Inspection on 13/05/10 for The Andover Nursing Home

This inspection was carried out on 13th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Andover Nursing Home 06/07/09

The Andover Nursing Home 08/07/08

The Andover Nursing Home 25/04/06

The Andover Nursing Home 13/12/05

The Andover Nursing Home 04/07/05

The Andover Nursing Home 14/02/05

The Andover Nursing Home 26/05/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for older people Name: Address: The Andover Nursing Home Weyhill Road Andover Hampshire SP10 3AN     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: Kima Sutherland-Dee     Date: 1 3 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: The Andover Nursing Home Weyhill Road Andover Hampshire SP10 3AN 01264333324 01264332063 matron@andovernursinghome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr B J Puddepha,Mr P J Puddepha Name of registered manager (if applicable) Type of registration: Number of places registered: care home 87 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 to be accommodated is 87. The registered person may provide the following category/ies of service only: Care home only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical Disability (PD) Old age, not falling within any other category - (OP) Dementia (DE) Date of last inspection Brief description of the care home The Andover Nursing Home is a privately owned, purpose-built care home for service users over the age of 65. The home is registered to provide personal and nursing care to service users who are physically disabled or who have dementia. The home is divided into two units. One unit is on the lower ground and ground floors and provides Care Homes for Older People Page 4 of 37 0 0 0 Over 65 0 0 0 Brief description of the care home care for older people with physical disabilities. The second unit is on the first and second floors, providing care for residents with dementia. Each unit has sitting and dining areas and there is a large lounge off the front entrance. The home is in a residential area of Andover, on a main road and close to local amenities. The home has a large garden to the rear and a small seating area at the front; there is a car park at the front of the home. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We prepared for this inspection by reviewing the last inspection report dated the 6th July 2009. We also looked at the action plan for improvement that the manager had developed in agreement with social services following a number of safeguarding concerns at the home. Our findings evidence that this action plan is not yet met. We also reviewed any other information that we had about this home since the last inspection. We visited the home for an unannounced inspection on the 13th May 2010 and this inspection lasted for 9 hours. During the visit we spoke with the care consultant and the provider as the registered manager was on holiday. We also spoke with a number of the residents, staff, three visitors and a physiotherapist and we reviewed a sample of the documents and records,as well as observing the care. The care consultant informed the commission that the current fees are 826.48 pounds per week for those that fund their own care. For people funded through the Primary Care Trust the fees are 695.00 pounds per week and for those funded by social Care Homes for Older People Page 6 of 37 services they are 487.85 pounds per week. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: All prospective residents need to be assessed so the home can assure them that those needs can be met prior to moving into the home. Each resident must have a care plan that identifies their needs and gives the staff the information they need to offer care in a way that the residents prefer. The residents must be protected from risks and the staff need to have information about how they can safely assist people to move around the home using mobility equipment. The care staff must maintain accurate daily records that give details about the care that each resident needs. These records must include details about the amount of food and fluids that the residents have had if this has been identified as a need. Not all of the residents are given the opportunity to participate in appropriate activities that suit their needs. The residents or their families must be asked about their interests and offered appropriate group or individual activities to choose from. The residents must be offered food that suits their needs and this includes special diets. The staff must be aware of the food likes and dislikes of each resident and any special food requirements. The manager must ensure that all complaints are managed according to the homes complaints procedure. The residents must be protected from harm and neglect by the staff maintaining suitable records that allow them to monitor the health of the residents. The manager must ensure that the staff report any residents who have deteriorating health and this must be referred to the appropriate agencies. The manager must ensure that the staff who administer medication are competent to do so. The records must be signed appropriately and medication must be administered as prescribed. Care Homes for Older People Page 8 of 37 The manager must ensure that the residents live in a home that is free from unpleasant odours and free from the risk of cross infection. The staff must be regularly supervised so that the manager can make sure that all the staff are working to a consistent standard for the welfare of the residents. The manager must find ways of seeking the views of all the residents. These views should then be used to make improvements to the home for the benefit of the residents. The manager should make sure that they manage the home effectively and that they fully implement the action plan and sustain any improvements for the benefit of the residents. Since the inspection a further sixth safeguarding referral has been made by a district nurse. This involved serious concerns about the nursing care and the records and the administration of medication. Social services will be carrying out further reviews at the home and the staff will require further training. As a result of this referral a senior member of staff has been dismissed and the manager has resigned. The deputy manager and a care consultant are temporarily managing the home on behalf of the providers. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their relatives have the information they need to make an informed decision about the home. The home has not always assessed prospective residents needs before they move into the home. The home cannot therefore assure prospective residents that it can meet all of their needs. Evidence: No new admissions have taken place at the home since the manager and the provider agreed to voluntarily suspend admissions in March 2010. This suspension followed safeguarding concerns at the home and the County Council placing a caution on the home, which meant they would not fund places until the home had agreed and met an action plan for improvement. We saw one previous admission assessment and this had not been completed for all areas of health and personal care needs. All prospective residents are given a copy of the service users guide and this was seen to be available in each residents bedroom. This guide contains information about the Care Homes for Older People Page 11 of 37 Evidence: services at the home, the staff and the facilities. The manager is in the process of updating the statement of purpose and this should be available by the end of July 2010. All new residents or their relatives sign a contract and this includes the terms and conditions of the home. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are very caring but it is not always possible to demonstrate that all of the residents personal care or nursing needs are being met, through the lack of adequate recording. The staff do treat the residents with dignity and in privacy. Medication is stored correctly but staff are inconsistent in the way they record the medication and they have failed to correctly administer medication as prescribed. Evidence: A sample of seven care plans were reviewed. The care plans contained a statement about the rights of the residents regarding confidentiality, therefore their permission was sought before the plans were reviewed. Four of the care plans had been updated and they included information about the care and personal needs of those residents. The information about the persons preferences had been included such as when they liked to have a bath and how the staff could help them communicate. One care plan had indicated the need to encourage independence and the staff had made sure the bed was at the right height to make transferring from the bed to a wheelchair easier for the resident. Care Homes for Older People Page 13 of 37 Evidence: Three of the care plans had brief information that did not always indicate how the staff should provide the care, or the residents preferences about their care. These included statements such as Maintain .... dignity at all times but no guidance about the practical steps the staff should take to achieve this. An action plan had been agreed between social services and the home manager to improve the care plans and record keeping following a number of safeguarding issues at the home. Two social workers attended the home on the same day as the inspection to review a number of the care plans. They stated that although some progress had been made, the care plans were inconsistent and required further improvements. They are continuing to review the care plans over the coming weeks. The staff are required to keep daily records of the care that they gave according to the care plans. Again this was inconsistent. Daily notes were seen for one resident for one week. Most of the records were detailed but on two days the staff had written All care given. This is an inadequate record of what care was given that day. Three care plans had details about making sure the residents were moved at certain times to protect their pressure areas for example change position every two hours and when in bed. We asked the staff how this was recorded and they were unable to show any evidence that the resident had been moved. The staff said they help the person use the toilet but apart from that they stayed in their chair with a special cushion. One resident required a fluid and food chart to ensure that they remained hydrated and that they had adequate nutrition each day. A trained nurse said the staff had had recent training in the importance of making sure people had enough fluids and in maintaining the records. The staff have also been instructed to report to senior staff if a resident is not drinking or eating enough. The chart for this resident was checked for the day of the inspection. There were three entries made but they indicated that between 9.00a.m and 1.00 p.m the resident would not have received enough fluids. This had not been reported. The nurse stated that this resident often refuses food and drink but this was not recorded in their care plan and no alternative arrangements had been made to ensure that the resident remained hydrated. The action plan stated that One person each day would be responsible for ensuring that adequate nutrition had been given to all residents in their care but this was not working in practice. Since this inspection a sixth safeguarding referral was made by a district nurse. Concerns were raised about the way a resident was being nursed and this had not been reported by the staff. This has resulted in the dismissal of a senior nurse and the resignation of the registered manager. Social services are following this up with a Care Homes for Older People Page 14 of 37 Evidence: further review of care at the home. The trained staff said that it was sometimes difficult and frustrating completing the nursing notes every day as the computer system where they are maintained was really slow. The provider explained that the computer system was due to be checked in the next two weeks which should speed this up. Two staff were able to give a detailed description of the care they offered to one resident. They could describe the persons needs and what they do to meet those needs. They said they write up the care they give in the daily notes and all the fluids the resident has had. They said that they do sometimes find gaps in the charts and they ask staff to complete these. They also said that they report any changes to the trained nurses. The care plans did include risk assessments. These included the risks for moving and handling, falling, pressure sores and nutrition. These assessments along with the care plans had been reviewed at least monthly. When a resident had been discharged from hospital their risk assessment and care plan had been updated to reflect their changed needs. It was not always possible to determine if the actions to minimise the risks to the residents are being taken each day because of the lack of recorded evidence. All of the residents and the relatives we spoke with said the care was really good and the residents were happy at the home. Comments included I think the staff are wonderful, we are impressed by how genuinely fond of our family member the staff are. We came to the home at night recently and the staff were in and out of our relatives room all the time and we were made to feel welcome The staff are friendly and more than charming. One visitor said the care was good and my relative tells me they like it at this home. Two care staff said they really loved caring for the residents and they enjoyed their job. The home provides trained nursing staff at all times. The involvement of other health care professionals had been recorded in the care notes. A physiotherapist employed part time at the home said that the staff were friendly and caring. They also said that they are told about any changes to the residents and they write up the assessments and treatments during every visit. The trained nurses administer the medication each day. We saw part of this process and discussed this with the nurse responsible. The medication is stored correctly and the charts that record the medication that had been given were completed. The nurses are not consistent in their practice. One nurse signed the charts when they took the medication from the packaging but before they gave this to the residents. Another Care Homes for Older People Page 15 of 37 Evidence: nurse signed after they gave the medication to the resident and noted that it had been taken. The care consultant at the home stated that medication should only be signed for after it had been given to the resident. One nurse said that they would like to meet regularly with the other trained staff to discuss practice issues and ensure everyone was following the same guidance. One relative said that when a new medication had been requested, the home had been very quick to get this and administer it to the resident. The action plan developed by the home stated that the staff would review the homely remedies policy, these include items such as vitamins and mineral supplements and some products that can be bought but have not been prescribed. The staff have changed the medication charts to include all medication including any homely remedies. Since the inspection, a safeguarding referral had been made by a district nurse and there were concerns that a prescribed medication had not been given to a resident. The district nurse asked the staff about this and the staff did not give a satisfactory account of when or why this medication should be given. Care Homes for Older People Page 16 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not fully meeting the social needs of all of the residents. Visitors are welcome in this home. The meals need to meet the dietary needs of all of the residents. Evidence: The home employs two activities co-ordinators. During the inspection they had scheduled the hairdresser as an activity. Because the hairdresser had cancelled they did not know what to do instead and required prompting from an administrator to begin planning an alternative for the residents. The care consultant stated that hairdressing should not be counted as an activity anyway as it is part of peoples care. The staff produce a useful monthly newsletter for the residents and their relatives. This included an activity calendar for the month. The opportunities on offer included a PAT dog visit, fellowship group, scrabble, quiz and painting sessions as well as a visit to a local cafe. The newsletter also had information about staff changes and residents birthdays and about how to compliment the home or make a complaint. The activity calender would appear to offer the residents a good variety of activity but while talking to the residents and staff it seems that the same more able residents make use of the activities but those with more advanced dementia may not Care Homes for Older People Page 17 of 37 Evidence: participate. The staff said that sometimes the activities take place in the unit for people with dementia but they usually happen in the activities room or the main downstairs lounge. This means that the people with more advanced dementia are not being given the opportunity to participate in appropriate activities. Staff said they would like to get to know the residents better. They said We dont know anything about the residents. When they come in we dont find out about their lives unless the relatives tell us. They thought a family history that listed peoples hobbies and interests would be useful so they could talk to the residents about this and engage them in their interests. After the inspection, the care consultant informed the commission that a social history was available in the activities folders but the staff had been unaware of this. Regular residents meetings are held but the staff on one unit said that the residents from this unit did not attend, although they added that some of the relatives go. This was confirmed by one visitor who said that one of their relatives attended the main meeting once a year. The newsletter for May 2010 included a reminder for relatives to complete an inventory of the residents belongings and to add to this when new items are brought in to the home. This is for the protection of the residents. The residents are able to bring in their own furniture and their rooms were individual and personalised. Eight residents were sitting in a large area on one unit where they eat breakfast. There was a radio playing quite loud popular music while staff attended to these residents. When asked, one resident said they did not mind the music but then went on to speak about the singers she liked. After some prompting the staff turned the radio off. There was then some discussion among the staff about getting some more appropriate music for the residents. There were many visitors to the home during the inspection and they said they were made to feel welcome. Some visitors were sitting playing cards with their relative and they had been supplied with tea and something to eat. Two visitors said that when they had needed to be at the home during the night the staff could not have been nicer and they were offered drinks. They added that their children and the dog were also welcome to visit. The cook at the home said that they get to know peoples likes and dislikes and there are always two options served. They said that the residents could choose at the mealtime or have an alternative. The home states that it caters for special diets such as vegetarian. The cook said that the day before the inspection the staff had ordered a pasta bake with cheese for one resident who was on a dairy free diet. The cook had to check this and offer a dairy free alternative. The staff had not been aware of the Care Homes for Older People Page 18 of 37 Evidence: residents needs. The residents food preferences were not recorded in the care plans. The chef changes the menu every four weeks and this is available for the residents or their relatives to comment on. The residents said they liked the food and two relatives said the food looked good. One relative said that they point out to the staff if the resident does not like something. The dining rooms were very busy at meal times and some residents sat in their chairs with a tray on a folding table. Others chose or needed to eat in their rooms. The staff did assist people with their meals as needed. Care Homes for Older People Page 19 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be confident that their complaints will be taken seriously but not that the correct complaints procedure will be followed. The residents are not being protected from abuse because the staff have not been reporting their concerns about peoples health. The manager needs to implement and sustain the action plan. The lack of correct recording is putting residents at risk of harm or neglect because the staff are not able to monitor if their health is declining or improving. Evidence: The home has a complaints procedure and this is available to the residents and their relatives in the service users guide. The residents and their relatives were reminded about how to make a complaint in the May 2010 newsletter. One relative said they would be happy to speak to the staff if they had any concerns. One complaint had been received from a relative but this had not been properly recorded or managed. The manager is responsible for following the procedure and for discussing any complaints with the providers at their management meetings. The staff were clear about the actions they would take if they had any concerns regarding safeguarding the residents. All of the staff have had training in safeguarding in April 2010. The staff were also clear about and had used, the whistle blowing procedure when Care Homes for Older People Page 20 of 37 Evidence: they needed to report concerns about another team member. Between January and April 2010 the home has had five safeguarding concerns and this has led to social services working with the home to make improvements and to protect the residents. The main findings from these safeguarding issues were that the home had to improve their care planning and recording systems and that the staff required training in safeguarding and manual handling. The home also agreed to increase the staff numbers, to start supervising staff and to change the respite care admission and discharge processes. Since the inspection, we have been informed by social services that there has been another safeguarding incident at the home. This was referred by a district nurse who was concerned that a resident was not being cared for appropriately and that the records about their care were inadequate. The district nurse did ensure that the residents care changed by the following day but the care was still not adequate. They also had concerns that the care had not been properly recorded. The manager of the home had not reported any concerns about the condition of this resident prior to the nurse raising concerns. The trained staff had a professional responsibility to report their concerns to the manager or to the appropriate authorities but they had failed to do so. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good range of facilities at the home for the benefit of the residents. Improvements need to be made regarding the risk of cross infection and odour. Evidence: The home is purpose built and it has several areas for sitting, dining and for meeting visitors. The home is divided into two units and each of these has communal areas and facilities, there is also a large activities room downstairs. The service employs cleaning staff and maintenance staff. There were communal areas of the home that required redecoration. The provider and the manager have a plan for improving the home, decorating and prioritising the replacement of worn items. The residents said they liked their rooms and they were comfortable. The homes bedrooms are well furnished and all are en suite. The bedrooms contained many personal items. The home employs a physiotherapist who assesses if the residents require equipment. This had then been supplied. The residents were seen to use their own mobility equipment and one resident had been recently reassessed as needing a wheelchair. Two areas of the home had an unpleasant odour and the care consultant stated that this would be addressed. There were a large number of used tissues spread around the floor in one upstairs sitting area. The staff working in this area required prompting to remove these. A solution needs to be found to reduce the risk of cross infection. Care Homes for Older People Page 22 of 37 Evidence: In a downstairs corridor there was a picture that was hanging level with the handrail. When this was touched it came away and this arrangement both impeded the use of the handrail and caused a potential hazard to the residents. The picture was removed from the area. The staff have had training in infection control and the equipment they require is available such as gloves and aprons. The staff were seen using gloves when they were helping to serve the meal. Care Homes for Older People Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are cared for by a safely recruited and trained staff team. The staff have failed to put their training into practice regarding care planning and daily records of care. Evidence: The staff said that the staff numbers had increased recently and this allowed them more time to care for the residents and spend time with them. The residents and three visiting relatives said that the staff were marvellous and cheerful. There are two trained nurses on each unit during the day as well as the care staff. The staff said that occasionally there had only been seven staff on each unit due to staff sickness and then they had been rushed but usually there were 10 or 11 staff. The care consultant said they had looked at the skills the staff had and they had moved staff around the home to meet the residents needs. A member of staff said they had been asked to work on a different unit and they had appreciated this as they had got to know the residents and developed their own skills. The care staff and the nurses have failed, despite training, to maintain adequate records of the care that had been given to the residents. The trained staff and the care staff asked questions about what detail is needed in the care plans and in the daily records and about how much they should write. The increased staff numbers have meant that the staff can spend more time with the residents, but the increase Care Homes for Older People Page 24 of 37 Evidence: was also meant to give the staff more time to keep accurate records. A sample of five staff files showed that the home carries out all the required checks before people start work in the home for the safety of the residents. The staff confirmed that they had the correct checks and references before they began to work in the home. The trained nurses have valid professional registrations and these are renewed annually. The staff said they had induction training when they started work and a staff file confirmed that this training had been completed. One member of staff said this initial training had lasted about two weeks and they also worked with senior staff to learn their role and responsibilities. The staff said they had taken part in training, and the records showed that staff had completed courses in infection control, fire safety, moving and handling and safeguarding. The home has a member of staff who is qualified to train other staff in safe moving and handling techniques. One nurse said they had also attended training in dementia and managing aggressive behaviours. They added that they were due to attend a course in the correct management of catheters the following week. The staff meet regularly but the trained nurses said they would like to meet to discuss practice issues and to decide how to work in a consistent way. Care Homes for Older People Page 25 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is not meeting all of the residents needs. The manager is failing to adequately seek the views of all of the residents. The manager has not ensured that all of the staff are supervised. Evidence: Since the inspection, the registered manager has left the home. This follows a safeguarding referral by a district nurse concerning the nursing care of a resident that put this resident at risk and caused them harm. The providers had recently employed a care consultant to support the manager and help them to review the homes systems and to prioritise the managers work. The staff said the manager was a nice person who was supportive. However they added that The manager has had too much to do and they have struggled, they keep things to themselves. The staff said that they make decisions and small changes at the home and then tell the manager because when they ask they do not always get a satisfactory answer or a decision. The provider stated that they are committed to improving the home and they are implementing the action plan for improvement. However the manager had been failing Care Homes for Older People Page 26 of 37 Evidence: to put the action plan into practice. The manager has now left and the care consultant will continue to work at the home alongside the deputy manager. Once this finishes, they will visit the home monthly and produce a report for the providers. The home has a deputy manager. The providers must write to the commission to inform them of the interim management arrangements whilst they employ a new manager. Each head of a department such as catering, maintenance and staff training are responsible for producing a monthly quality audit. This had not been completed for three months by one department. The residents and their relatives can contribute their views at regular meetings, but staff on one unit said the residents did not attend these meetings. The home has not considered how they can engage all of the residents in seeking their views about the service and about any improvements they would like. The manager is responsible for informing the providers about any quality issues at the home during their monthly meeting. The staff said that they have just started to be supervised in the last month. Not all the staff have had this opportunity yet. The senior staff have had training in how to supervise the carers. One nurse said that they had started to be supervised by the manager. Two staff said that they have had a yearly appraisal of their performance but this had not always happened in the past. The staff said that they never get praised or thanked for what they do and this has been demoralising. One recently recruited member of staff has started to thank the staff and they said this was appreciated. The supervision of the staff is part of the action plan that has not been fully implemented. The home has the policies that are required and a sample of these demonstrated that the staff should be following the most up to date guidance. The policy for infection control was available to the staff in both of the units. The staff knew where they could access information and policies. The manager has ensured that the staff are trained to work safely. This has included moving and handling training. During the inspection we observed a carer helping to move a resident to the dining room for lunch, using a wheelchair. The footplates were in place as they should be, but one of the residents feet had fallen between these plates and was trailing on the floor. When asked, the carer stated that it was not normal for this resident and the carer had been busy trying to support the residents head. This practice did put the resident at risk of injury and it was discussed with the provider and the homes independent care consultant. This resident did have a moving and handling risk assessment in their care plan but this did not identify the risks of using a wheelchair Care Homes for Older People Page 27 of 37 Evidence: or how to minimise those risks. Other staff were assisting residents were using wheelchairs safely. Care Homes for Older People Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Prospective residents must have all of their needs assessed prior to moving to the home, unless they are admitted in an emergency situation. 30/06/2010 Prospective residents need to know that their needs can be met at this home before they move in. The provider must tell us in writing when this requirement has been met. 2 7 15 Every resident must have a detailed care plan. The care that is given needs to be recorded daily. This is so that the care plans give the staff the guidance they need to meet the residents needs. And also so that the residents health Care Homes for Older People Page 30 of 37 30/06/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action and welfare can be monitored. The provider must tell us in writing when this requirement has been met. 3 8 12 The registered person must 30/06/2010 ensure the care home is conducted so as to promote the health and welfare of the service users. The residents must have their health care needs met and recorded. So that the residents are cared for according to their individual needs. The provider must tell us in writting when this requirement has been met. 4 9 13 Medication must be 30/06/2010 administered as it is prescribed. If the medication is prescribed PRN, or as required, a qualified person needs to ask the resident if it is required or make an assessment of their need for the medication. So that the residents get their medication regularly and on time. Care Homes for Older People Page 31 of 37 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 The provider must tell us in writting when this requirement has been met. 5 9 13 The staff must record the medications that they have given to the residents. 30/06/2010 So that the records of medication administered are accurate and people recieve the medication they are prescribed. The provider must tell us in writing when this requirement has been met. 6 12 16 The residents must be asked 12/07/2010 about the programme of activities. So that the residents are able to choose to take part in suitable activities, in groups or individually. The provider must tell us in writing when this requirement has been met. 7 15 16 The residents must be 30/06/2010 consulted about their dietary likes, dislikes and needs and this must be recorded. Care Homes for Older People Page 32 of 37 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 So that the residents dietary needs are met. The provider must tell us in writing when this requirement has been met. 8 16 22 The manager and staff must 30/06/2010 always follow the complaints procedure. This is because the residents have a right to make a complaint and for this complaint to be be responded to appropriately. The provider must tell us in writing when this requirement has been met. 9 18 13 The manager and staff must 30/06/2010 always report any suspicions of abuse. This is because the residents have a right to be protected from abuse, harm or neglect. The provider must tell us in writing when this requirement has been met. Care Homes for Older People Page 33 of 37 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 10 26 23 The home must always be kept tidy and clean and any rubbish must be removed. 30/06/2010 This is because the residents have the right to be protected from cross infection. The provider must tell us in writing when this requirement has been met. 11 26 16 The home must be free from 30/06/2010 unpleasant odours. This is because the residents should live in a home that is clean and fresh at all times. The provider must tell us in writing when this requirement has been met. 12 27 18 The manager must ensure that the staff are putting their training into practice and they are competently maintaining the care plans and the daily records. 30/06/2010 This is because the residents need to have their daily care accurately recorded so that there is evidence that this Care Homes for Older People Page 34 of 37 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 care was given. The provider must tell us in writing when this requirement has been met. 13 33 24 The registered person must 30/06/2010 establish and maintain a system for reviewing and improving the quality of care and nursing. This system must provide for consultation with the service users. So that people have a say in their care and their views are recorded. The provider must tell us in writing when this requirement has been met. 14 36 18 The registered person must 30/06/2010 ensure that persons working at the care home are appropriately supervised. So that residents recieve care from staff who are appropriately managed. The provider must tell us in writing when this requirement has been met. Care Homes for Older People Page 35 of 37 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 15 38 13 Risk assessments must be completed for staff to follow when they are assisting residents to move around the home. 13/07/2010 This is because the residents have a right to be protected from injury when they are being helped to move around the home. The provider must tell us in writing when this requirement has been met. 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 Care Homes for Older People Page 36 of 37 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!