Inspection on 03/02/10 for The Rosemary Care Home

This inspection was carried out on 3rd February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Rosemary Care Home 29/03/10

The Rosemary Care Home 08/10/09

The Rosemary Care Home 26/08/09

The Rosemary Care Home 26/06/08

The Rosemary Care Home 03/07/07

The Rosemary Care Home 29/01/07

The Rosemary Care Home 11/07/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Key inspection report Care homes for older people Name: Address: The Rosemary Care Home The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP     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: Lucy Burgess     Date: 0 3 0 2 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 30 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 30 Information about the care home Name of care home: Address: The Rosemary Care Home The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP 01706650429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Din T Vanat care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC 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 - Code OP The maximum number of service users who can be accommodated is: 27 Date of last inspection Brief description of the care home The Rosemary Care Home is a privately owned residential home, which provides care for up to 27 people. The home is in the centre of Milnrow and is close to local shops and pubs. It provides good access to the motorway network. The home is on three floors and there is a passenger lift to all levels. Twenty-one single and three double bedrooms are provided. Two of the bedrooms have the added provision of an en-suite. Two lounges and a dining area are provided on the ground floor and a combined diningroom and lounge on the first floor. A bathroom is provided on each floor and a Care Homes for Older People Page 4 of 30 Over 65 27 0 2 6 0 8 2 0 0 9 Brief description of the care home level access shower room on the ground floor. Two of the baths are fitted with fixed hoists. Toilets are located near to lounge areas and bedrooms. A well maintained garden is available to the front of the home where there is also parking. The most recent inspection report was available in the reception hall. The fees were £370 plus a top up fee of an additional £10. Additional charges were made for hairdressing, trips, newspapers, telephone, alcohol, clothing and personal toiletries. Care Homes for Older People Page 5 of 30 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: This was the second key inspection visit for The Rosemary, which included a site visit and took place over one day by an inspectors and a pharmacy inspector. The service did not know that the inspectors were to visit. During the visit time was spent looking at records including care files, recruitment and health and safety. Time was also spent looking at the environment. A full audit of the medication system was also carried out. Due to concerns identified at the key inspection on the 26 August 2009, a management review was held to discuss what further action was needed. An improvement plan was requested and provided and a random inspection was carried out by our pharmacist. The purpose of the random inspection was to look at the management of medication within the home. We found that serious concerns still remained in relation to the safe Care Homes for Older People Page 6 of 30 handling of peoples medication. Todays visit was to look at what improvements they had made in this area as well as action taken to address the requirements made at the key inspection. Again issues remained outstanding with regards to safe medication practice. Due to this information was taken under a cobe B and will be discussed as part of our management review process to decide what further action must be taken. Due to this and other concerns raised last year the local authority is currently not making placements at the home. As part of the inspection process the manager was asked to complete an Annual Quality Assurance Assessment (AQAA), which was then forwarded to us. Information provided detailed what work has taken place within the home as well as identifying what improvements they would like to make to improve the service further. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Medicines must be given to people as prescribed. This is important because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. Procedures for the checking (auditing) of medicines and assessments of staff competences must be put in place to ensure that medicines are safely handled by suitably skilled staff. Medicines must also be given at the right and best time for people. This is important to help make sure medicines work properly and peoples needs are met. Accurate records of all medicines administered must be kept. This will help make sure Care Homes for Older People Page 8 of 30 they are handled safely. Policies and procedures and documentation in relation to Mental Capacity and Deprivation of Liberty Safeguards need to be implemented ensuring, where necessary, all appropraite action is taken to protect people living in the home. The providers need to provide a redecoration and refurbishment plan showing how they are to improve the standard of accommodation so that people are able to live in a home which is comfortable and well maintained. Suitable hand washing and waste bins need to be provided to ensure safe practice and minimize the risk of any cross infection. Staff training and develop opportunities must be provided ensuring staff have the knowledge, skills and competencies needed to care out their duties safely so that peoples needs are met. On-going supervision sessions need to be provided to promote their on-going training and development so that they have clear direction and support in carrying out their duties. The manager needs to submit her application to register with us, so that the home is provided with clear, consistent management. Relationship between the manager and provider needs to be improved, with effective communication so that this does not impact on the day to running of the service. Servicing certificates should be provided with regards to the call bell system. boiler and dorgards ensuring people living and working within the home are kept safe from harm. Regular checks need to be made with regards to water temperatures ensuring they are regulated and maintained safely so that people are place at risk of harm. A further fire drill also needs to be carried out for those staff recently employed at the home so that they are aware of the procedure to follow ensuring people are kept safe. Systems need to be developed with regards to monitoring and developing the service so that people feel confident that they will receive a good quality service. 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 30 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 30 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. No new placements are being made at the home due to issues which have previously arisen. Due to this we have not been able to assess standards in this area. Evidence: Since our last key inspection in August 2009 there have been no new admissions at the home. This was due to issues that were identified in relation to the standard of care provided at the home. The home is in regular contact with the local authority and visits have been made by the contracts monitoring team to review the service provided. Standard 6 does not apply as the home does not provided intermediate care services. Care Homes for Older People Page 11 of 30 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. Clear information is provided about how residents needs are to be met however practice in relation medication management is unsafe and potentially leaves them at risk of harm. Evidence: Work has been undertaken to improve care files for each person living at the home so that they have more detail about their support needs and how they wish to be supported. Files were examined for three people were there had been changed in care needs and behaviours. Information held on file included; front sheet with the persons name, date of birth and photograph clearly identifying who the information belonged to. Personal information sheet, including their next of kin, list of medication on admission, professionals involvement in addition to a care plan, weight records, risk assessments, professional visits and diary notes. Plans and assessments had been reviewed on a monthly basis and updated where needed. Where possible good information in relation to the persons personal history has been collated. This provides a good insight in the lives of Care Homes for Older People Page 12 of 30 Evidence: people living at the home. The manager was asked to address two areas. One was in relation to mental capacity and deprivation of liberty forms held on file. Information was either incomplete or contradictory. We were told that these had been completed by the previous manager. Information should be reviewed and up dated. The second areas was in relation to one file examined. This person was receiving regular support from the district nurses however this had not been documented on the care plan ensuring all staff were aware of any intervention required. Good practice was noted with regards to action taken where there had been changes in need. Where residents had changes in their nutritional needs or their behaviour, referrals had been made to the GP, dietician, psychiatrist and district nurse teams. Where additional weight monitoring was required this had been done along with the introduction of supplements. A number of residents were found to have gained weight. Where there had been a change in people behaviour, monitoring charts had been introduced, further assessment had been undertaken by health care professionals and medication had been reviewed. The manager told us that all staff were to receive Dignity training. Information had been received, which had been handed out to staff and would be discussed within the training groups. These would enable staff to discuss how they can promote dignity within their care practice. As part of the visit a pharmacist inspector looked at how medicines were being handled because two previous visits had found shortfalls. We checked a sample of medicines stock and looked at a selection of medicines and care records. Overall we continued to find medicines were not always being handled safely because staff were not following the policies and procedures of the home. We found medicines stock to be generally well organised and medicines records were clearly presented. Records of medicines received into the home, given to people and disposed of were usually signed and up to date. Ordering and recording procedures were usually efficient and all medicines could be easily accounted for. However, when we checked a detailed sample of medicines we found some contained in traditional boxes were not always given properly because staff had forgotten them. Short courses of treatment such as antibiotics did not always add up showing they had been missed and other regular boxed medicines were sometimes missed. We discussed this with the managers who agreed that there had been problems with these medicines but they had not managed to make the necessary improvements. Missing medicines can Care Homes for Older People Page 13 of 30 Evidence: seriously affect a persons health and wellbeing. We looked at the times medicines were given to people and although there had been some improvements we found some examples of recent courses of antibiotics that were not properly given before food as they should have been because staff had not read the medicine label or medicine record. Giving medicines at the wrong time can stop them working properly. We checked the records of external medicines such as creams and found these were not completed accurately so we could not be sure they were being used correctly. We saw numerous gaps on the records and cream charts that were kept in peoples bedrooms because care staff were not signing after applying them. Poor record keeping can lead to medicines being mishandled and not used properly. We looked at how a person was supported to look after some of their own medicines and found the paperwork had been reviewed and updated since our last visit. A risk assessment and care plan had been written and this was now being reviewed regularly to help make sure this person received the right amount of support to manage their medicines safely. We looked at how care staff were trained to handle medicines. All staff had attended certificated medicines training provided by the local pharmacy but their competency in handling medicines was not formally assessed. We raised this issue on our last visit because we had general concerns about the competency of some staff in giving and recording medicines. We found no formal audits (checks on the medicines) were being carried out so effective action was not being taken to help make the necessary improvements. Regular training, efficient audits and formal competency checks help make sure care staff have the necessary skills to handle medicines safely. Care Homes for Older People Page 14 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines within the home are relaxed however further opportunities could e provided offering people more choice and variety to each day. Evidence: During our visit we looked at what arrangements were made with regards to peoples daily routines. The home does not have an activity worker. This is currently done by the manager. Weekly activity sessions include exercise, sing a long, quiz along a pamper session and baking are offered. Active Minds, an outside provider who offer an exercise class, also visit the home each week. Group activities are provided within the main lounge. There is also a weekly visit by the hairdresser and a monthly visit by the local church. Whilst some opportunities are provided this is an area that could be improved so that people are offered more choice based on their needs and wishes providing more variety to their day. Communal areas are provided on both ground and first floors. On the ground floor there is a quite lounge and television room. A further lounge is provided on the first Care Homes for Older People Page 15 of 30 Evidence: floor. All residents are encouraged to dine in the main dining room, however those people who wish to eat in the lounge on the first floor are able to do so. Since we last visited that home has had a summer house built in the garden. It is hoped that residents will be able to enjoy this when the weather improves. Residents are able to rise and retire as they choose. Morning routines were said to be flexible with people having a leisurely morning and breakfast. Residents appeared cared for and were appropriately dressed. Since our last key inspection the home has employed another cook who has experience of catering for people within care homes. Four weekly menus are in place offering a choice of meals at lunch time and the evening meal. The manager advised us that were being revised. Menus provided a choice of hot and cold meals at lunch time and tea time. Cereal, toast, eggs, preserves etc are available at breakfast with sandwiches, toast, biscuits and milky drinks available at supper. Jugs of juice are provided in each of the communal areas throughout the day As already stated residents generally have their meal in the main dining room. Tables are dressed with clothes with a plastic covering, there were paper napkins and cruets available on each table. Residents were able to eat independently and hot and cold drinks were provided with their meal. Sufficient food stocks were available. Fresh vegetables, meat and bread are delivered daily with other items bought from the local supermarket. A recent visit had also been carried out by the environmental health officer. Recommendations were made with regards to the extractor fan, the recording of fridge/freezer and food temperatures. The manager and cook confirmed that all action identified had been addressed. Regular monitoring is carried out with regards to residents nutritional needs. The home has been proactive in seeking the advice and support of residents GPs and the dietician where necessary. Regular weight monitoring is undertaken and supplements have been provided. Further training in food hygiene has been planned for the 2 cooks and two senior carers. Care Homes for Older People Page 16 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place with regards to complaints and protection ensuring people are listened to and kept safe. Evidence: An update complaints procedure is available within the home and is accessible to both residents and visitors. As previously requested the manager has a complaints book in place to record any issues raised. The manager and deputy manager stated that no formal issues had been raised. Comments made by residents and relatives had been addressed. The majority of staff have now completed training in adult protection as requested following our last inspection. Further training is required for the newest members of the team. Unfortunately sessions available from the local authority have recently been cancelled. Six members of the team had completed training in relation to Mental Capacity and Deprivation of Liberty Safeguards. This needs to be completed by members of the management team. The home also needs to implement a clear policy and procedure so that appropriate action is taken to safeguard people. The home does have a copy of the local authority adult protection procedure and handbook which summaries the responsibilities of staff. These have been distributed. Information in relation adult protection is also discussed in the skills for care induction workbook, which is completed by all new staff. Care Homes for Older People Page 17 of 30 Evidence: Arrangements were looked at with regards to residents finances. Personal allowances are held for each resident. Individual records are in place along with receipts for items purchased. The home does not act as appointee for any resident. Where support is needed this is done by the person relative or an appointed representative. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work needs to be completed to improve the standard of accommodation provided so that people live in a comfortable, well maintained home. Evidence: Time was spent walking round the environment with the manager. Accommodation is provided on 3 floors. All bedrooms are single with two rooms having en suite facilities. Bedrooms and bathrooms are available on each of the floors A passenger lift accesses floors. There are two lounges, the dining room and kitchen on the ground floor with an additional lounge and office on the first floor. The laundry is in the basement. A number of areas were identified during our visit in August 2009, which needed improving. Whilst action had been taken in relation to door locks and closing devises further improvements are still required. A number of areas throughout the home still required attention. These included: 1) Carpeting in some of the bedrooms and the main staircase were heavily soiled/stained and in need of deep cleaning or where necessary replacing; 2) Curtains needed to be provided in some communal rooms and bedrooms to offer further privacy; 3) Some of the fire doors were still not closing to the rebate; 4) Flooring and decoration in room 9 was poor and needed to be addressed; 5) The bath hoist in the Care Homes for Older People Page 19 of 30 Evidence: second floor bathroom was broken. This needs to be repaired or replaced; 6) Liquid soap needs to be provided in toilets and bathrooms to reduce any risk of cross infection; 7) Suitable bins need to be provided in all areas where people are supported with personal care ensuring soiled waste is disposed of safely; 8) The basement area needs to be cleared of all items being stored and disposed of if no longer required. The manager was advised that a plan of redecoration and refurbishment needs to be provided and include the areas identified above. The manager advised us that she has recently employed a handyman who will have responsibility for general maintenance, decoration and health and safety checks within the home. Whilst looking round the home, areas were found to be generally clean and tidy with no malodour. Domestic tasks had not been undertaken the day prior due to a member of staff not being available, however additional hours were being worked on the day of our visit to ensure that all areas were addressed. A recent inspection had been carried out by the Environmental Health Officer. Recommendations were made with regards to the basement area. The manager confirmed that this had been addressed. Sufficient supplies of protective clothing are provided. Staff were seen to wear aprons and gloves when supporting people with specific tasks. Hand washing provisions are provided in all areas where personal care is provided however some areas needed soap and a suitable bin for the disposal of soiled waste to minimise any cross infection. Hand washing provisions should also be made available in the laundry. Care Homes for Older People Page 20 of 30 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. Sufficient staffing is provided however further progress still needs to be made in relation to staff training and development ensuring they have the knowledge, skills and competences needed to support people safely. Evidence: A number of changes have taken place within the team. Since we visited in August 2009 a deputy manager has been appointed as well as a number of new care staff. Recruitment files were looked at for 3 new members of the team. Information held on file included: an application form with employment history and health declaration, written references, POVA first checks and criminal record checks (CRB), interview records and copies of identification. The manager is aware that staff must not commence employment until all relevant information and checks are in place ensuring only those people suitable for the role are appointed. Staffing arrangements were also looked at. Shift patterns are 8am to 3pm, 3pm to 10pm and night cover 10pm to 8am. Cover comprises of the 3 care staff for the early shift including the deputy manager, 3 care staff in the evening and 2 night care staff. The team is also supported by 2 cooks, 2 kitchen assistants, laundry assistant and 2 domestic staff. The manager has also recently appointed a handyman who had just been commenced work. Care Homes for Older People Page 21 of 30 Evidence: The home had been using alot of agency staff however this was said to have reduced considerably. Staff training and development was discussed. The manager advised us that this had been difficult as a number of courses provided by the local authority had been cancelled or were fully subscribed and therefore she was unable to access. Training from other providers was costly and therefore not booked. A training matrix is displayed within the office. This shows that 10 staff have completed training in NVQ at level 2 with some progressing to level 3. Some had also completed training in moving and handling, infection control, fire and deprivation of liberty. Further courses had been planned for a few staff in food hygiene and supervision. The registered person must identify and provide suitable training for all staff, particularly new staff, ensuring they have the knowledge, skills and competencies to carry out their roles and responsibilities safely. Without this there is no assurance that people will be supported safely in meeting their needs. Induction books in line with Skills for Care were in place. These were currently being completed by new staff with support form the deputy manager so that they are aware of the policies and procedures in place in relation to their roles. Care Homes for Older People Page 22 of 30 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. Whilst improvements have been made more effective working relationships need to be developed with the providers so that this does not affect the quality of service proivded. Evidence: A new manager has been appointed since we last visited the home taking up post in September 2009. The manager does not have experince of working in the care field however does have experience in business management and the childrens inspectorate. We discussed with the manager arrangements to register with us. She is currently completing her application. Once all relevant information is gathered this will be forwarded to CQC. The manager is supported in her day to day role by a deputy manager, who has manager years of expereince working within care homes. Each have delegated Care Homes for Older People Page 23 of 30 Evidence: responsibilities in relation to the day to day running of the home. However working relationships between the managers and providers need to be improved. More effective communication and arrangments about how the home is to be managed need to be developed so that staff are clearly directed in carrying out their duties ensuring this does not afffect those who live at the home. Work still needs to be completed in relation to monitoring the quality of the service provision. The man gager explained that satisfaction surveys are distributed to residents and visitors. Since commencing work at the home she has held a resident and relative meetings so that feedback can be sought. Staff meeting have also been conducted. The provider works on site each day and therefore does not carry out the regulation 26 monitoring visits. The production of an annual development plan should be made to show that the service is being monitored and areas of improvement are identified. This will ensure that people living at the home are offered a good quality service. Supervision sessions have commenced. These are carried out by the deputy manager. At present staff have received one session. They are aware that this is an areas for further improvement ensuring the team receives clear direction and support in carrying out their duties. A random check was made of health and safety checks including annual servicing certificates. Up to date records were seen for the hoists, gas range, 5year electrics, fire alarm, small appliances and passenger lift. The were no certificates provided with regards to the gas boiler, call bell system or automatic closing devises fitted to fire doors. These should be provided. In house checks were being carried out by the provider with regards to fire checks. Information also showed that the last fire drill was in September 2009. A further drill should be undertaken, particularly with new staff so that they are aware of the procedure to follow. However checks in relation to safe water temperatures were still not being done. The manager explained that these areas would now be overseen by the new handyman. Incident reports in line with reguation 37 have been forwarded to us, ensuring we are kept informed about events within the home and action taken to keep people safe. The provider must ensure that all health and safety checks are carried out in a timely manner and evidence of this is available ensuring people are kept safe from harm. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Residents must only be 27/09/2009 admitted to the home on the basis of a full written assessment undertaken by people trained to do so. To make sure the home has the facilities, knowledge and staff have the right training to care and support residents properly and to ensure residents receive the correct care and support. 2 9 18 Suitable procedures for the 12/11/2009 auditing (checking) of medicines and assessment of staff competence must be put in place. This will help make sure medicines are safely handled by suitably skilled staff. 3 9 13 Medicines must be given at the right and best time for people. This is important to help make sure medicines work properly and to help make sure peoples needs are met. 12/11/2009 Care Homes for Older People Page 25 of 30 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 9 13 Medicines must be given to 05/03/2010 people as prescribed. This is important because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. Accurate records of all medicines administered must be kept. This will help make sure they are handled safely. 05/03/2010 2 9 13 3 18 13 Policies and procedures and documentation in relation to Mental Capacity and Deprivation of Liberty Safeguards need to be implemented ensuring, where necessary, all appropraite action is taken to protect people living in the home. 30/04/2010 Care Homes for Older People Page 26 of 30 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 4 19 23 The providers need to 30/04/2010 provide a redecoration and refurbishment plan showing how they are to improve the standard of accommodation so that people are able to live in a home which is comfortable and well maintained. 5 26 13 Suitable hand washing and waste bins need to be provided to ensure safe practice and minimize the risk of any cross infection. 30/03/2010 6 30 18 Staff training and develop 30/04/2010 opportunities must be provided ensuring staff have the knowledge, skills and competencies needed to care out their duties safely so that peoples needs are met. This should include mandatory health and safety courses, adult protection and areas specific to the needs of those living at the home. 7 31 9 The registered person must ensure that an application is made by the manager to register with us, 30/04/2010 Care Homes for Older People Page 27 of 30 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 so that the home is provided with clear, consistent management. 8 31 12 Relationship between the manager and provider must be improved, with effective communication so that this does not impact on the day to running of the service. 9 33 24 Systems must be developed with regards to monitoring and developing the service so that people feel confident that they will receive a good quality service. 10 36 18 On-going supervision sessions must be provided to promote their on-going training and development so that they have clear direction and support in carrying out their duties. 11 38 13 Servicing certificates should 30/04/2010 be provided with regards to the call bell system. boiler and dorgards ensuring people living and working within the home are kept safe from harm. 30/04/2010 30/05/2010 30/03/2010 Care Homes for Older People Page 28 of 30 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 12 38 13 Regular checks must be made with regards to water temperatures ensuring they are regulated and maintained safely so that people are place at risk of harm. 30/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 Further activities and social opportunities based on the needs and wishes of residents could be provided so that people are offered more choice and variety to their day. The registered person must ensure that sufficient staff are provided at all times to meet the needs of those living at the home. A further fire drill also needs to be carried out for those staff recently employed at the home so that they are aware of the procedure to follow ensuring people are kept safe. 2 27 3 38 Care Homes for Older People Page 29 of 30 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. 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