Inspection on 11/11/08 for Time Court

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Time Court 02/08/06

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Time Court Woodlands Terrace London SE7 8DD     The quality rating for this care home is:   one star adequate 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: Sean Healy     Date: 1 1 1 1 2 0 0 8 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 36 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Time Court Woodlands Terrace London SE7 8DD 02083018080 02083018099 timecourt.admin@sanctuary-housing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sanctuary Care Ltd care home 56 Number of places (if applicable): Under 65 Over 65 56 0 old age, not falling within any other category physical disability Additional conditions: 0 56 The maximum number of service users who can be accommodated is: 56 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical Disability Code PD Date of last inspection Brief description of the care home Time Court first opened on 28th June 2004 and was one of three new Neighbourhood Resource Centres operated by Ashley Homes and replaced four homes previously operated by the London Borough of Greenwich for older persons. Since then the role of registered provider has changed and Sanctuary Care Ltd are the registered provider. The home is situated in Charlton and provides nursing care for 20 service users; 10 on Capella unit, and a further 10 in the category of intermediate care on Ross unit. This unit provides a specialist rehabilitative service prior to final discharge back into the community, residents having either been admitted from the community or direct from hospital. A further 36 service users are within the category of conventional care for older persons and are accommodated over three other units; Ursa, Orion and Carina. Care Homes for Older People Page 4 of 36 Brief description of the care home Within this 36, one placement is for emergency admissions and two placements for respite carer breaks. The home also operates a Day Centre in a dedicated part of the building and is generally well provided for in terms of communal facilities for service users including dining areas, hairdressing facilities and numerous quiet areas and transport for outings for service users. Meetings for residents and relatives are held on a regular basis and a League of Friends for the home has been set up. The email address for the home is timecourt.admin@sanctuary-housing.co.uk Care Homes for Older People Page 5 of 36 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: one star adequate 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 last key inspection for this home took place on the 2nd August 2006. The quality Rating for this service is 1 Star. This means that the people who use this service experience adequate quality outcomes. The inspection was unannounced and took place as a visit to the home on the 11th and 12th of November 2008. It ended on 14/11/08 following the receipt of information regarding residents protection. (Safeguarding) The home provided an Annual Quality Audit Assessment (AQAA) which was also used to inform the inspection. The registered care manager facilitated the visit supported by Care Homes for Older People Page 6 of 36 the deputy manager and Regional Manager. The inspection was supported by an Expert by Experience who interviewed 11 residents about their care and observed staff supporting them. Two care staff had discussion with me about their employment and understanding of their job. Two supervisors and the deputy manager and activities coordinator also were interviewed. Three care staff responded to the CSCI inspection survey. Six staff employment files were examined to check whether they had been properly recruited, trained and supervised. Three separate relatives of residents contributed their views of the home. Two other residents and three relatives discussed their views on the home with me and five other residents responded to inspection surveys. Nine residents files were examined including assessments and care plans. Comments were also received from three healthcare professionals and social services. Safeguarding adults information was also included. The inspection involved a tour of the premises and examination of a range of management documentation. What the care home does well: What has improved since the last inspection? What they could do better: The care staff on the intermediate care unit need to be given adequate information about residents care needs especially regarding how to safely support them in a way that they can most easily understand. Written and verbal communications between these staff and the healthcare professionals such as occupational therapists also needs to be improved. Residents care plans need to be reviewed each month and residents and families should be invited to contribute their views on these plans. Care Homes for Older People Page 8 of 36 The recording of medication given to residents by staff needs to be improved and residents who can should be supported to manage their own medication. The management need to check whether there are enough staff on the intermediate care unit to provide the support needed and make sure they are responding to requests from residents for support particularly at night. Care staff induction and training needs to be improved so that all staff have been fully informed about their job and responsibilities. All staff supervisors need to have up to date training in some areas such as risk assessment and protection of residents to better lead and supervise care staff. Care staff must receive supervision more often at least every two months so that they always fully understand what is expected of them. 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.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 9 of 36 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 36 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate information is provided for residents about the home and their care needs are assessed before they move in. Wtitten and verbal communications between care staff and healthcare professionals needs to be improved. Evidence: There were two requirements made at the last inspection regarding making necessary inclusions in the homes Statement of Purpose about details of ownership of the home and about ensuring that all residents be given a copy of this document. Both of these requirements are now met. There is an up to date Statement of Purpose and Service Users Guide which includes these details and which has been given to residents. The owners are Sanctuary Care and three residents confirmed having received this information. Care Homes for Older People Page 11 of 36 Evidence: A requirement made at the last inspection to include nursing care in contracts for residents was met. The homes management confirmed that all residents with the possible exception of those on the Intermediate Care Unit are issued with a Statement of Terms and conditions outlining their care and support and the fees charged by the home for their care. I saw copies of these on residents files I examined. The reason may be that the residents in this unit are given a substantial amount of support from the Rapid Response Team and they are given this information by them about the professional support they can expect. However the home provides staff support and accommodation and must provide complete information about the service and accommodation they can expect and the cost of these including who is responsible for payment of fees. It is not clear whether this information is currently provided to residents in the intermediate care unit and it is recommended that the home check this out and identify whether any residents in this unit need to have this information given to them. (Refer to Recommendation OP2) All 9 residents care files examined showed that they had been assessed regarding their care needs. Standard 6: In the Intermediate Care Unit the Rapid Response Team health professionals that attend daily write their notes in brief or in shorthand. This is not adequate for care staff who are not trained nurses. They need more detailed written guidance i.e. regarding individual behavioural support issues including what residents can do for themselvesand what they need support with and how to provide this. Risk Assessments and guidance for staff need to be reviewed monthly by the home. (see also Standard 9) Speaking to a Health Care professional I was informed that there had been problems getting up to date information from the home for weekly reviews. From some comments received it appears that not all care staff are comfortable giving information to Health Care professionals. Better written and verbal communication is needed between the care staff and health care professionals. The manager is addressing this but work needs to be done to ensure that care staff on the intermediate care unit communicate well with the health care professionals both in writing and verbally, and to help them to fully understand directions regarding care and support written in these plans by healthcare professionals. (Refer to Requirement OP6) There appears to be instances when admissions to the Intermediate Care Unit where the home feel they may not receive all the information they need to adequately inform their staff due to the speed at which the admission happens. The manager and other professionals involved at the home have discussed this and it is hoped that these sorts of admissions can be avoided, and the manager said this would be discussed with Care Homes for Older People Page 12 of 36 Evidence: relevant referral agencies and will ensure that adequate information is always available on admission. Care Homes for Older People Page 13 of 36 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are well set out in care plans but care plans and risk assessments are not consistently reviewed each month and more important information is needed. Health care needs are being met and medication is well managed bur residents are not fully assessed about self medication needs. Residents are generally treated in a respectful manner but there have been instances where residents have had concerns that some staff may hurry them or not have time to listen. Evidence: Two requirements made at the last inspection about care planning were met. Care plans now are up to date and include health welfare and social care needs of residents. Care plans for care of wounds include current information about the treatment regime and are discussed weekly for residents on the intermediate care unit and at least Care Homes for Older People Page 14 of 36 Evidence: monthly for all other residents. I examined care plans for 9 residents and found that all had a care plan based on their assessment of health and social care needs. All were up to comprehensive but a number were not reviewed on a monthly basis. Many included high levels of personal care support needs where areas of risk are assessed especially regarding moving and handling. The care plans themselves are usually comprehensive showing residents food preferences, preferred activities, health care needs and emotional support needs. The majority of residents have support needs in bathing, dressing and impaired vision. Support with the care of dementia mental health and continence care are also provided for a significant number of residents. There have been a number of safeguarding incidents involving residents falling particularly on the intermediate care unit. Discussion with the homes manager and three staff and with a number of health care professionals in the home showed that care plans and risk assessments about residents on the intermediate care unit are generated and written by health care professionals using abbreviated instruction and this may cause difficulty in care staff who are not clinically trained sometimes finding them difficult to understand. Health care professionals involved generally felt that the risk assessments were adequate and serve to protect residents when they receive support. Risk Assessments and guidance for staff regarding the management of risk must be fully understood by care staff who use them and must include some written guidance for staff in how to minimise risk to residents while also maintaining the residents independence in tasks they can do for themselves. These need to be reviewed monthly by the home. (Refer to Requirements OP7) The Home needs to be fully responsible in agreement with the Rapid Response Team for agreeing risk assessments. Given the short term support offered on the intermediate care unit the reviews of risk assessments should happen more often than every month. Not necessarily re-writing them but just clarifying and recording reviews and changes when they happen. (Refer to Recommendation OP7) Care plans do not consistently include end of life care needs or show that these have been discussed with residents. All long term residents need to have the opportunity to have their end of life care wishes discussed and included in their care plans. Where family or others are deemed to be in control of/responsible for all arrangements they should be clearly identified including their emergency contact details. (Refer to Requirement OP7) The home provides well for the health care needs of residents and employs nursing staff where residents require this level of care. This is mainly facilitated on the intermediate care unit where there is high level of involvement for occupational therapists and physiotherapists who work with staff in rehabilitation work for residents Care Homes for Older People Page 15 of 36 Evidence: in short term care. Access to community health care services is good, with weekly involvement from GPs and regular involvement from other healthcare professionals. The records seen indicated that residents had been assessed and reviewed by the GP, Optician, Tissue Viability Nurse and Care Managers and reviews undertaken for the provision of bedrails. On the Intermediate Care Unit staff were able to refer residents that were unwell to the medical diagnostic unit at the local hospital. This ensured that residents received prompt medical treatment. A number of healthcare professionals expressed a desire for improvement in the information provided by staff when requested regarding healthcare support needs of residents. This included an occupational therapist and a visiting GP. It is recommended that the home discuss this with staff and provide training where necessary to ensure that all staff responsible for liaising with healthcare professionals have the appropriate information to hand and provide it when needed. (Refer to Recommendation OP8) There was a requirement made at the last inspection for the home to medication management be improved in the following areas: temperature in the 1st floor medication room be maintained at 24 degrees centigrade, self medicating residents have risk assessments showing the support they need if any, handwritten MAR sheets to have two signatures and to be coompleted properly where no medication is given. All of these requirements were met. I inspected medication storage and records on two units. I found that there are gaps in the information recorded on MAR sheets regarding medication counts and quantities. There were also a number of times when medication given was not clearly recorded. The home must ensure that medication is always fully recorded on MAR sheets to include a correct count and that entries are always made and signed for when medication is given or missed or refused. (Refer to Requirement OP9) Currently none of the residents areself medicating and there is not a consistent means of assessment applied to identify residents who could possibly manage their own medication. The home must ensure that a process of assessing residents about their abilities and wishes regarding self medication is put in motion for current residents and that all new residents are assessed in this way at the point of admission to the home. (Refer to Requirement OP9) The Expert by Experience spoke with 11 residents about their experiences living at the home. Some of these residents were not able to give a clear response due to the nature of their support needs. The Expert commented that residents were well dressed and appeared to be generally well cared for. One resident told her she was quite happy with the care she received and another said that staff were generally very welcoming and pleasant. Another said it was the best place she had been and that staff were genuine and friendly. The Expert observed staff engaging in friendly conversation with Care Homes for Older People Page 16 of 36 Evidence: residents while supporting them to lunch and commented that they were respectful when helping with personal care sometimes using screens when necessary. However two residents commented on feeling very rished at bedtime and said the staff soemtimes seem too busy at night to listen properly and respond to requests for extra help with some personal issues. The homes management have already begun inplementation of higher levels of monitoring of night support provided and it is recommended that these comments be considered in this process and addressed with staff where needed. (Refer to Recommendation OP9) Care Homes for Older People Page 17 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with their lifestyle. They are supported to maintain contact with family and friends. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. Evidence: Residents care plans include a list of activities offered a daily basis which are recorded on a daily activities chart. This chart was examined and was consistently completed by staff. The home employs an activities coordinator whom I interviewed. Residents I spoke to confirmed that she sees them regularly and has asked them about activities they would like to be involved in. Activities include cinema, hairdressing, manicure reminiscence sessions story reading dancing shopping and outings twice a week on two buses provided by the home. There is a very good range of in house and community activities available and each resident has a written profile of the activities they like to take part. This is included in the homes assessment process. There is an activities room used for meetings with residents music bingo and for film evening each week. Care Homes for Older People Page 18 of 36 Evidence: Residents are supported by the home to have family and friends visit at reasonable hours and at nigh-time when they wish it. 11 residents spoke with the Expert by Experience and generally expressed a feeling that staff were able to support them in activities. On one occasion the TV was on too loud when discussion was taking place and when the staff realized that this was seriously affecting peoples ability to speak to each other they turned it down. Three residents said they had family who visit and also who take them out on a regular basis. One resident had not been out of his room in a number of months due to the nature of his disability and had involvement from the physiotherapist to improve his mobility to enable him to be more active in his personal care and in getting around the home. It is recommended that the homes management monitor progress on this as this resident expressed a strong desire to do so. (Refer to Recommendation OP12) Residents are able to entertain visitors in their rooms and there are also other communal areas where they can meet. Three family members I spoke with said that they always receive a welcome when they visit the home and they feel that they can visit at any time. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. The support needed is included in their care plans. The home provides a wholesome and nutritious diet for residents and offers a choice of food on a daily basis. All residents whom I spoke with said that the food is good and they are offered a choice every day. Residents also said this to the Expert by Experience with one saying that the food is very good with plenty of choice available. Food eaten is recorded and written menus are maintained. The kitchen was clean and tidy. I looked at records of food provided and sampled a meal and found that the food was wholesome and well presented. The Expert by Experience observed that drinks were served with meals but did not observe residents being offered drinks at any other time during her visit. It is recommended that the homes management check whether residents are regularly offered drinks and whether they can request or get one whenever they wish. (Refer to Recommendation OP15) Care Homes for Older People Page 19 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory systems are in place to manage complaints and the protection of vulnerable adults. However residents have not been consistently protected by staff in moving and handling practices. Evidence: The homes complaints policy was last reviewed in 2007. This policy adequately shows how complaints are to be managed, and residents have been given a copy. Five residents confirmed this. The registered manager is at the home on a daily basis and residents commented that she is available to speak with them whenever they need to. There have been 11 complaints made since last inspection and these have been fully investigated by the management and records kept. The Statement of Purpose includes a summary of complaints policy and all of staff had received training in how to deal with complaints. Records showed that complaints had been well managed and the majority of residents said they felt able to make a complaint if they needed to. The home has a written policy and procedure in relation to Adult Protection which was reviewed in 2007. There have been seven allegations of possible neglect referred to Greenwich safeguarding team since the last inspection. Three of these concerned one Care Homes for Older People Page 20 of 36 Evidence: previous resident either falling and suffering injury as a result or being left unattended when in need of support. All were reported properly to the boroughs safeguarding team and to CQC and were the subject of a number of safeguarding meetings coordinated by social services and including a range of care professionals involved in the home. The home management acted appropriately in reporting and in intervening and took appropriate action against the staff involved. It was identified that the monitoring and supervision of night staff needed to be improved as the majority of incidents occurred at night. The homes management have taken steps to address this issue and are making more unannounced night visits. There have been some problems in providing consistent formal supervision for night staff and this needs to be addressed to ensure consistent care is provided. (See requirement Standard 36) Two staff interviewed had a good awareness of adult protection and how to manage an allegation or suspicion of abuse but it is the case that not all staff supervisors have had up to date training in safeguarding. (Refer to Requirement OP30) Care Homes for Older People Page 21 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-maintained environment. The home was clean, pleasant and hygienic. Evidence: A high standard of cleanliness is maintained throughout the home. Cleaning staff were assigned to work in specific units so were able to establish good working relationships with staff and residents and felt part of the team. Cleaning supplies were readily available and the home had equipment that enabled staff to wash carpets treat stains and manage spillages promptly. Hand washing facilities were provided for staff and residents. Equipment to assist and promote residents wellbeing and comfort is provided. This included pressure relief mattresses and cushions profile beds hoists raised toilet seats grab rails and standing aids. All of the equipment provided was in working order and maintained in accordance with the required schedule. The home is modern and has good natural light. It is well maintained and decorated throughout. There is a maintenance plan in place and separate maintenance staff are Care Homes for Older People Page 22 of 36 Evidence: employed by the registered provider to keep the environment well maintained and well decorated. Residents bedrooms and bathrooms are suitable for their care needs and are comfortable and well decorated. Care Homes for Older People Page 23 of 36 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff meets residents needs but they cannot yet be said to be in safe hands at all times. Residents are fully protected by the homes recruitment practices but records of formal induction are not adequate. Staff are trained and competent to do their jobs but training plans for individual staff need improvement. Evidence: There was a requirement made at the last inspection for the home to ensure that agreed staffing levels be adhered to. This was specifically in relation to the nurse in charge who was working across two of the homes units instead of just one. This has now been rectified and there is a nurse in charge for each unit from 8am to 8pm. There has been a change in shift patterns for all care staff resulting in the residential unit now not having a formal handover period. Some concerns were expressed that this did not easily facilitate good communications regarding residents care issues although there are systems in place for provision of written handovers. It is recommended that the changes in shift patterns be discussed with staff to gain a sense of practical concerns and consider any issues arising. (Refer to Recommendation Care Homes for Older People Page 24 of 36 Evidence: OP27) Comments from some residents suggest that evening and night staff on the intermediate care unit may be rushed or very busy and not have time to respond to their requests. Comments received from other sources suggest that there may not be enough time for night staff to be provided with formal supervision at night. It is also the case that a number of safeguarding issues of concern have occurred at night on this unit. There were also concerns expressed that staff do not always follw healthcare professionals guidance for supporting residents and that information for review meetings is not always available on time. The homes management must conduct an analysis of staff on the intermediate care unit to determine whether any increase in staffing levels are needed to provide for residents care and any management and supervision activities necessary. (Refer to Requirement OP27) 35 full time and 34 part time care staff are employed across all units in the home. There are also 14 bank workers listed as available to work at the home. There are seperate ancillary staff for cooking cleaning and facilitating repairs and maintenence. More than 80 of care staff are qualified to NVQ level 2/3 which is a good level of qualified staff. There has been a high level of staff turnover over the past 12 months and the homes manager is aware of this and is working to improve retention of staff through improving supervision and teamwork within the home. Recruitment policies and procedures are in place. Six employee personnel files were viewed. These were generally well kept and included all of the information required by regulation. However one staff member was working in a role she had been transferred to within the home but did not have a job description or employment contract reflecting her current role. It is recommended that the homes management review this and determine whether a new job description and contract are appropriate. (Refer to Recommendation OP29) The home has an induction schedule in place which is in line with the Skills for Care requirements and Nursing staff employed are registered with the Nursing and Midwifery Council. Discussion with a number of staff and the homes manager and examination of six staff employment files showed that while staff have been provided with foundation training and information they need to understand residents care needs a number of staff who have been employed for six months had not yet completed the induction paperwork to show they had a full induction. The homes management must ensure that all staff employed in the past 12 months have completed the homes induction process fully and that there is a complete record of having done this on their files at the home (Refer to Requirement OP30) Care Homes for Older People Page 25 of 36 Evidence: The homes management are responsible for the induction of staff and there are materials and documentation available to do this adequately. Formal ongoing training is provided Greenwich local authority and other training is contracted by the provider when necessary. There is a training matrix showing the training staff have had and training planned and a training curriculum is produced twice annually for staff to be booked on. The training listed is suitable for the assessed needs of residents and is comprehensive. However care staff supervisors had not all had training in the following areas Safeguarding - Adults Risk Assessment - Care Planning and Staff Supervision. The homes management must ensure that all care staff supervisors and RGNs are scheduled to have this training. (Refer to Requirement OP30) Records of care staff training and interviews with staff showed that not all care staff have yet had stand alone safeguarding adults training. The homes management must ensure that all care and nursing staff employed have had or are scheduled to have this training. (Refer to Requirement OP30) Care Homes for Older People Page 26 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an experienced and committed manager but accountability for staff supervision is currently not adequate. The home is run in the best interests of residents. Residents financial interests are safeguarded health safety and welfare of staff and residents are promoted and protected. Evidence: The previous manager left employment a year ago and since then there was an acting manager who has been replaced in the past 6 months by the current manager. As a result there has been a gap in leadership in the home which the appointment of the current manager has begun to address. The new manager is experienced and has an NVQ4 in care. She is currently completing Care Homes for Older People Page 27 of 36 Evidence: the Registered Managers Award. She has previous experience of managing a large home for people with similar care needs and is supported by a deputy manager who is a qualified nurse and is responsible for the supervision of nursing staff in the home. Feeedback from residents and families - care staff and healthcare professionals during this inspection showed that the manager is highly respected and has over recent months done much to put in place systems for supporting the changes needed to ensure the home provides well for the care of residents and support of staff. It is agreed there is still more improvements needed and this is evidenced in a range of areas throughout this report. For example the staff supervisors and RGNS responsible for a range of management duties have training needs in areas such as safeguarding adults and staff supervision whcih need to be addressed to provide sound management and support for care staff. (See Standard 30 requirement in this report) The regional manager for the provider now visits the home at least weekly and has become involved in providing hands on support and advice and in attending management meetings. There is a system for quality assurance in place involving conducting residents satisfaction surveys - monthly management monitoring visits and monthly residents meetings. the majority of residents said that they feel they can easily speak with the manager if they need to and that they feel safe and cared for. However there is not yet a formal single annual quality audit system in place to take an overarching view of the full range of systems for residents care and staff support and there is not a single annual development plan for directing and prioratising the areas for development. The manager and provider have a range of ways of gathering the information needed for such a system which need to be pulled together to demonstrate a robust quality assurance is in operation. This will be further checked at the next inspection. All residents finances are managed by the residents themselves or by their families. Small amounts of money are given to the home for personal spending and this is recorded and receipts are kept. The home is not responsile for any residents bank accounts or benefits. Discussion with the maanger and deputy manager and with supervisors and care staff showed that formal staff supervision is not happening 6 times a year as is required. This was bourne out when I examined staff supervision records. There are adeqaute numbers of care supervisors and nursing staff who have responsibility for staff supervision. In another area of this report it was discussed that there is a need particularly to improve the supervision and monitoring of night staff. Overall staff say that they now feel supported by the homes management but the homes management must ensure that all staff receive formal recorded supervision at least 6 times a year and that records of these are available for inspection. (Refer to Requirement OP36) Care Homes for Older People Page 28 of 36 Evidence: All health and safety documentation and procedures were inspected and found to be in order. The risk assessments for residents need to be reviewed monthly and staff supervisors need to be trained in risk assesment. (See requirements Standard 7 and 30 in this report) Care Homes for Older People Page 29 of 36 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 36 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 6 12 The registered provider and manager must ensure that care staff on the intermediate care unit communicate well with the health care professionals both in writing and verbally, and to help them to fully understand directions regarding care and support written in care plans by healthcare professionals. This is to ensure that residents care needs are met and that healthcare professionals involved receive the information they need. 10/11/2009 2 7 13 The registered provider and manager must ensure that risk assessments and guidance for staff regarding the management of risk be fully understood by care staff who use them and must include some written guidance for staff in how to 10/11/2009 Care Homes for Older People Page 31 of 36 minimise risk to residents while also maintaining the residents independence in tasks they can do for themselves. This is to protect residents and to ensure they are independent where possible 3 7 13 The registered provider and manager must ensure that risk assessments and care plans for residents are reviewed monthly This is to ensure residents are protected and supported appropriately 4 7 15 The registered provider and 10/11/2009 manager must ensure that work is in progress so that all long term residents have the opportunity to have their end of life care wishes discussed and included in their care plans. This is to allow residents to contribute to end of life care plans in a dignified and timely manner 5 9 13 The registered provider and 10/11/2009 manager must ensure that staff responsible for the management and administration of residents medication act in accrodance with the providers medication policy and in doing so ensure that medication records are always completed and 10/11/2009 Care Homes for Older People Page 32 of 36 signed for appropriately as discussed in this report. This is to protect the health and wellbeing of residents 6 9 13 The registered provider and 10/11/2009 manager must ensure that a process of assessing residents abilities and wishes regarding self medication is put in motion for current residents and that all new residents are assessed at the point of admission to the home. This is to promote independence for residence in the management of their medication 7 27 18 The registered provider and manager must conduct an analysis of staff on the intermediate care unit to determine whether any increase in staffing levels are needed to provide for residents care and any management and supervision activities necessary. This is to ensure that enough staff are available for the benefit of residents health and welfare 8 30 13 The registered provider and manager must ensure that all care and nursing staff have had or are scheduled to have stand alone training in safeguarding adults 10/11/2009 10/11/2009 Care Homes for Older People Page 33 of 36 This is to protect the health and welfare of residents 9 30 18 The registered provider and manager must ensure that all care staff employed over the past 12 months have completed the homes induction process fully and that there is a complete record of having done this on their files at the home This is to ensure that care staff are qualified and competent to provide care for residents 10 30 18 The registered provider and 10/11/2009 manager must ensure that all care staff supervisors and RGNs be scheduled for training in the areas listed under standard 30 of this report This is to ensure that care staff receive appropriate support and direction from the homes management regarding their responsibilities for care planning and protection of residents 11 36 18 The registered provider and 10/11/2009 manager must ensure that all staff receive formal recorded supervision at least 6 times a year and that records of these are available for inspection. This is to ensure that staff are fully aware of their 10/11/2009 Care Homes for Older People Page 34 of 36 responsibilities and provide safe and competent support for residents Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The registered provider and manager should check whether all of the residents on the intermediate care unit are provided with a full description of their terms and conditions as discussed in this report and facilitate provision of this information where necessary. The registered provider and manager should consider a simple means of reviewing risk assessments for residents on the intermediate care unit more often than monthly to meet the residents changing support needs. The registered provider and manager should discuss with staff and provide training where necessary to ensure that all staff responsible for liaising with healthcare professionals have the appropriate information to hand and provide it when needed. The registered provider and manager should consider residents comments regarding feeling rushed and staff being too busy to respond to their requests as discussed in this report and include in discussion with night staff. The registered provider and manager should monitor the progress of one resident who wishes to be more mobile and leave his room on a regular basis and facilitate this if possible The registered provider and manager should check whether residents are able to access additional drinks and beverages whenever they wish and that they are being routinely offered to residents who cannot easily express their needs The registered provider and manager should discuss the effects of the changes in shift patterns with staff to gain a sense of practical concerns and consider any issues arising. The registered provider and manager should review the job description and employment contract for one employee as discussed in this report and determine whether any amendments or additions to these documents are needed. 2 7 3 8 4 9 5 12 6 15 7 27 8 29 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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