Inspection on 11/01/10 for The Victoria Residential Home

This inspection was carried out on 11th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Victoria Residential Home 29/03/10

The Victoria Residential Home 01/12/09

The Victoria Residential Home 06/10/09

The Victoria Residential Home 14/04/09

The Victoria Residential Home 22/04/08

The Victoria Residential Home 06/06/07

The Victoria Residential Home 17/05/06

The Victoria Residential Home 14/12/05

The Victoria Residential Home 18/05/05

The Victoria Residential Home 08/10/04

The Victoria Residential Home 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Key inspection report Care homes for older people Name: Address: The Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Playfer     Date: 1 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: The Victoria Residential Home Thursby Road Burnley Lancashire BB10 3AU 01282416475 01282441447 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Victoria Care Homes Limited care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of service users who can be accommodated is: 41. Date of last inspection Brief description of the care home The Victoria Residential Home is registered to provide accommodation and personal care for 23 Older People and 18 Older People with a Dementia. The home is a converted hospital with a spacious layout. It is located approximately 2 miles from Burnley town centre and there is a main bus route nearby. There are car-parking facilities at the front of the home and there is a public park directly opposite. Accommodation is provided in 30 single bedrooms and 5 double bedrooms on three floors. There is a passenger lift linking the floors. Seventeen of the single bedrooms and one double room have ensuite facilities comprising of a toilet and wash hand Care Homes for Older People Page 4 of 39 Over 65 0 41 41 0 0 7 1 0 2 0 0 9 Brief description of the care home basin. The home is split into three units and is staffed accordingly. The ground floor is known as the Thursby Unit and provides personal care for older people. The first floor provides personal care for older people who have a dementia and this part of the home is known as the Butterworth Unit. There were no residents accommodated on the second floor. At the time of the inspection (January 2010) the scale of charges ranged from £366.00 to £412.00. Additional charges were made for hairdressing and chiropody. Information was made available to prospective residents in the form of a statement of purpose and service users guide. The service users guide was usually given to relatives and/or prospective residents on viewing the home or at the point of assessment. Previous inspection reports can be viewed in the home or downloaded free of charge from the Commissions website at www.cqc.org.uk Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection, which included a visit to the home was conducted at The Victoria Residential Home on 11th and 12th January 2010. The inspector was accompanied by a Pharmacy Inspector on the first day of the inspection and additional Regulation Inspector on the second day. The pharmacy inspector last visited the home on 1st December 2009 and the last key inspection was carried out on 6th and 7th October 2009. Following the last key inspection, the manager submitted an improvement plan, which set out their planned action to meet the legal requirements set out in the inspection report and the timescales by which the requirements would be met. At the time of the visit there were 34 residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the manager. Care Homes for Older People Page 6 of 39 We also consulted our records about the service and information we have received over the last three months. As part of the inspection process we used case tracking as a means of gathering information. This process allows us to focus on a small group of residents living in the home, to assess the quality of the service provided. The pharmacy inspector carried out a detailed inspection of the management of medicines and her findings are included in this report in the Health and Personal Care section. The responsible individual was not requested to submit an AQAA (Annual Quality Assurance Assessment) prior to this inspection because a full AQAA had been received within the last seven months. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: The residents and/or their relatives must be consulted wherever practicable during the Care Homes for Older People Page 8 of 39 development and review of their care plan. This is to ensure the residents and/or their relatives have the opportunity to influence their individual service and staff are aware of their personal wishes and preferences. The care plans must also include details about the residents needs during the night. This is to ensure the staff are aware of the residents needs and preferences during this time. The management of medication must be significantly improved and the records must be more detailed. This is to ensure the staff manage medication in a safe and consistent manner. The service must be conducted in a way that respects the privacy and dignity of the residents. Staff must be guided and instructed to respect and understand the residents needs. This is to ensure the residents receive good quality care and have a positive experience living in the home. The residents must be provided with a programme of activities, which meets their needs and preferences. This is to ensure the residents live in a stimulating environment and their time is occupied in a meaningful way. A record of meals served must be maintained for all residents living in the home. This is to ensure that each residents diet can be monitored and it can be demonstrated that the residents are served a varied and nutritious diet. Residents must be given appropriate and timely assistance to help them with drinks. This is to ensure residents welfare is protected. The manager must make a record of all complaints received by a resident or their representative. This is to ensure that all complaints are thoroughly investigated and action is taken as appropriate in order to resolve any concerns. The manager must also ensure that all incidents resulting in harm to the residents are reported under the established safeguarding procedures. This is to ensure the residents are fully protected. The premises must be kept in a good state of repair externally and internally. This includes ensuring that windows operate properly at all times. Arrangements must also be made to ensure the hot water and heating systems are operating properly in order to provide sufficient hot water and heating at all times. This is to ensure the dignity, comfort and safety of the residents. All staff must complete specialist training courses on managing challenging behaviour and supporting people with a dementia. This to ensure all the residents needs are understood and met. The Responsible Individual must make a monthly report of his unannounced visits to the home. This is to enable the Responsible Individual to demonstrate that he is monitoring the quality of the service provided and is aware of the standard of the premises and any problems or complaints. 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. Care Homes for Older People Page 9 of 39 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 39 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had their needs properly assessed and they were provided with appropriate written information to enable them to make an informed choice about where to live. Evidence: Current and prospective residents were provided with written information in the form of a service users guide and a statement of purpose. Both documents met regulatory requirements and provided useful details about the service. The guide had been distributed to the current residents and a copy was available to view in each bedroom. The statement of purpose and the previous inspection report were accessible for reference purposes in the office. A brochure was also available to provide the residents with an overview of the service. This meant the residents had access to suitable and relevant information about the provision of care and support in the home. New residents were issued with a written contract, which included information about Care Homes for Older People Page 12 of 39 Evidence: the level and payment of fees and their rights and obligations. The contract was easy to read and was presented in a clear format. The residents funded by the Local Authority were also issued with an individual service agreement. This meant the residents and their representatives were aware of the terms and conditions of residence and knew what they could expect from the service. The personal files of three residents were looked at in detail as part of the case tracking process. Two of the residents were accommodated on Butterworth unit (formerly known as the Dementia Care Unit) and one resident was living on Thursby unit (previously known as the Residential Unit). The records showed that a full assessment of needs had been carried out prior to admission by a member of the management team and where applicable by a social worker. Copies of the preadmission assessments seen covered a range of individual needs including personal, social, health and cultural needs. It was evident that admissions were not made to the home in the absence of a full needs assessment, which meant the manager and staff had a good level of information about the needs of prospective residents before they moved into the home. Following the assessment of needs a letter was sent to prospective residents and their families to confirm the persons needs could be met in the home. This meant residents were assured that the home was a suitable place for them to live. The manager confirmed that prospective residents were invited to spend as much time as they wished in the home prior to making the decision to move in. This enabled the person to meet other residents and staff and experience life in the home. Following admission, the contract stated that a trial period of eight weeks was offered to every new resident, so both parties could make sure the placement was successful and the residents individual needs could be met. Care Homes for Older People Page 13 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents needs were not always understood and respected, which resulted in a poor quality service. The management of medication was unsafe and placed the residents at risk. Evidence: We looked closely at three residents files, as part of the case tracking process. From this we could see that all the files contained a care plan, which was based on the persons assessment of needs. Since the last inspection the care plan format had been updated to include more information and guidance for staff. The care files had also been reorganised in separate sections to ensure the documentation could be readily accessed. The care plans covered the residents social, cultural, physical and healthcare needs and included details about their preferred routines. However, the plans did not cover the residents needs and wishes during the night, which meant the evening staff had limited information about how best to meet the residents needs during this time. Personal profile information had been incorporated into various sections of the care Care Homes for Older People Page 14 of 39 Evidence: plan, to provide staff with facts about the residents past life experiences and current circumstances. However, one persons personal profile did not accurately reflect his behaviour and his views about the home. This meant there was the potential for staff to misinterpret the persons actions and compound the difficulties this person was having in making staff understand his concerns. Since the last inspection, memory diaries had been introduced and had been completed with each resident. The diaries covered significant events in the residents lives and informed the staff about was important to them. The care plans were supported by records of personal care, which provided information about changing needs and any recurring difficulties. The records had been made on a daily basis, to ensure staff were provided with ongoing details about the residents well being. However, we noted from one residents records that a member of staff had described this persons behaviour in an unprofessional and undignified manner. These comments demonstrated a lack of empathy and understanding of his actions and circumstances and were discussed with the manager, as a matter of concern. Charts had also been maintained to record personal care and hygiene, however, these had not been consistently completed, which meant it was difficult to determine the frequency of some personal care provided to the residents. Written records seen on the residents files demonstrated that the care plans had been reviewed and updated each month. However, whilst the residents or their relatives had signed a care plan agreement form when the care plan was first developed, some relatives spoken to on the Butterworth unit said they were concerned not to be given the opportunity to read and discuss their relatives care plan. This meant that staff may have been missing important information about the residents ongoing wishes and preferences and the relatives had limited formal opportunities to influence the care of their family member. Since the last inspection, the care plans had been updated to include information about the residents healthcare needs. This meant the staff were provided with information about how best to monitor and respond to the residents medical conditions. Residents had access to health care services and all were registered with a GP. Specialist advice was sought as necessary from health care professionals, such as the District Nursing Team. Chiropody and Optician services visited the home and residents were provided with support to attend hospital and community appointments. However, we noted that staff had not consistently completed a chart to indicate they had massaged a residents hands and feet with cream in line with healthcare advice in the care plan. This meant that there was the potential for this residents condition to Care Homes for Older People Page 15 of 39 Evidence: deteriorate. Potential risks had been considered as part of the care planning systems. However, risk management strategies had not always been drawn up in order to manage any identified risks in a safe and consistent manner. For instance, the moving and handling assessment for one resident had not been fully completed. This was important as the resident spent most of the time in bed. Detailed strategies had been drawn up to manage the risks posed by one residents challenging behaviour. However, one member of staff spoken to said she didnt know how to cope or respond to the persons behaviour, which meant there was the potential for challenging situations to be managed in an unsafe way. The staff were due to receive training on managing challenging behaviour in February 2010. The residents had mixed views about the care provided by the staff, one resident said the staff were caring and approachable, however, two residents felt they were not well looked after, one person said, I dont like anything about this home, everything is horrible and another resident commented, It is not a care home it is a care less home. Some staff are good, but others dont care a jot. These comments were discussed in detail with the manager at the time of the inspection, who agreed to carry out an investigation and take appropriate action to improve the residents experiences. We also observed that many of the female residents on Butterworth unit were not wearing appropriate underwear. This situation had the potential to impact significantly on the residents dignity and comfort and was a concern as the same issue had been raised at a previous key inspection in April 2009. We looked at how medicines were stored, handled and recorded. We looked at a sample of stocks and records and spoke with the manager, a member of staff and residents. Overall we found that there were still serious shortfalls in almost all aspects of medicines management within the home. On the day of the visit we saw that three people had not been given some of their medicines. When we asked the manager and staff about this, they could offer no explanation as to why these medicines had been missed out. On checking stocks and records we found that most medicines could not be accounted for. Some tablets appeared to be missing, whilst others appeared to have been given, but not signed for. There were incomplete and inaccurate records about the amount of stock currently held and this meant that it was impossible to tell whether or not some medicines had been given properly. We found some medicines present that were not listed on residents medication administration records (MARs) and other items that were being signed for as given even though no stock was available. Some MARs had Care Homes for Older People Page 16 of 39 Evidence: been handwritten, but not checked and signed by a second member of staff. Peoples health and wellbeing is at serious risk of harm when records are unclear and inaccurate. Medicines were not always given at the correct time of day or at the correct time with regard to food and drink intake. Manufacturers instructions were not always followed for example ensuring that a person stays upright after taking certain tablets to avoid serious side effects. The health and well being of residents is at risk of harm when medicines are not given at the correct time and instructions followed carefully. Controlled drugs (strong medicines that may be abused) were not stored in a cabinet that meets current legal requirements. These strong medicines are at risk of being abused when they are not stored securely. Not all staff who gave out medication had received appropriate training. There were no records to show that staff had been assessed as competent before being allowed to administer medication unsupervised. The manager told us that training was being planned for when the home changed their supplying pharmacy in February. Staff who have not had appropriate training are more likely to make mistakes when handling medicines. Some people chose to look after their own medicines. Whilst agreements for this were in place for some residents, full risk assessments had not been completed and there were no guidelines telling staff how to support people to self medicate safely. One resident had cream in their room, but was concerned that staff did not apply it regularly. Staff spoken to thought that the resident used the cream themselves, but there were no agreements or risk assessments for this in place and the cream was not listed on the residents MARs. People will not get their treatment correctly if clear arrangements for self medication (including creams and inhalers etc) are not in place. We looked at how the medicines management system within the home was audited (checked). Staff had counted stock a number of times, however no other checks had been done. This meant that mistakes and discrepancies were not noticed or acted upon by the manager or staff. Care Homes for Older People Page 17 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of meaningful activities meant that the residents were not provided with a stimulating environment. The food provided did not always meet the residents expectations. Evidence: The daily routines were flexible and were primarily designed to meet the needs of the residents. The residents spoken to said they had a choice in the times they got up and went to bed. One person said, I go to bed whenever I like. There was evidence in the daily care records of residents going to bed and getting up at different times and this was observed in practice during our visit. Information about the residents preferences in respect of social activities were recorded and considered as part of the assessment and care planning processes. Since the last inspection, individual activity records had been established for each resident. However, there were significant gaps in these records, for instance there was nothing recorded on three residents activity records between 23rd December 2009 and 9th January 2010. Many activities were passive such as watching the television or listening to music. Staff had not received training on suitable activities for people experiencing a dementia. Therefore activities tended to focus on a particular time slot during the Care Homes for Older People Page 18 of 39 Evidence: day rather than be part of an ongoing process to motivate and occupy the residents in a meaningful way. As such interaction between the staff and residents was limited, particularly on Butterworth unit. On the first day of the inspection, two residents on Butterworth unit were given colouring books and pens and were left by staff to start colouring. However, neither resident showed any interest in the activity and one person became distressed and repeatedly commented, I dont know what to do. We also observed that both the music player and the television were on at the same time, which had the potential to disorientate the residents further. The manager acknowledged there was a need to develop activities in the home and had recently designated a new member of staff to co ordinate a programme of new activities. She also confirmed that staff were due to receive training on activities in February 2010. The deputy manager also explained that residents had participated in activities, but staff had not recorded these on the individual records. The residents were supported to continue with their chosen form of religious worship and such choices were recorded within the care plan documentation. A representative from the Roman Catholic Church visited the residents on a regular basis. The residents had the opportunity to develop and maintain important personal and family relationships. There were no restrictions placed on visiting times and residents were able to receive their guests in private, should they wish to do so. Two relatives spoken to during the inspection had mixed views about the care provided. These comments were later discussed with the manager. The residents spoken to had varied and contrasting views about the quality of the food. One resident said the food was very nice and another resident said it was alright. However, one resident said the food was terrible and so bad he often couldnt eat it. This resident added that the plates were not warmed and as a result the food was frequently cold. He had told the staff on many occasions that he did not like the pastry, but was served this again on the day of inspection. When he said he didnt want the dessert, the manager did offer and provide an alternative. A record of meals served had been maintained for the residents living on the Butterworth unit, but there were no records to demonstrate what meals had been provided to the residents living on Thursby Unit. This meant it was difficult to assess whether the residents were served a varied nutritious diet. Drinks and snacks were served throughout the day on both units, however, we Care Homes for Older People Page 19 of 39 Evidence: observed that one person was given a cup of tea on Butterworth unit and was not offered assistance to drink it for approximately one hour. This meant that the resident had to wait a long time for support and was offered the drink cold, which she may have found unpleasant. Care Homes for Older People Page 20 of 39 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents had access to a clear complaints procedure. However, there was an inconsistent approach to recording and dealing with complaints and safeguarding issues, which meant the residents best interests were not always protected. Evidence: The complaints procedure was included in the statement of purpose and the service users guide. It was also clearly displayed in each bedroom. The procedure contained the necessary information should a resident or their representative wish to raise a concern. Some of the residents spoken to said they could speak to a member of staff if they had a problem. However, one resident had made numerous complaints to staff about his experiences in the home, none of which had been entered in the complaints record and therefore had not been properly investigated. This meant the complaints record was incomplete and there was little evidence that the service valued complaints or improved outcomes for residents as a result of complaints. The manager later offered to spend time with the resident and make a full record of his complaints, before conducting an investigation. According to records held by the Commission, there had been one complaint and one safeguarding alert made about the service since the last key inspection in October 2009. The complaint and the alert had been recorded in an overall log. The issues raised in the complaint were investigated under the homes internal procedure and a report was sent to the Commission. The safeguarding alert was coordinated by the Care Homes for Older People Page 21 of 39 Evidence: Local Social Services Department. This issue was ongoing at the time of the inspection. Policies and procedures were in place in respect to safeguarding vulnerable adults as well as a copy of Lancashire County Councils Multi Agency Policy and Procedure. This documentation set out the appropriate response in the event of any allegations, evidence or suspicion of harm or neglect. Since the last inspection, the internal procedures had been reviewed to ensure staff had access to current information. The staff confirmed they were familiar with the safeguarding procedures and had discussed the process with the manager. It was therefore a concern to note that behaviour displayed by a resident on Butterworth unit was not raised with Social Services or the commission as a safeguarding issue. This meant there was the potential for the other residents to be at risk. Care Homes for Older People Page 22 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were provided with spacious living accommodation, however, some aspects of the environment had the potential to compromise the residents dignity, safety and comfort. Evidence: The Victoria Residential Home is a converted hospital with a spacious layout. Accommodation is provided on three floors in 30 single bedrooms and 5 double rooms. Seventeen of the single rooms and one double room have an ensuite facility comprising of a toilet and hand wash basin. A large passenger lift provides access to all floors. Communal space is provided in lounges and dining rooms on each floor. All rooms provided sufficient space for the pursuit of recreational activities and the entertainment of visitors. We noted from our tour of the premises that residents had personalised their rooms with their own belongings, which included photographs, ornaments, furniture and televisions. Since the last inspection, various improvements had been made to the premises. For example, the leak had been repaired in the roof, a fire door had been repaired, the water outlet in the bathroom on Thursby unit had been covered and three double glazed units had been replaced. In addition a sanitizer had been purchased to remove Care Homes for Older People Page 23 of 39 Evidence: unpleasant smells from the air and new carpets had been fitted in two bedrooms. The furniture on Butterworth unit was more practical and suitable for purpose and a new digital lock had been installed on the front door to improve the security of the building. At the time of the visit, the manager was in the process of recruiting a new handyman to carry out repairs and general maintenance. However, we noted that on the second day of the inspection, there was no hot water, which meant that none of the residents were able to have a bath or shower. Staff reported that the water and heating system was unpredictable and there were occasions when there was no hot water. This meant that residents had to be assisted to have a wash in their bedrooms. The water temperatures had not been checked since November 2009. There was limited space in the assisted bathroom on Butterworth unit for the staff to use the hoist and there were no handrails on the wall to support residents whilst standing. The seat on this hoist also presented a risk of entrapment. One resident living on the Thursby unit said the shower room was difficult to use because there was no where to put the soap and there was only one handrail on the wall. A bedroom window in one room on the Thursby unit could not be closed, which was a significant concern given the outside temperature and the windows in one room could not be opened, which meant there was no ventilation in this room. Several windows panes were cracked and broken on the outside, which looked unsightly. The standard of cleanliness was generally satisfactory throughout the home. However, a carpet and commode was soiled in one bedroom. The manager explained that a new cleaning schedule had been developed and records had been completed when each task had been carried out. Care Homes for Older People Page 24 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents were supported by a staff team who knew them well, however, the lack of training in caring for older people with dementia impacted on the residents quality of life. Evidence: A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. Since the last inspection the staffing level on Butterworth unit had been increased, following the admission of additional residents. The roster indicated there were usually three staff working on Butterworth unit and three staff on the Thursby unit. There were two care staff on waking watch duty on each floor. Additional staff were employed to carry out domestic tasks such as cooking and cleaning. A recruitment and selection procedure was available and a checklist was used to track documentation required for the recruitment of new staff. We looked closely at the files of one member of staff and the manager, both of which had been employed within the last six months. At the previous inspection, we noted there was only one reference available for the manager, this had now been added to the file. All recruitment documentation had been collated in line with regulatory requirements, before the member of staff commenced work in the home. Care Homes for Older People Page 25 of 39 Evidence: Arrangements were in place for care staff to undertake an in house induction programme and they were encouraged to apply for NVQ training. According to information supplied at the time of the inspection 14 out of 21 care staff had achieved NVQ level 2 or above. This equated to 67 of the overall staff team. In addition, 3 members of staff were working towards this qualification. This meant the majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively. Many of the staff had worked in the home for sometime and knew the residents well. However, as mentioned previously some residents said the staff did not always demonstrate a caring and understanding approach. The manager agreed to investigate the residents comments and experiences discussed during the inspection. Staff were given the opportunity to attend training courses relevant to their role. An overall training plan and certificates seen on the staff files demonstrated that the staff had received recent training on moving and handling, fire safety awareness and safeguarding vulnerable adults. However, staff had not completed training in relation to the care of older people with a dementia and managing challenging behaviour. This meant that staff had limited knowledge about how to develop meaningful activities and how to respond and manage challenging behaviour. In turn this had an impact on the residents daily lives and the quality of care. The manager explained that training had been arranged for February 2010. We also noted that some members of staff designated to administer medication had not refreshed their knowledge for sometime. The home was linked via computer to the LWDP (Lancashire Workforce Development Partnership). This organisation operates an internet based staff training record and plan and provides access to training courses. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This meant the manager could use this tool to plan future training. Care Homes for Older People Page 26 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was appropriate information to promote health and safety. However, the current management systems did not always ensure that the best interests of the residents were protected. Evidence: The manager had been in post since September 2009. She was a Registered General Nurse and had a Degree in Health and Social Care and a Certificate in Management. She had also recently begun working towards a Leadership and Management qualification. The manager had many years experience caring for older people in both health and social care settings. She confirmed her intention to register with the Commission, however, this process had not commenced at the time of the visit. Whilst the manager had improved the care planning systems during her time at the home, there were areas of concern highlighted throughout the inspection, which reflected on the overall management of the home. The manager acknowledged there were more improvements to be made to improve the quality of the service. Care Homes for Older People Page 27 of 39 Evidence: There was a programme in place for staff supervision and the issues discussed during the meetings were recorded on a suitable format. In addition to staff supervision, senior staff attended regular meetings with the manager. The care staff had also been given the opportunity to attend meetings, which gave them the chance to discuss forthcoming developments and ongoing changes. The service had been awarded a post recognition Investors in People Award in October 2007 and had preferred provider status with the Local Authority. There were some internal systems to monitor the quality of care, for instance the deputy manager had distributed satisfaction questionnaires to the residents, their families and the staff in February 2009. The results had been collated and a development plan had been produced based on the outcomes of the surveys. However, the development plan had not been updated with the work required and carried out following the previous inspection. It was therefore difficulty to determine the managers current priorities. Residents meetings were held on both units at approximately six week intervals. The meetings gave the residents the opportunity to discuss their views about daily life in the home, such as the meals and activities. Since the last inspection, the manager had introduced new audits to check specific aspects of the operation of the home, for example, a new care plan audit had been implemented to monitor the quality and review of the plans. However, the audit systems used to manage medication were ineffective, which meant any errors of discrepancies were not noticed or acted upon. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of the records of monies held on the premises was found to be correct. Apart from one report dated October 2009, there were no reports seen of the unannounced visits made by the Responsible Individual in November and December 2009. These reports are important so the registered person can clearly demonstrate that he is monitoring the quality of the service provided and is aware of the standard of the premises and any problems or complaints. There was a set of health and safety procedures, in the main policy and procedure file. Staff had received health and safety training, which included moving and handling, food hygiene, first aid, fire safety and infection control. Documentation seen during the inspection indicated the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the Care Homes for Older People Page 28 of 39 Evidence: fire procedures during their induction and as part of mandatory training. Since the last inspection, the manager had devised some risk assessments, in order to identify and manage any potential hazards in the internal and external environment. Arrangements were in place to record accidents and incidents in the home. This ensured that the residents condition was closely monitored following an accident or incident. The Commission had been notified of most events significant events in the home, however, as mentioned in the Complaints and Protection section, an incident involving one residents behaviour had not been reported to the commission or Social Services as a safeguarding alert. Care Homes for Older People Page 29 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The residents and/or their representatives must be consulted about the development and review of their care plan. This is to ensure the residents have the opportunity to influence the individual service they receive. 30/11/2009 2 9 13 All information from 28/10/2009 prescription labels must be recorded on the medication administration record and all controlled drugs must be accounted for. This is to ensure the residents are given their medication in line with the prescribers instructions and a clear audit path can be maintained of drugs handled in the home. 3 12 16 The activities on the dementia care unit must be structured to meet the residents individual needs and preferences. This is to ensure the residents live in a stimulating environment. 30/11/2009 4 30 18 All staff must complete 26/02/2010 Page 30 of 39 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action specialist training courses including managing challenging behaviour and supporting people with a dementia in line with the needs of the residents. This is to ensure the residents needs are met. Care Homes for Older People Page 31 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Wherever practicable the residents and/or their representative must be consulted during the care planning process. This is to ensure the residents and their representatives are able to fully participate in the care planning process and have some influence on the delivery of their care. 08/03/2010 2 7 15 The care plans must include information about how to meet the residents needs during the night. This is to ensure the staff are aware of the residents needs and preferences during the night. All risk assessments must include risk management strategies. Where intervention or treatment is identified, staff must carry 08/03/2010 3 8 15 08/03/2010 Care Homes for Older People Page 32 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action out instructions in a consistent manner. This is to ensure unnecessary risks to health and safety of residents are so far as possible eliminated. 4 9 13 All medication must be given 08/03/2010 only as prescribed, at the correct time of day and at the correct time with relation to food and drink. This is to ensure that people receive their medicines correctly and that they work properly. 5 9 13 There must be full risk assessments in place for residents who chose to look after and administer some or all of their medication. This is to ensure risks are minimised and staff are able to support people to use their medicines safely. 6 9 13 There must be a robust system of auditing the storage, administration and recording of medicines within the home. This is to ensure the manager can check that medicines are being handled 08/03/2010 08/03/2010 Care Homes for Older People Page 33 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action appropriately and take action to improve where weaknesses, mistakes and/or discrepancies are noticed. 7 9 13 Controlled Drugs must be stored in a Controlled Drugs cabinet that meets current legislation. This is to ensure that these potent medicines are stored safely. 8 9 13 Medication must only be administered by appropriately trained, competent staff. This is to reduce the risks of mistakes happening. 9 9 13 There must be clear, accurate records of all medicines received, administered and disposed of by the service. This is to ensure that medicines are given properly. 10 9 13 The medication administration records must list all currently prescribed medicines (including creams, dressings, insulin etc). 08/03/2010 08/03/2010 08/03/2010 08/03/2010 Care Homes for Older People Page 34 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to ensure that medicines are given properly. 11 10 12 The service must be conducted in a way that respects the privacy and dignity of the residents. Staff must respect and understand the residents needs. This is to ensure the residents receive good quality care. 08/03/2010 12 12 16 The residents must be 08/03/2010 provided with a programme of activities which meets their needs and preferences. This is to ensure the residents live in a stimulating environment. Residents must be given 05/02/2010 appropriate and timely assistance to help them with drinks. This is to ensure the residents welfare is protected. 13 15 12 14 15 17 A record of meals served 08/03/2010 must be maintained for all residents living in the home. This is to ensure that each residents diet can be monitored and it can be demonstrated that the Care Homes for Older People Page 35 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action residents are served a varied and nutritious diet. 15 16 17 A record must be made of all 08/03/2010 complaints received by a resident or their representative. This is to ensure that all complaints are thoroughly investigated and action is taken as appropriate in order to resolve any concerns. All incidents resulting in 15/02/2010 harm to the residents must be reported under the established safeguarding procedures. This is to ensure the residents are fully protected. The premises must be kept 08/03/2010 in a good state of repair externally and internally. This includes ensuring that windows operate properly at all times. In order to ensure the dignity, comfort and safety of the residents. 18 25 16 Arrangements must be made to ensure the hot water and heating systems are operating properly. 08/03/2010 16 18 13 17 19 23 Care Homes for Older People Page 36 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure there is sufficient sufficient hot water and heating at all times. 19 30 18 All staff must complete specialist training courses including managing challenging behaviour and supporting people with a dementia in line with the needs of the residents. This is to ensure that the residents needs are met. 20 37 26 The Responsible Individual 08/03/2010 must make a monthly report of his unannounced visits to the home. This is to enable the Responsible Individual to demonstrate that he is monitoring the quality of the service provided and is aware of the standard of the premises and any problems or complaints. 21 38 37 The Commission must be 26/02/2010 notified without delay of any occurrence listed under Regulation 37, which includes any safeguarding alert. This is so the Commission can monitor events in the home and ensure such 26/02/2010 Care Homes for Older People Page 37 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action incidents are managed appropriately. 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 9 Medicines, including creams etc should not be stored in residents rooms unless risk assessments have been completed showing that this is safe. The maximum and minimum temperature of the medication fridges should be recorded daily to ensure that medication is stored at the correct temperature and does not spoil. An assessment of the bathroom facilities should be undertaken by a suitably qualified person for example an occupational therapist, to ensure the equipment is suitable to meet the needs of the residents. The annual development should be updated to include the work needed and carried out as part of the ongoing improvements to the service. This is to ensure the quality of the service is monitored. 2 9 3 22 4 33 Care Homes for Older People Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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