Inspection on 26/01/10 for The Good Companions

This inspection was carried out on 26th January 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Good Companions 24/05/10

The Good Companions 06/02/07

The Good Companions 05/12/05

The Good Companions 13/06/05

The Good Companions 07/12/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Key inspection report Care homes for older people Name: Address: The Good Companions Criffel Street Silloth Cumbria CA7 4BT     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: Margaret Drury     Date: 2 6 0 1 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: The Good Companions Criffel Street Silloth Cumbria CA7 4BT 01697331553 01697331553 info@goodcompanionscumbria.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Good Companions Cumbria Ltd care home 39 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 registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (Maximum places - 38), Dementia - Code DE (Maximum places - 38), Physical disability - Code PD (maximum places - 1). The maximum number of service users who can be accommodated is: 39. Date of last inspection Brief description of the care home The Good Companions is owned by Good Companions Cumbria Ltd with Mr Mark Newby being the responsible individual. The home is run on a day to day basis by Mrs Jacci Derrane. The home is situated in Silloth, a seaside town overlooking the Solway Firth. The Good Companions is an older property that has been adapted and extended for its present use as a care home. Accommodation for service users is on three floors that are served by a passenger lift and stair lifts. All of the bedrooms are for single Care Homes for Older People Page 4 of 33 Over 65 0 38 0 38 0 1 Brief description of the care home occupancy, with all but two having en-suite toilet and washbasin facilities. There are three lounges and a large dining room and a smoking area for those residents wishing to smoke. The toilets and bathrooms are equipped to assist people with disability. There are well kept gardens around the building and car parking facilities are provided. The home does not provide intermediate care. Full detials of the facilities, services and weekly charges at The Good Companions may be obtained by contacting the manager. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service took place overall several weeks. As part of the process we sent out surveys to some of the people that live and work in the home and also relatives of people using the service. Up to the time of writing this report we had received three surveys from relatives and one from a healthcare professional. We have also received a letter from a relative whose husband lives in Good Companions. These surveys have helped us to obtain views and opinions about the service. The lead inspector for this service, Margaret Drury was assisted by another inspector, Diane Jinks during this visit and we were in the home for just over six hours. We looked at a variety of care files, staff records, staff recruitment and training documentation and other records connected to the home that are required by law. One of pharmacy inspectors had, as part of this inspection, visited the home to check that the storage, records, administration and disposal of medicines are managed Care Homes for Older People Page 6 of 33 safely. She was in the home for a total of four and a half hours. Reference to her findings can be found in the summaries and the main body of the report. The manager completed an Annual Quality Assurance Assessment - the AQAA, prior to our visit. This document is a self assessment completed by the provider and gives information about the home and how the assessed needs are being met. It should also indicate any improvements made during the past twelve months and any plans for future development. Unfortunately the AQAA contained insufficient information to assist us with the planning of this inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We found, when looking at the care files that, although all residents have a care plan, these were not always up to date and gave insufficient detail to enable the staff to manage all the assessed needs. Notes from the daily records did not tally with the details on the care plan, which may mean any changes in dependency levels are not noted. It could also mean that action plans would not be put in place to ensure the correct level of care is given. Care plans were not always being consistently followed by staff. There were inconsistencies in the nutritional assessments which may mean that residents could be at risk of being under nourished. Overall there were some concerns in the way the way the home managed medication and this places the health and well being of residents at risk. The manager should ensure all records for medication, including medicines liable to misuse, are complete. This will ensure that all medicines are administered as prescribed and can be accounted for at all times. Care plans for residents with specific needs require reviewing and should be more detailed so that staff have clear guidance for managing these needs. The handling of medicines should be audited more thoroughly so that risks can be identified and managed promptly. The day to day running of the home is the responsibility of the registered manager. She has been in post for some time and is a registered nurse with experience in the care of older people. Unfortunately over recent months she seems to have spent considerable time away from the home working on other projects within the company. This has meant a lack of firm leadership that has been noticed by visitors and relatives. Care Homes for Older People Page 8 of 33 Comments in a letter received by the Commission and on returned surveys have included, I visit the home every day and at first I never saw the manager once and felt very let down. It has improved a little since Christmas and I see her maybe four times a week. Another relative told us that she wrote a letter voicing some concerns and hand delivered it to the home but has not had an acknowledgement or an answer to her concerns. It would seem that staff are not passing on information or concerns to the senior team and therefore the manager is unaware of what is going on in the home. It is extremely important that the lines of communication are always open. There have been issues that have gone unreported to the manager, social services or CQC. This can put the health and well being of those living in Good Companions at risk. The manager must ensure that all incidents affecting the lives of the residents are reported to the Commission under Regulation 37 of The Care Homes Regulations 2001. All relevant staff training should be brought up to date in order that the appropriate level of care can be provided. 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed prior to moving in to The Good Companions to ensure their needs can be met. Evidence: During our visit we discussed the admissions process with the manager and looked at a sample of care records. We found that all prospective residents have assessments of their social and care needs completed before they are offered accommodation at Good Companions. Assessments are also obtained from social workers if these are available. The assessments cover all areas of daily living but care should be given to ensuring all psychological needs are also assessed. The assessment should form the basis of the plan of care and all staff must be made aware of every aspect of care that will be required to meet the residents needs in a way that is appropriate and in their best interests. During out time in the home we observed that, in general, there was sufficient numbers of care staff on duty during the day to ensure the level of care provided was Care Homes for Older People Page 11 of 33 Evidence: adequate to meet the needs of those using this service. We did note, however, that some residents do have complex needs and care must be taken to ensure the numbers and experience of the staff on duty at any one time are sufficient. We did speak to some of the staff and they said there was enough staff on duty but also agreed that some residents need extra care at certain times of the day. All residents have a contract and terms and conditions of residency. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are incomplete with insufficient details recorded. Medication is poorly managed. This means that those using this service may not always get the treatment and support they should when they need it. Evidence: The manager completed the AQAA prior to the inspection and told us that all residents had a comprehensive, individualised plan of care that outlines fully the care required to meet all the assessed needs. During our visit we looked at a sample of the care plans and spoke to residents and staff and observed their care practices. There is a new care plan format being introduced and the manager showed us some of the plans that had been transferred over. All new residents would have this style on admission and work will continue transferring the remaining residents over to the new format. We could see very little difference in the two systems and there seemed to be very little change to the content and quality of the recorded information. Poor recording of personal and social care needs could mean that some people may not have all of their care and support needs recognised and met. Care Homes for Older People Page 13 of 33 Evidence: We looked at a total of four residents records including the care plans, daily notes, nutritional and risk assessments. We found that in all cases the daily notes recorded by the care staff during each shift did not match the information shown on the care plans. It was difficult to see where the reviews and updates had been completed and no outcomes were recorded. One care plan recorded that the resident had recently lost weight but there was no record of what, if anything, was being done to find out the reason for this. There was no fluid or food intake chart nor a request for advice from a dietician. There were some written instructions about twice weekly weight being recorded but this had not happened since April 2009. It was noted that other nutritional assessments, although in the main recorded, were not as detailed as they should be. One plan detailed, softer diet but there was no indication as to what this meant or instructions to the staff to ensure the resident received adequate nutrition. As the resident suffers from dementia it is even more important that the staff are able to communicate properly and effectively to ensure a good nutritious diet is taken. Daily notes were quite detailed but staff do not appear to understand the importance of passing on information to the senior team or manager. We noted incidents of challenging behaviour between residents resulting in potential harm or danger. The manager was unaware of these incidents, they were not recorded in the care plan nor had the adult protection team or social worker been notified. There was no Regulation 37 notification sent to the Commission either. There is obviously a breakdown in communications and this should be rectified as soon as possible to ensure those living in the home are free from any potential harm. When asked, the staff confirmed that there had been no training in how to deal with aggression or challenging behaviour. There are insufficient details in the care plans to ensure staff manage this type of situation safely or effectively. There is a record kept of G P visits and there is professional input into the care provided from the district nursing service and the community psychiatric nurses. Optical, dental and chiropody is available when required. The home uses a tagging system for those residents who are prone to moving around at night, that works with the call system. This alerts the staff to the fact that a resident has left their bedroom or has got out of bed and may be liable to fall. As there are only two night staff on duty at any one time this system is difficult to monitor. There is no proper risk assessment for this tagging to see if is suitable and no record of this being discussed with the residents or their advocates. As part of this key inspection the pharmacy inspector visited the home to meet with the manager and examine the procedure for the receipt, storage, administration and disposal of the medicines. The manager confirmed that the staff received good support from the dispensing chemist and that the team leaders and senior carers had completed training in safe handling of Care Homes for Older People Page 14 of 33 Evidence: medicines at Lakes college. Although the administration records appeared to be well completed, overall we found that medication was poorly managed and there were a number of areas that needed improvement in order to fully protect the health and well-being of those living in the home. There were missing signatures and hand written entries on the records were off line so that it was difficult to complete the record correctly. This could mean that residents are at risk from errors and that medication was not given at the correct time. Some records were not signed and hand written entries did not always align with the printed records, which made it difficult to check if the medication had been administered correctly. The medication for one of the residents was signed as given in advance of the time it was due. We counted a sample of medication to see the record of that administered tallied with the tablets remaining. In some cases they didnt which would indicate that some medication was missing and could not be accounted for and some were in excess which could mean medication had not been given. These practices put residents in danger and mean that their health and well being are not protected. The records for the disposal of medication were judged to be poor as the returns book did not contain records of medicines returned to the pharmacy for disposal . The dates in the book were not complete and some medicines were recorded without the residents names so they could not be accounted for properly. One prescription was changed from capsules to liquid but there was no record showing the disposal of the remaining capsules. Medication was not always recorded properly on the care records. There was no information or management plan in place for staff dealing with residents with diabetes or dementia. Although medication audits are completed, the manager needs to ensure that, in future these are more thorough and detailed in order that concerns or errors are identified as soon as possible to ensure those living in Good Companions are kept safe at all times. We recommended that a new register for the recording of drugs liable to mis-use be purchased as the one in place had loose pages. We also recommend that the medicines fridge be made more secure. During our visit we spoke to residents and observed the care staff providing care. The residents told us the the staff are lovely and I can dust the furniture and tables like I did at home. Staff were seen to treat the residents with respect and warmth. Care Homes for Older People Page 15 of 33 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 are provided with an activities programme and a variety of home cooked food, which they enjoy. Evidence: This service employs an activities organiser to ensure there are opportunities for residents to enjoy some leisure activities during the day. There is a monthly programme and although we did not see the programme for February we were able to see what had been enjoyed during the month of January. Many of the activities form part of a regular plan and include, a weekly shopping day , music afternoons, pampering afternoon, aerobics, bingo and games time and outings to the local tea dance. There is also a church communion service held every two weeks. This ensures that the spiritual needs of those to whom this is important are met. Relatives and friends are welcome to visit any time and are always offered refreshments whilst in the home. Visits can be made in private if the residents wish this. We were able to speak to one visitor who was visiting her friend of many years. She told us that she was always made very welcome when she came. Staff told us that some residents did not wish to join in group activities, in particular those who may suffer from dementia. We did not see any provision for activities for any residents who may have special needs, that could be enjoyed on a one to one Care Homes for Older People Page 16 of 33 Evidence: basis. This is an area that should be explored in oder to ensure all residents are given the opportunity to enjoy meaningful ways to spend time, during what otherwise could be a very long day. We spent some time talking to the catering staff and discussing the meals they prepared. There are two choices available at all meals but very often there are more than that prepared. If a resident does not like either of the set meals they can choose something else and it is always prepared. All cakes and puddings are home cooked on the premises and we saw fresh cakes and scones that had been baked on the morning of our visit. The residents we spoke to all said how much they enjoyed their meals. One comment a relative made on a survey form indicated that the food was always good and plentiful, if a little too much at times. The catering staff work very hard because as well as meals for those living in the home there is a luncheon club and the home prepares meals on wheels for people living in the community. Care Homes for Older People Page 17 of 33 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. There are inconsistencies in the safeguarding and protection processes that are in place in this service. This means that people using this service are put at risk of harm and of not being supported adequately. Evidence: There is a complaints procedure in place that forms part of the service user guide. We did speak to some residents during our visit and they said they would speak to one of the girls if they felt there was something wrong. There had been one complaint received since the last inspection that was investigated by social services. This was partly upheld and strategies have been put in place in an effort to ensure this does not happen again. Apart from this one we are not aware of any others and none have been reported to CQC. However, comments on one of the returned survey forms told us that a family member had cause to write about some issues she wanted to raise with the manager. As she visits her mother very regularly she hand delivered the letter to the office as the manager was not in the home at the time. She has not yet received an acknowledgement of the letter nor an answer to the concerns raised. The manager must ensure that all complaints are dealt with as soon as possible and in lines with the homes complaints procedure. When looking at the care records we noted that there had been occasions when there had been incidents between residents resulting from aggressive and challenging behaviour. Whilst such incidents are always serious at least two of the incidents Care Homes for Older People Page 18 of 33 Evidence: recorded in the daily notes of one resident were extremely serious but the staff who witnessed the incidents and recorded them did not think to alert the home manager or one of the team leaders. All incidents involving people living in the home should be reported to the manager, who should in turn report these to the appropriate agencies in order for an investigation to be completed. It appears that the incidents went completely unreported to the manager, social services adult protection team or CQC. This is not acceptable as the non reporting of such behaviour leaves other residents vulnerable and in danger of harm or abuse. This matter must be dealt with through staff training, supervision and staff meetings. There are obviously some gaps in the safeguarding processes in place and the manager must ensure this is put right as soon as possible. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environmental standards within this service are not well maintained and there are several areas that could provide risks to the health and well-being of those using this service. Evidence: Although the manager told us on the AQAA that there is an ongoing refurbishment programme in place there was no information about what had been improved during the past 12 months or what was planned for the coming year. The Good Companions is an old building that has been extended and adapted for its present use as a care home. The upper floors are accessed by a passenger lift with stair lifts to the mezzanine levels. We toured the building looking at the environmental standards within the building. Although there has been some redecoration to the corridors on the lower ground level the rest of the building needs a lot of work to bring it up to a level that will meet the National Minimum Standards. The main lounge, though nicely decorated shows signs of damp through the wallpaper. The windows do not have restrictors and as these are at a low level they could be hazardous to the residents. There is a small designated smoking room at the end of the ground floor corridor. This does not have an extractor fan so consequently smoke from the room permeates through the corridor and to the main sitting area. There was a very strong odour of cigarette smoke in the corridor that was extremely unpleasant. There are cracks on the ceilings in various parts of the ground and upper floor that look as though the Care Homes for Older People Page 20 of 33 Evidence: areas have been affected by damp. The shower room on the first floor contained a basket of communal toiletries including disposable razors. The shower area needed cleaning with tiles requiring new grout to remove the mould. We noted that many of the communal toilets and bathrooms did not have locks, just large holes where the lock would normally be. This means there is no privacy or dignity for those residents using these facilities and this should be addressed as soon as possible. There was a strong odour near one of the bedrooms although the manager had advised us this at the start of the inspection. New floor covering for this room has been ordered and will be fitted when received. There were other bathrooms with a supply of toiletries in them that seemed to be for communal use. All personal toiletries should be kept in the residents own rooms and should only be used by the individual concerned. The home is a very large building with three floors but there are only two domestics employed. On the day of our visit one was off so the remaining domestic was responsible for cleaning the whole building. It should also be noted that, during the week-end the domestic duties are the responsibility of the care staff. Some of the rooms had faulty windows that were taped up and could not be opened. the manager did confirm that there had been a price quoted for the repairs and was waiting for the repairs to be started. We were given a timescale of 4-6 weeks. Overall there are sufficient toilets and bathrooms for the number of people living in the home but all need attention to ensure the residents are able to enjoy the experience of bathing in more pleasant surroundings. We checked a sample of the bedrooms and found that many of them had no light shades in place, which left the room looking very tired. Those residents we spoke to seemed happy with their accommodation but overall the home does now need refurbishing to bring it up to an acceptable standard. Although there are double rooms registered, they are all currently used as singles. Some rooms had locks fitted but many did not and there was no indication on the care plans that residents had been consulted about this. Care Homes for Older People Page 21 of 33 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. Although recruitment of staff is good lack of training in some areas of care could put people using this service at risk. Evidence: On the day of our visit to the home there appeared to be sufficient staff on duty although they seemed to be very busy throughout the day. Good Companions provides social and personal care to people using the service and the staff team includes team leaders, support workers and ancillary staff. The residents we spoke to during our visit confirmed that the staff were very good and a good bunch of girls. We observed their practices and found these to be good as there was friendly interaction between them and the residents. However comments on returned questionnaires included, There are times when the carers go on their breaks all together leaving a lack of supervision in the lounge. Team leaders who are in charge of the shift should always ensure there are staff available should a resident need assistance or to be there should there be a crisis. Lack of staff in the main living areas does leave the residents vulnerable and in danger. Past incidents have proved this to be true. There are two members of waking night staff, which does not seem many for a building of this size and layout. Many of those living in the home have complex needs and only 2 night staff may not always be enough. The manager did say she would bring in extra staff if ever she felt it was necessary. Some 50 of the staff have completed National Vocational Qualifications with 1 currently working towards the Care Homes for Older People Page 22 of 33 Evidence: award. The manager told us there was another 5 due to start the course in April. Staff training is ongoing with the mandatory subjects all up to date. Dementia care training has been organised for March of this year, first aid in May and healthy eating and nutrition in April with manual handling updates also in April. Although there is plenty of training provided it seems that not all of it is put into practice as staff do not see the importance of effective recording of incidents or what constitutes abuse. This could mean that service users become vulnerable and not safeguarded at all times. Recruitment and selection is good with all stages completed correctly. All staff are fully checked prior to starting. Application forms are completed, references obtained and all legal checks completed. On the whole the training provided is good but there seems to be a lack of putting into practice what staff have learned. We did note that staff had not received training in how to deal with aggression or challenging behaviour even though there are some people with very complex needs. This needs to be put in place as soon as possible. Training in adult protection and the reporting of such incidents also needs to be addressed as although staff told us they had knowledge of adult protection there had been some incidents that had not been reported and therefore not dealt with in the correct manner. Staff supervision is completed, mainly by the manager. She needs to ensure that training needs and personal and professional development are discussed at length. This will give the staff team a greater understanding of how to deal with the care of residents with complex needs. Care Homes for Older People Page 23 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recent lack of consistent leadership means that people living at The Good Companions do not always receive a safe and satisfactory service. Evidence: The current manager has been in post for some time and is a qualified nurse with a lot of experience in the care of older people. The owner, who is also the responsible person visits the home each month. The manager sent to us (CQC) a completed AQAA which, under normal circumstances would give us information about what the home has achieved over the past twelve months and what plans are in hand for the following year. Unfortunately there was little information about what had been achieved and even less about future plans as many of the sections had been left blank. As part of the inspection process we sent out surveys to residents, healthcare professional and family members and advocates. Some of the comments we received include the following: I chose this home because of prior knowledge and excellent rating. I was very upset Care Homes for Older People Page 24 of 33 Evidence: at first as although I visited three times a day I never saw the manager. I felt very let down. The carers managed well but I felt there was some input lacking. I was told the manager was working from home. Since Christmas, however the situation has improved and the manager is there about 4 times a week. There is a good selection of carers some of whom I would rate as exceptional. There is always room for improvement. There are times when the carers are on their break at the same time leaving the lounge unattended. During the past year the home has not been well managed albeit there has been an acting manager. I have written to the home expressing my concerns and although I hand delivered the letter I have received neither an acknowledgement nor response to my concerns. I then went to the office to voice my concerns to the staff Speaking to the staff they felt they were well supported by the senior team although it appears that the manager has not been in the home very much in recent months. She did indicate on the AQAA that there are other projects in the pipeline so that the appointment of a new manager was being considered. We were concerned that, when speaking to the manager both during our visit and the feedback period at the end, the manager was unaware of what was going on in the home and seemed to be out of touch with every day happenings. Although staff training is organised through an external training provider the staff do not seem to put into practice what they learn. Staff supervision is ongoing and the records were up to date. However, the manager needs to look at the agenda for supervision to ensure it is meaningful and appropriate to ensure the staff are aware of their roles and responsibilities. As well as looking at a sample of care and staffing records we also checked a selection of the maintenance records. All electrical testing was up to date including the small electrical appliances. Fire equipment is serviced under an annual contract as are the passenger lift and stair lift. A gas safety check had recently been completed and the certificate was produced for our inspection. Care records included some risk assessments but these were not always reviewed in line with changing needs especially when a resident can display elements of challenging behaviour or aggression. Care Homes for Older People Page 25 of 33 Evidence: There are areas round the home that could could raise the possibility of cross infection such as poorly grouted tiles in the bathroom and toilet areas.These areas are not well maintained and there were communal toiletries on display in at least two of the bathrooms. These are all issues that could affect the health and safety of residents and staff. Whilst we were talking to the cooks we observed that all the required records such as temperatures charts and cleaning schedules were in place. We noted that for the period from February 2009 to October 2009 no notifications were sent to the Commission and there have been none since October of last year. It is extremely important that all notifiable incidents are all reported under regulation 37 as required by the Care Homes Regulations 2001. Care Homes for Older People Page 26 of 33 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 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 37 37 All notifiable incidents should 26/02/2010 be reported to The Care Quality Commission To ensure the health and safety of those using this service. 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 7 15 Each resident must have a plan of care that is relevant to the assessed needs with details as to how these needs can be fully met. The information contained in them must match with that recorded in the daily notes. To ensure all those living in the home receive the appropriate level of care at all times. 31/03/2010 2 7 15 All care plans must record full details of the tagging system where used and records of discussion with residents or advocates. 31/03/2010 Care Homes for Older People Page 28 of 33 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 To ensure all those living in the home are aware of all aspects of their care. 3 9 13 There must be a complete 31/03/2010 and accurate record of all medication, including controlled drugs, that are received, administered and leaving the service. This is in order for an account to be kept of the medinines and to ensure they are administered as prescribed. To ensure all prescribed medication is admistered appropriately and residents are kept safe. 4 16 22 The manager must ensure 31/03/2010 that staff notify her of any complaint received so that the matter can be dealt with in accordance with the recognised complaints procedure. To ensure all complaints are investigated to a suitable conclusion 5 18 13 The manager must ensure that training in dealing with agression and challenging behaviour is provided to all staff. 31/03/2010 Care Homes for Older People Page 29 of 33 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 To ensure all staff know how to deal with any incidents that could put residents at risk. 6 18 13 The manager must ensure all staff receive training in the reporting of incidents that put residents at risk of danger or abuse To ensure residents are kept safe at all times. 7 19 23 The matters regarding the 31/05/2010 environment identified in this report must be attended to. In particular the loose fitting windows in bedrooms and those with faulty locks or catches. The tiles in the bathrooms and toilets must be re-grouted to reduce the risk of infection and all toilets and bathrooms must be fitted with suitable locks. To ensure those using this service live in a home that is well maintained and fit for purpose. 8 19 23 Suitable locks must be fitted 31/03/2010 to all bedrooms unless a resident specifically requests no lock. 31/03/2010 Care Homes for Older People Page 30 of 33 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 To ensure the privacy and dignity of those living in the home. 9 31 7 The manager should spend sufficient time in the home to ensure all the managerial tasks are completed. To ensure the health, safety and wellbeing of those using this service. 10 38 13 The health and safety of those people using this service must be protected and promoted at all times. Unnecessary risks to the health and safety of residents must be identified and, as far as possible, eliminated. 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 01/03/2010 31/03/2010 1 2 3 4 9 12 19 19 We recommend that a new controlled drugs register be purchased and the drugs trolley made more secure. It is recommended that some specific activities are organised for those residents who may have special needs. It is recommended that all bedroom lights are fitted with suitable shades. It is recommended that an extractor fan be fitted in the smoking lounge. Care Homes for Older People Page 31 of 33 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 5 36 It is recommended that staff supervision puts more emphasis on personal and professional development. This will unsure all staff become aware of their individual roles and responsibilities. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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