Inspection on 28/10/08 for The Hollies Nursing Home

This inspection was carried out on 28th October 2008.

CSCI found this care home to be providing an Adequate 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

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Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Hollies Nursing Home Drake Lane Dursley GL11 5HA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathryn Silvey     Date: 2 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: The Hollies Nursing Home Drake Lane Dursley GL11 5HA 01453541400 Telephone number: Fax number: Email address: Provider web address: Charlotte@littlecombepark.com Name of registered provider(s): Name of registered manager (if applicable) Littlecombe Park Limited Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 category: Old age,not falling within any other category - (Code OP) Date of last inspection Brief description of the care home The Hollies is a new purpose built care home situated close to the small market town of Dursley. The home provides social care and nursing care for fiftyfive older people. The accommodation is on three floors and has assisted communal bathing adaptations for people with physically disabilities. The bedrooms are all single with ensuite shower facilities and are well appointed with appropriate furniture and fittings to provide comfortable and safe accommodation. All bedrooms have adjustable electric beds and those on the first floor have ceiling hoists. Portable hoists are also available for other rooms in the home. Each bedroom has access to a telephone, the Internet and some Sky television channels, and doors can be held open electronically but close they automatically when the fire alarm rings. The home has underfloor heating which can be Care Homes for Older People Page 4 of 35 0 Over 65 55 Brief description of the care home controlled in each room. Some first floor rooms have patio doors onto a courtyard area, as the home is built near a hillside. The main dining room and lounge area on the ground floor is spacious and attractive. The first floor also has an attractive lounge where people can dine if they wish, and the second floor has a smaller lounge. A lift provides access to all floors including the lower ground floor where there are offices and a spacious activity room. The home is approached from a long driveway where there is parking for visitors at the front of the home and an outside area with seating accessed from within the home on the first floor. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This is the first inspection for this new service, which was undertaken over two days with one inspector. We, the Commission, sent surveys to the home for the staff and people living in the home to complete for us. Eight completed surveys were returned from the staff and none from the people accommodated. Twentynine people were accommodated and most were seen and spoken to. Eleven people had a conversation with us in their own bedrooms. We also spoke to five people in the communal rooms, and five relatives or friends visiting the home. We had direct contact with the homes registered manager, the registered providers, the head of care, four members of the staff, and the chef. A number of Care Homes for Older People Page 6 of 35 records were looked at including care plans, risk assessments, health, medication and recruitment records. The care records of five people accommodated were looked at, three of them in more detail. The environment was inspected and staff were observed engaging with people living in the home. The registered manager had completed the Commissions Annual Quality Assurance Assessment (AQAA), this is an annual selfassessment about the home and is a legal requirement. The current fees are 650 pounds to 900 pounds depending on the room available, chiropody, hairdressing and newspapers are extra, information about the fees can be found in the Service User Guide available in the home. What the care home does well: What has improved since the last inspection? What they could do better: People are adequately assessed by a registered nurse before admission to the home to help ensure that the home can meet their needs, however, the environment may not be suitable for people admitted with dementia. There were some good individual actions in the care plans and goals to reach or maintain, and the reviews seen were meaningful. However, there had been no reviews completed for almost two months for some highly dependant people with complex nursing needs, which could put some people at risk. The records we looked at, and from the information that staff and the people that we spoke to gave us, it was apparent that personal care and nutritional needs were not always met. People living in the home told us; there is a shortage of staff, they are always rushed, I have been left waiting for a long time and i dont know when staff are coming back. There was no programme of activities as the activity coordinator that worked twenty hours had just left the home and had not been replaced. Most people we spoke to were bored and had nothing to do, one person would have liked to do exercises to music, another would like trips out locally. The menus include fresh produce and there was a variety of choice to include a hot and cold choice at supper time. However, people were not always asked what they wanted Care Homes for Older People Page 8 of 35 and mealtimes were disorganised with people waiting for food and drinks that were sometimes not hot enough. We saw a well completed complaint investigation, however, the staff should record all concerns voiced by people living in the home and their relatives, which would help ensure they are acted upon and reviewed. The home has underfloor heating which can be controlled in each room, however, several people told us they were cold and did not realise they could alter the setting. The staff must ensure that peoples individual temperature preferences are maintained at all times. There was insufficient staff to meet peoples needs, and whilst it is appreciated that the home is gradually admitting people there must be enough staff ready to complete care needs before people are admitted. Recruitment procedures were incomplete as not all the information had been recorded to help ensure that people are protected. We spoke to the providers about quality assurance and it was agreed that this should begin as some people and their relatives were obviously dissatisfied and there should be a formal way of finding out what people think and how improvements could be made. It is recommended that a questionnaire is completed by people living in the home to help the manager know what improvements are necessary. There were several verbal complaints raised by people during the inspection to include; staffing levels, organisation of staff, food temperature, choice of food, timing of meals, waiting for assistance and heating in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people had not been provided with a service users guide. People are adequately assessed by a registered nurse before admission to the home to help ensure that the home can meet their needs, however, people with dementia will require careful assessment as the environment may not always be suitable for them. Evidence: We looked at four pre-admission assessments and the formats used contained all the areas required in standard three. Generally there was sufficient information but one assessment had very little information regarding dental and optical care and any recent checks. We spoke to the manager about information people receive, which should include a service users guide, several people already admitted did not have the guide, the managed rectified this during the inspection. Three people were admitted in the last two weeks and it was evident that there was insufficient staff to meet everyones needs. Whilst it is appreciated that the home is new and will eventually Care Homes for Older People Page 11 of 35 Evidence: accommodate fiftyfive people, currently there are twentynine, staff should be employed before people are admitted to ensure all needs are adequately met. Some new staff may be less experienced and need time to learn and shadow more experienced carers or nurses. The home is not registered to admit people with dementia and careful assessment must be completed to ensure that the home can adequately meet peoples needs in an appropriate environment. There was no separate Statement of Purpose , this was incorporated in the Service User Guide. The manager must ensure that all the information required by Regulation 4 (Schedule 1), is in the Statement of Purpose, which must include staff qualifications and training. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans seen were detailed and the reviews were meaningful, however, a lack of reviews could put people at risk. Staff were unable to adequately complete the care needs due to lack of staff and in some instances organisation. Medication administration was taking nurses a long time and the two systems being used may be a hindrance. The medication records seen were well recorded and storage and administration practices were good. Evidence: We looked at three care plans in detail and spoke to the people accommodated and relatives or friends visiting during the inspection. There were some good individual actions in the care plans and goals to reach or maintain. The care plan reviews seen were meaningful, however, there had been no reviews completed for almost two months for people who are highly dependant and some having complex nursing needs. The daily records were detailed and generally contained the information required to aid continuity of care and identify changes. It was apparent from the records seen and staff spoken to that people did not always have their personal care needs met with Care Homes for Older People Page 13 of 35 Evidence: regard to bathing. The home has good facilities for assisted bathing for people with disabilities which did not appear to be used. However, ensuite showers were used but some would benefit from the provision of additional handrails to help promote independence. There were nine people nursed in bed and although on air mattresses they also required a thirty degree tilt of the mattress every three hours. It was uncertain whether this had been completed as there were no records kept. The use of specific wedges to achieve the tilt and a record of when it is changed is recommended as several people were at risk from developing a pressure ulcer. One pressure ulcer had become infected and the nurses had sought advice from the district nurse and doctor, however a photo could not be taken to record subsequent progress as the camera was unavailable. Wound care must be recorded to include the size and condition and what dressing is applied. Photographs seen of leg ulcers did not have a measure in the picture to help ensure that they were not increasing in size and requiring intervention. The care staff tried to ensure that people in a wheelchair at risk of developing a pressure ulcer spent some time out of their wheelchair during the day. All wheelchairs seen had appropriate cushions to help prevent pressure ulcers. We were told that the care staff inform the nurses about any care issues seen during completion of personal care, however, the nurses were very busy and were not always able to monitor and check all superficial wounds. A tool is used for identifying people at risk from malnutrition, all people are weighed monthly, however, a person with considerable weight loss did not have a record of diet and fluids taken to help ensure that they had sufficient nutrients. It is recommended that a record is kept of nutrients taken when people are identified to be at risk. There was only one nurse on duty and completing the medication administration took most of the morning, and then organising the lunch where seven people required feeding. One morning there was only five staff including the nurse and three people accommodated and their relatives complained that they had to wait twenty or thirty minutes for a bell to be answered and were up late and not washed and dressed when they wanted to be. This was not always recorded so that concerns could be addressed, and when staff finished their shift records had not been completed. This concerns us as the care staff completing the care need to ensure that all progress or otherwise is recorded daily and the care plans are updated as required. People told us; there is a shortage of staff, they are always rushed, I have been left waiting for a long time and i dont know when staff are coming back, the staff are too busy to bathe me and i am not sure when i am having a shower. We observed the nursing staff completing medication administration on both days of the inspection, which took almost three hours to complete two floors in the morning. The home currently has two systems of administration, monitored dosage and from Care Homes for Older People Page 14 of 35 Evidence: the dispensed containers. The staff hope that once all medication is on the monitored dosage system administration will be more efficient. The home has a medication policy and procedure which the nurses follow and an electric trolley which is taken to both occupied floors. The trolley was organised and clean, and the nursing staff use disposable medication cups for administration. None of the people accommodated were self-medicating but each room had a lockable cupboard should this be requested. The medication records were well recorded and the only as required medication were paracetamol and laxatives. We were informed that people were capable of deciding for themselves when they wanted them so protocols were unnecessary to help staff decide when to give. Transcribed medication records seen included all the information required. The medication fridge temperatures were recorded to ensure safe storage, and all medication was secure including the Controlled Drugs. The home had an up to date medication reference. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social and recreational needs were not being met as many people were bored as there was not a programme of planned activities. People have a lot of visitors and links with the local vicar who provides religious services. At times people were not able to exercise choice due to insufficient appropriate staff being available to complete activities Mealtimes were disorganised and people had to wait for food and drinks which were sometimes not hot enough. Evidence: There was no programme of activities as the activity coordinator that worked twenty hours had just left the home and had not been replaced. The manager was currently advertising for a replacement. We saw photographs of people taken at various places of interest locally by the previous activity coordinator, however the home does not have a mini bus yet so there is limited transport. There is a large activity room on the lower ground floor, which looked bare and uninviting, but there was evidence of people having completed some paintings. The manager told us that there was an activity book where life profiles had been started to help match activities that people enjoy. This Care Homes for Older People Page 16 of 35 Evidence: information should be transferred to the care plans to help ensure that all staff are aware of peoples interests and all activities completed are recorded. Most of the people we spoke to were bored and had nothing to do, one person would have liked to do exercises to music, another would like trips out locally. A few people enjoyed reading and writing letters but staff did not have much time to engage with people other than completing personal care, as they were so busy. We observed staff treating people with kindness and respect, however the use of some terms of endearment may not always be welcomed. People told us the staff were kind and usually cheerful and most were competent, but some new staff needed to gain more care experience. We interviewed the fulltime chef, spoke to the temporary chef in the kitchen and looked at the new menus in a folder. We also spoke briefly to a hostess, but the two hostesses seen were extremely busy and the manager had to help them after the chef had gone home in the afternoon. We were told the menus included all fresh produce and there was a variety of choice to include a hot and cold choice at supper time. The chef makes soup each day which is available at supper time. There were no menus available around the home for people to know what was for lunch or for staff on the units to know what they were giving to the people that required help with feeding. People had not been asked what they wanted to eat for lunch on the first day of the inspection, but we saw the list completed for supper choices. People living in the home told us that the food was ok, a good effort but too fancy, we need more suitable meals for older people, very good food but not much choice, the food is good i had bacon and eggs for breakfast today, and I like the puddings. Four people told us the food was sometimes cold when it arrived and that the hot drinks were often late and not hot enough. We noticed that drinks were late which meant that midmorning drinks were served near lunchtime and lunchtime hot drinks were served at 14.30 which was close to mid afternoon drinks. Lunchtime was chaotic on the first floor observed as either staff were waiting for the pureed food to be brought up or had to ring the kitchen, there was insufficient staff and some people were starting a pureed lunch at 13.50. We saw pureed supper brought up cold on a trolley to be microwaved in the small kitchen on the first floor, which is poor practice as food too hot may be given inadvertently. The chef later explained that food previously prepared should be gradually warmed in the kitchen before being taken to people living in the home. We discussed the issue of keeping food hot and the transportation from the kitchen along corridors and the need to ensure that food at the correct temperature is available when staff are ready to help people. It is recommended that staff have access to hot food on the first floor where nine people were in bed and several people choose to stay upstairs rather than go to the dining room on the ground floor. The kitchen on the first floor was untidy and staff were unsure who was responsible for cleaning the fridge and keeping it stocked with Care Homes for Older People Page 17 of 35 Evidence: provisions to make drinks. Organisation at meal times appeared to be a major problem, but we saw people in the dining room enjoying their meal, and most plates were empty after the meal. We informed the chef that two people told us that the meat was tough on the second day of the inspection. The home was providing diabetic and dairy free diets, and the chef was booked on a course about meal planning. The AQAA told us that a seventyfive percentage of the catering staff have a basic food handling qualification, all staff that handle food should have completed this training, which includes any of the care staff that help with catering when needed. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes complaints procedure does not include other formats for people with disabilities. When a complaint is investigated written information given to the complainant is detailed. However, the staff do not always record all concerns voiced by people living in the home and their relatives, which would help ensure they are acted upon and reviewed. Staff know what to do to help protect people from abuse, and the home has a policy and procedure for the protection of vulnerable people. Evidence: We looked at the homes complaints procedure in the service users guide and at the records of an investigation of a recent formal written complaint to the manager. The complaint was substantiated and the action taken was recorded. The written information given to the complainant was detailed and addressed the issues well. As we heard several concerns expressed to staff it is recommended that all complaints or concerns verbally given should be recorded in the daily records. This will enable them to be addressed and audited to help ensure that any improvements made continue. The head of care should ensure that the manager is aware of all comments made which affect the outcomes for people living in the home. The complaints procedure is not in any other formats to support people with disabilities. The AQAA told us that the home has information regarding advocacy schemes which Care Homes for Older People Page 19 of 35 Evidence: people may need to access if they want support to help them make decisions. Mental Capacity Act training is planned for all staff as people may need the support of Individual Mental Capacity Advocates (IMCAs) in some circumstances. The home has an adult protection policy which includes whistle blowing and this is read by all staff during their induction. The care staff spoken to knew what they should do if they suspected abuse as it was included in their induction and NVQ level 2 training. The AQAA told us that adult protection training and updates are part of the staffs mandatory training and that there is a copy of the Department of Health whistle blowing guidance called No Secrets for staff to refer to. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and has appropriate equipment to meet peoples changing needs and is fully accessible throughout for people with physical disabilities. People are able to adjust the temperature of their rooms and are not at risk from scalding or burns as all rooms have underfloor heating and water temperatures are regulated. Personal possessions in peoples bedrooms help to make them homely and comfortable. The home was clean and fresh smelling thoughout, but not all cleaning fluids were safely stored. Evidence: The home is a new building and has appropriate equipment to meet nursing care needs. This includes adjustable electric beds in all rooms and those on the first floor have ceiling hoists. There are portable hoists for use elsewhere in the home. All bedrooms are single and people are encouraged to personalise them as they wish. All rooms have access to a telephone, the Internet and some Sky television channels. The home has underfloor heating which can be controlled in each room. Several people told us they were cold and they did not realise they could alter the setting. The housekeeper and staff did not know what temperature the individual thermostats recorded, as there was no indication on the dial. It is recommended that staff know Care Homes for Older People Page 21 of 35 Evidence: what the dial represents in order to ensure that peoples individual preferences are maintained throughout the twentyfour hours of the day. All bedroom doors are held open electronically and close automatically when the fire alarm rings which helps people feel less isolated in their rooms but safe from the risk of a fire. however, the temperature in the corridors will also need to be maintained to prevent people becoming cold in their rooms. There are sufficient and suitable toilets and ensuite facilities which include a shower. Assisted bathing facilities are available on all floors. The communal areas looked inviting and were well furnished. We looked in the laundry which was well equipped and organised and spoke to the staff there. It is recommended that there is an infection control policy posted in the laundry so that all staff accessing the laundry know the procedure to help prevent cross-infection. There should be an infection control policy for staff to follow in the kitchen. We looked in one sluice and found cleaning liquid stored, the door was unlocked but when locked the key is hanging by the door and there is easy access for anyone living in the home or visiting. It is recommended that all cleaning liquid is stored safely when not in use. The home is currently advertising for a new maintenance person, however, we looked in the maintenance book and the homes handy person had completed any issues quickly to help ensure a safe home for everyone. The home was clean and people told us the their rooms were always kept clean. The housekeeper told us the carpets are cleaned as soon as they need to be to ensure all rooms are free from unpleasant odours. We saw the housekeeper shampooing a bedroom carpet during the inspection. Care Homes for Older People Page 22 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are times when people have to wait for their care needs to be met as there are insufficient staff available. The home recognises the importance of training, and delivers a programme that will meet the National Minimum Standard for care staff when all have completed their NVQ level 2 training. There were no training records completed but the manager recognises the importance of adequate training. Recruitment procedures were incomplete as not all the information had been recorded to help ensure that people are protected. Evidence: We looked at the staff rotas and spoke to the staff on duty and there were insufficient staff to ensure the outcomes for people met their needs at all times. Whilst it is appreciated that the home is gradually admitting people there must be enough staff ready to complete care needs before people are admitted. Three new people had been admitted in the last few weeks and staff were rushed and people had to wait for assistance. See evidence in Standard seven and fifteen of this report. We discussed with the manager and the provider the provision of additional care staff at peak periods of activity in the morning and the evening when people are getting up and going to bed. Care Homes for Older People Page 23 of 35 Evidence: Staff told us that when there is staff sickness they are struggling to meet peoples needs. One carer told us that they only had time to complete showers and not any baths for people in the last five weeks due to lack of staff. Staff were completing extra shifts and completing hostess duties when the hostesses were unavailable. One member of staff felt unsupported and that their induction was insufficient. The Head of Care is currently on night duty which may mean that continuity of care could be a problem. We had eight staff surveys returned to us and generally staff were positive about most aspects to include induction, training and facilities, however there were many negative comments about the inadequate staffing levels and support by managers. Two care staff told us that they never meet with the manager for support or advice. However,one carer said that they had been enrolled on a dementia care course at a local college and that they had been supported by the local Care Home Support Team. One survey said that the communication between all levels of staff could be improved especially prior to an admission, so that preparation could be made for new people coming to live in the home. One survey told us that staff morale was low as they struggled to meet needs with insufficient staff, but hoped that it would improve once more people were living in the home and the staffing levels improved. The surveys had been completed prior to the inspection and it was felt that on the day there had been some improvements in staffing levels, but still not enough. The AQAA dated 11 August 2008 told us that four care staff have an NVQ level 2 in care qualification and six are working towards it. Information given to us during the inspection indicated that thirteen staff have NVQ level 2 or are working towards it. This tells us that more care staff have been recruited who may already have the correct qualification or are willing to achieve it. The home has one fulltime chef, a kitchen assistant and two hostesses. There are four domestic cleaners, a housekeeper and one person fulltime in the laundry supported by the domestic staff when required. The home is constantly recruiting staff, which will include another fulltime hostess. We looked at three recruitment records and Criminal Records Bureau and Protection Of Vulnerable Adults checks for all staff. Application forms are completed and interview records are written. Two records only had one reference but we were told the administration staff were trying to obtain another for each person. One record with two references had little information about the last employment other than the dates the person had worked there. It is recommended that the manager obtains a verbal reference, if possible, to help protect people. Staff have job descriptions and a health assessment is completed. There was no evidence of any training previously completed Care Homes for Older People Page 24 of 35 Evidence: by the staff employed and training records had not been started. The manager gave us a handwritten record of all staff qualifications during the inspection, which did not include all the mandatory training required. We spoke to the homes trainer for manual handling and health and safety, she told us that all but three staff had received the training. The surveys completed by the staff indicated that they were given appropriate training. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 well qualified manager but the temporary absence of the head of care on day duty has had an impact on planned care. Quality assurance had not been started and people have no formal way to comment. Staff were not well supported as formal supervision has not been started. The home has safe working practices and the polices and procedures for staff to follow. Evidence: The registered manager is qualified and has several years previous experience of managing a large care home with nursing. All staff have job descriptions and there are lines of accountability within the management structure, which is recorded in the Service User Guide. The new providers have had a lot of experience running a large care home. The providers and the manager were completing additional duties during the inspection due to staff shortages and as previously mentioned in Standard seven the head of care was on night duty for the same reason. Care Homes for Older People Page 26 of 35 Evidence: We spoke to the providers about quality assurance and it was agreed that this should begin as soon as possible as some people and their relatives were obviously dissatisfied. There should be a formal way of finding out the views of people and how improvements could be made. It is recommended that a questionnaire is provided to help improve the service and to know if people felt the admission process was correct for them. There were several verbal complaints raised by people during the inspection to include; staffing levels, organisation of staff, food temperature, choice of food, timing of meals, waiting for assistance and heating in the home. The AQAA told us that the home does not handle peoples personal monies and that all financial affairs are handled by themselves, relatives or peoples representatives. We looked at how the accounts for peoples hairdressing monies were recorded. One carer told us that there had been a few staff meetings and that the manager had an open door policy if staff wanted to speak to her. The manager informed us that there was no formal recorded supervision of staff yet. The evidence provided in the AQAA tells us that the home is compliant with disposal of clinical waste, disposal of medicines, Control Of Substances Hazardous to Health, Portable Appliance Testing, and the checks required to maintain and service systems and equipment in the home. It also told us that all the required policies and procedures are in place and were reviewed in April 2008 including infection control. The manager told us that all accidents in the home are recorded and examples were seen. The manager plans to complete a monthly audit of accidents to help identify areas for prevention. Fire safety records are maintained and the manager ensures that the weekly fire alarm test is completed. The manager told us that all staff have had fire safety training and that new fire risk assessments are in place following recent changes in the fire safety regulations. The head of care has completed a four day first aid at work training. It is recommended that there is always a member of staff on duty with a first aid qualification. The manager also informed us that before the home was registered they had completed all the required risk assessments in the home to help ensure a safe environment for everyone. We recommend that staff responsible for health and safety in the home should have an appropriate qualification, and may need regular support from an outside agency. The AQAA contained most of the information required, however, additional evidence to support the comments made would have been useful and would have indicated how the home is planning to improve. The data set section of the AQAA was completed. Equality and diversity issues for people living in the home need to be more fully Care Homes for Older People Page 27 of 35 Evidence: addressed to help ensure that everyone with a disability has the same choice and options available to them, with particular regard to social activities. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 12 The registered person shall 30/11/2008 ensure that the care home is conducted so as to (a) to promote and make proper provision for the health and welfare of service users & (b) to make proper provision for care and, where appropriate, treatment, education and supervison of service users. The registered person must ensure that there are sufficient and experienced staff to care for people before they are admitted to the home, in particular people with dementia. And the home must be able to accommodate people in a suitable environment to ensure their safety and promote their well being. 2 7 15 The registered person shall keep the service users plan under review 30/11/2008 Care Homes for Older People Page 30 of 35 All care plans should be regularly reviewed, in particular those for people that are highly dependant, to help ensure that any changes are made to provide good continuity of care. 3 8 17 A record must be kept of any nursing provided to the service user, including a record of his condition and any treatment or surgical intervention. All wound care must be adequately described to include measuring, to help ensure that progress is made, and to identify the need to change the treatment if required. 4 12 16 The registered person shall 30/11/2008 consult service users about the programme of activities arranged by the home and provide facilities for recreation, having regard for the needs of the service users, activities in relation to recreation, fitness and training. A programme of activities must be provided after consultation with people to help ensure that they have sufficient activities that interest them to keep them occupied as they wish. 5 15 16 The registered person shall provide, in adequate 30/11/2008 30/11/2008 Care Homes for Older People Page 31 of 35 quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such times as may reasonably be required by service users. There must be sufficient staff at meal times to ensure that people have their meals on time. Pureed diets should not be microwaved before being given to people as they may inadvertently have food that is too hot. Staff should have access to hot food and drinks on the first floor to enable them to serve people with food that is the correct temperature at an appropriate time. 6 27 18 The registered person shall 30/11/2008 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. There must be sufficient staff to ensure the outcomes for people meet their needs at all times. 7 29 19 The registered person shall 30/11/2008 not employ a person to work at the care home unless full and satisfactory information is available in relationship to each of the matters specified in schedule 2 Care Homes for Older People Page 32 of 35 There must be two written references obtained and where applicable from the last employment with vulnerable adults. 8 30 17 The registered person shall maintain in the care home the records specified in Schedule 4 a record of all training undertaken, including induction. There must be a record of all training undertaken by staff. 9 33 24 The registered person shall establish and maintain a system for evaluating the quality of the service provided at the care home. There must be a quality assurance system to take the views of service users and their representatives into account and there should be a written report of the measures the registered person considers necessary to improve the quality of care. 10 36 18 The registered person shall 30/12/2008 ensure that persons working at the care home are appropriately supervised. Care staff should receive formal recorded supervision to cover all aspects of practice to help ensure that service users are in safe hands at all times. 30/11/2008 30/12/2008 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 5 8 We recommend that all people accommodated should be supplied with a service users guide. We recommend that wedges are used to provide a thirty degree tilt to the mattress every three hours to prevent pressure ulcers, and that records are kept to help ensure that care staff know when to complete the procedure on time. We recommend that a record is kept of nutrients taken when people are identified to be at risk from malnutrition. We recommend that menus are displayed around the home so that people know what is for lunch and that staff can advise people, they are supporting to eat, what they are eating. We recommend that all catering staff and care staff that help with catering when required complete basic food hygiene training. We recommend that all complaints or concerns verbally given should be recorded in the daily records initially. This will enable them to be addressed and audited to help ensure that any improvements made continue We recommend that staff know what the heating control in peoples bedrooms represents in order to ensure that peoples individual preferences are maintained throughout the twentyfour hours of the day. We recommend that all cleaning liquid is stored safely when not in use. We recommend that communication between all levels of staff be improved especially prior to an admission, so that preparation can be adequately made for new people coming to live in the home. We recommend that the manager obtains a verbal reference, if possible, where there is insufficient information to help protect people. We recommend that there is always a member of staff on duty with a first aid qualification. We recommend that staff responsible for health and safety in the home should have an appropriate qualification, and may need regular support from an outside agency. 3 4 8 15 5 15 6 16 7 25 8 9 26 27 10 29 11 12 38 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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