Inspection on 30/09/08 for Wyndham House

This inspection was carried out on 30th September 2008.

CSCI 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wyndham House 15/01/09

Wyndham House 21/11/08

Wyndham House 03/04/08

Wyndham House 28/11/07

Wyndham House 24/07/07

Wyndham House 07/06/07

Wyndham House 14/12/06

Wyndham House 04/05/06

Wyndham House 02/02/06

Wyndham House 30/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wyndham House Manor Road North Wootton Kings Lynn Norfolk PE30 3PZ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Patience     Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Wyndham House Manor Road North Wootton Kings Lynn Norfolk PE30 3PZ 01553631386 01553631105 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Brian Smith Type of registration: Number of places registered: Eaglecrest Care Management Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Admission to additional places can only begin following an improvement in the service level rating for the home Date of last inspection Brief description of the care home Wyndham House is a large detached building in North Wootton, close to the town of Kings Lynn. The Home was originally a Victorian house, which has been extensively extended. The Home provides care for up to thirty six older people who have dementia. There are twenty six single rooms and five shared rooms on the ground and first floors. The majority of the bedrooms are en suite. The fees for this home range from #380.00 to #597.74 0 Over 65 44 Care Homes for Older People Page 4 of 33 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 inspection was a key unannounced inspection and comprises of information gathered since the last key inspection in April 2008 and a site visit. The site visit was conducted by three regulation inspectors, including the Commissions pharmacist inspector. The visit took approximately 8 hours to complete and during the visit we looked at records relating to residents, staff and the running of the service. We also completed some casetracking and observed daily life in the home. We spoke with several residents, relatives and staff and their comments have been included in the report. Care Homes for Older People Page 5 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 6 of 33 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 7 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are not always fully assessed before moving into the home. Therefore the home cannot be sure that they can provide a service that will meet the individuals needs. Evidence: A random inspection was completed in July 2008 and we looked at records relating to people admitted to the home since the previous inspection in April 2008. We found that the pre-admission procedures had not been followed in all cases. For instance, one resident had been admitted without a pre-admission assessment taking place and there was no information relating to their background and needs prior to being admitted. An incomplete pre-admission assessment on file was written on the day of admission and was not signed by the assessor. At the time of admission it was not clear if the person had a diagnosis of dementia and the home did not have sufficient information to determine whether the persons needs could be met and if Wyndham Care Homes for Older People Page 8 of 33 Evidence: House was a suitable place. The persons file did not contain a care management assessment, but did contain a care plan written by the placing authority, which offered no information about what the persons needs are and how they should be met. At this inspection we were unable to fully assess this outcome area during this visit as the registered provider has voluntarily agreed with the local authority, not to admit any new residents until the quality rating has improved. However, we asked the crisis manager if the home has admitted new residents since the last inspection and were told they had not. When we looked at the admissions record there was an entry for a person admitted in July but the managers were unable to produce any records relating to the person. Care Homes for Older People Page 9 of 33 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 management still cannot provide a service that adequately meets peoples health and care needs due to poor care planning, risk management and medication practices. Evidence: We conducted a random inspection in July 2008 and found that there were shortfalls in care planning and associated records that resulted in poor outcomes for people using the service. At this inspection we looked at the records relating to 7 people living in the home and these were selected at random. We also spoke with staff and made observations of how well peoples needs were being met in accordance with the information written in their care plans. We found that there were still shortfalls and peoples needs were not always accurately reflected in the written plans. For instance, we noted from medication records that several people were prescribed nutritional supplements but this was not written into a plan of care. One person had a skin tear and there was no mention of it in the records or how this should be cared for. We also found that there was some variation in the quality of the care plans. For Care Homes for Older People Page 10 of 33 Evidence: instance some had been re-written and contained much more detailed information than others. Risk assessments in relation to health needs such as nutritional needs were completed by using a screening tool but they were not, in all cases, followed up with a plan of care setting out how the needs should be met. For instance, one person was assessed as at high risk but there was no care plan stating how the risk should be minimized and what steps should be taken to ensure the person maintained a good diet. This person was losing weight and had been prescribed nutritional supplements but this was not seen in the care plans. For other risks the home uses a generic risk assessment but this did not adequately cover all risks. Two people were smokers and this was not included in the risk assessments. in addition, one of those people also liked to drink alcohol but this was not taken into account when assessing risk. Risk assessments did take into account the risks posed by products in peoples rooms and stated that they should be locked away, however, the products were still accessible in peoples rooms. Observations also told us that in some cases peoples needs were not being met in accordance with care planning. For instance, the care plans for two people stated that they needed glasses but they were not wearing them. Another care plan stated that a person needed to walk with a frame, yet the frame was left in the dining room during the afternoon. In addition, there was at least one person needing increased fluid and diet as advised by the GP yet there were no records to show that the persons intake was being increased or monitored. One person required 2hrly turns but again there were no up to date records to show this was happening. One relative said she was very concerned about the inadequate care provided to her relative. Her mother was losing weight and she did not feel there was sufficient support for her at mealtimes. Care plans contained more information in relation to peoples life history, hobbies and interests. However, some social care plans were still incomplete and records did not show that activity had taken place in accordance with interests and hobbies. On the day of inspection there was very little stimulation and occupation for people. Many people were observed to be asleep for significant periods of the day. One relative who visits frequently said that there was very little activity for people and many were seen walking aimlessly or asleep. We noted that there were concerns in relation to promoting peoples dignity and privacy. Staff, although well meaning, were heard to use the same language with many people, for instance, using terms such as darling. We also saw that at mealtimes people were issued with plastic bibs. At least one person did not want to wear one and took it off. There was no alternative to this, such as a cloth napkin, Care Homes for Older People Page 11 of 33 Evidence: which may be considered more dignified. We also saw that there were a number of ladies without stockings and one gentleman that did not have a shirt under his jumper. His hair was not brushed and he had not been shaved. One other lady had no under garments on. We also noted that one resident was taken back to their room and the door was locked so the resident could not access the room without a member of staff unlocking the door. One relative said they would often visit and find that their relatives clothing is soiled with food. The inspection of the medication standard was undertaken by the Commissions pharmacist inspector Mark Andrews. His inspection follows previous inspections when issues relating to the homes poor management of medicines were raised. During this inspection we examined current and some previous medication charts, observed medicine administration in the home and looked at peoples associated care records. The home has provided lockable cabinets in peoples bathrooms for the storage of external medicines to prevent people coming to harm by accessing them. However, throughout the inspection, inspectors noted that not all such medicines were being stored in the cabinets provided. We also found that the home was not keeping records for the application of external medicines to people. For oral medicines, there were only some gaps in records for their administration but when we looked at medicines prescribed with variable doses the actual doses given were often not being recorded and these medicines could not be accounted for. We also found some medication chart entries were inadequate as they did not specify accurately the dose and frequency of medicine to be selected by staff when giving them to people. When we audited medicines available for use against medication charts we found there to be a system in place for accounting for some but not all medicines. We found there to be a significant number of discrepancies (approximately 50 of the sample) where medicines could not be accounted for and records did not confirm the medicines were being given to people in line with their prescribed instructions. There was also evidence from the records that two painkilling medicines were not available for administration to two people needing them for pain. For one of these an alternative painkiller had been administered by a member of staff on 23/09/08 during its nonavailability but this medicine was not prescribed for this person and was of a prescription only category. We also found recorded evidence of other medicines not given in line with prescribed instructions, for example an anti-diarrheal medicine given at double the prescribed dose to a person on 21/09/08. We observed medicines being administered by a senior member of care staff in the dining area at lunchtime. Procedures seen at this time were satisfactory, however, when we looked a medicines in the medicine trolleys, in one of the trolleys, we found Care Homes for Older People Page 12 of 33 Evidence: three labeled envelopes of medicines that had recently been found around the home including one found on the dining room floor on 29/09/08 suggesting medicines are not always being given properly to people. We also found a number of medicines being retained in the medicine trolley that related to a person no longer living at the home. These were available and could be used for other people. When we asked for care records for this person, the managers said these records were not available. There was also a quantity of psychotropic (and potentially sedative) medicines recently discontinued for a person living at the home located in the other medicine trolley to where their current medicines were being held. When we looked at staff training records relating to medication there are currently ten members of staff currently authorized to handle and administer medicines. We saw certificates of attendance at recent training for 5, we were told by the crisis manager that a further two had attended a training event on 17/09/08 but the home had not yet received certificates. The crisis manager was unable to locate evidence of training for the senior carer on duty administering medicines at the time of inspection and also said that she herself had had medication training but this was years ago. She told us that the home did not have records confirming that the competence of authorized care staff had been assessed. Care Homes for Older People Page 13 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not always support people to maintain a lifestyle that meets their expectations and previous experiences. Mealtimes do not always promote peoples health and well being. Evidence: As written in the health and personal care outcome area, the manager has gathered more information relating to peoples social care needs and life history. However, it is not clear how the information is being used to provide daily life and activities that meet peoples needs and expectations. The records showed very little evidence of person centered activity and on the day of inspection we did not see any activities taking place. Many people were sitting doing nothing or asleep. during the afternoon we saw relatives coming into the home and sitting in the dining room engaged in conversation with groups of residents. People appeared to enjoy the interaction. One relative said there is very little stimulation for people in the home. We observed the mealtime experience. Most people were seated in the dining room where tables were set with table cloths, placemats and cutlery. People were offered a choice of drinks and these were served in a variety of coloured plastic beakers. Meals Care Homes for Older People Page 14 of 33 Evidence: were served by care assistants and there was a variety of portion sizes showing that peoples individual needs were taken into account. People were observed to enjoy their meals and it looked appetizing. However, there were some people who had difficulty managing the food due to the way it was presented on the plate. Some people could not cut up their food and staff did not offer any support with this. One resident wanted to eat her meal in the armchair and staff tried to encourage her to sit at the table but let her stay in the chair as she wished. We saw staff give her a meal and place it on her lap as they were unable to find a suitable table that she could use. She ate only a small amount of the meal and her plate was taken away. Several people were observed to leave the majority of their meal and peoples records do not show sufficient detail relating to food intake to monitor who may need more support with maintaining a good diet. Staff said there was only one resident who needs support to dine and her relative visits every mealtime to give that support. The member of staff said the resident is doing much better now as they did not have the time to spend with one person. Care Homes for Older People Page 15 of 33 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 the home and their representatives know how to raise concerns, however, this is not publicised. People cannot be confident that their concerns will be dealt with and action will be taken to resolve issues effectively. Evidence: The service does have a complaints policy and procedure. However, on the day of inspection we asked the manager where the complaints policy was publicized and it could not be found on display. Relatives spoken with said they knew how to make a complaint and would raise any concerns with the manager. One relative had made a complaint and a record of it was seen in the complaints log. The complaint relating to a resident not wishing to have a male carer to assist with personal care. We looked at the persons care records and could not find any record of this in the notes. We also spoke with a male carer who was not aware this was a concern for the resident. The Commission has been made aware of concerns raised by another relative who said the concerns were raised with the home. There was no record of this in the complaints log. Staff spoken with said they knew how to support people to make complaints and would raise any concerns they had with the manager. Care Homes for Older People Page 16 of 33 Evidence: Since the last inspection we have not been made aware of any safeguarding adults concerns. The manager said that staff have been trained in adult protection and the two members of staff interviewed both confirmed they had received training. However, this could not be checked for all staff as on the day of inspection we could not access full training records for staff. Care Homes for Older People Page 17 of 33 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. People cannot be assured they will be provided with a clean, odour free, safe environment. However, their own personal space can be made pleasent and homely. Evidence: In July 2008 we conducted a random inspection of the home and found that we still had concerns about the standard of the environment. During this visit, a tour of the premises was undertaken and some peoples bedrooms were entered. We found continuing concerns about the standard of the environment. On entering the home unpleasant odours could be detected and as we toured the building odours could be detected in other areas and in some bedrooms. The manager said that the carpets in the lounge and dining room had been professionally cleaned only 4 days prior to the inspection. However, there were already two stains on the lounge carpet. Some of the chairs in the lounge and dining room were soiled and smelt when sat on for any length of time. One arm chair was soiled with what looked like faeces. The manager said that the provider had obtained quotes for cleaning all the furniture and this will be done in the near future. Some parts of the home are still in need of redecoration. For instance, in one room the Care Homes for Older People Page 18 of 33 Evidence: wallpaper is peeling off the wall. In other areas the decor is in need of refreshment. The dining room tables and chairs need to be replaced with something more domestic in appearance and suitable for older people. One bedroom entered had recently been redecorated and looked pleasant. Many of the rooms were homely and contained peoples personal items. Some bedroom doors were named and showed a photo of the person who occupies the room and some were not named or numbered even though people were occupying the rooms. In addition, it was found that some of the bedroom doors could not be locked as there was no mechanism in place to facilitate this. All the bedrooms have en suite facilities. In one room the sliding door to the bathroom was not fixed at the bottom and was difficult to open and close. In another room a resident (who uses a wheelchair) said there is a step into the en suite making it impossible for them to use the facilities independently. Most of the en suites now have lockable cabinets for the storage of products that have been assessed as a potential risk. However, we still observed products such as creams and toiletries on display in rooms. In general, the home lacks directional signage to assist people to orientate around the building and back to their rooms. It was noted that many peoples bedrooms contained pressure mats. The use of pressure mats should be carefully considered on an individual basis as part of a needs assessment. We did not inspect the laundry facilities on this occasion. Care Homes for Older People Page 19 of 33 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. People living in the home cannot be confident that they will be cared for by adequate numbers of trained and competent staff. In addition, recruitment practice could be more robust so as to ensure the protection of people living in the home. Evidence: We conducted a random inspection in July 2008 and found that staffing levels were inadequate, rotas did not accurately reflect the staff on duty and staff were expressing concerns about an inability to meet peoples needs due to low staffing levels and high staff turnover. We also found that at least one member of staff had not been trained in dementia care and the manager could not provide us with details of staff training. We asked the manager to forward this information to us but at the time of writing the report it had not been provided. During this visit we looked at staffing in the home by taking copies of the staff rotas so we could Analise the staffing levels over the last 4 weeks, we examined staff files and supervision records. We also interviewed two members of staff and spoke with others when working in the home. We were told by the manager that the target staffing levels based on the needs of people living in the home were set at 6 in the morning, 5 in the afternoon and 3 at Care Homes for Older People Page 20 of 33 Evidence: night. A copy of the rota on display in the entrance hall was not an accurate record of staff working in the home. We asked for an accurate record and were provided with it once the manager had updated it by transferring information held in other records. The rotas we were given were unclear and it was difficult to accurately count the number of staff on duty each shift. However, there were times in the two weeks leading up to the site visit where staffing levels had fallen below the numbers provided by the manager. For instance, on the 25/09/08 for a period of time there were three care assistants on duty in the afternoon and on the 28/09/08 there were 4 on duty in the morning and three in the afternoon. The number of staff on duty during the night has consistently been 2. On the day of the site visit there were 6 care assistants in the morning and 6 in the afternoon and observations showed that peoples needs were not always being met with this number of staff. For instance, some people needed support with dining and did not get it and there was no activity or stimulation for people. In addition, the appearance of some people indicated that their personal care needs had not been met. Feedback from staff and relatives indicated that there had been a turnover of staff in the recent weeks. We asked the manager for a list of staff who had left and those that have started but it was not available at the time of the inspection. The manager told us that they had experienced some staff sickness and had been using agency staff to ensure there were an adequate number of staff on duty. On the morning of the inspection there were 3 agency staff working and one was expected to stay for the afternoon shift. One of the two night care assistants was from an agency. The manager said the home is using the same agency staff so they become familiar with the residents. We were not able to fully assess training as the manager could not produce full training records. There was no evidence of recent training taking place. Staff spoke with said they felt well supported by the manager and that staff morale had improved. One member of staff was aware that there was a lot of new staff being recruited to replace the agency staff. A member of staff said that staffing levels had improved more recently and staff had more time to spend on activities with residents. The staffing levels were said to be consistently 5 in the morning and 4 in the afternoon. An agency worker was interviewed and said they had worked at the home for the last week and had covered 5 random shifts prior to that. This care assistant had completed all the mandatory training with the agency and confirmed a brief induction to the home had been completed. This person said that the staffing levels were usually somewhere between 4 and 6 in the mornings. We looked at records relating to new staff appointed. We found that the home had Care Homes for Older People Page 21 of 33 Evidence: followed correct procedures for the appointment of staff and files contained most of the information required. However, for two people who had started work with a clear Protection Of Vulnerable Adults (POVA) check, there was no record of a full CRB check being received. For another person there was no evidence of a contract or a start date. Care Homes for Older People Page 22 of 33 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. This home continues to lack good management and leadership to ensure that systems are in place for the delivery of good care. Evidence: Since the last random inspection conducted in July 2008 the manager and the deputy manager at that time have left. The provider appointed two crisis managers to manage the home and to make improvements in the standard of the service. A new manager has now been appointed and is the 6th manager since the home was taken over by the current provider in 2005. On the day of the inspection visit we were told by the new manager and the crisis manager that the crisis deputy manager had left due to a dispute with the provider but were unable to provide us with further details. The new manager said he has several years of experience of management in social Care Homes for Older People Page 23 of 33 Evidence: care and provided us with improvement plans for the short, medium and long term. Since the last inspection when several repeat requirements were made the home has provided us with an improvement plan, which stated that all the requirements, apart from one, had been met by the time of this visit. Since the last inspection the provider has supplied only one report in accordance with regulation 26. During the visit we asked the manager what quality assurance monitoring had taken place and were told that the home was unable to produce any information in relation to this. The managers were unclear about what monitoring systems were in place. Staff reported that they have felt well supported by the crisis manager and there is evidence of regular supervision. We did not look at how the home supports people with their finances on this occasion. During this visit and the last random inspection we identified numerous health and safety concerns, such as poor hygiene and infection control and inadequate risk assessments. However, all equipment is under contract and is checked annually. In addition, fire safety checks have been carried out and all staff are trained in fire safety. During the inspection we found that the managers were unable to provide us with records relating to a resident admitted for respite and subsequently discharged to hospital. This was not reported to the Commission in accordance with regulation 37. Care Homes for Older People Page 24 of 33 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 3 14.1(2) People who use the service 17/07/2008 must have their needs assessed prior to admission so that the home can assure people they have the capacity to meet their needs. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 2 7 15.1 People who use the service 17/07/2008 must be assured that their needs are properly assessed and written into care plans so that their holistic needs can be met. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 3 7 17.1(a) People who use the service 17/07/2008 must have the name of the registered GP written in their records so that staff know who to contact if medical advice is needed. People who use the service must be assured that risks 17/07/2008 4 8 13.4 Care Homes for Older People Page 25 of 33 associated with daily living are assessed and action taken to minimise or eliminate risk so that they are safeguarded from harm. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 5 8 12.1(a) People who use the service 17/07/2008 must be assured their nutritional needs are accurately assessed and met so that their health is safeguarded. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 6 26 23.2(d) People who use the service 17/07/2008 must be assured that the home will be kept hygienic, odour free and in a good state of repair and redecoration. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 7 27 18.1(a) People who use the service 17/07/2008 must be assured that suitably qualified competent and experienced staff will be available in sufficient numbers at all times. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now Care Homes for Older People Page 26 of 33 being considered. 8 30 18.1(c) People must be assured the 17/07/2008 home will provide staff who have been trained to carryout the duties they are expected to perform. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 9 37 17.2 The home must keep an 17/07/2008 accurate up to date record of staff on duty each shift to ensure they know who is on duty and that staffing levels can be accurately monitored. Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 17 The service must retain 30/10/2008 records, in accordance with schedule 3 and 4, relating to people living in the home for any period of time. This is so that the service can show information relating to individuals health and care needs and how they have been met. 2 9 13 Medicines must be given to 29/10/2008 people at the home in line with prescribed instructions at all times. This must be demonstrated by the homes record -keeping practices . Repeat requirement 08/08/08 This is so that peoples health and welfare is safeguarded. 3 9 13 Medicines no longer in use for people prescribed them must not be retained at the home. timescale 14 days 29/10/2008 Care Homes for Older People Page 28 of 33 This is so that peoples health and welfare is safeguarded. 4 9 13 Full and accurate records for 29/10/2008 the administration of medicines (including external medicines and those prescribed with variable doses) must be completed by staff at all times. Repeat requirement 08/08/08 This is so that peoples health and welfare is safeguarded. 5 9 12 The non-availability of medicines must be avoided at all times. Medicines must be promptly obtained so they can be given to people at the home as prescribed. Repeat requirement 08/08/08 This is so peoples health and welfare is safeguarded. 6 9 13 Medicines prescribed for external application must be safely and securely stored so that people at the home are not at risk of accidental harm . Repeat requirement 08/08/08 This is so peoples health and welfare is safeguarded. 7 9 13 Medicines must be 29/10/2008 administered to people living at the home by staff who follow safe procedures for their administration at all 29/10/2008 29/10/2008 Care Homes for Older People Page 29 of 33 times. Repeat requirement 08/08/08 This is so that peoples health and welfare is safeguarded. 8 10 12 The service must ensure that peoples privacy and dignity is promoted at all times. This is so that peoples health and well being is promoted. 9 12 16 The service must ensure 30/10/2008 that people living in the home have the opportunity to exercise choice in relation to all aspects of daily life. This is so that peoples health and well being is promoted. 10 15 16 The service must ensure that people are provided with a nutritious diet that is presented in a way that meets their physical and cognitive abilities. This is so that peoples health and well being is promoted. 11 22 23 The premises must be designed in a way that meets the needs of people with demenia. This is so people are supported to orientate independently around the building and to enhance well being. 30/10/2008 30/10/2008 29/10/2008 Care Homes for Older People Page 30 of 33 12 33 24 The service must have systems in place to monitor the quality of the service. This is so that the service can identify any shortfalls and make improvements where necessary to promote the health and welfare of people living in the home. 30/10/2008 13 37 17 The service must retain records relating to people who live in the home. This is to safeguard the health and welfare of people living in the home. 30/10/2008 14 38 13 The service must have a robust risk management system in place. This is so that people living in the home are safeguarded. 30/10/2008 15 38 37 The service must report all 30/10/2008 serious incidents occuring in the home in accordance with regulation 37. This is so that the handling of serious incidents can be monitored to ensure the protection of people living 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 16 The service should ensure that the complaints procedure is well publicised in a format that is accessible for people with a variety of needs. Care Homes for Older People Page 31 of 33 2 3 18 19 The service should ensure that all staff are trained in safeguarding adults. The home should continue to find a way to reduce the conflicting noise between the two lounge areas. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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