Inspection on 01/03/10 for The Old Vicarage Residential Home

This inspection was carried out on 1st March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage Residential Home 07/09/09

The Old Vicarage Residential Home 09/07/08

The Old Vicarage Residential Home 18/05/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: The Old Vicarage Residential Home 2 Tibberton Road Malvern Worcestershire WR14 3AN     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: Christine Potter     Date: 1 2 0 3 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 35 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: The Old Vicarage Residential Home 2 Tibberton Road Malvern Worcestershire WR14 3AN 01684569523 01684569523 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): SJS Care Ltd Name of registered manager (if applicable) Mrs Annette Hoskins Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The Home may also accommodate a maximum of 9 people over 65 years of age with dementia illnesses. Date of last inspection Brief description of the care home The Old Vicarage is situated a short distance from Malvern town and all the towns amenities. The Provider owner, S.J.S. Care Ltd., was registered with the commission in November 2006. Dr. R.C. Sumanasuriya has been nominated as the responsible individual who supervises the management of the care home on behalf of the Provider company. Care Homes for Older People Page 4 of 35 Over 65 2 17 17 0 0 0 0 7 0 9 2 0 0 9 Brief description of the care home The home is a Victorian house on three levels that has been adapted to provide care for older people. There are thirteen single bedrooms, seven of which have en-suite facilities, and two shared bedrooms. In addition, there is a communal lounge and conservatory and a communal dining room. A stair lift is fitted to the main staircase to facilitate movement between the ground and first floor. A small number of steps do have to be negotiated, as the stair lift does not reach the first three or four steps from the ground floor. Grab rails are, however, provided. The house is surrounded by a well-established, accessible garden. The home is registered to accommodate 17 residents who have care needs arising from the ageing process or who are over 65 years of age and have care needs arising from physical disability. The service can accommodate up to nine residents over 65 years of age who have care needs arising from dementia and two residents over 65 years of age who have care needs arising from mental health problems. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the commission, undertook an unannounced inspection of this service, which means that the home did not know of our visit. This was a key inspection, an inspection looking at a wide range of areas. The last Key inspection was the 07/09/2009 and the overall rating for the home was poor. This report should be read with the previous report. The Old Vicarage returned their Annual Quality Assurance Assessment (AQAA) document when requested earlier in the year. The AQAA is a self-assessment and a dataset that each registered provider has to complete each year and send to us within agreed timescales. The document tells us about how providers of services are meeting outcomes for people who use the service and is an opportunity for them to share with us what aspects of the service they believe they are doing well. Information was gathered from speaking to and observing people who lived at the Care Homes for Older People Page 6 of 35 home. Four people were case tracked, which involved discovering their experiences of living at the home by meeting and observing them, looking at medication and care files. Case tracking helps us understand the experiences of people who use the service. We received 12 surveys from people using the service, staff and professionals involved with the home. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Issues around medication were found during the inspection. The home must ensure that people receive their prescribed medication correctly. The storage of medication must be safe to protect people using the service. Social stimulation and the provision of activities require further improvements so that all people, whatever their interests and abilities, are provided with appropriate stimulation and activities that meet their mental health needs. Staffing arrangements need to be reviewed to ensure that staff are always deployed effectively and in sufficient numbers so that people in the home have the individual care and attention they need. The home should find out more about recognised best practice in dementia type illnesses including care practice, communication, training and how the environment can be used to help people. To ensure that people feel listened to, the complaints procedure should be reviewed. The home needs to work on improving the quality of written plans describing peoples care needs to make sure the information provides clear guidance to staff and reflects each persons needs and wishes. The health and social care needs of the people who use the service need to be promoted and staff need to act upon outcomes of assessments and instructions from health professionals to ensure people are not placed at risk of harm through neglect of care. To further protect people living in the home, the service must ensure that new staff are recruited safely and ensure that the appropriate safety checks have been completed. Care Homes for Older People Page 8 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. To assist people with their choice of home, the information should be developed in alternative formats suitable for the individuals needs. The pre-admission assessment needs to show that individuals are assessed thoroughly before admission to ensure they can meet peoples health and social care needs. Evidence: The last key inspection rated these standards as adequate. We were unable to assess if the home were completing pre-admission assessments, as they have not admitted anyone into the home. This will be monitored at the next key inspection. We were shown copies of the new documentation developed to assist in assessing people prior to admission. This appears to cover all the appropriate information. Whilst looking through the care records for people, we noted that the terms of residency for one person dated 2003, which has not been reviewed or replaced for the new ownership. Care Homes for Older People Page 11 of 35 Evidence: Information about the home is available in the reception area. This is in picture format to assist people in understanding the information. A copy of the Service Users Guide is available in all bedrooms, but has not yet been developed in alternate formats. The Statement of Purpose and Service User Guide did not have a review date on them. The manager told us that they were in the process of developing an easy read version for people. Surveys received from seven people using the service confirmed that they had received enough information about the home to assist them with their choice. On the day we visited, we spoke to staff providing the care and assistance to people who live at the Old Vicarage. We spoke to the manager, registered provider, residents and relatives. Full discussions with people living at the home were not always appropriate. Therefore, our observations and discussions with staff and relatives will be referred to throughout this report. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans are not person centred and do not provide the information needed by care staff to enable them to meet the needs of the people who use the service. This places the people who use the service at risk of not receiving the help and care they need. The homes policies and management of medication need to be improved to ensure peoples medication is recorded, administered, stored and disposed of correctly to ensure people are not placed at risk of harm. Evidence: The last key inspection rated these standards as poor. Since the last inspection there have been no new admissions into the home. The home has received support and training from the quality care team. This included guidance with the format of care plans. Therefore, we were disappointed with the progress made to ensure that people living in the home had a care plan in place reflecting their health and personal care needs. We looked at the care records for four people living in the home. These showed significant shortfalls in record keeping, and practices that could potentially Care Homes for Older People Page 13 of 35 Evidence: compromise people in not receiving the care that they require. Care plans and assessments were not being reviewed and updated frequently, for example 05/05/2008 to 19/01/2010. The assessments and care plans fail to include person centred care planning, so therefore individuals choices, preferences and dislikes may be missed in staff practises. The care plans fail to provide staff direction and guidance. For one person, it was unclear as to when they moved into the home. There was no photograph consent or key consent form in place. A personal inventory had not been completed on admission to assist in monitoring that personal items do not get lost. Following admission to the home, the person had been admitted to hospital for treatment. The home had accepted them back via a telephone conversation, without reassessing them to ensure that they could still meet their needs. This resulted in a delay in equipment being provided for them to assist the person for two days. For another person, the nutritional assessment recommended, on the 23/03/2009, that supplements should be considered. However, they were not reviewed again until 31/01/2010, and we could not confirm how their nutritional needs were being monitored. Another person assessed as requiring encouragement with diet and fluids, and nutritional supplements on 24/03/2009 this assessment was last reviewed 04/10/2009. We looked at the care records for a person who was having frequent falls in the home. For the most recent fall, we could not find the completed accident record. It was difficult to know whether the person may have benefited from referral to the falls clinic. Care plans were not being updated to reflect changes in the persons health care needs. For example one person with sore eyes had been recommended that their eyes were bathed four times per day, but this was not reflected in the care plan. Therefore staff are relying heavily on each others recordings, and not developing short or long term care plans, so errors could be made. The personal care checklist in bedrooms is not always completed by the carers either. We spoke to the relatives of one person who felt that the home has deteriorated since their relative moved in. They have issues around the management of nails and dental care, and concerns about diet and the standards of food, as their relative was losing weight. They have found X wearing someone elses clothes. They had never seen a care plan or discussed Xs care with anyone. We could find no care records for the Care Homes for Older People Page 14 of 35 Evidence: management of nails, or discussion with families in the care records we looked through. Other comments received included Staff are lovely and helpful, staff understand Xs needs and X is always happy We looked at the management and control of medication where the last key inspection made requirements for the management of medication to be improved. The drugs fridge arrived whilst we were in the home, and the maintenance person was in the process of installing this so the requirement is actioned. The medication cupboard had not arrived yet, the manager told us that they were still awaiting its delivery. We found discrepancies with the administration and recording on the Medication Administration Records(MAR), which staff were unable to explain. We found that the medicine records were not always documented with the receipt or balances of medicines available, making it difficult to check whether medicines had been given to people living in the home. We saw some MAR charts, which were poorly documented. Some MAR charts were not documented with a signature for administration of a persons medicine or a code recorded to explain why the medicine had not been given. Examples of gaps included Simvastatin 40mgs 26/02/2010, Gabanetin 100mgs- gap for the 26th, 2100 hours. Movical- gap for the 28th. One person was on sodium valporate, but we could find no reason in the persons care records as to why they were taking this medication. Handwritten entries on the MAR were not countersigned by two staff, and there was no protocol in use for giving prescribed medication as required. For prescribed creams, no record was being maintained for why and when this was being applied. We were extremely concerned to find, for one person, that they had been prescribed a strong analgesia for pain relief. However, they had ran out of stock and given the person the old medication, which had been discontinued by the doctor. We issued a code B notice and seized evidence of these shortfalls seen during the inspection. Personal care plans were not always documented with information relating to peoples medicines. We looked at four peoples care plans and the information was either missing or just a list of medication with no date when this was developed. 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. Person centred care is not provided and people who use the service are not being consulted and supported to meet their individual social and emotional care needs to ensure they have the opportunity to make the most of their abilities. Evidence: The last key inspection rated these standards as poor, and made a requirement that the home should ensure that there are sufficient staff on duty. This is to ensure that people who use the service are supported to continue enjoying their hobbies and interests in, and outside, the service. Since the last key inspection the service have provided a table in the dining room with recreational activities for people to use. Recreational activities are included within the duties of the carers. On the day of our visit, people were sat around the lounge in chairs with the television on. During the morning there was a local religious service for those people who wished to attend. There was little evidence of planned recreational activities for people, and lack of information recorded in peoples care records. There was also no information about peoples social histories, which are particularly important to plan activities and social stimulation. Comments received from people included They just seem to sit and sleep in the chairs, try more stimulating activities, outings, employ someone for the activities. Care Homes for Older People Page 16 of 35 Evidence: There is an open visiting policy, which means that people can see their visitors as they choose and maintain relationships that are important to them. The home has a four-week rolling menu. Lunch is the main meal of the day and two choices are offered for the main course. The evening meal also consists of two choices of soup and sandwiches or a hot meal. Fresh fruit is also available in the home. The home is able to cater for diets for medical or cultural reasons. We observed the lunchtime meal and staff assisted people to eat their meals in a discrete manner so as to maintain their dignity. Comments about the food included standards of food could be better. Care Homes for Older People Page 17 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Complaints are not being recorded so people cannot be confident they are being listened to. Evidence: The last key inspection rated these standards as adequate. Since that inspection, the service was referred to the Multi Agency Safeguarding Team because of the zero quality rating. The home agreed a voluntary ban on admissions to address the shortfalls. We looked at the homes complaints records and nothing had been recorded. However, from speaking to relatives who had made several complaints, they felt that they were not being addressed by the home. To ensure that people feel listened to, the home must ensure that all complaints are recorded and show how the complaint was investigated, timescales and the outcome of the investigation when concluded. Staff spoken with had received training about recognising potential abuse and were clear of the action they would take to report it within the organisation. The staff training matrix shows all but three staff have received safeguarding training in the last twelve months. Since the last inspection the manager told us that they had updated their policy on abuse. Care Homes for Older People Page 18 of 35 Evidence: For the one member of staff appointed since the last inspection, the service had not adhered to their recruitment policy and failed to complete thorough checks. This does not ensure that people are safeguarded from harm. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a comfortable environment in which to live. Cleanliness and infection control procedures do not ensure that the home is clean and safe for people to live in. Evidence: The last key inspection report rated these standards as adequate. An immediate requirement notice was issued for the home to complete a risk assessment on all windows above two metres from ground level where people who use the service have access. This was actioned by the home. The last two inspection reports told us: the accommodation isnt ideal for people who have mobility difficulties because the stair lift can only be accessed via a short flight of internal steps. The manager told us they are planning to extend the home and a passenger lift will be included in the extension to enable access for people with mobility difficulties to the first floor rooms. The environment is not easy for people with short term memory problems to find their way around the home. It is recommended that the home look at some of the good practise guidance for people living in care with dementia. There are three communal areas on the ground floor; a lounge, conservatory and Care Homes for Older People Page 20 of 35 Evidence: dining room. The chairs in the lounge are placed around the outside of the room, which does not support and encourage social interaction in small groups with the people who use the service, and their relatives and friends. It is recommended that the home review the chairs in the lounge, dining room and conservatory. Some of the chairs in the dining room were unstable and would be difficult for people with mobility problems to stand up from. Some of the chairs in the lounge and conservatory were stained and quite odourous. We looked around the home and saw that some bedrooms are personalised for the resident using the room, and this gives a more homely appearance. Some areas of damage were observed whilst walking around the home, yet there should be a system in place for reporting and attending to damaged areas. These items included broken drawers in bedrooms, damage to furniture, damage to light fittings, and damage to decoration from water leaks and wear and tear. It is recommended that the service complete an audit of the home and an action plan for the repairs. One relative told us that they had waited for two years for a repair to be completed for Xs bedroom. Some areas were odourous, and on the days of the inspection, no domestic cover was provided. We were told that the domestic was working care hours as they were short on care. The domestic arrangements for the home should be reviewed to ensure people live in a clean, fresh environment. At the last inspection it was reported that the washing machine was only washing to 65 degrees. A note has been placed in the laundry to remind staff about this. Given the amount of people with incontinent problems and acquired infections, it is recommended that a washing machine with a sluicing facility is provided to assist in reducing the risk of cross infection in the home. Care Homes for Older People Page 21 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure does not ensure that people are safeguarded from harm. Some staff training is required to ensure that they have the knowledge and skills to meet peoples needs effectively. Evidence: The last key inspection rated these standards as adequate. It was recommended that the staffing levels closely monitored, to ensure there are always sufficient staff to meet the dependency levels of the residents. On the day of our visit, there were two care staff (seniors) and the manager on duty. The manager was covering a shift for a member of staff who was on sick leave. The cleaner was on annual leave and working care duties on the days of the inspection. The cook was covering care duties, and we were told that they have qualifications in care. Given some people are dependant on staff for their daily living tasks, and to give attention for activities, it is questionable as to whether sufficient staff were on duty. The manager told us that they are advertising for staff, and at the moment they are using an agency to cover at least one shift per day. We looked at the recruitment folder for the one person who had commenced since the last key inspection. We were concerned that the service had failed to carry out safety checks on the person prior to them commencing at the home. The staff file checklist had not been completed. It stated that induction training completed 26/12/2009. Care Homes for Older People Page 22 of 35 Evidence: There was no record to show if the person received moving and handling, fire, food hygiene, health and safety and infection control training. The person had no previous experience in care work. Only one reference had been obtained from a family friend. The person had one job from leaving school but the dates of employment were not recorded. The Criminal Records Bureau clearance had not been received, and no risk assessment was in place to show that they would be working supervised at all times. Since the last inspection, the service have been provided with support and training from the quality care team, which they told us had been beneficial for them. The training matrix showed gaps for staff inspem areas including safeguarding which was on the previous report. Care Homes for Older People Page 23 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home needs significant improvement to ensure it is run safely and in the best interests of the people who use the service. Evidence: The last key inspection rated these standards as adequate. We were disappointed with the poor progress made from the last inspection. There has been no management changes. The manager, Mrs Hoskins, holds the Registered Managers Award which is a recognised qualification for home managers. The Quality Care team have been supporting the home with training including care plan documentation, but in six months, only the care plans updated by the Quality Care Team have been reviewed. Management of records does not necessarily affect the care for the people living in the home, but potentially there is a risk for their health and safety, and care issues being missed. Given the shortfalls identified at this inspection, the service should look at developing a more structured system to audit their internal systems. For example care plans, accidents, medication and staff training. Care Homes for Older People Page 24 of 35 Evidence: Comments from people using the service included, they have a lovely manageress, and very kind staff. The requirement on the last inspection report for the registered provider to carry out monthly unannounced visits to the home has been actioned. Copies of these reports were shown to us at the inspection. On the 20/02/2010, an entry, the cleaner had never been in the conservatory to clean it as part of their duties. The comments were generally about the environment and repair needed. We looked at the fire records the homes fire risk assessment has not been updated since December 2008. The daily fire checks were not been completed daily, there were blank spaces for the 27th and 28th February 2010. The weekly fire safety checks had been completed for 03/03/2010 on the 01/03/2010. The call bell in room five reported the 15/02/2010 as not working. There was no record of what action had been taken to address this, and if a risk assessment had been completed for the person in this room. The water temperatures were being checked weekly and the guidance states that they must be no higher than 43 degrees Celsius. However, the records showed the bath temperature was 48.4C on the 22/02/2010. There is no risk assessment or record of what action is being taken by the home to deal with the hot water. Given some of the health and safety issues identified during the inspection. It is recommended that the service develop a more robust method of ensuring people are safe. The service needs to develop risk assessments for the environment, and people potentially at risk. Set up a review of how the maintenance of systems in the home are looked after and action for outstanding issues. We looked at some of the policies and procedures which were dated 2009. It appeared that the date had been changed without reviewing the policy to ensure it was up to date and reflected current practice. The complaints policy still refers to NCSC and CSCI. We were pleased to see the minutes for residents meetings, and that comments from people are accommodated. For example, one person said that they would like curry on the menu and this is being provided. The management of accidents should be reviewed, and include information to show what action was taken to follow up the persons needs. The service should also provide Care Homes for Older People Page 25 of 35 Evidence: CQC with information in the form of a regulation 37 for all significant accidents and incidents that occur in the home. We looked at the records of money held for the people whose care we tracked. These records are only accessed by the manager and deputy manager. The money was checked and correct and receipts were seen for any expenditure. There were two signatures for receipt or expenditure of any monies on these records. Care Homes for Older People Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 12(1) The health and social 31/10/2009 care needs of the people who use the service must be promoted and provided. To ensure they are not placed at risk of harm through neglect of care. Not met 2 9 13 13(2) To make arrangements 31/10/2009 to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. To ensure that there is safe control and handling of peoples medication. Remains outstanding 3 9 13 13(2) The policy and 31/10/2009 procedure for the receipt, handling, administration, storage and disposal of medication must be reviewed and action taken. To ensure medication is being appropriately managed. Remains outstanding 4 9 13 13(2) To make arrangements 30/11/2009 Page 27 of 35 Care Homes for Older People 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 to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. To ensure controlled drugs are being stored safely and securely to prevent misuse. Advised CD on order e -mail of order seen 12/02/2010 5 9 12 13(2) To make arrangements 31/10/2009 to ensure the administration of all prescribed medication is recorded on the medication records. To ensure people who use the service are receiving the medication as prescribed. Remains Outstanding 6 27 12 12(1) There must be sufficient staff on duty to ensure people who use the service are supported to continue to enjoy their hobbies and interests in and outside of the service. To ensure people have access to social stimulation suited to their needs and expectations and which support them to retain their Care Homes for Older People Page 28 of 35 31/10/2009 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 mental and physical capacity. Remains outstanding 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 7 15 Regulation 15 a b c All people living in the home should have a care plan which accurately reflects their health and welfare needs and provides clear guidance for the staff to follow. This should be reviewed and updated to reflect any changes or at least monthly To ensure that peoples health and personal care needs are met. 28/05/2010 2 8 12 Regulation 12 1 a 28/05/2010 The home should ensure that appropriate risk assessments have been completed, and any potential risks are dealt with to ensure that the persons health and welfare is not being compromised. This includes referring to other professionals for advice and Care Homes for Older People Page 30 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action treatment for people where it is required. To assist in protecting people who live in the home. 3 9 13 Regulation 13 2 30/04/2010 To make arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. This is to ensure that the care service maintains accurate records of medicines. So the home can account for all the medication in the home at all times. 4 9 13 Regulation 13 2 30/04/2010 The service must make arrangements to ensure that medication administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry on the medication administration record; that the meaning of any codes are clearly explained on each record; and that the person administering the medication completes the medication administration record in respect of each Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action person at the time of administration. So people have their prescribed medication correctly. 5 9 13 Regulation 13 2 29/04/2010 The service must make arrangements to ensure that medication is stored securely. To protect people living in the home. 6 9 13 Regulation 13 2 To make arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for staff to give medicines prescribed when required. People have their prescribed medication correctly. 7 12 12 Regulation 12 1 There must be sufficient staff on duty to ensure people who use the service 28/05/2010 30/04/2010 Care Homes for Older People Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action are supported to continue to enjoy their hobbies and interests in and outside of the service. To ensure people have access to social stimulation suited to their needs and expectations and which support them to retain their mental and physical capacity. 8 16 22 Complaints records must be available and complaints must be responded to. So that people feel confident that they are being listened to. 9 19 16 To ensure people living in 28/05/2010 the home have any damage to furnishings and fittings repaired in a timely manner. To protect the person from potential risk and improve the environment. 10 27 18 To demonstrate that their 28/05/2010 are sufficient staff on duty at all times. To ensure that the health and personal needs of people are safely met. 30/04/2010 Care Homes for Older People Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 11 29 19 the service must ensure that 30/04/2010 all staff working at the home have been recruited following the correct procedure. To protect people living in the home. 12 37 37 The home should notify CQC 29/04/2010 about any event in the home which affects the well being or safety of anyone. To protect people living in the home. 13 38 12 The service should ensure that all policies, procedures and risk assessments are reviewed and updated to ensure best practice. To further protect people living in the home. 30/07/2010 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 The service should ensure that people have a contract with accurate terms and conditions of residency, so that their rights are protected. To provide people living in the home with a clean and fresh environment. 2 26 Care Homes for Older People Page 34 of 35 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). 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