Inspection on 30/06/09 for The Squirrels

This inspection was carried out on 30th June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Squirrels 26/05/10

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Squirrels 7 Oaks Crescent Chapel Ash Wolverhampton West Midlands WV3 9SA Lead Inspector Jean Edwards Key Unannounced Inspection 30th June 2009 08:15 DS0000073012.V376333.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. DS0000073012.V376333.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address DS0000073012.V376333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Squirrels Address 7 Oaks Crescent Chapel Ash Wolverhampton West Midlands WV3 9SA 01902 423 855 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Merron Care Ltd Manager post vacant Care Home 11 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (9) DS0000073012.V376333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Dementia over 65 DE(E) 1 Mental Disorder MD(E)1 Old age not falling within any other category (OP) 11 The maximum number of service users to be accommodated is 11 2. Date of last inspection New Registration. First Key Inspection Brief Description of the Service: The Squirrels is a private care home registered to provide residential care for up to 11 frail older people, including one older person with a mental disorder and one older person with dementia. The home has been registered with a new provider, Merron Care Ltd since January 2009. The home is located near to main bus routes, and close to the Wolverhampton City centre with many amenities. The large detached property is set in its own grounds with accessible gardens and car parking. The Home provides bedrooms, on the ground and first floors with bathing and toilet facilities nearby. There is a passenger lift providing access to the first floor. The communal lounge and dining room is located on the ground floor. The home offers a number of aids and adaptations, including one adapted bathing facility, and portable lifting equipment, emergency call system in every room and two refurbished first floor bedroom with en suite facilities. The home has not published the range of fees. People are advised to contact the home for up to date information about the fees charged. DS0000073012.V376333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating of this service is Zero Star. This means that the outcome for people using this service is poor. The home was purchased and registered with a new provider in January 2009. This was the homes first Key Inspection since the new registration. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included, discussions with the acting manager, area manager now acting Responsible Individual nominated by the company, and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the Commission. We looked at a number of records and documents. The acting manager submitted the homes Annual Quality Assurance Assessment (AQAA) as requested prior to the inspection visit. We looked around the premises, looking at communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. Responses to CQC surveys have been included throughout the report. The quality rating for this service is Zero Stars. This means the people who use this service experience poor quality outcomes. What the service does well: The acting manager and acting responsible individual had a proactive approach in that they had started to audit some records and take action where necessary. We received positive comments from people living at the home which included, they are very patient, always make sure everything is alright and they keep me nice and tidy and feeling comfortable. DS0000073012.V376333.R01.S.doc Version 5.2 Page 6 The staff on duty were genuinely caring and friendly and tried to make conversation with people living at the home. We saw staff talking to people and offering choices and assistance at a level and pace that they needed. Relatives told us they felt welcomed when they visited and comments from the relatives survey included, very welcoming, most staff appear to be caring and residents are cared for and looked after. People looked smart and well cared for, with makeup and jewellery according to their preference. There were other comments such as homely environment, and family type dining room and we were told that people and relatives were told to treat it as their own home. People told us the home was clean and had no nasty odours. What has improved since the last inspection? What they could do better: There must be robust management arrangements in place at all times and any changes must be notified to us without delay. Some medication practices were potentially unsafe. Care plans need to be person centred and give clear guidance on how to work with and meet the needs of all the people in the home, including those with dementia. The premises were not being maintained to an acceptable standard. A full assessment of the environment and action with timescales should be developed. The management must be able to demonstrate that there are skilled staff in suitable numbers to meet all the needs of the people living at the home. There must be thorough employment checks in place to make sure the people living at the home are safeguarded. Some people told us they were bored and comments from relatives surveys about what the home could do better included, more everyday activities when possible, and more weekly activities as well as occasional ones. There should be allocated time to provide suitable activities and social events for each person living at the home. DS0000073012.V376333.R01.S.doc Version 5.2 Page 7 The multi-agency procedures to safeguard people at the home must be followed diligently with any concern reported to the lead agency. A relative commented on the need to modernise the bathing and showering facilities. The quality assurance audits must be more robust so that failings can be recognised and actions taken to improve the service. Equipment such as bedrails must comply with health and safety requirements. Any adverse event affecting people living at the home must be notified to us without delay to show that people are safeguarded. 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. DS0000073012.V376333.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000073012.V376333.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 People using the service experience poor quality outcomes in this area. People living at the home do not have up to date contracts terms and conditions of occupancy, and there was no accurate and up to date information about the home and new provider. This has the effect that people and their advocates do not have good information regarding their rights and entitlements, and how care will be provided. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at a copy of the homes statement of purpose and service user guide, which had not been updated since the new provider was registered in January 2009. We were not shown any evidence that the documents could be provided in alternative formats for people unable to read or understand written information. There were a number of omissions in the documents on display DS0000073012.V376333.R01.S.doc Version 5.2 Page 10 such no clear aims and objectives or the homes admission criteria. All documents should provide accurate, easy to understand information about the home. There was no information about the range of fees and payment arrangements included in the service user guide. This document should offer people full information about the service to help them make decisions about the choice of home. There were no new admissions to the home since the new registration in January 2009. The sample of case files of two people living at the home showed that each person had been provided with a contract and statement of terms and conditions. However the contracts referred to the previous provider and had not been revised and updated. These documents should be easy to read and understand; and set out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. From the information provided at the home we saw that the majority of people were funded through the Local Authorities whilst other people were funding the costs of their own care. The examination of a sample of care records showed that there was assessment information, which recorded individual preferences such as rising, retiring, preferred activities, likes and dislikes. This meant that staff had good information about each persons needs and preferences about how they wished their care to be provided. DS0000073012.V376333.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience adequate quality outcomes in this area. The care plans and risk assessments do not give sufficient guidance to staff to make sure that all needs are fully understood and met for each person. The arrangements for administration of medication do not always ensure that every person at the home receives their medicines as prescribed by their doctor, which poses risks to their health and well being. People are treated with respect and courtesy, with rights to privacy and dignity maintained. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw that everyone had care plans, risk assessments and health screening assessments in place. However the care plans contained typewritten statements, which were not individualised for each person. This meant that DS0000073012.V376333.R01.S.doc Version 5.2 Page 12 they were not person centred and did not give staff specific guidance to meet each persons needs. For example they did not show staff how to care for people with conditions such as behaviours, which challenged the service, dementia, diabetes and short term infections, when they would need additional supervision, care and support. The medication regimes in care plans had not been updated and did not always contain the same information as the MAR sheets. There were no care plans or written protocols for the administration of when and as required (PRN) medication. The references to agitated and aggressive behaviour in daily progress records were not specific. The lack of care plans and protocols for the use of anti-psychotic medication meant that staff did not have clear guidance. Records for one person showed us that staff were administering this medication at a set time each day without recorded reasons for its use or evaluation of its effectiveness. The acting manager told us that the medication was administered once each day at the same time because the person showed an escalation of distressed behaviour at this time each day. This meant that the medication was being administered on a regular basis rather than when and as required. The management must make sure that any changes to the way medication is administered is always reviewed and agreed with the persons doctor, family and advocate as necessary. The acting manager had introduced an effective distraction for someone who was distressed and agitated at times. A large photo of the persons spouse was placed in view near to them in the lounge and this had a calming effect. This was not written in the care records and would depend on verbal communication between staff for it to be used appropriately. However we spoke to the persons spouse who told us he was pleased that this had been introduced and saw the soothing effect it had. We saw that one person had been assessed as having high risks relating to tissue viability, nutrition and mobility but had low dependency scores, which did not correspond with the high level of supervision, care and attention required from staff. There were significant changes in one persons condition, loss of mobility and general deterioration. The acting manager told us this had been discussed with the persons doctor for advice and support. The weight records of two people were recorded as stable, even though it was also recorded unable to weigh. The acting manager explained that the home did not have sit on scales for people with poor mobility and judgement about any weight loss was based on the fit of their clothing. The Malnutrition Universal Screening Tool (MUST) was not being used for appropriate weight monitoring for people unable to be weighed. There were significant numbers of people unable to be weighed using conventional stand on scales and there were no alternative arrangements such as sit on scales. We saw that people living at the home had good access to health care services to meet their assessed needs both within the home and in the local DS0000073012.V376333.R01.S.doc Version 5.2 Page 13 community. Some people were able to choose their own GP within the limits of geographical borders and there were records to show that some people had access to dentists, opticians, and other community services. The daily notes we saw were very basic, and there was no evidence to show that staff had been trained to make records more informative and meaningful about the persons life and experience at the home. The home did not have a key worker system. We looked at the homes systems to manage and administer peoples medication. The previous location where medication was stored, which had excessive temperatures had been changed to a location where temperatures were better controlled. The area was carpeted and the décor was poorly maintained. All surfaces in this room including the flooring should be easily cleanable to maintain good infection control measures. There were small amounts of medication, which needed to be refrigerated, were stored in a domestic fridge in an unlocked container. The acting manager told us that the drugs fridge was not working. All staff and some people living at the home had access to the kitchen and though daily fridge temperatures were being recorded the security and safety of the refrigerated items could not be guaranteed. The home was supplied with medication from a local pharmacy provider but the acting manager told us she was not aware of a written contract. A contract should be requested from the pharmacy provider and regular audits and support should be requested. Staff had received medication training and were generally knowledgeable about medication people were receiving. There was an up to date specimen signature list for staff administering medication, and the homes medication policy and procedure was available, though it was undated. This document should be regularly updated to include all relevant good practice guidance. We looked at a sample of MAR (Medication Administration Record) charts, which documented each persons current medicine requirements and regime. Records of receipt of medication received into the home and carried forward balances of medication stocks on the MAR (Medication Administration Records) sheets were not consistent. In addition variable dosages such as one or two tablets were not consistently recorded. This meant that the accurate auditing of medication dispensed in original containers could not be easily carried out. The acting manager had carried out an audit of the MAR charts and we saw that the MAR charts started for the new month had improved, which was positive. We undertook some random audits of MAR charts and medication stocks, the majority of which were accurate. There were some we were not able to audit DS0000073012.V376333.R01.S.doc Version 5.2 Page 14 and there some discrepancies. This meant that there were not always assurances that people were always receiving their medicines as prescribed by their doctor. The administration and records of Controlled Drugs were accurate but the storage no longer complied with updated legislation and the management must assess this and provide suitable storage. We saw that all staff were aware of how to treat each person with respect and to consider their dignity when they were providing personal care. People were well groomed, with clothing appropriate to the weather, some wearing makeup, nail polish and jewellery of their choice. DS0000073012.V376333.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience adequate quality outcomes in this area. Each person cannot always be assured that there will be appropriate activities for them to participate in. People are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person are catered for with a balanced and varied selection of foods that meet their preferences and nutritional needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The routines of the home were generally flexible to meet each persons needs. However we saw that there were times during the day when people were left unattended in the lounge when the two staff on duty were working in other parts of the home. There was 45 minute period in the morning when three people in the main lounge had no contact with staff who were busy elsewhere. The home does not have an activities organiser and staff at the home had to use their knowledge of peoples preferences to plan activities, which people DS0000073012.V376333.R01.S.doc Version 5.2 Page 16 might like. There was a notice and pictures of activities displayed in a corridor but it was left to individual staff to make suggestions of activities. We were told that most people were disinclined to participate. One person living at the home told us we do nothing, theres nothing to do. The acting manager told us that though staff try to offer suggestions people choose not to participate. She stated it was their choice. We did not see evidence of involvement with the wider community, trips or outings. Staff respected that some people preferred to spend their time in their own bedrooms. We were told that one person who wished to continue with their faith was visited by their priest. We looked at a sample of peoples individual activities records, which were generally completed with refusals recorded. The acting manager told us she had tried to arrange for a guitarist to come to the home. She also told us that events such as Halloween had been tried but people living at the home did not want them. She showed us comments recorded in residents meetings such as, daft what they have to do. There were no allocated hours to ensure that there were suitable activities and social events for each person living at the home. We saw that family and friends were welcomed and we spoke to some visitors who told us they knew they could visit the home at any time. They told us that the acting manager and staff team always made time to talk to them and offer them drinks. People were encouraged to bring in their personal possessions to make their room more familiar and homely. There were no inventories of personal possessions on the sample of files examined. Inventories of each persons possessions should be recorded and should be kept up to date, signed and dated by the person or their representative and witnessed by the member of staff. We discussed nutrition with care staff and acting manager. They were generally knowledgeable about each persons nutritional needs and we were told that a choice was always offered, there were also diabetic and soft diets. We were told there was also added calorific value at mealtimes for people with poor appetite or at risk of weight loss, using cream, butter and cheese. Food records for each person had been put in place since the last inspection, prior to the new registration. A new cook had recently been employed for six hours from 10:30am - 1.30pm for five days each week. The main meal looked and smelled appetising. One of the two care staff on duty had to make the breakfast, tea, supper and drinks and snacks at all other times. Staff were aware of the needs of people who found it difficult to eat at mealtimes and they offered sensitive assistance with feeding. They were DS0000073012.V376333.R01.S.doc Version 5.2 Page 17 aware of the importance of offering food at the persons pace, so that they were not hurried. The main meal was unhurried over about an hour and a half. One person chose to have their meals, particularly tea at a different time and in their bedroom, which was positive allowing them time and space to eat at their own pace. Efforts had been made with the dining room to make it look inviting with attractive tablecloths, crockery and condiments. There were written menus on the tables, there were no other formats for people unable to understand the written information. We asked some people about the meals. There were generally favourable comments, though one person told us they didnt like the choice of liver they had been given but had eaten it. DS0000073012.V376333.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience poor quality outcomes in this area. The information available to people assist to raise concerns and complaints had not been updated with accurate contact details. The procedures to safeguard people living at the home from risks of harm are not always followed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the homes systems to deal with complaints. We saw that there was a complaints procedure displayed in the home and available in the Service Users Guide. Some of the information was out of date. There were no other alternative formats for people who may not be able to read or understand written information. We looked at the complaints log. There were no recorded complaints about the home or people living there. We spoke to a relative and people living at the home, who told us they had no complaints but could tell the staff or manager if they wanted to complain. The surveys returned to us confirmed that people were aware of the homes DS0000073012.V376333.R01.S.doc Version 5.2 Page 19 complaints procedure; however as already identified the information was not accurate. The home had policies and procedures to inform staff about abuse and responsibilities for reporting suspicions or incidents. We saw that there was a programme of safeguarding training and certificates for five staff who had recently attended training. The acting manager told us that she had booked training places for other staff. We spoke to two members of staff who told us that they knew where they must report allegations or suspicions of abuse. We were concerned to see an accident record identifying bruising with unknown cause, which had been investigated by the acting manager but not notified to us or to the local authority as a safeguarding referral. The accident record described bruising to a persons face and shoulder. The acting manager told us that some staff were not very skilled in completing records and the extent of the bruising had been exaggerated and not accurate. We spoke to the relative, who had no concerns about the extent of the injury. However the failure to refer concerns to appropriate agencies told us that the homes safeguarding procedures were not followed, which meant people might not be protected from risks of harm. We also saw that the recruitment processes for new staff were not always robust and did not provide adequate safeguards for people living at the home. DS0000073012.V376333.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 People using the service experience adequate quality outcomes in this area. The home provides a warm, homely and comfortable environment for people living there. There systems in place for maintaining infection control are not sufficiently robust. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The interior of the home was bright, cheerful and homely. There were attractive, well maintained gardens, with garden furniture for people to use in the warm weather. We were told that there were plans to provide better access to the large front garden. DS0000073012.V376333.R01.S.doc Version 5.2 Page 21 We looked around the premises and saw some improvements had been made and the redecoration and refurbishment of two first floor en suite bedrooms was nearing completion. We looked at a sample of bedrooms with peoples permission where possible. Some were attractively decorated and personalised according to individual preferences, with family photographs, ornaments and small items of personal furniture. People told that the home was generally clean, warm, and comfortable and this was confirmed by comments contained in surveys returned to us. The premises were not being maintained to an acceptable standard. Work was needed to the exterior paintwork. The interior of the home also needed attention in a number of areas, which were showing wear and tear. Other examples were wardrobes which were not secured and may pose a risk to people in their bedrooms, uneven floorboards and torn carpet on the first floor landing. The management must assess this and develop and implement a programme that shows what actions are to be taken with a prioritised timescale. There were bedrails in use, which needed attention to ensure they were fitted and maintained in a safe condition. The height dimensions of a set of bedrails did not comply with requirements because of the replacement pressure reliving mattress on the bed. This did not satisfactorily safeguard the person from risks of harm. The registered manager agreed to replace them with more suitable bedrails. The bathing and toilet facilities needed to be assessed and refurbished to meet the needs of the people living at the home. We were told that one bathroom was not used because people could not access the bath. The flooring in this bathroom had lifted and we saw cockroaches in this area. The management must make sure there are effective pest control measures in place. The laundry was located in the basement, and was equipped with a commercial washer and tumble dryer. Improvements had been made to make the access via steep steps in the garden more secure to prevent accidents to people living at the home. There was no separate hand wash basin to promote good hand washing hygiene in this area. There were no laundry or domestic staff employed and care staff carried out all laundry duties. The management should revise the laundry procedures to reflect good practice guidance in the Department of Health Essential Steps for Infection Control. The kitchen was maintained in good order, and it was clean and tidy and well organised. The home had been inspected by the Environmental Health Service but the management could not tell us what score had been awarded for DS0000073012.V376333.R01.S.doc Version 5.2 Page 22 healthy eating and food safety. The acting manager told us that the actions required had been completed. There were opened food items without date labels; these were thrown away during this inspection visit. There were no records of food probe calibration checks, though we were told these were done, and there were no food safe probe wipes. There were some flies in the kitchen and there was no electrical insectcuter in this area, which meant surfaces and food may become contaminated. The management must risk assess this area and implement control measures to improve food safety. DS0000073012.V376333.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience poor quality outcomes in this area. The number and skill mix of staff may compromise the way the needs of each person living at the home can be met. The recruitment processes do not provide sufficient safeguards for people living at the home. There is a training programme in place to equip staff with skills to meet peoples needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There were eight people living at this home with a range of dependency levels and different needs. The acting manager had not reviewed staffing levels on a regular basis, taking account of the occupancy and dependency levels of the people accommodated. She claimed that two care staff on each day time shift was sufficient to meet the needs of each person at the home. We observed that there were two people with dementia requiring supervision, assistance and support, five people needing the assistance of two staff for their physical needs, and the majority of people required assistance with feeding. The management must be able to demonstrate that there are trained and competent care staff on duty with sufficient allocated care hours to meet the needs of people living at the home. We saw that care staff had duties other than caring for people, such as all the domestic work, all the laundry. Care DS0000073012.V376333.R01.S.doc Version 5.2 Page 24 staff also did the catering for breakfast and tea time each day and catered for all meals for two days each week when the cook was off duty. We saw that these duties meant there were periods of time when people had no contact with staff. As highlighted at the Daily Life and Social Activities section of this report there were also no allocated hours to ensure that there were suitable activities and social events for each person living at the home. There was a staff team of nine care staff, the acting manager and a part time cook. The acting manager told us that she was usually on the care rota as one of the two carers on duty. She had no recorded managerial shifts and she told us she allocated herself some managerial hours on some afternoon shifts. This meant there was only one other carer to carry out all care and ancillary tasks during this time. The management must be able to demonstrate that there are robust management arrangements to provide effective leadership and quality assurance monitoring to ensure the health, well being and safety of people living at the home. Three personnel files of staff recently employed were examined. The files were organised with a recruitment checklist. The recruitment process was not robust and did not provide safeguards for people living at the home. The application form only requested 10 years employment history, instead of a full employment history; employment gaps had not been explored; not all files contained two satisfactory references, there were staff employed on a POVA (Protection of Vulnerable Adults) First basis, without a risk assessment, and there was insufficient information to show that overseas staff were eligible to work in the UK. This is important to be sure that the people are suitable and capable of working with vulnerable people in this environment. There was evidence of an in house induction on the staff files, some supervision records and evidence of the Skills for Care Common Induction Standards, which were in the process of being completed. Four of the nine care staff had achieved a NVQ (National Vocational Qualification) level 2 care award and other staff were enrolled on the training. There was a training matrix, which showed that the majority of staff had attended dementia training and training in other areas had been booked. DS0000073012.V376333.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service experience poor quality outcomes in this area. The management arrangements do not provide sufficient safeguards for people living at this home. There are systems for consultation with people living at the home, with views sought and acted upon. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The acting manager had been in the post since January 2009 and she told us she would be applying for registration with the CQC. She had worked at the home with the previous provider since 2003 and had achieved an NVQ level 4 DS0000073012.V376333.R01.S.doc Version 5.2 Page 26 and Registered Manager Awards. She also told us she had a Degree and Masters Degree in Science and Education. There were records of quality assurance checks, with a policy and reference to the Dignity Challenge. The audits included the fire systems, care files and accidents records. She had also put in place maintenance and development plan and action plan, though the timescales were mainly reactive. Examples of remedial actions were a new wash basin fitted in a bedroom, painting the kitchen ceiling, new carpets in two bedrooms, and fire training for all staff in June 2009. There were areas needing attention identified during this inspection visit, which were not recorded on the maintenance programme. There were records of recent staff meetings though these concentrated on the change of provider and their new terms and conditions of employment. There were monthly residents meetings, with topics such as food and activities, with recorded comments from people living at the home indicating they did not wish to participate in activities, events and outings. There were also very positive results of surveys circulated by the home. These views were not necessarily reflected when people spoke to us or in some of the surveys we circulated. We noted that the acting manager had been instructed by the organisation to replace some existing records, such as standardised care plans and moving and handling risk assessments. As highlighted in the Health and Personal Care sections of this report the new versions needed to be expanded and improved. Supervision records told us that staff had been receiving regular supervision since January 2009. There were records of two recent unannounced visits by the acting responsible individual on behalf of the organisation (Regulation 26), to check the management and running of the home since January 2009. The most recent visit was on the day before this inspection visit. The report highlighted some good practices and some areas, which needed to be improved. Previously to these visits the new organisation had not demonstrated support and good quality assurance systems at this home. The acting manager and acting responsible individual, present for part of this inspection visit, had attended training relating to the Deprivation of Liberty Safeguarding (this ensures that peoples rights are met) and told us there were plans to make this available for all staff so that they have awareness and understand their role. We were told that people were offered the opportunity to manage their own DS0000073012.V376333.R01.S.doc Version 5.2 Page 27 money if they wished, and there were facilities to help keep it safe. We looked at a random sample of balances and records of monies held in temporary safekeeping on behalf of people living at the home, which were accurate, with records of all transactions. We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and well organised. The gas service certificate stated, not to be used as a Gas Safety Certificate so the management should obtain documentary evidence of a Landlords Gas Safety Certificate to show that people are safe. There was evidence that staff received mandatory training appropriate to their roles, such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training and there was evidence that training had been booked where there were gaps. We discussed the concern about the height of bedrails in use with a pressure relieving mattress with the acting manager. She agreed to take action to have them replaced to make sure the dimension were a minimum of 220mm as specified by the HSE (Health and Safety Executive) to maintain peoples safety. There were no risk assessments or regular safety checks for the bedrails. We also looked at accident records and Regulation 37 notifications. There were 3 recorded accidents since January 2009. The acting manager had implemented an accident analysis and evaluation, which would identify trends and risks, which could be controlled or minimised. As highlighted at the Complaints and Protection section of this report we saw an accident record describing bruising to a persons face and shoulder and the cause was unknown. The acting manager had carried out an investigation and staff statements were available on file. This incident had not been notified to the commission or referred to the Lead Agency to determine whether it should be considered as safeguarding. The acting manager told us that it was possible the person had sustained the bruises accidentally because of their condition. She also told us that some staff were not very skilled in completing records and the extent of the bruising had been exaggerated and not accurate. These actions told us that safeguarding procedures were not followed. The management must notify the CQC of any event, which adversely affects people living at the home, without delay and must also proactively refer any suspicion of abuse to the lead agency for them to decide the course of action. The acting manager agreed to make a retrospective notification and safeguarding referral, and give us evidence of the action taken. DS0000073012.V376333.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 1 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 2 X X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 2 2 DS0000073012.V376333.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No. This home has a new registration. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement To ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to monitor and inform the relevant healthcare professionals as needed. This is to safeguard the health and well being of people living at the home. 2 OP9 13(2) To ensure that all persons living 01/09/09 at the home receive their medication as prescribed by their doctor. This is to maintain their health and well being. 3 OP9 13(2) A Controlled Drugs Cabinet to ensure Controlled Drugs are appropriately stored in compliance with the Misuse of Drugs Act 1973 must be provided. This is to ensure the health and well being of people living in the home is safeguarded. DS0000073012.V376333.R01.S.doc Version 5.2 Page 30 Timescale for action 01/09/09 01/10/09 4 OP9 13(2) All medication must be stored 01/08/09 within the temperature range recommended by the manufacturer to ensure that medication does not lose potency or become contaminated. This is to ensure the health and well being of people living in the home is safeguarded. 5 OP18 13(6) To ensure that any suspicion of abuse is reported immediately to the lead agency for them to decide the course of action. This is to safeguard people living at the home. 01/08/09 6 OP26 13(4) To ensure that all areas of the home are clean and meet the infection control criteria. This is to ensure the health and well being of people living in the home is safeguarded. 01/08/09 7 OP27 12(1) To demonstrate that the number 01/09/09 of care staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 8 OP29 19(1) To ensure that all staff employed at the home are recruited following robust recruitment procedures, with documentary evidence to demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to safeguard people living DS0000073012.V376333.R01.S.doc 01/08/09 Version 5.2 Page 31 9 OP37 37 at the home from risks of harm. To ensure that notifications are submitted to the CQC for any event, which adversely affects people living at the home, without delay. This is to ensure people living at the home are safeguarded. To ensure there are effective pest control measures in place. This is to safeguard people living at the home from risks of harm 01/08/09 10 OP38 13(3) 01/08/09 11 OP38 13(4) To implement management systems to ensure the safe use of bedrails, which includes correct fitting, rigorous risk assessments, diligently followed, documented checks and staff guidance and training relating to bedrails. This is to safeguard the health, well being and safety of people living at the home. 01/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations That the homes statement of purpose and service user guide should be revised, updated and reissued to people living at the home in easy to understand formats suited to their capabilities. That the range of fees should be published in the service user guide so that people have information to assist them to decide on their choice of home. DS0000073012.V376333.R01.S.doc Version 5.2 Page 32 2 OP1 3 OP2 That the contract / terms and conditions of residence should be revised, updated and reissued to each person living at the home to accurately reflect the new providers details. All health care risk assessments and care plans should include all of each persons assessed needs, and accurately reflect changes, which should be referred for professional advice where necessary. That care plans, monitoring and management strategies should be put in place for people described as having agitated, aggressive or other challenging behaviours with ways to evaluate the effectiveness of strategies and use of PRN medication. That carried forward stocks of medication are recorded on each persons MAR sheet and random audits of medication stocks should be carried out, with recorded remedial action for any discrepancies. That variable dosages such as one or two tablets, 5mls or 10mls should be consistently recorded on the MAR sheet. Time for activities, with staff training to ensure appropriate social stimulation should be offered to everyone and especially to people with dementia and sensory disabilities should be made available. Inventories of each persons possessions should be recorded and should be kept up to date, signed and dated by the person or their representative and witnessed by the member of staff. That a copy of the DoH guidance Essential Steps should be used to audit and improve infection control measures at the home. 4 OP7 5 OP7 6 OP9 7 8 OP9 OP12 9 OP14 10 OP38 DS0000073012.V376333.R01.S.doc Version 5.2 Page 33 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: 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. DS0000073012.V376333.R01.S.doc Version 5.2 Page 34 - 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!