Inspection on 20/07/09 for Tawburn House

This inspection was carried out on 20th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Tawburn House Tawburn Sticklepath Devon EX202NL     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: Anita Sutcliffe     Date: 2 3 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Tawburn House Tawburn Sticklepath Devon EX202NL 01837840737 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pauline_daccs@yahoo.co.uk Taw Care Ltd Name of registered manager (if applicable) Mrs Allison Balsdon Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 14 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old Age, not falling within any other categoruy (Code OP) Dementia (Code DE) Physical Disability (Code PD) Date of last inspection Brief description of the care home Tawburn House is a large Victorian house in the village of Sticklepath. The home caters for 14 older people who may have a range of other needs such as dementia or physical disability. Many of the people who use the home are from the local area. Care Homes for Older People Page 4 of 35 Over 65 14 14 14 0 0 0 Brief description of the care home The home is at the centre of the village and adjacent to the Village Hall. People are accommodated over three floors. Access to rooms is by stairs or the passenger lift. The kitchen and lounge/dining area is on the ground floor and the laundry is on the first floor. All bedrooms but one have ensuite handbasin. There is one shared bedroom. The home has garden space available for peoples use. The provider of the home is Taw Care Ltd. There is a registered manager. Any health care needs are met through the community health services, such as district nursing. The home is staffed 24 hours a day, but staff during night hours sleep. Weekly fees at the time of this inspection ranged between £420 and £500. An additional fee is made for hairdressing, private chiropody, newspapers and mangazines, personal toiletries and transport. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . As a new service there is no previous inspection report for people to see. 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: We have collected information about the service since the home was registered April 2009. Toward this first key inspection the home provided us with information about the service provided, such as peoples needs. We were also told what the home considers they do well, barriers to improvement and areas recognised needing improvement. We sent surveys to people who use the service; four were returned, some having been completed on peoples behalf, and staff; six were returned. We received information from the district nursing service and a person visiting the home in May on a professional basis. We did two unannounced visits to the home, one starting at 6 am. We looked closely at the care of some people. We met all who were resident and one person visiting. We sat in on a staff meeting and talked individually with some staff. We looked at many records. We visited all areas of the home on both occasions. Care Homes for Older People Page 6 of 35 People who use the service may be referred to within the report as residents, clients or service users. 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: Care plans, especially regarding assessment of risk, need to be more regularly reviewed and the information in them must be current. This way staff will be fully informed of what is expected of them. Plans should always be signed and dated as they are legal records of the care which is to be provided and that which is provided. All staff providing care need the knowledge to ensure health care problems, such as pressure sores, do not occur. People who use the service must be listened to and their choces respected. We issued an immediate requirement that peoples wishes and feelings must be taken into account when deciding at what time to help them out of bed and dressed in the morning. The homes complaints policy should include timescales for response so that complainants would know what to expect. The arrangements for prevention of cross infection put people who use the service at risk. Staff do not always have protective clothing to wear, clean laundry is stored close to that not yet washed and staff have to open a bin by hand to use it. Staff should also have the equipment to ensure the home stays fresh and clean available when needed. Care Homes for Older People Page 8 of 35 The home must be kept in a reasonable state of repair; the torn wallpaper and broken electrical box must be mended. We made an immediate requirement that there be sufficient qualified and experienced staff on duty to ensure the health and welfare needs of people who use the service are met. Staff training in aspects of health and safety must be up to date. They must be trained in areas of care relevant to the needs of people at the home. Staff should receive one to one supervision on a regular basis so they can discuss issues relating to their work and training needs. The manager should ensure that two good references are received from any potential staff before they start work at the home. Management should ensure that staff understand new legislation, in this case the deprivation of liberty safeguards, which protect people who lack capacity to make informed decisions relevant to their well-being and safety. The home must be fully informed about this. Management must notify the Commission of any event which might adversely affect the well-being of people at the home. This is a legal requirement which protects people. The registered provider must ensure that a representative of the organisation does a monthly unannounced visit to the home to check on the standard of service delivered. A report from this visit must be provided for the manager and the Commission. Steps must be taken to ensure that staff, and any person with connection to the home, feel able to comment on the home, so that the quality of the service can be adequately reviewed. To ensure good record keeping and protection two people should record when a persons account at the home is credited or debited. Steps must be taken to ensure the security of the building both from intrudors and to protect the vulnerable people who live there. Requirements made by other agencies, in this case the fire service, must be actioned within a reasonable timescale so that risk is reduced or removed in a timely manner. All hazards within the home must be risk assessed, so risk can be removed or minimised as necessary. Hot water should not be distributed to a bath at a temperature more than 43 degrees celcius as this has the potential to scold. The registered providers of Tawburn House responded very positively to the inspection findings and were able to show us improvements already in place at the point this report was published. Care Homes for Older People Page 9 of 35 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 10 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 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People, or those working on their behalf, are able to make an informed decision as to whether the home is suitable for their needs. Peoples needs are assessed and understood prior to admission. Evidence: We received four survey responses from people who use the service. All told us they had received enough information to help them decide if Tawburn House was the right place for them. We looked at the way the last admission to the home had been handled. This was, however, prior to Tawburn House being registered as a new home following the change of provider. The manager told us that she always visits people prior to admission to assess their needs. We found that the assessment, made prior to the persons admission to the home, Care Homes for Older People Page 12 of 35 Evidence: was quite detailed and would have provided the information necessary from which their care could be planned. There was also assessment information from social services, which would further help the home to understand the persons needs. We were unable to have a meaningful conversation with the last person admitted, due to their level of dementia, but we saw that they looked well settled in the home. We were able to see the arrangements being made for a new admission during our inspection. The manager gave staff some clear information as to their needs and how they should be met. However, they were coming to the home for a short period of time and were already known to some staff. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although routine care and health needs are met staff may not always have the skills or experience to ensure problems to do not occur. Evidence: We looked closely at the care provided to two people at the home. This involved meeting them, reading their records and talking to staff and the manager about their needs. Five staff told us through survey that they are always given up to date information about the needs of people they support and care for and one said they usually are. We were present when information was given to them on a new person soon to be admitted. Care records were well organized in that it was easy to find information. We saw that some care was well planned. This included physical, emotional and social needs. There was some good information about how to interpret body language where the person was not easily able to tell staff what they wanted. There was some good detail on how Care Homes for Older People Page 14 of 35 Evidence: to assist them to move about. There were also some gaps in information, including about medicines use and personal preferences for bathing and personal care. We also found some plans were unsigned and had not been reviewed for many months, so the information was not necessarily reflective of their needs. We discussed the need for peoples plans to include information on any advanced decisions they have made about their care; for it to be clear whether they have a person legally responsible for making decisions on their behalf and information required by medical services should they have a medical crisis. We were informed by social care staff that no concerns had been identified during the review of four peoples care early 2009. Each of the four people who responded to survey said they always receive the care and support they need and each said the home always makes sure they get the medical care they need. One persons relative told us: The care and attention my mother receives from the staff is wonderful. However, a safeguarding alert, earlier in the year, concluded that one person at the home developed a pressure sore whilst they were resident. The manager told us that it happened when a pressure relieving mattress had been turned off in error. We looked closely at the care provided to the person with the history of pressure sore. The assessment records, pertaining to the risk of sores occurring, rated the risk as high. However, the risk had not been reviewed since December 2008, prior to the sore occurring. With a high risk rating plus a history of pressure sores occurring, it was not sufficient for the risk to be reviewed so infrequently. Although the persons care plan had been reviewed the two documents did not marry up. Information was not clear and well organized in this case. The home reports that they need to be better at ensuring all staff are trained in the prevention of pressure sores. We asked the carer, who we were informed bathes people, what she might need to check on when bathing people. She did not mention looking for signs of pressure damage. Staff told us they have not been trained in pressure sore prevention but on further questioning some had some knowledge of what to look for. We saw that people appeared to be well care for in that their personal care needs were met. The home employs a carer to follow a bath routine/list. Whilst each person should have individual care planned (not based on a list which indicates an institutional approach to care) we were told that people could bath any day they chose. We are also aware of the home meeting some specific bathing requests people have made. Care Homes for Older People Page 15 of 35 Evidence: Records indicate that the home is usually alert to ensuring health care professionals are consulted, so that peoples medical needs are met. This included physiotherapy, district nursing, optician and community psychiatric nursing. A district nurse told us that she has confidence in the homes ability to meet peoples needs when the manager is on duty, but not so when she is not. No people at the home are able to administer their own medicines. District nurses have confidence that the manager is sufficiently skilled to administer medicines. We found that all medicines were kept securely and safely at the home. The medicine records we examined were complete and clear. We discussed with the manager how medicines are managed when she is not on the premises. She reports the need to ensure all staff are trained to administer medicines and told us there is some difficulty when senior care staff are not on duty. One person at the home told us staff are: Very good at privacy. We saw staff knocking on peoples doors before entering and where people were being bathed this was done in privacy. Observing staff we saw they were kind and respectful to the people in their care, appearing to have a genuine desire to look after them well. However, we found that peoples requests were not always honored - see standard of choice in the next Outcome Area. Care Homes for Older People Page 16 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 generally lead contented and full lives at Tawburn House, but peoples choices must be respected. Evidence: Tawburn House is very much a village care home, situated on the main street, near local facilities. We were told that some at the home use the local church. Two people who responded to survey told us the home always arranges activities that they can take part in and two said it usually does. The home reports that they promote individual activities and encourage involvement in the community. The lounge, dining room and conservatory, where many people at the home spend their day, are homely and inviting. There is a large television for peoples use. Staff told us of giant snakes and ladders, cooking buns, hand massage and that staff are always trying: to think of new activities to do. Records seen provided some good information on peoples interests. There was some family/life history information, of great importance to staff where people have memory difficulties. We saw that the home had considered how to prevent social isolation and Care Homes for Older People Page 17 of 35 Evidence: information was available to staff on how to communicate with a person where they were unable to do so verbally. At our first visit we noted some people, although up and dressed, were asleep in their chairs. We decided to visit early for the second visit, arriving at 6:10 am. We saw one person got up and dressed although we heard them tell staff they were tired and wanted to stay in bed. We visited another person at 6:25 and found them dressed, in a chair and their bed made. We checked the care plans for both people. Neither had a preferred time of getting up recorded or any explanation of why early rising was necessary. Staff told us that it was their routine to get those people up so early; that it was expected. We made an immediate requirement that peoples wishes and feelings must be taken into account when deciding at what time to help them out of bed and dressed in the morning. People told us about the nice atmosphere at the home and we saw staff engaging with people, talking and assisting them. One visiting family told us she has always felt welcomed and spoke highly of the manager. There are no restrictions on people visiting the home. Three people who responded to survey told us they always like the meals at the home and one said they usually do. One added: Food brilliant. We shared a meal with people at the home. It was tasty and enjoyed. People have a choice of meal and we saw staff serving lunch at table-side. People were also able to choose what they did or did not want from what they saw. One person had previously told us their choice of lunch, which was curry or fish and chips. Where people needed assistance to eat the staff member sat near them and they were not rushed Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are, for the most part, protected by the way the home is run. Evidence: Most people at Tawburn House are very vulnerable, most having dementia. Each of the four people who responded to survey told us there was somebody they could speak with informally if they are not happy and each knew how to make a formal complaint. There is a complaint procedure displayed at the homes entrance. It contains the contact details of the Commission, but no timescales for response as it should. All staff told us through survey that they knew what to do if someone has concerns about the home. The manager is very well liked by people who know the home and very available for discussion. We were told that new staff have received training in how to protect vulnerable people from abuse and we saw this was confirmed by certification. We spoke with six staff who knew how to respond, taking concerns that might be abuse, out of house. However, staff did not know about legislation which protects people unable to make decisions about their own welfare, such as those with dementia. The manager told us they had, none the less, received some training in this. We have not received any complaints about the home. One safeguarding alert, Care Homes for Older People Page 19 of 35 Evidence: relating to a pressure sore which developed at the home, has been discussed in the Outcome Area called Health and Personal Care. One person, asked if they felt safe at the home, told us that they mostly do. Care Homes for Older People Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment meets the needs of people who live there although some upgrading would make their lives more comfortable. The arrangements for prevention of cross infection put people who use the service at risk. Evidence: Tawburn House is a Victorian building on the main road in the village of Sticklepath. People are accommodated over three floors. Access to rooms is by stairs or the passenger lift. The kitchen and lounge/dining areas are on the ground floor and the laundry is on the first floor. All bedrooms but one have en suite handbasin. There is one shared bedroom. We looked around the home, visiting all shared areas, the kitchen, laundry and all bedrooms. We found that many areas of the home looked tired and in need of decoration. When we asked what the home could do better one persons family said: decorating and staff told us: Improve the environment. One bedroom had torn wallpaper and the electrical socket was taped where the plastic box housing it was broken. However, we found that where a bedroom had been vacated it had been redecorated and re carpeted prior to a new person moving in and were told this was the norm. The one lounge/dining room is homely and domestic in appearance and people have a Care Homes for Older People Page 21 of 35 Evidence: level garden available for their use. A second choice of seating area is a conservatory which overlooks the garden. Bedrooms are very individual to the person and people have personal items around them. We found that some were fresh but some were not, smelling of urine and cleaning products. The home was generally clean and there were adaptations, such as handrails, available to help people move around. We visited the laundry in which there is a new washing machine. The room is small and we found clean laundry and bedding in close proximity to soiled laundry in a cupboard with no doors. Clean and soiled laundry must be kept apart to reduce the possibility of cross contamination. Three people who responded to survey told us the home is always fresh and clean and two said is usually is. The manager records that the home have to be vigilant in ensuring the home is clean and the home now uses more intense cleaning products. However, staff talked, in a staff meeting held the first day of our visit, about the lack of availability of deep cleaning equipment to clean carpets. We found that staff did not have adequate personal protective clothing. None had aprons for use when providing personal care and we were told that, quite recently, they had been so short of gloves that some had used plastic bags on their hands instead. We made an immediate requirement that all necessary protective clothing be fully available for staff use. We saw that staff did have liquid hand soap, paper towels and antibacterial hand gel available to them. We found staff could only open a bin in the staff toilet by hand as the foot pedal was broken. This is not hygienic. Care Homes for Older People Page 22 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 are not protected by the staffing arrangements at the home. Evidence: People said of the staff: Kind, thoughtful, encouraging and friendly and The care and attention my mother receives from the staff is wonderful. Three staff told us through survey that there are always enough staff to meet the individual needs of all people who use the service and two said there usually are. Most of the eleven people currently at Tawburn House have dementia and are in need of regular attention to ensure their safety. Staff have to operate over three floors to do this. We received information in April from a professional person visiting the home. She expressed her concern that she was able to enter the building on two occasions and that on both there were no staff immediately available, the first time for several minutes, and people who use the service were on their own in the lounge and entrance. At our first visit, arriving at 8:15, we found the manager administering medicines and two care staff. A third carer arrived at 9 am. For the second visit, arriving at 6:10 am we found two care staff on duty. We were surprised to find that neither had been Care Homes for Older People Page 23 of 35 Evidence: waking night staff. This means that throughout the night hours there are no staff awake in the building. This is not fully clear in the information about the home, called the Statement of Purpose, which provides detail of what the home does and does not provide. At 8:50, when about to leave, we found a person looking through papers on the staff desk. She then started to remove a clock from the wall. With only two staff in the building this was an unsafe situation. They were attending to peoples needs (breakfast and getting them up) which left no staff in the lounge/dining room, entrance area. We decided we could not leave until the situation was safe. We made an immediate requirement that staff are provided in sufficient numbers to ensure the safety of people who use the service. Four staff told us through survey that their induction training covered everything they needed to know to do the job well when they started. Two said it mostly did. We spoke with two care assistants new to the home. One said she had been working along side more experienced staff. Staff told us that sometimes inexperienced staff are working together. We were unable to see records of peoples induction training as they were not available to us but those records were seen shortly after the visits to the home. We were able to speak with seven staff who attended a meeting. Each told us they had received training in infection control, dementia care, safeguarding vulnerable adults and fire safety. Asked about prevention of pressure sores and catheter care (both relevant to the home) we were told no. We were told by staff that moving and handling and first aid training was lacking but we later established that they had received moving and handling instruction. Staff told us of a training method they had liked but which was now stopped and that external trainers, arranged to come into the home to instruct staff, had let them down. This also happened the day we visited. Staff told us: We all need refreshers in all training. This lapse in training has the potential to put people at risk. Four staff told us through survey that that they have enough support, experience and knowledge to meet the individual and diverse needs of people who live at the home and one said they usually do. A relatively new member of staff was seen providing care in a professional and caring manner. However, district nurses visiting the home say do not have confidence in staff ability when the manager is not on the premises. We asked what qualifications in care staff have achieved. We were told that of the ten care staff four have National Vocational Qualifications in care (NVQ) to level two or above. One is working toward this. Care Homes for Older People Page 24 of 35 Evidence: We looked at whether the homes procedure for staff recruitments protects people from those unsafe or unsuitable to work with them. We found that each of the three we examined had a completed police check before they had started at the home and each had two references in place. However, the standard of references was somewhat weak, for example, one had no date on it. Another was a character reference and another dated back to 2005 and so was not current. Care Homes for Older People Page 25 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 who use the service are not protected by the way the home is managed. Evidence: Tawburn House was registered as a new service 17th April 2009 following a change in ownership. The manager, Alison Balsdon, had been considered fit to be the manager and is registered with the Commission. She has 10 years experience at the home and has achieved National Vocational Qualifications (NVQ) in care to level 4 and qualifications in managing a care home. She told us that she has done no training since the home was registered as a new service, other than fire safety, but we later established that she has received much mentoring from the new owner of Tawburn House. However, we found she lacked some information she should be aware of, such as new legislation on the deprivation of liberty safeguards, part of the Mental Capacity Act 2005. People are very complimentary about Alison Balsdon. District nurses told us they have confidence in her. Comments received with survey responses include: The manager, Care Homes for Older People Page 26 of 35 Evidence: who works so hard is such a lovely lady. Mrs. Balsdon was present throughout most of the inspection visits. We looked at how the home will test the quality of the service it provides. Surveys have been sent to peoples family, staff and health care professionals. We were present when there was a staff meeting. Mrs. Balsdon asked why the surveys staff had been given, in which they could comment about the home and were part of the homes quality assurance measures, had not been returned. It was clear from what staff said that they did not feel confident to write what they wanted in case the management knew who was making the comments, which were presumably negative. Staff later told us that they: didnt feel listened to. Where a home is owned by an organization or partnership, the home must be visited, at least monthly and unannounced, by a representative of the organization to check on the standard of service being delivered. They must then write a report on the visit and supply a copy to the manager and the Commission. The home is now under the ownership of Taw Care Ltd. We asked to see reports from the unannounced visits. The manager told us there were no reports although the provider visits at least weekly. We found that the home is not notifying the Commission of events which affect the wellbeing of people who use the service. This would include any death at the home, a visit by the fire service from which requirements were made and the development of a pressure sore whilst a person is at the home. This information is used to monitor the service provided and therefore helps to protect the people who use it. We asked how peoples financial interests were safeguarded and were told that the home keeps some money for people. We saw that it is locked away securely and we checked two which were correct to the recorded balance. We were told that no money goes into the business account. The money kept for people was available to them but we were told it is mostly used to pay for visiting services, such as hairdressing. We saw receipts were kept from transactions. However, only one staff makes a record of when money is removed. It is good practice that two staff sign when money is credited or debited on an account. We asked staff and the manager if they were receiving formal supervision of their work and were told this has not yet been started. This would help give staff the opportunity to discuss areas of their work and identify training needs. We looked at health and safety within the home. Care Homes for Older People Page 27 of 35 Evidence: We saw some very detailed risk assessments for individuals at the home. These included their room, moving and handling and likelihood of falls. The fire service visited the Home March 2009 and required some safety improvements. We were shown two of those requirements which had been actioned. However, the required fire safety risk assessment had not been done four months later. We checked the temperature of the water at a bath seen to be in regular use. Using the homes own thermometer the water temperature was 52 degrees, very hot. Records of weekly water safety checks also confirmed this temperature. The manager told us there was a temp control thermostat in place and we saw that staff adjust the bath water and record the temperature each time somebody bathes. It is, however, expected that water is not delivered to a bath at greater than 43 degrees centigrade; to prevent scalding. We saw people in the vicinity who could enter the bathroom unattended and be at risk. We found that staff had been working without protective gloves. One said she had found it necessary to provide personal care to a person with plastic bags on her hands. When we visited staff did not have protective aprons available to them. These items of clothing protect staff and are used to prevent cross infection or contamination. We made an immediate requirement that this equipment be made available before the weekend. We also found staff could only open a bin in the staff toilet by hand as the pedal was broken. We found that staff were not fully up to date with mandatory health and safety training and specific training in areas relevant to their care work, such as pressure sore prevention and catheter care. We found insufficient staff on duty to ensure peoples safety. We asked to see any assessment of risk relating to the stairs, which were seen in use by people who use the service and the homes cat. We were told this risk had not been assessed. We received information in April from a police officer who had visited the home and was very concerned about the lack of security. She said she was able to enter the building on two occasions and that on both those occasions there were no staff immediately available, the first time for several minutes. At our first visit we found one door to the home unlocked and the other wide open. A pressure mat was in place at the closed door so that staff will be alerted should any person go through the door, Care Homes for Older People Page 28 of 35 Evidence: but this was clearly no use at all with a door a few feet away wide open. Care Homes for Older People Page 29 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 30 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 12 12 (3) Peoples wishes and 31/07/2009 feelings must be taken into account when deciding at what times to get a person out of bed and dressed in the morning. To promote both their physical well-being and dignity. 2 27 18 (1) There must be, at all times, suitably qualified and experienced staff, in sufficient numbers as are appropriate for the health and welfare of people who use the service So that people with dementia are not put at risk as they are unsupervised. 31/07/2009 3 38 13 (3) There must be the 24/07/2009 necessary quantities of personal protective clothing (gloves and aprons) available to staff providing personal care, at all times. So they can be used to prevent cross contamination and ensure hygienic practices for people who use the service. 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 1 19 23 (2) The premises must be 12/09/2009 kept in a good state of repair, in this case regarding decoration and the mending of a broken electrical box. So that people can live in a pleasant and safe environment. 2 30 18 Staff must receive training, in all aspects of health and safety, and that training must be updated regularly. So that staff are skilled and knowledgeable in their work and people are safe. 30/11/2009 3 30 18 Staff must receive training in the areas of care relevant to meeting the needs of people at the home, in this case pressure sore prevention and catheter care. To promote peoples health and welfare. 30/11/2009 4 33 37 The Home must notify the Commission, without delay, of any event which adversely affects the wellbeing of people who use the service. This helps protect people who use the service. 31/08/2009 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 5 33 26 The Home must be visited, unannounced, by a representative of the organization, at least once a month, and provide a copy of a report on that visit to the manager and the Commission. This is part of the homes quality assurance measures and helps to protect people who use the service. 31/08/2009 6 38 13 All potential hazards within the home must be risk assessed, so that risk is understood and can be managed. To protect the vulnerable people who use the service. 30/08/2009 7 38 13 The home must have a fire safety risk assessment and the home must comply with health and safety requirements made through other services. To protect people who use the service the service. 31/08/2009 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 7 Peoples plan of care should include information on any Page 33 of 35 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations advanced decisions they have made about their care; for it to be clear whether they have a person legally responsible for making decisions on their behalf and information required by medical services should they be taken ill suddenly. 2 7 Peoples plan of care should be regularly reviewed and include current and up to date information, so that staff are fully informed. Plans should always be signed and dated. The equipment necessary to keep the home clean and fresh must be available for staff use. The registered manager should ensure that she receives two good written references for people who wish to work at the home, so that she can make an informed judgment as to their suitability for the work. The management should ensure that all people associated with the home can, with confidence, comment on the service provided, otherwise quality assurance measures will be of no use. There should be two staff recording the debiting or crediting of any money in a persons account at the home. This protects both the person and the staff. Staff should receive formal, one to one, supervision of their work on a regular basis to support their daily working practices. Hot water should not be distributed to a bath at more than 43 degrees centigrade, so that the risk from scalds is removed. Each bath should have pre-set valves of a type unaffected by changes of water pressure and which have fail safe devices fitted. 3 4 19 29 5 33 6 35 7 36 8 38 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. 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