Inspection on 03/12/09 for Woodgreen Nursing Home

This inspection was carried out on 3rd December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodgreen Nursing Home 19/05/10

Woodgreen Nursing Home 10/03/10

Woodgreen Nursing Home 29/12/09

Woodgreen Nursing Home 22/10/08

Woodgreen Nursing Home 25/02/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/03/2010.

Key inspection report Care homes for older people Name: Address: Woodgreen Nursing Home 27 Wood Green Road Wednesbury West Midlands WS10 9AX     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: Mandy Beck     Date: 0 3 1 2 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 37 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 37 Information about the care home Name of care home: Address: Woodgreen Nursing Home 27 Wood Green Road Wednesbury West Midlands WS10 9AX 01215560381 01215052772 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Woodgreen Care Home Ltd care home 40 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 to be accommodated is 40 The registered person may provide personal care (with nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 40 Date of last inspection Brief description of the care home Woodgreen Nursing Home is a privately registered care home providing nursing care for up to 40 elderly people. Situated opposite Brunswick Park on a main road between Walsall and the M5 motorway, it is within walking distance of Wednesbury town. There is car parking at the front of the home surrounded by mature garden borders. There are two lounges, a conservatory and a large dining room which is split up be a fireplace all on the ground floor. The garden to the rear of the property is pleasantly landscaped with borders, patio and a small lawn. The Home has single and shared bedrooms, located on both ground and first floor, the majority of which have en-suite facilities. There is a staff call system throughout the home. There is a small passenger lift that enables people access between the ground and first floor. There are two adapted Care Homes for Older People Page 4 of 37 Over 65 40 0 2 2 1 0 2 0 0 8 Brief description of the care home bathrooms that can be used by dependent people and also a number of toilets throughout the home. The home arranges for the chiropodist, dentist and optician to visit on a regular basis and arrange visits by the GP, as people need it. Ancillary services of catering, cleaning, laundry and maintenance are provided in-house. The mobile hairdresser visits regularly and an additional charge is made for this service. Information about the range of fees the service charges in not available in the service user guide. Readers of this report are asked to contact the home directly for this information. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection of the home, they were given no prior notice that we were going. The inspection was completed in three days by two inspectors and our specialist pharmacist inspector. We visited the home on the 3rd December, 10th December and 17th December 2009 We looked at all the information that we have received, or asked for, since the home was last inspected. This included the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical about the service. Information we have about how the service has managed any complaints and Care Homes for Older People Page 6 of 37 safeguarding investigations. What the service has told us about things that have happened in the home, these are called notifications and are legal requirement. We have also used the information from any reports we have made about the home since the last inspection and also the results of any enforcement action we have taken with the home. We spent time talking to people living in the home and to the staff who support them. People have also provided us with information from surveys we sent to them. We have also included information we have been given from other health care professionals, their comments have been added into the report. We also looked at the care of three people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes ability to meet peoples needs. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The home must improve its record keeping. The information that should be included in peoples care plans to guide staff is missing in most cases. The overall management of peoples medication in this home is poor. There are problems with ordering, safe storage, safe administration and disposal of medication that the home must address. Most of the people living in the home were satisfied with the activities and the meals provided. However, some people have told us they feel bored at times. They said I wish there was more we could do, they also told us I wish there was more to eat at tea time than sandwiches. The home will need to consult with people living the home about how they do this. There are areas in the home that need improvement, there are worn carpets in places and some bedroom furniture is in need of replacement. We have made two immediate requirements during this inspection. This meant the home had to take immediate action to put right the serious concerns we raised. The first was in relation to hot water. We found that there was not a consistent supply of hot water to some peoples bedrooms. The second immediate requirement was in relation to the safe fitting of bed rails. We found in some case bed rails were not fitted correctly and were placing people at increased risk of entrapment. The home has told us they have taken action to address these issues and we have been back to the home to check this has been done. We saw that hot water temperatures show there is a consistent supply of hot water and peoples bed rails have now been fitted safely and as the manufacturers recommended. The home needs to develop its quality assurance system. It was evidence from this inspection that the current system is inadequate because it had failed to identify the shortfalls in service provision we did. Care Homes for Older People Page 8 of 37 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 37 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 37 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 choosing to live in this home have the information they need to make their decision. All people will have their needs assessed before they move into the home although improvements could be made. Evidence: We looked at the information the home gives to people to help them make a choice about living in the home. Generally the service user guide is informative and does give people details of the service they can expect from the home. We have made one recommendation about the inclusion of fees the home charges people to live there. We looked at the care documentation of three people during this inspection. We found that each person had an assessment of their needs but the home had not kept those assessments up to date. One persons has not been reviewed since December 2008. In the twelve months since this assessment was completed by the home the persons needs had changed but the assessment had not. We also looked at the assessment of Care Homes for Older People Page 11 of 37 Evidence: needs for a new admission to the home. The assessment was completed but not detailed. We asked the person about the admission process to the home. They told us the matron came to see me before, I did get to talk about what I liked. The home needs to make sure that it keeps peoples assessments up to date so that changes in their condition can be planned for and addressed. The home told us in the AQAA people are given the opportunity to spend time in the home before they make a decision about living in the home. They told us We operate an open door policy with all prospective residents, they can visit at any time and they are told that any member of staff will show them around. People we spoke to told us I didnt get the chance to see the home before I came here but I am very pleased with it, another person said, I would prefer to be at home but this is nice enough. Both people agreed that they had been given the opportunity to see the home before they came but had declined. This home does not offer intermediate care facilities. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The medicine management was poor. There was no systems in place to assess nursing staff competence in the safe handling of medicines or to check the medicines received into the home. Evidence: We looked at the care records of three people during this inspection. Each person living in the home has their own risk assessments and care plans. These documents should contain all the information about an individuals needs and how staff should support them. We found that there are improvements to be made. Care records were disjointed, and did not reflect the care that people were actually receiving. We looked at risk assessments for people in relation to their moving and handling needs. One persons risk assessment and care plan was contradictory and it was not possible to determine if they could walk unaided or were unable to weight bear. Entries written by staff stated can get out of bed unaided and uses a walking stick, another entry said unsteady and unable to weight bear needs a hoist and a wheelchair to transfer. We spoke to the staff on duty about this, they were able to Care Homes for Older People Page 13 of 37 Evidence: tell us they stand using a lifting belt, no we dont use the hoist. This shows us that care records are not reflecting the care that staff are giving this person. We found similar issues when we looked at the bed rail risk assessments. In one assessment we found the following entry cot sides no longer in use bed lowered to the floor level. We went to check this persons bedroom and found that this was not the case. The bed was not lowered to the floor and there were in fact bed rails on the bed. One member of staff told us it was lowered but that was a while ago, they dont need it like that now. The home completes Waterlow risk assessments, the Waterlow scale determines a persons risk of developing pressure sores. One persons score showed them to be at risk of developing pressure sores and staff had recorded a pressure reducing mattress should be in use. When we checked the bedroom of this person, the pressure reducing mattress was not in place. We asked the staff about this persons needs they told us she doesnt have any damage, we know what to look for, like reddening skin or blanching, we always go straight to the nurse and tell them if we see anything like this. Nutritional screening is carried out by the home. This means that people will be assessed and those at risk of being malnourished can be identified and the home can take action to prevent this from happening. Part of the management of this, is to monitor and record peoples weight. We looked at weight charts and found in some cases people had not been weighed for over three months. The home needs to keep regular monthly records of peoples weight so that they can appropriately manage this. We saw the home is able to offer people specialised diets and uses moulds with pureed diets. This will make the meals look more visually appealing and people are more likely to want to eat them. During this inspection we spent time talking to staff and to the people who live there. It was evident staff are caring and do possess a good understanding of peoples needs. The information the staff know and understand about people should be recorded in the care plans and used to evaluate the care people receive. People we spoke to said the staff are lovely, they never rush us at all, I would like to choose when I go to bed instead of taking it in turns. If I am ill the doctor will come out straight away. People living in the home can choose their own doctor, at this time there are over seventeen doctors who may visit the home to see their patients. We also noted that Care Homes for Older People Page 14 of 37 Evidence: people have the opportunity to see the chiropodist, optician and the dentist. We looked at medication management and found that we could not audit the medicines the home had obtained. We could not be sure about which medication people were taking and when it was being administered. The home manager told us that she got confused by the ordering system at times. As a result we asked our specialist pharmacist inspector to visit the home and complete their inspection of the homes medication management systems. The pharmacist inspection lasted four hours. Six peoples medicines were looked at together with their Medicine Administration Record (MAR) charts. The medicine round was observed. Two nurses were spoken with. The medicine management was poor. All the current medicines in use were stored in a dedicated medicine room in one medicine trolley. This was too small to store all the medicines prescribed and dispensed for each person. It was not used as intended to transport the medicines to the people in the home. One nurse was seen preparing the medicines in a small pot and then walked throughout the home to the person to administer them. There would be nowhere to safely put the medicines if an emergency arose. Surplus medicines were kept in locked wooden cabinets by persons name. Some medicines were found on top of a work bench that had not been locked away. Anyone gaining access to the room, would have access to the medicines within. Currently there was no system to check the prescriptions before they were dispensed and as no copy of the prescription was taken it was not possible for the nurses to check the medicines and MAR charts received into the home for accuracy. Vast quantities of medicines were found on the premise, in some instances up to a years supply of medicines. We, the commission were assured that every effort had been made to address this issue, but the nurses had failed to halt the over prescribing of medicines seen. The quantities of medicines received were recorded but balances carried over from previous cycles had not been. Audits were therefore difficult to undertake to demonstrate that they had been administered as prescribed and records reflected practice. It was possible to audit some medicines accurately though and serious errors were seen. Medicines had been recorded as administered when they had not been. Out of date medicines had been administered. Medicines were available for administration but had Care Homes for Older People Page 15 of 37 Evidence: not been recorded on the MAR chart so it was not possible to identify if or when they had been administered. Unlabeled medicines were seen and it was not possible to clarify who they had been prescribed and dispensed for, other than the section they were found in the cupboard for. Despite the vast stocks of medicines seen some medicines were not available for administration. One persons medicines were routinely administered to other people due to the lack of space in the medicine trolley mainly. This is considered very poor practice as all medicines are the property of the person they are prescribed to. In addition it was not possible to demonstrate these had been administered as prescribed. One new person to the home did have the quantities of medicines he bought in recorded on the MAR chart so it was possible to undertake audits to demosntrate whether they had been administered as the doctor intended. These indicated that medicines had been signed as administered when they had not been. A new supply of one medicine had not been sought resulting in the person not receiving one medicine for the last nine doses. One eye drop had no label on it so it could not be demonstrated when it was dispensed, whether they were for him and whether they were out of date. Two further eye drops had been administered past their expiry date increasing the risk of a potential eye infection. Gaps on the MAR chart were seen. In one instance the medicine had been administered but not recorded as such, in others not administered and the reason for non administration not recorded. 690ml of one liquid medicine had been recorded as administered but only 300ml had been recorded as received. This is of serious concern as the nurses are not administering the medicines as prescribed and not following their own code of conduct with respect to the safe handling of medicines. Hand written MAR charts were poor. Incomplete dates had been documented so in future it would not be possible to see what time period they related to. One nurse spoken with said that all new medicines bought into the home were documented on the MAR chart. At no time was this information checked with their doctor to ensure that their current medicine regime was recorded to be administered, were their current drug regime and all medicines were available to administer. One warfarin dose had been poorly written and recorded misleading information. Audits indicated that this had not been administered as prescribed. Again this is of serious concern. People were encouraged to self administer their own medicines but no risk assessment Care Homes for Older People Page 16 of 37 Evidence: was seen and no compliance checks undertaken to confirm they did so safely. The management has no quality assurance system in place. Errors were therefore not identified and the problems rectified. Of more serious concern the management was totally unaware of the serious issues identified during this inspection. However they were keen to improve the medicine management to safeguard the people who lived in the home On a positive note all the controlled drug balances were correct and stored in compliance with current regulations and the nurses spoken to understood what the medicines they administered were for. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to take part in some activities whilst living in the home. There are further improvements the home could make to keep people active and support them in leading active lives. Meals provided are of a good quality, nutritious and people are offered a balanced diet. Evidence: We looked at the activity provision in the home. People who completed our surveys told us there is usually something to do, others said more activities would be nice. We also spoke to people during this inspection about how they keep active, they told us well the staff do quizzes, games and karaoke with us, they also have this new ball that opens up and it helps us to move our arms and legs, another person said I do wish there was more to do, I am a bit bored at times, and my favourite is the cat, he sits on my lap for fuss but I do think he is a bit spoilt, and finally day to day activities are now practically non existent although equipment had been bought. The staff on duty told us they try hard to keep people active, they also confirmed that activities do take place and recent events have included fish and chip suppers, carols by candlelight and turkey and tinsel evenings. Other parties have included the Ascot Care Homes for Older People Page 18 of 37 Evidence: racing day, Halloween and a new years eve party is planned. Relatives told us we can visit when we want, the staff are welcoming and very obliging, nothing it too much trouble. The home tells us that visiting times are open and people can visit when they wish. We looked at some peoples bedrooms during this visit, we saw the home does encourage people to make their rooms their own by bringing in ornaments and small pieces of furniture from home. This makes peoples rooms feel very personalised. The home encourages all the people living there to manage their own finances and is able to offer information on advocacy services for people should they want to use them. We saw meal times during this inspection. The food is freshly prepared in the home. We spoke to the cook who is made aware of all peoples specific dietary requirements, birthdays and other special events. People we spoke to said the food is lovely, very nice, another person told us actually I would like more variety, especially at tea time because it tends to be always sandwiches. The dining room has recently been decorated and offers a pleasant place for people to eat their meals. We noted throughout meal times people were assisted by staff when they required it. Care Homes for Older People Page 19 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home feel confident their views will be listened to and acted upon. The home needs to improve its record keeping to make sure all complaints are recorded. Staff understand their role in protecting people from harm or abuse and will take action to report this. Evidence: The home has a complaints procedure that is available to people living in the home. In addition to this they also have a compliments book which had lots of cards and letters from families who were happy with the care they had received. People we spoke to told us they felt happy to complain if something was wrong. One person said Id talk to matron she always asks us if we are happy, the staff are very good and do make sure that they try to put things right for us. People who answered our surveys also confirmed that they knew who to speak to. The home told us in the AQAA they had received three complaints over the past twelve months. We asked to see the records of the complaints log and any investigations the home had undertaken as a result of those complaints. The manager told us we havent had any, we saw an empty folder there was no record of the three complaints the home had told us they had investigated. The home should keep accurate records of any complaints it deals with. We have made a recommendation the home begins to do this. Care Homes for Older People Page 20 of 37 Evidence: We also looked at how the protects those vulnerable people living there. We spoke to staff who were able to give us good examples of what abuse is and who they report any allegation or incident to. Some staff said that the safeguarding training was not up to date and they had not had a refresher course for some time. The home will need to make sure that all staff have refresher training in adult safeguarding. This will keep staff up to date with any changes in legislation and practise in this area. The home has not made any referrals to the safeguarding team since our last inspection. At the time of this inspection one persons concerns were being investigated under the safeguarding protocols and the home is assisting the local authority in this process. Care Homes for Older People Page 21 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is adequately maintained. It is clean and fresh but improvements could be made. Evidence: We looked at most of the home during this inspection. We saw that generally the home was clean and free from offensive odours. We noticed in places that carpets and furniture is worn and in need of replacement. We saw the carpet on the landing on the first floor was taped where it had frayed and in some places was stapled. This is not ideal and the provider should consider the replacement of this carpet. We sat with people in the lounges and they told us the home is very cosy, I have a key to my room and the staff bring it to me once they have cleaned it, its always clean, another person said they have decorated it lovely. We saw that lounges were cosy but we did also see that some of the furnishings could benefit from a deep clean as they were stained. We noticed that one pressure reducing cushion was not suitable for use as it was worn out. We asked the manager to dispose of it and arrange a replacement. People who answered our surveys told us the home is generally clean but over the last two years the standards have dropped, I wish they could do something about the toilet in the reception area, people are all queued up there, they dont use the Care Homes for Older People Page 22 of 37 Evidence: other toilets and theres alot of people waiting. Its because they cant get wheelchairs into the others. We looked at peoples bedrooms as part of our case tracking process. Whilst we were doing this we noticed that not all people had a hot water supply in their bedrooms. We checked the homes records and found that this was a persistent problem. We spoke to staff on duty who told us yes the hot water can be a problem we borrow from those that have it in theirs. We gave the home an immediate requirement. This means we wanted them to take immediate action to sort out this problem and to give people a consistent supply of hot water in their bedrooms. We visited the home again seven days later to check this had been done. We were told by the home that a new boiler had been fitted and new regulators had been fitted to taps. This means that temperatures are kept at required temperatures. We checked taps and hot water temperatures again and found there had been an improvement and the home had done as we had asked them. People do now have a consistent supply of hot water in their bedrooms. We also noted that peoples bed rails were not fitted safely, there were excessive gaps which meant the risk of entrapment to people was very high, other bed rails were not fitted in pairs as recommended. We were very concerned about this and the risk to the people using this type of equipment. We left the home with an immediate requirement to take action to put this right. We visited the home again seven days later to check that this has happened. We found the home had ordered new bed rails for people who needed them, new bumpers and when we checked all but two peoples bed rails had been appropriately fitted and were secure. This means the risk of using this type of equipment has been lessened. The home still needs to develop their risk assessment process and their thinking around bed rails. The home must be able to consider other methods of keeping people safe in bed especially when their own risk assessments tell them that bed rails are not suitable for use. The home has its own laundry facilities. We noticed some areas for improvement, for example we saw staff carrying soiled laundry into the into the laundry room and not using a trolley with covered skip bag. We saw that staff do have access to gloves and aprons that will help them to reduce the risk of cross infection to people however staff must remove these promptly. We observed staff walking around the home wearing gloves and aprons and taking people into the dining room wearing them. This is not good practice and the manager will need to address this with the staff. Care Homes for Older People Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet peoples needs. Staff do have training but poor record keeping makes it difficult to confirm that all staff have appropriate training for they job they need to do. Evidence: The people we spoke to told us the staf are very good here. We asked them if they had to wait for long periods for staff to help them. They told us sometimes but it is difficult when we all want the toilet at the same time, another person said, they come straight away, if they are rushed they tell us and they always come back. The staffing rota showed us that there are usually six staff on duty this always includes a qualified nurse. The home told us in the AQAA that eighteen of the current twenty care staff have achieved an National Vocational Qulaification (NVQ) level 2. We found when we spot checked training records we could not confirm this. Off the four staff files we looked at only one had a certificate confirming this training had taken place. We spoke to staff who told us they had completed some training but they could not be specific about what training they had completed. The manager told us that record keeping in the home could be better but she knew that staff had done the training. The home must keep up to date accurate records of staff training. This will show that staff are being kept up to date with current best practice and that the home is providing this training Care Homes for Older People Page 24 of 37 Evidence: for staff. It will also give people confidence that staff are appropriately trained and they will not be placed at risk as a result by staff who are inappropriately trained to care for them. We looked at staff files, we did this because we wanted to make sure the home is continuing to recruit new staff safely and is not placing people living in the home at risk. We found that staff files were disorganised and information was difficult to find. The majority of information the home is required to obtain in respect of new employees was in their files. The home will need to complete an audit of staff files to make sure that they all contain the required information as detailed in the Care Homes Regulations 2001. We did see evidence the home does make sure the appropriate security checks are in place before staff are allowed to start working in the home. This includes obtaining two written references and a check against the Criminal Records Bureau (CRB), these measures will help the home prevent unsuitable staff working with vulnerable people. The home does have an induction process for staff to complete. There were no new staff on duty for us to talk to during this inspection. We found no records of an induction that would meet the Skills for Care induction standards but we did see an induction record for staff in their files. This induction gives staff a knowledge of the home and what is expected of them whilst on duty. This included making sure they knew how to act in the event of fire, an introduction to moving and handling and a tour of the home. Care Homes for Older People Page 25 of 37 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. There are areas for improvement in this home the management must address in order to demonstrate the home is being run in the best interests of the people living there. Evidence: There has been no change in the management of this home since our last inspection. Mrs Jennifer Weston continues to run the home and is supported by two deputy managers. People told us during this inspection Matron is very good, she always asks us if we are alright and tries to help. Another person responded to our surveys said The management are helpful and easy to approach. The home did send us the AQAA when we requested it. The AQAA gave us a reasonable picture of the current situation within the home. The AQAA gives us limited information about the areas the home still needs to improve upon and this will need to be developed. The home has told us they have regular meetings with the people living in the home. Care Homes for Older People Page 26 of 37 Evidence: They do this so people can raise any issues they may have and also to discuss what is going well within the home. The manager also told us that people are asked to complete satisfaction surveys. These had recently been completed by no action plan had been drawn up to show how issues arising were going to be addressed by the home. We have seen during this inspection there are areas for improvement that the home has not identified. The problems with the poor medication management, poor risk assessment and potentially unsafe equipment (bed rails) were not identified through the homes own audit system. The home will need to develop the quality assurance system so that these shortfalls are monitored and appropriate action is taken to improve. The owner of the home does complete an unannounced monthly visit to the home, however these visits do not appear to have captured the shortfalls that we have found either. The home will also need to develop staff understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguards. There are no clear policies and procedures in place for staff to follow. When we spoke to staff they did not know about the Mental Capacity Act and the deprivation of liberty safeguards. The home needs to review the way in which it uses bed rails. We have already said that bed rails were poorly fitted and were not safe. We have also said that following our immediate requirement the home has taken action to address this. There is still more work for the home to do. The current risk assessments in place for bed rail use are very limited in information and do not contain most of the information recommended by the Health and Safety Executive (HSE). The manager told us that she is currently making sure all of her staff understand the HSE guidance before they change the risk assessments. We have also discussed our concerns about bed rails being placed onto peoples beds first and risk assessed later. The home must be able to consider other ways of managing peoples safety when they are in bed if bed rails are judged to be unsuitable. The home has taken action to also make sure that people have the consistent supply of hot water they need following our immediate requirement. They have also developed the records they keep of hot water temperatures and will record what action they will take when temperatures fall outside of the recommended temperature. The home has a health and safety policy that aims to protect the health and welfare of Care Homes for Older People Page 27 of 37 Evidence: the people living in the home. This also involves staff training, we have already said because of the poor record keeping systems in the home this can be difficult to evidence. Staff have confirmed that they have recently taken part in fire training and moving and handling training. This is done at the home because the manager is a trained trainer for these subjects. We looked at maintenance records for slings and hoists, we found the home is making sure that equipment is being serviced and checked however the company that does this is not specific about the slings it has checked. We have recommended this happens so the home can take action to replace worn equipment. Care Homes for Older People Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 37 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 7 14 The home must make sure that peoples assessments are kept up to date and reflect changes in their condition. Peoples needs change and this must be recorded. 31/03/2010 2 8 13 People using bed rails must have a comprehensive risk assessment in place before they are used. This will prevent the misuse of bed rails and also make sure that only those people who require bed rails have them on their beds. 29/01/2010 3 8 17 The home must make sure that it keeps regular monthly records of peoples weights. This will enable them to take action when unplanned weight loss or gain occurs. 31/03/2010 Care Homes for Older People Page 30 of 37 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 4 9 13 All medicines that are administered must be in date and be labelled by a pharmacist. This is to ensure that the correct medicine is administered to the right service user and their stability is not compromised 22/02/2010 5 9 13 Staff must transport medicines throughout the home in a safe manner and all medicines must be able to securely held in a locked facility in the event of an emergency This is to ensure that all medicines are safely held on the premise at all times. 22/02/2010 6 9 12 All prescribed medicines must be available for administration and must be administered to the service user they are prescribed to only. The practice of administering medicines dispensed to one service user to another must cease immediately. This is to ensure that the service users is administered their prescribed medication 22/02/2010 Care Homes for Older People Page 31 of 37 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 only as the doctor intended. 7 9 13 All dose regimes must be 22/02/2010 clearly written on the MAR chart, checked by a second member of staff for accuracy and the MAR chart must includes all relevant details for example the date. This is to ensure that the staff have clear directions to follow and the recorded information meaningful. All service users must be risk assessed as able to self administer their own medication and regular compliance checked undertaken and documented. This is to ensure that they can handle their medication safely and take as prescribed 9 9 13 All medication polices must 22/02/2010 be reviewed and reflect good practice. Staff must be trained to adhere to them. This is to ensure that all staff have clear information to handle medication safely. A system must be installed to check the prescription prior to dispensing and to 22/02/2010 22/02/2010 8 9 13 10 9 13 Care Homes for Older People Page 32 of 37 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 check the dispensed medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. The quantity of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. This is to ensure that the audit trail for all medicines is seen and all medicines are adminsitered as prescribed at all times. 11 9 13 A system must be installed to check all new service users medication with their doctor at the earliest oppurtunity This is to ensure that they are administrated their current drug regime 12 9 13 The medicine chart must 22/02/2010 record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of 22/02/2010 Care Homes for Older People Page 33 of 37 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 the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practise 13 9 13 A quality assurance system 22/02/2010 must be installed to assess nursing staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practise. This is to ensure that individual nursing staff practise is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. The home must audit the staff recruitment and training files to make sure that all required information 26/02/2010 14 29 19 Care Homes for Older People Page 34 of 37 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 is there and is easily accessible for inspection. They must do this so that they are not in breach of the Care Homes Regulations 2001 and to protect the people living in the home. 15 33 24A The home must submit an improvement plan that shows how they will address the issues in this report. This will be required 16 38 17 The home must keep 30/04/2010 records of the hot water temperature. They must also record what action they have taken when temperatures are not within recommended limits. This will provide the home with a clear record of the action they have taken in order to maintain a consistent supply of hot water for 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 05/03/2010 1 1 The service user guide should be updated to include the range of fees the home charges per week for residency. This will ensure that people have all the information they Care Homes for Older People Page 35 of 37 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 need about deciding to live in the home. 2 12 People living in the home should be consulted about the type of activity they want to take part in. Once this is know the home should consider how these activities can be built into the activity programme. People should be consulted about the choice on the menu at tea time. The home should keep up to records of each complaint, investigation and outcome. The home should make arrangements for staff to receive refresher training in safeguarding of vulnerable adults. They should also keep records when this training has been completed. The manager will need to look at infection control practises with in the home to make sure staff are aware of current best practise and are not placing people at increased risk of cross infection. When slings are checked as part of the servicing of equipment, individual identification numbers should be allocated to them so they can be tracked and a clear trail of when they were last checked can be seen. 3 4 5 15 16 18 6 26 7 38 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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