Inspection on 25/03/10 for Urmston Cottage

This inspection was carried out on 25th March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Urmston Cottage 19/01/10

Urmston Cottage 07/05/09

Urmston Cottage 08/09/08

Urmston Cottage 07/04/08

Urmston Cottage 14/11/07

Urmston Cottage 16/10/06

Urmston Cottage 17/03/06

Urmston Cottage 10/11/05

Urmston Cottage 23/09/04

Urmston Cottage 15/04/04

Urmston Cottage 21/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Urmston Cottage Greenfield Avenue Urmston Manchester M41 0XN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Bell     Date: 2 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Urmston Cottage Greenfield Avenue Urmston Manchester M41 0XN 01617473738 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Urmston Cottage (Mcr) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 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 anyother category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 45 Date of last inspection Brief description of the care home Urmston Cottage is an extended Victorian property offering care and accommodation with nursing support to 45 service users. There are several lounges and a dining area for service users communal use. Bedroom accommodation is on two floors and is for single and double occupancy. Some bedrooms have en-suite facilities. A passenger lift supports service users to reach all parts of the home. There are gardens to the rear of Care Homes for Older People Page 4 of 31 Over 65 45 0 0 45 Brief description of the care home the property, which are well used in fine weather and parking space is available to the side of the home. The home is near the centre of Urmston, close to a number of shops and market place. It is close to local bus routes and the Metrolink. Fees are dependant on assessed care needs and individual funding arrangements and details of these can be obtained by contacting the manager at the home. Care Homes for Older People Page 5 of 31 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: This was a key inspection, which included a site visit to the home by three inspectors. The visit was unannounced, which means that the manager was not told beforehand that we were coming to inspect. We received concerns in November 2009 about the quality of the service provided to people living in the home. These concerns were passed onto the local authority for investigation under their adult safeguarding procedures. This prompted a joint review of the care provided by the home by social services and the Primary Care Trust, the outcome of which raised further concerns. We then paid a visit to the home in January 2010 to look at specific standards relating to how the home was being managed. During this visit we assessed all the core standards. We spent time talking to people living in the home, one of the directors, the manager, deputy manager, care and nursing staff, domestic staff, the cook and activity co-ordinator. We also spoke to Care Homes for Older People Page 6 of 31 relatives of four people living in the home. An Annual Quality Assurance Assessment (AQAA) which is a self-assessment document had been completed and returned to us prior to our visit. We sent out 19 staff surveys and 10 surveys to people living in the home, although none of these had been returned at the time of writing this report. We also examined documents such as care plans, complaints and accidents records and a selection of policies and procedures during our visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 31 We found several areas of concern during this visit. The quality of care planning in place was found to be poor. The information in care plans was disorganised and repetitive. This did not provide an audit trail to clearly show that the plans were being followed to meet peoples assessed needs. We found two examples where individuals health had been compromised by qualified staff not following the advice given by health care professionals. Two relatives we spoke to also had concerns about staff not following care plans. These relatives also said that their complaints had not been addressed fully. Six people had received injuries while being transferred into their wheelchairs. Management had taken no action to address poor moving and handling practice with staff. We found management systems within the home to be poor. There was a lack of quality audits and a failure to address health and safety issues and staff practice within the supervision process. This had resulted in the health and welfare of several people living in the home being put at risk. Medicines record keeping needs to improve particularly for prescribed external preparations e.g. creams and for nutritional supplements to better support and evidence their correct use, as prescribed. Care needs to be taken to ensure that clear records of advice from healthcare professionals are made to help ensure that it is promptly and accurately acted upon. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. The admissions process does not always ensure that peoples care needs are properly assessed and people cannot be sure they will receive support according to their preferences. Evidence: We looked at the written information that is available to people using this service. It was provided in two documents; a Service User Guide and Statement of Purpose. Both documents provided good information about the services and facilities available, the procedure for expressing concerns and complaints and the terms and conditions for admission and residency in the home. Neither document was dated and we found some of the information to be out of date. For example the page containing details of the registered persons named a manager that had resigned in 2008. One of the directors told us that they were aware the documents needed to be reviewed and updated. We also recommended that pages are numbered and cross-referenced with the index. This will make it easier to find specific information. Care Homes for Older People Page 11 of 31 Evidence: We looked at the care records belonging to four people living in the home to find out if their needs had been thoroughly assessed prior to admission. Care manager assessments of need had been obtained for the four people. One person recently admitted had their needs assessed by a nurse before moving into the home. The form used for this required the assessor to highlight areas where the person needed support. It contained very little additional information to demonstrate that the person or his representative had been consulted about their preference for the manner in which their care and support was to be provided. Additionally, assessment information was incomplete. We spoke to a person who said that they had lost their partial set of dentures since moving into the home. The assessment did not record that this person had partial dentures and we found no evidence that a referral had been made to a dentist. Another persons assessment of personal care stated, needs help. This level of detail is insufficient to inform nursing and care staff of the support needed by individual people. Urmston Cottage does not offer an intermediate care service. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are not clearly identified and staff have no clear instructions about how they should be cared for. This places peoples health and safety at serious risk. Evidence: We looked at the care records belonging to 4 people living in the home. These care plans were disorganised, with no clear audit trail to track how staff were meeting peoples health and personal care needs. Monthly reviews were found to be repetitive and did not include significant events relating to changes in needs. Consequently the information in care plans and assessments of risk were out of date. For example, one of the care plans stated that barrier nursing was in place, although there was no evidence of this in the persons bedroom. One of the nurses told us that they had confirmation that the persons infection had cleared up. There was no written evidence of this. Of particular concern were instances of qualified staff not following advice given by health care professionals. In one example this failure to follow guidance had resulted Care Homes for Older People Page 13 of 31 Evidence: in a deterioration in the persons health requiring prolonged treatment. There was no evidence of a person-centred approach to care provision. Care plans did not detail individuals preferences for how they wanted their support to be provided. There was a lack of detailed guidance to inform staff what they needed to do to meet peoples needs. Two relatives told us they had expressed concerns that staff were not following peoples care plans. A relative also had observed the persons position in bed to be inconsistent with what staff had recorded in the turning chart. During our visit in January we made a requirement for all people using this service to have assessments and plans of care for managing oral health care. This had not been consistently addressed. Three of the four care records contained oral health care plans, although these did not adequately inform staff what they must do to meet that persons needs. During this visit we observed that staff talked to people in a respectful way and we saw staff respecting peoples privacy by knocking on toilet and bedroom doors before entering. People sharing bedrooms were afforded privacy by the provision of screens. However, we were concerned to be told by a relative that her husband had to wait varying amounts of time for staff support when he needed to use the toilet. A pharmacist inspector looked at medicines administration. Medicines were administered by staff who have completed certificated medicines training or to people resident for nursing care, by qualified nurses. We saw that arrangements were in place to help ensure that special label instructions such as before food were followed but we were concerned that because of the time taken to administer everyones morning medicines there was a risk that where doses of the same medicine were repeated throughout the day, they may be given too closely together. The times that medicines are administered should be monitored and changes made if needed, to ensure that medicines are given at the best and right times for people living at the home. We looked at a sample of medicines stocks and records. We found that the medicines administration records were generally clearly and accurately competed enabling medicines both in the monitored dosage system and in boxes and bottles to be accounted for (tracked). However, there were weaknesses in the arrangements for handling and administering prescribed external preparations e.g. creams and prescribed nutritional supplements. For example, we found that some creams kept in Care Homes for Older People Page 14 of 31 Evidence: peoples rooms were no longer listed on their current medicines record, some that were no longer needed and some that had no pharmacy label. We also found that records were not always completed by the person who had actually applied the cream so they cannot be relied upon as being accurate. We similarly found a lack of information about the use of supplements and some examples of poor record keeping that meant we could not always tell whether prescribed supplements were being used correctly. Some medicines have a limited life on opening. We were concerned to find that one limited life medicine had not been replaced on time and a second example where a new supply of eye drops had not been started on time. Care needs to be taken to ensure arrangements are made to reduce the risk that medicines with a limited life may be used for too long. We found that generally adequate stocks of medication were maintained without overstocking, but we saw occasional examples where doses were missed because there was none left to give. This was followed up by staff at the home, but re-ordering arrangement should be looked at to see if this could be addressed more promptly. We looked at how information within peoples care plans supported medicines administration. It was of concern that for one person we were unable to track and confirm as correct that a medicine marked as stopped the previous month should have re-started. Similarly, we saw that a second person was given two nutritional supplements instead of the one instructed on the label but we found no record of the advice given to increase its use. Clear records of dose changes and health care advice need to be made to reduce the risk of mistakes. We found that medicines including controlled drugs were stored securely. This helps to reduce the risk of miss-handling or miss-use. We saw that some creams were kept in peoples own rooms, these arrangements need to be assessed to ensure they are safe and secure. Regular audits (checks) were carried out. Consideration need to be given to the way these are carried out to help ensure they are effective in ensuring that should any weaknesses in medicines handling arise, they will be promptly addressed. The homes medicines policy was available for reference but it could be usefully reviewed to offer clearer guidance to staff about medicines handling at the home. Care Homes for Older People Page 15 of 31 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. People are provided with activities and a variety of home cooked food, which they enjoy. Evidence: We assessed the provision of activities for people living in the home. Urmston Cottage employed an activity co-ordinator who worked between 09:00 and 15:30 from Monday to Friday. She told us that people living in the home met with her every month to discuss the type of activities they would like to be provided. Their suggestions were incorporated into a monthly activity list, which had been posted on the homes noticeboard. This showed that people had opportunities to participate in a range of activities that provided stimulation and interest. The programme included exercise sessions, a weekly social visit to the Salvation Army centre, alternative therapies, such as Tai Chi and Reiki sessions and arts and crafts. We saw that people had made bonnets to celebrate Easter and a group of people were going out to the Salvation Army centre on the day of our visit. Two people told us that they enjoy socialising at the centre and look forward to this each week. Good records had been kept detailing the outcome of individuals involvement in activities. We asked the activity co-ordinator what was provided for people who were confined to Care Homes for Older People Page 16 of 31 Evidence: bed. She told us that more person-centred interactions were provided, such as hand massage, manicures and sitting talking to people. However, we were concerned that people confined to bed may not receive such interactions in a consistent manner. Over a 6-hour period we visited a frail person in their bedroom on four occasions, but did not see staff spending time with the person. We asked two members of staff if they ever had chance to just sit and hold a persons hand or sit and have a conversation with someone. Both staff said, No, not really. We do have a chat when we are doing something for them. Throughout our visit we observed that interactions between staff and the people accommodated were task-centred, such as when transferring people from room to room and when providing personal care. We saw visitors coming and going throughout the time we spent at Urmston Cottage. We asked one of the visitors about their views of the home. She said that she couldnt fault the care her aunt received. She visited every day and was always made to feel welcome. She added that staff were friendly, caring and helpful. We assessed the quality of meals provided for people living in the home. Menus provided evidence that people were given choices in what they liked to eat and the meals provided variety and good nutrition. At our last visit in January 2010, we were concerned that food stocks were low. On this visit we found ample food stocks including fresh fruit and vegetables. The chef told us that he regularly consults individuals about their nutritional needs and incorporates their suggestions and preferences in the menus. He had a good understanding of each persons dietary needs, particularly in relation to special diets. The meal provided during our visit looked and smelt appetising and people were observed to be enjoying their food. A number of people we spoke to said they enjoyed the food and one person said, The meals are always good here. Care Homes for Older People Page 17 of 31 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. Systems are in place to ensure that people are protected from abuse and harm and people know who to contact if they want to make a complaint. However, people cannot be confident that their complaints will always be addressed. Evidence: We looked at how concerns and complaints were managed in Urmston Cottage. The home had a suitable complaints policy and procedures for dealing with concerns within a 28-day timescale and this had been communicated to people living in the home and their representatives. The people we spoke to told us they would speak to staff or the manager if they had any concerns and they were confident that such issues would be dealt with. We spoke to 4 relatives of people living in the home. One person was satisfied with the care and support provided. This person described the staff as caring, friendly and helpful. A second person thought the staff were nice people and that they keep relatives well informed. The remaining two people gave examples of concerns they had expressed about the care being provided. One person commented that the family felt they had to visit every day, because the staff did not follow the care plan. Another concern expressed related to people having to wait for staff support to use the toilet, especially at mealtimes. Additionally, this person has complained on two occasions that clothes go missing when they are sent to the laundry. Staff say they will look for them but they were never found and no other action was taken to improve the Care Homes for Older People Page 18 of 31 Evidence: situation. We saw no evidence during our visit that these two peoples complaints had been formally investigated. The self-assessment completed by the manager and one of the directors told us that there had been eight complaints in the previous 12 months and that none of these had been upheld. However, one of the complaints that we looked at related to missing personal items belonging to a person living in the home. This persons relative had reported the missing items to the manager, although she had taken no action to deal with this. The relative then put her concerns in writing in February 2010. Records provided evidence that the complaint was upheld and appropriate action had been taken to remedy the situation. The remaining complaints had been addressed within the specified timescales. Urmston Cottage had a suitable policy and procedures for safeguarding the welfare of people living in the home. There was evidence that staff had received training in what action they should take if they suspected a person was at risk of harm and one of the directors told us that each person was assessed on their competency once they had been trained. We recommended that records are kept of all competency assessments undertaken with staff. We had been informed of ten safeguarding referrals made to the local authority during the previous twelve months. This prompted a review of the care provided in the home, conducted by social services and the Primary Care Trust. The outcome of the review was that several improvements were required in relation to care provision and the environment. The provider told us that these improvements had been complied with. Systems must be developed to ensure that all elements of service provision are subject to regular auditing and review. This will highlight shortfalls and provide evidence that such issues are being dealt with at source by management. A decision had been taken by the provider to enrol staff on Trafford Consortiums safeguarding training. It was encouraging to find that safeguarding was being discussed at the monthly staff meetings. Care Homes for Older People Page 19 of 31 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. Failure to adequately manage fire safety in the home continues to place the welfare of people living and working in Urmston Cottage at risk of serious harm. Evidence: We looked around the internal and external areas of the home to assess cleanliness, hygiene, infection control and maintenance. We found the home to be clean, tidy and hygienic, with no unpleasant odours present. Staff told us that they had sufficient supplies of personal protective equipment such as gloves and aprons and each member of staff had received training in the control of infection. Significant improvements had been made to the environment since our last visit in January 2010. A new heating system had been installed and upgrades had been undertaken to the fire safety and electrical systems. All bathrooms, toilets and the laundry had new flooring installed and the laundry and clinic room walls had been re-tiled. We were concerned to find that the new floor tiles did not provide a non-slip surface when wet. We saw written evidence that a member of staff had slipped in one of the bathrooms. We asked one of the directors about this. She told us that the floor tiles had been bought as non-slip although they had been found to be a hazard when wet. A paint-on coating had been ordered, which would ensure they were fully non-slip. We recommended that hazard warning notices be posted in the laundry and all toilets and bathrooms, until the flooring had been made safe. Care Homes for Older People Page 20 of 31 Evidence: During our January visit we found that three bedroom doors were being propped open with stools. We were concerned that this potentially placed people at risk of smoke inhalation in the event of a fire. This had been addressed by the installation of door guards linked to the fire alarm system for those people who wanted their bedrooms doors left open. We had also been concerned in January about staff leaving bedroom doors ajar at night. We were given assurances that staff had been informed that this was unsafe. However, we found that five bedroom doors did not fully close within their rebates. This was rectified before the end of our visit. We recommend that staff be reminded of their responsibility to consistently report such health and safety issues so that people living and working in the home continue to be safe in the event of a fire. We found further concerns in relation to fire safety. The electric switch room in the cellar was a high voltage area and its door must be kept closed at all times. This had been propped open with a water dispenser. Additionally, an adjoining room contained a high volume of cardboard boxes containing various items of equipment awaiting relocation. The door to this room had also been left open. This placed the safety of people living and working in the home at serious risk of harm in the event of a fire. A third room in the cellar was being used as a dry food store. The walls of this room were in a poor condition, with paint and plaster loose and flaking off. We discussed this with the director who said the food stocks would be removed and stored elsewhere. We also noted that a bottle of liquid cleaner sanitizer had been left in this room. As the cellar was inaccessible to people living in the home this did not pose a serious risk to their safety. However, cleaning fluids should be stored in accordance with the Control of Substances Hazardous to Health (COSHH) regulations. The grounds of the home had generally been well maintained. However, the external cellar steps were covered in wet leaves creating a slipping hazard. The director said that these steps were rarely used by staff. We recommend that the steps are kept clear of leaves and that this is monitored during scheduled health and safety audits. Care Homes for Older People Page 21 of 31 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. A robust system of recruitment ensures that people living in the home are afforded protection. However, the moving and handling skills of some staff is not based on good practice and this potentially places people at risk of harm. Evidence: On the day of our visit there were 7 care staff and 2 nurses on duty in addition to the deputy manager and housekeeping team. Staff spoken to felt that staffing levels were sufficient for meeting the needs of people living in the home. However, we were concerned that only one nurse working the night shift had to administer medication to 42 people in addition to providing clinical interventions. We also observed that interactions between staff and people living in the home generally only occurred during clinical or care interventions. Two staff told us that they dont usually have time to just sit and talk to people. It was not clear whether this focus on tasks had become custom and practice or whether more staff were needed. We recommend that this is reviewed and that the people accommodated and their representatives are consulted within the process with a view to providing a more person-centred approach to providing care and support. Records provided evidence that mandatory health and safety training had been kept up to date. However, we observed that some staff were not following good practice when providing support to transfer people into wheelchairs. This may be related to Care Homes for Older People Page 22 of 31 Evidence: risk assessments not being kept up to date. We looked at the accident records and found that there had been six incidents since January 2010 of people sustaining skin tears to their legs during transfers to and from wheelchairs. We asked the manager what action she had taken to minimise further occurrences of these accidents. The manager told us that she had not taken any action. We did find that the newly appointed deputy had reviewed the latest incident and had reminded staff of the need to take care when transferring people into wheelchairs. Care staff had access to National Vocational Qualification awards and additional training had been provided where the need had been identified. The self-assessment completed by the manager and one of the directors told us that the cooks and kitchen assistants had current food safety certificates. However, when we looked at the training records we found that the weekday cook and a kitchen assistant did not have current certificates. We looked at the recruitment process for two staff that had been employed in the previous 12 months. Records provided evidence that the full range of pre-employment documents had been obtained and induction programmes had been provided for both staff. Care Homes for Older People Page 23 of 31 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 current management systems do not ensure the efficient running of the home and the ongoing improvement of the service. Evidence: Urmston Cottage has not had a registered manager in post since 2008. The director told us that the current manager had tendered her resignation and that a new manager had been recruited and would take up her post on 29th March 2010. During our visit we found concerns in the way the home was being managed. The manager had failed to regularly monitor and supervise the care that staff provided in the home and this had resulted in people being placed at risk. The standard of care planning, risk assessment and moving and handling practice was poor and this compromised the welfare and safety of people living in the home. We did not find any evidence that the manager had taken action when people sustained injuries while being transferred to wheelchairs, nor was any action taken when qualified staff failed to follow the advice of health care professionals. We were also concerned that little Care Homes for Older People Page 24 of 31 Evidence: attention had been paid to ensuring fire doors were kept shut at all times, as identified in our January 2010 inspection report. Evidence must be provided that staff receive regular supervision and that appropriate action is being taken to address issues of poor practice, particularly in relation to meeting personal and healthcare needs, moving and handling and health and safety. We discussed our findings with the director who gave a firm commitment to ensuring that the required improvements would be addressed. A system was in place for surveying the views of people using the service and their representatives. The most recent survey had resulted in 15 completed questionnaires. Comments were generally positive. Several people complimented the improvements made in relation to meals. We were told that invitations were being sent out to relatives and representatives to participate in the review of care plans. This is a positive move towards a more person-centred approach in care provision. We looked at a sample of records detailing the management of peoples personal finances. Records contained good detail and balances of money held in the safe were accurate. Expenditure had been cross referenced to receipts. All transactions had been signed by a member of staff. We recommend that two signatures are obtained for transactions, one of which should be the person using the service, wherever possible. We looked at a sample of health and safety and maintenance records and found these to be accurate and up to date. Care Homes for Older People Page 25 of 31 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 8 12 Care plans must contain sufficient detail to demonstrate that peoples needs are being met appropriately and in accordance with their stated preferences. To ensure that people are receiving care and support that promotes their wellbeing. 19/02/2010 2 19 23 Fire doors in the home must be kept closed at all times. To safeguard people from the harmful effects of smoke inhalation in the event of a fire. 19/02/2010 3 31 9 The manager of Urmston Cottage must apply for registration with the Care Quality Commission. To ensure that the manager is a fit person to manage a home for older people. 05/03/2010 Care Homes for Older People Page 26 of 31 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 8 12 Staff must ensure that people living in the home receive the right care and appropriate treatment. To ensure that peoples personal, health and safety needs are met. 25/04/2010 2 8 18 There must be a system in 25/05/2010 place to monitor and supervise staff practice in the quality of care provided to people living in the home. To provide evidence that individuals personal and healthcare needs are being met. 3 9 13 All medication including 30/04/2010 prescribed nutritional supplements and external preparations e.g. creams must be safely administered as prescribed and supported by clear and accurate record keeping Care Homes for Older People Page 27 of 31 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 evidence their correct use to support peoples health and wellbeing. 4 16 22 Complaints received from people using the service or their representatives must be investigated and corrective action taken where appropriate. People have a right to have their concerns and complaints taken seriously. 5 18 24 Systems must be in place for reviewing and auditing all aspects of the service being provided. To ensure that standards are being met and that people using the service are safeguarded from harm. 6 19 13 The storage of combustible materials in the cellar must be kept to a minimum. To ensure the safety of people living and working in the home. 7 27 19 Staff must be assessed as confident and competent and regularly supervised when providing moving and handling support to people living in the home. 25/04/2010 25/04/2010 25/04/2010 25/04/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the people accommodated are safe from accidental harm. 8 31 24 The registered provider must ensure that appropriate systems are in place for the efficient management of the home. To provide evidence that the home is being managed in the best interests of the people accommodated. 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 25/06/2010 1 1 The Service User Guide and Statement of Purpose should be reviewed and updated to ensure that they provide people with up to date information about the home. Both documents should be dated and the pages numbered and cross-referenced to the index. This will make it easier for people to find specific information that is of interest to them. The times that medicines are administered need to be monitored and if needed adjusted to ensure that adequate dosage intervals are maintained and medicines are administered at the best and right times for people living at the home. People who are confined to bed and unable to participate in group activities should be consistently provided with interest and stimulation in a structured manner. To ensure that each person accommodated in the home has regular opportunities for meaningful interaction with other people. 2 9 3 12 Care Homes for Older People Page 29 of 31 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 4 19 Staff should be reminded that they have personal responsibility under health and safety legislation to report hazards, such as fire doors that are not fully closing. The steps down to the external cellar should be regularly monitored and maintained to ensure that leaves do not create a slipping hazard. Cleaning fluids should be stored in accordance with COSHH regulations to minimise the risk of accidental harm to people living and working in the home. People living in the home should be involved in a review of staffing levels with a view to developing a more personcentred approach to providing care and support. Staff employed to prepare and serve food in the home should have current certificates in safe food handling. Two signatures should be obtained for all transactions relating to the personal finances of people living in the home. 5 19 6 19 7 27 8 9 28 35 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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