Inspection on 20/10/09 for The Priory

This inspection was carried out on 20th October 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Priory 10/02/10

The Priory 02/02/10

The Priory 30/06/09

The Priory 02/12/08

The Priory 21/10/08

The Priory 08/07/08

The Priory 31/07/07

The Priory 02/03/07

The Priory 11/12/06

The Priory 06/10/06

The Priory 08/05/06

The Priory 14/11/05

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 17/02/2010.

Key inspection report Care homes for older people Name: Address: The Priory Springhill Wellington Telford Shropshire TF1 3NA     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: Dawn Evans     Date: 2 2 1 0 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 37 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 37 Information about the care home Name of care home: Address: The Priory Springhill Wellington Telford Shropshire TF1 3NA 01952242535 01952641577 thepriory.home@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wellcare Management Ltd The registered provider is responsible for running the service care home 37 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 37 Date of last inspection Brief description of the care home The date of the last key Inspection was 09 December 2008. The Priory is care home for older people and also provides nursing care for individuals with complex nursing needs due to their physical health condition. The home is located in residential area and is accessible via public transport and is nearby to local amenities, such as shops and pubs. The two storey property is situated within its own grounds, offering single Care Homes for Older People Page 4 of 37 2 1 1 0 2 0 0 8 0 Over 65 37 Brief description of the care home bedrooms on both the ground and first floor. The majority of bedrooms are equipped with en suite. Bathrooms and toilets are provided on each floor and are nearby to communal areas. A lounge, dining room, kitchen and laundry is situated on the ground floor and are accessible to people who live there. Equipment and adaptations are in place for people with restricted mobility. These include a passenger lift, grab rails and lifting appliances. Staffing is provided throughout the day and night. People do not have access to previous inspection reports. Access to these reports should enable people to find out about the quality of service provided and peoples experiences of living there. The fees charged for the service provided at The Priory was not made available to us. The reader is advised to contact the service direct for this information. Care Homes for Older People Page 5 of 37 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: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was carried out over three days; the home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have Care Homes for Older People Page 6 of 37 to let us know about by law, and an Annual Quality Assurance Assessment [AQAA]. This is a document that provides information about the home and how they think that it meets the needs of people living there. Three people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, 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. We looked around some areas of the home. A sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. We sent 10 of Have your Say surveys to people who use the service and 5 to staff members. We received 7 of returned surveys from people who live there and 4 from staff members and their views have been included in this report. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: To ensure people are given a copy of the Statement of Purpose and Service User Guide in a format they can understand, so they know what to expect from the service. All care plans need to provide clear and informative information, so staff know how to meet peoples needs properly. An authorised document from a medical consultant should be in place to support information relating to Do Not Resuscitate contained in a care record or this information should be removed. This should ensure the person receives the necessary nursing intervention if and needed. Staff practice and procedures should be reviewed so they are all aware of the importance of respecting peoples dignity and right to privacy. To ensure the management of peoples prescribed medicines are more robust, so people can be confident they will receive their medicines safely. To ensure people are provided with the necessary support to engage in their chosen social activity, so they are able to live a fulfilled lifestyle. To ensure people have access to a complaints procedure in a format they can understand, so they can share any concerns they may have. All staff should have access to the homes safeguarding policy, so they know how to recognise various forms of abuse and protect people from this. Care Homes for Older People Page 8 of 37 All allegation of abuse should be recorded and show what action has been taken to protect people from further abuse. To ensure people who use the service are supported to have access to a self advocacy service, so they have additional support if and when needed. The home must ensure they comply with the Enforcement Notice issued by the Fire Safety Department, so people can be confident systems and practices will ensure their safety. To ensure people are provided with the necessary equipment or adaptation, to promote their independence and safety. To ensure the door leading to the cellar is secured at all times, so not to place people at risk of harm. To ensure the driveway is repaired and maintained to a good standard, so people who access the service are not placed at risk of trips or damage to their vehicles. To ensure sufficient staffing levels are provided throughout the day and night, so people can be confident their needs will be met. To ensure monthly quality assurance visits are carried out, so peoples best interests can be assured. Chemicals that may place people at risk of harm must be stored securely. To ensure all wardrobes are secured to the wall or risk assessed, so people are not placed at risk of harm. To ensure all windows that may place people at risk of harm are fitted with a restrictor. Furnishings that have been disposed of outside the building must be removed, so people are not placed at risk of tripping. 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 37 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 37 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 may not always be provided with relevant information before they move in but the undertaking of an assessment should ensure their needs are met. Evidence: The home has a Statement of Purpose and Service User Guide, this told people about the service and facilities available within the home. Access to this information should enable people to find out if the home will be suitable to meet their needs. Discussions with staff confirmed these documents are not available in different formats, to ensure everyone can understand them, such as large print, pictorial or other languages. Four out of seven surveys received from people who use the service told us they were given enough information about the home before making a decision to move in. Care Homes for Older People Page 11 of 37 Evidence: One person spoken to said they did not receive any information about the home until they moved in. This means people cannot always be confident they will be given relevant information about the service, to enable them to have an informed choice of the homes suitability to meet their needs. The AQAA shows people have an assessment before they move into the home. This assessment should enable the home to find out the persons needs and how to meet them. Two people who use the service told us they had this assessment before they were admitted to the home. We also saw evidence of this contained within peoples care records. The AQAA shows people can have a day visit, one person who lives there said their family came to have a look around the home, to ensure it was suitable to meet their needs before they moved in. Care Homes for Older People Page 12 of 37 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. People cannot be confident that all staff will know how to meet their needs and poor management of their prescribed medicines may place them at risk of harm. Evidence: We case tracked three people and looked at their care plans. A care plan should tell staff about peoples care needs and how to support them to live an independent and fulfilled lifestyle. The information contained within care plans were not consistent to ensure staff know how to meet peoples needs. For example, one care plan shows the person requires equipment to mobilise but did not tell staff about the relevant equipment needed. This care plan also told staff that the person required adequate intake of fluids [drinks], but did not tell staff how much. Discussions with staff members confirmed their awareness of this persons needs and the support they required. However, because relevant information is not written in the care plan, this person Care Homes for Older People Page 13 of 37 Evidence: cannot be confident that all staff will know how to meet their needs. This person did not have the capacity to discuss the care they receive. Another care plan shows the person has a sensory impairment, this care plan provided more detailed information about how to assist the person. For example, it told staff to talk to them, to ensure their awareness of their surroundings and how to assist them at mealtimes. Discussions with staff also confirmed their knowledge of how to meet this persons needs. This person can be assured that staff will know how to meet their needs properly. One care plan shows Do not resuscitate [DNR]. This means if the person stops breathing, the nursing staff will not take the necessary measures to assist them to breathe again. We did not see relevant documented authorisation from a medical consultant for the DNR. The nurse in charge confirmed authorisation from a medical consultant was not in place and staff would ignore this information and assist the person. This information should be removed, so the person can be assured they will receive the necessary nursing intervention if and when needed. Staff said where possible people are encouraged to be involved in their care planning. One care record shows the person did not have the capacity to be involved in their care planning but their relative assisted. Four out of seven surveys received from people who live there said they are given the care and support they need. The means the standard of care is not always consistent to ensure all people receive good outcomes. We saw that all bedroom doors are fitted with a security lock, this should promote peoples right to privacy. However, one person who uses the service told us, The older staff are quite polite rather than the younger ones. They also said, Not all the staff knock on my door before entering my room. Another person said, My door is always open so staff dont knock. One other person told us, The staff are all very good, they are all helpful and treat you with respect. People cannot be confident their dignity and right to privacy will always be respected. We looked at the homes medication system and practices; these were not robust to ensure people receive their medicines safely. Medication administration records shows peoples prescribed medicines, dosage and when they should be given. These records were not always signed to show if people have received their medicines. Care Homes for Older People Page 14 of 37 Evidence: One nurse said they had given out a prescribed medicine but had forgotten to sign the medication administration record. These practices may result in people receiving the incorrect dose of medicines and place them at risk of harm. One medication administration record show staff had ticked the record instead of signing it. One nurse said this was because the person had been admitted with their medicines dispensed in a dosette box [not the original container], because they were not sure what these medicines were, they were given to the person but not signed for. The nurse in charge showed us a hand written medication administration record and explained this was put in place when the person was admitted to the home and said these medicines had been signed when given out. However, these records also show a number of signatory gaps. This person cannot be confident they will receive their medicines as directed by their doctor and this could compromise their health. We saw medicines that need to be stored in the refrigerator were not stored at the correct temperature. This could affect the chemical balance and if given to people may place their health at risk. We identified this to the nurse in charge and showed them the information relating to the recommended storage temperature as shown on the container. They acknowledged these medicines were not stored appropriately. Medication administration records show some people are prescribed, When required medicines. These are medicines that should only being given when needed. For example, medicines prescribed for pain relief. We did not see a written protocol for the safe use of these medicines. The nurse in charge said this was not in place. The absence of a written protocol does not ensure staff will know how manage these medicines safely and ensure peoples health. Care Homes for Older People Page 15 of 37 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. People cannot be assured they will be supported to pursue their social interests to enable them to live a stimulating and fulfilled lifestyle. Evidence: The AQAA shows the home has advertised for an activity coordinator. The nurse in charge said they were still advertising the post. An activity coordinator should ensure people are supported to pursue their chosen social interests. Discussions with staff and people who use the service said social activities are very limited. One person who lives there said they have not been out since moving in eight months ago. They told us, I went in the garden twice when the weather was nice. I would like more social activities. The homes AQAA shows that quality assurance questionnaires completed by people who use the service comment about the lack of social activities. Two out of seven surveys received from people who use the service told us the home never arranges social activities they can take part in. Three said sometimes, one said usually and remaining one did not comment. Care Homes for Older People Page 16 of 37 Evidence: One person said, I dont go out much because I cant walk, my nephew takes me out. Another person told us they use to enjoy going to the theatre and would like to do this again. They also said, I would like to go out shopping, that would be nice. One staff member said people do not go out; the last day trip was to Chester Zoo in the summer this year. We read to them and put the video on and chat to them. Another staff member said, We have not got the staff to take them out. This means people cannot be assured they will be able to continue to pursue their chosen social interests or live a stimulating lifestyle. The Service User Guide shows that people are able to have visitors, people spoken to also confirmed this and we also observed people visiting the home throughout the day. One person told us, I am able to have visitors and the staff do make them a cup of tea. This means people are able to maintain contact with people important to them, so they can have meaningful relationships. Staff confirmed and we also observed people were able to personalise their bedroom to reflect their interests. This included photographs, ornaments and small items of furnishings. We looked at the homes menus, which shows people are offered a variety of meals to reflect their likes, dislikes and nutritional needs. A number of people required a special diet due to their health condition. Care records show some people have access to a speech and language therapist due to swallowing difficulties relating to their health condition. Care records also show that some people require a special diet because of their health condition. The staff members we spoke to were aware of peoples special dietary needs to promote their health. Staff told us no one required a special diet due to their cultural or religious needs. We sampled a meal provided for lunch, which was well presented and appetising. These are some of the comments from people who use the service: Care Homes for Older People Page 17 of 37 Evidence: The food is good. The food is not bad, we have a choice. The food is very good and I can have a drink anytime. Care Homes for Older People Page 18 of 37 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. People cannot be confident that procedures or practices will protect them from potential abuse and the lack of access to a written complaints procedure does not support their right to complain. Evidence: We saw a written complaints procedure located in the main entrance of the home, which shows complaints will be addressed within 20 days. The nurse in charge told us people are not given a copy of the complaints procedure. This does not ensure that all people will know how to share their concerns or be assured their rights will be supported. However, one person who lives there said, If I am unhappy I would talk to all the staff, they are good at sorting things out. Another person told us, If I am ever unhappy, I would talk to any of the staff, they would put things right. The homes complaints procedure shows people will be supported to access a self advocate. This is an independent service that provides people with support. Discussions with the nurse in charge confirmed she was unaware of this service. Due to the fact that people are not given a copy of the homes complaint procedure and staffs lack of knowledge of access to a self advocacy service, could mean people are not able to access additional support if and when they need to share their Care Homes for Older People Page 19 of 37 Evidence: concerns. Records show complaints are recorded and show what actions have been taken to resolve the concern. Theses practices should ensure peoples complaints are listened to and taken seriously. We have not received any complaints about the service since the last inspection visit. The nurse in charge on the day of our visit was not sure if the home has a safeguarding policy. This policy should tell staff how to recognise abuse and how to protect people from this. We looked at the staff training matrix, which shows the majority of staff have receive safeguarding training. Two staff members spoken to said they have received this training. One staff member said if they receive an allegation of abuse they would, Report it to the person in charge, contact the Police or Social Services. However, it is of concern that the nurse in charge of the home did not know the correct procedure to safeguard people from potential abuse. This could compromise peoples welfare. The AQAA shows the home have not received any complaints since the last inspection visit. The home has had three safeguarding referrals. The nurse in charge said one allegation was unfounded and she was unsure of the other two allegations. Since the inspection visit we have received one safeguarding referral. The home did not tell us about this referral and have a legal responsibility to do so. Failure to follow the appropriate procedures could place vulnerable people at risk of harm. Care Homes for Older People Page 20 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The poor maintenance of the property and the lack of emphasis on health and safety may place people at risk of harm. Evidence: The Priory is set within its own grounds, the two storey property provides single bedrooms located on both the ground and first floor. The majority of bedrooms are equipped with an en suite. Communal rooms such as lounges and dining rooms are situated on the ground floor and are suitably furnished to meet peoples needs. Grab rails are situated in the corridors to assist people with restricted mobility. However, the clutter of lifting appliances and wheelchairs in the corridor could place people at risk of tripping and reduce the means of escape in the event of a fire. The care records we looked at, discussions with staff members and our observations confirmed people have access to equipment and adaptations. However, these may not be appropriate to meet peoples needs. For example we saw staff using a wheelchair without foot plates. This could place people at risk of injury. One person who lives there said, My wheelchair is uncomfortable. Its tight, the Care Homes for Older People Page 21 of 37 Evidence: arms hurt me. We saw that this wheelchair was too small and did would not meet this persons needs. Another person told us, I havent got a wheelchair, I have to book one. This means people cannot be confident they will have the necessary equipment or adaptations to promote their independence and ensure their safety. Fire safety systems are not robust to ensure peoples safety in the event of a fire. For example fire doors do not close properly to provide a sealant to allow people time to leave the building should there be a fire. There are no appropriate means of escape for people with reduced mobility located on the first floor. Staff spoken to said they would not be able to evacuate people to a safe place if there was a fire in the home. Access to certain areas within the home could place people at risk of harm. For instance the door leading to the cellar is not secured and exposes people to the risk of falling some distance. We issued an Immediate Requirement on the day of the visit, asking the home to ensure this area is secured immediately to ensure peoples safety. On the second day of our inspection visit we saw that the cellar door had been secured. Entrance to the property is via a driveway, the surface of which is uneven and is not suitable for wheelchair users, people with reduced mobility or any visitors to the home. Speed humps on the driveway are not identified and could also pose a tripping hazard or damage vehicles. Four out of seven surveys received from people who use the service told us, the home is always fresh and clean. We also observed the cleanliness and hygiene standards within the home were good and this should ensure peoples comfort. Care Homes for Older People Page 22 of 37 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. Staff members are skilled to meet peoples needs but insufficient staffing levels may compromise the care they receive and place them at risk. Evidence: The home is able to provide accommodation for 37 people; on the day of our visit 30 people were living there. The nurse in charge told us that due to staff long term sick leave and maternity leave, this equated to a deficiency of 80 hours per week during the night. There was also a deficiency of 54.5 hour per week during the day. These hours are covered by the existing staff team. The nurse in charge said, due to the dependency levels of people living there, the current staffing levels are not sufficient to meet their needs. As previously shown in this report one staff member told us, We have not got the staff to take people out. They also told us that, Staffing levels at the moment are just enough to give basic care. A comment received from the homes quality assurance questionnaire stated, I can tell when mum has had a little extra care, rather than just being cared for, you seem Care Homes for Older People Page 23 of 37 Evidence: a bit short staff. We received a survey from a person who uses the service, who raised concerns about the lack of frequency of receiving support with their personal care needs. Two out of seven surveys from people who use the service said staff are always there when they needed them. The remaining five said the staff are usually available. The nurse in charge said, All people require assistance with their mobility. Six to eight people need help with eating, drinking and continence management. We also observed this. This means that people who use the service cannot be assured sufficient staffing levels are in place, so they can be confident their needs will be met. One person who uses the service told us, The staff are really good. Everyone is very nice. The AQAA shows 19 out of 29 staff members have obtained the National Vocational Qualification Level 2 or above in Care or Social Care. Two staff members we spoke to said they had received this training. If the skills learned from this training are put into practice, it should ensure peoples needs are met properly. We looked at the staff training matrix, which shows staff have access to training. We spoke to three staff members who told us they have received the following training: Health and Safety, Infection Control, Moving and Handling, Medication, Safeguarding and Fire Awareness. This training should ensure staff have the skills to undertake their roles and responsibilities properly. We looked at three staff personnel files, these contained evidence that staff have the necessary safety checks before they start working in the home. These included a Criminal Record Bureau clearance, Protection of Vulnerable Adult [PoVA 1st] and two written references. The staff we spoke to told us they had received these safety checks before they commenced employment within the home. These safety checks should ensure staff are suitable to work with vulnerable people. Care Homes for Older People Page 24 of 37 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. People cannot be assured the home will be run in manner that ensures their needs will be met or systems and practices will support their health or safety. Evidence: The registered manager for the home resigned in August 2009. The owner did not tell us that the manager had left the service. The owner has a legal obligation to do so. We wrote to the owner asking him about the management arrangements for the service. We were informed that a new manager was due to commence their post 02 November 2009. This was also confirmed by the nurse in charge on the day of our visit. Since the inspection of the home the prospective manager contacted us to say they have not had the appropriate safety clearance to enable them to start working in the home. Care Homes for Older People Page 25 of 37 Evidence: The absence of a manager may compromise the quality of care provided and does not ensure peoples needs will be met. We looked at systems and practices that should promote quality standards. Records given to us show that three Regulation 26 visits have been carried out in 2009. A regulation 26 visit is undertaken by a nominated person to look at the quality of the service provided to people who live there. These visits should be undertaken on a monthly basis to ensure people have good outcomes. The infrequency of these visits does not ensure people will receive a good service. The nurse in charge told us they had recently given people a quality assurance questionnaire to complete. These questionnaires should give people the opportunity to express their views and opinion on the service they receive. The questionnaire asks questions about the cleanliness of the home, meals, social activities and ask if staff treat them with respect. These were some of their comments: Never any contact with the owner, he only seems to do cheap jobs that do not last. Most staff are kindly attentive. We received a survey from a member of staff that stated, The owner of the home appears very mistrusting of his staff and constantly cuts corners in order to save money. The homes AQAA provided insufficient information to show the service offered to people, how they monitor quality standards or how they aim to improve services, so peoples best interests will be assured. We looked at how the home manages peoples financial affairs. The nurse in charge told us that a small amount of cash is held in safekeeping for some people who live there. We randomly selected two account files and saw a record is maintained of financial transactions and receipts. The funds in safekeeping tallied with the financial records. This should mean people can be confident their finances will be well managed. We looked and systems and practices that should promote the health, safety and welfare of people who access the service. Care Homes for Older People Page 26 of 37 Evidence: When we looked around the home we saw that a number of fire doors were wedged open. This could compromise the safety of people in the event of a fire. We saw there were insufficient fire safety systems and procedures in place. For example, there are no means of escape for people who live on the fire floor. We spoke to two staff members who said they have never had a fire drill since working in the home. One of these staff members said Im not sure if I could evacuate the first floor in the event of a fire. We have not got the equipment to get them out. The home had a fire risk assessment in place dated March 2007, which shows deficiencies with fire safety within the home. These had not been addressed. A regulation 26 visit report dated August 2007, states, The environment is as usual safe and well maintained. This report and others did not show deficiencies with the fire safety as shown in their fire risk assessment. We contacted the local Fire Safety Officer who carried out an inspection of the home on 21 October 2009. The Fire Department has issued an Enforcement Notice, telling the owner to complete all the necessary works as shown in the fire risk assessment by 23 January 2010. This should improve safety standards within the home and reduce the risk to people who live there. We saw that chemicals were not securely stored; we identified this to the nurse in charge and issued an Immediate Requirement, telling them to store all chemicals away securely. On the second day of our visit to the home we observed these chemicals had been removed to a secure area. The former registered manager contacted us via telephone on 13 May 2009, telling us a wardrobe had fallen on top of a person and they sustained an injury. When we looked around the property we saw wardrobes had not been secured to the wall. The nurse in charge did not know if a risk assessment was in place. This could place people at risk of harm. Although the dining room is located on the ground floor, the opening to the window exposed people to fall of some distance. The nurse in charge acknowledged this could place people at risk. We saw old furnishings had been disposed of outside the building, such as chairs, Care Homes for Older People Page 27 of 37 Evidence: electric bed pan washer and a bed. This could also place people at risk of harm. Care Homes for Older People Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 37 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 12 Action must be taken to ensure that information relating to Do not resuscitate [DNR] is supported by the relevant authorised documents from a medical consultant or removed. This should ensure people are given the relevant nursing intervention if and when needed. 07/12/2009 2 7 15 Measures must be taken to ensure staff have access to clear, informative care plans. This should ensure staff know how meet peoples needs properly. 23/12/2009 3 9 13 Action must be taken to ensure medicines stored in the refrigerator are maintained at the correct 07/12/2009 Care Homes for Older People Page 30 of 37 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 temperature, as directed by the manufactures. This should ensure peoples health. 4 9 13 The appropriate measures must be taken to ensure medication administration records are completed accurately. This should ensure people receive their medicines safely. 5 9 13 The necessary measures should be taken to ensure a written protocol is in place for the use of When Required medicines. 07/12/2009 07/12/2009 This should ensure staff know when and how to administer these medicines properly. 6 12 16 The necessary measures should be taken to ensure people are appropriately supported enabling them to pursue their chosen social interests. This should ensure all people live a fulfilled and stimulating lifestyle. 30/12/2009 Care Homes for Older People Page 31 of 37 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 7 16 22 Action must be taken to ensure people have access to a complaint procedure in a format they understand. This should ensure people know how to share their concerns. 04/01/2010 8 19 23 The appropriate action must 30/11/2009 be taken to ensure all clutter in the corridor that pose a tripping hazard and compromise the means of escape in the event of fire are removed. This should promote safety standards within the home. 9 19 23 The necessary measures 31/03/2010 must be taken to ensure the driveway is repaired and maintained. This should reduce the risk of falls and damage to peoples vehicles. 10 19 23 Action must be taken to ensure all fire doors are in working order. This should allow staff sufficient time to evacuate the premises in the event of a fire. 26/01/2010 Care Homes for Older People Page 32 of 37 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 19 13 Action must be taken to ensure the door leading to the cellar is locked at all times. This should promote peoples safety. [An immediate requirement was issued on the day of the inspection]. 13/10/2009 12 22 23 The necessary measures need to be taken to ensure people are provided with relevant equipment or adaptations that are safe and meet their needs. This should support peoples independence and safety. 29/01/2010 13 27 18 The necessary action must 30/11/2009 be taken to ensure sufficient staffing levels are provided throughout the day and night This should ensure people are appropriately supported and their needs met properly. 14 33 26 The necessary action must be taken to ensure monthly quality assurance visits are carried out. This should ensure the service provided meets peoples needs. 30/12/2009 Care Homes for Older People Page 33 of 37 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 15 37 12 Action must be taken to ensure furnishings disposed of outside the building are removed. This should ensure people are not placed at risk of harm. 18/12/2009 16 38 23 Action must be taken to 26/01/2010 ensure all deficiencies shown in the homes fire risk assessment dated March 2007 are addressed and also comply with the Enforcement Notice issued by the Fire Safety Department. This should enhance fire safety systems in the home. 17 38 23 Measures must be taken to ensure the practice of wedging fire doors open stops. This should promote fire safety standards within the home. 30/11/2009 18 38 12 Action must be taken to ensure all wardrobes are secured to the wall or a written risk assessment put in place that show control measures to reduce the risk to people. 18/12/2009 Care Homes for Older People Page 34 of 37 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 This should ensure people are not placed at risk of injury. 19 38 13 The appropriate measures must be taken to ensure all chemicals are securely stored. [An immediate requirement was issued on the day of the inspection]. This should ensure people are not placed at risk of harm. 20 38 13 The necessary measures 30/11/2009 must be taken to ensure any windows that may place people at risk are fitted with an appropriate restrictor. This should ensure peoples safety. 14/11/2009 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 To ensure people are given a Statement of Purpose and Service User Guide in a format they can understand, before they move into the home. This should enable them to find out if the home will be suitable to meet their needs. To ensure staffs practices and approach are reviewed, so people can be assured their right to privacy will always be respected. To ensure people who use the service are aware of contact Page 35 of 37 2 10 3 16 Care Homes for Older People 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 details for the self advocacy service, so they can have access to additional support if and when needed. 4 5 18 18 To ensure any allegation of abuse is clearly recorded and show what action has been taken to safeguard people. To ensure all staff are aware of the homes safeguarding policy, so people can be confident staff will know how to protect them from potential abuse. To ensure speed humps on the drive are colour coded or signed to prevent the risk of falls and damage to vehicles. 6 23 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!