Inspection on 30/03/09 for West Lodge Care Home

This inspection was carried out on 30th March 2009.

CSCI found this care home to be providing an Adequate 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Lodge Care Home 28/11/08

West Lodge Care Home 03/05/07

West Lodge Care Home 19/04/06

West Lodge Care Home 09/11/05

West Lodge Care Home 13/06/05

West Lodge Care Home 25/01/05

West Lodge Care Home 24/08/04

West Lodge Care Home 12/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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: West Lodge Care Home 238 Hucknall Road Sherwood Nottingham NG5 1FB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Wells     Date: 3 0 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: West Lodge Care Home 238 Hucknall Road Sherwood Nottingham NG5 1FB 01159606075 01159606075 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Razma Vanessa Alishan care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service suers who can be accommodated is 27. The registered provider may provide the following category of service only:- Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admision to the home are within the following category: Old age, not falling within any other category - Code OP Physical Disability - Code PD Dementia - Code DE Date of last inspection Brief description of the care home West Lodge Care Home was established in 1987. Located on a main road in Sherwood, it is on a main bus route into Nottingham city centre. The home consists of a large converted house, with a purpose built conservatory. Care Homes for Older People Page 4 of 34 Over 65 0 27 0 27 0 27 2 8 1 1 2 0 0 8 Brief description of the care home There are 6 double bedrooms and 13 single rooms 4 of which have en-suite facilities. There is ramped access to the building and a passenger lift serves all three floors. The homes grounds are mainly to the front of the building and are well maintained although there is open access to the road. There is car parking space at the front of the home. A copy of our last inspection report is available in the foyer of the home. The current fees range from £329.85 to £515 per week. Newspapers, toiletries, hairdressing and private chiropody are not included in the fees. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for the service is one star. This means the people who use the service experience adequate quality outcomes. The inspection visit was unannounced and took place over 2 days, the 4th and 30th March 09, 14 hours in total were spent at the home. There were 17 people living at the home on the day of the inspection. 6 residents, 5 staff, 4 visitors, three visiting professionals and the owner manager were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received since the last key inspection on the 3rd May 2007. This included: Care Homes for Older People Page 6 of 34 What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection report. A complaint received by The Commission For Social Care Inspection. Case tracking was used during the inspection visit to look at the quality of care received by people living at the home. 3 people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 34 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. Peoples needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. Evidence: The statement of purpose gave information about the home, and was in each persons bedroom. It had been revised in April 2008 to reflect the additional registration of dementia care. Some parts of the document needed amendment. For example one page called the home The Beeches and the name of the organisation that people can complain to was incorrect. Peoples records that were seen showed that assessments of peoples needs had been completed before the person was admitted to the home. This was to ensure that the service could meet individuals needs. On the day of the inspection visit a care manager from Social Services brought a new person for respite care. They had brought with them a full needs assessment for staff at the home. The nurse in charge Care Homes for Older People Page 11 of 34 Evidence: said that the person and their family had visited previously to look around the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although peoples health and personal care needs were generally met, their health care needs were not sufficiently recorded, which could lead to errors with peoples health care and individual preferences not always met. Evidence: Four peoples records were seen during the inspection visit. Three out of four of the records had a plan of care in place. However some care plans lacked detail, were disorganised and were not always fully completed or clear. For example one person that came to the home regularly for short periods of respite care had no care plan in place. The manager could not find the daily records for their most recent stay. Another person was incontinent and various records gave differing guidance to staff concerning their toileting needs. One persons plan concerning oral care was blank and two people did not have a social history. The issue of records was raised at the previous inspection visit. There was little evidence of records reflecting individuals preferences and choice around their health and personal care needs. Most people s records had risk assessments in place concerning pressure sores, falls and nutrition. People also had individualised risk assessments for example concerning smoking and challenging Care Homes for Older People Page 13 of 34 Evidence: behaviour. However these were not always regularly reviewed. Some records were very difficult to read. Not everyone had their photograph in place for easy identification. A PCT nurse assessor was spoken with. She said that the staff were very accommodating, but some records were not up to date and could be disorganised. One person had pressure sores, which they had when they were admitted to the home. A specialist tissue viability nurse had been contacted and had visited to give advice and guidance. This person was spoken with after the inspection visit. They said that the manager did not always follow their guidance, however no ones health had been put at risk as a result of this. They said that the manager regularly contacted them for support. There were clear records of GP visits, but not always up-to-date records of other health professionals visits, for example chiropodist, dental or opticians. Several people needed a hoist for their moving and handling needs. Although there was a plan for their mobilising needs, this had insufficient detail to support staff to give the correct help. Staff spoken with confirmed that a hoist was always used when needed. Staff spoken with said that the manager was very good at keeping them informed of individuals changing needs, and this was usually done verbally in preference to them reading individuals records. Staff were observed providing care for people with respect for their privacy and dignity. Staff spoken with were able to give examples of how they did this on a dayto-day basis. All residents and visitors spoken with were happy with the level of care provided. One relative said, I know that my mother is well cared for. The medication systems were checked. Medication was safely stored apart from creams. Staff practice was to store peoples creams in their bedroom. Several creams did not have a lid in place. An immediate requirement was made concerning this issue. This requirement had been met by the second inspection visit. The nurse in charge was observed administering medication. Safe practice was used, including locking the trolley for safety when she went to each person. The medication administration records were generally in good order, apart from where medication stated an optional dose, the dose given was not always being recorded. The manager Care Homes for Older People Page 14 of 34 Evidence: agreed that she had handwriting that was very difficult to read. Where she had written the medication administration records, these were not always legible. There was no evidence that this had caused any medication errors. The medication room was locked and the temperature of this room was now stable due to a recently purchased air conditioner. The room and fridge temperatures were regularly checked. Controlled drugs storage and recording was in good order. The nurse said that balance checks were done at each shift. One person who attended day centre was not having their pain relief medication when they attended the day centre. Around the home there were several notices that did not respect peoples privacy and dignity. For example there were notices in bedrooms naming all service users that needed particular continence wear. There was also the Bristol stool form scale up in each toilet and bedroom areas. This was discussed with the manager, with the emphasis on the importance of treating all areas that residents have access to as their home. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals were varied and met peoples needs, and activities were provided to suit peoples needs and preferences. Evidence: During day one of the inspection visit a mealtime was observed. Staff were assisting people to eat if they needed this. However there seemed to be some poor organisation and planning, for example the nurse in charge was talking to a visiting research nurse throughout the lunch period, rather than assisting. One person was moved by two staff from their chair to a wheelchair with a hoist, whilst food was being eaten by other people. The person was then sat at the table in their wheelchair for 25 minutes before their lunch was served. This needed to be warmed up. One person spoken with said that the food is okay. Another person said the food is quite good at times, not too bad at others. The cook was seen talking to residents about their preferred choice at tea time. The cook was spoken with. She explained that she met with each resident in the morning to ask them which of the two choices of meals they preferred at lunchtime. She said that they try to cater for alternative diets and preferences including halal meat, Afro-Caribbean and Asian specialities. A resident spoken with said, I enjoy the Asian food. There was not the menu displayed of the planned meals for the day. Care Homes for Older People Page 16 of 34 Evidence: There was an activities co-ordinator working 15 hours per week over three days. She had previous years experience as a care assistant and knew people well. She organised some group activities for example dominoes and bingo as well as spending one-to-one time with individuals that preferred or needed this. On the day of the inspection visit she was helping people with painting. She provided evidence of completing scrap books with people, either of their families or things they were interested in. She had brought in relevant books on subjects that individuals were interested in. Some people enjoyed making cards and she was planning to make Easter cards with them. Several people enjoyed baking and this was done occasionally. The activities co-ordinator said, it isnt always about doing things, some people just like to talk, its about what they want. She made a record of activities done with each individual. Two outside Pentecostal groups visited the home for a church service. A resident spoken with said, there are things to do most days. Several people enjoyed reading a newspaper or doing word search. Several visitors were at the home on the days of the inspection visit. They all commented on the friendliness of staff. One person said, they always offer me a drink and make me feel welcome. Another person said, staff are always polite and helpful. There was evidence that people brought their personal possessions with them to help personalise their own space. There was an orientation board in the dining area. The date and season was incorrect which could be confusing for people. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with information about how to make a complaint and staff understood the importance of reporting any potential abuse so that people were safe. Evidence: There was a written complaints procedure in the entrance hall. The homes complaints record showed two verbal complaints had been made. The record showed that there had been an investigation into each complaint and the outcome had been passed to the complainant. However the investigation records were not dated or signed. CSCI received a complaint about the service in November 2008. As a result of this complaint an inspection visit took place. The inspector looked at how peoples continence care was being managed, how peoples laundry and clothing was managed, medication systems, the environment and the owners response to complaints. As a result of the inspection visit, requirements were made concerning administering and recording of medication and the premises being kept in a good state of repair-see outcome area 5 for more information. Training records showed that some but not all staff had received training in safeguarding adults. Some peoples training needed updating. Staff spoken with were aware of the importance of reporting any allegations of abuse. Care Homes for Older People Page 18 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was not well maintained, did not promote peoples independence and may put people at risk. Evidence: During day one of the inspection visit a tour of the building took place. The main entrance was secure with an alarmed door. It was of concern that staff and the nurse in charge on the day did not know how to release the emergency door lock. An immediate requirement was made to ensure that all staff knew how to release these doors in the event of an emergency. The fire officer was contacted and visited on the same day. Day two inspection visit showed that improvements had been made to the fire exit release equipment. The manager confirmed that all staff had now been trained and showed how to operate the system and staff had signed that they had understood the procedure. Some areas of the home were well decorated, however there were areas that were badly in need of redecoration with wallpaper badly scuffed and very badly marked doors and door frames. This had been highlighted at the previous inspection visit. There were several areas, including some bedrooms and toilets that had a smell of Care Homes for Older People Page 19 of 34 Evidence: urine.This was less so on day two of the inspection visit. A new electric assisted bath had been purchased and put in place. Residents spoken with said that they liked this bath. There was also a new toilet in this room. The person in charge said that it had been replaced 2 months ago. There were holes in the tiles where the old toilet had been. There were also broken and mismatched tiles in other areas of the room. There were chemicals, including a chlorine based bleaching agent kept around the home and not stored securely on day one of the inspection visit. The cleaning trolley was seen on several occasions unattended. None of the sluice rooms that held chemicals were locked. This was of particular concern as the home was registered to admit people with dementia, who are particularly vulnerable. An immediate requirement was issued on the first visit concerning the safe storage of chemicals.The visit on day 2 showed that chemicals were securely stored. On the first floor there was a passageway with three bedrooms. The door at this passageway had a keypad lock. The nurse in charge said that this door was locked at night to stop people wandering. There was no toilet in this area. The nurse in charge said that people were given a commode. The main lounge on the first floor was separated into two areas and the dining area. There was also the conservatory off this area. On day 1 of the inspection, the heating in the conservatory had been switched off and no one was using the room. The room was cold. An immediate requirement was made that there must be adequate heating at all times in this area. On day 2 this room was heated, and several residents were making use of the room. There was outside seating area off the first floor conservatory. On day one of the inspection this area was in need of cleaning. There were cigarette ends on the floor, wet cardboard and a dirty bin full of cigarette ends and plastic cups. There was also the old bath stored in this area. On day two of the inspection 3 weeks later, the area had improved, although the bath was still outside. One bedroom had broken and potentially dangerous furniture in place as there were screws sticking out of the bottom and the top was loose. The person in charge said that the furniture belonged to the resident. The resident was spoken with and was happy for the furniture to be repaired or replaced. Most but not all toilet areas had hand rails or other aids to assist people with poor mobility. Care Homes for Older People Page 20 of 34 Evidence: The light pull cords in toilets and bathrooms were dirty and in need of replacing. There was a smaller lounge-dining area that was comfortable and well decorated. Several of the foot pedals on the clinical waste bins did not work on day one and day two. The manager said that she was not aware of this. The staff room was also used as a residents smoking room. Several residents used this area for smoking and staff said that they were left unsupervised. There was a boiler with a sign stating hot watch out. This room was not kept locked. Staff said that the residents that used this room were not likely to burn themselves. Some bedrooms were very dark due to small windows and restricted views. The use of low energy bulbs meant that the rooms could not be brightly lit and may put anyone with poor sight at risk. Several window restrictors were either broken or not in place. An immediate requirement was issued on day 1 of the inspection for a risk assessment to be completed. Window restrictors were in place on day two of the inspection visit. There was not a lock on some bathrooms and toilets. Some bathrooms had a domestic bath, and staff said that these were not used as residents were unable to access them. Some bedroom furniture were in a poor state of repair. For example there were handles missing on several chest of drawers and the back of a wardrobe that was seen was broken. Several carpets were badly worn and stained. Some had been recently replaced and the manager said that others were due to be replaced. Care Homes for Older People Page 21 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. There were adequate staff on duty to meet peoples needs, however not all staff had received the necessary training to ensure that they have the skills to meet peoples needs. Evidence: On the day of the inspection visits there were 17 residents living at the home. 6 of these residents required nursing care. The staff rotas showed that there was always one nurse on duty, however the owner manager was doing many of these nurse shifts. She explained that by the end of April this was likely to improve, with a nurse returning from holiday and a new nurse had just started. There were either three or four care staff on duty in the day time as well as a domestic worker and a cook. At night there was a nurse and a care assistant. Observations showed that although staff seemed very busy, peoples needs were being met with the staffing levels available on the day. Two staff files were seen. These showed that generally safe recruitment practices were being followed. However the managers poor record keeping meant that information was not readily available. For example the manager had completed a POVA first check but was unable to find the documentation. The umbrella organisation had to be contacted to provide this evidence. Care Homes for Older People Page 22 of 34 Evidence: There was a training matrix available. However the manager said that this was not up to date. It was likely that there was a shortfall in all key areas of training, although this was difficult to clarify due to poor recording. One worker said that they had done all training, but it needed updating. Most staff had undertaken relevant mandatory training at some point, however refresher training was not always done. A staff member spoken with said that she had not completed safeguarding adult training. The manager said that she had completed this, but was unable to find evidence. Although the home recently obtained registration to provide care for people with dementia, not all staff had undertaken dementia care training. The manager said that some staff needed the literacy foundation course before completing further courses. There was however no evidence that people living at the home were receiving poor quality care as a result of lack of organised training. Several staff were spoken with. One person said, all staff work fine together, I like the service users very much and I enjoy my job. Residents and visitors spoke highly of the staff. One resident said, I think there is enough staff to look after us, I dont think anyone is not looked after. A visitor said, staff seem to do a pretty good job. The manager said that 9 out of 13 staff had completed NVQ 2 Care. Several staff spoken with confirmed that they had completed this qualification, but they were waiting to attend refresher courses in other training areas. Care Homes for Older People Page 23 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. Although the manager is experienced and knowledgeable, there are not effective systems in place to manage the home well and in peoples best interests. Evidence: The owner of the home is also the manager. She is a qualified nurse and has many years experience. She has not completed a managers qualification, although she has kept her knowledge and skills updated by relevant short courses, including deprivation of liberty training, motivating and retaining staff and certificate in dementia care. She was described by staff as strict but knowledgeable. A visitor spoken with said, the matron rings me if I need to know something, I have every confidence in her. The manager was observed and staff confirmed that a detailed handover was completed at the end of every shift. There were no formal quality assurance and quality monitoring systems in place. However there was a recently implemented audit system for fault finding around the Care Homes for Older People Page 24 of 34 Evidence: building, that was due to be started. There was no evidence of recent staff or residents meetings. The insurance certificate was displayed and was up-to-date. There was only one persons money being held at the home. These records were checked. Although they were not in good order, after clarification, the amount held balanced with the records. The manager confirmed that informal supervision was taking place as and when necessary, particularly when dealing with any issues of poor practice. However there was not a formal system in place for regular, planned, formal, recorded supervision for all care staff. Records were not kept secure, up to date and in good order. For example on day one of the inspection visit archived files of individuals no longer at the home were in an unlocked area with the door left open. The managers office door had a notice saying keep locked, but this door was left unopened throughout the inspection visit, often unattended, with confidential information about people readily accessible. There were two shopping bags full of records in the office. The manager had great difficulty accessing relevant records when requested. As mentioned previously there were issues concerning fire safety and staff being unable to open the fire exit. The fire service became involved and have requested a fire risk assessment. Fire safety records were not in good order. For example records of weekly alarm tests were being completed on average monthly. The owner manager had recently received a new fire log book to start recording more effectively. There were some poor infection control practices for example, as explained previously, medication creams with tops off, dirty light pull cords and clinical waste bins with foot pedals that did not work. Staff spoken with confirmed that they were using gloves and aprons appropriately and they were readily available. As stated previously hazardous substances were not being safely stored, but this has now improved. A number of servicing records were checked. Most were found to be in order, including legionella inspection, nurse call system, and emergency lighting checks. The gas safety certificate had run out several days previously. The manager did not seem aware of this, but agreed to deal with it as a matter of urgency. Care Homes for Older People Page 25 of 34 Evidence: There were not up to date policies and procedures available. The manager explained that they were at home being revised. Environmental risk assessments were not in place. The manager was clearly dedicated to residents. However the amount of time that she was spending working shifts as a nurse was having a negative impact on her management and administrative duties that she was responsible for as the registered manager. Care Homes for Older People Page 26 of 34 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 38 23 The premises must be kept in a good state of repair. This will ensure that people are safe. 28/02/2009 Care Homes for Older People Page 27 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 1 9 13 The registered person must 02/04/2009 make arrangements for safe handling and keeping of medicines in the care home. Creams must be stored safely at all times. This is for the health and safety of people living at the home. This requirement was met by the 2nd inspection visit. The registered person must 02/04/2009 ensure that all chemicals are securely stored and chemicals in use are not left unattended. This is for the protection of vulnerable people living at the home. This requirement was met by the second inspection visit. 2 19 13 3 19 13 The registered person must complete a written risk assessments concerning the use of window restrictors. Window restrictors must be in place where potential risk is identified to vulnerable people living at the home. This is for the protection of vulnerable people living at the home. This requirement was met by the second inspection visit. 02/04/2009 4 19 23 The registered person must 02/04/2009 Page 28 of 34 Care Homes for Older People 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 ensure that all fire doors can be quickly opened at all times in the event of an emergency, and all staff are aware how this is done. This is for the protection of people living at the home and staff. This requirement was met by the second inspection visit. 5 25 23 The registered person must ensure that all areas of the home are suitably heated, including the conservatory area. This is to ensure that all communal areas are safe and comfortable for people to use at all times. This requirement was met by the second inspection visit. 02/04/2009 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 23 There must be a system of regular checks on fire systems and equipment. This must be kept up to date. 30/04/2009 Care Homes for Older People Page 29 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 This is to ensure that people are protected from risk of fire. 2 19 23 Internal doors within the building must not be locked at night to prevent people wandering around the communal areas of the home. There must be a risk assessment of the environment and action taken to minimise any risks identified, including the stairs. The risk assessment and any action taken must be provided to CSCI by the timescale given. This is to ensure the health and safety of people living at the home, whilst minimising restrictions of the communal area. 3 19 23 The registered person must 18/05/2009 ensure that the home is well decorated and maintained. They must provide a written programme of maintenance and redecoration to CSCI with timescales that should be met. The timescale given is for the written programme to be provided to CSCI. 18/05/2009 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 This is to ensure that people live in a safe and comfortable environment. 4 30 18 All staff providing care must 20/07/2009 have up to date training in all mandatory courses including moving and handling, fire safety, first aid, safeguarding adults, food safety, infection control as well as dementia care training. This is to ensure that they have the knowledge and skills to provide safe, good quality care. The registered person must ensure that all confidential records are kept secure at all times. This is for for the privacy of residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 5 37 17 30/04/2009 1 1 The statement of purpose provided for each person should be revised to ensure that it gives people fully accurate information. Peoples care plans and other records should be up to date, regularly reviewed and in sufficient detail to ensure that staff have the guidance to follow when providing care for 2 7 Care Homes for Older People Page 31 of 34 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 individuals. 3 9 Where medication states an optional dose, the dose administered should always be recorded to ensure safe administration practice. The handwritten medication administration records should be legible to minimise the risk of errors occurring. When a person leaves the care home, there should be safe systems in place to ensure that they can take their medication whilst they are away. This is to ensure that people have access to their medication when needed. All notices in communal areas that breach confidentiality or may be offensive should be removed.This is to respect peoples privacy and dignity. Any orientation tools used should be accurate and up-todate to minimise the risk of confusion for residents. Staff should be deployed in the best way at lunchtime to ensure that people receive their meal together if they choose, without the need for unnecessary delays, and residents receiving warmed up meals. The menu for the day, including choices should be displayed, so that people can be reminded of the meals being provided. All staff should receive training, including refresher training in safeguarding adults, to ensure that they have up to date information to protect people. The registered person should have all communal areas, in particular all bathrooms and toilets, assessed for handrails and other assistance for people with poor mobility. These should be put in place where necessary to promote peoples independence and safety. There should be privacy locks on all bathroom and toilet areas to respect peoples privacy and dignity. All furniture should be reviewed. Any furniture that is damaged should be repaired or replaced. This is to ensure that people live in a safe, comfortable environment. The foot pedals on the clinical waste bins should be operational to ensure infection control measures are in place. Page 32 of 34 4 5 9 9 6 10 7 8 12 15 9 15 10 18 11 21 12 13 21 24 14 26 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 15 26 The registered person should take action to ensure that all smells of urine are eliminated from the home. This is to ensure that people live in a comfortable, clean environment. There should be enough nursing staff available to work so that the registered owner does not have to work a high number of nursing shifts. The registered owner can then complete her managerial duties and responsibilities. The registered manager should commence and complete a recognised management qualification so that she has the required qualification to manage a care home. The registered person should establish and maintain a system for reviewing and improving the quality of care using effective quality assurance and quality monitoring systems. Staff should recieve formal 1 to 1 supervision on a regular basis, This supervision should be recorded.This is to ensure that all staff have their work monitored and have the opportunity to discuss their work and career development needs. The registered person should ensure that they have a system so that regular servicing takes place of boilers and central heating systems to ensure peoples safety. The registered person should ensure that general risk assessments are in place concerning the environment, taking into account the vulnerability of people living at the home. 16 27 17 31 18 33 19 36 20 38 21 38 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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