Inspection on 02/03/09 for Waterside Care Centre

This inspection was carried out on 2nd March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Waterside Care Centre 21/01/10

Waterside Care Centre 26/11/09

Waterside Care Centre 24/08/09

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Waterside Care Centre Waterside Care Centre Leigh Sinton Malvern Worcestershire WR13 5EQ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Rumble     Date: 0 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Waterside Care Centre Waterside Care Centre Leigh Sinton Malvern Worcestershire WR13 5EQ 01886833706 01886832882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Minster Care Management Limited care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 46 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: Dementia (DE) 46 Date of last inspection Brief description of the care home This is a purpose built two storey home situated in the village of Leigh Sinton, near Malvern.It provides nursing care on a permanent and respite basis for up to 46 older adults who have dementia and may also have some physical disabilities.All bedrooms are single occupancy and have ensuite facilities.There is a choice of well furnished seating areas. Bathing facilities are available on each floor offering a choice of a bath or shower. Aids and adaptations are available so that people requiring assistance can Care Homes for Older People Page 4 of 34 Over 65 0 46 Brief description of the care home receive it safely.There is a passenger lift so that people can access all parts of the home and there is a secure garden to the rear of the premises that is accessible to people with limited mobility.At the front of the building is a car park providing off road parking for staff and visitors. The home has a no smoking policy. There is a bus route to Leigh Sinton and the home is within walking distance of the local shops. In the reception area there is a range of information for people living in the home and their visitors to access about the home . A copy of the inspection report should now be added to that information.The home has a range of fees and the manager should be contacted for up to date information about what these are. Care Homes for Older People Page 5 of 34 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 home is new and was recently registered with the commission. This was the homes first inspection since they were registered. On the day of the inspection 27 people were living in the home. The inspection was carried out over one day by two inspectors. The home did not know we were going to visit. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, Care Homes for Older People Page 6 of 34 and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three people living in the home were case tracked.This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Other peoples care records were also looked at briefly. Because the people living here are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experiences. We call this the Short Observational Framework for Inspection (SOFI). This involved us observing four people who use services for one hour and 45 minutes and recording their experiences at regular intervals. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. We spoke to some staff working at the home and four relatives of people who are using the service. What the care home does well: What has improved since the last inspection? What they could do better: Information available about the home ,the services it offers and how to complain could be in alternative formats so that it is easier to understand. Arrangements should be in place to ensure that all complaints and concerns are fully investigated so that people can be confident that their views are listened to. Individual care plans need to be more detailed and arrangements put in place so that all staff are aware of the content of them so that people can be confident that their health and personal care needs are met in a way that they prefer and expect. Care Homes for Older People Page 8 of 34 Improvements are needed so that people can be confident that they are receiving their medication as prescribed and their health and well being is promoted. Where people are assessed as needing bed rails to keep them safe these must be fitted with bumpers to eliminate the risk of them getting trapped. People should be offered the opportunity to see a dentist regularly so that their dental health is maintained. Staff need more training and supervision so that they have all the skills and knowledge they need to be able to look after with people who have dementia and safeguard them from harm in a way that promotes the persons sense of wellbeing. The arrangements for meal times should be reviewed so that people receive support they need in a timely way that meets their needs, and promotes their dignity and enhances the social aspects of mealtimes. Consideration should be given to improving the in and out of house activities available for people . Improvements are needed in the way the home responds to concerns and complaints so that people can be confident that their views are listened to. The handover period should be included in staffs paid working hours so that the home is not reliant on their good will to arrive early or stay late for their shift . 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place so that people can be confident that their assessed needs are known on admission and will be met in a way they prefer. Evidence: There is a service user guide and a statement of purpose available .These documents give prospective residents and their families information about the home so that they will know what they can expect if they decide to live there, including how much it will cost and what is included in the fees.The service user guide is available in large print so that people with poor eye sight can read it. These documents are not currently available in alternative formats such as pictorial or audio visual formats so that the information is easier for some people to understand . People moving into the home are given a contract of residence so that they know what to expect from the home and what the terms and conditions of their stay are. Care Homes for Older People Page 11 of 34 Evidence: Pre admission assessments are completed before some one comes to live at the home.The pre admission assessment we looked at included information about the persons health and personal care needs and also some information about what they use to like doing and their interest. This should mean that staff have the information they need to be able to meet the persons needs when they come to live at the home . The language used within the pre admission forms refers to marital status . This may discourage some people from feeling comfortable about disclosing personal relationships that are important to them . We were told that people thinking about moving into the home will be able to visit the home for a trial period to see if they like it before they make their decision . People living at the home were unable to tell us about their experiences of their admission to the home because of their dementia. However we spoke to relatives of people living in the home .They had been consulted about their relatives needs and were happy with the care their relatives received in the home . One lady was admitted to the home during our visit. It was disappointing that in the afternoon this lady was seen to distressed, stating she was cold and wanted to go to her room. Neither the carer or the nurse was aware of which room this person was in so she could be supported to her room. This shows that the admission processes and communication within the home are not always as good as they should be. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be confident that their assessed needs will be met in a way that promotes their health and well being . Evidence: Each person has a written care plan. This is an individualized plan about what the person is able to do for themselves and what assistance they need from staff so that their needs can be met.We looked at the care plans for three people we case tracked in detail, and briefly looked at some others.We found that people have written care plans that said what their health and personal care needs were. Some of these had enough information in them so that staff should know what help they need and how they prefer it to be given. We found evidence that how peoples needs were being met was mixed, some good, some poor. We saw good practice with staff caring for people in a way that maintained their dignity and privacy and a number of relatives of people living at the home spoke highly about the care their relative received. Without exception relatives commented that when they visited their relative was always clean and well groomed and they Care Homes for Older People Page 13 of 34 Evidence: thought the care was good .During our visit we saw that people were wearing clean clothing that was appropriate to their age and gender and reflected individual choices. We also found evidence of poor practice which meant that not all people who use the service are safe.Some care plans lacked detail about how to meet the persons needs. For example; needs assistance with hygiene , without saying what assistance is required or how it is to be given. Or, when X is in pain, give pain relief. There was no guidance so staff would know when the person was when in pain and needed their medication. Care staff spoken to were unaware of the content of care plans. They said that they did not look at care plans but learned about peoples needs from the nurse and from watching other carers to see what works.Staff descriptions of how they give care to people were not consistent with what was recorded in the care plans. During our observations we saw examples where people were not offered a special diet that was suitable to meet their health care needs. We also have received a complaint from a relative who said that they had seen their relative being given a diet that is not suitable to meet their dietary needs . This places people at risk of harm . This means that people are not necessarily receiving care in a way that they have been assessed as needing or as they prefer it, and care staff are not monitoring peoples health care needs effectively as they are unaware of what these are. There are risk assessments in place for nutrition , sore skin , moving and handling , falls , continence and the use of bed rails. We saw examples where these would not give staff enough information about how to keep the person safe .For example one persons care plan did not have any risk control measures in place so that staff would consistently know how to manage the risk of sore skin. This was despite the risk assessment identified them as being at high risk of getting sore skin and the pre admission assessment commenting that they had sore skin on admission. One person was assessed as needing hoisting on admission due to his poor mobility. However records show that this person did not like being hoisted. His care plan had being amended so that two staff were to assist him move. Care staff described how they were manually supporting him to move .There was no reassessment of the risk or the persons needs prior to this amendment other than the persons preference not to be hoisted. This places the person and staff at risk of harm. We saw one lady asleep in a chair in her room at 10am. At 5 pm this lady was still asleep in her chair with her untouched lunch time meal and drink still in front of her.Staff had not completed any records to show that they had been in the room to Care Homes for Older People Page 14 of 34 Evidence: look after her. This shows that peoples care is not always offered in a person centered way and that people are at risk of getting sore skin, not having enough to eat or drink as well as being socially isolated. There is evidence in the records that people were seen by the GP and Optician as they needed. The home has not arranged for any people to see a dentist, although we were told that the family can arrange to take people to see a dentist of their choice. One relative told us that she wished that a dentist could visit her mom. There is some equipment in the home to help move people safely and to stop them getting sore skin. We saw that some people had bed rails fitted so that they would not fall out of bed . To make sure people are not at risk of getting trapped in the rails these should be fitted with bumpers .It was of concern that we did not see that there were any bumpers fitted and we were told by a senior member of staff that there were none available in the home. Given the needs of the people living at the home this means that they are at risk from this practise . Peoples medicine is stored safely in a locked trolley, there is a separate trolley for each floor. These trolleys and surplus medication are kept in dedicated rooms in the home. We looked at the medication administration records(MAR) for some people .These records did not show that all the people were receiving their medication as prescribed and this places them at risk of harm. For example we saw that there we some gaps where the record had not been signed and no reason recorded why medication had not been given . There were no written protocols in place for as required, medicines.This means that staff do not have guidance to know when they should give this medication.We saw examples where records show that people had been regularly offered as required, medicine to help calm them although they did not need this. One person recently admitted to the home had brought some of their medication into the home with him. This had not been recorded so meant they had not being offered any of this medication since their admission to the home. One person had been refusing her prescribed medication for a while . There was no evidence that staff had contacted her doctor to discuss what they should do nor that the situation was being monitored. It is disappointing that the Annual Quality Assurance Assessment (AQAA) the home sent to us did not recognize that they were not consistently providing health care care Care Homes for Older People Page 15 of 34 Evidence: as well as they said they would in the statement of purpose. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can not be confident that they will be supported to lead a stimulating lifestyle that meets their needs and preferences .People do not recieve support with their meals in a way that provides a pleasant and sociable experience . Evidence: The care plans we looked at included some information about peoples past interest,religious beliefs and life experiences so that staff should have the information they need to provide stimulating activities that meet peoples needs . The home employs an activities coordinator who does some activities with people . People who use the service were not able to tell us their views about the activities available. We spoke to a number of relatives who said that staff try to do activities with people including dominos, bingo , cake making , ball games and music. External entertainers also periodically visit the home . A music man visits monthly and over Christmas a local school visited to sing Carols . A hairdresser visits regularly so that people can maintain their personal appearance if they wish.Opportunities for people to do activities out side of the home and in the local community with staff are not happening at present.This is disappointing as the information people receive about the home say that these are available . Care Homes for Older People Page 17 of 34 Evidence: A priest visits the home monthly and holds Holy Communion for those people who wish to take it so that people are able to meet their religious needs. The home has an open visiting policy, which means people can see their visitors as they choose and maintain the relationships that are important to them .Relatives said that they are able to eat meals and are always offered drinks when they visit, making the visit enjoyable and, that they are able to take their relative out when they wish. The home looks out on to a lake. Some of the people living at the home enjoy going to watch the ducks on the lake . The lake is fenced off so that it is safe but people can only go out if they are supervised by care staff or the activities coordinator. This means that sometimes they may have to wait to go out and then only if they ask. Discussions and observations of care staff showed that they are busy and have little time available to do activities with the people living at the home. Staff spoken to confirmed that they have no time to take people out or do one to one activities with people . We observed the care four people received over hour and 45 minute period in the ground floor lounge . We looked to see what people had to do so that they could keep busy , if they were happy or sad and how good staff interactions were . We saw that for long periods people did not have anything to do. Two people we observed spent between 55 to 86 percentage of the time without anything to do and no staff contact . One person had a visitor which meant they were occupied for most of this period and the other person observed received a lot of staff attention .We observed that there was nothing for people to people to pick up and choose to do by themselves if they wanted . For example newspapers, magazines , rummage boxes or ornaments .We also saw that the ladies did not have handbags with them so they could keep things that they like and are important near to them . On the day of the inspection the lunchtime meal was mince, potatoes, green beans and carrots.No alternatives or choices were offered. We were told that people can have an alternative such as an omlettes or jacket potato if they do not like the meal offered . It is not clear how people would know this on a day to day basis given their dementia. Dining space was limited, there were two tables seating a maximum of eight people. This meant some people received their meals in their armchair . There we two staff available to provide assistance to ten people who all required some assistance with their meal, which was insufficient to meet peoples needs. There was some poor practice which was in response to staff trying to meet the Care Homes for Older People Page 18 of 34 Evidence: competing demands and needs at the same time. This meant that the meal time was not an enjoyable sociable event. We saw that no condiments , sauces or napkins were offered. Some people needed plate guards so they did not spill their food, these were not provided. Meals were placed in front of people with no explanation about what the meal was. Staff frequently left people they were assisting part way through the meal with no explanation .We heard some staff talk about people in a way that was not person centered.Two people were being fed at the same time by one carer and there were no conversations with people during the mealtime. A number of people needed encouragement to eat their meal and this was not provided so their meal went cold and people did not eat as much of their meal as they might have .A carer handed one person a pudding that was not suitable for their dietary needs , she was stopped by the nurse .This means all staff do not know what peoples individual needs are. There did not seem to be any clear organization to the meal time or system in place to ensure every body received their meal in a timely way. One lady was not brought to the dining area for over half an hour after the meal had started as staff said that they had forgotten her. One lady told us that she had still not received her pudding over a hour after the meal time had commenced. We brought this to the staffs attention to ensure that she received her pudding. Menus showed that people have a varied diet .We were told that the home has just started to gather information about peoples dietary likes and dislikes. There is no date for completion of this work so staff will know about peoples dietary preferences. The cook has no records of people requiring special diets because of health or religious reasons. She said that she relies on nursing staff telling her when people require a special diet . It was of concern that the cook told us that there is one person with diabetes in the home and one person receiving a liquidized diet . This information was inaccurate as there were three people living in the home with diabetes requiring a special diet. Care Homes for Older People Page 19 of 34 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. People can be confident that the homes recruitment practices will safeguarded them from harm. Improvements are needed so that people can be confident that their concerns are taken seriously . Evidence: Written information about how to complain is displayed in the reception area and is also included in the service user guide. This may mean that the information is hard to understand for some people using the service. It is good that the home also has a comments book so that people can leave comments or suggestions to improve the service offered. The manager signs to acknowledge they have seen the comments but the form does not provide any space to respond to the suggestion.This was revised during the inspection so that feedback can be given to the person about their suggestion. The home stated that they had not received any complaints .Prior to the inspection CSCI had received a concern about people being soiled and not dressed appropriately and one anonymous complaint saying that there are not enough staff on duty, and staff were not competent . We asked the home to investigate this . The home have written to us saying the complaint was not upheld.It is disappointing that rather than investigate the complaint they appeared to have relied on the outcome of their monthly audits to make this judgment. A few days after the inspection we received two complaints from relatives about a number of issues.Including not enough staff on duty, people getting hurt by other Care Homes for Older People Page 20 of 34 Evidence: people living at the home, people not getting the special diet they needed to keep them well and people being soiled. We have written to the provider asking them to investigate these things. One of the complainant said that she had raised her concerns with the manager in December and was still waiting for a response . It is disappointing that the homes complaints log did not record these concerns and what action they had taken as a result of them. Staff spoken to said that they had received training about how to safeguard people from harm. They were able to give adequate responses to questions about what they would do in the event of or suspicion of abuse so that people will be safe. However, we have received some information from the home where people have been hurt by others living in the home. These incidents have not be recognized by the service as things where other agencies should be informed under safeguarding procedures . The relatives we spoke to were aware of how to complain and said that they had no reason to complain . They also said that when they had made any suggestions or comments these had been acted upon . The homes recruitment procedures are robust, which means that only people suitable to work with vulnerable older people are employed. Care Homes for Older People Page 21 of 34 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. People using the service live in a home that is comfortable, well maintained and meets their needs. Evidence: This two story home has been purpose built to a high standard . There are 46 single bedrooms , all of which have en suite facilities. People are able to bring personal items and effects with them to make their room more homely and to reflect their taste and interest. On each floor there are a choice of combined lounge and dining areas so that people can choose to spend time with others, or in the privacy of their own bedroom. These rooms are well decorated and furnished to a high standard. However, there is not enough dining space available so that everyone could choose to eat at a table if they wished. All areas of the home were clean and well maintained. There are a number of toilets and bathrooms with special baths or wet rooms so that people can choose whether they want a bath or shower.Equipment is available so that anyone requiring assistance can receive this safely. Corridors are wide, fitted with grab rails and provide space for people to walk about if they wish . There are varied and colourful pictures , including many of the local area Care Homes for Older People Page 22 of 34 Evidence: to interest and stimulate people whilst also creating a homely environment . We saw that peoples bedroom doors had names and numbers ,door colours are subtle. Some of these colours were very similar to those used in service areas of the home , such as the sluice areas . This provides limited visual clues and may not aid people who have dementia to be able to easily find their room. Access to the home and to the stairs between to each floor is restricted by the use of key pad door locks. This makes sure that people are unable to leave the building unsupervised or access stair wells so they are safe.However, when peoples freedom of movement is restricted the home must have records to show that this is in the persons best interest. CCTV cameras monitor the car park and the homes frontage for security reasons. The home looks out onto an expanse of water at the back .This is railed off so that it is safe for people to visit. The rear garden is accessible to people with mobility difficulties and is fenced so that it is a secure area for people to use . There are raised flower beds which we were told will be planted. The home have said that they intend to provide garden furniture in the near future so that people can choose to spend time in the fresh air if they wish. The AQAA states the garden area is safe and accessible to all but doors to the garden are kept locked and we were told that people using the service can only go into the garden if accompanied. Care Homes for Older People Page 23 of 34 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. Staff require further training so that people using the service can be confident that they have the skills needed to meet their needs. Evidence: In addition to care and nursing staff the home employs an administrator, cleaners, laundresses and cooks to support people in the home . Current staffing levels are two carers and a nurse to look after eight people on the first floor and three carers and a nurse to nineteen people on the ground floor.The home are still recruiting staff and these staffing levels will increase as more people come to live at the home. Without exception relatives commented that staff were kind and they were pleased with the care their relative received. At lunchtime our observations were there were not enough staff available to support people with their meal in a way that promoted their dignity. The lunchtime was hectic because so many people required assistance at the same time. Records show that care staff are regularly working long days from 7am to 9pm . This means that staff may be tired and are not at their best when caring for people , this may place people at risk. Staff receive a handover at the start of their shift so that they know what they are Care Homes for Older People Page 24 of 34 Evidence: expected to do for that shift and who they are looking after. However the nurses giving this handover have to stay late after their shift and are not paid for this time.This means that the home is relying on staff good will, and does not demonstrate that sufficient emphasis is placed on this importance of this handover to ensure all staff have all the information they need. As stated in the health care section of this report staff did not know about all the needs of the people they were looking after which means that people may not get all the care they need. Staff told us that when they start to work in the home they receive an induction booklet to work through . Induction training provided follows the standards required by Skills for Care. So that staff have some basic information about they need to do to look after people. Staff have individual training plans . Staff receive training in topics such as fire safety, manual handling, first aid and the protection of vulnerable people so that they have the skills to meet peoples needs. The home provides in house training for staff on dementia . This was described as a three part process of initial introduction, use of a workbook and written assessment with feedback given. Some staff had not received feedback on the assessments completed in January. This means that any shortfalls in staffs knowledge and understanding had not been addressed in timely way. Records and discussions with staff show that care staff need some further training so that they can meet the specialist needs of the peole living at the home. for example looking after people with sore skin and diabetes. We were told that the home has identified some external training in dementia that they will send staff on in the near future so that their skills will be further improved. During our observations we looked at the way staff interacted with people. While we observed that staff were willing and patient their interactions with people did not have a positive affect on them. All the interactions for three people were neutral. Suggesting that staff need further training to be able to make people with dementia feel good about themselves. We also heard staff referring to people in a way that does not enhance the self respect and self worth Recruitment practices in the home are robust so that only people that are suitable to work with vulnerable adults are employed in the home. Care Homes for Older People Page 25 of 34 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. Arrangements in place need some further improvements so that people can be confident that they will benefit from a service that is consistently run in their best interest. Evidence: Since the home was opened the registered manager has left her employment at the home. An acting manager is in post who is supported in this role by the project manager. The acting manager has previous experience of working in a care home and is a qualified nurse.We were told that the home will be recruiting to the vacant manager position in the near future. The Annual Quality Assurance assessment (AQAA) returned to us was brief and lacked detail about how the service planned to improve over the next twelve months. The home has been holding meetings with people who live at the home and their relatives. Records of these meetings are available so if people were unable to make Care Homes for Older People Page 26 of 34 Evidence: the meeting they are able to see what was discussed and any outcomes. The owners arrange to do the legally required monthly visits, where as well as looking around the home they speak to a number of staff , relatives and people who use the service to see what they are doing well and what they need to improve. Reports of these visits are available so the home and are used to improve and monitor the quality of care . The home has a quality assurance system in place that also includes seeking the views of the people using the service and their relatives so that people using the service can be confident that their views are listened to and this helps to improve the service. However these systems had not being effective in identifying the shortfalls we saw in the provision of health and personal care for people . The home has kept records to show that it is well built to the required standards and that the equipment in it is well maintained and safe to use . A Food Hygiene inspection recently visited to look at food hygiene and safety standards in the home . The standards in the home have being commended. The home does not manage peoples personal finances but does hold some money on behalf of some of the people using the service. This money is kept safely and records kept of the balance of money held and expenditure. Staff do not receive adequate supervision to ensure that people using the service benefit from a well skilled and supported staff team . Records and discussions with staff showed that only one nurse has received any supervision since the home opened and care staff have only received one supervision session each.During our observations we saw examples of staff practice that indicated that some more training and supervision is needed so that staff have the skills and knowledge to look after people with dementia .Also a number of care staff have being recruited with no previous experience of working in care. Hence greater priority should be given to ensuring staff receive supervision at regular intervals so that they can receive constructive feedback on their performance which will enable them develop their competence further. Communication needs to be improved so that all staff have the information they need to meet peoples needs .We were told by a member of staff that communication is ad hoc and given examples of this . This may mean things are missed. For example staff did not know which room a lady had being admitted to and people were not offered support in a way their care plan said they needed. Protocols were not in place to tell Care Homes for Older People Page 27 of 34 Evidence: staff when they should offer as required medication. This meant people were being offered medication at times when they did not need it . Care Homes for Older People Page 28 of 34 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 29 of 34 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 18 Staff must have regular supervision. So that they get feedback and support they need to carry out their jobs . 01/05/2009 2 7 12 Care plans must be in 13/04/2009 sufficient detail and periodically reviewed. this is so that staff have all the information they need to meet peoples health and personal care needs. arrangements must be in 15/05/2009 place so that staff have the training appropriate to the work they do and are competent and experienced. This is so that they can meet the individual and collective needs of the people living at the home. 3 8 18 4 8 13 Arrangements must be in place so that unnecessary 16/03/2009 Care Homes for Older People Page 30 of 34 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 risk to the health and safety of people are identified and so far as possible action is taken to minimize or eliminate the risk. This is so that people are kept safe. 5 9 13 Arrangements must be in place so that people receive their medication as prescribed . This is so that their health in maintained and promoted. 6 16 22 Arrangements must be in place so any complaint made is fully investigated. This is so that people can be confident that their views are listened to and acted upon. 7 18 13 Arrangements must be in 25/03/2009 place by training of staff or other measures to prevent people being harmed or being placed at risk of harm. This is so people are safe from the risk of harm. 8 30 18 All staff must receive sufficient training. 01/05/2009 25/03/2009 16/03/2009 Care Homes for Older People Page 31 of 34 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 enable them meet the individual and collective needs of the people using the service 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 Consideration should be given to providing information to people, including the statement of purpose, service user guide and complaints procedure in accessible formats so that the information it is easier to understand . Consideration should be given to the language used in the homes documentation so that people may feel more comfortable and confident discussing relationships that are important to them Arrangements should be made so that people using the service can see a dentist regularly so their dental health is maintained. Consideration should be given enabling people to access a range of tactile items and objects so that they have an opportunity to occupy themselves . Consideration should be given to enabling people to access a range of tactile items and objects so that they have things to explore and do. People should have opportunities to access the local community with staff on a regular basis so that they are supported to lead interesting and meaningful lives. People should have the opportunity to access the local community with staff on a regular basis so that they are supported to lead interesting and meaningful lives. Aids and equipment should be provided to enable people eat independently whilst maintaining their dignity. People should be offered a choice of meals daily so that Page 32 of 34 2 3 3 10 4 12 5 12 6 13 7 13 8 9 15 15 Care Homes for Older People 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 their dietary ptreferences are met. 10 11 15 15 People should be offered a choice of meals daily so that their personal and dietary preferences are met. The arrangements for mealtimes should be reviewed so that there is enough staff available to help people with their meal in a way that promotes their dignity and independence and enhances the social aspects of mealtimes. The arrangements for mealtimes should be reviewed so that people can recieve support in a way that promotes their dignity and enhances the social aspects of mealtimes. Aids and equipment should be provided to enable people to eat independently whilst maintaining their dignity. Consideration should be given to creating additional dinning space so that all people living at the home can choose to eat at a dinning table if they wish. Where peoples freedom of movement is restricted records should be available showing that this decision is made in the persons best interest. Consideration should be given to providing additional visual clues so that people can find their bedroom easily. Consideration should be given to providing additional staff at peak periods so that the needs of people using the service are met in a timely manner. Staff should not work long days so that they are not tired and are able to meet the demands of the people using the service. Consideration should be given to including the handover period in staffs paid hours so that the good will of staff is not eroded. Consideration should be given to identifying ways that communication within the home can be improved so that people in the home benefit 12 15 13 14 15 20 15 22 16 17 22 27 18 27 19 27 20 32 Care Homes for Older People Page 33 of 34 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). 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