Inspection on 04/01/10 for The Hurst Nursing Home

This inspection was carried out on 4th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hurst Nursing Home 20/02/08

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

Key inspection report Care homes for older people Name: Address: The Hurst Nursing Home 1 Mill Road Worthing West Sussex BN11 4JR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ann Peace     Date: 0 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: The Hurst Nursing Home 1 Mill Road Worthing West Sussex BN11 4JR 01903236935 01903236566 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lotus Care 1 Ltd Name of registered manager (if applicable) Mrs Susan Lamb Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 21 The registered person may provide the following category of service only: Care home with Nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following catergories: Old age, not falling within any other category - (OP) Date of last inspection Brief description of the care home The Hurst is a care home offering Nursing and personal care to up to 21 older people. It is situated in a quiet residential area of Worthing. It is a detached corner property with a well-maintained garden. Accommodation is available on three floors and there is passenger lift access. One room is accessed from a mezzanine between floors and there is a stair lift available. Two rooms are shared. All areas are well decorated in a homely manner. Care Homes for Older People Page 4 of 33 Over 65 22 0 Brief description of the care home The fees charged are 550 pounds-635 pounds. The registered providers are Lotus Care and the Registered Manager is Mrs S Lamb. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced site visit as part of the inspection was made to The Hurst on January 4th 2010 and lasted five hours. Before the visit to the Hurst we looked at all of the information we have received from them and from other people with an interest in The Hurst. We looked at ten surveys that were returned to us from residents living at the home, a General Practitioner who visits the home and members of staff who work in the home. During our visit we spoke to residents and their visitors, managers and staff working in the home. We looked at information about the residents who live there and how well their needs are being met. We looked at other records that must be kept in the home to evidence health and safety procedures are followed to keep residents and staff safe. We looked Care Homes for Older People Page 6 of 33 at records to prove staff have the skills, knowledge and training to meet the identified needs of residents they support and care for. We also looked around the building to make sure it was clean, comfortable and safe. Unfortunately some of the record keeping in the home did not show that safe policies and procedures have always been followed, which has caused a safeguarding alert to be raised, an allegation that residents were at risk of harm. The investigation has been carried out and completed by Social Services. An allegation of institutional abuse was inconclusive, an allegation of abuse by one member of staff was substantiated. The home co-operated with the investigation and we noted that the member of staff the allegation was against had been immediately suspended once the allegation was made so one of the immediate risks to residents had been removed. We collected information under a Code B notice in which further shortfalls were identified which continued to pose a potential risk to residents. We spoke to the group manager and the Mrs Lamb the registered manager and told them we were making an immediate requirement that these two risks be dealt with by the home. Both managers agreed, and since we visited an action plan has been sent to us telling us what the Hurst is going to to to address the issues identified. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 33 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A Statement of Purpose is available to give people information about The Hurst so that they can make a decision about whether to live there. The assessment process means that people wishing to live at the home will be assessed prior to admission and following admission to ensure their needs can be met. All residents are given a contract stating the terms and condition of the home. Intermediate care is not available at The Hurst but respite care is available. Evidence: There is an up to date statement of purpose and service user guide in each of the residents rooms and the complaint procedure for The Hurst is enclosed. The information gives prospective residents and their representatives good information about the home so they can make a choice about whether to live there. Care Homes for Older People Page 11 of 33 Evidence: We saw that no residents are admitted to the home without a pre assessment being carried out to ensure the home will be able to meet their needs. Once admitted a full needs assessment is undertaken and care plans and risk assessments compiled. For those people referred through the care management services the home obtains a summary of the Social Services Assessment and a copy of the care plan. Evidence to support this process was in the residents care records. Prospective residents are able to spend time in the home on a trial basis to see if they want to live there and that the staff can cope with their differing needs. New residents are provided with a contract. Intermediate care is not provided at The Hurst but respite care is available. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents who live at The Hurst have their health and personal care needs met and arrangements are in place for safe handling and administration of medication. Residents told us they are treated with respect and we concluded that at time of death residents and their families would be treated with care sensitivity and respect. Evidence: Four assessments and care plans were examined and three contained the basic information staff need to look after residents. We could see that care pans are reviewed on a regular basis. Many of the residents are heavily dependent and are being nursed in bed, we saw that they had specialist equipment in place, seemed comfortable and staff were noted to be caring and friendly with them. One resident had not had a nutritional assessment completed although they had been in the home almost a month, the risk assessment that had been completed and had identified that this resident was at risk of developing further problems due to known health problems and that a nutritional assessment was important. There was no care plan to indicate why this resident was on a pressure relieving mattress or to what Care Homes for Older People Page 13 of 33 Evidence: pressure the mattress should be inflated to. Mrs Lamb assured us that this would be completed. The care plans are not person centred so do not show the individual preferences of residents in relation to how they want to be looked after, what time they like to get up and go to bed or how they want to spend their day. There were no specific social care plans in place. When we asked residents about choice they said that they did not realise they could pick and choose to suit themselves, they were not given the choice of when to get up or go to bed it was done to suit the staff on duty and the routines of the home. However they did tell us that if they specifically asked staff then their wishes would be respected and one lady had asked to stay in bed that day and had. One resident in particular said that on the day of our visit she was woken at 7am and was still waiting to get up at 10.45am which she thought was too long to wait. When we asked about this we were told that it was because one member of staff had not turned up for work so there were some delays. Three surveys from residents told us that there was always enough staff on duty to meet their needs, one said usually. Three residents said that staff always listen to them and act on what they say one said usually. All four said they have the medical attention they need. During our visit we observed that staff were kind and caring in their approach to residents and all residents and visitors spoken to were complimentary about the staff and they way they care for residents. We looked at the medical administration procedures in the home and saw that only qualified staff give out medication, staff have training updates and the records were competed as they should be. We did a random check of the controlled drugs for two residents and found everything to be in order. Four residents did not have a photograph in their medical administration records which could be a potential problem as agency staff are being used in the home especially on night duty. One of these residents had been in the home since early December 2009. During our visit a camera was produced and we were told the photographs would be done that day. We did see that staff respect the privacy and dignity of residents by closing bedroom Care Homes for Older People Page 14 of 33 Evidence: and bathroom doors when they were carrying out care, or if the residents wanted privacy and speaking to residents in a friendly but professional manner. Through circumstances that happened and by observing staff with a poorly resident on the day we visited we concluded that at the time of death staff would treat residents and their families with care sensitivity and respect. A General Practitioner had completed a survey and told us that the health care needs of residents are always met, staff always act on advice given, medication is always administered appropriately, staff always respond to residents diverse needs and that staff usually have the right skills and experience to meet those needs. Some comments were: There is a friendly atmosphere for residents and visitors alike and nothing is too much trouble for the staff. I am satisfied with the care X receives and he is happy here. Staff are always caring and considerate. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Person centred social care plans must be in place to enable staff to fulfill the personal preferences, choice and control of residents. Residents are supported and encouraged to maintain contacts with family and friends. Residents receive good home cooked meals. Evidence: The Hurst has a nice friendly and homely atmosphere, in the foyer of the home there was a large Christmas tree and seasonal decorations were around. There is a comfortable lounge with a new large flat screen television on the wall and a small dining room which is partitioned off to provide a nurses station. There is a PC which residents are free to use if they wish. There are no specific social care plans in place for residents, staff complete an activity chart but they record activities as a resident having visitors or hairdressing. Which are not activities that the home is providing. Care Homes for Older People Page 16 of 33 Evidence: Occasionally there was an entry for 1-1 session but not what they were. None of the activities recorded tied up with the very basic information taken on assessment about the interests of residents. One resident had completed a survey for the home in October saying they would like to do crosswords and puzzles but there was no record that anyone had taken this on board or even read it. The activity programme for 2009 was still on the notice board and recorded that every Wednesday a lady comes in to carry out activities, there were theme days advertised such as pancake day and valentines day and weekly hand massages and manicures. Outside entertainers are employed to come into the home usually once a month. Due to the heavy dependency of residents most activities would have to be on a 1-1 basis but must be relevant to that resident and must be recorded. Social care plans should be compiled and be person centred. Two surveys from residents said there was always enough activities, one said sometimes and one said they did not know. The dining room would be able to seat probably half of the residents accommodated although at present this is not a problem as the majority of residents stay in their rooms or in the lounge through choice. The main meal served on the day we visited was minced beef casserole with dumplings followed by sultana sponge and custard. We tasted the casserole and found it to be good. Residents told us that they could choose something else if they wished. The Statement of Purpose states that residents can have a snack and drinks at any time during the day or night. We were told that the manager and chef were due to have a meeting the day we visited with residents who could offer an opinion to ask what food they would like on the menu. Due to unforeseen circumstance this had been postponed but we were told that it would be held in the near future. During the visit, by speaking to residents, their visitors and staff we could see that residents are encouraged to maintain contacts with family and friends. Residents are encouraged to attend clubs in the community and we saw records that evidenced arrangements were being made for a resident to attend a stroke club. Care Homes for Older People Page 17 of 33 Evidence: Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaint procedure and residents told us that they would feel able to complain. Residents at The Hurst are not safeguarded by the present recruitment procedures in operation, an immediate requirement was made that The Hurst addresses this. The Hursts safeguarding and Whistle Blowing policies and procedures are out of date. The majority of staff have had recent safeguarding training but not all. Evidence: The Hurst has a complaint procedure which is displayed in the foyer of the home and in each room in the Statement of Purpose. Residents and their relatives told us in surveys and on the day of the visit that they knew how to complain and who to and they said they felt their complaints would be taken seriously. There was one complaint recorded in the complaint records for Sept 2009 following an injury to a resident because of poor manual handling practices on nights. Following the complaint further manual handling training was given to staff. Care Homes for Older People Page 19 of 33 Evidence: In November during a routine visit to a resident by a Social Worker the resident made an allegation of abuse. They told the Social Worker that they had informed the Registered Manager Mrs Lamb. When the Social Worker spoke to Mrs Lamb a safeguarding alert had not been made, one was made following the Social Workers intervention. The allegation resulted in a Level 1 investigation by the home and during this investigation six other residents made allegations of abuse about one member of staff to Mrs Lamb who then alerted Social Services. These further allegations were investigated by Social Services at Level 4 they found that: The allegation of institutional abuse was inconclusive but the allegation of abuse by one member of staff was substantiated. The Hurst did appeal to Social Services against the decision regarding institutional abuse, but they were unsuccessful and the decision stands. As soon as the allegation was originally made one member of staff was immediately suspended. Following this, from training records we could see that the majority of staff received updates in safeguarding training in December 2009. A small number of very part time staff did not have any recorded so a requirement was made. We also noted that policies for Safeguarding and Whistle Blowing were out of date. The homes Safeguarding policy and procedure was last updated in 18/11/08 and Whistle Blowing 31/7/07. We were told this was in hand and new ones were presently being compiled. We were told by Mrs Lamb that during the Social Services investigation staff disclosed concerns to Social Workers about the allegation of abuse which they had not disclosed to Mrs Lamb or the Registered Providers, this does indicate that they were not familiar with the Whistle Blowing procedure. We also noted that recruitment records for some staff did not evidence that the providers had collected enough evidence to ensure they were fit to work with vulnerable people. This also is discussed later in the report and an immediate requirement made. The Commission requires the registered provider to visit the home monthly and make reports about conduct in the care home. However there was no mention of the September 09 complaint or the following internal investigation in the Reg 26 reports Care Homes for Older People Page 20 of 33 Evidence: carried out by the provider. This will be discussed later in the report. An immediate requirement was made that the providers assure themselves that they have done every thing possible to ascertain that staff working in the home are fit to work with vulnerable people. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, homely well maintained environment with specialist equipment in place to meet their needs. Evidence: The Hurst was clean, fresh and well maintained, it is furnished in a homely and comfortable fashion. We could see that residents are able to personalise their rooms as they wish with small furniture, pictures and ornaments. A programme of routine maintenance is ongoing and since our last visit a new shower room has been provided, a new security system installed and some rooms re carpeted and re furbished. There is a rear garden which is accessible to residents. Residents who live at The Hurst have their needs met by the provision of suitable equipment and adaptations. The home has a passenger lift, although not all rooms can be accessed by the lift other adaptations to use the few stairs are in place. The Hurst has a call bell system in place and was seen to be in good working order on the day we were there. Maintenance records were available to evidence that all safety systems are tested on a regular basis and equipment is serviced as it should be. Care Homes for Older People Page 22 of 33 Evidence: During our visit we saw that staff followed safe infection control procedures. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents told us that there is usually enough staff on duty and they thought they has the right qualifications and skills to meet their needs. There is a staff training system and records showed that the majority but not all of the staff have had adequate training. The recruitment procedure and monitoring system at The Hurst are not robust so do not safeguard residents. Evidence: In the morning of the day we visited staff were very busy helping residents get up washed and dressed, one member of staff had not turned up for work so they told us they were busier that usual. One resident did tell us that she had waited a long while to get up from 7am till 10.45 but this was unusual. Many of the residents are heavily dependent and being nursed in bed and we noted staff were still carrying out their personal care at 11.45am. When we asked about this, we were told that the home does have vacancies both for nurses and carers although on the day we visited one member of staff had not turned up so made them short. We were told that they were presently advertising and until they fill vacancies agency staff will be used. Care Homes for Older People Page 24 of 33 Evidence: Three residents told us in surveys that there was always enough staff on duty to meet their needs, one said usually. Three said staff always listen to and act on what they say, one said usually. They all thought staff had the right skills and experience to meet their needs. Residents we spoke to during our visit and their relatives were very complimentary about the staff and said that they were friendly and caring and nothing was too much trouble for them. They said they were always considerate to residents and visitors. There is a team of domestic staff who support care staff and these staff were noted to have friendly chats to residents as they were cleaning their rooms. We were told that over 50 of the care staff have a National Vocational Qualification of level 2 and above. There is a staff training system in the home and from this we could see that staff have training in POVA, Health & Safety, infection control, food hygiene, abuse, the Mental Capacity Act and Deprivation of Liberty, communication and in the majority of cases these were up to date. We noted that four part time staff needed training in safeguarding and so a requirement was made in that section. We looked at three staff recruitment files and we found that none of them fully met legal requirements that the provider has to hold records to ensure that residents rights and best interests are safeguarded by the homes record keeping policies and procedures. We made an immediate requirement that the providers ensure staff are safe to work in the home. We found that when one member of staff had been employed at the home, a POVA first check had been carried out but the Criminal Record Bureau check (CRB) was not returned until almost three weeks later, there were no records to evidence that during the interim period this member of staff had been closely supervised by another member of staff or a risk assessment had been carried out. We also noted that the home had accepted CRBs from previous employers before the rules regarding the portability of CRBs was changed. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a potential risk to residents by the lack of quality assurance monitoring of the running of The Hurst. Poor recruitment procedures and lack of staffs knowledge about whistle blowing procedures also pose a risk to residents. Evidence: The Registered Manager for The Hurst Mrs Lamb is a registered nurse, Mrs Lamb is registered with the Commission and has the required qualifications, skills and experience to manage the home. There is a clearly defined organisational line of accountability and responsibility in the home and this is recorded in the Statement of Purpose. Although, due to recent problems at The Hurst there is an indication that there is a serious lack of monitoring in the running of the home from directors and senior members of the organisation. We were told that there is a quality assurance system in the home and various audits Care Homes for Older People Page 26 of 33 Evidence: were available for us to see but the quality assurance system is not robust or used as a quality assurance monitoring tool. If it had, shortfalls in the recruitment records would have been identified earlier and the risks to residents removed, it would have been noted that some important policies and procedures had not been reviewed or kept up to date, Regulation 26 reports would be pertinent to what was presently happening in the home and night visits would have been undertaken following the complaint and alerts. Surveys are distributed which are based on seeking views of residents, as mentioned earlier one resident had completed a survey in October 2009 expressing dissatisfaction with activities and bathing/showering opportunities and requesting specific one to one activity sessions. Although we were told by Mrs Lamb that the showering issue had been noted and staff had tried to resolve the issue this was not recorded anywhere. The only records were that this resident had 4 showers in Dec 09 and 1 so far in Jan 10. There was no record that the lack of suitable activities for this resident had been addressed or that it had been acknowledged. Monthly visits under Regulation 26 are carried out by the Registered Provider and reports made, but as stated earlier these again are not robust. Reports for April 2009 through to October 2009 were available for us to see. Reports for April and May recorded the same statement that issues had been identified related to the number of residents who now need help with feeding. For June through to October (5 months) a statement regarding this was the same for every month i.e. The number of residents needing feeding is very high and so continues to be a good decision to have extra carers. The Provider had not recorded anything about the complaint recorded in the homes complaint book in September 2009 which resulted in a an injury to a resident and a following investigation, and had not recorded anything about a safeguarding alert being raised or the following investigation regarding care provision on nights. There was no indication from the Provider that a visit out of hours visit may be required to find out what was going on and no times were recorded in the Regulation 26 reports to indicate that visits are made at different times to observe different shifts. No reports were available for November or December 2009 to evidence that the Providers had visited The Hurst since the safeguarding alert was raised to satisfy themselves that the home was safe. Care Homes for Older People Page 27 of 33 Evidence: This does indicate a degree of complacency at The Hurst and by the Registered Providers. There is a staff supervision system in the home and records were seen, staff on duty when we visited told us that they were well supported by the manager and said they felt able to discuss issues with her. Although it is concerning that some members of staff did not bring concerns about one member of staff to managers attention under The Whistle Blowing Procedure. This does indicate they were not familiar with the Whistle Blowing Procedure. Despite this, staff, residents and visitors told us that they were very happy with the care given at the home, relatives spoke highly of Mrs Lamb and said they felt they would be able to speak to her openly and that they thought their views would be listened to and acted on. One comment was The all round care and communication is good and I dont think they can improve. The home does not hold monies for residents. We saw records that indicated that health and safety training is given and that procedures are in place to regularly check on safety systems throughout the home. During the inspection information gathered under a Code B notice was shared with the Group Manager and Mrs Lamb and an immediate requirement was made. we were assured that the issues identified would be addressed immediately. Since the inspection The Hurst has sent us an action plan telling us how they are going to address the issues raised. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person shall 08/01/2010 not allow a person to work at the care home unless (a) the person is fit to work at the care home; (b) the empoyer has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of Schedule 2 of The Care Home regulations. Records must be available to prove the providers have satisfied themselves and recorded that people working in the home do not pose a risk to residents. 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 12 16 Consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. 28/02/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action That residents have person centred social care plans and that their needs are met. 2 18 13 The registered person shall make arrangements by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. That all staff are aware and trained in the safeguarding and whistle blowing policies and procedures in order to safeguard service users. 3 33 26 The registered person shall carry out visits to the care home and under 26(4) b, c, inspect the premises of the care home, its record of events and records of any complaints. Prepare a written report on the conduct of the care home. That a robust system of self monitoring is in operation in the home to safeguard service users. 28/02/2010 31/01/2010 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!