Inspection on 19/01/10 for The Regency Nursing Home

This inspection was carried out on 19th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Regency Nursing Home 01/12/08

The Regency Nursing Home 01/12/06

The Regency Nursing Home 07/11/05

The Regency Nursing Home 04/05/05

The Regency Nursing Home 24/01/05

The Regency Nursing Home 27/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: The Regency Nursing Home St Helens Parade Southsea Portsmouth Hampshire PO4 0QJ     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: Anita Tengnah     Date: 1 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Regency Nursing Home St Helens Parade Southsea Portsmouth Hampshire PO4 0QJ (023)92820722 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): regencynursinghome@hotmail.com Mr Michael Raven,Mrs Julia Christina Raven Name of registered manager (if applicable) Mrs Hazel Adeoye Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The Regency Nursing Home is currently registered to accommodate 26 service users under the registration categories of Older Persons requiring nursing and personal care. The service is situated along St Helens Parade, Southsea and is a short walk from the Care Homes for Older People Page 4 of 32 Over 65 26 0 0 1 1 2 2 0 0 8 Brief description of the care home attractions of Southsea front and pier. The property is a period town house, which has been adapted to accommodate the service users, offering a passenger lift to all floors and ramped access where required. The bedrooms are a mix of single and shared accommodation and communal facilities include a dining room, lounge and sun lounge. Information about the fees charged should be sought from the service. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit to the service was undertaken as part of the inspection on 19 January 2010. The inspection was carried by two inspectors over one day and lasted six hours. The registered manager was present through out the day of the visit and feedback was given as part of our process. We also talked to one of the providers who was at the service. We also walked round the home and looked at a number of the service users bedrooms, communal areas such as the lounge, dining area, laundry room and bathrooms. As part of the visit, staff and service users views were sought, care, staff and other records were looked at. We sent out our Annual Quality Assurance Assessment to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We received the completed AQAA and this gave us good information about the service. This is included in this report, as was information gathered by the Commission since the last inspection Care Homes for Older People Page 6 of 32 to contribute in assessing judgements in this report. Comments that we have received from people whom we surveyed will be reflected in the report as appropriate. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 8 of 32 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 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a pre admission assessment process in place. There is a lack of clear information regarding dates that they have been carried out and by whom to show that these are completed prior to admission as required. The service does not provide intermediate care. Evidence: We looked at records of three service users pre admission assessments as part of this visit. The AQAA states that each service user receives a comprehensive, individualised pre-admission assessment to ascertain if the home can meet their needs. The manager said that the pre admission assessment is usually carried out by herself or one of the providers. The records showed that both the service users were assessed as part of the pre admission process. One of the records contained a care managers assessment. The Care Homes for Older People Page 10 of 32 Evidence: records contained details of the needs of the people such as communication, dietary needs and mobility. The pre admission assessments did not contain details/ evidence of the service users or their advocates involvement in the assessment process. This should be included to ensure that the information received is accurate and reflects their current needs and ensuring that the service can meet them. The manager reported that prospective service users are offered the opportunity of visiting the service, however they were unable to do so due to their poor physical state and frailty and the service users family visited instead. Discussion with staff indicated that rooms were allocated as per funding and this included the shared rooms. The pre admission records seen did not contain the dates that they were undertaken and the name of the assessor. The manager said that this will be looked into and staff have been told that they must date and sign these documents. This is to ensure that the assessment is completed prior to admission by someone who is qualified to do so. The manager confirmed that the there is no intermediate care facility provision at the service. Care Homes for Older People Page 11 of 32 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. There are some care plans in place and assessments are completed. These do not meet all the current needs of the service users. The medicines management is unsatisfactory and does not ensure that people receive their medicines safely and put them at risk of harm. People are treated with respect and their privacy respected. Evidence: The AQAA from the service states that each service user is supported to make their own decisions, the home uses a person centred care planning approach which is evaluated at regular intervals. We looked at four service users care plans as part of our fieldwork. Some care plans and assessments were available in the service users records. Assessments of risks that were seen included mobility, falls, nutrition and communication. The manager reported that the service was in the process of introducing a new care planning Care Homes for Older People Page 12 of 32 Evidence: system and some of these had been completed. The care records were variable in relation to the information needed in order that they reflected all the assessed needs of people and what action was required in order to meet these. There were some evidence that the care plans were reviewed, however the records showed that some of these had not been reviewed since November 09. The records seen showed that some people were having their weights monitored and staff kept records of these. One service users record showed that their last weight was recorded in August 09, their nutritional assessment showed them as high risk with a score of 21 and no further record was available. Another persons record showed that their weights fluctuated from 68.kg to 60.kg and up again to 66 kg the following month. The care plans did not show what action was taken. Following receipt of their draft report, the provider has informed us that one person was not able to have their weight monitored due to their frail health. This information was not shared with us at the time of the visit. We looked at the record for a service user who was receiving their feed through a tube inserted in their stomach. A feeding regime was seen with some information being hand written such as the amount of flushes and it was unclear when this was amended. There was no speech and language therapist (SALT) assessment available when we asked the manager. There was no care plan in place for the management of this persons feed. The fluid records we looked at were confusing and difficult to follow. According to the fluid records seen, on two separate occasions, the records did not contain two lots of fluids that should have been administered at midnight. The records for service users who were receiving thickening agents in their fluids did not contain SALT assessments as required in order to inform practice. The manager stated that this has been filed in the old notes/put in for filing and we were unable to access them. These assessments should be available to inform care plans, as they contain details of the assessed needs of people and how the home would be meeting those needs. Care plans did not contain details of the amount of thickening agent required in fluids in order to inform the staff practices. The label on the container for the thickening agent seen stated use as directed and no other information was available. The manager agreed that the care plans should contain clear information, however these were not available. Care Homes for Older People Page 13 of 32 Evidence: We looked at the records of two service users who were insulin dependent diabetics. The manager showed us records of blood sugar monitoring that were carried out for these service users. The records for the diabetics did not have any care plans to demonstrate how their diabetic needs would be met and information such as frequency of blood sugar monitoring, insulin administration and diets. The manager stated that these would be developed and included in the new care planning system. These care plans are vital to ensure that people receive appropriate care in order to meet their assessed needs safely and effectively. The staff maintained records of diet and fluids that they administered and these were completed during the day. The staff kept good records of the food that had been taken. The fluids records we looked at showed that these were not maintained accurately and no record of fluids that had been administered were available from 17:30 until the next morning between eight and nine oclock. This puts the service users at risk of dehydration and their needs not being appropriately met. Fluid balance charts were unclear, not filed for easy reference and not designed to support accurate information recording so that peoples fluid needs can be monitored and met. The manager stated that the night staff were failing to maintain the fluid balance records and this had been brought up with them previously.This showed a lack of effective management of responding to peoples needs. The AQAA states that when service users are unable to manage their own healthcare,the service aims to identify any health problems so that they can be dealt with from an early stage. We found that one of the service users had an occupational therapist assessment completed and clear information was provided regarding application of splints. All the service users are registered with the local doctors surgery and the manager is aware and supports them in accessing external care and advice as required. As part of our survey we received a comment that they were frustrated that a profiling bed had been promised and still was not here. The manager confirmed that this was now available for the service user. Assessments such as pressure risks scores were maintained and pressure relieving equipments were put in place as part of preventative measures and treatment. The manager stated that there was no one with pressure ulcers at the time of the visit. The records for one service users dated 5 December 2009 showed that they had a sacral sore and had detail of dressings to be applied. There was no further record/ evaluation to show whether this was still current and what treatment if any they were receiving. Care Homes for Older People Page 14 of 32 Evidence: Another service user record showed that a wound care plan was put in place on 25 December 2009 and this has not been reviewed and remains unclear about what care was being provided. The manager reported that the settings for pressure mattress were determined by the service users weights. However no settings for air mattresses were recorded in care plans seen. We looked at the medication management that the staff undertook on behalf of the service users. The manager confirmed that no one was administering their own medicines at the time of this visit. The home was using the monitored dosage system that ran over a twenty eight day period. The staff maintained a record of medications administered on the individual medication administration record (MAR) charts for the service users. There was a record of medicines that are received and those discarded at the service. A sample of the MAR records seen showed that they were completed with no blank spaces observed. When we looked at a random sample of the service users medicines, we found that one was correct, however there were inaccuracies in the others. This showed there were six extra tablets for one person and seven extra tablets for another person. The MAR charts records indicated that these had been administered. We brought this to the attention of the manager as the discrepancies could not be accounted for. It was not possible to establish that people had received their medication safely and as prescribed. One of the service users record showed that they were receiving insulin. The insulin in use seen displayed the date of opening as 4 December 2009. The box contained clear instruction that this should be discarded after 28 days of first opening. We found that the service user continues to receive this insulin despite that this had passed the expiry date. This was immediately brought to the attention of the manager and was removed from use and replaced with a new bottle of insulin at the time of the visit. This shows that staff are failing to ensure that medicines are administered safely and do not carry out necessary checks as required. Some medicines that were kept in the drug fridge included eye drops, antibiotics and insulins. We found that some of these medicines contained the date of opening as required and others did not. This poses risk of people receiving medication that is out of date if this is not appropriately managed and the date of opening is not recorded. The fridge temperature was monitored but did not include the minimum and maximum temperature, the manager stated that this will be addressed. Care Homes for Older People Page 15 of 32 Evidence: There is a lack of clear auditing to ensure that staff check and ensure that medications are administered safely at all times. We looked for care plans for people who were prescribed as required medications that included apperients and pain killers. None of them had a care plan that described to staff what the medicines were for, or when they should be given. The manager stated that these were not available. The lack of care plans for these people, and these medicines, puts them at risk of not receiving the medicines that they need when they need them or at risk of being given the medicines when they do not need them. A cabinet that complies with the law and a Controlled Drugs register were available at the service. The manager reported that only the registered nurses were responsible for the management of medicines at the service. We were told that there is a list of homely remedies that had been agreed with the service users doctors that the registered nurses could administer. This was not available to us when we requested to see it. A number of creams and ointments were found in the service users bedrooms that did not contain their names or when they were opened. These are particularly a concern for people in the shared rooms and put them at risk of receiving creams that they have not been prescribed and pose an infection control risk. We looked at at some of the shared bedrooms during our visit and found that privacy screens were available. Two people we spoke to and comments that we have received showed that people felt that they were treated with respect. We received eight completed surveys and six indicated that they were completed with the help of a carer. A relative comment to what the home does well was everything in general. Comments were that usually they received support when they need and staff act on what they say. Care Homes for Older People Page 16 of 32 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. There is currently little evidence of a planned activities programme to meet the recreational and social needs of people accommodated. People are supported to maintain links with their family and friends. The meals at the home was managed to the satisfaction of the service users. Evidence: The AQAA states that the service has strong links with the community so that service users can access local activities and the community can be involved in the homes activities. Information on how to access the advocacy service was available to the service users. The home has an open visiting policy and records of visitors as maintained at the home showed that people visited at varying times of the day. The manager reported that they had recently employed a staff member to provide activities four days per week and the activities programme was being developed. Manager stated that the records of activities dated back to last year when the last person left. People we spoke to said that Christmas was lovely. Care Homes for Older People Page 17 of 32 Evidence: The vicar visited weekly and the priest also visited some of the service users weekly. The manager said that they are also available at other times as required. The manager said that an external people also attended the home and provided entertainment on a fortnightly basis and one of the providers provided some activities.The AQAA states that the plan for the coming months includes reviewing the range of activities and broadening it if possible. The provider is looking at providing the service users with a computer which would give them access to the Internet. During our fieldwork visit,there was no evidence available to illustrate activities provided, no posters observed on premises to advertise or celebrate activities. New programme reportedly was being developed. We received eight comment cards/ surveys and six of these were completed with the help of a staff member. When asked does the home arrange activities that you can take part in. Six of the surveys received responded always and two said sometimes. We observed the lunchtime meals and found that meals were not rushed. The service users said that the food is good. They are offered choices and an alternative to the main menu was also available. The meals looked well presented and appetising. Meals included pureed diets that were served individually. Staff were observed to offer support with meals in a sensitive manner. Care Homes for Older People Page 18 of 32 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. There is a process in place for investigating complaints. There is a lack of record including safeguarding investigation and action plan as required. Evidence: The AQAA that we have received from the service states that they have a robust complaints procedure in place. They listen carefully to all complaints, concerns or suggestions and act accordingly. We looked at the complaints log that the home is required to maintain. This showed that the last recorded complaint/ concern was dated February 2006. The manager stated that they have not received any complaints. However the last inspection report of December 2008 showed that a complaint was received in January 08 and this was dealt with by the service. The data set record that we have received showed that no complaint or safeguarding investigation had been carried out. Information that we have received indicated that the safeguarding team were in the process of carrying out an investigation following concerns that they had received. The manager stated that she had attended a safeguarding meeting with one of the Care Homes for Older People Page 19 of 32 Evidence: providers and they do not have a copy of the minutes and had assumed that the safeguarding issue had been closed, since the committee reportedly concluded that no further action was needed. There was no record of this safeguarding investigation, outcome or action plan available at the service at the time of our visit. The safeguarding investigation was in relation the health and welfare of people living at the home. According to information that we have received, this has not as yet been resolved at the time of writing this report. The manager stated that training for the staff in adult protection from abuse was available, however we were unable to ascertain how many staff have completed this training as the training matrix was not available. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are provided with a homely accommodation that they say meet their needs. However substances that are hazardous to health were not always maintained safely. The infection control process is satisfactory. Evidence: We looked at some parts of the home as part of our visit. The AQAA states that there is an ongoing programme of refurbishment at the service and they continue to invest in the physical structure of the home both internally and externally. Some of the work that has been undertaken included redecoration of 4 bedrooms and a complete redecoration of the lounge and relaying of the patio in the past year. The home was clean and homely and it was evident that the service users are supported to bring with them items of personal belongings to personalise their rooms such as photographs, items of furniture. The shared bedrooms have screens available as required. There is a large lounge, small dining area and a sun lounge that are available to the service users. The dining area had three tables and these were in use. As reported in the last report the current dining facility is inadequate to accommodate all the service users and most therefore eat in the lounge area. The staff reported that extra tables would be made available if required. Care Homes for Older People Page 21 of 32 Evidence: The home has a laundry facility on site and all the service users laundry was undertaken internally. The laundry in the annexe was fitted with washers and driers and some laundry was also undertaken in the basement laundry. There is no hand washing facility in the laundry situated in the annexe in order to observe good infection control practices. The staff stated that they could use the bathroom next door to wash their hands. The staff reported that people are encouraged to clearly label their clothing to avoid these getting mixed. Some of the items of clothing we saw at the time were marked and there were others left in a container that the staff said needed to be sorted as they were not labelled with the service users names. We discussed the door that opened to steep stairs from the annexe leading to the laundry area in the basement that may pose risk to the service users. We later observed a lock was being fitted to that door. Two of the bedrooms we visited had some offensive odour and the staff said that they were aware of this and were trying to manage this by regular shampooing of the carpets. Comments that we have received indicated that the service users were happy with their accommodations. When asked if the home was fresh and clean they responded always. Comments we have received included: I have nothing to complain about, everything is good for me. Another comment was space for visitors is very crammed. Items that may be hazardous to health were not always maintained safely as we found three bottles of cleaning materials that were left in the corridor and may be detrimental to peoples health and welfare. This was brought to the staffs attention and immediately removed at the time of the visit. One of the service users bedrooms contained a rusty commode that poses infection control risk as the staff would be unable to clean this properly. The manager later reported to us that this commode has been discarded. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate staff to meet the current needs of people accommodated. There is a satisfactory training programme in place. The recruitment process is inadequate and put people at risk of harm. Evidence: The AQAA states that all staff undergo an induction and the home has in place a robust recruitment process and carry out various checks on potential employees, for example, CRB, POVA, references, employment history. We looked at the duty roster as maintained at the service and this gave details of the staff hours worked including ancillary hours to support the care staff. According to the duty roster there are 1 trained staff and 5 carers on the day shifts and night duty has 1 trained nurse and two carers. There are two chefs who worked opposite each other and provided seven days cover. The house keeping staff were available during the week but not at the weekends. There was also a maintenance person who worked during the week. Comments were that there were usually adequate staff to support them when needed. Interaction and practices observed showed that the people were supported in a respectful manner. Care Homes for Older People Page 23 of 32 Evidence: Some of the staff records seen contained certificates of courses completed and included moving and handling,health and safety ,fire safety and medication. The manager reported that staff undertook in house training on moving and handling as one of the providers and two other staff have completed the train the trainer courses. There was no training matrix to demonstrate that all staff have completed the necessary training. The provider stated that they had developed a training matrix and this was not available at the service as it was kept elsewhere. One of the staff had been out of nursing for a couple of years and an induction programme to reflect how this person would be supported in their role was not available. The data set from the service indicates that 13 carers have completed the National Vocational Qualification (NVQ) 2 or above and 6 staff need to complete this training. We looked at the recruitment records for the staff who have been recently recruited. We found that the staff completed an application form and attended interview as part of the process. Some of the records seen contained evidence of checks and references had been sought. However the recruitment process was not consistent. The records for the registered nurses showed that a nursing and midwifery council (NMC) checks were completed to ensure that they were registered with the NMC and are able to work as registered nurses. One staff member had a completed Criminal Record Bureau( CRB) check prior to employment. Another staff had a CRB from an agency but not from the home as required. One staff record showed that a new CRB was needed in the interview notes maintained, however there was no evidence that this has been completed prior to the person being employed and currently working at the home. Record showed that a staff member had only one reference and not from the person indicated. Another record showed that two references were available but not from the last employer. One trained staff started work in October 2009 and did have a full CRB clearance until December 2009. A POVA first check was not available when this person started work and was received fourteen days later. The manager stated that they had worked under supervision, however there was no record available to support this at the time of the visit. The manager said that she had not maintained any records. The registered person was failing to undertake checks including POVA first prior to staff starting work and this may pose risks to the service users. Care Homes for Older People Page 24 of 32 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 is a registered manager with day to day control of the service. There is a good process in place for the maintenance of equipments and training in health and safety. Some care practices including medicines management and the lack of checks do not promote safe care and may put people at risk of harm and reflect on the management of the service. Evidence: The service has a registered manager who is a registered nurse and has completed her registered managers award (RMA). The manager stated that she worked closely with the providers and she has the responsibility for the nursing care delivery at the service. Allocated time was available to her in order to devote time to her management role and this worked well for her. Care Homes for Older People Page 25 of 32 Evidence: The provider stated that they are involved in the running of the service and service provision is audited to ensure that the home is run in peoples best interests. We asked to see records of Regulations visits that must be completed by the provider to show that they undertake regular reviews and meet their commitment as stated in their statement of purpose. There were no records available as the provider reported that they had stopped doing this. We were informed that they attended the service daily. The manager confirmed that the home did not manage any of the service users personal allowance. This section was not looked at during this visit. Information from the AQAA indicates that there is an ongoing programme for the servicing of equipments and policies and procedures are reviewed regularly as part of the homes quality assurance process. Record shows that heating and gas appliances were serviced in August 2009. Fire safety equipments, fire alarms, hoists and emergency lightings were serviced in September 2009. There is a programme for the cleaning and maintenance of the service users wheelchairs. As reported in the previous sections the health and welfare of people including medications management , care planning and lack of appropriate checks do not ensure that people receive their care safely at all times. Care Homes for Older People Page 26 of 32 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 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that detailed care plans, assessments and reviews are in place to meet the assessed needs of the service users So that people are assured that the home can meet their needs. 26/02/2010 2 8 14 The registered person must ensure that nutritional screening, including specialist assessments are completed and records are available. to ensure that risks are identified and care plans are put in place to manage those risks safely and effectively. 15/03/2010 3 8 17 The registered person must ensure that staff monitor and maintain accurate records of fluids received by the service users. 15/03/2010 Care Homes for Older People Page 28 of 32 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 To ensure their assessed nutritional needs are met safely 4 9 13 The registered person must ensure that arrangements are in place for the safe handling, recording, safe administration of medicines in the care home. So that you can ensure that people are not put at unnecessary risks of harm. 5 12 12 The registered person must ensure that arrangements are in place for the service users to engage in social activities, hobbies and leisure interests and up to date information is available to them. To ensure that the social and recreational needs are met to their satisfaction. 6 16 17 The registered person must ensure that a record of all complaints and all allegations of abuse are followed up and records are maintained at the service. To ensure that people are not put at risk of harm. 7 29 19 The registered person must ensure that all necessary 28/02/2010 26/02/2010 15/02/2010 15/03/2010 Care Homes for Older People Page 29 of 32 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 staff checks are completed as part of a robust recruitment process and records of these are maintained at the service. To ensure that people are not put at unnecessary risk of harm. 8 33 26 The registered person must 28/02/2010 ensure that monthly visits are completed and records are maintained and available to the commission as required. To ensure that the quality of the service provision is audited and records maintained. 9 38 13 The registered person must ensure that the home is conducted so as to promote and make proper provision for the health and safety of people accommodated. To ensure that care is provided safely at all times and people are not put at risk of harm. 28/02/2010 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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