Inspection on 02/04/09 for Sycamore Rise Residential Care Home

This inspection was carried out on 2nd April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Rise Residential Care... 07/09/09

Sycamore Rise Residential Care... 15/06/09

Sycamore Rise Residential Care... 17/04/08

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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: Sycamore Rise Residential Care Home Hill Lane Colne Lancashire BB8 7EF     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: Christopher Bond     Date: 0 2 0 4 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 37 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Sycamore Rise Residential Care Home Hill Lane Colne Lancashire BB8 7EF 01282864209 01282870897 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Crystal Care Homes Ltd Name of registered manager (if applicable) Mrs Linda Morrison Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP. Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 23 Date of last inspection Brief description of the care home Sycamore Rise is a care home that accommodates 23 residents including people who have dementia. The bedrooms are mainly single rooms and most of them have ensuite facilities. There are two shared double rooms. There are two lounges, one that Care Homes for Older People Page 4 of 37 care home 23 Over 65 0 0 23 23 23 0 Brief description of the care home doubles up as a dining area. There is a lift available that serves all floors. The home is situated in a rural setting on the outskirts of Colne, Lancashire. There are good views of the surrounding countryside and some of the rooms overlook the hills around the home. There are no services in the immediate vicinity of the home. There are, however, shops and other services in the local town. Bus services into the town are limited and the home does not have its own transport at present. Information relating to the homes Service User Guide and Statement of Purpose is included in the welcome pack, which is given to all prospective residents. This information explains the care service that is offered, who the owner and staff are, and what the resident can expect if he or she decides to live at the home. At the time of this visit the information given to the Commission showed that the fees for care at the home are from GBP366.00 to GBP 413.00 per week, with added expenses for hairdressing and chiropody. Care Homes for Older People Page 5 of 37 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: As part of the inspection process an unannounced visit took place over a total of 7 hours on the 2nd April 2009. The residents personal files and care plans were examined. Care staff records and recruitment records were also looked at. A Care Quality Commission Pharmacist also looked at the medication processes, policies and procedures at the home and the results of this have been included in this report. We spoke at length to the manager of the service during our visit. We also spoke to three care staff, and the cook. People who used the service were also spoken to as part of the inspection process. We also spoke to three visitors to the home to find out their Care Homes for Older People Page 6 of 37 views of the service and how their relative was being cared for. The Commission for Social Care Inspection also sent out surveys to the care staff of this home to tell us about their experiences of working at Sycamore Rise Care Home. We received information about the home from the local authority social services who have placed people at this home. A social worker who was visiting the home at the time also spoke to us about the service whilst we were there. As part of the inspection process the manager of the home was asked to complete an annual quality assurance assessment about how she felt the service was progressing and what changes had been made since our last visit to the home. The results of this have been assessed and aspects of this document have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: Although everyone had a care plan, some of the information within these was incomplete. More care needs to be taken by the manager and care staff when completing these and current information must be readily available. Care plans are there to tell the carers what current health and social care the people who use the service are receiving, they need to be regularly reviewed and updated with important information which is clear, precise and consistent. Important areas of care planning had been ignored and important records, such as risk assessments and weight charts, had not been completed for most of the residents for a long period of time. We also found that there was very little information within each care plan regarding issues of pressure area care, continence management and the management and risk assessment of falls. The District Nurse visited the home regularly to attend to pressure sores; the information that she passed on regarding each person was not recorded by the staff within the care plan. Good information regarding this area of care must be readily available to all those who have the responsibility of caring for the people who use this service. There have been some concerns at this home about people not being cared for properly. Residents have been left with long finger nails and poorly dressed. We noticed that one of the residents needed changing whilst we were there, leaving a wet Care Homes for Older People Page 8 of 37 patch on one of the outside benches. It is important that basic care tasks are regularly carried out by the carers and that people are treated with dignity and respect. The Care Quality Commission Pharmacist looked at the medication records of the service. It was found that the storage and administration of important medication was poor. it was also found that the care staff were not following the policies and procedures that were set down by the service. This put the people who use the service at risk. Although there were social activities for the residents going on during our visit, we found that there wasnt a planned programme of activities. It seemed to be left to the care staff to decide whether activities took place. A diary was available to show when people had taken part in social activities: the entries in this were infrequent. This was a home that cared for people who had dementia; no special activities took place in this service for those who needed extra stimulation because of this condition. We spoke to visitors to the home during the inspection. We were told that their relative had left the premises without the knowledge of the care staff and was missing for a period of time. They were not informed of this until some time later. It is important that relatives are kept informed at all times of incidents that may affect the residents well-being. The main lounge of the home did not smell very nice when we were there. This has been a problem at this home for some time and has not yet been properly addressed. The manager must ensure that people live in nice surroundings that do not have offensive smells. Some of the furniture, in particular the beds, was old and in need of replacement. Its important that the people who use the service live in a clean home with nice things around them. Staff records showed that the new staff at the home had not had a period of recorded induction where they are shown the basic requirements and practices of working in a care setting, and instructed how to use equipment. The manager told us that this happened informally but there were no records to show this. Fire drills had not taken place at this home for some time. There were no records to show that this important area of safety was being addressed. There had, however, been instruction for some of the care staff in fire safety. We also found that some of the prescribed medication that was kept by the home was not being stored and administered properly, which put the people who used the service at risk. The manager must make sure that the care staff are managed properly and that there are always enough care staff available to ensure that people are safe, and not left to their own devices. We have been told from several sources that staff go on breaks together leaving minimal cover. Incidents have occurred because of this and residents have been put at risk. A serious incident took place a this home recently; this remains under investigation by Care Homes for Older People Page 9 of 37 Commission and other agencies. 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.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 10 of 37 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 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current information is available to help people make a decision as to whether their needs can be met by the service. Health and social needs are assessed properly by the manager so that she can decide whether the service has the skills and facilities to provide a good standard of care. Evidence: We found that this home had information that was given to prospective residents and their families or carers about what services the home provides. There were two documents that were available, the Service User Guide and the Statement of Purpose. These contained information about the accommodation, the managers and staff, and other important information, such as the vision and values of the service, and the complaints procedure. This information had recently been reviewed, and contained the name of the current manager and the fees that the home charges for providing care. There was also information about what services the home does not provide, and those Care Homes for Older People Page 12 of 37 Evidence: that have an extra charge, such as the supply of toiletries and hairdressing. We also looked at the information that had been gathered by the manager about each resident before they were admitted to the home. These were called pre -admission assessments. This information included the health and social needs of the person and helped the manager to make a decision as to whether or not the service could provide sufficient care to meet their needs and aspirations. This information was then transferred to a plan of care that guided the care staff in addressing these needs. We spoke to two residents and three visitors to the home. It was confirmed that the manager had visited to acquire this information. We were also told that each prospective resident is invited to look round the facilities available at Sycamore Rise prior to making a final decision as to whether the home was right for them and could meet their, and their families, needs. This service does not provide intermediate care. This standard has not been assessed. Care Homes for Older People Page 13 of 37 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 planning at this home was inconsistent. The information available about the care needs of some of the people who use the service was incomplete, which could cause confusion about their care. Evidence: Everyone who lived at this home had a care plan that informed the care staff as to their social and health needs and aspirations. There was some instruction as to meeting these needs, and an plan of care had been outlined for the care team to address. We found, however, that there were clear inconsistencies regarding what the care plan said should be done and what the care staff were actually doing. For example, most of the care plans had instructions to say that the residents must be weighed regularly to ensure that important nutritional issues werent missed. People losing, or gaining weight is also a good indication of their general health and monitoring this is very important. We found that most of the care plans did not contain a weight chart. We Care Homes for Older People Page 14 of 37 Evidence: also saw that where there had been an effort made to record someones weight, this wasnt being done regularly enough. We also found that some of the residents were prone to falling. There seemed to be no assessment of why this was happening. The care plan stated that a falls risk assessment should be completed on a monthly basis to monitor falls and to try and prevent falls. Although there was a risk assessment tool on most of the residents care plans, these were not being filled in properly. One resident, whos care plan clearly stated that they were at risk of falling, hadnt had this risk assessment filled in for five months. There didnt seem to be a clear indication of how this information was being used to help prevent falls within the home. Some of the residents had, at some time, developed pressure sores. The care plans did not tell us what was being done about this. The district nurse team had been visiting the home to help address this but there was very little information within the care plans to show how the care staff were dealing with pressure area care, or whether peoples skin condition was improving or deteriorating. The care staff that we spoke to were unclear about what they should be doing. One of the care staff told us that there were turning charts in peoples bedrooms but we did not see any when we walked round the home. Some residents had special pressure relieving mattresses. These looked quite old, as did some of the pads that were being used on the chairs in the lounge. The pressure relieving equipment must be assessed regarding its suitability and replaced where necessary to help ensure that this is fit for purpose. It seemed that pressure area care was being left to the District Nurse team and that there was little involvement in this area of care by the staff at the home. Little, or no information was available within the care plans. We would also expect that each persons care be reviewed properly and professionally on a regular basis. A review sheet was evident in most of the plans. Apart from dates being entered there was no information to tell us how most of the people who lived at this home were progressing. There were no outcome statements about how the residents were or what their current state of health was. Good, regular reviews help to show that peoples care is consistent and can be used to measure progress or record health issues. The review process at this home was poor. Some of the residents who lived at Sycamore Rise had incontinence issues. It was clear that the continence of the residents was not being addressed properly. There was a smell of urine in the main lounge. Visitors that we spoke to said that this had been the case for some time. We have also been given information by the local social work department to say that a complaint was made to the home by a relative about Care Homes for Older People Page 15 of 37 Evidence: continence issues and the smell in the lounge. Some of the relatives that we spoke to told us that incontinence pads were left on their relative for a long time and were not being changed regularly. Whilst we were there we noticed that a person using the service had left a wet patch on the wooden bench in the garden of the home. Poor continence management has a direct affect on peoples dignity and can be a cause of tissue breakdown. We spoke to the manager about this and she agreed that improvements must be made regarding continence care. The visitors that we spoke to also said that their relative had gone missing from the home for a period of time a few weeks earlier and no-one had informed the family of this. There were also concerns about personal care issues: finger nails left to grow too long, people wearing the same clothes for days, and poor medication practices. We observed some of the care staff whilst they were working. Everyone was polite and respectful to the residents, and spent time talking with them. The residents we spoke to were happy with the care they were receiving, although one person told us that care was sometimes rushed, and the staff always seemed very busy. This was a home that was registered to care for people who had dementia. There was evidence that some training had taken place to improve the awareness of this condition among the staff at the home. We sent out surveys to the care staff who worked at Sycamore Rise. Of the six surveys that we received back, five care staff told us that they were concerned about the way that information about the people who used service was passed on. Good communication is vital when peoples health and social needs are being addressed. The care plans told us that this was not being done properly. One visitor told us that there was very often confusion when she asked about her relatives care, and care staff usually didnt know. We were told that things had improved recently because a new member of staff had joined the care team. The relative told us that getting current and consistent information was like banging your head against a brick wall, and very frustrating. We looked at the arrangements for managing peoples medicines and found some weaknesses that need to be addressed to help ensure people are best protected. Staff handling medicines had completed medication training and the homes medicines policies were available for reference. But, these policies and current guidance were not always followed in practice. For example, on arrival at the home most people had taken their breakfast medicines but the medicines records were not referred to or completed at the time of administration. Instead, the medicine records were completed all together at the end of the medicines round. This unnecessary reliance on Care Homes for Older People Page 16 of 37 Evidence: memory increases the risk of making mistakes. Most medicines were supplied in a monitored dosage system, and this was used correctly. But, we found it was not possible to track (account for) the safe handling of medicines in boxes or bottles. It was of concern that on checking, one persons inhaler was empty, and no further supplies were available at the home. Care needs to be taken to ensure sufficient stocks of medicines are kept at the home, without overstocking. We looked at medicines record keeping and found some areas that need to be addressed to help improve the clarity of these records: Where doses were not administered, the reason was not always recorded. This is important as advice should be sought from the doctor where medicines are regularly not taken as prescribed. We saw that medicines were quickly obtained when new prescriptions were left at the home, but we found it difficult to track verbal dose changes and staff did not seek written confirmation of these. Written confirmation is important in ensuring dose changes are accurately made. Where medicines were prescribed when required there was some individual guidance about when these medicines may be needed but this had not been completed for everyone. Similarly, there was a lack of information about the use of prescribed creams. It was of concern that one persons medicines administration record showed they were self-administering their inhalers, but on speaking with that person they said they no longer needed inhalers, and didnt have any. The home needs to have an accurate and up-to-date list of prescribed medicines for people living at the home to ensure any visiting healthcare professionals are aware of what medicines are being taken. We found that generally medicines were safely locked away, but it was of concern that a new box of a Controlled Drug had gone missing. By law, these medicines need to be stored in a Controlled Drugs cupboard. The tablets were found during the visit, but the person they were prescribed for had missed doses on three days, because none could be found. On one occasion, records showed that this had resulted in them being unable to sleep properly. The supplying pharmacist had recently carried out an advisory visit to the home but regular in-house audits of medicines handling were not carried out. Regular audits are recommended to help ensure that any shortfalls are quickly identified and addressed. Care Homes for Older People Page 17 of 37 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. Activities for the residents are infrequent, unplanned and unprepared, meaning that the residents receive insufficient stimulation. Evidence: During our visit several of the residents were playing Bingo in the main lounge. We did not see a list of planned activities for that week and the service did not have a dedicated member of the staff team to organise daily activities for the residents. We did look at a record book that documented when activities had taken place. This showed that although some activities were taking place for the residents, these were ad-hoc and not built in to the daily routines of the home. No special activities were being organised for the residents who had dementia. Two people who lived at the home told us that there were sometimes things to do as a group within the home but this didnt happen very often. Activities are important, and help to keep people active and alert. We spoke to some of the people that were visiting the home at the time of the inspection. They told us that they were always made welcome and were encouraged to Care Homes for Older People Page 18 of 37 Evidence: visit. Two visitors told us that they occasionally saw activities taking place but felt that the residents did not get enough stimulation. The manager had organised a live entertainer for Mothers Day but we were told that such entertainment was infrequent at the home. There was some evidence that peoples interests, hobbies and preferences were written down in the care plans. There was also some information about what the residents lives were like prior to coming to live within the service. It is important that the people who use the service have a detailed social history and lies and dislikes are written down in detail. Individual and group activity, and stimulation, can be organised with this information in mind. Lunch was served during our visit. The food looked nutritious and was well presented. The manager and the cook told us that menus were changed to suit the likes and dislikes of the residents. There was a choice available on the days menu. One of the residents that we spoke to described the food as grand. Three of the residents told us that the food was usually very nice and that they were pleased with the catering arrangements at the home. Care Homes for Older People Page 19 of 37 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 residents safety is being compromised by insufficient staffing levels and poorly managed care staff. Evidence: We found that this service had a complaints procedure. This was written down in the information that the people were given about the home before they moved in. There was also a copy of this procedure on the wall in the hallway of the home. The complaints procedure informs the residents and their Representatives of how to voice their concerns about the service that is being provided. There had been three complaints about this home since our last visit. These complaints were either made through the local authority or via the Commission for Social Care Inspection. We found that these complaints had been taken seriously by the manager and dealt with properly. The manager of the home is also responsible for ensuring that the people who use the service are safeguarded from harm. There was evidence that some of the care staff had received training regarding protecting vulnerable adults from whilst being cared for at this home. Since our last key inspection there has been two safeguarding incidents at this home where the local authority have investigated an incident regarding the safety of a person who uses this service. Care Homes for Older People Page 20 of 37 Evidence: There have been issues raised regarding how people are cared for at this home. Visitors that we spoke to on the day of the inspection said that it was sometimes hard to find care staff, and that some of the staff have been known to go on cigarette breaks together, leaving residents to their own devices. Concerns about this matter have also been raised by the local authority. Surveys that received back from care staff said that there were staffing issues at the home and that there were only sometimes enough staff to meet the individual needs of the people who use the service. Insufficient staffing levels and poorly managed staff mean that residents are not always cared for properly, and they are not always being supported properly. This affects their safety, particularly when addressing the needs of people who have complex needs, such as dementia. Recent events at this service outline that the residents must be supported properly, and supervised at all times to ensure that their well-being is not compromised. As previously mentioned, a resident recently went missing from the home for a period of time. The relatives were not informed of this and the proper procedure was not implemented. This affects the safety and security of all residents and must be addressed. Relatives must be informed of any incident. The Care Quality Commission must also be informed of such incidents. Care Homes for Older People Page 21 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home had a pleasant outlook and good outdoor facilities. Parts of the home did not smell fresh. Areas of the home were in need of decoration to help ensure that people lived in a pleasant environment. Evidence: This service was set in a picturesque location just outside Colne, Lancashire. There were nice views of the surrounding countryside and hills from most of the rooms at this home. The garden area was quite well kept and there were seats available for the residents to sit out in good weather. It was nice weather during our visit and some of the residents were outside enjoying the views and the sunshine. We also looked at the facilities that were available inside the home. The bedrooms were quite spacious and most of them were quite nicely decorated. Some of the bedrooms had quite large windows that let in a lot of natural light. There were also rooms at the side of the house that were a little dark. Most of the bedrooms that we saw had personal possessions that helped make them more homely, such as pictures, photographs, ornaments and books. Some of the residents had brought their own furniture with them. We spoke to three of the residents who told us that their rooms suited their needs and were pleasant. One resident described her room as very nice. Care Homes for Older People Page 22 of 37 Evidence: We found that some of the bedroom furniture was old and didnt match. It was clear that some of this furniture was in need of replacement. The manager told us that replacing this was on the business plan for the service and that this would happen over the coming months. She told us that the owner of the home also intended to replace and renew many of the beds, as they were clearly very old and in poor condition. Similarly, some of the furniture in the communal areas was old and damaged. Chairs needed replacing and the lounges needed brightening up. A new dining table and chairs had been purchased since our last visit to the home. The communal corridors around the home were also of concern. They were poorly decorated and the carpets were dirty. The dining room was in need of re-decoration. This had been done shortly before our last inspection, but the workmanship was poor, with badly painted skirting boards. We also found that there were areas of the home that did not smell very nice, in particular the main lounge. We also found this to be the case during our last visit. There are clear issues around continence management and cleaning regimes that need to be addressed by the manager of the home. We discussed this with her whilst we were there and she agreed that there is a need for improvement. The dignity of the residents needs to be respected. People also need to live in pleasant, clean surroundings that are free from unpleasant odours. There were sufficient bathrooms around the home, and some of the bedrooms had ensuite facilities. There were also aids around the home to help people whose mobility wasnt too good. The water pressure had improved since our last visit to this home. Improvements had also been made to the boiler system and hot water was coming through much quicker in the bedrooms. Care Homes for Older People Page 23 of 37 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. Recruitment and training of care staff have improved at this home. Most of the care staff had been given instructionas to how to do their jobs adequately. Care staff numbers and their deployment need to be addressed because people are not being cared for and supervised adequately. Evidence: We looked at the rotas for this service. There was evidence to show that recent staffing levels were good. There were also enough staff on duty whilst we were there to help ensure that peoples assessed needs were being met, and they were cared for properly. because of the evidence that we found during our visit, however, this does not seem to be a consistent picture of what actually happens at this home. We spoke to the care staff whilst were there and it was generally thought that there were enough around to ensure that people were being looked after. We also sent out surveys to the care staff who worked at the home. Most of the surveys that we received back, however, told us that there were only sometimes enough care staff on duty to meet the individual needs of all of the people who used the service. The residents whom we spoke to said that they felt they were being looked after properly but staff were sometimes rushed and didnt have a lot of time to spend with residents individually. One resident commented, Its sometimes hard to get their attention. Care Homes for Older People Page 24 of 37 Evidence: We also spoke to some visitors to the service who were there to see their relatives. It was generally thought that staffing levels werent sufficient to enable everyone to receive a good level of care. It was thought that the care was rushed, and some of the residents who were incontinent were not being changed as regularly as they should be, or assisted to use the toilet frequently enough. Staff management was also criticised, particularly when it came to staff having their breaks. There was a strong feeling that too many staff were allowed to go for breaks at the same time, and that the residents were often left unsupervised. A social worker who was visiting the home whilst we were there agreed with this. She said that important areas of care were being missed because the care staff were not available to provide this at key times. There had been a recent serious incident at this home which is still being investigated by the Commission and other agencies. As a consequence of this incident, questions have been raised regarding the levels of supervision that the people who use the service experience. There have been further issues raised regarding how effectively the incident was managed. We found evidence that care staff did not complete important care records properly and in enough detail. Important information was missing from care plans. Whether this was because the care staff did not have enough time to complete things properly remains open to question. Each of the care staff had a file that contained information about them and held their training and development records. We looked at all of these files and found that there was enough information available, and that the care staff had been properly checked prior to commencing work. This helped to ensure that the residents were protected from unsuitable staff. Unfortunately there were few records to tell us how new care staff were inducted into the service. The manager said that she had been told that she didnt have to give new carers a full induction regarding how the home ran and how information was recorded. There were no records to show that the care staff had been shown how to use equipment. Clear and precise induction records are important. Two of the care staff said that they had been given some information by the manager when they started, but not in great detail. These records also told us that there had been training provided for the care staff since our last visit to the service. Some of the staff had received training in Dementia Care Homes for Older People Page 25 of 37 Evidence: Awareness. There had also been instruction for the care staff with regard to protecting vulnerable adults. Over 50 of the care staff now had a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). Mandatory safety training had also been provided for the care staff and manager. Care Homes for Older People Page 26 of 37 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 residents safety and health care requirements are being compromised by poor management. The service is not being managed appropriately. Evidence: A new manager had been registered to run this home since our last inspection. She has a nationally recognised qualification in care (National Vocational Qualification level 4), and is currently in the process of achieving a managerial qualification. There had been a few changes in the management team, including a new senior carer. We found that there were some aspects of the managers performance that were good. A programme of maintenance of the building was being carried through and some positive changes had been made. The staff team were being supervised regularly and staffing records were being kept well. There were other areas that were not being addressed properly. The manager had not Care Homes for Older People Page 27 of 37 Evidence: ensured that the planning of the residents care was being done properly and reviewed regularly. There were also matters of inadequate staff support for the people who used this service. Important information had not been completed: falls risk assessment had not been properly updated. The odour in the lounge area has been a long standing problem which demonstrates that continence management has not been properly addressed and cleaning regimes need to improve to bhelp eliminate the odours that this has created. The manager of the service must recognise her responsibilities in dealing with these issues. This has led to poor outcomes for the people who use this service. A serious incident had taken place at this home recently and this remains under investigation by the Commission, the local authority and other agencies. Questions have been raised regarding the management of this incident and the instruction of staff. We spoke to the manager about this incident during our visit to the home, and the actions that she should have taken to ensure that the residents and care staff were supported properly. The managers office was situated in the basement of the building, away from the main part of the home. The owner of the home should consider moving this to an area of the home where the care practice can be observed and monitored to ensure that people are being cared for properly and professionally. Some mandatory safety training had taken place since out last visit to the service. Most of the care staff had received instruction in ensuring that people are moved around the home safely. There had also been some first -aid training and most of the care staff had received instructions regarding fire safety. The manager, however, told us that regular fire evacuation practice did not take place. There had also been no instruction for the care staff regarding infection control. Some of the residents had small amounts of money that were being kept by the service. This was being safeguarded and monitored properly by the manager. As part of the inspection process the manager of the home is required to complete an Annual Quality Assurance Assessment to inform the regulating body of the changes that have occurred within the service and what plans have been made to ensure that the service adapts to changes over the coming year. Although this was returned to the commission within the given timescale, the content of this assessment was brief. This Care Homes for Older People Page 28 of 37 Evidence: did not tell us enough about the service and the amount of information that it contained was insufficient. The manager told us that the owner of the home visited the service on a regular basis and fulfilled his obligation as a provider by completing regular reports about his findings. This calls into question as to why inadequacies in the care planning of the people who use the service were not identified. The enviromental issues, such as the bad smell in the lounge and the poor state of the decor in some of the communal areas should have been picked up and dealt with properly by the provider. Care Homes for Older People Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 39 (h) The owner of the home must 31/12/2008 continue with the renewal and refurbishment of the home to improve the environment for the people who live there. The residents should live in nice surroundings with nice things around them. This adds to their well-being. 2 26 12 (1) (a) The manager must ensure that the home smells fresh and that unpleasant odours are eliminated. This is to help ensure that people live in pleasant surroundings. 30/06/2008 Care Homes for Older People Page 30 of 37 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 The care plan of each resident must be reviewed properly at least once a month. This is to help ensure that current health and social needs are being addressed correctly, and recorded as such in sufficient detail 29/05/2009 2 7 15 Care staff providing day to day care must have good, current and consistent information about a persons health, personal and social care needs. This is needed to help the care staff to care for the people who use the service properly. 29/05/2009 3 8 13 Those people who use the service who are deemed as in risk of falling must be adequately risk assessed, and action taken to prevent this from happening. 29/05/2009 Care Homes for Older People Page 31 of 37 This is to help ensure that areas of risk or danger are addressed properly and that people live in a safer home. 4 8 13 Proper advice, support and 29/05/2009 equipment must be available for those people who use the service who have continence issues and needs. Action that is being taken must be recorded properly and fully in each persons care plan. This is to ensure that peoples dignity is being adressed and that assocoated health issues are being dealt with. 5 8 13 Pressure area care must be recorded properly within the care plan. This is to help ensure that peoples skin condition is being assessed and any breakdown is recorded and dealt with accordingly. 6 9 13 Staff handling medication 01/06/2009 must follow the homes policies and procedures, and adhere to current good practice guidance. And, adequate stocks of prescribed medicines must be maintained without overstocking to help ensure medicines are safely administered as prescribed. 29/05/2009 Care Homes for Older People Page 32 of 37 7 9 13 Complete, clear and 01/06/2009 accurate lists of currently prescribed medicaiton, the dosage instructions and time and date of administration must be maintained for each person to support the safe administration of medication at the home. 8 9 13 Controlled Drugs must be safely locked away in a Controlled Drugs cupboard to meet with current law. 01/06/2009 9 12 16 Regular, planned and 29/05/2009 appropriate activities must be provided for all residents. particular consideration must be given to those residents who have dementia, and suitable activities provided accordingly. This is to help ensure that people who live within this service are stimulated mentally and physically and that their interests and hobbies are addressed. Activities must be enjoyable and suitable. 10 19 23 The owner of the home must 30/06/2009 continue with the renewal and refurbishment of the home. This is to help ensure that peole live in a pleasant environment with good Care Homes for Older People Page 33 of 37 quality fixtures and fittings around them. 11 26 16 The owner of the home must 30/06/2009 ensure that unpleasant odours are eliminated and contributory factors regarding this are addressed properly and completely. This is to ensure that incontinence and cleaning issues are addressed and that the residents live in a pleasant, odour free environment. 12 27 18 Care staff numbers must be sufficient to meet the assessed needs of the residents who live at the home at all times. Sufficient care staff must be available to supervise and safeguard the people who use the service during allotted break times. 13 30 18 Care staff must have a period of time where they are inducted to the workforce and shown how care practices operate. This must be recorded. This is to help ensure that the care staff have the basic skills to complete tasks properly and that people work as a team to provide good care. 29/05/2009 29/05/2009 Care Homes for Older People Page 34 of 37 14 31 10 The manager must ensure that the care of the residents is properly planned, delivered and reviewed. All aspects of health and social care must be addressed properly and the care plans must hold reference to this. 29/05/2009 15 32 10 The manager must ensure that she is fully in charge of the home at all times. She must delegate responsibility, liaise with other agencies and ensure that all of the residents are safeguarded from harm. 29/05/2009 16 37 23 The welfare and safety of the residents and staff must be paramount at all times. Fire safety drills must take place on a regular basis. 29/05/2009 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 8 All equipment associated with the care of people who have pressure sores should be appropriately assessed, by a person who is trained to do so, in order that it is deemed fit for purpose. A missing person procedure should be implemented should a person leave the building without the knowledge of the care staff to ensure that appropriate bodies are aware of this. Relatives must be informed of this as soon as possible. The current regulatory body must also be notified of such incidents. 2 18 Care Homes for Older People Page 35 of 37 3 4 18 38 The residents of the home should be supervised as much as possible in order that they remain safeguarded from harm. All aspects of mandatory safety training must be addressed to help ensure that people live in a safe home. This includes infection control to ensure that the home is clean and people remain free from infection. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. Care Homes for Older People Page 37 of 37 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!