Inspection on 03/03/09 for The Foundation of Lady Katherine Leveson

This inspection was carried out on 3rd March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Foundation of Lady Katherine... 12/05/09

The Foundation of Lady Katherine... 09/06/08

The Foundation of Lady Katherine... 06/07/06

The Foundation of Lady Katherine... 18/11/05

The Foundation of Lady Katherine... 10/06/05

The Foundation of Lady Katherine... 19/01/05

The Foundation of Lady Katherine... 14/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Foundation of Lady Katherine Leveson The Foundation of Lady Katherine Leveson Temple Balsall Solihull West Midlands B93 0AL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Brown     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: The Foundation of Lady Katherine Leveson The Foundation of Lady Katherine Leveson Temple Balsall Solihull West Midlands B93 0AL 01564772850 01564778432 Telephone number: Fax number: Email address: Provider web address: www.leveson.org.uk Name of registered provider(s): The Foundation of Lady Katherine Leveson care home 30 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Foundation of Lady Katherine Leveson was founded in 1674 to provide almshouses for women in need. It now provides sheltered and residential care accommodation for older men and women. The foundation, which is a charity, offers accommodation for 30 residential service users and 15-sheltered accommodation places. The Court of Lady Katherine Leveson is situated in Temple Balsall, lying between Knowle and Balsall Common. It is a listed building and the majority of service users live in self-contained accommodation in the Court Yard where they have views of the mature gardens and a secure and pleasant place to walk and sit. The accommodation is mixed, all have ensuite toilet facilities, and some have a bath or shower. There are a number of suites Care Homes for Older People Page 4 of 35 Over 65 30 0 Brief description of the care home comprising of a bedroom, small lounge, kitchen and bathroom. The Court of Lady Katherine Leveson has a Christian ethos, and although they will consider nonChristians, it is required that the people resident are sympathetic to the Christian ethos. There is also a 14th Century Templar Church on the premises and people are invited to attend the service on Sundays and other Christian celebrations. The registered provider is referred to as the Master and is an Anglican priest. Fees vary and are dependent on the needs of individual people. Items not covered by the fees include toiletries, private treatments such as physiotherapy and chiropody, hairdressings and newspapers. The homes ranges of fees are between £447 and £519 per week. For up to date fee information the public are advised to contact the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home without notice on a day in March 2009 and undertook a key inspection where we looked at the majority of the National Minimum Standards. The home gave us information in an Annual Quality Assurance Assessment (AQAA) before the key inspection. The AQAA shows how the home rates their performance in the areas set out in this report and what they intend to do to improve. During the inspection 5 peoples care was case tracked, this involves looking at all the records about this person and how the home manages their care. The pharmacist inspection lasted just over four hours. Six peoples medication were looked at, together with the Medicines Administration Record (MAR) chart and care plans. Two members of staff and two people living in the home were spoken with. All feedback was given to the deputy manager and manager. We also looked at the surveys that people had Care Homes for Older People Page 6 of 35 completed for the home. We looked around parts of the building and viewed the health and safety checks that had been undertaken. We spoke to 4 staff, the manager of the home and the Master who is the reverend of the church and the representative of the service provider. We were advised about concerns about the care of individual people living in the home. We last undertook a key inspection in June 2008 and a Pharmacist inspection was undertaken in July 2008. What the care home does well: What has improved since the last inspection? What they could do better: Further information needs to be collected about peoples mental health needs to Care Homes for Older People Page 8 of 35 determine whether people can be admitted safely and so that the staff can be aware of signs that show that a persons mental health needs are met or are deteriorating. Care plans and risk assessments must respond to identified need and when peoples needs change. Care plans should be in place for medication where this is prescribed, and end of life care and mental health where these have been identified as needs. Care plans should be reviewed routinely to ensure that any deterioration can be identified. The storage, administration and recording of medication must improve to ensure the safety and well being of people. We will be taking action to ensure this improves. Whilst in the majority of cases staff are employed with necessary checks being in place. one member of staff was employed without the necessary checks from the Criminal Records Bureau or the Protection of Vulnerable Adults list. Another was employed without references and this could put people at risk. This was a previous requirement and we will be taking action to ensure a consistent safe employment process is put in place. There was a lack of management and measures in place to ensure that people had a service that promoted their health and well being. Whilst people are happy with the service these are areas that people rely on the home to deliver well. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about what the home offers but not always about the terms of their stay and this may affect the choices they make. Details are not collected about all peoples needs before admission and this means there may be gaps in the care they receive. Evidence: Information is available to people wanting to come into the home in the homes handbook which contains the homes Service User Guide and Statement of Purpose. This is given to people when one of the management visits the person to assess their needs. The service user guide contains information about the homes current fees. At the last inspection in June 2008 people spoken to had received a copy of the handbook. The handbook contains information about the supported living accommodation on the site and there is also a website that people and their representatives can look at. This level of information allows people to make an Care Homes for Older People Page 11 of 35 Evidence: informed choice about whether this home will suit them. We found that there was a lack of clarity about a person receiving a lot of care in the supported living accommodation. People cannot be part of the residential service unless they are in part of the accommodation that is registered with us, as this breaches the homes conditions of registration. People can receive an extensive domiciliary care service in supported living service under the domiciliary care regulations and need to be funded and have a contract for this and be part of domiciliary care service inspection process. Not all people have a formal contract covering their stay at the home. A number have the support of a contract through funding arrangements from local councils. This was raised with the manager in June 2008 but the provisional document shown to us at that point has yet to be finalised. Contracts are one way in which vulnerable people can have their rights protected as it makes clear the terms and conditions of their stay. Information was collected about people before they were admitted to the home. One of the care home management team usually collects information by visiting the person at home or if need be at hospital. On occasions the home receives applications from people living out of the local area and the management then try to get information from people involved in caring for the person. People are offered the chance to visit the home before making the decision to move. The home states that people have a trial stay for 8 weeks. We looked at the information collected on 2 people and tracked the care that these people received. In both cases information was collected from relatives and from peoples previous placements. Although information was collected on peoples physical difficulties, how it affected them and the care they might need, little was collected on peoples mental health needs despite indications from medication and so on that these needs were present. This means that planning for these needs is not comprehensive as it should be. On admission to the home people are given a designated carer for the day who ensures that people are assisted to find their way around the home and gets to know them and this is good practice. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The planning and review of care does not support staff to give the individual care people need to maintain their health and wellbeing. The administration, storage and auditing of medication did not ensure the health and well being of people living in the home and had placed them at risk. People are treated well and are happy with the service they receive. Evidence: We looked at the care plans for 5 people and found gaps in planning and updating of peoples plans and this meant that people did not get the care and attention they needed. For example one person did not have a plan for their end of life care or, medication plan and this meant that pain relief given was not adequate. Another person did not have a plan in place that reduced pressure areas enough for the person to be comfortable and did not have monitoring records for turns to ensure that skin healing was maintained. Another person had instructions that staff were to maintain contact on a hourly basis and there was a record that the person had reminded the Care Homes for Older People Page 13 of 35 Evidence: staff that this was the case and that they were to fill in the monitoring chart. Care plans lack information to direct staff how care should be given to meet peoples needs and respect their choice of how they would like their care to be given. Information is given for example about a person being confused and aggressive, or depressed without information about how staff are to manage the behaviour and this means that staff may not recognise the signs of behaviour change or what to do. The form that the home uses to summarise peoples care does not have a section on behaviour. People were not always weighed monthly, where this may be difficult because a person is unable to stand no other measure was taken. Where a person was of low weight already they did not review the persons care when they had lost weight. Although the home uses a system of red trays for people that need to be encouraged to eat, the home needs to ensure that this is working for all people at risk or poor nutrition. Routinely there was a lack of review of peoples care. Peoples care should be looked at routinely monthly to see if the persons needs are changing, and whether the care given still remains effective as well as when it is clear that needs have changed. The management of the home told us that where a person has bed rails fitted they are assessed for their suitability and supplied by the health equipment store. We have advised of the need to have a risk assessment and have directed the manager to the Health and Safety Executives information on the use of bed rails. The home ensures that equipment is available for people to assist them to retain their independence and for one person they had gone to some lengths to find a piece of equipment that would enable the person to call for assistance. The medicine management within the home was poor. This had deteriorated since the last inspection. All the medicines are held in each persons own room. Due to the layout of the home this works well for those living outside the main house, but for those inside the main house staff were seen preparing the medication in the persons room and then going around the home with the medication in an open pot until they were found. There would be nowhere to put these medicines in the event of an emergency and this means they may not be securely held at all times. Surplus medication is now locked in a separate cabinet within a locked room. There is a controlled drug cabinet but this was not reserved for the storage of controlled drugs Care Homes for Older People Page 14 of 35 Evidence: and some were kept in the persons own room so were not stored correctly. One dose for one person was missing. No explanation was given as to why. The home keeps a stock of two homely remedies only, both for a dry cough. There was no supporting protocol detailing their use, and a stock book recorded other medicines as well that the home no longer kept. People who live in the home were purchasing their own homely remedies but these had not been checked by the pharmacist for any drug interactions. This was a requirement at the last inspection. One care assistant spoken with during the inspection had a poor knowledge of the medicines she administered. Without such she cannot fully support the people she looks after. Concern was raised that one person who required pain relieving medication was not administered as much as she could have, due to the care assistant not understanding exactly how much she could administer in 24 hours. The care assistant told the commission that this resulted in the resident experiencing unnecessary pain. Advice was eventually sought but this was not relayed to the staff. The home does have a system to check the medicines before they are administered but audits indicated that not all the medicines had been administered as prescribed at all times. This is of serious concern as this was a requirement left at the last inspection. Conversely some medication was unaccounted for. Gaps were also seen. It could not be ascertained whether the medicine had been administered or not. Staff recorded codes when they had not administered the medication but these did not reflect actual practice. People are encouraged to self-administer their own medication. There were no risk assessments seen to assess whether the resident understands their medication or any compliance checks to confirm they safely take them. Records were very poor though and did not record all the medicines the resident self-administered. One person had been prescribed warfarin. This has to be administered at doses set after the most recent blood test. After some searching this book was found but staff had not written the dose on the new MAR chart. This resulted in the resident being administered the incorrect dose. This is of serious concern. Medicines were found in peoples rooms that had not been locked away. Two were unlabelled so it could not be demonstrated that they actually belonged to the person especially as there was no record on the MAR chart that they had been prescribed and dispensed it. Many other medicines seen were not recorded on the MAR chart. It was unclear if they had been discontinued by the doctor but still administered. Care Homes for Older People Page 15 of 35 Evidence: Two boxes of different medicines were seen that had more than the dispensed medication as labelled on the box. This indicates that the care staff put the contents of two boxes into one. This is poor practice as it may lead to errors. The deputy manager admitted to doing this. The care plans were poor and detailed very little about the clinical conditions of people. External healthcare professional visits were not routinely documented. This had resulted in one person failing to have a medicine administered by the district nurse and was a week overdue. The resident realised that he had not had his medication and prompted staff to contact the district nurse. No records were seen of any visit by the district nurse or any records on the MAR chart as to when this had been administered despite the medicine being available on the premise to administer. Despite all the care assistants having been sent on many courses in the safe handling of medicines, it was apparent that it had not been put into practice resulting in a severe shortfall in adherence to the regulations. Due to the poor level of medicine management seen we, the commission, have issued a statutory requirement notice regarding medication. This may lead to further enforcement action if not fully complied with. We spoke to 3 people living in the home, observed staff attitudes with people and looked at the responses to surveys sent to the home. We found that staff were respectful of people they cared for. People said:Of the care given they are here a 100 . Your care and comfort is their main concern. You should know by now its excellent The attitude of the staff is excellent. All the care staff are pleasant both male and female carers are so discreet. Although the home needs to improve in ensuring the medical care of people who are dying, people are able to have the spiritual support to prepare for death. People in the home are encouraged to attend funerals of people that have died and the home is unique position to have access to the church. Families are supported both by the service and afterwards where they are able to have tea with people that knew and cared for their relative. One person commented that it was a very caring community. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have activities and are assisted to have trips out and this enhances their life. Food is available at all times and people are happy with choice offered to them and this helps to maintain their well being. Evidence: The home has an activities coordinator who is employed in this capacity for 3 days per week. A weekly newsletter is produced, which gives people information on which activities are available each week. These activities include, keep fit, hairdressing, communion and prayer group, poetry group, quiz evening, lexicon, singing and shopping. The home has recently, at the request of a number of people, invested in sky sports channel. There are organised shopping trips to a supermarket for those that wish to go and trips out. A person said about the activities:- The social side is very good there is something on most days. Today we are having a fish and chip supper and tomorrow we are going to a centre (garden). Other comments found in the homes surveys were: - The social activities are very much improved. Would like to play cards. There seem to be no undue restrictions on people visiting and some comments suggest that communication could sometimes be improved when the office is closed. Care Homes for Older People Page 17 of 35 Evidence: People are not restricted in moving about the home and the courtyard. The courtyard gates are locked on a night to increase the security for people living in the home. At the last inspection the food supplied was found to be good. Comments received from people and from the homes own survey found that people thought this remained the case. They said: - There is always a bowl of fresh fruit on the table you can have it for pudding or take it away for later. There are tureens for you to help yourself, which I like. Good choice of menu. There is more choice of food, excellent. I like the home made soups and salads. The home manager has started the a system for ensuring that people who are of low weight are encouraged and assisted to have a good diet. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People did not always have their interests safeguarded and this could affect peoples well being. Where people have made formal complaints these are responded to. Evidence: The home has written policies and procedures for complaints. The home had logged 3 complaints since the last inspection. One person in the homes survey thought the responses to complaints could be more timely. Complaints recorded were about the gate in the courtyard being locked and issues around the admission of a person to hospital. There were responses to the complaints made and these were available for inspection. One person said that if they had a problem about the home they would speak to the manager but would speak to the head of care if they had concerns about the care. The adult protection procedure lacked any information on institutional abuse and practical contact numbers when the manager wasnt present. It didnt indicate that their first priority was to ensure the safety of the person and that confidentiality may not be maintained if this colludes with abuse. Staff were aware of what instances they need report to a senior manager but not always aware of how the disclosure would be managed after this. The majority of staff have received training in the need to safeguard people and further training has been planned. We are aware of concerns Care Homes for Older People Page 19 of 35 Evidence: that some of the commissioners of the service have about the care of individual people. The recruitment of staff is not consistently good enough to ensure that people are not put at risk. (Please see Staffing outcomes) The home takes an inventory of peoples belongings as much as they are able and this assists in ensuring the safety of peoples property. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment was clean, fresh and homely and met the needs of the people living there. Evidence: The homes environment was inspected in June 2008 when it was judged to be good. On the day of this inspection the home was well ordered, clean and fresh. The registered part of the buildings are either ground floor or in the main house where there is access to a passenger lift. People are able to bring some of their own furniture with them especially in the flats in the courtyard where there is more space. People living in the courtyard have some access issues to the the main house was the dining room is in inclement weather. The home continues to upgrade and refurbish the homes environment and the homes Annual Quality Assurance Assessment stated that they had upgraded the equipment in the main kitchen, and the paths in the courtyard in the last year. The homes surveys showed that people were happy with the laundry service they received. Comments were made such as the laundry was very nicely pressed and clean. One person was impressed that she had her own slings for the hoist saying its much more hygienic. There seems to be some inconsistency with the cleaning of flats Care Homes for Older People Page 21 of 35 Evidence: however people did not perceive this to be a major problem. Care Homes for Older People Page 22 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the benefit of well trained, helpful and committed staff that to care for them. However training has not made staff knowledgeable enough to meet all peoples needs including the administration of medication. This has meant that peoples health and well being has been put at risk. Management are not always ensuring all required checks are carried out before people are employed and this can potentially put people at risk. Evidence: We looked at the rotas given to us by the home and found that there are 5 care staff on in the morning and five staff on from 5pm to 10pm there is usually 4 staff between the end of the morning shift and 5 pm. The home has had to use agency or casual care staff to meet the rota in the past month. There are laundry and kitchen staff daily and cleaning staff Monday to Friday. The home has an activities co-ordinator 3 days per week. The home is not in a town or village so all staff have to travel. During the recent snowfalls staff have shown great commitment staying over night in some cases to ensure that people received the care they needed. People in the homes surveys said Staff helpful and friendly. Very helpful in settling Mam. Staff willing and caring. Care Homes for Older People Page 23 of 35 Evidence: The homes Annual Quality Assurance Assessment stated that 67 of staff have reached the National Vocational Qualification level 2 in care which means staff have had training in how to give care to people. A number of staff have also progressed to level 3. We looked at the files of staff that had been recruited since the last inspection and whilst the majority of staff had been recruited appropriately, with the correct checks, some had not. One person had been appointed without appropriate references and another without checks from the Criminal Records Bureau or the Protection of Vulnerable Adults List and this could put people living in the home at risk. This was a repeat of a previous requirement and we are considering our further action. We looked at the records of training of staff and found that the home uses trainers with appropriate qualifications. Although there were some gaps in required training we found the training was audited and shortfalls in training were addressed as soon as practicable. New staff are given induction training to assist them to give care from the start of thier employment and this training fits with the common induction standards recommended by the Skills for Care Organisation. In addition to this the majority of staff have been given training in the Mental Capacity Act, Dementia Awareness and are to receive training on diabetes shortly. Care Homes for Older People Page 24 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the management of the home does its utmost to ensure that people are happy they are not ensuring that people are safeguarded and their health and welfare needs are met. Evidence: The manager and deputy have worked for many years in the care profession and have had the appropriate training to undertake the role. However there was a lack of review and auditing of care . This was shown in care plans that did not plan to meet all peoples existing or new needs and lack of resultant care, the failure to maintain appropriate standards in medication administration and lack of meeting regulations before people are employed. These deficits have an effect on the health, well being and safety of people and represents a systemic failure by the home to deliver safe and adequate care for all people in residence. There is evident confusion in the delivery of care to people in residence and those that are tenants supported by a domiciliary care service. As the care is given by the same Care Homes for Older People Page 25 of 35 Evidence: staff this has lead to confusion and difficulties. It was clear that the home wanted to ensure that people were happy with the service they receive. So generally the interactions between people living in the home, staff and management were good. (See Staffing and Health and Personal Care) There were genuine attempts to get the views of people living in the service and to act upon their views of how the service can improve. In this way people are happy with the improvements made in activities and food provision and these areas that enhance peoples lives. The areas of deficit are areas that people living in the service are less likely to comment on and trust the service to do well. We looked at the management of peoples personal money. Wherever possible people manage this themselves. For those who have difficulty managing money, money is brought in usually by relatives either in cash, posted cheques or by standing orders. People bringing in money receive a receipt. The money is kept in a pooled residents account and some money is kept at the home for people if they need it. At present only one person collects cash from the office, all the rest their money is used to pay invoices for services such as chiropody and hairdressing they have received. We looked at the recent records of 3 people and these appeared correct. We looked at a number of health and safety records for electrical, gas and fire safety. The home has had all the electrical safety checks in place. We have been told that there has been a delay in gaining the gas safety certificate, this was not available for inspection but was supplied to us later. A fire drill was needed to ensure that all staff including new staff have the opportunity to practice. We noted that one person did not have accident form completed for fall that resulted in a visit to hospital. This is required to meet the health and safety legislation. Care Homes for Older People Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13(2) Staff must adhere to the homely remedies approved list and any medication for homely remedies use not on this list must be disposed of appropriately. This will ensure residents do not receive any medication that could possibly be undermine their current medication regime. This requirement remained outstanding at a further inspection in July 2008 as did 2 further medication requirements found in requirements numbers 13 and 14 all have been outstanding since 10/08/08 26/06/2008 2 29 19 4 (1)(b) The home must carry out its 26/06/2008 own Criminal Records Bureau check (CRB) prior to staff commencing employment at the home to ensure that a robust recruitment procedure is carried out to safeguard residents safety and wellbeing Care Homes for Older People Page 27 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 2 5 1(c) Care Standards Act 2000 People receiving a funded residential care service must be in the registered accommodation. All people receiving a residential service must have a standard form of contract for the provision of this service. This is to ensure that peoples rights under the terms and conditions of the contract are protected. 10/04/2009 2 7 15 (1),12(1)(a)(b)Care plans must be prepared for every care need identified. This is to ensure that people have the care, treatment and medication they need to maintain their health and wellbeing. 20/04/2009 Care Homes for Older People Page 28 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 7 15 15(2)(b)(c) 12(1)(a)(b) 20/04/2009 Care plans must be reviewed regularly and when a persons needs change. This is to ensure that people receive care appropriate to their current needs 4 8 13 (4)(c) People must have a detailed assessment for the use of bedrails. Records must be kept of checks made that bed rails remain in good order. This is to ensure that the person is not put at more risk by their use. 20/04/2009 5 9 13 (2) 12(1)(a) Staff must transport medicines throughout the home in a safe manner and all medicines must be able to securely held in a locked facility in the event of an emergency. This is to ensure that all medicines are safely held on the premise at all times. 10/04/2009 6 9 13 (2)12(1)(a) The quantity of all medicines received and any balances carried over from previous cycles must be recorded. 10/04/2009 Care Homes for Older People Page 29 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is enable audits to take place to demonstrate the medicines are administered as prescribed 7 9 13 (2)12(1)(a) All secondary dispensing must cease. All medicines must be administered from the pharmacist labelled box at all times. This is to ensure that the correct medicine is administered to the right service user as dispensed by the pharmacist 8 9 13 (2) 12(1)(a) All dose regimes must be clearly written on the medicine chart and checked by a second member of staff for accuracy. This is to ensure that the staff have clear directions to follow. 9 9 13 (2) 12(1)(a) All medication 10/04/2009 polices must be reviewed and reflect good practice. Staff must be trained to adhere to them. All staff must be further trained in the indications and side effects of the medicines they handle in line with the Skills 10/04/2009 10/04/2009 Care Homes for Older People Page 30 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action for Care Knowledge sets on medication This is to ensure that all staff have clear information to handle medication safely and can fully support the service users clinical needs. 10 9 13 (2)12(1)(a) All service users 10/04/2009 must be risk assessed as able to self administer their own medication and regular compliance checks undertaken and documented. Full documentation of all medication service users chose to self administer must be recorded. This is to ensure that they can handle their medication safely 11 9 13 (2)12(1)(a) A quality 10/04/2009 assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that individual care staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. 12 9 13 (2) 12 (1)(a) All controlled drugs must be stored in a controlled drug cabinet that complies with the Misuse of Drugs Regulations (safe custody) 1973, and their administration witnessed by a second member of staff and recorded in the Controlled drug register. This is to ensure there is no mishandling. 13 9 13 (2)All medicines must be stored in locked cabinets at all times. This is to ensure medicines are safe and this protects vulnerable people. This requirement was given at a random inspection on 10 July 2008 and has not been uplifted into this report. Its compliance date of 10 August 2008 was not met please ignore other dates. 10/04/2009 10/04/2009 Care Homes for Older People Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 14 9 13 (2) The medicine chart must 10/04/2009 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the correct medicines are given to people and an accurate record kept. This requirement was given at a random inspection on 10 July 2008 and has not been uplifted into this report. Its compliance date of 10 August 2008 was not met please ignore other dates. 15 29 19 (4)(b)People must not be 31/03/2009 employed without references This is to ensure that staff are safe to work with vulnerable people Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Where people are identified as having a mental health Care Homes for Older People Page 33 of 35 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 difficulty further information needs to be collected to ensure that this is not their primary need and to assist with the planning of their care. 2 18 The procedure for safeguarding should be reviewed and amended to ensure that it maintains the safety of the person, ensures there is no collusion with abuse and recognises institutional failures. The Commission must be notified of incidents that affect the health and wellbeing of residents so that the home can monitor between inspection visits. There should be regular fire tests to ensure that staff are aware of how to react to a potential fire. 3 38 4 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - 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!