Inspection on 24/02/10 for Tapton Court Nursing Home

This inspection was carried out on 24th February 2010.

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

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

Other inspections for this house

Tapton Court Nursing Home 12/02/10

Tapton Court Nursing Home 06/04/09

Tapton Court Nursing Home 14/04/08

Tapton Court Nursing Home 18/04/07

Tapton Court Nursing Home 26/04/06

Tapton Court Nursing Home 01/11/05

Tapton Court Nursing Home 26/04/05

Tapton Court Nursing Home 02/11/04

Tapton Court Nursing Home 20/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Key inspection report Care homes for older people Name: Address: Tapton Court Nursing Home 63 Tapton Crescent Road Crosspool Sheffield South Yorkshire S10 5DB     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: Ian Hall     Date: 2 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Tapton Court Nursing Home 63 Tapton Crescent Road Crosspool Sheffield South Yorkshire S10 5DB 01142660648 01142661345 care@amocura.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Amocura Limited Name of registered manager (if applicable) Mrs Eleanor Pearl Hallam Type of registration: Number of places registered: care home 69 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The service can admit service users between the age of 60-65 years provided that their care needs can be met. Date of last inspection Brief description of the care home Tapton Court is a purpose built home situated in the Crosspool area of Sheffield, which was first registered in 1996. Nursing and residential care is provided for up to 69 older people of both sexes with mental health problems. The home is a two-storey building with a passenger lift, and is fully accessible. Communal lounges and dining rooms are situated on each floor. All of the bedrooms are single, and all are provided with ensuite toilet facilities. Sufficient bathing facilities are in place. A central commercial type kitchen and laundry serve the home. A car park is available. There is easy access to local facilities, such as shopping centres, public houses and bus routes. Information about the home is provided to people. Copies of the most recent inspection report, and Care Homes for Older People Page 4 of 35 Over 65 69 0 0 6 0 4 2 0 0 9 Brief description of the care home statement of purpose, are available from the home. £377.00 to £519.30. The scale of charges ranges from Care Homes for Older People Page 5 of 35 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 who use the service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The unannounced site visit undertaken as part of the inspection started at 07:50 am on the 24th February 2010. The inspection was conducted by the lead inspector Mr I Hall and regulatory inspector Mrs S Turner. The site visit included a tour of the building, reading records, discussions with staff and Care Homes for Older People Page 6 of 35 people who use the service and meals provided. We also met with the manager and other members of staff. In addition the inspection took account of information received about the service since the last key inspection 6th April 2009 and a random inspection 11th February 2010. A random inspection had been undertaken by CQC following serious concerns being brought to our attention that staff were being employed by the homes manager without checks of their character and suitability being undertaken, this did not keep vulnerable people safe. We checked our records of telephone conversations with staff, events notified to CQC and records of management visits to the home. Prior to the site visit the home carried out a self assessment of the service. This is called the annual quality assurance assessment (AQAA). People spoken to were happy to assist with the inspection. Comments were positive when describing the care and motivation of the staff, these included : I like it at this home, They are good to me, and Its lovely here the staff are smashing. At the end of the site visit verbal feedback was given to the manager. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Effective management and leadership must be provided to ensure peoples care is maintained. The providers must monitor the management of the service to ensure that people were being offered good levels of safe care and support, so that people were not placed at risk of harm. Peoples care needs must be reassessed and care plans updated to support staff providing care. People and their relatives must be offered the opportunity to have input into devising their care plans to ensure their needs had been accurately identified. Staff must be trained in how to devise and review peoples care plans to ensure their needs were accurately reflected in their care plans. People with dementia care needs required more support to take part in meaningful activities to ensure these people lived in a more stimulating environment. Staff needed to ensure peoples safety at mealtimes to prevent risk of choking. Care Homes for Older People Page 8 of 35 Staff needed training about safeguarding vulnerable people, to ensure peoples safety at all times. Refurbishment of the home must continue, with more consideration given to making the environment more stimulating for people with complex needs. Adequate numbers of staff must be on duty at all times to ensure peoples assessed needs could be safely met. Staff need more training to develop skills and knowledge in areas such as dementia care, care planning and record keeping. Some records in the home had not been kept accurately. In some cases this had placed people at risk of harm for example medication records and staff recruitment. 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 35 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 35 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. Peoples initial care needs had been assessed. Care plans had not been compiled for staff to inform staff meeting all identified care needs. This placed people at risk of their needs not being adequately met. Evidence: We checked four case files. These contained a needs assessment; this included such things as daily living, personal care and health care. Not all areas of risk although identified, had been addressed with a suitable plan of care for staff information and guidance. This included risk of falls and challenging behaviours. Peoples social interests and preferred activities lacked information and sufficient detail. Whenever the need for specialist caring equipment had been identified this had been obtained prior to the person moving into the home. The assessment formed the basis for the initial care plan. Care plans had not been compiled for all identified problems. This placed people using the service at risk. Care Homes for Older People Page 11 of 35 Evidence: People said they had been able to discuss their wishes and the type of help they they needed before they made the decision to live at Tapton Court. Whenever possible people had been encouraged to visit and spend time at the home so they could meet members of staff and other people living at the home. This was confirmed by written entries within the case files. The files did not follow a set format and the inspectors found it difficult to find key information quickly. Not all areas of the file had been completed in a timely manner, some lacked dates and signatures of the author. We asked the acting manager if there were people whose current needs could not be met at the home. They advised that currently all of the people at the home were being reassessed and they believed that up to four people may be inappropriately placed and they were working with care mangers to address this. Copies of contracts, social work referrals and assessments were available and kept in the case file. Care Homes for Older People Page 12 of 35 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 systems did not fully enable staff to support peoples health and social care needs. People were not fully protected by the homes medication procedures and practices. Evidence: Four peoples care records were examined. Peoples care needs had been assessed. A range of recognised assessment documents were available to measure peoples needs. These included mobility, mental ability, state of nutrition, and areas of risk such as falls. These provide a baseline for staff to measure peoples progress or increasing level of need. This enables staff to plan the help or support people need. Care plans had not been compiled for all identified areas of need or risk. These included mobility, risk of falls, confusion and challenging behaviour. Care plans had not been reviewed consistently, a number lacked the authors signature. People had been returned from hospital to the home without being reassessed by the homes manager to ensure the home could safely meet their care needs. This concern Care Homes for Older People Page 13 of 35 Evidence: had triggered an adult safeguarding meeting. No outcome had been reached; the result of the coroners inquest was awaited. Staff at the home had not completed required records consistently or accurately. These included fluid balance charts, turning charts (positional), Glasgow coma scale charts. We asked five people who lived at the home, or their advocates, if they knew about their care plans and they told us they had not been offered the opportunity to see or contribute to their care plans or reviews. They did not know who their key worker (named nurse) responsible for their care delivery was. There was little evidence to show that peoples changing needs had been reflected in individual care plans. The acting manager advised us that she had concerns whether the care plans were being reviewed adequately. Peoples care needs were not accurately reflected in the care plans. There was a lack of pen portraits of the person, their lives and interests to provide staff with background information to enable staff to review peoples health and wellbeing and change plans of care as needed. There were records of visits by the GP, community nurse dentist, opticians and chiropodist. All people were registered with a family doctor; there were good relationships with the doctors and district nurses. There were wheelchairs, aids and equipment provided to meet peoples moving and handling needs. The inspectors observed one person seated in a wheelchair unsuitable for his needs. It was small and lacked footplates. Staff acknowledged that he was seated in another persons wheelchair. He had not been assessed to obtain a wheelchair that was specific to meet his needs. Four people were seen to be seated in bucket chairs which could potentially limit peoples freedom of choice and movement. They had not been assessed to ensure that these chairs were suitable for their needs. An immediate requirement was made for people to be assessed by a suitable qualified person to assess their suitability to maintain peoples rights, choice and safety. People appeared to be clean and suitably clothed; we observed a number of men had not been shaved, they said this made them feel uncomfortable. Care Homes for Older People Page 14 of 35 Evidence: We observed the homes storage and handling arrangements for medicines. We also observed medicines being given to people after their midday meal. Pots were used to hand medication to the person and water was offered to help with the taking of medicines. Time was spent with each person and encouragement given given to help them take their medication. There were unexplained gaps within the medication administration record charts (MAR). This presented a risk of medications being administered twice to people. Sample signatures of staff signing for medicines were incomplete. Information detailing peoples allergies to medicines had not been completed consistently. This information is required to maintain peoples safety. We saw that the medication storage room was cluttered with boxes and lacked storage space. We were told that no people currently administer their own medication. Staff dispensing medicines had been provided with training, their practice had been assessed to maintain peoples safety. People living at the home said Staff were caring and helpful and that Nothing was too much trouble. We observed interactions between staff and people living at the home. We saw that people were treated with positive regard. Staff were professional yet informal and friendly with people who used the service. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had limited opportunities to meet their social, cultural and recreational needs. People who live at the home were encouraged to eat a healthy and varied diet. Evidence: Four care files and care plans were checked. They contained little reference to activities that people enjoyed or chose to participate in. We observed how people were supported on both floors of the home and found their opportunities for activities to be limited. We saw people reading, watching television or listening to music. A number of people were not engaged in any way with staff, each other or any activity. This did not meet their complex needs. A dedicated member of staff had been recently employed to organize activities and encourage social interaction. She had compiled a list of activities and a newsletter for people to choose activities they enjoy. She had worked with a number of the people to produce decorations for Easter. Entertainers visit the home for peoples enjoyment. She had plans to introduce fish and chip suppers, and trips to local places of interest. Staff said they were busy providing care and had little time to spend with people. They Care Homes for Older People Page 16 of 35 Evidence: said that numbers of staff on duty did not permit them time to take people outside the home. People said they were able to go to bed and rise as they chose. Peoples comments included The foods good here, Dads needs are well catered for, Mum says the meals are good and thats all that matters to me, I visit every day to help the staff with feeds, they are so busy. We saw the cook baking cakes and buns. She said these were freshly made each day. People said they enjoyed them with their cups of tea and there was always plenty to eat. A list of birthdays had been provided for the cook who said she prepared teas for peoples birthdays. The meals provided were appealing and smelled appetizing. People said they enjoy their meals. They can choose other meals if they dont like the meal provided. People were seen and heard to make choices at dinnertime. Staff were seen to help and encourage people with their drinks and meals. Four people were seated in bucket chairs these limit peoples freedom of choice and mobility. They were positioned almost flat whilst staff attempted to feed them, this practice was unsafe and presented a risk of choking. The inspectors spoke to the manager who ensured staff positioned people so they were able to eat comfortably and safely. Mealtimes were unhurried with extra portions provided as required. Peoples personal likes and dislikes were documented and known by staff. Special diets were available as needed. Staff said they sought the dietitians advice when necessary. Drinks and snacks were available through both day and night times. Care Homes for Older People Page 17 of 35 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 complaints procedure enables people to raise any concerns; staff had little understanding how to safeguard and protect people. There had been a high number of adult safeguarding referrals from the home, which showed people had not been adequately protected from being harmed or suffering abuse. Evidence: Visiting relatives and some people were able to describe how they would raise concerns with staff. Their comments included: I found my mother dressed in another persons clothing, it was very distressing to see when she has so many of her own clothes in her wardrobe, and Ive found other peoples clothing in my mothers wardrobe on a number of occasions. Members of staff said, I told the previous manager about my concerns a number of times but she never did anything about them, I reported my concerns about a member of staff to management but nothing happened. The adult safeguarding team had been notified of concerns about 3 peoples care at Tapton Court. Two of these continue to be investigated; one has been referred to the Coroner for an inquest into the circumstances of a persons death. Two people had brought their concerns to the managers attention, these were Care Homes for Older People Page 18 of 35 Evidence: investigated within the homes policy and procedure. Changes had been made to improve the standard of service provided. We were told that should people have no advocate or next of kin they would be provided with access to advocacy services provided by Age Concern. Staff had received some training in adult protection procedures; however staff spoken with had little understanding about adult abuse, whistle blowing or how to effectively respond to any any concerns presented to them. This did not ensure that people were adequately protected from abuse. Care Homes for Older People Page 19 of 35 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. The home was unclean but generally well maintained. People had not been provided with clean and homely surroundings. Evidence: We saw that the home had not been adequately cleaned. Toilets had not been cleaned or rooms hoovered. There were no odours. The acting manager confirmed that there was one member of staff on duty to clean the building and undertake laundry services. Visitors comments included Its clean and homely here, and Im very happy with the cleanliness, theres no smells Bedrooms were lockable with keys available for those who wished to exercise the choice to lock their own door. All bedrooms were en-suite. Some families had assisted with personalization of bedrooms with favourite items and memorabilia. We identified a number of bedrooms that had a spartan appearance. People without relatives had not been supported to personalise their bedrooms so they could be surrounded by personal possessions and enjoy a homely setting. There were very few personal possessions, one person had a single photograph that did not have a frame, it had been left on the sink. Beds had been carelessly made with bedding trailing onto the floor. Rooms had not been cleaned or hoovered. We identified items of furniture in Care Homes for Older People Page 20 of 35 Evidence: need of repair or replacement. People were not being provided with pleasant and homely surroundings. The en-suite toilets had not been cleaned. There were many boxes of incontinence products stored in these areas; these presented a trip hazard to people who lived at the home. Secure storage had been provided for toiletries and shampoos, these cupboards were not secured and presented a risk to people of accidental ingestion. The communal areas whilst spacious lacked a comfortable homely appearance. Chairs were being used by some people that were confining and limited their personal choice and movement. Corridor areas were being painted at the time of inspection. There was no variation in colour scheme to help people to find their way around the home. Signs provided were small and unsuitable for people with impaired vision and dementia. There was level access throughout the home with handrails provided to assist people to maintain their independence and mobility. Toilets and bathrooms had a clinical appearance, they lacked domestic features. They were being used to store items inappropriately. The laundry area was secured to ensure staff only access. It was untidy. It requires review to separate clean and dirty service areas to reduce risk of cross infection. Appropriate seating had been provided in the garden area for people wishing to sit outside whenever the weather permitted. Staff confirmed that they were provided with protective clothing if they needed it and that equipment was in working order, being serviced as required. Care Homes for Older People Page 21 of 35 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. People who lived in the home had not been fully protected by the staff recruitment procedures in place. The staffing levels did not always ensure that there were enough staff available to meet peoples complex needs. Staff had completed most mandatory training. Evidence: We met with seven staff including the manger during the course of the inspection. On the day of our visit we saw that there were two trained staff and seven care assistants providing care for forty six people over the two floors of the home. Twenty three people had been assessed as having high dependency needs, nineteen people had medium dependency needs and four people having low dependency needs. All people suffered with varying degrees of dementia. One person required to be nursed in bed. All people appeared to be suitably dressed, however a number of the gentlemen had not been shaved, staff said they had been busy but would provide shaves later that day. At lunchtime six people were being assisted to eat. Four people were observed to be poorly positioned and at risk of swallowing problems. This was remedied by the acting manager when it was brought to her attention to ensure peoples safety. Staff told us and the staff duty records showed, the staffing levels needed were not Care Homes for Older People Page 22 of 35 Evidence: being maintained at all times. One person was seen to be undertaking laundry and domestic duties for the home; three people normally undertook these tasks. The manager told the inspectors that the ancillary staff absences had been notified the previous evening. The duty rota showed that they had been absent for three days. No replacement staff had been found. This meant that peoples health and wellbeing were placed at unecessary risk The manager told the inspectors seven care staff were on duty. The duty rota showed six care staff working. This meant that people were placed at unecessary risk and their needs were not always being met. This information was fed back to the acting manager to address as a priority. An immediate requirement made to ensure that adequate numbers of staff were on duty to meet peoples assessed needs at all times. We saw staff working with people and noted there was an atmosphere of mutual respect; their conversations were relaxed and friendly. The staff group were well motivated and enthusiastic about their work. Staff we spoke with confirmed they had to provide two satisfactory written references and a criminal records bureau check before commencing employment. Personnel files were sampled. The homes management had failed to ensure that all statutory checks had been made to ensure fit and proper people were recruited to care for vulnerable people. An immediate requirement was made at a random inspection. We were able to confirm that the home is now following company staff recruitment procedures. We advised that information be stored in staff files to enable monitoring of recruitment practice. Records of staff supervision and and their training needs were examined. We saw the staff training plan and records. Training courses planned and completed were seen. These included health and safety, moving and handling, first aid and dementia awareness. During our discussions with staff it was clear there was a lack of awareness of adult safeguarding, whistle blowing, writing care plans, daily record keeping (including Glasgow Coma Scale Records, fluid balance, positional (turn) charts), dementia care, and communication skills. Additional training would enable staff to meet peoples complex needs and safely care for people. Five staff had achieved National Vocational Qualifications in care, with eight further Care Homes for Older People Page 23 of 35 Evidence: staff working to wards the award. This did not ensure that staff had been assessed as having appropriate skills and knowledge to support peoples complex care needs. Skills for prevention of fire and health and safety were updated each year to ensure staff were trained to meet peoples care needs safely. Care Homes for Older People Page 24 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had not been living in a well run service. Adequate monitoring checks had not been completed at the service. Some record keeping within the service had not been maintained to an adequate standard to protect people. Evidence: The registered manager left the service in February 2010. Therefore there is currently no person registered with us as the manager of the home. An acting manager had been brought appointed in February 2010, to manage the home on a short term basis. This was because the home was identified as not providing good standards of care to people who lived there or management and leadership to the staff who worked there. People said I feel the home is run very well, they organize events for residents but these arent always well attended by families. We found the acting manager needs more day to day support to ensure she can manage the current crises within the home as well as day to day running of the Care Homes for Older People Page 25 of 35 Evidence: service. This was fed back to the acting manager after our visit, who advised that they would address this as a matter of priority. In the long term however, this service needs to be managed by a permanent manager in order to discharge their responsibilities fully, to provide leadership to the staff team and offer some stability to people who lived in the home. We saw that a senior company manager visits the home home to monitor care and standards at the home. A written report of their findings was available at the home, no report had been completed for December 2009, this did not ensure the service was adequately monitored for the benefit of people who lived at the home. We examined regulation 37 notifications (to CQC) of events that had occurred at the home. These lacked detailed information of events such as falls that required hospital admission. Each event must be recorded seperately with sufficient information to detail the circumstances of each occurrance, treatment required and outcome. We saw that the manager handles money on behalf of some people. These were sampled. We saw that account sheets with receipts were being kept. A second person witnessed each transaction. This helped to ensure that peoples financial interests were being safeguarded. We examined the homes record keeping and found that some records were not being maintained accurately, and some were not up to date. These included the medication administration records (MAR), staff recruitment files and regulation 26 and 37 reports, and these placed people at risk. We saw that there were no regular meetings for people who live at the home and their advocates. These are required to provide people with a voice to say how the home is organised. We looked at the health, safety and welfare of people who lived at the home and that staff safety was promoted and protected. Overall staff mandatory training had been completed by the majority of staff. Statutory servicing and checks of equipment were up to date. Risk assessments for bucket chairs, the laundry area and hazardous substances required review to maintain a safe environment for people. Care Homes for Older People Page 26 of 35 Evidence: Fire safety records were mainly correct and up to date, fire checks for December 2009 had not been completed, these are required to ensure peoples safety. Care Homes for Older People Page 27 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 35 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 1 8 15 Peoples opportunities for appropriate exercise and physical activity are not restricted, appropriate interventions are carried out to prevent risk of falling following assessment by a person trained to do so. To protect people from risk and safeguard peoples rights and choice. 24/02/2010 2 9 13 Accurate medication records 24/02/2010 must be maintained, where a medication has not been taken this must be recorded as refused. To protect people from risk of error. 3 27 18 Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed needs of the service users, the size, layout and purpose of the home at all times. Service users needs are met by the numbers and skill mix of staff. 24/02/2010 4 38 13 The registered manager ensures the health and safety of service users by safely storing substances hazardous to health. The health, safety and welfare of service users and staff are promoted and 24/02/2010 Care Homes for Older People Page 29 of 35 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 protected. 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 The registered manager must ensure that no service user moves into the home without having his/her needs assessed and being assured that they can be met To ensure peoples care needs can be safely met. 05/04/2010 2 3 14 The registered person must ensure that as peoples needs change they are reassessed To ensure care provided meets peoples care needs. 05/04/2010 3 7 15 The service users care plan 05/04/2010 sets out in detail the action which needs to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service user are met. To ensure staff can safely peoples health and care needs. Care Homes for Older People Page 30 of 35 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 7 15 The service users plan is 05/04/2010 reviewed by care staff in the home at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. To provide people with care that meets their individual needs. 5 7 15 A plan of care generated 05/04/2010 from a comprehensive assessment is drawn up with each service user and provides the basis for the care to be delivered. The plan is drawn up with the service user, recorded in a style accessible to the service user; agreed and signed by the service user whenever capable and/or representative (if any). To ensure people are involved in planning the care they receive. 6 12 15 Service users interests are 05/04/2010 recorded and they are given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capabilities; particular consideration is give to Care Homes for Older People Page 31 of 35 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 people with dementia and other cognitive impairments. People can maintain their social and recreational activities 7 12 15 Service users have the opportunity to exercise their choice in relation to leisure and social activities People can maintain their social and recreational activities. 8 18 13 The registered person must ensure that people are protected from being placed at risk of harm or abuse. To protect peoples health, welfare and safety. 9 19 23 The home must meet be safe, well maintained and meet service users needs in a comfortable and homely way, with a programme of renewal of the fabric and decoration of the premises produced and implemented with records kept. People live in a safe homely and well maintained environment. 10 22 23 The registered person demonstrates that an assessment of the premises 05/04/2010 31/03/2010 24/03/2010 05/04/2010 Care Homes for Older People Page 32 of 35 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 has been made by suitable qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the signs and aids to independence are suitable for the client group. People are helped to maximize their independence. 11 24 13 The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meet the assessed needs of each service user. Suitable storage is provided in each bedroom to ensure peoples safety. People live in safe comfortable bedrooms with their own possessions around them. 12 28 18 Ensure that persons employed by the registered person to work at the home receive training appropriate to the work they are to perform. 31/03/2010 31/03/2010 Care Homes for Older People Page 33 of 35 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 Service users are in safe hands at all times. 13 33 26 The registered person must 31/03/2010 ensure regulation 26 reports are completed on a regular monthly basis and a copy is sent to CQC for the forseeable future To ensure the homes owners have identified areas of risk and taken appropriate actions to protect people. 14 38 13 The registered manager ensures risk assessments are carried out for all safe working practice topics and that significant findings of the risk assessment are recorded. The registered manager ensures as far as is reasonably practical the health and safety and welfare of service users, by ensuring substances hazardous to health are safely stored. 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 31/03/2010 Care Homes for Older People Page 34 of 35 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 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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