Inspection on 29/04/08 for Tendring Meadows Care Home

This inspection was carried out on 29th April 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tendring Meadows Care Home 17/09/08

Tendring Meadows Care Home 11/06/07

Tendring Meadows Care Home 12/05/06

Tendring Meadows Care Home 01/02/05

Tendring Meadows Care Home 09/09/04

Tendring Meadows Care Home 13/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Tendring Meadows Care Home The Heath Tendring Clacton on Sea Essex CO16 0BZ Lead Inspector Francesca Halliday Unannounced Inspection 29th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tendring Meadows Care Home Address The Heath Tendring Clacton on Sea Essex CO16 0BZ 01255 870900 01255 870973 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) G A Projects Limited Care Home 53 Category(ies) of Learning disability over 65 years of age (1), Old registration, with number age, not falling within any other category (53) of places Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 53 persons) One person, over the age of 65 years, who requires care by reason of a learning disability whose name was made known to the Commission in September 2003 Five persons of either sex, aged between 60 and 65 years, who require care by reason of old age only The total number of service users accommodated in the home must not exceed 53 persons 11th June 2007 3. 4. Date of last inspection Brief Description of the Service: Tendring Meadows Residential Home is in a very rural position to the north of Colchester. It is registered to provide personal care for 53 older people. The home is also registered to accept five residents between the ages of 60 and 65. The resident accommodation is on two floors, the first floor being accessible by both stairs and lift. The home has a mixture of single and double rooms available. The accommodation is divided into four distinct areas, Clover, Poppy, Primrose and Bluebell. There are communal rooms in each of the four areas. One of the lounges is predominantly used as an activities area. The fees at the time of inspection in April 2008 were £371 to £450. These fees did not cover private chiropody, hairdressing and toiletries. For more up to date information on fees please contact the home directly. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means that people who use this service experience poor quality outcomes. This key inspection was carried out on 29th and 30th April 2008. The term resident is used throughout the report to refer to people who live in the home and the term “we” refers to the Commission for Social Care Inspection. Derek Brown inspecting pharmacist for the Commission carried out an inspection of medicines management in the home on 29th April 2008 and the findings are included within this report. The manager was present throughout the inspection. We spoke with six members of staff including the manager and with four residents during the inspection. We spoke with one relative prior to the inspection concerning a complaint and with two relatives who were visiting at the time of inspection. We spoke with the GP and district nurse for Tendring Meadows and a nurse specialist from the Primary Care Trust following the inspection. We carried out a tour of the premises and sampled the records held in the home. We also looked at the Annual Quality Assurance Assessment (AQAA) completed by the manager. The last key inspection was carried out in June 2007 and an additional random inspection was carried out in January 2008 to follow up on the outstanding requirements from the key inspection. In January and February 2008 there were five safeguarding referrals. Due to concerns about residents’ safety and about standards of care at Tendring Meadows, Essex County Council (ECC) suspended their contract and placed an embargo on further admissions to the home. Frequent monitoring visits were carried out by both ECC and district nursing staff. They also gave considerable support, advice and training to staff in the home. The decision concerning the embargo was reviewed on 27th March 2008 and due to continued concerns was still in place at the time of this inspection. In July 2007 Tendring Meadows submitted an application to us to be registered for dementia care. Following our inspection in September 2007 the application was refused on 16th January 2008, as the home was not suitable for dementia care. What the service does well: Residents told us that they were happy in the home. One resident said, “The home is nice, the staff are good and I’m happy with the food”. Another Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 6 resident said “I like the staff they’re good to me”. A relative we spoke with said, “All of the carers are so kind and friendly. They are very caring”. What has improved since the last inspection? What they could do better: Despite the fact that there had been five safeguarding referrals, made by healthcare professionals visiting the home, staff had not received any refresher training on how to identify, prevent and report the different types of abuse. Verbal complaints were not being recorded and complaints were not being investigated and responded to appropriately. The home and grounds still did not provide a safe environment for residents. This was particularly of concern as the home’s GP indicated that a number of residents in the home had some form of dementia. The provider had failed to address many of the requirements in the last two inspection reports that related to the environment. There were unguarded heaters in all the communal rooms. The grounds were not safe for frail older people or people with dementia. Hazardous chemicals were not locked up and were not labelled appropriately. Some staff were working extremely long hours and a mix of day and night duty in the same week. At times there were insufficient staff to supervise residents in such a large premises. A letter of serious concern highlighting these issues was sent to the provider following this inspection. The manager had no management experience prior to taking up this present post. They had received considerable input, training and support from outside agencies. The overall standards of care had improved considerably since the random inspection in January 2008. However, we are concerned about whether the home will be able to sustain the improvements made in the past few months when all the external support is withdrawn, as limited support had been made available from within the company. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4, 5 Quality in this outcome area is adequate. Prospective residents can be assured that their needs will be assessed prior to admission but cannot be assured that the home can fully meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre-admission assessment documentation had been revised and was much more comprehensive. We were not able to assess the admissions process, as there had been no recent admissions. One resident spoken with said that they had visited the home before admission and after a six-week trial had decided to stay. The home is registered to care for older people. We received an application to register the home for dementia care in July 2007. The application was refused as staff were not trained in dementia care and the premises was not safe and secure for people with dementia. The home’s GP indicated that a number of Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 10 current residents had either been admitted with dementia or had developed the condition whilst living in the home. However, the premises and grounds were not safe for residents with dementia. There were unguarded heaters, hazardous chemicals were not appropriately stored and labelled and the front door was not kept locked. The grounds were not safe and level for both people with dementia and people with problems with balance or mobility (see the section of the report on the environment for details). The manager, deputies and senior carers had received some dementia care training. At the time of inspection none of the carers had received dementia care training. This had been a requirement in the inspection report of June 2007 and the training should have been completed by October 2007. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is adequate. Residents can be assured that their wishes are respected but cannot be assured that all their needs will be identified and that they will be fully protected by the home’s medication procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives spoken with at the time of inspection told us that they were very happy with the standard of care in the home. Residents told us that staff respected their privacy in their room. Staff were observed to have a courteous and respectful manner towards residents. Staff had received training in care planning and the standard of care plans and risk assessments had improved considerably. The new care plans we sampled were more individualised, contained details of residents’ preferences, abilities and care needs and the risk assessments assessed the risk to the individual resident. Staff are to be commended for the work they had done to improve the care documentation. However, following our discussion with staff it was evident Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 12 that they were still not writing some key information in residents’ care plans and that this was resulting in a lack of consistency in their approach to some aspects of care. The manager was regularly checking care staff’s understanding, knowledge and use of the care plans. The recording of accidents had improved but details of the accident were not always being recorded in the daily care records and care plans were not always being updated. The manager said that they were hoping to introduce a key worker system in order for residents and their relatives to have a specific carer to liaise with. There was evidence from the records we sampled, and our discussions with staff, that they were actively trying to improve the nutrition of residents who had a reduced appetite or were losing weight. Residents we spoke with said that they had optical checkups. Residents and relatives confirmed that a chiropodist visited the home on a regular basis. Staff told us that they contacted a dentist if residents had any problems with their teeth. Staff told us that they had extremely good support from the GP and district nurses. A relative said that the resident they visited saw the GP whenever there were any health concerns. The records relating to GP and district nurses’ visits had much improved and now contained more information relating to changing care needs and instructions about treatment. Our specialist pharmacist inspector examined practices and procedures for the safe handling of medicines. There were written procedures for the safe use of medicines but they were very brief and there was a need to expand these for the protection of residents e.g. to include the use of home remedies. Medicines were stored securely and the temperatures of the storage areas were monitored regularly to ensure medicines were kept at the appropriate temperature to maintain their quality. Supplies of medicines in use for residents were kept to a minimum but there was a need to ensure that the date of opening was clearly recorded on medicines with a limited shelf life. This will prevent medicines being used for the treatment of residents beyond their usable life. There was a cupboard provided for the storage of controlled drugs but this did not comply with the Misuse of Drugs (Safe Custody) Regulations since it was not fixed to the wall properly. A register was used to record the use of controlled drugs but there was a need to clearly record the name and address of the supplier (or recipient on disposal). Clear records were made of when medicines were received into the home, administered to residents and when they were disposed of. This provided a good audit trail. Although recording of the use of creams and ointments etc. could be improved. There were a number of examples where the printed medication forms carried entries for medicines no longer prescribed, or where the printed instruction was for the medicines to be given regularly but they were only being given on a “when required” basis. There was a need to Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 13 discuss this with the prescriber and with the supplying pharmacist to ensure the records were accurate. There were also a number of occasions where the doses of medicines had changed but no justifiable reason for the change could be found in the care notes. Where handwritten changes or additions are made to the medication records it is good practice for these to be signed and dated by the person making the change and for these to be checked for accuracy by a second person. We watched one carer giving medicines to some residents and they were seen to given medication to residents with respect and to handle the medication safely. Staff only administered medication following a training programme and an assessment of competence. However, the current level of training was basic and additional training was needed so that residents were protected from a risk of harm. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 Quality in this outcome area is good. Residents can expect a range of social activities and to be consulted about choices on the menu. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had two part time activity co-ordinators. However, one of them was on long-term sick leave. Despite this the overall standard of activities had improved in the home. The Residents who did not want to join in activities told us that they appreciated the fact that the activity co-ordinator spent time in their room having a chat. Staff told us that one resident went for regular walks in the grounds. Since the last inspection staff had arranged for a minister to hold a service in the home once a month. They were planning to develop a vegetable patch for residents and purchasing a barbecue so that they could have more activities outside. Two residents spoken with said that they would like to have animals visiting the home as they missed the pets that they had left behind. The activity coordinator spoken with said that they were hoping to arrange a trip out to Colchester Zoo. A sweet trolley had been introduced and residents were asked Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 15 about they type of things they wanted on the trolley. We sampled some of the activity records. Staff were using codes for the different type of activities but this made it difficult to assess their participation, enjoyment or response to the activities. The manager said that the two activity co-ordinators were due to attend a day course on activities in May 2008. She said that she was exploring how the home could further improve its links to the community. A resident told us that they tried to be as independent as possible and that they got up and went to bed when they wanted and had their meals in their room as that was what they preferred. Staff were able to demonstrate to us how they promoted choices in residents’ daily lives and this was evidenced in the improved care documentation. Residents we spoke with said that they were generally happy with the food. They confirmed that choices were available, although one resident did not consider that there was enough choice. The menus were inspected and they demonstrated that choices were available. A relative told us “the standard of food has improved”. The kitchen was inspected. It was clean but some of the sealant around sinks was damaged and growing mould and needed to be replaced. Some of the food in fridges and freezers had no date labels so that it would not be possible to establish the dates by which the food should be safely used. Residents had recently been consulted about their views on the food served and as a result some changes to the menu had been made. The manager told us that all the kitchen staff were completing food hygiene level 2. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is poor. Residents cannot be confident that their complaints will be fully investigated or that staff have an understanding of how to protect them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints policy, which was on display in the home. This needed to be updated with the name of the current manager. Residents told us that they would talk to the carers or the manager if they had any problems but said that they had not had any recent concerns. We received one complaint from a relative about care in the home prior to this inspection. Essex County Council (ECC) investigated this complaint and others about the same resident under their safeguarding procedures. The complaint highlighted poor care, poor management and considerable problems with staff communication over health and care related issues and also poor staff communication with relatives. The complaint responses we saw were very defensive, did not fully address the health and care related issues raised and put some of the responsibility for raising issues of poor care back onto the relatives. The ECC safeguarding team was taking these concerns up with the provider. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 17 The records of these complaints and investigations identified that staff were not documenting verbal concerns and complaints. The documenting of verbal complaints was a requirement in the last two inspection reports; however, staff spoken with at this inspection confirmed that they were still not documenting them. If staff had documented the concerns raised by the relatives, this might have prompted actions to address the many issues raised and prevented the need for a safeguarding referral. There were five safeguarding referrals in January and February 2008. Staff did not identify any of the safeguarding issues and they made none of the referrals. Four referrals were made by a visiting healthcare professional and one referral was made as a result of the above complaint. The records indicated that six staff had not received any safeguarding training for over two years and only one member of the staff had received safeguarding training from 1st January 2008 to the date of this inspection at the end of April 2008. However, due to the seriousness of the safeguarding issues and the lack of staff referrals it is essential that all staff receive additional training to ensure that they have a full understanding of the types of abuse that could occur and the actions to take if abuse is suspected. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24, 25, 26 Quality in this outcome area is poor. Residents cannot be confident that the environment is safe and is maintained in a hygienic condition. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The overall security of the building had improved since the last inspection and there were alarms on the majority of external doors to alert staff if a resident left the building. However, we noted that the front door was at times left open with the reception area unattended. This was confirmed by a visiting health professional. The grounds were still not safe and secure for residents with dementia or safe and level for residents who had problems with balance or mobility, despite this having been a requirement in the last inspection report. At the front of the home there was a patio area with no fencing, which was open to the car park and gave access onto the road. The back garden had a number of hazards. The garden was not level, the ramps into the garden did Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 19 not have rails and there was a long ditch, which had a stream running along it after it rained. A number of freestanding heating towers and radiators were located in the communal areas and on the day of inspection we found the majority of them extremely hot to the touch. There were still no guards in place preventing residents coming into contact with the hot surfaces, despite this having been a requirement in the last two inspection reports. The heating towers had notices stating that they were extremely hot but these notices would be unlikely to be understood by a resident with dementia. The manager told us that some new linen had been delivered since the last inspection. However we still saw extremely lumpy pillows, frayed towels and thin grey sheets in use. A number of the rooms needed redecorating or the paintwork or wallpaper retouched. Some of the furniture seen needed to be repaired and some in extremely poor condition replaced. Some of the carpets seen in bedrooms were stained. The manager said that they would have further intensive cleaning carried out but if this did not improve the state of the carpets she would request replacements. She told us that new armchairs were on order to replace the stained ones in use. The last report contained a requirement about storing and appropriately labelling cleaning products. However, we observed a cleaning trolley with chemicals on it but with no staff member in the vicinity. It was very poor practice to leave a trolley with chemicals unattended as this placed residents with dementia at risk. The chemicals had been decanted from the original containers. One had no label at all and others only had general labels such as “disinfectant” and “air freshener”. If there was an accident with the chemicals this could mean that staff would not know the actions to take to minimise harm and would not have the appropriate information to give the GP or hospital about the chemical used. Residents told us that they were happy with the standard of the laundry service. The laundry assistant confirmed that the home had washing machines with a sluice facility and that staff were using red dissolvable bags appropriately. Two members of staff considered that cleaning could be improved and that at times there had been only one cleaner for the whole home. A relative told us “they didn’t have a cleaner for a week so the room wasn’t vacuumed”, but said that the standards had improved with the new cleaner. The manager said that a cleaner with poor standards had now left. One of the occupied bedrooms we inspected was in an extremely poor condition. There was an overpowering smell of urine, the carpet was highly stained and had become so loose and rucked-up that it was a trip hazard. The manager confirmed that the resident’s room had been in this condition for some period of time. However, the annual quality assurance assessment stated that residents’ rooms were kept “fresh and clean”. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 Quality in this outcome area is adequate. Residents cannot be assured that there are always sufficient appropriately trained staff to meet their needs. Residents are not protected by the home’s recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The GP, district nurse, specialist nurse and staff from Essex County Council who visited on a regular basis advised us that the home was at times “understaffed”. Residents told us that staff generally responded to the call bells fairly promptly but said that at times they had a long wait. There were five staff on duty during the day and four at night for twenty two residents at the time of inspection. However, staff were covering four units and some residents were not be able to use a call bell, making it essential that staff regularly supervised and monitored their needs in all parts of the home. Relatives making the complaints said that they frequently visited the home and did not see a single member of staff for the whole time of their visit. Visiting professionals also said that they regularly had problems locating staff in the home. Some of the staff from Latvia were working very long hours, sometimes in excess of 60 or 70 hours each week. Some of them were also working both day and night shifts in the same week, with sometimes only six and three Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 21 quarter hours between the end of the night shift and the beginning of the late shift. Some of the Latvian staff were also working in the kitchen for one shift each week and attending college to learn English in their one day off. These long hours and the mix of day and night duty could impact negatively on the standard of care that they were able to provide. According to the rota on some nights there was no senior carer on duty for the whole home. Care staff said that they carried out some laundry and cleaning duties and also covered the kitchen for four evenings a week as there was no kitchen assistant on those evenings. The home did not have a rota for ancillary staff. Some ancillary staff covered a number of roles, it was therefore difficult to ascertain how many staff were on duty each day, whether these staff had received appropriate training for each role and whether there were sufficient staff to meet residents’ needs. The induction for new staff had improved since the last inspection but still was not in line with Skills for Care. However, the manager had been using a number of the Skills for Care knowledge sets for in house training to improve staff competence. Six care staff had completed National Vocational Qualification (NVQ) at level 2 and four staff were undertaking the course. One carer had completed NVQ level 3 and four had nearly completed the course. We looked at a sample of three staff records. Staff had criminal records bureau (CRB) and protection of vulnerable adults (POVA) list checks carried out, but in two of the records inspected there was no evidence that two references had been obtained prior to employment. One of the visiting health professionals considered that some of the training being accessed by the staff was not at an appropriate level; our inspecting pharmacist confirmed this. Both of them said that they were advising the manager about further, more appropriate training. According to the training records the majority of care staff had received moving and handling training but one senior carer had not received training for over two years. Five ancillary staff needed load management training. There were not sufficient staff with first aid training to ensure that there was a member of staff with training in dealing with accidents or emergencies on duty at all times. Only three care staff and three ancillary staff had received infection control training, despite this having been a requirement in the last inspection report. Infection control training was particularly needed as an outbreak of diarrhoea had spread through the home last year. The manager was trying to access training relating to the specific care needs of residents in the home, for example on diabetes, care of a tracheostomy and Parkinson’s disease. She was also downloading information from the internet in order to provide staff with additional information on these conditions. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 38 Quality in this outcome area is poor. The health, safety and welfare of residents is not promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the previous year there had been three managers covering the home. The changes in management had had a negative impact on the home. The standards of management had been poor and there was a lack of consistency of care. The poor standards of care had resulted in five safeguarding referrals being made. At the time of inspection the new manager had been in post for six months. She had no previous management experience prior to taking up this post. However, she was attending a management course and had also commenced the registered manager’s award. A relative told us that the home Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 23 was “more organised under the new manager”. Whilst considerable improvements had been made to the care under her leadership, it was of serious concern that there were so many outstanding requirements and safety issues in the home. The new manager was receiving considerable support from health and social care professionals. However, there was limited support from within the company. There was concern as to whether the improvements could be sustained when the external support was withdrawn. The manager was promoting a more open, positive and inclusive style of leadership. We were shown minutes of staff meetings and staff confirmed that there were regular meetings, improved communication and more management support. The manager carried out regular night visits to check on standards at night. This was very positive as it allowed the manager to check whether staff were meeting residents’ care needs at night as well as during the day. Staff told us that they now had regular supervision and appraisal, which they had never had in the past. The manager said that she was developing audits for the home and had sent out quality assurance questionnaires. The feedback from residents and their relatives was good and the manager was addressing some of the suggestions for improvements. The standard of the annual quality assurance assessment (AQAA) we received was an improvement on the AQAA submitted by the home last year. The registered provider was carrying out Regulation 26 monitoring visits to the home. However, the home did not demonstrate a commitment to quality assurance as so many health, safety and welfare issues remained outstanding. The manager was sending us appropriate notifications about events that adversely affected residents in the home. We inspected a sample of residents’ personal monies. The balances were correct and there were receipts available. The administrator told us that they managed the monies on behalf of residents and the manager audited the records once a month. We inspected the systems for servicing and maintenance of equipment. There was evidence that they were up to date apart from the electrical safety inspection, which was overdue. There was evidence that fire drills had taken place and that fire alarms were regularly tested. Water temperatures were checked on a regular basis to ensure that they were within safe limits for residents. The handyman was booked for training to carry out portable appliance tests. The annual quality assurance assessment stated that the management had a “good understanding of health and safety”. The plans for improvement in the AQAA only identified one of the health and safety issues. However, the number of hazards identified in the section on environment demonstrated that the health, safety and welfare of residents were not being protected. The majority of these hazards had been identified in previous reports and were Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 24 repeat requirements. However, no action had been taken to address them leaving residents at risk of harm. Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X 1 1 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 1 X 3 3 X 1 Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Staff must ensure that care plans are up to date and reflect residents’ current needs and that accidents are appropriately recorded in order that staff can provide the most appropriate and consistent care to residents. Timescale for action 01/07/08 2. OP9 13(2) Staff must provide accurate 01/06/08 records of prescribed medication in order to protect residents from risk. Controlled drugs must be recorded in accordance with the Misuse of Drugs Act and associated Regulations. Controlled drugs must be stored in accordance with the Misuse of Drugs Act and associated Regulations. All staff authorised to administer medication must follow a robust training course and be assessed as competent. This will protect residents from the risk of harm. 01/07/08 3. OP9 13(2) 4. OP9 13(6) 18(1)(a) 01/08/08 5. OP15 16(2)(i)(j) The damaged sealant on the basins must be replaced in order DS0000015329.V364682.R01.S.doc 01/06/08 Tendring Meadows Care Home Version 5.2 Page 27 to create a more hygienic kitchen for the preparation of residents’ food. Food in the fridges and freezers must have a use by date in order to reduce the risk of residents being served food that is past the date for it to be safely used. 6. OP16 22 All aspects of complaints must be fully investigated and resolved. Staff must document verbal complaints and action taken to address them in order to improve communication within the home and prevent recurrence of the same complaints. This requirement had a timescale of 21/01/08, which has not been met. Enforcement action is now being considered. 7. OP18 18(6) All staff must receive 01/07/08 safeguarding training in order that they can identify the different types of abuse that can occur and have an understanding of the actions to take if they suspect a resident is suffering from any type of abuse. The front door must be kept 29/04/08 locked at all times when there is no one at reception in order to ensure the safety of anyone who may be at risk of leaving the premises. Cleaning products must be safely stored and appropriately labelled so that they do not create a potential hazard for residents. This requirement had a timescale of 21/01/08, which has not been met. DS0000015329.V364682.R01.S.doc Version 5.2 Page 28 29/04/08 8. OP4 OP19 OP31 OP38 13(4) Tendring Meadows Care Home Enforcement action is now being considered. 9. OP19 OP4 OP38 10. OP25 OP4 OP38 13(4) 13(4) The grounds at both the front and rear of the home must be made safe for residents’ use. The timescale of 01/05/08 had not yet expired. The methods of heating in the home must not create a hazard for residents. This requirement had timescales of 01/10/07 and 01/05/08, which have not been met. Enforcement action is now being considered. Residents’ rooms must be kept in a safe, hygienic and wellmaintained condition. 01/05/08 29/04/08 11. OP26 OP31 OP33 23(2)(d) 29/04/08 12. OP27 18(1)(a) Staff must not work extremely long hours and a mixture of day and night duty as this could impact negatively on the standard of care they provide to residents. Sufficient staff must be available so that care staff do not have to carry out kitchen and domestic duties. This requirement had timescales of 31/03/07, 21/06/07 and 21/01/08 which have not been met. Enforcement action is now being considered. Staff must not be employed until all the required information has been obtained. Staff must have infection control training. This requirement had a DS0000015329.V364682.R01.S.doc 29/04/08 13. OP29 19(1) 29/04/08 14. OP30 13(3) 29/04/08 Tendring Meadows Care Home Version 5.2 Page 29 timescale of 01/04/08, which has not been met. Enforcement action is now being considered. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Hand-written changes or additions to medication records should be signed and dated by the person making the change and checked for accuracy by a second person. Staff should record more detail about residents’ participation in social activities in order to assess whether the home is meeting their social care needs. The home should consider having pets in the home or visiting on a regular basis to improve the quality of residents’ lives. The quality of linen, towels, blankets and pillows should be reviewed and replacements ordered when necessary to ensure that residents are not supplied with very poor quality and torn items. The staff rotas should identify all staff working in the home and their roles on each shift if this is subject to change in order to ensure that there are sufficient staff to meet residents’ needs. The induction should follow the Skills for Care common induction standards in order that a consistent standard of resident care can be provided. Sufficient staff should be trained in first aid so that there is a member of staff on duty at all times who can provide first aid to residents following an accident or emergency. 2. OP12 3. OP12 4. OP24 5. OP27 6. OP30 7. OP30 Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tendring Meadows Care Home DS0000015329.V364682.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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