Inspection on 19/05/09 for The Granary Care Centre

This inspection was carried out on 19th May 2009.

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

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

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Key inspection report CARE HOMES FOR OLDER PEOPLE The Granary Care Centre Lodge Lane Wraxall Nailsea North Somerset BS48 1BJ Lead Inspector Grace Agu Unannounced Inspection 19th May 2009 09:00 DS0000072886.V375517.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 2 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 The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Granary Care Centre Address Lodge Lane Wraxall Nailsea North Somerset BS48 1BJ TBC TBC Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Shaw Healthcare (Wraxall) Ltd Manager post vacant Care Home 60 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 60. The maximum number of service users who can be accommodated to receive nursing care is 40. New Service 2. 3. Date of last inspection Brief Description of the Service: Shaw Healthcare currently operates The Granary a new purpose build Care home in Nailsea and a direct replacement for Sycamore House with additional nursing care beds. The Granary Care Centre provides a total of 60 beds, 20 providing personal care only for people with dementia and 40 providing nursing care for people with dementia. In addition to the above the home has a ten place day centre on the ground floor, and a 20 bedded private hospital secure mental health unit on the ground floor. The accommodation is on the first and second floors, accessed by passenger lift or stairs. There are six lounge/dining rooms (3 per floor) providing a variety of aspects to the surrounding countryside. There is an assisted bathroom on each wing (total of 6 bathrooms) and all the bedrooms have an en-suite showering facility. There are a total of 60 single rooms with en-suite facilities, 40 dedicated nursing beds and 20 dedicated personal care beds. The philosophy of the home is to provide the best possible care and related support services for those who are unable to care for themselves without help. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience Poor quality outcomes This is the first key unannounced inspection for The Granary Care Centre since it was registered by the Commission on 12 November 2008.The visit was undertaken by two inspectors (one being a pharmacist inspector) over two days to review the requirements made at two random inspections in relation to concerns about unsafe medication practices and poor standards of care at the home. The visit also followed up Regulation 37 notifications sent by the home following medication errors, unexplained bruises, serious accidents to residents resulting in hospital admissions and other issues that affect the health and safety of the residents at The Granary. We (The Care Quality Commission) reviewed the last inspection requirements and it is disappointing to note that most of the requirements have not been met despite the action plan sent to us by the organisation. Furthermore we looked at the outcome of the complaints made by relatives/representatives of residents in relation to care and other services provided at the home. The inspectors reviewed the actions undertaken by the home and the provider to minimise the impact of the above concerns on the residents. A full report on these incidents can be found in the body of the report. We met with the interim Home Manager Evette Townley Keogh, Regional Manager Alison Ashcroft and the Head of Quality for Shaw Health Care, Carole Rees-Williams. We spoke with several residents, three relatives and some staff members. A tour of the building was undertaken, and a number of records were reviewed. What the service does well: Generally the home was found clean, tidy and warm and free from unpleasant odour. Staff were working as a team and interacting with residents. The residents seen looked well cared for at the home. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 6 A comprehensive Service User’s Guide is given to the prospective resident to enable them to make an informed choice about moving to the home and residents and relatives are informed on admission of a one month trial to enable the person to make a decision whether to stay at The Granary. A robust complaints procedure is in place. Aids and equipment are provided in sufficient quantity to assist care staff in meeting the needs of residents. The Regional Manager told us that two floor managers and two trained nurses had been recruited and are due to commence in June subject to satisfactory recruitment documentation. What has improved since the last inspection? What they could do better: The home must ensure that no individual is allowed to commence employment without an enhanced disclosure from the Criminal Record Bureau or appropriate measures put in place for supervision, if awaiting receipt of the disclosure. This is so that people living in the home are protected from people who should not be working there. The home must ensure that all unexplained bruises/injuries are reported to the Care Quality Commission via the Regulation 37 Notification process and also reported under the Safeguarding Adults from Abuse protocol. To ensure that resident’s needs are appropriately met specific care plans must be put in place. The home must ensure that no individual is admitted to the home without a pre admission assessment. This is so that the home can make a judgement about meeting the person’s needs. Care plans and risk assessments must be in place for residents who are prone to falls and reviewed at each fall to minimise or prevent further falls. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 7 To ensure that people’s health is protected action is needed to make sure that medicines are given as prescribed by the doctor and that accurate records are kept of all medicines given by staff. Action is needed to make sure that rooms used to store medicines are kept at a suitable temperature for safe storage of medicines. The organisation must ensure that an experienced manager is appointed to the home to provide leadership and direction and support to staff in relation to care provision to the residents. All staff must receive regular supervision to enable them to raise concerns in relation to residents’ care and or other areas of responsibility. Staff must attend training on identified topics (Protection of Vulnerable Adults from Abuse, Dementia Awareness) to ensure that the needs of individuals living in the home are met. The home must increase the staffing levels to ensure that residents are monitored and supported in accordance with the assessed needs. The home must undertake a generic risk assessment of the building to include residents’ bedrooms, lounges, corridors and any other area that residents have access to. 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. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a Statement of purpose and a Service Users Guide which prospective residents and their relatives can access to enable them to make a decision about moving to the home. It also ensures a one-month trial and the terms and conditions of stay. However it failed to undertake appropriate and detailed preadmission assessment to ensure that one individual’s need s are met. EVIDENCE: The home’s statement of purpose has detailed information about services and facilities to be provided. This was confirmed in the Annual Quality Assurance Assessment (AQAA). The home also has a Service Users’ Guide that is given to prospective residents and or their relatives when they visit or enquire to enable them to make an informed choice about moving to the home. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 10 The home’s statement of purpose has detailed information about services and facilities to be provided. This was confirmed in the Annual Quality Assurance Assessment (AQAA). The home also has a Service Users’ Guide that is given to prospective residents and or their relatives when they visit or enquire to enable them to make an informed choice about moving to the home. The care record of one resident admitted recently for respite care was viewed. There was no detailed assessment from the home to include physical, psychological, mental and social needs before the individual was admitted. This assessment was to ensure that the needs of the resident would be met at the home. The home stated in the Statement of Purpose (SOP) “Senior staff will visit potential Service Users and significant others in their current surroundings to gather relevant information”. Furthermore the SOP states “A small number of places may be made available for older people who require a short period of respite care”. The admission policy and criteria will be as above although where a resident is returning for another period of respite care an assessment will be made to establish if any change has taken place since they were discharged and care records will be updated during the first 72 hrs of admission”. We are concerned that the Granary has not followed the admission processes in relation to the individual mentioned above. To ensure that people are not admitted to the home without assessment we have issued the home with a requirement and will be monitoring the process in our subsequent visits. The AQAA stated that residents are offered trial visits to enable them to decide whether to stay. All residents are provided with Terms and Conditions of their admission to the home. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Doctors and other health professionals are involved in the care of the residents. However, limited progress has been made on improving arrangements to ensure that health care needs of residents are identified and met. Procedures and policies for the safe handling of medicines are in place but are not always followed. These shortfalls can place residents at risk. EVIDENCE: We looked at ten residents’ care files during our two day visit to the home following concerns raised by relatives about the standard of care provided to residents at The Granary. We noted that care plans were in place. Most of the care files reviewed showed day and night entries detailing how the assessed needs were being met. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 12 There was also documentation in relation to risk assessments, manual handling and falls. However not all were regularly reviewed and updated when needs changed. As a result of concerns raised about standards of care a safeguarding meeting was held. At a follow up meeting in March 2009 the home produced an action plan on how they would improve care. North Somerset council agreed to lift an embargo on admissions to the home including a condition that: “For respite cases, an initial assessment would be undertaken and the care plan drawn up, and if the individual returned at a later date, they would be reassessed and the information updated as necessary. Any significant change would be reported to the Social Worker. The Home was not registered for emergency respite placements and would not take anyone who was unknown to them.” However records showed that an individual was recently re-admitted for respite care without appropriate reassessment from the home to ensure that their needs would be met. The nurse we spoke with stated that the individual was admitted as an emergency and that this had been authorised by the company’s Area Operations Manager. Information in the records from a psychiatrist, brought to the home after the person had been admitted, suggested that the person may be difficult to look after in a care home. It was unclear whether the home or the General Practitioner (GP) was aware of this information before the person was admitted As a result of this inappropriate admission we were notified that the individual was challenging and threatening to other residents and staff. Observation on the day of the inspection, looking at the individual’s records and discussion with staff evidenced that the home had not been meeting the person’s personal and mental health needs since their admission. Care plans had been updated for support with personal care stating that two members of staff were needed in order to minimise aggression and possible harm to other people. There was not enough evidence to suggest that this care plan had been reviewed in order to meet this person’s needs. A multidisciplinary meeting was held for this person and they have been moved to hospital for treatment. We looked at the care file of another individual who sustained a very serious injury due to a fall in the en-suite toilet. The person’s head was trapped between the cistern of the toilet and some hand rails. The emergency services came to help free this person. Resulting injuries included severe swelling on the head and bleeding from a shoulder injury. The person was later transferred to hospital. We noted that there was a risk assessment and care plan in place on the person’s return from hospital, to reduce the risk of falls. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 13 However the person fell again a month later and was admitted to hospital for the second time. On reviewing the care plans between the two falls we believe that the falls could have been prevented if the care plan and action stated on the risk assessment had been followed. The Care Quality Commission was not notified of the second incident. We also reviewed the care files of other residents who had suffered falls, showed aggressive behaviour, or were losing weight. We noted that one person who had lost weight had no specific care plan to enable staff to monitor their weight in order to prevent further weight loss. An individual who had a fall in February, which resulted in a fractured hip, had a manual handling risk assessment which was last reviewed in September 2008 and a night care assistance plan was last reviewed in November 2007. There was a daily record maintained for each person whose records were seen and these detailed the person’s daily health and welfare. Some residents interviewed confirmed that staff treated them with respect and knocked at their door and waited for an answer before entering to attend to their personal hygiene needs. One resident’s relatives met on the day told us that they were happy with the care provided for their relative. Thorough examination of care documentation evidenced that residents are well supported with their health care requirements in order to access services. There were records of when individuals have been visited by Dentist, Optician’s District nurses and General Practitioners (GP). A GP visits each floor of the home once a week and sees people as needed. The pharmacist inspector looked at how medicines are handled in the home. Medicines are supplied by a local pharmacy using a monthly blister pack system. None of the people living in the Granary are able to look after their own medicines so medicines are looked after and given by the nursing staff. We saw some of the morning medicines being given. These were given from the labelled container supplied by the pharmacy. The medicines administration record sheet was signed when medicines had been given. We saw a nurse crushing some medicines to give to one person. This practice had been agreed with the person’s doctor, but staff told us that they had not checked with their pharmacist that all the medicines being crushed were safe to be given in this way. This is important because crushing some medicines could be harmful. The pharmacy provides printed medicines administration record sheets for staff to complete when they give medicines. Each floor has a record sheet for staff to check that the medicines administration record sheets have been completed fully, which is signed by two nurses each day. Despite this we noted that there were some gaps in the record for one person who has a medicine earlier in the The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 14 morning, given by the night staff. The medicines administration record sheets stated that many creams and ointments were recorded on sheets in people’s rooms. We checked one sheet and found that the record was not complete and a nurse confirmed that these were not always filled in. We checked a small sample of blister packs to see if they had been given as recorded. We saw two medicines which were still in the blister packs but had been recorded as having been given. Protocols for the use of some medicines prescribed to be given “when required” are in place. This gives more information for staff about the use of these medicines to make sure they are given appropriately. We saw that one emergency medicine supplied for a resident had not been added to the new medicines administration record sheet. A protocol was not available for the use of this medicine. This means that the information was not quickly accessible to the nurse on duty about how this medicine should be given, although some information was available in the person’s care plan. Some medicines are prescribed with a variable dose. A record was not always made of the amount of medicine that had been given. This means that it is not clear how much medicine a person is having. We saw that one medicine prescribed twice daily and supplied in two blister packs was signed as having been given three times a day for five days until a nurse had realised the error and amended the record. Secure medicine storage is available on each floor of the home, within a locked clinic room. Daily records show that the temperature of the room on each floor is close to or above 25 degrees C (Centigrade). It is recommended that medicines should not be stored at temperatures above 25 degrees C. Action is needed to make sure that these rooms remain at a safe temperature. An Oxygen cylinder stored in one clinic room needs to be secured so that it cannot fall over and cause injury. The sign on the door needs to include statutory warnings. Each floor now has three medicine trolleys, one for each of the three wings. Staff told us that this had made it easier to give the medicines. On the day of the inspection most morning medicines had been given by eleven in the morning. One person was having medicines later, when they woke up. It was not clear that staff take action to ensure that when morning medicines have been given very late a suitable time gap is left before the lunch time medicines are given. This could mean that people are given some medicines too close together and others too far apart. Care must be taken that medicines are always given at suitable time intervals. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 15 Staff record all the medicines received into the home. A licensed waste disposal agency removes waste medicines from the Granary. However, at the time of the inspection staff were unclear about the correct procedure for returning medicines. This could have resulted in medicines being disposed of inappropriately. Records are kept of the disposal of unwanted medicines. We looked at the records for one person who had come to the Granary recently. It appeared that staff had not confirmed with the person’s doctor that the medicines brought in were correct. This increases the risk of medicine errors being made. Many of the checklists in the person’s file had not been completed. Staff interviewed were aware of policies and procedures in place for dealing with a resident who was dying. Three staff members spoken with were aware of the importance of keeping information about residents confidential. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the 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 Home enables the residents to maintain contact with families, friends and the local community. It provides meaningful activities and choice in respect of meals and meal times. EVIDENCE: Discussion with the relatives, staff members and evidence from the visitors’ book showed that the residents maintain good contact with families and representatives. The level of contact varies for each resident living at the home, some receive regular visitors and go out with family and others do not. The home would contact individual’s next of kin should they need to be informed of issues, which affect the well being of an individual living at the home. A tour of the building evidenced that residents were spending time in their bedrooms and the communal lounges. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 17 Information seen evidenced that the individuals living at the home are provided with a variety of social activities and are able to participate or not. This is dependent on the individual’s choice. The home has an Activity Coordinator who is responsible for providing activities based on individual capabilities and choices. These included: Bread making, chair based exercises, cards, musical bingo, church services, radio/music discussions, seasonal craft, knitting and painting. Each resident has an activities record to ensure that their participation is monitored. On the day of the visit residents were supported to sit out in the garden and have their tea and the Activity Coordinator told us that four residents were taken out for a walk to the duck pond nearby and that residents who prefer to be in their bedroom are engaged with as one to one activity. We observed residents having their meal at lunchtime. The meal was relaxed and residents were given the meals based on the choices they made after consultation about the meals available to them. Residents who were unable to feed themselves were given appropriate support; staff approached the residents in a sensitive manner and treated them with dignity and respect. Residents spoken with stated that they enjoyed their meal. The kitchen was found clean and tidy. The chef stated that staff working in the kitchen have attended basic food hygiene training. Some certificates were displayed in the kitchen area. There was a regular record of the fridge and freezer temperatures. The food in the fridge was labelled. The laundry room was clean and had three industrial washing machines and three industrial tumble dryers available to provide better laundry services for the residents at the home. Staff showed knowledge of their role and responsibilities about ensuring that the home is free from any form of infection. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has failed to protect some residents from abuse and has not responded to complaints in the time frame as stated in the complaints procedure. EVIDENCE: The Home has appropriate and robust procedures in place for management of complaints. This document was noted displayed in the hallway at the entrance and in the Statement of Purpose. The acting manager stated that this document is given to all of the residents or their relatives at the home on admission. This document contains information about the Care Quality Commission to enable individuals to contact the Commission if they were not satisfied with the outcome of their complaint to the organisation. Our records show that The Granary had received six complaints in relation to unsatisfactory care practices and medication practices since January 2009. The Head of Quality for Shaw Health Care, who had been responsible for investigating the complaints, told us that two of the complaints had been fully investigated with satisfactory outcomes and the rest are at different stages of the investigation. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 19 The Head of Quality stated that she had a very positive meeting with a recent complainant and that an agreement was reached to update the individual while investigation continues. Evidence from the records showed that Registered Nurses working at the home had their own Personal Identification Numbers verified by the Nursing and Midwifery Council (NMC) before commencement of employment and periodically to ensure that residents are adequately protected. However it was concerning to note that the home had not received Criminal Records Bureau (CRB) enhanced disclosures in relation to a recently employed floor manager before the person commenced employment. Furthermore there was no evidence that that this individual was being supervised following a satisfactory Pova First check while waiting for the CRB clearance to arrive. The home must ensure that staff are employed correctly so that people living in the home are protected from people who should not be working there. As a part of this visit we looked at the Regulation 37 Notification we received from the home in relation to unexplained bruises, swelling to hand and black eye to two residents. We noted that the daily entry on the day of the incident for one of the resident’s care file was missing. This made it difficult to gather information on this incident. While there was an incident report the information was limited. We are concerned that there was another incident report of three unexplained bruises on the same individual and another person with two unexplained bruises on their lower arm. We have referred the above incidents to the Safeguarding Adult Team at North Somerset Council for further investigation. We noted that the protocol for reporting suspected abuse, for example unexplained bruises, was displayed on the notice board on the ground floor however it seems that staff are not made aware of this protocol. Review of staff training on the Protection of Vulnerable Adults from abuse (POVA) showed that twenty one staff have not attended training on POVA. We believe that the lack of training on POVA contributed to the above incidents. The home was issued a requirement at the last random inspection in January 2009 and this requirement has not been met. We have issued another requirement to protect the residents. The home is reminded that failure to meet requirements could lead to enforcement action. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. People using the 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 home has a safe and well-maintained environment, comfortable bedrooms and specialist equipment suitable for residents’ needs. EVIDENCE: The Granary is a purpose built care home, opened in November 2008 and therefore complying with all spatial and environmental standards. It is situated in a residential area surrounded by large areas of garden. The accommodation is on the first and second floors, accessed by passenger lift or stairs. There are six lounge/dining rooms (3 per floor) providing a variety of aspects to the surrounding countryside. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 21 There is an assisted bathroom on each wing (total of 6 bathrooms) and all the bedrooms have an en-suite showering facility. There are a total of 60 single rooms with en-suite facilities, 40 dedicated nursing beds and 20 dedicated personal care beds. The home was found clean, tidy and free from offensive odours. All the corridors have handrails fitted on both sides. The toilets and bathrooms had grab rails and various manual handling equipment and aids to assist the staff with meeting service user’s needs. Staff were seen using this equipment in a professional manner. The home has a policy on infection control and staff working in the laundry are aware of their responsibilities regarding infection control and have attended training on Control of Substances Hazardous to Health. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has failed to protect the residents through unsatisfactory recruitment practices, poor skills mix and lack of staff training. EVIDENCE: The home has a robust recruitment policy and procedure in place to ensure that only appropriate staff are recruited at the home. There has been high turnover of staff since the Granary opened in November 2008. We looked at records of recently appointed staff members. Two of the files contained required information to include CRB disclosures, two references, proof of identity and medical questionnaire to ensure fitness for employment. However there was no evidence to indicate that one newly appointed floor manager had CRB clearance before starting work at the home on 4/05/09. While there was evidence of a satisfactory initial check there was no system put in place by the home on how this individual was being supervised while waiting for the CRB disclosure as required by the Criminal Records Bureau. It states: The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 23 “The Department of Health (DH) allows applicants, who have applied for a CRB check, to start work as a care worker under supervision if they are not on the Protection of Vulnerable Adults (POVA) list”. This practice has led us to believe that the home is putting the safety of residents at risk. In light of the above we have issued a requirement to ensure that this is not repeated in future. The Granary stated in its Statement of Purpose that “All staff will be offered training and development programmes that are identified by Shaw healthcare through an annual appraisal system”. “Statutory training in fire, Health & Safety, basic food hygiene, and moving and handling will be given 6 monthly either in the home or at regional training facilities.” Evidence from the training records show that the home has not provided staff with training as stated above. For example twenty care staff have not attended manual handling training, twenty seven staff have not attended fire lectures and twenty three staff have not attended training on Health and safety. We believe that lack of staff training has contributed to poor performance in relation to providing good quality of care to the residents. We looked at the staffing levels in relation to the dependency and the category of the residents at the home. On the first day of inspection there were forty eight residents at the home. The staffing rota showed that there were two Registered Nurses (RN) and two floor managers from 8am to 2pm and twelve carers, two RN and twelve carers from 2pm-8pm and two RN and five carers on night duty. There were also five house keepers working from 8am to 2 pm, one laundry assistant, three kitchen staff, one maintenance person and two administrators. We can confirm that the above staffing levels are in line with the minimum numbers stated in the revised Statement of Purpose. We randomly selected two dates on the rota which were 17/05/09 and 18/05/09 for review, to help us to make a judgement on how the home maintains the staffing level and if there were continuity of care. We noted that on the 17/05/09 there were two RNs from 8am-2pm one of whom was an agency nurse and there were eleven carers instead of twelve. The interim manager told us that it was an oversight that she would make sure it will not happen again. In the afternoon there were two RNs from 2pm-8pm one of whom was an agency nurse and twelve carers two of whom were from the agency. There were two RN on night duty, one of whom was from the agency. On the 18th May the staffing levels were the same however, two agency carers worked at the home. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 24 Agency nurses and carers are not permanently employed by the home. They are provided by a suitable agency, to cover staff shortages. We received several concerns from relatives about lack of permanent staff and in some cases shortage of staff. While we are aware that Shaw Health Care meets the minimum staffing notice it set for The Granary and in some occasions exceeded the numbers we are concerned about the numbers of falls, serious injuries, medication errors and unexplained bruises to residents and lack of adequate monitoring of residents with very challenging behaviour in relation to risks to themselves, other residents and staff. We believe that the numbers of staff on duty at peak times are not adequate to monitor the residents in order to minimise injuries. We also believe that there is an excessive usage of agency staff and this has led to a lack of continuity of care at the home. We have issued a requirement for the home to increase staffing levels and to ensure adequate monitoring in order to reduce risk and ensure that agency staff are reduced to a minimum. The Regional Manager told us that two floor managers and two trained nurses had been recruited and are due to start work in June subject to satisfactory recruitment documentation. There was evidence from the records which shows that registered nurses working at the home have satisfactory checks from the NMC for proof of registration. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,36,37,38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being managed properly and there is no leadership, guidance and direction for staff to ensure that residents receive good care. However Quality Assurance systems, Provider’s Monthly visits alongside the policies and procedures go some way to safeguard the welfare of the residents. EVIDENCE: There is no registered manager at The Granary and this has been the case since one month after the home open in November 2008. There have been three acting managers in this time, the last one left the home a fortnight ago. Ms Evette Townley–Keogh is the current interim manager at The Granary. Ms Townley–Keogh is a registered manager of a sister home in Wales owned by The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 26 Shaw Health Care and was brought in to manage The Granary following the departure of the previous manager. Staff spoken with stated that there is a sense of instability at the home due to changes in management since the Granary was opened in November last year. Staff told us that they were very disappointed that the only person who would listen to them was leaving the home in a few days time. One person stated “we don’t know what to do now”. While relatives, staff and some visitors we spoke with made positive comments about the staff team at The Granary, some examples were given of poor communication, lack of direction and poor continuity of care due to use of agency staff. Staff supervision records were reviewed. Evidence from the records viewed showed that some staff had received supervision. One staff member stated that they benefited from the exercise. It afforded them the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to residents’ care. Two staff spoken with stated that they have not received supervision since last year to enable them to perform their duties effectively and deal with any areas that need improvement in relation to meeting the needs of the residents. The staff told us that lack of supervision, no guidance and low morale is impacting on their performance. We have made a recommendation for the home to provide guidance and direction to staff to ensure that residents receive consistent quality care. The interim manager stated that she would ensure that staff supervision remains an ongoing process. Regulation 26 visits by the registered provider are regular and had highlighted areas of concern, improvement and action to be taken in the last report sent to the Commission. For example the provider visit undertaken in April highlighted minor discrepancies in recording of residents’ monies and was rectified immediately. The managers told us that this is part of the Quality Assurance process. Other tools used for reviewing the quality of their service include staff meetings. The last meeting took place on 12 February 2009 and issues discussed included; new staff structure, rotas, handovers, reporting and recording. The interim manager stated that staff meetings will be planned every six to eight weeks. A residents/relatives meeting also took place in January 2009 to enable the residents and their relatives to have a say in the running of the home and for The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 27 staff to listen to their concerns and to take action where necessary. Issues discussed included management structure update, staffing structure and the quality team. The interim manager told us that she would ensure that this meeting is held more regularly. Health and safety records included passenger lifts, fire alarm systems, a test of all portable electrical appliances, nurse call systems and Liability Insurance. While we noted that the home has undertaken some generic risk assessment of some areas, it would be better if it included the lounges, dining areas, bedrooms and other areas that the residents have access to. The home told us before this report was completed that risk assessment of the identified areas including the kitchen had been put in place. The fire logbook is well maintained. There is evidence that some staff have attended fire lectures. It was noted that some staff members have not attended fire drills. The interim manager told us that the home will ensure that all staff are supported to attend fire drills as soon as possible. There is evidence that this process had started since she arrived at The Granary. Regulation 37 notifications are generally sent to the Care Quality Commission to report any incidents/serious accidents affecting the health of any person living in the home, as required by the regulations. However the home failed to report one serious accident to the Commission. It was also concerning to note that some observations that compromised the safety of the some residents had not been notified to the Safeguarding Adult Team and the Care Quality Commission. For example unexplained bruises to some residents. Policies and procedures in the home include whistle blowing, complaints, health and safety and manual handling, missing persons, challenging behaviour and Protection of Vulnerable Adults from Abuse (POVA). Resident’s information and records were securely locked away. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X 3 2 3 2 The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13.2 Requirement The registered person must ensure that medicines are administered as prescribed by the doctor. Accurate records must be kept of all medicines given by staff; if medicines are not given a reason must be recorded. This is to protect residents’ health. This is a repeated requirement. The registered person must ensure that medicines are stored at a safe temperature. The home must ensure that care plans are in place to meet the assessed needs of people living at the home. The care plans must be reviewed regularly and as needs change. All residents must have risk assessments based on individual circumstances . Residents with recent falls must have risk assessments and same DS0000072886.V375517.R01.S.doc Timescale for action 14/06/09 2. OP9 13.2 01/07/09 3. OP7 15 30/06/09 4. OP7 13 30/06/09 The Granary Care Centre Version 5.2 Page 30 reviewed regularly. This is a repeated requirement 5. OP36 18 Staff must receive regular supervision to ensure residents receive good standards of care. This is a repeated requirement A qualified competent manager must be employed at the home to provide leadership and support at the home. This is a repeated requirement. Ensure that all care staff have received training on Health and Safety, Manual Handling, Fire Lecture, Dementia awareness and behaviour that challenges. Ensure that all staff receive update training on the Protection of Vulnerable Adults from Abuse to ensure awareness of the Protocol to be followed if abuse is suspected. This is a repeated Requirement An accurate detailed record of events must be kept in each resident’s notes to ensure protection. The Care Quality Commission must be notified of death, illness and other events. 31/07/09 6. OP31 8 31/07/09 7. OP30 18 31/07/09 8. OP30 18 31/07/09 9. OP37 17 26/06/09 10. OP38 37 30/06/09 11 OP3 14 12 OP27 18 Accommodation must not be 30/06/09 provided to residents unless their needs have been assessed. That assessment must be in sufficient detail to enable staff to meet the resident’s needs’ be kept under review and having regard to any change of circumstance be revised as necessary. Ensure that enough trained 20/05/09 nurses are deployed on each DS0000072886.V375517.R01.S.doc Version 5.2 Page 31 The Granary Care Centre 13 14 OP29 OP25 19 13 floor for early shifts to meet the needs of people living in the home. CRB check must be obtained for 30/06/09 new staff employed to work at the home before they start. Undertake a generic risk 30/06/09 assessment of all the areas residents have access to and take necessary steps to minimise the risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP32 Good Practice Recommendations Provide guidance and direction to staff to ensure that residents receive consistent quality care. The Granary Care Centre DS0000072886.V375517.R01.S.doc Version 5.2 Page 32 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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). 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