Inspection on 11/05/10 for The Whispers Care Home

This inspection was carried out on 11th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Whispers Care Home 11/09/09

The Whispers Care Home 12/09/08

The Whispers Care Home 27/03/08

The Whispers Care Home 30/10/07

The Whispers Care Home 11/05/06

The Whispers Care Home 20/03/06

The Whispers Care Home 05/01/06

The Whispers Care Home 09/06/05

The Whispers Care Home 16/02/05

The Whispers Care Home 21/06/04

The Whispers Care Home 16/03/04

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Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for older people Name: Address: The Whispers Care Home 30 Rambler Lane Langley Slough Berks SL3 7RR     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 Willis     Date: 1 1 0 5 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 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: The Whispers Care Home 30 Rambler Lane Langley Slough Berks SL3 7RR 01753527300 01753527300 hyaremoni@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Mohanjit K Hyare Name of registered manager (if applicable) Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 21 The registered person may provide the following category of service only: Care home only (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 (OP). Dementia (DE) Date of last inspection Brief description of the care home The Whispers is a small independently owned residential home for 21 service users situated in a quiet cul de sac off the A4 Bath Road linking Slough and Langley. This home is a converted domestic house, which still retains some of the original structural and decor embellishments when built and is set in a moderate sized garden Care Homes for Older People Page 4 of 37 Over 65 0 21 9 0 Brief description of the care home encompassed by large residential properties. The fees charged range from GBP420 to GBP500 per week and include basic hotel costs of staffing, meals, drinks, laundry and accommodation. Additional charges are made for hairdressing and chiropody. Care Homes for Older People Page 5 of 37 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: The unannounced key inspection was carried out over two visits, the first visit was undertaken by Julie Willis and Janet Shipman, regulatory inspectors on 11 May 2010 with a duration of approximately nine and half hours and the second follow up visit was carried out by Janet Shipman and Wendy Hughes on 25 May 2010, with a duration of three and half hours. The inspection took place in response to concerns expressed by the Local Authority following a serious incident that occurred at the home, when a service user newly admitted to the Home on respite died. Following the first of the visits to the Home, concerns were such that Sue Sheath, Compliance Manager, met with the provider and made urgent requirements which we felt were necessary to ensure the welfare of the service users in the immediate term. These were detailed in a letter. The purpose of the second visit was to check compliance with those requirements. This was the first inspection of the home since an additional condition was added to the registration, allowing the Home to accommodate Care Homes for Older People Page 6 of 37 up to nine people with dementia, and increasing the number of places to 21 by adding five rooms on the top floor. On the day of the first inspection visit, there were twelve service users accommodated in the Home, five people on the ground floor, four service users on first floor dementia unit and three people on the second floor. On the second visit, only ten people were accommodated, six on the ground floor and four in the dementia unit. The inspection was a thorough look at how well the service was meeting standards and regulations. It took into account detailed information provided by the service in the AQAA Annual Quality Assurance Assessment and any information that the CQC has received about the service since the last inspection, which took place on 11th September 2009. Prior to the visit, surveys and comment cards were sent to the home for distribution to service users and staff. The five replies were used to help form judgements about the service. Additionally the inspectors spoke to one relative on the day of inspection and received feedback about the quality of service on offer at the home. At the time of both inspection visits, the manager was not present. The inspectors gave feedback about their findings to the proprietor Mrs Hyare at the end of each visit, and spoke of their particular concerns over the health and welfare of the service users with dementia. There are eighteen legal requirements made as a result of this inspection. It is the intention of the Commission to take enforcement action in respect of the care of the people who have dementia. The Commission has received information concerning three safeguarding matters since the last inspection. Two matters have been resolved and one matter is currently under investigation. The Local Authority has held safeguarding meetings, which were ongoing at the time of this inspection, and they had also provided staff to the Home to monitor the welfare of the service users. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The registered provider and manager must improve the pre assessment process to ensure that information is gathered from all key services prior to admitting a service user to the Home. This is to ensure that the registered persons are able to make an informed judgement about whether they can meet the needs of the individual, and to ensure that they have the necessary plans in place to meet any identifiable risks. The registered persons must ensure that they have detailed care plans and risk assessments in place to meet the identified needs of people with diabetes. At the first visit, it was found that staff did not have the skills and knowledge to care for people with diabetes, nor to recognise the signs and symptoms of hypoglycemia or hyperglycemia, and know what to do in an emergency. Care practices in general need to be based on autonomy and choice rather than being task orientated, offering little choice and flexibility. Residents who have dementia and present a challenge to the service must have detailed risk assessments and risk management plans in place to enable staff to respond to the individual appropriately. There were many shortfalls in the environment. The dementia unit, which is located on the first floor, does not reflect any national best practice for providing a good quality environment for people with dementia. For example, the decor has no contrasting colours to enable people to distinguish between walls and doors and there are no landmarks within the environment to assist people to find their way around the unit. The bedrooms have no distinguishing features to enable residents to locate their own room and there are no signs for residents to understand what the different rooms are within the unit. Care Homes for Older People Page 8 of 37 The use of the dementia unit dining room should be reviewed to ensure that it meets the needs of residents, as it is small. At the time of the inspection visits there were only four residents, and if the service were full there would not be enough room round the small square tables for all the residents to sit comfortably. All call bells need to be accessible. Ensuite toilets should be fitted with doors that can be opened and closed easily by the service users. All bedrooms except one in the dementia unit have sliding patio doors, with no opening windows. As a result there was no ventilation in the bedrooms and the dementia unit felt very stuffy and uncomfortable. In the second floor rooms, ventilation is through the velux windows which can only be opened an inch or two. In one bedroom there is no window at all, only a locked glazed door, therefore no ventilation is possible in this room. The registered provider must review the ventilation on these two floors and take appropriate action to ensure enough ventilation is provided in residents bedrooms. At the time of the second visit, no one was occupying rooms on the second floor. The registered persons must improve the outcomes for people with dementia in their day to day living, by ensuring that service users are offered a range of meaningful activities based on their wishes and aspirations and suited to their needs. People living in the dementia unit must be provided with activities that are age appropriate, and not books or toys that are intended for pre school children. The registered persons must ensure that the garden area is made safe and suitable for all the service users living in the Home in order for people to access the garden area when they choose. The garden needs to meet the specific needs of people with dementia and be an enabling and safe environment for people to explore. The top floor bedrooms require suitable locks to be fitted to the bedroom doors. This was a requirement of the registration of this floor and the registered provider said that suitable locks would be fitted. People living on the second floor have their freedom restricted, as they have to rely on staff to assist them down and up in the platform lift. This lift is not easy to use as it has a push button which needs to be held until the lift reaches the floor level. Once inside, the person would need to hold the toggle switch down until the lift arrived at the required floor, and if they take their hand off the toggle switch the lift will stop, which can be between floors. Therefore people occupying the second floor should have Deprivation of Liberty assessments. The laundry has makeshift flooring put down, which is not impermeable so as to prevent cross infection. The wash hand basin must be accessible to staff. The kitchen requires cleaning and the fridge and freezer need repair. The use of the two tier trolley to transport food to the first and second floors should be reviewed in consultation with Environmental Health. The heated trolley in the first floor dining room needs replacement. The menu must be reviewed to ensure that it provides a variety of healthy, nutritious foods suited to the needs of residents. The registered person must ensure that the menus are changed on a regular basis and provide a choice of meals. There should be more home cooked meals and less reliance on shop bought foods. The menu should be provided to residents in a format that suits their capabilities. The registered person Care Homes for Older People Page 9 of 37 must review the way in which some staff assist residents, to ensure that, when offering assistance to residents, this is done in a discreet and sensitive way. The registered persons must ensure that there are sufficient numbers of staff deployed on each floor throughout the home to meet the needs of all service users, in particular the needs of people with dementia. The staffing numbers of three staff on shift evidenced at the inspection visit on 11 May were inadequate and put service users at risk of harm through not having their specific needs met. An urgent requirement was made, and at the time of the second visit, the staffing levels were improved. The staff recruitment processes must be more robust to ensure residents are not put at risk. The staff induction should be in accordance with Skills for Care guidance. Training records should be more detailed and kept on file. All staff should receive training in dementia, diabetes and safeguarding and should have regular supervision and appraisal to support them in their work role. An urgent requirement was made regarding training staff about diabetes, and at the time of the second visit, all staff except one had received training. The management of health and safety requires review to ensure that the home is free from hazards to service users safety. The building is in need of investment to bring it up to good standard. The registered provider must visit the Home at least once month to monitor the conduct of the Home, actively seeking the views of users and other stakeholders. A report on each visit must be produced, and this must be shared with the manager. Please see text of report for further detail. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 37 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 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 Statement of Purpose and Service User Guides do not provide an accurate picture of the environment. This could be misleading for residents. The care needs of users are not fully evaluated and risk assessed posing a significant risk to users. Evidence: From examination of documentation it is clear that the home provides information to prospective users about the aims, objectives, philosophy of care, services and facilities at the home. There is however, a need to review the Statement of Purpose and Service User Guides description of the environment, to accurately reflect that some of the windows on the top floor have limited views through standing height velux Care Homes for Older People Page 12 of 37 Evidence: windows and the limited access to the upper floors. The proprietor said that all potential residents and their carers are shown the rooms available and may choose the room they wish to occupy. It is evident from examination of six care files that an assessment of need is carried out for prospective residents. The assessment is carried out in the persons own home or in hospital, and information is gathered from the main care giver and other sources. However, there is limited detail about the needs of some service users, and little or no consideration of the specialist care that a person might need whilst resident. In the case of three people with diabetes there were no risk assessments or care plans relating to this health care need. It is clear that the pre admission process does not consider fully if the home can successfully meet individual need. The result is to provide a poor quality service to residents through a lack of knowledge and untrained staff. Care Homes for Older People Page 13 of 37 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. 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. Poor quality care and unsafe practices put residents at risk. Evidence: Six care plans were examined. It was not clear if there had been any consultation with residents in planning their care, as there was little written evidence to support this. Residents input was not apparent anywhere in the care plans. The plans gave basic information about care and support needed by individuals. There were risk assessments concerning risk of falls, manual handling, pressure area care and nutrition. However, there were no risk assessments for diabetic care and no guidelines for managing behaviours that may at times challenge the service. The bathing risk assessments omitted the risk of scalding and one resident had no risk assessment or consent form in relation to the use of bedrails, despite their use on the persons bed. Care Homes for Older People Page 14 of 37 Evidence: In room 15, the bed had two mattresses, the top one being a ripple mattress which was connected to a socket, and the bottom one was a pressure reducing mattress. Advice must be sought from a tissue viability nurse with regard to the appropriate use of pressure relieving mattresses. The inspectors were informed that there were three people living in the home who had diabetes, including one person who was insulin dependent. In regard to special diet, the inspectors were told by the proprietor that people with diabetes were provided with low sugar custard, cheesecake and Angel Delight. These may not be suitable for the needs of the individual. Staff, when questioned on the first visit, had received no training on this aspect of care and were unaware of the implications of potentially life threatening signs and symptoms of hypo or hyperglycemia. At the time of the second visit, the proprietor had complied with an urgent requirement, and all but one of the staff had received training in relation to diabetes. Likewise, little consideration has been given to the skills, ability and knowledge that staff will need when caring for individuals with dementia. Care practice was observed that put service users at risk. Staff when questioned said they had not received the training they needed to provide the right care. Parts of the care plans were incomplete, and did not demonstrate that the wishes and needs of people had been sought. In the case of one service user, the interests section said none and spiritual needs said nothing special. The personal care section said not able to express and cross gender care section said unable to state a preference. The risk assessment for one user said that the user should be supervised in their wheelchair at all times and not to be left alone. This individual was found in the dining room at lunchtime tipped backward in their wheelchair against the kitchen unit and had to be assisted to safety by the inspectors. During lunch, challenging behaviours were being exhibited in the first floor dining room by one of the residents. On examination of the persons file, there was an unevaluated risk assessment for challenging behaviours, which failed to quantify the risk. There were no guidelines in place for effective management of the behaviours. There was no reference to good practice guidance for working with people with dementia on the dementia unit. There were no meaningful activities taking place and Care Homes for Older People Page 15 of 37 Evidence: activity materials were not age appropriate. When questioned, staff said that they had only had a distance learning course in dementia care and two staff said they felt they needed more training. Staffing levels on the dementia unit were inadequate at busy periods during the first visit. At lunchtime, a staff member was observed to wait twelve minutes before being assisted with a hoist. At the time of the second visit, the proprietor had complied with an urgent requirement made by the Commission, and the level of staffing had increased. Poor practice was observed over lunch. A member of staff talked inappropriately and in a derogatory manner over a service users head when answering an inspectors question. The carer stood at the side of the resident whilst trying to feed them. The resident appeared very agitated and displayed some challenging behaviours towards the member of staff. The situation was only calmed when another carer intervened. The medication round was observed and medication storage examined. Medication records were up to date and accurately recorded and there were no gaps on the MAR charts. The administration was undertaken appropriately. However there was evidence that medication had not always been administered by people competent to do so. As a consequence, a requirement was made that medication be administered by a competent person on each shift, identified on the rota, At the second visit, it was found that Mrs Hyare had complied with this requirement. There is a need to ensure that the temperature of the locked room where medication is stored is kept at a safe temperature. On the first day of inspection, sun was shining through the window increasing the temperature in the room to an unacceptable level. At the second visit, inspectors found a tablet on a bedroom floor, which appeared to have been spat out. This was discussed with the provider, who said that staff had been told to make sure the service user took the tablet. However, nothing was found in the care plan in relation to this. Some instructions in relation to medication were written on Post It notes and stuck to the relevant pages, and were not secure. This is not safe practice. Charts from the medication administration folder were found to be falling out of the file. Care Homes for Older People Page 16 of 37 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. 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. Little consideration is given to enabling residents to express their choices in relation to everyday living. Activities are minimal and not age appropriate. Staff were observed to refer to people with dementia without respect. The food provided to residents is variable in quality. There are no food choices provided to people on the dementia unit. The dining room is cramped and institutional. Evidence: During both visits there were no meaningful activities taking place anywhere in the home. On the first floor the television was on all day. A staff member, when questioned, said that she had been looking at books with the residents earlier. All except one of the books were inappropriate for the age of the service users, and in the main they were pre-school books. There were a number of soft toys and dolls for users to engage with. At the second visit service users had colouring books, while a member of staff sat in the room, engaging little with people. Care Homes for Older People Page 17 of 37 Evidence: One resident was alone on the top floor at the first visit. There did not appear to be any staff presence on the floor except at mealtimes. Lunch was observed on all three floors. Tables on the ground floor were appropriately set with tablecloths and cutlery. The mealtime seemed quite relaxed and unhurried. The lady on the top floor was given her meal on a tray. At the first visit, four residents were sat around two tables in the first floor dining room for people with dementia. They had been sitting at the tables for a lengthy period of time. One resident had tipped her wheelchair backward so that it was on two wheels and resting against the kitchen unit. This user was assisted to safety by the inspectors. This dining room was cramped for four residents. When questioned about what happened when there were more residents, the staff member said the three walking go downstairs and the more troublesome stay upstairs. There was no cutlery, crockery, condiments, mats or tablecloths on the wooden tables. When challenged about the lack of equipment, the staff member said residents were given cutlery for their meal. The staff member could not say what was for lunch and when asked if there was a menu, the carer said no. The carer said the starter was always soup and they knew what people want. There was no choice offered. The food was bought up from the kitchen on an unheated two tier trolley which was dirty and unhygienic. A broken and dilapidated hot trolley had been plugged into a socket in the dining room. Staff took out several meals and put them inside the trolley. The food trays were missing from the top of the trolley and the sliding doors were broken, so that heat escaped. The inside of the trolley was very dirty and unhygienic, with food debris on all internal surfaces. The lunch was tomato soup which was watery, followed by pre-cooked meat pie with potato and vegetables. None of the residents was offered a choice or told what they were eating. Several residents were observed to push the food away or drop it on the floor. One resident started to display challenging behaviours covering her hands with soup and throwing it across the table. The staff member did not sit next to her, to help her eat in a relaxed manner, but instead stood over her. Care Homes for Older People Page 18 of 37 Evidence: The carer was asked if the user would have preferred to drink soup from a cup. The carer responded by saying that the resident was demented and aggressive. The resident became more agitated and unsettled during the mealtime calling the staff member names and attempting to scratch and push her away. The atmosphere in the dining room was tense and strained throughout the whole of the lunch time period at the first visit. Care Homes for Older People Page 19 of 37 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. 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 complaints procedure needs clarifying for residents and their relatives, so that people can express their views effectively, about the quality of the service. Not all staff have received training in safeguarding, which poses a risk to users of the service Evidence: There is a need to review the complaints policy to ensure that it meets the needs of standard and regulation. There were two different copies of the Homes complaints procedure at the home. One had been updated, but the second copy did not provide details of the timescales for resolution of a complaint. Examination of the complaints records indicated that only one complaint had been received since the last inspection. The complaint was appropriately documented and the outcome had been recorded. The home has a copy of the inter agency strategy for safeguarding adults. There have been three safeguarding matters investigated since the last inspection. Two have been fully resolved and the third is currently under investigation. There is a need to ensure that all staff have received safeguarding training. Records Care Homes for Older People Page 20 of 37 Evidence: and discussion with the Proprietor confirm that nine members of the staff have received safeguarding training in November & December 2009 and six staff are waiting to go on a training course. Care Homes for Older People Page 21 of 37 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. 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 environment is not conducive to people with dementia and does not follow best practice guidelines. The home was not clean and hygienic which could pose a risk of cross infection. Evidence: Since the last inspection the first floor of the home has become a unit for people who have dementia. Most of the bedrooms on this floor have large sliding glass doors. Due to a recent serious incident, Environmental Health have required that the doors are fitted with restrictors. This has been accomplished by fitting wooden blocks to the runners to prevent the doors opening beyond a safe distance. However, at the time of inspection, all the doors were locked shut, which did not allow any ventilation in the rooms at all. This area smelled strongly of urine. The proprietor has developed the dementia unit with no reference to best practice guidance. There are no colour contrasts or landmarks to aid orientation; nor is there personalisation of rooms and doors to aid recognition. Furnishings in the unit were old and worn. En-suite bathrooms had dilapidated vanity units and the entire unit required Care Homes for Older People Page 22 of 37 Evidence: redecoration. Several mattresses and much of the bedding needed replacement. Many of the wardrobes and dressing table units had chips and cracks in the fascias. Several rooms had hooks on the walls but no pictures. Several rooms had call bell cords missing. A number of the bedrooms had pull switch light fittings. The light cords were tied around hooks attached to the ceiling which posed a risk to residents. In one room, the overhead light was approximately two feet from the pillows, which did not appear to be a safe distance and could be hazardous to the occupant of the room. All of the lights were fitted with low wattage or low energy bulbs, which gave insufficient light for users with visual impairment or for reading. There were few bedside lamps, and shades were broken. The light fitting on the ceiling in room 16 had been moved exposing the wiring. The en-suite toilets had bi-fold doors. Several were difficult to open, and one was not able to be closed. The radiator cover in the corridor between rooms 15 and 16 was loose and needed repair. With one exception, the bedrooms on this floor are fitted with sliding glass doors to the outside, opening onto a Juliette balcony, but with no opening windows. Following a recent incident restrictors have been fitted to the doors. However, this arrangement does not allow for adequate ventilation in the bedrooms and is therefore not suitable. The first floor dining room is furnished with a sink unit and two wooden tables surrounded by chairs. At lunchtime it was clear that the room is cramped when wheelchair users are seated. The room is carpeted which does not aid effective cleaning of the area. The lounge in the dementia unit has two televisions. When asked about it staff said one TV has a remote the other doesnt have one. The picture on the television in use at the time was unclear and grainy. The second floor was newly in use. The floor, with five bedrooms is accessed via a platform lift. The call button must be held continuously to summon the lift, and as such may not be suitable for use by older people. Once inside, a toggle switch must be held down the whole time the lift is in operation. The inspectors were informed by the proprietor that service users do not operate the lift alone and that staff are to accompany them to and from the top floor at all times. This could potentially restrict the movements of residents on the second floor as they are required to wait for staff to assist them. There were no Deprivation of Liberty assessments available for the residents on this floor despite the limits on their movements. There were two store rooms in the eaves of the home. Both were very cluttered and disorganised, with boxes of incontinence aids, old files and assorted equipment that Care Homes for Older People Page 23 of 37 Evidence: could pose a risk to staff should they need to access them. One of the rooms had a bed made up with duvet and pillows. The room contained old equipment and furniture in addition to the bed. It was not clear if the room was being used as a sleep-in room as the proprietor was unaware where sleep-in staff actually slept. Four of the five rooms on the top floor have sloping ceilings and standing height velux windows, which do not provide a view for the occupants. As a consequence of a recent incident, these windows have been fitted with wooden blocks to restrict their opening. Rooms were equipped with a wardrobe, chest of drawers and bedside cabinet. One room had French doors that led onto a small balcony with railings. There was a plastic bag at the bottom of the doors to stop rain entering the room. The doors were locked closed with no alternative ventilation. None of the bedroom doors had locks fitted which was a requirement of registration. Mrs Hyare told inspectors she was trying to find suitable locks to fit that can be automatically overridden in case of emergency. The shower room on the second floor had not been cleaned properly since grouting. The inspectors were told by the proprietor that it is not used. Extra electrical sockets had been fitted in the bedrooms to meet the requirements of registration but the finishing of plasterwork was poorly completed. On the ground floor there was a large lounge and dining area which was spacious and light. Residents seemed very happy and content sitting in the area. Rooms were well personalised on the ground floor but a number were slightly malodorous and a number of the ceilings needed painting where they were water marked. Rooms 6 and 7 had ridges in the carpet which could pose a trip hazard for the occupant. The kitchen was seen. One freezer in the kitchen had a broken handle; the second had a door that was broken. The cooker, microwave and work surfaces were not clean at the time of inspection. The laundry is small and dark, and no light could be located by inspectors. Adjacent to the laundry is a small area with wash hand sink, which was difficult to access due to the size of the space and items on the floor. The sink in this area was dirty. The area was carpeted but was not clean and hygienic. The laundry itself had lino that only part fitted the floor which could pose a risk of cross infection. Care Homes for Older People Page 24 of 37 Evidence: Externally the home is in need of refurbishment. Paint was chipped and cracked. Windows throughout the home needed cleaning both inside and out. The garden provides a poor environment for the service users. There is limited access, and the area itself is not safe. A fence panel was down in the garden, giving access to another adjacent garden. There was a padlock on the garden gate which was unlocked. This could pose a significant risk to people with dementia, should they access the garden. There was a shed in the garden which was full of rubbish and in need of repair. The external emergency staircase goes to the first and second floors. There were no restrictions on the staircase which could be easily accessed. The staircase could pose a risk to people with dementia. The garden is uneven and has a raised patio area with tables and chairs. There was a ramp up to the area but no safety measures in place to prevent people from stepping off the edge of the patio. The gardens were not user friendly particularly for residents with dementia or wheelchair users. Care Homes for Older People Page 25 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 is no system in place to ensure sufficient staff are provided to meet the needs of the service users, and to take into account the layout of the building. There were gaps in the recruitment records that could put residents at risk. Evidence: At the time of the first visit, three carers worked on the morning shift and three in the afternoon. There was one waking and one sleep-in staff on duty at night. This was not sufficient to provide safe and effective care. No staff were seen on the top floor except at mealtimes. The lift from the first to the second floor requires a member of staff to assist residents with its operation. This could result in the movement being restricted at the busiest times of the day. There were insufficient staff on the dementia unit to provide support, particularly at times when users behaviours may challenge the service. Staff had to wait excessively long periods to be assisted with the use of the hoist. The layout of the home and the needs of the service users must be taken into account when organising the rota. As a result of the concerns highlighted at the first visit, Mrs Hyare was required to Care Homes for Older People Page 26 of 37 Evidence: provide a minimum staffing level of two care staff on each floor occupied by service users, plus one identified team leader with an NVQ qualification as a minimum for each day shift, and a minimum of 2 waking staff and 1 sleeping-in at night including a team leader as per the day shifts, At the second visit it was found that the top floor was now unoccupied. The staffing levels were in accordance with the rota supplied by Mrs Hyare. There were now two staff on each floor, with an identified team leader. The recruitment files for four of the staff were examined. There were a number of deficits including gaps in the employment records for two staff, lack of a second reference for one member of staff, visa discrepancies in one file and lack of evidence of induction and training in all four files. There was little evidence of regular supervision and appraisals taking place. Care Homes for Older People Page 27 of 37 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. 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. Lack of proper management monitoring systems at the home put users at risk. Evidence: At the time of inspection the registered manager was off sick and Mrs Hyare was managing the home on a day-to-day basis. A consultant is being employed to provide additional support to the home and has formulated an action plan to remedy shortfalls in the service. The action plan has been drawn up in response to concerns expressed by the Local Authority as a result of a recent serious incident resulting in a fatality. Examination of records indicated that Mrs Hyare has not undertaken visits to the Home under the provisions of regulation 26 since December 2009. The reports for October and November 2009 were not signed by the Provider. These visits should take place regularly to monitor the quality of services provided and the conduct and Care Homes for Older People Page 28 of 37 Evidence: operation of the home. The visits should record the views of residents and other stakeholders about the quality of service provided. A copy must be made available to the manager. The accident book was examined. There was a copy of the accident report that gave details of the recent serious incident. Some of the information however, was difficult to decipher. There is a need to improve the quality and scope of health and safety audits at the home to identify possible hazards in the environment as well as effective maintenance of equipment. A copy of the Fire Officers report was seen confirming that essential works had been undertaken on the dementia unit and had been completed to their satisfaction. Care Homes for Older People Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 37 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 1 4 The information in the 01/07/2010 Statement of Purpose and Service User Guides must be reviewed and updated to ensure they accurately reflect services and facilities provided. To ensure residents have accurate information about services and facilities provided 2 3 14 Have a system in place to ensure that a comprehensive needs assessment is undertaken prior to admission, which identifies all the individual care needs. To ensure service users needs are fully evaluated and that those identified needs can be met within the home. 01/07/2010 3 7 15 Ensure all care plans contain 01/07/2010 sufficient information to Page 31 of 37 Care Homes for Older People 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 enable staff to meet the identified needs of the service users. Service users must be involved in the planning of their care and their input is recorded. To ensure residents are provided with effective and safe care. 4 8 15 Review all care plans and update them so as to accurately reflect the needs of the service users, including health care needs of service users, including those with diabetes or dementia. Care plans must include risk assessment and risk reduction measures. To ensure that all residents are provided with safe effective care that meets their needs. 5 12 16 Have in place a programme of activities to ensure that residents have access to a range of activities suited to their assessed needs. To provide mental and physical stimulation. 01/07/2010 01/07/2010 Care Homes for Older People Page 32 of 37 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 6 14 16 Ensure residents are 01/07/2010 provided with a choice of wholesome and nutritious food in comfortable, hygienic surroundings. To ensure that residents have a choice of nutritious foodstuffs suited to their needs and preference 7 16 13 Ensure that all staff are 01/08/2010 trained in safeguarding adult procedures To protect residents from abuse and exploitation 8 16 22 Review the complaints procedure and update to ensure it meets the requirements of the regulation, and is clear to service users. To ensure residents and other stakeholders can express their concerns effectively 01/08/2010 9 19 23 Ensure that the dementia 02/08/2010 unit is developed in line with best practise guidance. To aid orientation and recognition for people with dementia Care Homes for Older People Page 33 of 37 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 10 20 23 Ensure that all areas of the home and gardens are maintained effectively and made safe. To ensure that all service users are able to safely use the garden 02/08/2010 11 24 23 Repair or replace all worn and damaged furniture, fixtures and fittings in the dementia unit. To provide residents in the dementia unit with a pleasant environment in which to live. 02/08/2010 12 24 23 Review all lighting in the 01/08/2010 Home and provide lighting levels which are safe and sufficiently bright to enable all service users to access the home safely, and to read in their rooms should they wish to. To ensure the comfort of service users. 13 24 23 Produce an action plan detailing how you are going to ensure that all rooms have ventilation suitable for service users as required by the occupant. To ensure the comfort of service users. 01/07/2010 Care Homes for Older People Page 34 of 37 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 14 26 16 Consult with the local environmental health authority regarding the laundry room and follow guidance given to ensure the risk of cross infection is minimised. To protect users from risk of cross infection 01/07/2010 15 27 18 Ensure all staff receive training in dementia care appropriate to their role. To ensure effective care and support is provided. 01/08/2010 16 27 18 Ensure that at all times 01/08/2010 there are sufficient numbers of staff on duty to effectively meet the needs of residents. To protects users from harm 17 29 19 Have in place a robust system for the recruitment of staff to ensure that all documentation required by regulation is available. To protect users from harm 01/07/2010 18 33 26 The Proprietor must carry out quality monitoring visits unannounced, at least once a month. The visits should seek the views of residents and other stakeholders about the quality of services provided. A report of the 01/07/2010 Care Homes for Older People Page 35 of 37 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 visit must be made, and a copy provided to the manager. To ensure that the service is monitored effectively. 19 38 13 Have a system in place for health and safety audits to include examining the fabric of the building for risks and hazards To protect residents from harm 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 01/07/2010 1 9 In consultation with appropriately qualified persons ensure that medication is stored at a safe temperature. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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