The person did not look as well cared for as they should be. Failure to monitor peoples hygiene needs could place them at risk of ill health and compromise their dignity. This issue may be one of consistency, as two relatives spoken with were happy with the care of their loved ones, she is always clean and well looked after. However, we observed one resident walking in a corridor and they had an incontinence pad sticking out of the front of their trousers. A staff member walked past and did not do anything to support the person. Staff members told us that time constraints put pressure on the number of baths they would like to carry out and that residents were sometimes rushed when it came to personal care. Residents spoken with were generally happy with the care they received. One person spoken with told us that staff helped him to have a wet shave, but theyve missed a few bits today and another stated, you can have a bath when you want. One resident also told us that staff knocked on the door before entering their bedroom. One resident was unshaven on the day of the visit and their fingernails were long. They were not positive about the home and food but said the staff were, pretty good. Another resident told us that staff didnt support them to clean their teeth. We examined how medication was managed in the home. We looked at medication Care Homes for Older People Page 15 of 40 Evidence: administration records and checked storage and recording. The home used a monitored dosage system (MDS) provided by a local pharmacy. When medication was provided in the MDS, the amounts of medication was signed into the home correctly. However, when medication arrived mid-cycle and outside of the MDS, it was not always signed into the home, did not have a witness signature and the full instructions were not always handwritten onto the medication administration record (MAR). This means that staff would not have clear and accurate instructions. There were also times when medication was stopped or the dosage changed but this was not signed and dated. There was evidence that people did not consistently receive the medication they were prescribed for by their doctor. There were various reasons for this. For example the MAR for one resident told us they did not receive important medication for their epilepsy for at least eleven days. There were also instances when people were asleep at the time of the medication round so they missed their medication. There was no evidence that staff returned later when they had woken. There were gaps noted on the MAR charts but no codes to explain the reason why. Some residents declined to take their medication but there was no evidence that the GP had been contacted and informed. One person was prescribed pain-relief medication six hourly when required but the record indicated they were only asked if they required it once a day. Failure to ensure that people received their medicines as intended by their doctor means that their health and welfare could be compromised. There were recording errors in the controlled drugs book. Staff had not correctly put the name of the controlled drug on the page header but had just written, patch instead. The descending amount of Oromorph liquid had not been recorded after each administration and the book stated a resident had a number of Temazepam tablets in stock but the resident no longer lived in the home. These were mentioned to the manager to seek advice from the local pharmacy and address. Care Homes for Older People Page 16 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Minimal activities were provided to people especially those with dementia care needs. This could mean that people will be bored and their quality of life affected. The meals prepared were well presented but choice could be expanded by preparing an alternative to the main meal of the day. Evidence: There was some evidence of social stimulation but this was minimal for some residents. The dementia care unit looked quite sparse and although staff had made some effort and displayed a few pictures, the environment as a whole lacked a homely touch. People spoken with told us they enjoyed sing-a-longs, watching television and played games. Staff said some residents participated in painting, sing-songs, 1-1 chats and watched television or listened to the radio. They told us that residents in the dementia care unit participated in crafts and bubble games. An entertainer visited the home every two weeks to play the organ and, motivation visited monthly. This involved an entertainer providing games and sing-songs. Care Homes for Older People Page 17 of 40 Evidence: We looked at activity records for the previous two months. There were four arranged activities in October, a church service for 13 residents, a music afternoon for 13 residents, a quiz for 6 residents, and games (dominoes and snakes and ladders) for 3 residents. Monthly Motivation also visited and 14 residents in the main unit and 6 in the dementia care unit participated. In November there were five activities organised. These included three in the dementia care unit, crafts, colouring and bubble therapy and two in the main unit, both of which were music afternoons. During the visit one of the inspectors completed a short observation of residents and staff in the dementia care unit for approximately one hour. There were between three and six residents observed and two staff were on duty. People wandered around the unit but they were unable to exit, as doors were locked via a code system. Generally interaction was positive, although it was noted it was mainly one staff member that provided most of the conversations and explanations. There was one time when both staff members went into the bedroom area and the main lounge was left unattended. The television was on in the background, although people did not appear to be watching it. The small ratio of staff to residents meant that there was time for one to one chats and appropriate support at meal times. The activity plan on display in the main lounge broadly reflected what was on offer. To improve, staff could look at how they could include the residents in the running of the home and see if there are any light occupational activities they would like to participate in such as gardening, potting bulbs, baking, setting tables, making their sandwiches for tea, dusting their bedrooms and flower arranging. Staff could use 1-1 time to support residents to tidy their wardrobes and drawers. There did not appear to many outings or walks to local shops unless relatives escorted people. Relatives spoken with told us they were welcomed at any time and staff kept them informed of issues. There was evidence that people could make choices about aspects of their lives but this could be limited for some residents, especially those with dementia. The menus rotated on a three-weekly basis and the cook advised that for breakfast there was a choice of porridge, cereals, eggs or a, fry up. The main meal of the day was at lunch. The menu indicated one choice of meal but the cook advised there were alternatives should residents not like what was on offer. The difficulty with this is that people with dementia sometimes need visual cues to help them with decisions. To improve, two choices at lunchtime could be prepared after consultation with residents to determine how many of each were required, and people with dementia could be offer a visual choice. Care Homes for Older People Page 18 of 40 Evidence: Staff members served meals from a bain-marie, which enabled them to provide people with the right amount for their appetite. Comments about the meals were, she enjoys the food - its nicely presented, the food is good, the foods ok - its the same things every day and the food is alright. Care Homes for Older People Page 19 of 40 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. The home has not been able to fully protect residents from abuse, which has led to injuries and emotional upset. Evidence: The home had a complaints policy and procedure on display. There was a log maintained of complaints and records of action taken to try and resolve them. Staff spoken with were clear about what to do if people raised complaints with them. It is recommended that the complaints log details whether the complainant was satisfied with the outcome of any investigation. Some residents spoken with were not sure how to make a complaint and a relative spoken with was unsure about the formal procedure. To improve, the manager should ensure that all residents and relatives are made aware of the complaints process and how any complaints or concerns will be managed. The home had a copy of the multi-agency policy and procedure for safeguarding vulnerable adults from abuse. However, it was clear from examination of records that the policy and procedure has not been used. Incidents of poor practice and allegations of abuse have been dealt with internally instead of referral to the local authority for investigation. There is currently an ongoing police and local authority investigation into an allegation of abuse by two staff members. The staff have been suspended. Care Homes for Older People Page 20 of 40 Evidence: Staff have received training in how to safeguard vulnerable adults and the acting manager has completed more in-depth training. However, in light of the lack of action in following policies and procedures, staff at all levels may require refresher training. We examined records of incidents that had occurred between residents. These occurred during a specific time when one resident had behaviours that were challenging to others and resulted in people being assaulted. The incidents were numerous and neither the Care Quality Commission nor the local authority were informed. This is contrary to the policy and procedure for safeguarding adults from abuse. This was discussed with the manager and provider to address. Care Homes for Older People Page 21 of 40 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. There were areas of the home that were unsafe and in need of cleaning, redecoration and refurbishment. This will help to provide a pleasant and safe environment for residents and staff. Evidence: The home had a separate dementia care unit with placements for up to twelve residents. Communal areas in the unit consisted of a lounge, with space for a dining table, and a conservatory. There was laminate flooring throughout the lounge and conservatory, which was sticky in parts, and some of the chairs were dirty and stained. The television in the corner was on and had a poor signal/picture and the room lacked the stimulation required for people with dementia. The doors leading from the dementia care unit to the main home had coded locks. Staff told us that some residents had bedrooms on the unit but spent the day in the main part of the home. There were six residents sitting in the unit during the site visit. The main part of the home could accommodate up to twenty-five people. Communal areas here consisted of a lounge with two tables and chairs at one end, a conservatory attached to the lounge, and a dining room. Sections of the home were looking tired and in need of decoration and corridors had badly chipped paintwork in doorways. The manager advised that new carpets were due to be fitted soon. Care Homes for Older People Page 22 of 40 Evidence: Bedrooms were personalised to varying degrees dependent on the taste of the residents and we observed some nicely decorated and clean and tidy bedrooms. However, other bedrooms were cluttered and had very untidy wardrobes with clothes not hung up properly. One bedroom chair had the cushion missing and the bottom was torn and dirty and a shared room had a privacy curtain that wasnt secured properly. Two commodes required further cleaning and one of the bed rails had faeces on it. Two overhead lights required shades. Not all sections of the environment were poor but there was a general lack of care for the environment in some areas and a strong odour of urine in the entrance. The kitchen had the main room where food was prepared and an additional servery area. The servery was in need of decorating and cleaning and staff advised they did not have time to do this properly, as they worked from 8am to 2pm and concentrated on cooking the main meals, baking and seeing to the main kitchen. The main kitchen was dated and in need of modernisation. Some equipment such as the microwave and deep fat fryer were close approaching the need for replacement. The kitchen bin had no lid. Some items in the fridges were not covered or labeled with the date of preparation. The inspector observed uncooked meat left in the servery and advised staff to put it in the fridge. The staff toilet and one of the residents toilets had no soap for people to wash their hands. Communal bathrooms and some bedrooms had very hot water, noted at 55-57 degrees centigrade, which is very hot for people with fragile skin. This could cause scalds and was mentioned to the health and safety officer from the local authority. They visited and advice was given to manage the risks. Conversely it was recorded that a resident had been bathed in water which was 37 degrees, which is quite cool. Hot water in communal areas and bedrooms, unless risk assessed as requiring a higher temperature, needs to be close to 43 degrees for a safe and ambient temperature. It was clear that environmental checks need to take place regularly so the manager is able to pick up the kind of shortfalls we identified during the visit. The provider needs to produce a refurbishment and redecoration plan with timescales so that shortfalls can be addressed in a structured way. Care Homes for Older People Page 23 of 40 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. We could not be sure that staff had the skills, knowledge and experience to care for vulnerable people with a range of health care needs. This places peoples health, safety and welfare at risk. Evidence: During the morning there are three carers in the main part of the home and two carers in the evening. The dementia care unit had two carers all day and there are three carers at night covering both sections of the home. The manager is supernumerary and the home has separate catering and domestic staff. Care staff members spoken with told us they were very busy and did not always have time to sit and read care plans. We spoke to two relatives and both were happy with the care their loved one received. They described staff as polite and caring. Residents spoken with stated staff were, quite good, pleasant, pretty good, ok and alright. We spoke to a health professional on the day who expressed some concerns about staff management of a particular health need of one resident. It was arranged that the dietician would visit to provide information and training to staff. This visit took place during our inspection of the home. Care Homes for Older People Page 24 of 40 Evidence: According to information provided by the manager there were large gaps in staff training, such as moving and handling, fire safety, health and safety, basic food hygiene, infection control, safe handling of medicines and first aid. Four staff had completed a dementia care awareness course. There was no evidence on the training record of staff training in conditions affecting older people, such as strokes, diabetes, catheter care, Parkinsons disease, arthritis and sensory loss etc. We were unsure if the gaps in training was due to recording deficiencies or whether the training had just not taken place. The manager needs to audit staff files and have discussions with the staff team about their training needs and ensure this is planned for and carried out. Staff members spoken with stated they had received training in the past but this had been in a previous home. We received information from the manager during the writing of the report that approximately nine out of seventeen care staff were recorded as having a national vocational qualification in care at level 2 or 3. This figure may be higher when the information is fully collated. There have been incidents when staff have not acted in the best interests of residents, for example in obtaining medical attention and advice for people quickly. This is a training issue for the staff team. Two staff members were suspended by the provider when he was notified of allegations of abuse. The homes recruitment processes were generally sound although there were gaps in employment history for one person that required the reasons recording. Application forms were completed, two references obtained and criminal record bureau checks were in place for the records seen. Care Homes for Older People Page 25 of 40 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 has not been well managed, which has led to the safety, health and welfare of residents being compromised and staff not being fully supervised. Evidence: The home does not have a registered manager at present. The previous manager left several months ago and the home has been managed by the deputy manager and overseen by an area manager, Sue Tyler, who was the registered manager for the home up until 2007. The provider advised that Sue Tyler was now managing the home and he was recruiting for a permanent manager. The certificate of registration was not on display. This is a legal requirement and was discussed with the provider. Part of the certificate could not be located and a copy was forwarded from the companys head office. The manager was advised to ensure the certificate was on display and more suitably placed to avoid loss or diversion. The home has not been managed effectively and systems of care support, care Care Homes for Older People Page 26 of 40 Evidence: planning, risk management, recording of care, specific administration of medication, safeguarding alerting procedures, staff training and supervision, and environmental checks have all slipped. These areas need to be addressed quickly to ensure the safety, health and welfare of people living in the home. The area manager had delegated responsibility for completing visits in line with regulation 26 of the care homes regulations. These visits need to make sure that the home is being managed effectively and must include examination of records and discussions with people living in the home and staff working there. A report has to made of the visit. The area manager is now managing the home until a replacement manager is recruited and the provider needs to ensure the monthly visits are carried out either by himself or another responsible person. The reports must be forwarded to the Care Quality Commission for the next few months so we can audit progress. The home evidenced that residents were sent surveys to complete in 2009 about catering and their views on the home in general. There was no action plan to look at any shortfalls identified. The area manager stated that surveys to obtain the views of relatives were due to go out in December and staff surveys have been sent out but none were returned. We checked progress of quality monitoring against the plan produced by the previous manager but it was clear that the quality assurance plan of audits and surveys has not been adhered to this year. It is important to consult widely regarding the services provided to enable shortfalls to be identified and improvement to be made. There was some evidence of formal 1-1 staff supervision and examples of staff being observed in their practice. One staff file contained three 1-1 sessions in the last year, another had two observations of practice, one of which stated that a 1-1 session needs to be arranged with the manager due to identified training needs from the observation. Although a month had passed since the observation the management meeting had not been carried out. Care staff members should have access to more frequent 1-1 supervision sessions with their line manager to enable them to discuss practice issues and areas of concern. The records required for the running of the service were not all in place and up to date. This refers to initial assessments of need, care plans, risk assessments, daily recording, medication charts, monitoring records, staff supervision and training and environmental checks. It is important that appropriate records are maintained so we can check the home is operating safely and the residents receive the care that they need. Care Homes for Older People Page 27 of 40 Evidence: There were some issues of health and safety that were identified during the site visit. We noted that the hot water outlets in communal bathrooms and some bedrooms had hot water temperature between 55-57 degrees centigrade. This is unsafe for people with fragile skin and could lead to scalds. We also noted the home had four residents that required bed rails. Two of the rails were fitted to divan beds and one of these had become loose. We mentioned it to the manager on the day to address. The manager had put a bed rail check form above each bed to ensure that staff completed a visual check of bed rails at each use. The checklist was started on the 22nd November 2009 but had not been completed for the 23rd or the morning of the site visit, the 24th November. We contacted the local authority health and safety officer and he visited the home to complete an additional inspection. He gave advice and instructions regarding risk management and ensuring communal bathrooms were locked until thermostatic controls were in place. The health and safety officer is to complete a further visit to the home. We noted the home had an uncovered drain hole in a corridor near the kitchen. Staff had placed a wooded fruit crate over it. This area was accessible to residents and staff and was a safety risk. We spoke to the provider on the day and he ensured the hole was appropriately covered and secure during our visit. There were other health and safety issues that required attention. A radiator in the unit supporting people with dementia was unguarded. Staff were observed pushing a resident in a wheelchair without placing their feet on the footrests. We observed a resident in the dementia care unit being moved and handled in a hoist. They slipped through but fortunately landed in the wheelchair. We were unsure if the correct sling had been used or if it had been attached correctly. One of the shared bedrooms had a wheelchair blocking the access to the en-suite section of the room and a sewing machine had been placed on the floor, making its position a trip hazard. One of the empty bedrooms had double doors to the garden that were not secured properly. Staff told us that usually steradent tablets were held in the medication room if residents were unable to manage them safely, but we observed this was not consistent throughout the home. All these points were mentioned to the manager and provider to address. We did not assess residents finances during the day so these will be examined thoroughly at the next unannounced inspection. Care Homes for Older People Page 28 of 40 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 29 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Peoples needs must be 22/01/2010 assessed thoroughly prior to admission. This will ensure that staff have full information and can decide whether the persons needs can be met in the home. 2 7 15 Care plans must be 22/01/2010 produced in a timely manner and be updated when significant needs change. This will ensure that staff have information quickly about how to care for people. 3 7 15 People must have their 22/01/2010 assessed needs detailed in care plans with clear task for staff in how to meet them. This will help to ensure that care is not missed. Care Homes for Older People Page 30 of 40 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 4 8 13 Risk assessments must 22/01/2010 contain a full analysis of risk and the measures needed to reduce risk. This will help to ensure that staff are fully aware of any risk and what steps they need to take to minimise it and support people safely. 5 8 12 Prompt medical attention 22/01/2010 and advice must be obtained for issues affecting peoples health and welfare. This will ensure that people receive medical attention quickly and provide staff with information they need to care for people. We will be issuing a Statutory Requirement Notice for the breach of this regulation. 6 9 12 People must receive their medication as prescribed for them. This will help to ensure their health and welfare. We will be issuing a Statutory Requirement Notice for the breach of this regulation. 22/01/2010 Care Homes for Older People Page 31 of 40 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 7 9 12 Peoples medication must not be allowed to run out of stock. This will ensure that people receive the medication as prescribed for them. We will be issuing a Statutory Requirement Notice for the breach of this regulation. 22/01/2010 8 10 12 Residents must be supported to maintain personal grooming such as nail care, oral hygiene and general presentation. This will help to support people to maintain their health, their dignity and their previous standard of presentation. 22/01/2010 9 12 16 Residents must have their social and occupational needs assessed to help identify past and current interests and also help to identify current abilities. This will enable activities to be tailored to meet needs, especially of people with dementia or memory impairment. 22/01/2010 10 18 13 Staff at all levels must be aware of, and use, the 15/01/2010 Care Homes for Older People Page 32 of 40 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 multi-agency policy and procedure for safeguarding vulnerable adults from abuse. This will ensure that any allegations of abuse and poor practice will be reported to the correct agencies and investigated quickly and thoroughly. 11 19 23 A refurbishment and 22/01/2010 redecoration plan must be produced with timescales for completion. This will enable improvements to be monitored against the plans drawn up. 12 21 13 The shower room must be de-cluttered. This will ensure it can be used safely by people. 13 21 13 All toilets must be provided with hand washing facilities. This will help to prevent the spread of infection. 14 25 13 The temperature of the hot water outlets must be addressed to ensure it is at or near 43 degrees centigrade. This will help to ensure that 15/01/2010 22/01/2010 22/01/2010 Care Homes for Older People Page 33 of 40 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 scalds do not occur and people experience water at an ambient temperature for them. 15 26 12 The home and equipment used in it must be clean and tidy and free from offensive odours. This will help to improve the quality of life for people living there. 16 30 18 The staff team must be 22/01/2010 provided with training in order to gain the right skills, knowledge and experience to care for vulnerable people with a range of needs. Included in this is mandatory and service specific training. This will give staff confidence in how to care for people and help to ensure that care is not missed. Staff files to be audited and a training plan produced by the timescale for action date. 17 31 12 The home must be managed 22/01/2010 in a safe and effective way. This will ensure that residents are protected from harm, their needs are met 15/01/2010 Care Homes for Older People Page 34 of 40 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 and their wellbeing promoted. 18 33 26 The provider or delegated 22/01/2010 person must complete visits to the home in line with regulation 26 of the care homes regulations and, until further notice, forward reports of these visits to the Care Quality Commission. This role had been delegated to the area manager but they are now managing the home. This will enable us to be sure the provider is satisfied the home is being managed safely and appropriately. 19 37 17 Records required for the effective running of the home must be in place and up to date. This will enable agencies to monitor how the home is managed and be sure that residents needs are being met. This refers to initial assessments of need, care plans, risk assessments, daily recording, medication charts, monitoring records, staff supervision and 22/01/2010 Care Homes for Older People Page 35 of 40 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 training and environmental checks. 20 38 13 The health and safety issues 22/01/2010 highlighted in the report must be addressed. These include hot water outlets, safe use of wheelchairs and hoists, an unguarded radiator, the safe keeping of steradent tablets and general staff training in mandatory areas. This will ensure that people living in the home are safe and any risks minimised. It is recognised that staff training will need to be planned and this is covered in another requirement. 21 38 37 All incidents affecting the 22/01/2010 welfare of residents must be reported to the Care Quality Commission. This will enable us to monitor that the home is managing the incidents appropriately. We will be issuing a Statutory Requirement Notice for the breach of this regulation. Care Homes for Older People Page 36 of 40 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 3 Following assessment of their needs, people should receive formal, written confirmation that their needs can be met in the home. Care plans should contain preferences and wishes about how people would like their care to be carried out. Care plans should be signed by the resident or their representative to evidence they have seen them and agree the contents. Monitoring charts, obviously put in place for a reason should be completed thoroughly. This will help to provide important information to staff and visiting professionals involved in their care. The controlled drugs book needs to be corrected to accurately reflect the medication in stock. Advice should be sought from the local pharmacist about this retrospective action. Changes to medcation times or dosage should include a witness signature and be followed up with written confirmation from the prescriber. Handwritten information on MAR charts should have the full instructions and have a witness signature. Staff should receive further training in how to maintain privacy and dignity. A weekly or monthly at a glance log would alert staff to those residents that had not participated in anything so this could be addressed. Residents should have more choice regarding the activities and occupations that they are able to participate in. This will help them to remain mentally active. There should be two choices available at the main meal of the day. This will enhance the range of meals available and provide people with more choice. In light of some comments from residents and a relative, the manager should remind people about the complaints procedure. This will ensure important issues will be raised and addressed quickly. In light of the lack of knowledge around the reporting of safeguarding incidents the manager should re-take the Page 37 of 40 2 3 7 7 4 8 5 9 6 9 7 8 9 9 10 12 10 14 11 15 12 16 13 18 Care Homes for Older People 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 training facilitated by the local authority specifically for the managers role in referral and investigation. 14 15 20 24 The lounge in the dementia care unit should be made a more homely and stimulating environment for people. Residents clothes should be hung up neatly in wardrobes and if there are too many clothes, this should be discussed with residents or their relatives and alternative arrangements made. This will help to ensure people maintain their previous smart appearance and promote their dignity. The manager should complete environmental checks to monitor cleanliness so that shortfalls can be addressed quickly. In light of observations regarding personal care and staff comments about time constraints, the amount of staff on duty needs to be evaluated and reviewed. It is recognised that a reduction in the numbers of residents has affected staffing levels but this needs to be checked out to ensure it is proportionate. The home should work towards 50 percent of care staff trained to NVQ level 2 and 3. The appointed manager should apply for registration with the Commission quickly to add stability to the home. It is recommended the home obtains the views of professional visitors as part of quality monitoring. This will enable a wider view of how the home is managed. In view of the limited response from the staff team, management should consider alternative means of obtaining their views about the way the home is managed. Action plans should be produced to address any shortfalls highlighted in surveys and audits, and in view of the number of issues found during the visit, the audits need to be completed more thoroughly. Care staff members should have a minimum of six formal, and documented supervision sessions per year. This will enable managers to monitor practice and provide staff with the opportunity to discuss issues of concern. The system of bedrail checks should be carried out consistently. This will prompt staff to check they are safe Page 38 of 40 16 26 17 27 18 19 20 28 31 33 21 33 22 33 23 36 24 38 Care Homes for Older People 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 and in good working order. Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 40 of 40 - 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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