Inspection on 07/09/09 for The Old Vicarage Residential Home

This inspection was carried out on 7th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage Residential Home 01/03/10

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 26/11/2009.

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: Sandra Bromige     Date: 0 7 0 9 2 0 0 9 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 34 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 34 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): Type of registration: Number of places registered: SJS Care Ltd 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. 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 Care Homes for Older People Page 4 of 34 0 0 0 Over 65 2 17 17 Brief description of the care home 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 34 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 completed the last inspection of this service on 9th July 2008. This was an unannounced inspection. One inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. we looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also requested survey forms from people who use the service but we did not have any returned before the inspection. Care Homes for Older People Page 6 of 34 The manager told us she did not receive any surveys for completion. We have not received any complaints about this service since the last inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Assessments are carried out by the home manager before people move in, although there is no format used for recording this information so that people can be confident that the home are able to meet their needs. The homes service user guide needs to be produced in further formats, for example audio and easy read versions to ensure it is suitable for the people they provide a service for. Care plans need to be improved so that they are person centred and provide staff with the information they need to ensure peoples care needs are met at all times. Medication needs to be stored securely and at the correct temperature as recommended by the manufacturer to ensure it does not deteriorate which can make the medication ineffective and possibly harmful to people who use the service. They need to ensure controlled drugs are being stored safely and securely to prevent misuse. The homes policy and procedures for ordering, recording, administration and storage of medication needs reviewing to ensure medication is being managed appropriately. The home need to ensure 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. They need to ensure the administration of all prescribed medication is recorded on the medication records to ensure people who use the service are receiving their medication as prescribed by the Doctor. People are not being consulted and supported to meet their individual social and Care Homes for Older People Page 8 of 34 emotional care needs to ensure they have the opportunity to make the most of their abilities. Staff need to be proactive in managing the nutritional care needs of people who are frail and losing weight. The homes policy and procedures for recognition and reporting any allegations of abuse need to be reviewed so that staff know how to recognise and where to report any possible abusive practices. Improvements are needed to the environment and current practice for the management of infection control to ensure the home and its facilities are more pleasant and suitable for the people who use the service and to ensure they are not at risk of cross infection. More staff are needed for the provision of social care to ensure people have the opportunity to maintain their hobbies and interests and provide specialised support for people with dementia and mental health illnesses. Improvement is needed to the recruitment and induction of staff in the home to ensure staff have the right skills and knowledge to support the people who use the service. Staff need training about the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards to ensure they have clear understanding of how this impacts on the care of people who live in the home who lack mental capacity. The Provider must carry out monthly unannounced visits to the service and provide the manager with a copy of the findings from this visit to ensure they monitor the quality of the service being provided to the people who use the service. There should be two signatures for all receipts and expenditure of monies being held by the home on behalf of people who use the service to ensure their is a robust audit trail of all monetary transactions. 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 34 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 34 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. People are assessed prior to admission to ensure the home are able to meet their care needs. The service need to produce documentation to be completed by staff who undertake the pre-admission assessment to ensure all areas of need are assessed thoroughly before admission to ensure they can meet peoples health and social care needs and to enable a care plan to be formulated prior to admission. The service does not provide intermediate care. Evidence: A copy of the homes statement of purpose and service user guide is available in the home. This document is available in normal and large print formats. The home should provide the service user guide in other formats to ensure they are suitable for prospective people they offer a service for, for example audio and easy read versions. We tracked the care of a person who has recently started using the service. We could not see any written information to show a pre-admission assessment had been carried Care Homes for Older People Page 11 of 34 Evidence: out for this person. We were told this person had been assessed two weeks before they were admitted to the home, but the notes made at the time of the assessment had been destroyed. We spoke to the person who uses the service and they told us the head carer has visited them whilst they were in hospital. Care Homes for Older People Page 12 of 34 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: We tracked the care of two people who use the service. We found the quality of the information in the care records was poor and people were not being consulted about their care needs. For example, the plans of care for a person who had recently started using the service were not written until four to five days after they were admitted to the home. The care plan stated they needed some assistance with personal care. It did not specify the assistance they needed from care staff. There was no care plan for the management of diabetes. There was no information about the care of this persons skin, feet and nails. An entry in the accident book dated 1st September 2009 stated this person had a fall and injured their toe. There was no entry in the care plan about Care Homes for Older People Page 13 of 34 Evidence: this accident and no evidence of any follow up by care staff. The risk assessment for falls was not reviewed following the accident. The risk assessment for personal care stated they had a bad toe but there was no further information. We spoke to the person who uses the service and they showed us their feet. They were wearing shoes with no socks or tights. They had a plaster on a toe of their left foot, which they told us had been put on after they fell. We also saw they had a blood blister on another toe. This information was not recorded in the care records. We spoke to a care assistant and they told us they were aware they needed to check this persons skin and feet each day but it was not being done. The care plan did not state how often this person required a bath. We spoke to care staff who told us they had a bath once a week on a Saturday. We looked at the daily records and could not see any baths recorded since this person started using the service six weeks ago. The bath record in the care records was blank. The care staff showed us the bath list for the bathroom this person uses and there was one bath recorded for this person on 15th August 2009. The person who uses the service told us they had not had a bath or shower recently. The nutritional risk assessment had been reviewed on 21st August 2009. An entry on the weight record dated 30th August 2009 showed this person had lost 13lbs in a month. The risk assessment had not been reviewed. Care staff told us they were aware they had lost weight but were not aware of the significant amount of weight loss. The care records for the second person we tracked who had dementia did not specify the care and assistance they needed to enable them to meet their needs. It stated all care needed, but this information is not sufficient to enable staff to understand the care needs of this person. It stated their skin was dry and needs creaming daily. There were no instructions about the type of creams or ointments in use and where they are to be applied and how often. We saw Diprobase cream, Ibuprofen gel and Sudocrem in this persons bedroom. The sudocrem cream was not on this persons medication chart. The care plan stated this persons feet was to elevated during the day and night. We observed this person throughout the day and their feet were not elevated as per the instructions in the care plan. The weight chart for this person shows they have lost over a stone since December 2008. The manager told us they had lost weight but the amount recorded is inaccurate as they do not have any sit on scales to enable them to monitor this persons weight accurately. The nutritional risk assessment stated this person had not lost any weight. We spoke to a senior care assistant who was not aware this person had lost any weight. There was no evidence the general practitioner had been informed about the Care Homes for Older People Page 14 of 34 Evidence: weight loss. We spoke to this person, their hair was clean and tied back and they were well dressed, although they had sleep in their eyes and their finger nails needed cleaning. We looked at the management of medication for these two people. One medication administration record (MAR) was handwritten. There were no signatures of the person writing the MAR and no signature to show it had been checked by a second person for any transcription errors. One person was administering their own insulin, although there was no self medicating risk assessment available in the care records. We looked at the instructions for monitoring this persons blood sugar levels and they were unclear. We asked the senior care assistant to clarify the instructions, but they told us they were also unclear about how often the blood sugar levels are checked. There was no care plan for the management of this persons diabetes. There was an entry dated 4th September 2009 recording a high blood sugar of 16.9mmols. There was no information to indicate the home had consulted any health professionals about this. The second MAR was printed by the pharmacy, although the allergy section had not been completed. There were 14 gaps on the MAR where no entries had been made to indicate if the prescribed ointments had been given or a reason for not administering as prescribed by the general practitioner(GP). Two medicines were not being given at the times stated on the MAR. We asked to see a copy of the prescription for these medicines or any other written information to confirm the times of administration had been changed, but there was no information available in the home. We were told only senior care staff administer medication. We saw a list of staff signatures in the front of the MAR folder. This is good practice, although the form is not up to date. We were unable to carry out an audit of the medication for either person as one persons medication was all in a liquid format and medication had not been recorded upon admission for the other person we tracked. The senior care assistant told us they do not carry out any periodic medication audits in the home. Medication is stored in two places in the home. The staff are not monitoring the temperatures of the rooms where medication is stored. There was no light or shelving in the upstairs medication storage cupboard. We saw external and internal medication being stored on the same shelf. This needs to be placed on separate shelves. We saw the stock of insulin was being stored in a refrigerator used for food in the cellar. Care staff were not monitoring and recorded the daily temperatures of the refrigerator. The cupboard used for storage of controlled drugs was not secured correctly to the wall. The cupboard was dirty and the internal lock was broken. We found 14 ampoules Care Homes for Older People Page 15 of 34 Evidence: of Morphine sulphate in the cupboard which were not entered as stock in the controlled drug register. We looked at the homes medication policy. The policy had been reviewed on 2nd March 2009. The policy does not give comprehensive information about the homes procedures for the receipt, administration, storage and disposal of medication and needs to be reviewed in line with the guidance provided by the Royal Pharmaceutical Society of Great Britain called The Handling of Medicines in Care Homes. We saw staff speaking respectfully towards people who use the service. One lady told us there is a male carer who assists them with personal care and they do not mind, although this information is not in this persons care plan. Care Homes for Older People Page 16 of 34 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 poor 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. People are offered a well balanced diet although staff are not proactive in managing the nutritional care needs of people who are frail and losing weight. Evidence: We saw the current menu which is a four week rolling menu. Breakfast is at 8.00am and is a choice of cereals or porridge, toast, prunes or grapefruit. When we arrived at 09.30hrs we saw one person was just finishing breakfast, which indicates there is flexibility of timings for serving breakfast. Lunch was served at 12 noon. The menu shows a choice of meals each day except on a Sunday when there is just a roast dinner provided. A vegetarian choice is not available each day on the menu, although the home do not currently have any people who use the service who are vegetarian. Lunch on the day of the inspection was a choice of homemade shepherds pie or ham salad, followed by a desert of rice pudding. A rice pudding suitable for people with diabetes was provided. Evening meal is a light supper (hot and cold choices) served at 17.30hrs. An evening snack is provided later in the evening. Snacks are provided mid morning and mid afternoon. Lunch was served and individually portioned by the cook Care Homes for Older People Page 17 of 34 Evidence: in the dining room. People were offered an additional helping of their main course. Staff were seen assisting people to eat at the table and in other parts of the home in a discreet and sensitive manner. A person whose care we tracked told us the food is really good and there is plenty of it. Please refer to the health and personal care section about the management of the nutritional care needs of the two people whose care we tracked. The social care information in the care records was poor and there was no evidence that people had been consulted about their social care needs. The social activities for one person stated in house activities. There was no information about this persons hobbies and interests. We spoke to this person and they told us they liked to watch television and do word search puzzles and they went out with their family most Saturdays. None of this information was in the care records, although the care assistant we spoke to was aware that this person enjoyed these activities. The activity log in the care records for another person was blank. The service user guide states activities are arranged on a daily basis by care staff either as a group or on a one to one basis. The care staff we spoke to told us they carry out activities each day for one hour every afternoon and they record them on the activity records. We looked at the activity records which were on the notice board in the staff room. The last entry was dated 29th August 2009, nine days before the inspection visit. Activities were recorded for the following dates 3rd July, 4th, 6th, 8th, 17th and 29th August 2009. The activities which had taken place were, watched film and weights done, took three people for a walk, reflections about own past, colouring, music man, writing letters. There was no evidence to show they were providing person centred care which was appropriate for the people they offered a service for, for example people with physical, mental health and dementia care needs. People were sitting in the lounge and two people used the conservatory. The chairs in the lounge were all placed around the outside of the room and not in small groups to enable people to engage in conversation. There was a television and CD player in the lounge. There was a small selection of books available, although there were no large print or audio books for people with visual impairment. Holy Communion took place on the morning of the inspection and people sitting in the conservatory were asked if they wished to attend. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service feel safe with the staff, and they are confident their problems will be listened to and taken seriously. The homes policy and procedures for recognition and reporting any allegations of abuse need to be reviewed so that staff know how to recognise and where to report any possible abusive practices. Evidence: The AQAA completed by the manager and submitted prior to the inspection told us they have not received any complaints in the last twelve months. We looked at the homes complaints records and there are no complaints recorded. We have not received any complaints about this service since the last inspection in July 2008. We spoke to staff and they were aware of what to do if they received a complaint. One person whose care we tracked told us they knew who to speak to if they had any concerns. They told us they felt safe and secure living in the home. We were asked for our identity by the staff before they invited us into the home. This is good practice. 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. We looked at the homes adult protection policy, which stated they would begin investigating any allegations. We spoke to the manager about this as the home must not begin any investigation into any allegations of abuse and the policy did not include any information about making referrals to Worcestershire Care Homes for Older People Page 19 of 34 Evidence: County Council who are the lead agency for co-ordinating investigations about any allegations of abuse. The manager told us they have a copy of the local procedures for reporting alleged abuse but was unaware of who to contact in the event of this happening. The manager and deputy manager have not received any training about the Mental Capacity Act or the deprivation of liberty safeguards. Criminal records bureau checks had been carried out prior to employment for the two most recently recruited staff working in the home. Care Homes for Older People Page 20 of 34 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. Improvements are needed to the environment and current practice for the management of infection control to ensure the home and its facilities are more pleasant and suitable for the people who use the service and to ensure they are not at risk of cross infection. Evidence: As stated in the last inspection report dated 9th July 2008, 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. There is a homely atmosphere in the home and it is clean, tidy with no bad odours. There are three communal areas on the ground floor; a lounge, conservatory and 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. The AQAA states the conservatory is now in use, although we saw there remains a small leakage of water into this area. The AQAA told us the kitchen has been refurbished and the dining room has been redecorated. There has been a water leak through the roof light in the main entrance above the staircase, this has been repaired and is awaiting redecoration. Care Homes for Older People Page 21 of 34 Evidence: We looked at the bedrooms and toilet and bathing facilities used by the two people whose care we tracked. They were single rooms with an en-suite facility. The rooms were personalised with photographs and their own possessions. They were clean and nicely decorated. The locks on the doors were the type approved by the commission. One person told us they did not have a key to lock their room, but they did not want one. Staff need to ensure all people are asked if they require a key to enable them to lock their doors and record this information in the care plan. The assisted bathroom was accessed by walking through the dining room. There was a fixed hoist to enable people to get in and out of the bath. The bathroom was clean and contained hand washing facilities. We saw the washable flooring was not sealed around the pedestal of the toilet, this needs to be done to prevent any possible cross infection. Staff told us they use colour coded communal flannels for washing peoples face and body. They told us they washed them on number four setting on the machine. We looked at the temperature of this wash which was 60 degrees Celsius. This is not hot enough to prevent cross infection. The home have received a visit from the Environmental Health Officer in May 2009 to look at the health and safety arrangements in the home. The manager told us they are expecting them to visit again soon to assess the progress of their risk assessment documentation. The home has recently been given a good rating for food hygiene by the Environmental Health Officer. Please refer to the management section of this report about maintenance checks by the home. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More staff are needed for the provision of social care to ensure people have the opportunity to maintain their hobbies and interests and provide specialised support for people with dementia and mental health illnesses. Improvement is needed to the recruitment and induction of staff in the home to ensure staff have the right skills and knowledge to support the people who use the service. Evidence: The manager and three care staff were on duty at the time of the inspection. A cook and cleaner was also at work. The home provide two care staff at night time. We could see from the staff rotas these numbers were representative of the usual staffing arrangements. The home does not employ an activity person to co-ordinate social care activities in the home and in the local community. The current arrangements are the care staff provided this for one hour each day. Please refer to the daily life and social activity section of this report. We looked at the staffing rota and there are only staff Christian names on the rota. The rota needs to contain staff surnames to enable staff to be identified accurately on the rotas. The AQAA states 65 of the current staff have attained NVQ 2 or 3. Staff told us they have received their core mandatory training in the last twelve months, for example Care Homes for Older People Page 23 of 34 Evidence: moving and handling and fire training. The training matrix confirms this information. No staff have received any continence training in the last twelve months. The manager and staff have not undertaken any training about the Mental Capacity Act and Deprivation of Liberty safeguards. This needs to be arranged without delay especially as the home offers care for people with mental heath and dementia illnesses. The home employ male and female staff. A deputy manager was appointed in June 2009 to assist in the day to day running of the home. She is undertaking NVQ level 4. We looked at two staff recruitment files. We found this needed to be more thorough. For example, we were unable to see if a full employment history had been given on the application form for one person as employment start and end dates had not been given. One person had started work in the home prior to receipt of the employment reference. We saw the interview record for one person and this was not dated or signed by the person conducting the interview and the reason for the person leaving their last employment had not been explored. The manager told us she had established the reason for leaving but had not written this on the form. Criminal records bureau checks had been received prior to employment. We looked at the induction records for these two people. The current induction programme is not in line with the Skills for Care Common Induction Standards and is in need of review. The manager told us she was aware of this. Care Homes for Older People Page 24 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some shortfalls in the management and administration of the service which need to be improved to ensure a higher standard of care and improve the safety of the people living and working in the home. Evidence: The manager Mrs Hoskins holds the Registered Managers Award which is a recognised qualification for home managers. She has completed her first year of her Health and Social Care degree. She told us she is due to attend training next month about the Mental Capacity Act and the Deprivation of Liberty safeguards. She has also undertaken mandatory core training for health and safety, moving and handling and fire training in the last twelve months. We saw the homes training matrix showing the core mandatory training attended by staff in the last twelve months. The manager and two further staff who appear on the staffing rota are not included on the training matrix. There are gaps on the training matrix where staff have not received any training for safeguarding, health and safety, Care Homes for Older People Page 25 of 34 Evidence: food hygiene, infection control and Control of Substances Hazardous to Health. Staff spoken with did not know about the Mental Capacity Act 2005 and the deprivation of liberty safeguards and how they affect their work. This training needs to be arranged for all staff as a matter of urgency. An AQAA was returned to us before the inspection. The information in the AQAA was very brief in parts and the information about the maintenance of equipment had not been completed. The last inspection report also stated the AQAA was rather brief in parts. Guidance about the completion of AQAAs is available from our website www.cqc.org.uk. The AQAA tells us about the policies and procedures they have in place and that they have all been reviewed in March 2009. We looked at the homes adult protection and medication policy. Both of these policies need reviewing as they did not contain the correct and sufficient detail of information for the staff to refer to them as guidance. We saw that people who use the service and their relatives had been recently consulted about the standard of the service and any shortfalls had been addressed through an action plan by the manager. The AQAA tells us the service receive unannounced visits by the registered provider or their representative on a monthly basis. We asked to see the reports provided for the registered manager following any visits from representatives of the provider. The manager showed us the last report she had received which was dated 18th May 2008. We looked at the records of money held for the people who 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 no signatures for receipt or expenditure of any monies on these records. We asked the manager to complete the information in the AQAA to tells us when the homes equipment had been last serviced. The information provided stated all equipment had been serviced in the last twelve months. We looked at the fire records held in the home and we saw the weekly and monthly checks had been recorded. The homes records for checking the water temperatures in the home where people who use the service have access were seen. They were last checked on 3rd September 2009 and the outcome was 13 hot water outlets were higher than the recommended temperature of 43 degrees Celsius. A Legionella risk assessment was carried out on 24th August, this was not available in the home at the time of the inspection. Following the inspection the Provider told us they had collected the report on the 4th Care Homes for Older People Page 26 of 34 Evidence: September, in order to read it and follow necessary actions. There have been recommendations with no timescale for fitting TMVs (thermostatic valves) and we are in contact with the water risk assessors regarding remedial work needed. We asked for the records of the maintenance checks for the window restrictors. We were told they did not have any window restrictors in place. We left an immediate requirement to risk assess all windows above two metres from ground level to ensure the safety of the people who use the service. We visited the home on 2nd October 2009 and saw the risk assessment. The home had fitted wooden blocks on the first floor windows to restrict the opening to ensure people could not open the windows and fall out of them. Care Homes for Older People Page 27 of 34 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 28 of 34 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 38 13 13(4)(a)(c) 08/09/2009 A risk assessment must be carried out for all windows above 2 metres from ground level where people who use the service have access. To ensure the safety of the people who use the service. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 15(1)(2) 31/10/2009 Care plans must be sufficiently detailed and care needs reviewed as peoples needs change. To ensure staff understand what is required and people can be sure their needs will be met. 2 8 12 12(1) 31/10/2009 The health and social 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. Care Homes for Older People Page 29 of 34 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 3 9 12 13(2) To make arrangements 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. 31/10/2009 4 9 13 13(2) 31/10/2009 To make arrangements 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. 5 9 13 13(2) 31/10/2009 The policy and procedure for the receipt, handling, administration, storage and disposal of medication must be reviewed and action taken. To ensure medication is being appropriately managed. 6 9 13 13(2) To make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse 30/11/2009 Care Homes for Older People Page 30 of 34 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 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. 7 9 13 13(2) To make arrangements to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. To ensure medication does not deteriorate which can make the medication ineffective and possibly harmful to people who use the service. 8 12 12 12(1) The health and social 31/10/2009 care needs of the people who use the service must be promoted and provided. 17/10/2009 To ensure they are not placed at risk of harm through neglect of care. Care Homes for Older People Page 31 of 34 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 9 26 13 13(3) Foul laundry must be washed at temperatures above 65 degrees Celsius. To ensure it is thoroughly clean and controls the risk of cross infection. 31/10/2009 10 27 12 12(1) 31/10/2009 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 mental and physical capacity. 11 33 26 The Provider must carry out monthly unannounced visits to the service in accordance with this regulation, prepare a written report and supply a copy to the registered manager. To ensure they monitor the quality of the service being provided to the people who live in the home. 31/10/2009 Care Homes for Older People Page 32 of 34 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 1 The homes statement of purpose and service user guide should be available in other formats to ensure it meets the needs of the people they provide a service for. Pre-admission assessment information should include all of the information as stated in S3.3 of the National Minimum Standards to ensure the service assess all aspects of health and social care needs of prospective people who may use the service and to enable them to formulate a care plan prior to admission. The homes policy and procedures for recognition and reporting any allegations of abuse need to be reviewed to ensure staff know how to recognise and where to report any possible abusive practices. Staff should receive training about the Mental Capacity Act and the Deprivation of Liberty safeguards to ensure they have a clear understanding of how this impacts on the care of people who live in the home who lack mental capacity. The induction programme should be reviewed to ensure it is in line with the Common Induction Standards which have been developed by Skills for Care as these set down minimum expectations about learning outcomes that need to be met so that new workers know all they need to know to work safely and effectively. There should be two signatures for all receipts and expenditure of monies being held on behalf of the people who use the service to ensure their is a robust audit trail of all monetary transactions. 2 3 3 18 4 30 5 30 6 35 Care Homes for Older People Page 33 of 34 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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