Random inspection report
Care homes for older people
Name: Address: The Squirrels 7 Oaks Crescent Chapel Ash Wolverhampton West Midlands WV3 9SA one star adequate service 03/03/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Tina Smith Date: 2 6 0 5 2 0 1 0 Information about the care home
Name of care home: Address: The Squirrels 7 Oaks Crescent Chapel Ash Wolverhampton West Midlands WV3 9SA 01902423855 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Merron Care Ltd care home 11 Number of places (if applicable): Under 65 Over 65 0 0 11 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 1 1 0 The maximum number of service users to be accommodated is 11 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 - maximum number of places: 11, Dementia - Code DE - maximum number of places: 1, Mental Disorder, excluding learning disability or dementia - Code MD - maximum number of places: 1.
Care Homes for Older People Page 2 of 21 Date of last inspection Brief description of the care home 0 3 0 3 2 0 1 0 The Squirrels is a detached house near the city centre, with ramped access and car parking. Personal care is provided for up to 11 older people. Merron Care Limited have run the home since January 2009. Single and double bedrooms are on two floors accessed by a lift, with assisted bathing and toilet facilities nearby. Some rooms are ensuite, including one with a wet room. Communal areas include the lounge, dining room and garden. The fee range was in the statement of purpose on our visit, £364£424 per week. Please contact management for up to date fee information. Care Homes for Older People Page 3 of 21 What we found:
The quality rating has been poor since the first inspection in June 2009. We found continued non-compliance with a range of care regulations which placed peoples health, wellbeing and safety at risk when we visited in December 2009, January 2010 and March 2010. Enforcement action was taken and two Statutory Requirement Notices were issued on 20th April 2010. The purpose of this visit was to check compliance with these expired notices, and eight requirements made on previous visits. Just before our visit the council reported concern about bedrail safety and dietary provision. On 26/05/10 compliance and pharmacist inspectors visited the home unannounced and were told that the acting manager was on unauthorised leave. No one knew when the manager was due to return. The senior in charge had no contact with or from the Area Manager, who last visited the home two days earlier. No arrangement was made for the homes oversight. This was of serious concern. Assurances were given by the provider in December 2009 that proper arrangements would be made for oversight of the home and medication system due to recurrent errors affecting peoples health. The provider had confirmed that they too found the senior left in charge was inexperienced. At the key inspection in March 2010 a new acting manager had been in post for one week. There were signs that the home could improve if there was sufficient and appropriate oversight, but there were further medication errors. This inspection was extended to a second day because the purpose of the inspection was disrupted. The senior could not answer all our questions and could not find all of the records, policies and procedures which should have been readily accessible. The compliance inspector was asked for advice and direction many times. The senior was unable to make decisions to protect people from immediate risks. We asked the responsible person for Merron Care, the area manager to attend the home on the first day to address immediate risks and to have feedback from the pharmacist inspector. The Director also attended. The inspection also collected evidence of further non-compliance under the Police and Criminal Evidence Act. We arranged to meet the area manager on the second day to provide opportunity to identify action taken to comply and to discuss our findings. Both visits were long, nearly 12 hours on each day because of risks posed to people. On 26/05/10 management were made told that a CQC manager made a safeguarding report to the council during the visit, and immediate requirements were made by both inspectors to protect people. The pharmacist inspector fedback concerns about the medication system, and established staff responsible with management. On 27th May 2010 the compliance inspector visited the home and was informed that a person had fallen out of bed overnight when very confused, had a bruised face and was taken to hospital. They returned diagnosed with a recurrent urinary tract infection. The senior sought advice about times to administer new antibiotics and was advised to ring the chemist or GP. No action was taken during the day to our queries about high risk of further falls or about their fluid intake. This was a recurrence of three previous falls in the past two months, and various infections. Care Homes for Older People Page 4 of 21 We checked sufficient temporary steps were taken to keep the person safe over the bank holiday weekend, and we made a further report to the council for their urgent protection. The area manager notified us the next day that they would request re-assessment for nursing care. This meant that the persons needs had exceeded what the home and district nursing services could provide. The area manager intended to take up serious concerns with the acting manager on their return. Over two days we walked around the home several times, observed everyone and spoke to three people, two visitors and four staff. From the homes records, care and health records and from our discussions, it was evident that health professionals and relatives closely involved were not kept fully informed by the home. Nurses, doctors and relatives were not made aware of all the injuries and incidents we found in the homes records, or of the poor facilities, food provision, and falling standards of cleanliness and hygiene. Inbetween CQC inspections, our reports and the homes quality rating were not made known to relatives and we did not see CQC reports on display. This meant that people and their representatives were not aware of concerns, and could not make informed decisions or ask questions in light of them. MEDICATION The pharmacist inspector visited the home on the 26th May 2010 to help assess whether the home had met a Statutory Requirement Notice. Part of this notice stated that the home was required to put in place effective systems to establish and maintain the competence of staff who administer medication to people who use the service. We found that the home had still not developed and implemented a programme of assessing whether the staff who were administering medicines were competent to handle and administer medicines safely. The homes policy and procedures document did not illustrate how the home would ensure that the staff were competent to handle and administer medicines to the people who used the service. We found a number of examples of the staff not being competent to manage medicines safely when auditing a sample of the medicines and the associated medication records. Staff were administering a medicine which should be given at least half an hour before food with food, and we found that the staff were not aware of the additional requirement of administering in an upright position with plenty of water. A member of staff had signed to confirm the administration of a number of medicines on two separate sets of medication administration record (MAR) charts on the 19th April 2010 thus indicating that the medicines had been administered twice. The dose of a medicine licensed for the treatment of schizophrenia and episodes of mania had been reduced but the homes records were not able to demonstrate whether the correct dose had been administered on all occasions. The home was having to cut the tablets in order to administer the prescribed dose. Parts of the tablets were placed in small envelopes in readiness to be returned to the pharmacy for disposal. We examined these envelopes and 4.25 tablets could not be accounted for. Quantities recorded in the disposal register were different than the quantities found in the individual envelopes examined. We also found that the home had not ensured for the following month that the directions on the prescription had been altered so that the pharmacy could deal with the cutting up of the tablets. Care Homes for Older People Page 5 of 21 A number of the issues described above could be attributed to one particular member of staff. We were told that this member of staff was fully trained to administer medicines but on closer examination of their personnel file we found that they had only completed a medication awareness course and had no formal appraisal of their competence. Records showed they had been authorised by management to manage and administer medication and they were on the rota at times in sole charge of the home. We therefore concluded that the home had not met the requirement stated in the Statutory Requirements Notice and were still in breach of regulation 18 [1] [a]. The area manager intended to change the weekend rota. Six peoples GP was changed and medication reviews had taken place for as required medication. As this was now prescribed, one requirement no longer applied and was removed. Two medication requirements were not met and two new medication requirements were made due to risks to health from poor storage and lack of accurate record keeping. We also examined the temperature of the fridge on the day of the inspection and found that the maximum temperature was 14 degrees Celsius and the minimum temperature was 5 degrees Celsius which exceeded the safe range. We had previous concerns about people sleeping a lot during the daytime so on this visit both inspectors made further enquiries. One persons morning medication was removed by the GP and they were livelier. Staff said that one person has occasional sleep disturbance at night (see protection and staffing). RISK ASSESSMENTS AND CARE PLANNING Care plans improved their detail about individual preferences and guidance to staff. Diabetes plans were introduced, which included eye and foot care and access to health monitoring. The chiropodist came to see everyone except one person with diabetes, who only recently was referred. Inter-linked risks were not addressed, such as fluid monitoring to prevent urinary tract infections and dehydration which can raise pressure sore risk or pressure sore deterioration. There were no short term illness care plans but three people had recurrent infections. Nutrition plans and dietary provision did not address all needs or health conditions. Care plans show how care should be provided, but this is not always followed, for example frequent changing, toileting programmes, use of the hoist. Two people smelled of urine and faeces, noticed also by a visiting relative. They were not changed for over three hours. The homes records showed this was not an isolated occurrence. A person with a pressure sore was not provided with their pressure relieving cushion during this time and the district nurse found further reddened areas. Risk assessments and care plans were not reviewed following falls or after unexplained injuries. The risk assessment of the person who fell was closely examined. It was not scored correctly; risk had been underestimated. It had not been reviewed in the light of falls and there was no falls prevention plan. The person had been immobile for many months, but there was no bedrail risk assessment, which was not in accordance with the homes policies and procedures. DAILY LIVING
Care Homes for Older People Page 6 of 21 There was a changed atmosphere from our last visit in that staff were less observant and attentive to peoples needs and people appeared shepherded together. Two people were cold and uncomfortable when the inspector asked how they were. Two staff in the room were not aware of this. The senior closed the window and instructed that blankets should be provided for both people. Four other people were unable to effectively communicate or were asleep. Their temperature was not checked and they were not provided with blankets. Another person was in discomfort and was waiting for the doctor all day. Two people were undergoing medical investigation for severe constipation leading to pain, discomfort and periods of not eating. One was underweight. One person was unhappy in the lounge and wanted to return to their room. We were told everyone was in the lounge so that rooms could be thoroughly cleaned. We did not see any cleaning activity. They were only returned to their room because the district nurse attended. There were new 4-week menus which showed more nutritional balance but did not meet cultural and religious needs. Food provision for people with diabetes improved. When asked what provision was made for someone who is Sikh, the Director responsible said that lentil soup was provided. There were no low fat provisions in the fridge for people with high cholesterol or heart conditions. A requirement was not met. PROTECTION Records showed some staff had supervised practice by the manager for poor moving and handling, but it was not clear why. A visiting district nurse and a visiting relative told us that the hoist was not being used with two people who could not bear their own weight. Staff saw no alternative to lifting people to change continence pads and for bathing (see environment). Lifting people is poor practice and places people at risk of being dropped and of being injured by staff. It also poses risk to staff. Some staff recently had council training and advice from doctors about their own health, and they knew this was wrong. Since the last inspection four people had unexplained bruises, two had unexplained skin tears, and one had grazes. These were not always recorded on incident and accident forms but were in the communications book, and requests to complete forms were ignored and not followed up by the manager. Most matters were not reported to CQC or under safeguarding protocols to the council so that people could be made safe, and a requirement was not met. One person had a large infected wound from a fall - we were notified about the fall but not the extent of the injury. Peoples risk assessments and care plans had not been reviewed to prevent recurrence. The pharmacist inspector found a number of people had medication with sedative effects at night. We had concerns that a medication review, i.e. sedation, was routinely considered as a less restrictive alternative to a bedrail on the bedrail risk assessment form. This does not match best practice and poses increased risk that a person may fall during the daytime. ENVIRONMENT Essential equipment and facilities in the home did not match peoples needs. One person was at risk of falls out of bed, chair and wheelchair as falls were not investigated.
Care Homes for Older People Page 7 of 21 Records showed their bedroom chair had been moved to another persons room because it looked unsafe, but the other person was placed at risk. We suggested consulting district nurses about a non-slip pressure cushion, and advised that a multi-agency best interest decision would be needed for restraint, such as a lap belt. The area manager limited risk of injury if they fell out of bed over the weekend. Another person needed a pressure mattress. The hoist was not being used with people who could not bear their own weight. One bed did not allow the hoist to be used. The wheelchair could not get close enough to the bed and staff told us they could not change the person doubly incontinent without lifting them onto the bed. Staff could not find any other aids in the home. There were empty beds that were more likely to be suitable for the hoist, but the senior did not think they could use them as no action had been taken by Merron Care when staff raised the matter several times, we were told. Staff said they were also lifting other immobile people into the bathtub because the hoist did not fit in the bathroom or the lift, also known to management. The assisted bathroom was never used, we were told because a previous manager said not to. Staff did not know the assisted bath seat went up and down. Management said they were not aware of this. The equipment had been serviced. This resulted in an immediate requirement to address a safe means for bathing, personal care and to prevent pressure sores. We were told that a worker did not want to use the assisted bath seat and hoist without trying it first which was wise, but the senior told her not to because she did not think health and safety would allow this. The senior confirmed that they tried equipment on their training. The homes records showed falling standards of cleanliness and hygiene, placing peoples health at risk since our last visit. People were not being changed or bathed as frequently and records linked this to the recurrence of a pressure sore. Incontinence pads ran out in April 2010 because no one ordered them, and the washing machine broke down with all the extra washing. The boiler was broken for 11 days, limiting hot water. On this visit two bedrooms had malodour and we queried if carpets were cleaned. The assisted bathroom and a toilet looked less clean than it had in March 2010. The bathtub had paint splashed on it and builders dirt in it. Tile grouting had not been completed. There was still only one sling shared by people. There was no soap for the use of people and staff for basic hygiene after using the toilet. One toilet seat was worn, posed infection control risks and did not have a raised seat. A toilet bin had not been emptied and overflowed. Since March three people had recurrent infections. Two people recovered from MRSA found on routine screening by health services. On day two the assisted bathroom and a toilet were clean and soap was provided. A bed was changed which allowed the hoist to be used, but the foam mattress to reduce risk of pressure areas overhung the bed. This could pose slip risk if someone sat on the end of the bed. We were told that an incapacitated person could become fearful if physically uncertain when transferred but staff said that they responded well to use of the hoist overnight. A visitors survey remarked on the lack of a call bell in the lounge. The managers audits of call systems since the key inspection in March 2010 showed three bedrooms, three bathrooms and the lounge did not have accessible or working call bells, that this had been reported to Merron Care and no action was taken. One person had a portable call
Care Homes for Older People Page 8 of 21 system and used this in the lounge but a requirement was not fully met. The call system of the person who fell was not addressed since the key inspection as we had been told. When people are left alone for periods in the lounge they will not usually have access to help in an emergency. STAFFING The compliance inspector assessed another Statutory Requirement Notice. Part of this notice stated that effective structures must ensure that all documents and accurate information required to establish fitness of workers are obtained and discrepancies explored to decide if a person is fit to work at the home. The recruitment policy and procedure were not available in the home. We were shown a memo dated 26/04/10 from the area manager to care home managers with new guidance on checks of staff. We saw eight staff records, including three previously seen with discrepancies and missing checks. The file with police checks could not be found however we established that the manager had undertaken appropriate recruitment and fitness checks regarding a new worker. Discrepancies previously found regarding three workers had not been resolved. On our visit a worker said they were experiencing physical strain after lifting people into the bath the previous evening. They had just returned to work following major surgery. There were no discussions or risk assessments of fitness for the job since their return to work, confirmed by their staff records. The area manager and Director showed little understanding of their responsibilities for the safety of employees under health and safety law when we discussed this. An existing worker in similar circumstances had an insufficient assessment of their fitness to do their job safely as the reasons for their long absence had not been established since January 2010. The area manager confirmed they had an unexplained employment gap which was not explored; police and barring list checks had not been renewed. This worker was undergoing supervised practice by the manager for poor moving and handling. Two existing workers did not have moving and handling training - one was booked to attend council training in April 2010, the other was not booked. The area manager confirmed they had not followed up discrepancies about the fitness of another worker who went off sick in early April 2010. During this visit we were told that the area manager had taken an untrained seniors word for a clear staff reference and had not checked it, but it contained concern about health fitness. We were told that the worker was contacted during our visit, that they had sent a resignation letter which could not be found. A criminal disclosure and police check which came back with relevant information had not been risk assessed by the area manager, and the staff member had been left in sole charge of the home on many occasions. Another workers right to work in the UK had not been established. Staff have been given roles that they were not trained for, for example with medication, audits, bed rail risk assessments and running the home which placed peoples health and safety at risk. We therefore concluded that the home had not met the requirement stated in the Statutory Requirements Notice and were still in breach of regulation 19 [1], Schedule 2 as the safety and fitness of workers had not been established and the system in place was not effective to safeguard people. It was not
Care Homes for Older People Page 9 of 21 clear which staff had been sent on council training in Moving and Handling, and in Safe Handling of Medicines. The managers report after a staff survey said that staff wanted more training and should be consulted about what they want training about. The training matrix had been updated but bookings with the council did not reflect how all missing mandatory training and refreshers would be addressed. Infection control training was addressed in a staff meeting and staff were working through a DVD provided by the Primary Care Trust, but standards fell. The area manager said that staff who cook all have food hygiene training, but the opposite was noted by the manager in an audit. Staff were disciplined and removed from roles with medication following each of our inspections since December 2009. Seniors with current roles were found to lack competence by pharmacist inspections. Records showed that the manager had been attempting to appraise and develop staff in a number of practice areas but there was also evidence of staff resistence to change their ways of working, so efforts were not effective. There was no change in staffing levels since our last visit, when CQC and the manager had concerns. A requirement was not therefore met. People are now kept together more during the day, sometimes left on their own in the lounge or dining room. There were not enough staff to feed everyone served dinner at the same time; this was not be staggered. The communication book showed that staff were not stimulating people. One person who needs two staff to mobilise gets up at night, and there was a nightime fall during our visit of someone needing the hoist. They now need frequent checks through the night. There is one waking and one sleeping night care assistant. We have continued concerns about some staff understanding and communication with people in English. Records showed that the manager was taking some steps to improve this. MANAGEMENT The area manager said that they were not aware of the extent of incidents occurring to people. Their unannounced visits to the home on behalf of Merron Care were supposed to check on peoples health, safety and the quality of care and provisions. Reports of these visits were not found on the premises and were also not available on our last visit. They were not sent to CQC as we required. The area manager was not aware that this was required, and confirmed they had not overseen or ensured compliance with the key inspection and Statutory Requirement Notices, stating they had delegated this to the acting manager. They went to their car and returned with brief hand-written Regulation 26 reports which showed that incident and complaint records were not checked. Risk was not well thought out or checked by Merron Care for individuals or for the home. An example from the homes health and safety system was the overall risk of fatality and serious illness from inhalation of nail varnish, considered high, compared with similar risk from medication error, which was considered low. However repeated inspection reports and immediate requirements about errors posed serious concerns for peoples health. The area manager confirmed that they were responsible for recruitment and disciplinary processes before the acting manager was in post and for regulation 26 reports of unannounced visits, but could not provide us with satisfactory evidence to meet requirements or statutory notices. The acting manager in turn had delegated management tasks to seniors, including medication roles and audits. Key workers had been assigned and responsibilities documented. However the senior in charge told us that they needed a list of tasks from the manager to know what to do, and had not been left
Care Homes for Older People Page 10 of 21 one. Accountability has not improved and oversight of the home was deteriorating. There was evidence that staff relationships with management, the Director and seniors were breaking down in response to punitive approaches and changes in staff hours. Staff were not cooperating as a team to peoples benefit. This contributed to the change of atmosphere. Financial constraints appeared to be affecting repairs, facilities, food and service provision. What the care home does well: What they could do better:
There was deterioration rather than progress and a changed atmosphere. People were unhappy and in discomfort. Staff were less attentive to their needs. Medication was not administered as prescribed on all of our visits since Dec 09, resulting
Care Homes for Older People Page 11 of 21 in under and over dose. On this visit medication could not be accounted for and was not stored correctly again. No system was put in place to determine staff competence. People remain unprotected without regulator visits because management are unable to identify errors or appropriate staff for medication roles. This poses ongoing serious risk to peoples health. Risk is underestimated and interlinking risks are not identified and planned for. People had insufficient prevention for falls and pressure sores and recurrent infections. Dietary needs were not all catered for with regard to health conditions, culture and religion and two people are under medical investigation for pain and discomfort associated with their nutritional intake. These factors contribute to poor health and lack of dignity. Care plans show how care should be provided, but this is not followed by staff. Falling standards of personal care and hygiene make health risks more likely. Facilities and equipment do not match peoples essential needs and the hoist cannot always be used. Lifting people is common practice and is unsafe; places people and staff at ongoing risk of injury. Those who cannot bear their own weight or make their own decisions about care and handling are having unexplained recurrent injuries - bruises, grazes and skin tears. We also have concerns that sedation is considered a less restrictive alternative to bedrails to prevent falls out of bed, without consideration of whether this may increase falls during the daytime. Staff are assigned tasks and roles without training, including medication, preparing food, moving and handling and management tasks. Staffing levels were not addressed and people were shepherded together. They had less choice of where they preferred to be in the home. On this visit we had concern about night staffing, how decisions are made to authorise staff roles, and the training plan does not address some staff who need mandatory training or refreshers. Recruitment check deficits were not addressed, and the fitness of staff for their roles continues to raise concern. This does not safeguard people. A second acting manager was absent without explanation. There was insufficient management cover for the home and insufficient accountability for health, safety, quality of care and compliance with the law by the provider. Relationships between management and staff are breaking down. A duty of care is not being exercised in peoples best interests. Institutional abuse and neglect is occurring unchecked and reports are not being made to relatives, health professionals and statutory authorities including CQC to make sure people are safe. The home is not run transparently. Two Statutory Requirement Notices were not complied with, along with seven other requirements. We have concerns that management do not know how to comply, and that financial constraints are contributing to the homes deterioration. One requirement was no longer applicable and was removed, and one immediate requirement was met. New requirements were made. We have concern that people are at heightened risk of harm to their health, safety and welfare. In response to continued non-compliance and proportionate to these risks, we fedback to the area manager and Director on this visit that CQC will be taking further enforcement action. This will affect re-registration under new care law. 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 set out on page 2.
Care Homes for Older People Page 12 of 21 Care Homes for Older People Page 13 of 21 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 13(2): The dose of when 14/04/2010 required medication must be recorded when administered. Medication records need to confirm that the homes protocols are followed for peoples health. (Not met on 27/05/10 and 22/06/10) 2 9 13 13(2): Medication records must be completed at the time medication is administered by the care worker involved. 14/04/2010 Medication records must be accurate to ensure people have medication as prescribed. (Not met on 27/05/10 and 22/06/10) 3 9 18(1)(a) Staff knowledge and 03/01/2010 competence in the safe handling, recording and administration of medication must be established and regularly confirmed. Care Homes for Older People Page 14 of 21 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Peoples health must be protected. (Not met on 21/01/10 and 03/03/10. Statutory Notice issued on 20/04/10 with compliance due by 30/04/10. Not met on 27/05/10 and 22/06/10.) 4 12 12 12(1)(a)(b), (3): Sufficient and appropriate stimulation must be provided matching individual needs, as agreed with people. 03/06/2010 Mental and physical agility and independence needs promotion and protection. (Not assessed on 27/05/10. Not met on 22/06/10) 5 15 16 16(2)(i): A varied and nutritionally balanced diet must be provided that matches individual health, religious and cultural needs. 14/04/2010 People need to eat well and have their customs respected to retain their health, wellbeing and dignity. (Not met on 27/05/10 and 22/06/10) 6 18 17 17, Schedule 3: A timely 14/04/2010 record of incidents, accidents and the homes actions must be made in accordance with
Page 15 of 21 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action the homes policy and procedures, and notifications made to statutory agencies as appropriate. People must be safe after events such as falls, medication errors and unexplained bruising. (Not met on 27/05/10 and 22/06/10) 7 22 13 13(4)(c): Call systems must be accessible to people to reach staff day and night. 14/04/2010 People must be able to call for assistance and in an emergency. (Not met on 27/05/10 and 22/06/10) 8 27 12 12(1): Staffing levels and roles need to reflect that they match peoples needs day and night. Help should be available when needed and without people left unattended for long periods. (Not met on 27/05/10 and 22/06/10) 9 29 19(1) To ensure that all staff 03/12/2009 employed at the home are recruited following robust recruitment procedures, with documentary evidence to
Page 16 of 21 03/05/2010 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to safeguard people living at the home from risks of harm. (Timescale of 01/08/09 not met on 03/12/09 and 03/03/10. Statutory Notice issued 20/04/10 with compliance due by 30/04/10. Not met on 27/05/10 and 22/06/10) 10 38 26 26: Unannounced monthly 14/04/2010 visits must take place by a suitable person on behalf of the registered provider, in accordance with the CQC guidance. Accurate and timely reports of visits which account for follow up actions must be retained at The Squirrels and must be sent to CQC monthly. Management must ensure ongoing health, safety and welfare of people and the service. (Not met on 27/05/10 and 22/06/10) 11 38 24(a) Merron Care Limited must supply accurate improvement and action plans to the Commission on request, within the timescales set. 03/01/2010 Care Homes for Older People Page 17 of 21 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action This is to ensure peoples health, safety and welfare. (Not assessed on 03/03/10 and 27/05/10. Not met on 22/06/10) Care Homes for Older People Page 18 of 21 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 8 12 12(1), 13(5): The registered 28/05/2010 person is required to ensure there is an appropriate hoist and system of manual handling in place within 48 hours so that people can be safely bathed and their health and hygiene needs met. This is to protect health and to prevent pressure sores developing and deteriorating. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 13(2): Medication must be stored at the correct temperature, in accordance with their product licence. This is to ensure medication is safe and effective for peoples health. 22/06/2010 2 9 13 13(2): Records of the 22/06/2010 receipt, administration and disposal of all medicines must be robust and accurate to demonstrate that all medication is administered as prescribed. Peoples health must be protected. Care Homes for Older People Page 19 of 21 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 9 19 The medication policy and procedure needs review for a safe and lawful medication system and practice. Care plans need to specify safe fitting instructions for bedrails so that daily checks are effective. An overhanging mattress needs risk assessment. The provision of slings and their laundering, replacement of a toilet seat and maintaining hygiene in communal bathrooms and toilets should ensure infection controls protect health. Staff development and training plans should review roles, mandatory training deficits, literacy and language skills. The responsible person and Director need to update their knowledge of the law pertaining to their responsibilities to employee health and safety. 3 26 4 5 30 36 Care Homes for Older People Page 20 of 21 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. Care Homes for Older People Page 21 of 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
