Inspection on 08/06/09 for Westhampnett Nursing Home

This inspection was carried out on 8th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westhampnett Nursing Home 06/06/07

Westhampnett Nursing Home 06/02/06

Westhampnett Nursing Home 07/06/05

Westhampnett Nursing Home 30/09/04

Westhampnett Nursing Home 10/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westhampnett Nursing Home Westhampnett House Westhampnett Road Chichester West Sussex PO18 0NT     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: Val Sevier     Date: 0 8 0 6 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 32 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 32 Information about the care home Name of care home: Address: Westhampnett Nursing Home Westhampnett House Westhampnett Road Chichester West Sussex PO18 0NT 01243782986 01243778935 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Philip Norman Davis,Mrs Mary Davis care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Westhampnett Nursing Home is a care home registered to provide nursing care for up to 32 older people. It is a two storey listed Georgian building located in Westhampnett Village, which is situated on the outskirts of Chichester, West Sussex. The building has been thoughtfully converted to ensure the original features remain. Accommodation is provided on two floors, serviced by a passenger lift. There are 24 single and 4 double rooms. Large landscaped and beautifully kept gardens surround the property. These are accessible to the residents and seating is available. The current fees being charged Care Homes for Older People Page 4 of 32 Brief description of the care home by the home are: from #625 to #750 for a single room and #850 to #900 for a double room. Care Homes for Older People Page 5 of 32 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 this service 1 star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 8th June 2009 between the hours of 10:00 am and 5:25 pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in June 2007. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by Care Homes for Older People Page 6 of 32 the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is meeting the needs of people who live at the home. The registered manager was present throughout our visit and the registered provider came in briefly to see us while we there. We met with three staff, two visitors and there were three people who use the service involved in the inspection visit. We have sent ten surveys to staff, people who use the service and five to other professionals. At the time of writing the draft report we have had three surveys returned. We looked at four pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. What the care home does well: What has improved since the last inspection? What they could do better: Pre admission assessments must be carried out for all prospective users of the service to ensure that the home can meet their needs. Care plans must detail the care and support needs for individuals where support has been identified, so that staff are aware of what they need to do for people who live at the home. The management and administration of medication for those unable to do this for themselves, must be robust to ensure that people receive their prescribed medication safely and in a timely manner. Where individuals wish to manage and administer their own medication an assessment must be undertaken. The procedure for recruiting staff must ensure that there are CRB, POVA first and references before employment commences, to protect those people that live at the home. Care Homes for Older People Page 8 of 32 Staff must receive training in mandatory areas such as manual handling, fire, first aid, COSHH and food hygiene. They must also receive training in areas where it has been identified that they need to support a specific individual need such as diabetes or stroke. Fire safety training and checks must be carried out to protect those that work and live at the home. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can not always be assured that their needs will be assessed and documented before they agree to an admission. Evidence: The AQAA from the home stated that: Trained Qualified nurses visit prospective service users in their own homes or in hospital and do detailed assessments of those individuals, involving the patient and his her family or representative and any relevant health care professional prior to admission to this home. We allow a trial period of six weeks for new patients to decide if they want to stay. The registered service providers give each service user a contract or Statement of Terms and Conditions of living here after a six week trial period. We looked at four pre admission assessments for people who have moved into the home since January 2009. We found that two assessments had been fully completed Care Homes for Older People Page 11 of 32 Evidence: stating medical history, current needs and information on how staff could meet those needs; for example: preferred name, can see clearly with glasses, eye drops to be administered as has dry eyes. Likes to have meals in own room, prefers female staff, physio involved. They had been signed and dated by the registered manager who had carried out the assessments. The second two assessments we saw had information on the front page only, the document has six pages to be completed which includes not applicable or able to do this, which enables staff to begin to understand the needs and support that is required for each individual. These assessments had not been signed or dated. We discussed these assessments with the manager at the time of the visit. He said that one person was known to the home as they had been in for short stays previously, to enable their pain relief to be reviewed. He agreed that the assessment should have been completed again as the needs may have changed. The manager called a nurse into the office whilst we were there and spoke to them about their assessment of the individual concerned, he asked them to complete the assessment before they went home that day. The individual had been admitted to the home in May 2009. The manager undertook to speak with another nurse who had carried out the other assessment to ask them to complete it. This individual had also been admitted to the home in May 2009. Two people who use the service and a relative commented that they had been given information prior to coming to the home and that the information was sufficient to help them decide if the home was right for them. Intermediate care is not offered at the home. Care Homes for Older People Page 12 of 32 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. The records and systems within the home do not always ensure that the personal and health care needs of people who use the service are met safely and effectively. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The AQAA for the home stated that they have: Individual risk assessments and care plans for the prevention of falls and prevention of pressure sores. All other care planning necessary for individual patients. Promotion of continence and good management of incontinence. Ensure that patients have access to GPs and specialist nursing, dental, pharmaceutical, chiropody and therapeutic services. Follow robust policies and procedures for the ordering, receipt, recording, storage, administration and disposal of medicines including Controlled Drugs. Give full consideration and respect to patients privacy, dignity and choice at all times. Care Homes for Older People Page 13 of 32 Evidence: The four care plans seen had information on individual aspects of health, personal and social care, detailing the action needed to be taken by staff, whilst ensuring that people are supported to retain individual levels of independence. For example it is stated that someone has difficulty sleeping. Also interventions stated includes ensure comfort heat / cool, call bell, bed rails if, disagrees dont use. Also phrases such as able wash their faces and hands. The manager informed us of care needs for two individuals including oxygen therapy and the need for medication for pain relief and we noted that there were not any care plans for these needs to be met. We saw in the pre admission assessment and the care plan, that one individual had been receiving physiotherapy support to assist with mobility and that this was recorded as taking place weekly until April 2009. The care plan did not indicate a change was needed. We asked the manager about this as we read that the individual had had a fall in April. The manager stated that the person was to receive an assessment for further support from a physio that visits the home, and undertook to update the care plan. The home has a number of ways of reviewing care plans, which includes a formal bi monthly review and daily progress reviews. The manager said that the home does not routinely do a complete care plan review monthly but changes to the care plan are made as and when needed in between the bi monthly review if a person needs change. Other tools used to review and assess needs for example Waterlow, are done at the beginning of the month. Individual risk assessments were observed to be in place for prevention of falls and pressure areas, with identified risk and action to be taken to lessen those risks. We saw documented evidence of visits from GPs and other specialist medical services. An area identified for improvement by the manager in the AQAA returned to the commission, is to increase the involvement of people living at the home and their relatives in care planning and review the plan monthly. We noted that this area for improvement by the home was also mentioned in their AQAA returned to the commission before the last visit in 2007. We saw that in the surveys returned to us that people who use the service said in two cases that they usually receive the care and support they need, and all three said that staff are usually available when they need them and listen and act on what they say. Staff are very caring but also professional. The ethos seems to be to encourage Care Homes for Older People Page 14 of 32 Evidence: as much independence as possible and to make ones own decisions. A doctor comes to the home every Thursday and patients own doctor comes when asked. People involved in the inspection commented that they were happy at the home, and felt listened to, we saw that people being cared for in bed were covered and dressed either in night wear or day clothes. The home had written policies and procedures for the management and administration of medication. Medication was kept in locked and secured in three medicine trolleys, a clinic room and where required in a medical refrigerator. We saw a list of specimen signatures of staff that handle medication which the manager stated is updated yearly. The medication records we saw on this occasion were dated between 1st June 2009 and 8th June 2009. We saw that the medication administration records (MAR) had a photo for each individual person. The manager told us that he types the MAR sheets up each month and makes changes as needed to ensure that the staff have up to date information. We looked at one trolley and saw that each individual has a container with their medication in it. The qualified nurses administer the medication by taking the trolley to the persons room, taking the medication from the original container into a medicine pot, going into the room and handing the pot to the person. Where necessary they assist the individual in taking the medication. Medication that is in liquid form is taken to the person from the trolley and dispensed via a spoon. We saw that for as required medication there was no record of how the nurse came to the decision to give the medication, and its effect. The manager said that this is recorded in the progress record; evidence of this was not seen. We saw that there were crosses X in the medication records indicating according to the key the home uses, that medication had not been given. We saw that in several cases the medication was to be given regularly at prescribed times not as required. The manager said that the qualified nursing staff had assessed that these medications were not needed or had been refused in the past. The manager said he would have these medications reviewed. We also saw that for some people medication was to be given at specified frequencies such as twice a day and that the medication was given once a day. We saw that for one person one of their medicines had been recorded as out of stock since the 1st June 2009 and is prescribed to be administered three times a day. We spoke to the manager about this and he said that medication is ordered monthly for the home two weeks before the end of the month the problem had been with the chemist and supply. He spoke to the chemist whilst we were at the home and assured that the medication would be at the home that day. Care Homes for Older People Page 15 of 32 Evidence: One person living at the home told us that they have their own inhalers to use as needed. They were not aware of any assessment about this. The manager told us that there is currently no risk assessment to support individuals to manage some or all of their medication. The manager said that occasionally an agency nurse may be used to work a night duty at the home. They are asked to come in an hour early so that they can be verbally told about medication and other procedures at the home, shown round and told where things are. Following the visit to the home Mr Gilarty has written to us advising us of the work he has already undertaken. This includes updating care plans and seeking support from the GP regarding the medication. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said: Provide good quality, nutritious food which is prepared and served under required regulatory standards. We provide meals suitable to meet the dietary needs of patients e.g. meals for diet controlled diabetics, vegetarians. Relatives are free to dine with patients at no extra cost. These occasions create good opportunities for patients and relatives to socialise, and for relatives to see and taste the quality of that patients get. Every room is supplied with a T.V. and telephone unless patients or their relatives instruct us otherwise. The home ensures that daily and or weekend newspapers and magazines of individual patients choice are delivered here. The home operates an open visiting policy i.e. patients are able to receive visitors at any reasonable time. A travelling library supplies books for patients who want them. A music afternoon is held once twice a month. While we do encourage Care Homes for Older People Page 17 of 32 Evidence: patients to attend, we respect their right to refuse to attend or to choose not to attend. Patients birthday celebrations are organised by staff if needed. Special occasions e.g. Easter and Christmas are observed with relevant celebrations and service users and their family attending. We noted that at our last visit the home said that they could improve by having more social events at the home their AQAA this time said the same; More regular social events which service users and their family could attend. We saw on some of the care plans that individual interests had been recorded such as walking and gardening. We did not see on the care plans how interests were supported to be continued. A couple who live at the home have separate rooms and have been supported to share meals and leisure time together. Another individual has both a bedroom and a small lounge next to their room where they have a television and telephone; they choose to have their meals there. Whilst they enjoy this they said the meals were sometimes cooler than they liked. We saw comments in surveys about activities, social events and the food. The home remembers birthdays including a card and a cake is baked for them, decorations are put up at Christmas and beautiful presents from Father Christmas to each patient, a little less food. Someone was celebrating a birthday on the day of the visit and we saw a birthday cake being shared with everyone at the home with afternoon tea. Staff said that the menu is written daily and people living at the home choose what they would like from that menu or they are able to ask for anything else. The home does soften all or part of a meal for people who have difficulty. We saw that people had chosen a variety of foods for supper on the day of the visit, soup and a choice of brown or white bread, curry, bacon and scrambled egg, varied sandwiches followed by strawberry jelly, mandarins and cream, ice cream and sponge fingers, yogurt flavoured and plain with honey and fruit. Visitors said they felt welcomed at anytime and were able to have meals with their relatives if they wished. Care Homes for Older People Page 18 of 32 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. The complaints procedure enables those people using the service to know that any complaints will be taken seriously and responded to. However people living at the home would be better safe guarded if staff received training in safe guarding adults protocols. Evidence: The AQAA for the home stated that: Listen to, record and follow up complaints so that they are dealt with within a maximum of 28 days. Ensure that each patient and his her family have access to the homes complaints procedure. Liaise with patients next of kin, power of attorneys, where necessary to ensure service users protection. Respond to suspicion or evidence of abuse. We encourage whistle blowing. We do not get involved in witnessing service users wills being drawn up, in assisting in the making of or benefiting from service users wills. The home has complaints procedure, which is outlined in the Statement of Purpose and Service User Guide and on display in a number of places around the home including on a notice board above the visitors signing in book. It includes the timescale of response and the address of CQC. Comments received by us concerned communication failure at times and that the home could ensure that all staff have a good command of English. An anonymous Care Homes for Older People Page 19 of 32 Evidence: feedback included that person wrote; Occasionally I get bullied (perhaps I deserve it) by two staff members. This individual had stated that they wished to speak with an inspector however they had not included their name or contact details to enable us to do so. People said they know how to make a complaint and who to speak to if they were not happy. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. The manager has identified as an area for improvement in the AQAA that they could Organise more training for staff in Safeguarding vulnerable adults. We note that this was an area of improvement identified by the manager before our last visit in 2007. We saw six staff files with certificates regarding training they have received, we saw that two staff had had attended training in the protection of vulnerable adults in 2007 one in 2008. Staff said they would speak to the manager if they suspected or saw anything regarding patient care that they were not happy about. The AQAA for the home stated that the plans for the next twelve months are: To ensure that all staff receive and familiarise themselves with the policies on whistle blowing, service users wills etc. Patient satisfaction surveys to include their views on how we deal with complaints. It is our intention to incorporate useful suggestions into our procedure for handling complaints. To ensure staff training in Safeguarding Vulnerable Adults is upgraded annually. More staff to be trained in risk assessment management. Care Homes for Older People Page 20 of 32 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. The home is clean, well maintained and offers people a comfortable, pleasant, environment to live in. Evidence: The AQAA for the home stated that: The home and the grounds it is set in, are well maintained. The home has a designated Fire Officer who does fire risk assessments for the home and fire safety training for staff. Toileting and bathing facilities are sufficient for the number of users the home is registered to accommodate. Most rooms; 18 out of 28, have ensuite toilet, 2 rooms have ensuite baths and one room has a walk in shower. There are 3 communal bathrooms and five communal toilets, plus staff and visitors toilets. We use Hoists, Rota-Stands, Stand-Aid, Sliding Sheets and Turntables where necessary to move, handle and transfer patients. The home has grab rails and we provide Zimmer frames, rollators and sticks to aid mobility for patients. The home is kept clean and fresh. Good infection control practices are applied. Infection control measures were in place. Alcohol hand gel and antibacterial soap dispensers are provided in rooms. There was a supply of gloves and aprons present in each residents bathroom, communal bathrooms and toilets. People living at the home spoken with during the visit were pleased with the accommodation provided and pointed out what ornaments, pictures and small pieces of furniture, which they had Care Homes for Older People Page 21 of 32 Evidence: brought to the home. Comments received said that the home usually is clean and fresh. Staff commented that there is always decorating happening and that the home is kept clean. Care Homes for Older People Page 22 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have not received the mandatory training that is expected each year, and it was not clear that staff have received training to meet all the needs of people who use the service. The lack of checks in the current recruitment process places people who use the service at risk. Evidence: The AQAA for the home stated: Continue to get tissue viability training for staff. NOTE Infection Control training update booked for all nursing care staff and some domestic staff will be completed by end of May 2009. What we do well: provide adequate staffing levels for the needs of our patients. Each staff recruited has had a POVA check, CRB check, and each has two written references. All care staff have been issued with the GSCC Code of Practice. Each staff who qualifies for a contract has one. How we have improved over the last twelve months: One member of staff has achieved her NVQ Level 2, and one her NVQ Level 3 in Health and Social Care. One member of staff who has NVQ Internal Assessors Qualification continues to assist with NVQ training in the home, will also soon commence their NVQ Level 4. Staff training done include Food Hygiene and Handling, Moving and handling of Patients, Continence Care, Care Homes for Older People Page 23 of 32 Evidence: Tissue Viability, Safeguarding Vulnerable Adults. We looked at the staff rota displayed and whilst looking at recruitment we saw rotas for September 2008 and December 2008. The same names were seen on these rotas. The staff pattern seemed to be consistent with the information given in the homes AQAA. People who use the service and relatives commented on what they saw as shortages of staff saying that other staff seem to come in and help. That staff sometimes seem tired. On the day of the visit staff were unable to confirm training undertaken. Training records for staff consist of a file with plastic wallets with copies of certificates of what they have done. The manager said he monitors training needs by checking and rechecking the file. We looked at six staff wallets, and saw certificates for one staff for basic life support that was dated 18th March 2008 and which was deemed to run out on 17th March 2009. We saw that three certificates for moving and handling had run out, two staff had undertaken moving and handling in February 2009 and there was no evidence that the other staff member had training in moving and handling. We could not see evidence that supported the statement in the AQAA of training staff had done. We did not see evidence of training that had been booked. We saw four staff files of people who had been employed since our last visit to the home in June 2007. All staff had checks regarding their suitability and safety to work in the home, these checks included references, POVA First and CRB checks. For one there was a verbal reference and one written reference the manager said a written reference had been requested. One member of staff was seen to have had their checks carried out over a period of time for example references were dated September 2008 and the rota supported that this was the month they were working. The POVA First was not on record for that time. We asked the manager to clarify this. He said that he had obtained both the POVA First and the CRB for that period however he could not find it and thought he may have destroyed it. He explained that the person did not continue to work at the home until more recently. We saw from the rota that the staff member had worked from December 2008 and the POVA First on record is dated 22nd January 2009 and the CRB 23rd February 2009. The information was kept in files in a locked cabinet in the office, and could only be accessed by the home manager or registered provider. Care Homes for Older People Page 24 of 32 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. The lack of good management practices in significant areas such pre admission assessments, current medication administration and recording, recruitment practices, and fire safety and training place people who use the service at risk. In addition the lack of clear training records, and plans for staff training to meet the needs of individuals and to protect the health and welfare of staff and people who use the service, place all at risk. Evidence: The certificate of registration for the home was displayed in the hallway and was seen to relate to the statement of purpose. The registered manager, Ignatius Gilarty is a qualified nurse, holds a BSc in Health and Social Care and an N.V.Q level 4 in Health and Social Care. He has managed the home Care Homes for Older People Page 25 of 32 Evidence: for several years. The registered providers are Mr and Mrs Davis. Mrs Davis communicates with the commission and came to the home whilst we were there. The AQAA for the home stated that: The home is managed in an open and transparent way. Service Users are encouraged to keep and handle manage their own money where practical. Any money that the home keeps for a patient is done so at that persons or their familys request, and is kept securely and well accounted for. Service Users have access to their own records. Fire Safety, Food Safety and Hygiene, COSHH Risk Assessments, and Health and Safety are all part of training that staff receive; though not every member of staff has done training in each of these areas in the last 12 months. The home plans for the next twelve months include: Continue with users satisfaction surveys but also to extend the use of these to other health & social care professionals and first time visitors; in order to help incorporate users views into our service where practical possible. Where possible, involve Users more in the planning and review evaluation of their care. Ensure that more staff are aware of and familiar with important policies especially those relating to their specific roles within the organisation. Staff training and development Do more staff training at NVQ Levels 2 and 3 in Health and Social Care. Continue developing individual staff training and assessment profiles for each member of staff and do more training updates in: Infection Control, Food Hygiene & Handling, Safeguarding Vulnerable Adults, Moving & Handling patients, Communication. Keep regular staff meetings. We saw on staff files that supervision had taken place although this was not regular. The home does not manage peoples monies. The home has a designated member of staff who is the appointed Fire Officer. This person spoke with the inspector about the fire risk assessments, which she had carried out and the fire safety training which she ensures staff undertake. We looked at the fire procedures, risk assessments and safety checks we saw that the records stated the date the emergency lighting had been tested was 9th March 2009 with call points 22nd August 2008. Both the manager and the fire officer looked for the records regarding call points as they both said these had been carried out. No records could be found at the time of our visit. There had been a fire drill in March 2009 attended by twelve staff. The records of regular fire training indicated that night staff had not had regular training in fire safety. The manager asked the fire officer about this at the time. Care Homes for Older People Page 26 of 32 Care Homes for Older People Page 27 of 32 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 28 of 32 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 3 14 14 Sch 3 (1)(a) The registered manager must ensure that all prospective users of the service receive an assessment to ensure that the home can meet their needs. This must be done to ensure that the person receives the right service to meet their needs, safely. 06/07/2009 2 9 13 13(2) The registered person 06/07/2009 must ensure that a record is kept of why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 3 9 13 13 (2) The registered person must ensure that prescribed medication is always 06/07/2009 Care Homes for Older People Page 29 of 32 available for the individuals living at the home. This must be done to ensure that individuals living at the home receive the prescribed medication 4 9 13 13 (2) The registered person must ensure that medication is administered at the times and in the amount that it has been prescribed, or are reviewed to ensure appropriate medication is given. This must be done to ensure that individuals living at the home receive the prescribed medication 5 18 13 13 (6) The registered person must ensure that staff receive training in safeguarding adults. Staff must receive training in safeguarding adults in order to protect the individuals living at the home. 6 38 23 23 (4) (a)(iv)(v) 06/07/2009 The registred person must consult with county fire officer to ensure that fire equipment is checked as per Fire Safety Guidance and that records are kept of the checks. 31/08/2009 06/07/2009 Care Homes for Older People Page 30 of 32 This must be done to protect the people living at the home. 7 38 23 23 (4)(d) 10/08/2009 The registered person must ensure that staff receive training in fire safety to protect staff and people who live at the home. This must be done to protect the people living at the home. 8 38 13 13 (4) 10/08/2009 The registered person must ensure that there are sufficient staff that have had training in first aid on each shift at the home. This must be done to protect the people living at the home. 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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