Inspection on 02/09/09 for Whittington Village

This inspection was carried out on 2nd September 2009.

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

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

Other inspections for this house

Whittington Village 22/10/08

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 09/06/2011.

Key inspection report Care homes for older people Name: Address: Whittington Village 119 Handley Road New Whittington Chesterfield Derbyshire S43 2EF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rose Moffatt     Date: 0 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 35 Information about the care home Name of care home: Address: Whittington Village 119 Handley Road New Whittington Chesterfield Derbyshire S43 2EF 01246455000 01246453018 bridgethodgkinson@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Whittington Village Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered provider may provide the following category of service only:- Care Home - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older Persons Code OP Date of last inspection Brief description of the care home Whittington Village provides personal care for up to 18 older people. It is situated on the main road in New Whittington, on the outskirts of Chesterfield. The home is a detached house that has been extended. The majority of the bedrooms are single with en-suite facilities. The home is set back from the road and has a patio/garden area at the rear. Local amenities, including a post office, shop and pub are located nearby. Fees at the home range from £344.82 to £452.88 per week. This information was provided by the acting manager on 2nd September 2009.. Care Homes for Older People Page 4 of 35 Over 65 18 0 2 4 1 0 2 0 0 8 Brief description of the care home Information about the home, including CSCI inspection reports, is available in the main entrance area of the home, or from the acting manager. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use the service experience poor quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The previous key inspection of this service was on 22nd October 2008. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us Care Homes for Older People Page 6 of 35 about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. The home went into administration on 11th August 2009. The administrators are involved in the day to day management of the home and are providing support to the acting manager and staff. We carried out an unannounced inspection visit that took place over 7 hours on 2nd September 2009. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 7 completed responses, 6 of these completed with help from staff. We sent out 5 surveys to staff employed at the home and received 3 completed responses. There were 9 people accommodated in the home on the day of this inspection visit. People who live in the home and staff were spoken with during the visit. Some people 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. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 3 people were selected and the quality of the care they received was assessed by speaking to them and / or observation, reading their records, and talking to staff. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Ensure that care plans have sufficient detail of individual needs and preferences to ensure care is delivered in a person centred way. Ensure that people, or their representatives, are always actively involved in planning their care. Provide people with lifestyle opportunities that match their expectations and preferences and satisfy their social, cultural, religious and recreational interests. Employ a suitably qualified and experienced cook so that there is a more structured approach to menu planning. This will ensure that people are offered a suitable range and variety of meals to meet their preferences and expectations. Ensure that staff are fully conversant with recognised safeguarding procedures and ensure that these are always followed where necessary. Keep the home in a good state of repair, and address all items noted in the Environment section of this report. This will ensure that people have a safe and pleasant home environment. Ensure there are effective infection control systems and procedures operated that comply with recognised guidance, including the Department of Health Infection Control Guidance for Care Homes, and by staff that are conversant with these and competent in their application. This will promote the health and safety of people in the home. Ensure a robust recruitment system with all the required documents and information in place for all staff. This will protect people living in the home. Ensure that all staff have relevant training to enable them to carry out their roles effectively and safely. This will help to promote the health and safety of people in the home and ensure their needs are met. Care Homes for Older People Page 8 of 35 Ensure compliance with all relevant health and safety legislation. This will ensure people in the home live in a safe environment. Develop policies and procedures to address how the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards will be implemented in the home. Ensure that staff are conversant with their role and responsibilities regarding these. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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 had sufficient information about the home and their needs appeared to be met. However, the lack of detail in care plans did not ensure effective and consistent delivery of care according to the persons needs and wishes. Evidence: At our last inspection in October 2008 we found that people had access to sufficient information about the home and were confident that the home could meet their needs. The Statement of Purpose had not been updated to have correct information about the ownership of the home. At this inspection, we found that the Statement of Purpose had been updated and included the required information. However, the details of the registered provider and the contact details for CQC were incorrect. We looked at the records of 3 people living in the home. All had an assessment of Care Homes for Older People Page 11 of 35 Evidence: their needs carried out by social services staff prior to admission to the home. 2 people had very brief assessments of their needs by staff at the home prior to admission. As noted in the Health and Personal Care section of this report, the care plans produced from the assessment of individual needs lacked detail of the persons needs and preferences. The admission procedures did not include any reference to the persons capacity to make decisions. New documentation for care plans had been introduced and this included an assessment of the persons capacity to make decisions. However, none of these had been completed. The relevant codes of practice relating to the Mental Capacity Act 2005 were not available in the home. Staff had not received training about the Mental Capacity Act 2005 and its implications for people living in the home. People told us they usually received the care and support they needed. We observed that peoples needs appeared to be met, although people told us they would like more activities to be provided. We found that when there was a change in peoples needs, they were appropriately reviewed. Standard 6 did not apply as there were no people receiving intermediate care in the home. Care Homes for Older People Page 12 of 35 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 approach to care planning was not person centred as care plans had insufficient detail and people were not actively involved in planning their care. Evidence: At our last inspection in October 2008 we found that people were not fully involved and consulted about their needs and preferences, and that some people did not have care plans in place. We made a requirement that all people in the home must have a care plan in place that showed how their needs were to be met at the home. At this inspection we found that new care plans had been introduced. We looked at the care plans of 3 people. 1 had not been fully completed in the new format, though there was an existing care plan in place in the old format. The care plans in the new format lacked detail about the persons needs and preferences. There was no evidence that the person, or their representative, had been involved in planning their care. The care plans seen had not been reviewed since June 2009. The requirement made at the previous inspection had been met as each person had a Care Homes for Older People Page 13 of 35 Evidence: care plan in place. However, as the care plans were brief with very little detail of the persons needs and preferences, we issued a serious concerns letter to the administrators following this inspection requiring them to take action to urgently address this issue. We found assessments of each persons mental and physical health, their nutritional needs, risk of developing pressure sores, and the assistance required with mobility. We found that these assessments were repeated in different formats. This was potentially confusing for staff, an unnecessary repetition of information, and showed a lack of understanding of the use and purpose of the assessments. None of the assessments seen had been reviewed since June 2009. We saw that peoples weight was monitored and records kept. However, we were told that the sit-on scales had been taken to a sister care home and so people at Whittington Village had not been weighed for approximately 2 months. The scales were returned to the home two days after the inspection visit and the weights of most people in the home were recorded. There were records of the input of the GP, District Nurse, chiropodist and optician. People appeared to be referred promptly to the GP when necessary. The acting manager said she was trying to find a local dentist to visit people in the home. As noted at our last inspection, medication was stored in a trolley and a large cupboard in the main lounge / dining room which detracted from the domestic style of this room. There were satisfactory records of the receipt, administration and disposal of medication. Staff had received appropriate training, though there were no records of assessments of their competence in the safe-handling and administration of medication. There were insufficient details in care plans about medication to be given as required. The care plans we looked at lacked details of how staff should ensure and promote peoples dignity and privacy. We observed that staff had a friendly and appropriate approach to people in the home. We saw that staff knocked on doors before entering and ensured that toilet doors were closed when in use. People told us they usually received the care and support they needed. They said they always had the medical care they needed. They said that staff usually listened to them and acted on what they said. They said staff look after me very well, and said that staff were friendly and kind. Care Homes for Older People Page 14 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines were generally flexible around the needs and preferences of people in the home. The activities and meals provided did not always meet the preferences and expectations of people in the home. Evidence: At our last inspection in October 2008 we found that there were reasonably flexible routines and suitable activities were provided. We made a recommendation that the range of activities should be further developed. At this inspection people told us they could follow their preferred routines, such as getting up and going to bed when they wanted to. The care plans we looked at had very little information about each persons preferences regarding their daily routines. People who wanted to smoke were allowed to do so in one of the lounges. However, as noted in the Management and Administration section of this report, the home was not fully complying with smoke-free legislation. Care Homes for Older People Page 15 of 35 Evidence: We found no change to the range of activities offered since the last inspection. People told us they enjoyed playing dominoes, watching television and listening to music. They said there were usually activities offered that they could take part in, though they would like to go out more often. Most people ate their meals in the main dining area. This was clean, though the carpet appeared stained and marked. People told us they usually enjoyed the meals, though some people said they did not always like the choices available. We observed that people were helped appropriately by staff at lunchtime. There was no menu displayed in the dining room. As at the previous inspection, care staff were planning the days menu and preparing the meals as there was no cook employed at the home. We found an unstructured approach to menu planning that did not always ensure a good variety and choice of meals. People in the home were regularly consulted about the meals provided through meetings and surveys. Care Homes for Older People Page 16 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures were not always correctly followed so that people were put at risk. Evidence: At our last inspection in October 2008 we found that there were satisfactory policies in place and good staff awareness so that people were protected and appropriate action taken to address any complaints. We made a recommendation that any complaints raised at meetings for people in the home should be recorded with details of the action taken and the outcome. At this inspection we found that there were no complaints recorded. There was a complaints book in the main entrance area. This still had the previous name of the home. The acting manager told us that the complaints procedure was usually displayed in the main entrance area, but had been removed as this area was being redecorated. The complaints procedure seen in the Service User Guide did not have the correct details for CQC. No complaints about the home had been received by CQC/CSCI since the previous inspection. All except one of the staff had received training in May 2008 about safeguarding vulnerable adults. There were suitable policies and procedures in place. None of the staff had received training about the Mental Capacity Act 2005 and the Deprivation of Care Homes for Older People Page 17 of 35 Evidence: Liberty Safeguards. We found two incidents of alleged abuse where the correct procedures had not been followed. People told us they knew who to speak to informally if they were not happy and most people knew how to make a formal complaint. We saw that people were asked at meetings if they had any complaints. As noted in the Staffing section of this report, there were gaps in the recruitment procedures that could put people in the home at risk. As noted in the Management and Administration section of this report, there were health and safety issues that put people in the home at risk. Also, we found there was a lack of clarity about the arrangements for the management of personal money for 2 people in the home. Care Homes for Older People Page 18 of 35 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. Although some maintenance had been carried out, there were outstanding repairs and environmental health and safety issues that could put people at risk. Evidence: At our previous inspection in October 2008 we found that the home was clean and suitably equipped, but was not always well maintained. We made an immediate requirement for an action plan to be produced with details of the maintenance needed and the timescale by which this would be achieved. The action plan produced said that the maintenance and repairs would be completed by 31st December 2008. At this inspection we found that most of the work specified in the action plan had been completed. The outstanding work was to replace double-glazed windows in two bedrooms. We found other items of maintenance needed: the floor covering in the storage room next to the kitchen was in a poor condition; the skirting board in room 5 had been removed following a water leak and not replaced; the floor covering in the lower ground floor bedrooms en-suite bathroom was cracked. The window in bedroom 4 had leaked in recent bad weather and this was repaired the day after the inspection visit. Some areas of the home had been redecorated since the last inspection and the acting manager said further redecoration was planned. The decor in the main lounge/dining Care Homes for Older People Page 19 of 35 Evidence: room appeared tired and worn. There were 3 lounges and a dining area for use by people in the home. The lounges were comfortably furnished. As noted at the previous inspection, the main lounge/dining area had a large cupboard and a trolley used to store medication and this detracted from the domestic style and appearance of the room. People in the home were allowed to smoke in one lounge, although this did not comply with smokefree legislation. The Statement of Purpose did not include any details about smoking in the home. The bedrooms seen were clean and bright and were personalised with peoples own belongings, photographs and so on. The main lounge/dining room had doors opening onto a small patio area. This had garden furniture and a gazebo to provide shade. As noted at the previous inspection, this area looked bare with no plants or tubs. The patio was used as a staff smoking area and there was a bucket of discarded cigarette ends and other rubbish outside the lounge window. People told us the home was always clean and fresh. The acting manager said that staff had received training about infection control, but certificates for this had not been received and there was no record of this training. We found there were some issues with control of infection and food hygiene, including: the kitchen hand wash sink had no soap or paper towels; we found leftover food in the fridge not covered and not labeled with the date; both ground floor toilets used by people in the home had ordinary hand towels, rather than disposable paper towels. One of these toilets had no soap; the kitchen extractor fan appeared dirty and greasy. There were no records that this had been cleaned and it was not included on the cleaning schedules seen; there were no disposable aprons available for staff to use; we were told that soiled bedding and clothes were pre-washed by hand in the sluice sink in the laundry before going in the washing machine, even though the washing machine had a sluicing programme; the sluice sink in the laundry was used to clean commode pans, contrary to the Department of Health guidance on infection control. There were other health and safety concerns, as noted in the Management and Administration section of this report. Care Homes for Older People Page 20 of 35 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. There were gaps in staff recruitment procedures and staff training so that people were not fully protected. Evidence: At our previous inspection in October 2008 we found that staff recruitment, induction and training were not sufficiently robust to ensure people were always protected, and to ensure that staff were fully competent to give the care and support required. At this inspection people told us that staff were usually available when needed. We looked at the staff rotas for the home and found that the acting manager was now usually working supernumerary for 5 days per week. The care staff continued to do all the preparation of meals, as noted at the previous inspection, and so there were still times when only 1 care assistant was available to meet peoples needs. Staff told us the situation was better on the days when the acting manager was supernumerary, though their availablility to people in the home was still limited on the other days. We looked at the records of 3 members of staff. Since the previous inspection, all records now included a photograph of the member of staff. All 3 records included a Criminal Records Bureau (CRB) disclosure. There was no employment history for 1 member of staff and no reference from their last employer. As the requirement we made at the previous inspection regarding staff records had not been met, we issued a Care Homes for Older People Page 21 of 35 Evidence: serious concerns letter to the administrators following this inspection requiring them to take action to urgently address this issue. Nearly all of the care staff, 7 out of 8 staff excluding the acting manager, had acheived a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard of 50 of care staff with NVQ at level 2 or above. Although there was an induction programme that met Skills For Care standards, staff recruited since the previous inspection had not done this. Individual staff training records were kept, plus a training matrix to give an overview of staff training completed and planned. The training records showed that staff had not received any update training about manual handling since July 2007, and 1 newer member of staff had not had this training at all. 6 out of 9 staff had received fire safety training in February 2009. The requirement made at the previous inspection regarding fire safety training had not been fully met and so we issued a serious concerns letter to the administrators following this inspection requiring them to take action to urgently address this issue. Care Homes for Older People Page 22 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were gaps in records and lapses in procedures so that the health, safety and welfare of people in the home was not promoted and maintained. Evidence: At our previous inspection in October 2008 we found that there were gaps in records relating to personal care, staff, and health and safety. Also, the quality assurance system was not sufficiently developed to ensure the home was run in the best interests of people living there. We made requirements that equipment used for manual handling must be regularly serviced and maintained, that there must be a current Landlords Gas Safety certificate for the home, and that all fire safety equipment must be properly maintained. At this inspection we found that one of these requirements had been met as the fire safety equipment had been serviced in July 2009. Two other requirements had not been met and so we issued a serious concerns letter to the administrators following this inspection requiring them to take action to urgently address these issues. Care Homes for Older People Page 23 of 35 Evidence: We found other concerns regarding health and safety: no staff had received training since 2007 to update them about manual handling; there were no records of fire drills held in the home. This was a requirement at the previous inspection and had not been met. We made an immediate requirement for a fire drill to take place and to be properly recorded and this was complied with in the timescale allowed; accidents to people in the home were not always properly recorded and correct procedures were not always followed in reporting incidents to CQC and social services; the employers liability insurance had expired on 13/08/2009; the home did not comply with smokefree legislation; we found cleaning chemicals in an unlocked cupboard in a toilet used by people in the home; we saw that several fire doors were wedged open; the passenger lift had not been serviced since June 2007; there were infection control and food hygiene concerns as noted in the Environment section of this report At the previous inspection we found that the personal records of people in the home were not stored securely and we made a requirement regarding this. At this inspection we found that this had been partially complied with as most records had been moved to a locked filing cabinet. We made an immediate requirement for the remaining records to be moved and this was complied with in the timescale allowed. The acting manager had been in post for approximately 1 year, having previously worked as a senior care assistant at the home for about 2 years. She was working towards NVQ level 4 in care. She had not made an application to be registered with CQC. She was usually supernumerary for 5 days a week. This had improved since the previous inspection when she was supernumerary for 2 or 3 days per week. The home went into administration in August 2009. The administrators were involved in the day to day management of the home and were providing support to the acting manager and staff. The quality assurance system had not developed further since the previous inspection. There were regular surveys completed by people in the home, mostly with help from staff, and regular meetings for people to express their views and opinions. There was no analysis of completed surveys and no report of the findings. The acting manager said the providers representative made monthly visits as required by regulation 26. However, there was only 1 visit report available from July 2009. The acting manager told us that all except 2 people at the home managed their personal money or had relatives who did this for them. For 2 people, their personal allowance was sent directly to the provider and the acting manager requested money Care Homes for Older People Page 24 of 35 Evidence: on their behalf as required. The arrangements for managing this money were not clear so we issued a serious concerns letter to the administrators following this inspection requiring them to take action to urgently address this issue. Care Homes for Older People Page 25 of 35 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 29 19 Staff records must include all 30/10/2009 the required information and documents, specifically, a full employment history, two written references, and a recent photograph. This will ensure people are better protected by a more robust recruitment system. Previous timescale was 31 December 2008. This has not been met. A time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be taken. 2 30 23 All staff at the home must have training in fire prevention. This will help to protect people living in the home. Previous timescale was 31 December 2008. This has not been met. A time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be taken. 30/10/2009 3 38 23 There must be a current Landlords Gas Safety 30/10/2009 Care Homes for Older People Page 26 of 35 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 certificate available in the home. This will promote the safety of people living in the home. Previous timescale was 31 December 2008. This has not been met. A time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be taken. 4 38 23 All equipment used for the 30/10/2009 manual handling of people in the home must be regularly maintained and serviced. This will ensure compliance with relevant health and safety legislation and promote the safety of people in the home. Previous timescale was 31 December 2008. This has not been met. A time extension has been given. If this extended timescale to meet this requirement is not met, enforcement action will be taken. Care Homes for Older People Page 27 of 35 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 37 17 All records relating to the 04/09/2009 personal care of people living in the home must be kept securely. This will ensure personal information is kept confidentially. 2 38 23 Fire drills must be carried out 04/09/2009 at the home at suitable intervals as advised by the local fire and rescue service. This will promote the safety of people living in the home. 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 7 15 Each person in the home 30/11/2009 must have a care plan that details how their personal and healthcare needs will be met, and the care plan must be produced after consultation with the person, or their representative. This will ensure a more person centred approach so that peoples individual Care Homes for Older People Page 28 of 35 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 needs and preferences are met. 2 18 13 The agreed local multi30/09/2009 agency procedures must be followed for all allegations of abuse of people in the home. This will protect people and ensure effective action is taken to prevent further abuse. 3 19 23 The home must be kept in a good state of repair, and all items noted in the Environment section of this report must be addressed. This will ensure that people have a safe and pleasant home environment. 4 25 13 There must be effective 30/11/2009 infection control systems and procedures operated that comply with recognised guidance, including the Department of Health Infection Control Guidance for Care Homes, and by staff that are conversant with these and competent in their application. This will ensure that people in the home are protected. 30/11/2009 Care Homes for Older People Page 29 of 35 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 5 30 13 All staff in the home must have up to date training in manual handling from a suitably qualified and experienced person. This will ensure that the health and safety of people in the home is promoted. 31/12/2009 6 31 8 If the acting manager 31/12/2009 continues to manage the home, they must submit an application for registration to the Commission. This will ensure that they do not continue to manage the home without registration as referred to under Section 11 of the Care Standards Act 2000. 7 33 26 The responsible individual, 31/10/2009 or their representative, must visit the home unannounced at monthly intervals and prepare a written report of their visit in accordance with this regulation. This will give the provider an opinion of the quality of care and service provision people receive. 8 35 13 Where the personal money of people in the home is managed for them, there must be a system in place 31/10/2009 Care Homes for Older People Page 30 of 35 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 that ensures their financial interests are safeguarded. This will ensure that people are protected. 9 38 13 All cleaning chemicals must be stored securely in the home. This will ensure that people are not exposed to avoidable risks. 10 38 23 The passenger lift must be serviced and maintained in line with current health and safety legislation. This will promote the health and safety of people in the home. 11 38 12 There must be a current certificate of employers liability insurance displayed in the home. This will promote the health and safety of people in the home. 12 38 13 All accidents in the home must be fully and accurately recorded. This will promote the health and safety of people in the home. 13 38 13 People in the home must be safeguarded by ensuring 31/10/2009 30/09/2009 30/09/2009 31/10/2009 30/09/2009 Care Homes for Older People Page 31 of 35 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 there are effective procedures and systems operated that comply with smoke-free legislation. This will promote the health and safety of people in 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 1 1 The Statement of Purpose should be updated with correct details of the registered provider. The complaints procedure, included in the Statement of Purpose, should have correct contact details for CQC. The admission processes should include: - recording whether the person has made an advance decision on receiving medical treatment, and if they have a Lasting Power of Attorney, Independent Mental Capacity Advocate, or Relevant Persons Representative. - consideration of the persons capacity to make decisions about their daily lives, care and treatment. This will ensure that people are safeguarded and their rights are promoted. Care plans and assessments should be reviewed at least every month to ensure that peoples changing needs are known and met. The sit-on scales should remain in the home so they are always available to ensure that each persons weight is regularly monitored as part of assessing and meeting their healthcare needs. There should be annual assessments of staff competency in the safehandling and administration of medication, carried out by an appropriately trained and experienced person. This will ensure a more robust system that protects people in the home. Page 32 of 35 2 3 3 7 4 8 5 9 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 6 12 The range of activities should be further developed and an activities coordinator should be employed. This would ensure that all people in the home are offered opportunities to be involved in appropriate activities in and out of the home. A suitably qualified and experienced cook should be employed so that there is a more structured approach to menu planning. This will ensure that people are offered a suitable range and variety of meals to meet their preferences and expectations. The complaints procedure should include the current contact details for CQC so that people have correct and up to date information. The cupboard and trolley used for medication storage should be moved out of the lounge/dining room to make the room look more homely for people living in the home. The patio and adjacent garden area should be improved with planting to enhance the area for people to enjoy. People in the home could be involved in planting pots, containers, or raised beds. All staff should have manual handling training annually to ensure they are competent and up to date with all relevant procedures. This will promote the health and safety of people in the home. All new staff should complete the Skills For Care induction programme to ensure they are able to fulfil the aims of the home and meet the changing needs of people living in the home. An annual report should be produced from the analysis of quality assurance measures taken in the home, giving details of action taken to meet issues raised. The report should be made available to people in the home and their representatives. This will help to ensure the home is run in the best interests of people living there. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are Page 33 of 35 7 15 8 16 9 19 10 19 11 30 12 30 13 33 14 33 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 promoted and upheld. 15 38 There should be monthly audits of all accident reports to ensure correct procedures are being followed and to spot any trends. This will help to promote the health and safety of people living in the home. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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