Inspection on 24/02/09 for The Wight House Care Home

This inspection was carried out on 24th February 2009.

CSCI 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Wight House Care Home 05/08/09

The Wight House Care Home 25/09/08

The Wight House Care Home 01/04/08

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Wight House Care Home 138 Portsmouth Road Lee on the Solent Hampshire PO13 9AE     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia Trim     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: The Wight House Care Home 138 Portsmouth Road Lee on the Solent Hampshire PO13 9AE 02392552291 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Wight House Care Ltd care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies 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: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP). Date of last inspection 2 5 0 9 2 0 0 8 12 12 0 Over 65 0 0 12 Care Homes for Older People Page 4 of 37 Brief description of the care home The Wight House was an existing service purchased by and registered to new providers on 2nd October 2007. The home provides care and accommodation to 12 older persons who may have dementia or mental health needs. Accommodation comprises 10 bedrooms on two floors. Two rooms are capable of accommodating 2 people who use services, but these are predominantly used as single rooms unless people express a wish to share. There is a stair lift to help people reach the first floor but there are a number of areas that need people to be able to walk up a few steps. Three bedrooms are located on the ground floor. There is a communal lounge and dining room on the ground floor and a small quiet room on the first floor. There is a small garden and patio area. The home is situated very near the seafront, with views of the sea. Local shops and amenities are a short walk away. The current fees, as given by the manager, are from 335.00 pounds to 655.00 pounds per week. 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 information used to write this report was obtained in the following ways. We looked to see if we had received any complaints about the home and saw that we had not. We also looked at any information the home had given us about what might have happened since we visited. We used some of the information the provider gave us about the home in a form called the Annual Quality Assurance Assessment (AQAA). This is a form the home has to fill out every year to tell us what they are doing to make sure the home gives the people who have used the service the care that they want. We also used information we received from surveys. We sent surveys to eight people who use the service to ask what they thought about it. We received four surveys back. Care Homes for Older People Page 6 of 37 We also sent six staff surveys to the home and asked them to give them to staff. We received four surveys back. The home was visited twice by one inspector to carry out a key unannounced inspection. This took a total of 10.5 hours to complete. During the visit time was spent talking with three of the people who use the service to get their views about it. Time was also spent observing staff practice and the interactions between people who use the service and staff. There was also an opportunity to get the views of two members of staff who worked in the home. A tour of the environment was carried out and a random selection of documents was viewed. Five people who use the service were case tracked. This means their records were looked at to see how the provider identified their needs and made sure they were met. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 37 240 7535. Care Homes for Older People Page 9 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service do not have up to date information about the service they receive. An assessment of need, completed before someone moves into the home, means people who use services will only be offered a place if the service can meet their identified needs. Evidence: A requirement was made at the last inspection, that the Statement of Purpose must be updated to reflect the changes in management since the Wight House Care Limited became the owners of the service in October 2007. The providers were also required to give an updated copy to every person using the service. Although the manager has been sent a copy to amend, this has not yet been returned to the registered person to print and give to people who use the service. The manager did not have a copy of the service users guide. Care Homes for Older People Page 11 of 37 Evidence: People who use the service have a contract that gives them information about which room they will have, what the weekly charge will be and what is not included. However, the contract has not been amended since the new providers took over and does not have the correct name of the provider on it. People who use the service need to be given revised contracts that tells them who they are contracting with. No-one new had moved to the home since the last inspection, so there were no new assessments to view. The last person admitted to the home had been assessed using a more detailed format than had previously been used. If this tool is consistently used the manager will be able to gather sufficient detail to enable her to make a judgement as to whether the service can meet the persons identified needs. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans enable staff to provide personal care in a way that respects peoples rights to privacy and dignity but relevant risk assessments are also needed if the risks to people who use the service are to be minimised. People who use the service have good access to health care professionals. Staff have training in medication management but their competency to manage medication safely needs to be assessed if the risks to people who use the service are to be minimised. Evidence: The manager is replacing existing care plans with a detailed description of each persons daily routine and preferences. These give staff information on how each person likes to receive their care. They also identify what the person is able to do for themselves and how staff should offer support when needed. However, these describe the whole daily routine and would not make it easy for staff to find out how to support a person with a specific task such as bathing. The manager said she was trying to introduce a more structured care planning Care Homes for Older People Page 13 of 37 Evidence: system, as at present, current records are mixed with previous ones. Some records are undated and it is not easy to identify the most up to date information. Some care plans contained detailed information about what help someone needed. For example, one plan identified that the person liked to have a strip wash each day and could manage this independently. However, other plans were very brief and did not give staff the guidance they needed to consistently provide care the the way the person liked it. People spoken with did not think they had been asked what support they thought they needed, or had been involved in reviewing their care plans. There was no evidence they had been consulted about their care needs. There was evidence that the service works well with other health care professionals to meet the needs of the people who use the service. People who used the service said they were able to see their doctor when they wished and some said they were visited regularly by the district nurse. Daily records showed referrals were made to a wide range of health care professionals such as chiropodists, community psychiatric nurses and continence advisors. The primary health care team were visiting regularly to monitor and support people with health care needs. The use of risk assessment to identify and manage potential risks is inconsistent, so staff have guidance on how manage some risks but not others. For example, one person was identified as having skin problems. The problem was monitored, with appropriate action being taken as the risk increased. However there was no risk assessment or plan on how to support another person manage their diabetes. Some of the people who use the service have mental health needs. There were no risk assessments or plans about their needs or how staff should support them. However, staff were able to describe the needs of these people and explained how they supported them, but this information must be written down to ensure peoples needs can be consistently met. People who use the service felt staff treated them with dignity and respect. Four people commented in surveys that staff always listened to them and acted on what they said. They said staff always knocked on their doors before entering and staff were observed doing this. They felt staff offered support where it was needed, but let them do what they could for themselves. One person commented staff are not overpowering. They let me do what I can, but offer help. A persons preferred name of address is recorded in their files and staff were heard using these names when Care Homes for Older People Page 14 of 37 Evidence: speaking to the person. The homes policy and procedure for managing medication has not been reviewed by the management since the new organisation took over the service. The manager has a certificate evidencing she has completed medication training and said she was attending a training session for managers the following week. She stated that only staff who had completed medication training were permitted to assist with medication. Two staff stated they did not assist with medication as they had not had training. Three other staff had training certificates to evidence they had completed a distance learning course. They confirmed they did give out medication. There was no record in their files to demonstrate they had been assessed as competent to give out medication. The manager was observed giving out medication at lunchtime. Medication was given out following best practice guidance and records signed in accordance with Royal Pharmaceutical guidelines. The records for one person who uses the service were checked against the stock of medication held and found to be correct. All records had been signed to evidence the morning medication had been given out. The majority of medication is supplied in a monitored dosage system. A record is kept of medication received into the home and any returned to the pharmacist. It was noted that some changes to the medication administration record had been written in by hand. The manager explained this was due to instructions received from the health care team and daily records supported this statement. She was advised that if possible she should ask the person ordering the changes to sign the medication administration record to evidence this. If this was not possible, she should get another member of staff to sign and witness the changes she made. Medication is stored in a locked cupboard, but additional supplies are kept in a locked cupboard in the kitchen, which is not used just for medication. This is not acceptable practice as the temperature may be too hot at times and other people need to access the cupboard for reasons not related to medication. The providers purchased a new medication cabinet after the inspection carried out on 1st April 2008, but this has still not been fitted. The home is regularly required to refrigerate a medication. This is kept appropriately but consideration should be given to supplying a separate storage facility that can be kept locked so people who use the service do not have access to it. If the medication continues to be stored as at present, a risk assessment needs to be completed to show that people who use the service are not at risk. Care Homes for Older People Page 15 of 37 Evidence: The manager said that at present, no-one was managing their own medication, but the service would support someone wishing to do so. One person managed part of their medication needs, supported by staff. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about how they spend their time. Some activities are provided that provide mental stimulation and that people enjoy. However, people who use the service would benefit from the opportunity to join in more activities that they have been involved in choosing. The service offers a well balanced diet that gives people choice about what they eat. Evidence: The manager is updating care plans to include information about peoples preferred daily routines. For example, the morning routine records whether they like a cup of tea before getting up, prefer their breakfast before or after getting dressed and whether they like to rest in their rooms after lunch. People who use the service felt they were able to make choices about their daily routines. They said they could get up and go to bed when they wanted. They could join in or spend time in their rooms. During the visit to the home, people were seen moving freely around the home. Some liked to rest in their rooms, or watch television there, whilst others preferred to spend time in the lounge, reading, listening to music or chatting to each other and staff. Care Homes for Older People Page 17 of 37 Evidence: The home has a small library with some large print books, which some people were seen using. Others had a newspaper delivered. Some people have their hair done by the hairdresser who comes the home fortnightly, whilst others prefer to visit their hairdresser or have their hair done by their family. People who use the service felt they were offered more activities than they used to be but would sometimes like more. One person felt they would like to be able to do some gentle exercise, whilst another missed the chance to take part in quizzes. This had been provided by someone visiting the home on a monthly basis, but no longer happened. Another person said she would like more to do, but was unable to say what she wanted. Staff spend some time each afternoon providing activities such as bingo or indoor bowling and people said they enjoyed these sessions. They were seen joining in or watching others doing so and people who use the service and staff showed enjoyment of the time spent together. The AQAA identified that changes had been made to introduce daily activities. The manager wanted to introduce more 1 to 1 support so staff could help each person to do the things they wanted to. The manager said she was trying to introduce resident meetings, so activities could be planned based on what people said they wanted. One meeting had taken place, but there were no minutes and people spoken with could not remember what was discussed. People who use the service said the manager and staff had worked hard to give them a good Christmas. They had been visited by a local choir and had the opportunity to go to a pantomime. The home is not visited by any religious representatives. The manager said no-one currently living in the home had expressed any spiritual needs and no-one spoken with said they wished to have contact. People who use the service thought the meals provided were good and that they had choice. Comments included Im finicky and dont always want a main meal. I can always have something else. The home has a four week menu plan to ensure a balanced diet is provided. The main Care Homes for Older People Page 18 of 37 Evidence: meal for the first day of the visit comprised toad in the hole, with potatoes and two vegetables. On the second day it was cottage pie, carrots and cabbage. A record is kept of the choices made and this showed several people choosing alternatives such as omlettes. The evening meal on the 24th February was changed so that staff could cook pancakes with the people who use the service, as it was Shrove Tuesday. Several people needed to monitor their sugar intake. The cook said this was done by monitoring portion size or providing puddings made with sugar substitute. There was an ample supply of fresh, frozen and dried goods. The cook said the manager does an on line order each week from a local supermarket as well as placing a weekly order with a greengrocer. 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. The complaints procedure is out of date and does not contain the information people who use the service need if they are to be able to raise issues with the provider. Staff have training in respect of safeguarding but need a policy and procedure that provides up to date guidance if they are to be confident they have the information they need to minimise the risk of abuse. Evidence: Following a requirement made at the last inspection, the complaints procedure had been amended in the statement of purpose but as stated in section 1 of this report, this had not yet been given to the people who use the service. This gives them information about the current provider. The complaints procedure displayed in the entrance hall in standard print size has updated contact information about the commission but does not give a name or address for the registered provider. It tells complainants to address their concerns to the proprietor or the manager. The requirement made at the last inspection had not been met. Three people who use the service told us they did not know who currently owned the home, although one person said he had spoken to a gentleman but had not had a conversation with him. However, those people spoken with and those who returned survey forms all felt they could raise issues with the manager and were sure she Care Homes for Older People Page 20 of 37 Evidence: would try to resolve their concerns. No complaints had been recorded since the providers took over the home and none had been received by the commission. A requirement was made following an inspection in April 2008 that all staff must have training in respect of safeguarding. A random selection of staff records seen at the next inspection in September 2008 showed that training had been given. At this inspection all staff records were viewed and it was noted that 3 staff did not have a certificate to show they had attended this training. A new member of staff had attended a training course and the manager said another course was being arranged for a second new member of staff. She was advised to make sure all staff training in respect of safeguarding was up to date. The AQAA did not record whether the safeguarding policy and procedure had been reviewed since the new providers took over. The manager said she did not think any policies or procedures had been reviewed. The homes copy of Hampshire Adult Services Safeguarding policy and procedure was out of date and the need to get a new one was discussed. The manager said she would contact Adult Services to get one as soon as possible. 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. The continued failure to comply with fire safety regulations puts the people who use the service at risk. A programme of renovation is required if people who use the service are to live in a comfortable, well maintained environment. Evidence: The environment is showing signs of wear and tear. The enamel has worn off hand rails, walls and ceilings are stained and the hall carpet is very stained. Coving in the main lounge has come away from the ceiling, which staff said was due to a leak coming in from the roof above. Wallpaper was peeling from the ceiling in the upstairs hallway. The paving slabs outside the home had moss growing between them and was uneven in places. Wooden benches that people could sit on were showing signs of rot. Gutters had moss growing in them and the front door was sticking so that staff were having difficulty opening it to admit visitors. A wooden fence to the rear of the property had collapsed and parts of it were lying on the ground. A requirement to repair the downstairs toilet had not been met and the wooden panel was stained. It was noted that the lids of two toilet cisterns had come loose. This is unpleasant for the people who use the service. Hot water temperatures were not being monitored and there was no evidence thermostatic control valves were being serviced. Care Homes for Older People Page 22 of 37 Evidence: Additional heaters were being used in the lounge and in one bedroom, as the manager said people had not found the heating sufficient during the cold period recently experienced. No risk assessment had been completed in respect of their use. The environmental risk assessment had not been reviewed since the previous providers left. The manager said she was not aware of this assessment. A requirement was made following the last inspection that the service must comply with the requirements made by Hampshire Fire and Rescue Service. Work had begun to meet one of the requirements but would not be completed within the given timescale and no action had been taken to meet others. The majority of bedrooms are well furnished, but people who use the service are not provided with lockable storage. The keys to their rooms are kept on hooks above the door, which cannot be reached by some people. The dining room is used to store the majority of the homes records in a filing cabinet in the corner. The medicine cupboard is also kept there. Although there is room for eight people to sit at the table, the need for staff to use the cabinets limits peoples access to the room. The dining room is also used for staff handovers, record keeping and storage of staff personal items. In the improvement plan submitted by the providers after the inspection of 1st April 2008, they promised to provide suitable office space by building one in the garden. This has not yet been implemented. The home had a recent food hygiene inspection which was satisfactory. The manager said requirements made had been met and fridge and freezer temperatures were now being recorded. The home has a small laundry, attached to the kitchen. It has a washing machine with a programme for managing soiled laundry and a tumble dryer. The walls have mould growing on them, which staff said was caused by condensation, as the tumble dryer is not vented. The providers stated in their improvement plan that they were going to renovate the laundry, but this work has not started yet. People who use the service said the home was always clean and fresh. The home employs a part time cleaner Monday to Friday, who cleans every room in the home each day they work. The manager said there was a cleaning schedule but this was no longer followed and there was no record that any part of the home was deep cleaned Care Homes for Older People Page 23 of 37 Evidence: on a regular basis. Some parts of the home were found not to be cleaned sufficiently. Two bedrooms have an unpleasant smell. The manager said the cleaning staff took action on a daily basis to minimise the odour and people who used the service did not comment about the smell. However, at the inspection of 1st April 2008, when the issue of the odour was raised with the area manager, he stated the carpets would be replaced immediately with an easily cleaned covering. This has not been done. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The employment procedure ensures the risk to people who use the service is minimised. A system to monitor the induction, training and supervision of staff needs to be introduced to enable staff to develop and maintain the skills they need to support people who use the service. Evidence: People who use the service said staff were attentive to their needs and answered calls for help promptly. Staff were observed answering call bells quickly throughout the day. Those staff spoken with felt there were usually enough staff on duty to provide the support needed to people who use the service. The normal staffing levels are two staff on duty throughout the day and evening, with one waking and one sleeping staff covering the nights. As stated in other sections of this report, a cook is employed to provide the main meal and a cleaner works in the home Monday to Friday mornings so staff are free to provide care during these times. At the previous inspection it was noted the manager had sometimes to work as care staff to fill staff vacancies. This time the manager said two new staff had recently been employed to fill two vacancies and she was currently trying to recruit bank staff to provide cover for sickness and leave. However, she was providing waking night cover due to sickness on the first day of the visit. Care Homes for Older People Page 25 of 37 Evidence: The home has a recruitment procedure and the files of two new staff were viewed to see if the relevant checks had been completed. Both staff had been required to complete an application form, provide references and apply for Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks before beginning work. Feedback from staff surveys and information obtained during the visits, showed staff thought the recruitment procedure was thorough and fair. Feedback from staff surveys showed two staff thought their induction was thorough, whilst one thought it mostly covered what they needed to know. One new member of staff was completing an induction record which showed what was covered during the first few weeks of work. This person said she had been able to shadow experienced members of staff, before being observed giving care herself. Records showed she had been monitored during her induction. There was no record for the second new member of staff, but the manager said a similar record had been completed, which the person in question had with her. Certificates in staff files showed last year they were able to attend mandatory training courses and had, in the past, completed training relevant to the needs of the people using the service, such as dementia. The manager had a training matrix to enable her to monitor training needs, but this needed to be updated to identify training needs for the coming year, as some staff records showed they needed refresher training. The manager said she did not have a training budget, so had to ask the providers for any course she wished to book. The AQAA recorded that two staff had a National Vocational Qualification (NVQ) whilst seven staff were completing it. The manager was one of the two staff with the qualification. Several staff confirmed they were completing their NVQ whilst one new staff said she was registering to start it shortly. Care Homes for Older People Page 26 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. The providers are failing to monitor service provision to make sure it is fit for purpose and meets the needs of the people who use it. They are also failing to provide ways for people who use the service to give feedback about the service they receive. The health and safety of people who use the service is compromised by the failure of the providers to comply with fire safety regulations or to monitor other possible areas of risk. Evidence: The home has been without a registered manager since January 2008. In the improvement plan sent to us on 1st July 2008, the responsible individual informed us it was proposed that, after a probationary period of 3 months, an application to register the current manager would be submitted. At the time of the visit, the application still had not been received and the manager was unsure whether she still wished to apply for registration. The current manager has limited management skills and has not had the training she needs to be able to manage the home. She was completing a Registered Managers Award, but the course was suspended and she has Care Homes for Older People Page 27 of 37 Evidence: not been supported by the provider to find an alternative. In the AQAA she stated she feels she needs more support from the company to enable her to do her job. The AQAA was completed by the manager with no imput from the responsible individual. It was brief and gave us very little information about the service. There was no information about how the providers planned to improve the service. During the period the home has been without a registered manager, the providers have failed to support staff or to monitor the day to day running of the home. The Statement of Purpose states various systems which ensure close monitoring maintains all of the homes services and procedures. Quality assurance audits are carried out on a four weekly basis and are action planned. These cover individual care plans, medication, cleaning and kitchen. There is no evidence that this monitoring is taking place. A requirement was made following the inspection visit of 1st April 2008, that the provider must make arrangements for a monthly visit to be made by a representative of the organisation. This is called a Regulation 26 visit. The responsible individual, in the improvement plan, made a commitment that these visits would be carried out. At the next inspection visit on 25th September 2008, a visit had been made by the responsible individual and a copy of the report the visit generated was sent to the commission. On the visits made on 24th and 26th February 2009, no subsequent reports were available and the visitors book recorded only two visits made by the providers. The only copy of any reports resulting from the visits was one for a visit made in January. This report contained no evidence that the responsible individual had monitored the environment or spoken to any of the people who use the service to ask their views on the service provided. Throughout this report it has been identified that there are no systems in place to monitor the day to day running of the home. The provider is failing to implement a system to:Monitor and review records. Monitor the environment and develop a plan for its renovation. Provide, update and monitor the environmental risk assessment. Care Homes for Older People Page 28 of 37 Evidence: Update the fire risk assessment. Monitor and plan on going staff training and to provide a training budget to do so. Plan and carry out regular staff supervision. Enable people who use the service to give feedback about it. Provide regular support to the manager and staff. Last year the providers failed to pay the bed fees due to the commission within the given timescale. This year they have again failed to pay the bed fees by the due date. This matter is being dealt with as a separate issue to this report. Some people who use the service choose to manage their own money, but some like the manager to look after small sums on their behalf. Records of income and expenditure are kept, and people who use the service sign the record to show they have made a withdrawal. The records have not been audited by the providers. Receipts of any expenditure are kept, but there is no system for auditing these. At the last inspection visit, it was noted the current storage facility for keeping the money safe was not suitable. It was also noted that due to the location, people using the service who wished to withdraw money could not do so in a way that promoted their privacy and dignity. No change to the storage facility had been made. The AQAA recorded that the manager wanted to re-introduce regular supervision. One staff survey recorded the person had regular supervision, but staff supervision records showed no formal supervision sessions had been recorded since August 2008. The new member of staff had received supervision as part of the induction programme. The manager stated that she had not had training in how to give staff supervision. As stated in the previous section of this report, the staff training matrix needed to be updated. The majority of staff had received mandatory training, but training certificates showed that several needed refresher training in moving and handling and not all staff had completed infection control training or food hygiene. Following a requirement made at the last inspection visit, staff fire safety training was arranged for November 2008. Records showed that some staff were not able to attend this training and no further sessions had been booked. New staff had received basic fire induction training. Arrangements must be made to ensure that all staff have sufficient training to enable them to take appropriate action in the event of a fire. Care Homes for Older People Page 29 of 37 Evidence: The AQAA provided a list of dates for when equipment was last serviced. A range of certificates and service contracts were viewed which confirmed equipment had been recently serviced. During the visits to the home, it was noted that cleaning products were being stored in an unlocked cupboard after the cleaner had finished with them. The manager said she would have a lock fitted to the cupboard immediately to prevent any risk to people who use the service. Care Homes for Older People Page 30 of 37 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 19 23 The damaged toilet in the ground floor bathroom must be repaired or replaced This is to provide a comfortable environment for the people who use the service. 01/01/2009 Care Homes for Older People Page 31 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 registered person must give every person who uses the service an up to date copy of the Statement of Purpose so they have up to date information about the service they receive. 30/06/2009 2 8 12 The registered person must 30/06/2009 ensure a care plan, completed from information obtained in the assessment, is put in place for the mental health needs of people who use the service so that staff have the guidance they need to manage and support the individuals mental health needs. 3 8 13 The registered person must ensure that where a risk to the persons health care needs is identified an assessment is completed 30/06/2009 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 that identifies the risk and gives clear guidance on how it should be minimised. The risk assessment must be kept under review. This is so all staff know what the risk is and how it needs to be managed to minise it. 4 9 13 The registered person must ensure all medication is stored in accordance with the requirements of the Medicines Act 1973, guidelines from the Royal Pharmaceutical Society and the Misuse of Drugs Act 1971 so that it is kept in a way that maintains its efficacy. 5 16 22 The registered person must ensure a revised copy of the complaints procedure is given to every person who uses the service so they have the information they need to make a complaint. 6 19 23 The registered person must comply with the Regulatory Reform (Fire Safety) Order 2005 and any requirements made by the Fire Officer. 30/06/2009 30/06/2009 30/06/2009 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 To ensure the safety of people who use the service. 7 19 23 The registered person must introduce a system to monitor the environment, together with an action plan to renovate and redecorate the home. This is so people who use the service may live in a safe, comfortable environment that meets their needs. 8 26 23 The registered person must ensure that all parts of the home are regularly cleaned. This is to ensure people who use the service live in a clean environment where the risk of infection is minimised. 9 31 8 The provider must make 30/06/2009 arrangements for an application to be submitted to the Commission for Social Care Inspection for the registration of a manager so the day to day running of the home can be managed. 10 33 26 The registered person must arrange for a monthly visit to be made to the home by the registered person or 30/06/2009 30/06/2009 30/06/2009 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 their representative in accordance with this regulation and a report of this visit must be available at the home at all times. This is to demonstrate the registered person is monitoring the service. 11 35 23 The registered person must arrange for secure facilities to be provided for the safe keeping of money and valuables held on behalf of people who use the service. This is so they can be confident their money and valuables will be looked after by the service. 12 38 24 The registered person must 30/06/2009 establish and maintain a system to review the quality of care at the home in consultation with people who use the service and their representatives This is to ensure the home is well run for the benefit of people who use the service. 13 38 13 The registered person must 30/06/2009 ensure the risk assessment for the environment is updated and includes the use of free standing heaters, uncovered radiators, the 30/06/2009 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 temperatures of hot water outlets. This is to make sure environmental risks to people who use the service are minimised. 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 You should consider providing a separate refridgerator for the safe storage of medication that needs to be stored in this way. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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