Inspection on 20/01/10 for York House

This inspection was carried out on 20th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

York House 02/03/10

York House 01/12/08

York House 21/08/07

York House 14/11/06

York House 31/01/06

York House 04/07/05

York House 01/02/05

York House 26/08/04

York House 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: York House 8-10 Cauldon Avenue Swanage Dorset BH19 1PQ     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: John Hurley     Date: 2 1 0 1 2 0 1 0 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 34 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 34 Information about the care home Name of care home: Address: York House 8-10 Cauldon Avenue Swanage Dorset BH19 1PQ 01929425588 01929425588 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Maxine Valerie Toni Jacqueline Wylie,Mr Richard Graham Wylie care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home York House is a large, older style, detached property that overlooks a recreational/garden area and is close to the seafront. The home is approximately a mile from Swanage town centre, which has a G.P surgery, community hospital, shop, banks, a post office and places of worship. Accommodation is provided over three floors, all are serviced by a passenger lift. All communal lounges and dining areas are on the ground floor, also the kitchen and managers office. There are 30 bedrooms in the home; 20 have en suite toilet facilities. Two rooms are registered for use as shared rooms. A maximum of 34 service users can be accommodated in the category OP (older persons). 0 1 1 2 2 0 0 8 0 Over 65 34 Care Homes for Older People Page 4 of 34 Brief description of the care home Mr and Mrs Wylie are the registered providers and have owned York House since 1988. The registered manager is Mrs Street, who is supported by a Deputy Manager and a team of care and household staff. The gardens and grounds are well tended with garden furniture available so that residents can sit outside in good weather. There is car parking space at the front of the house for use by visitors. Laundering of clothing and household linen is carried out at the home and arrangements are made for chiropodists, opticians and other health and social care professionals to visit individual residents. The fee range quoted in the service user guide at the time of inspection was £455 to £515 per person per week. Up to date fee information may be obtained from the service. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was undertaken over the course of two separate days at the end of November and the beginning of December in 2009 by two separate inspectors. The reason for the second inspector was to check compliance with the immediate requirements that were made following the first day of the inspection. The focus of the inspection was to look at relevant key standards under the Commission for Social Care Inspection (now the Care Quality Commission) Inspecting for Better Lives 2 Framework. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good adequate and poor. The judgment descriptors for the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. The home completed an Annual Quality Assurance Assessment( AQAA) and information provided in that is also referred to in this report. Care Homes for Older People Page 6 of 34 We looked at three selected care files in detail and sampled others, the staff files, undertook a tour of the building and looked at all the documentation relevant to the running of a care home. We also spoke with visiting relatives. We sent and received a number of questionnaires from those who use the service, people important to them, staff and visiting professionals. Care Homes for Older People Page 7 of 34 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 on page 4. Care Homes for Older People Page 8 of 34 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 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment documentation needs to provide sufficient and robust information to staff to ensure that a persons needs are met in the way that has been agreed with the recipient of the care. Evidence: We looked at the documentation in relation to two people who had recently moved in to establish how the home had carried out the required needs assessment. The recording evidenced that an assessment of need had been made prior to the person entering the home. This assessment covered areas such as medication, falls risk assessment, health and personal care etc. The section relating to the persons risk assessment was by way of expressing a numerical score against a set of questions. The person who had completed the assessment could not inform us what the score meant or its relevance to the persons wellbeing which may mean they have unmet needs. The further informed us that that Care Homes for Older People Page 11 of 34 Evidence: had not had any specific training with regards to carrying out risk assessments. Whilst the documentation described the tasks that would need to be carried out it did not guide and inform staff as to how the person wanted the tasks to be performed. Therefore the assessments lacked the detail required for example the documents used may asked the question any falls with the answer being yes, but no exploration as to the circumstances of the fall or comment on the likely hood they will happen agian. We spoke with the person whose designated role it was to carry out the initial assessment in the community who informed us that they had not received any training with regards to carrying out initial assessments but did have many years experience of working in the care sector. We found in most of the files we sampled the initial assessment documents had not been signed by either the assessor or the person they related to. The assessment documentation did not explore any issues relating to the persons ethnicity or sexuality. At the time of the inspection we were informed that there was no one receiving an intermediate care service. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and subsequent reviews do not give an accurate picture of the person needs at the centre of the care, which may mean they have unmet needs The systems in place for the administration of medication may put people at risk. People are not always treated with dignity and respect. Evidence: Care plans are generated from initial assessment of needs and reviewed thereafter. There is evidence that some people are included in the care planning process but not all. We looked at a sample of the care plans and reviews in order to assess how the National Minimum Standards are consistently met within the home. In general terms the plans give some details of some but not all of the tasks to be completed by staff. However these need to be developed to evidence that the home is providing person centered care, for example files state what the task is but not what staff have to do to Care Homes for Older People Page 13 of 34 Evidence: carry out that task in a way that has been agreed with the individual for example in one file of a person who could be aggressive the file stated that staff to assess the persons mood before providing care. However there was no direction of how this assessment was to be made or what to do if the persons mood meant they could not receive personal care. In one persons file who had recently returned from hospital it was noted that they suffer from dementia and was not eating well in hospital. There did not appear to be an assessment to cover their return to the home although it was noted that the person had moved room to one on the ground floor for their safety. It was stated that the room move was made to reduce the likelihood of them falling out of bed, however it was not clear in the documentation what had made the previous room or bed unsafe as the risk assessment had not been updated. The documentation did not evidence that any management systems had been considered with regards to monitoring the person food and fluid intake nor had they been weighed to establish a bench mark which would evidence either weight gain or loss. The persons dementia was not explored in the documentation ie how it has effected their life and what topics should be encouraged to maintain the persons individuality. The pre admission assessments regarding this person did not give a clear statement as to the persons dementia only stating in the mental state section of the assessment tools, alert. Other omissions on the pre admission assessment were noted as the Health Section was blank as were the Weight and Diet sections on the assessment material. Many of the assessments made gave a numerical value to the question asked but no one could tell us what the overall score meant or what needed to be done next to reduce or increase the numerical value as appropriate. Another file also evidenced a lack of instructions to staff and systems in place to effectively address some mental health issues. For example this individual was not eating and refusing medication. The response had been to introduce food and fluid monitoring charts to ensure the person was receiving or being offered nutrition throughout the day. This is a positive and proactive response to this issue. However the impact of the person refusing medication had not been addressed. As they were taking medication for anaemia this may have meant they could be at an increased risk of falls but the falls risk assessment had not been updated. Similarly Care Homes for Older People Page 14 of 34 Evidence: there was no evidence that a doctor had been consulted as to the risks of them not taking the medication or the next action to take to ensure that the persons needs were being met. We spoke with the deputy manager who agreed with our observations. The file demonstrated that the person experienced a degree of depression and could be quite tearful at times. Again this illness was being treated by way of medication but the impact of them not taking their medication had not been evaluated. The care plans did not explore this issue in any depth ie what caused the person to be tearful but stated that if they became tearful then to sit quietly and talk. There was no evaluation of what topics assisted and which ones to avoid. In the file we looked at in relation to initial assessments it was noted in the daily recoding that there were up to seven days when no entries had been made. An entry in the daily recording file evidenced that the person was not always taking their medication at the stated time. We spoke with the deputy manager about this and established that the person had a habit of hiding their medication (there was no evidence or a risk assessment in relation to this) whilst exploring this issue we further established that staff do not always watch to ensure that people who have been given their medication actually take it. When we had first entered the home and sat in the managers office we observed a medication pot on the table with medication in it. The office was not locked. During our discussion with the deputy manager some hours later it was noted that the medication was still on the table. During these hours the office had remained unlocked. We pointed this out to the duty manager who said they will dispose of it. During the tour of the premises we observed creams and ointments in several locations, communal bathrooms and peoples private bedrooms. It was noted that in most cases they did not have opening or discard dates on them. We looked at the medication records and found that some people self medicate. The individuals files who self medicate did not contain any risk assessments in relation to this. These risk assessments should be made on entry to the home and reviewed on a monthly basis to ensure the safety of those who live at the home. We sampled the Medication Administration Records (MAR) relating to medication. With regards to those who self medicate we noted that the home receives medication on the persons behalf and gives it to the individual concerned. They do not record or sign what has been handed over or the quantity given and so an auditable trial does not Care Homes for Older People Page 15 of 34 Evidence: exist. This may put people at risk as the home has no one of knowing exactly how much of any preparation is on the premises. The MAR contained many references to people being administered medication on a Per Required Needs (PRN) basis but there was no evidence that staff had clear guidance on how to give medication via this route. Staff need to have clear instructions for giving any medication on a PRN basis to ensure that it is given appropriately. When care plan reviews were available it was noted that there was no consideration given to the use of PRN medication or evaluation as to its effectiveness. We also looked at the Controlled Drugs register. We found that on one occasion a preparation had not been signed for thus undermining the integrity of the recording system. There did not appear to be a sample signature record on file and so we could not establish if those who dispense medication have been suitably trained to do so. We spoke to a number of individuals about the approach of staff particularly about whether they felt treated with respect. All individuals said they felt staff did so and that they are all very friendly and that theyare helpful and kind. These commnets were further verified by visiting relatives. Questionnaires received prior to the inspection also commented positively with regards to staff interaction. Whilst looking at the care records we found that there was evidence that one person had been urinating on their bedroom floor at night. The response at the time was to wake the person up throughout the night so they could go to the toilet. The person had a diagnosis of dementia. This practice does evidence that the person was treated with dignity or respect. A further response to this issue was to move the persons to a room with an en suite toilet and bathroom. (please see the section on the environment with regards to further comments on this move) Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More needs to be done to ensure all those who live at the home have opportunities to have their social and recreational needs met. Visitors are welcomed and individuals are assisted with maintaining contact with relatives and friends Evidence: People who use the service were observed in a number of different locations. They choose when to get up and when to retire. They have free access to their bedroom and communal facilities. Those who use the service are able to meet privately with visitors either in their rooms or in a designated lounge. Those who were spoken with indicated that they were happy with their life in the home and confirmed that the staff support them in following their preferred lifestyle. Some of the people who live at the home informed us that there are things to do and the pace of life suits them. Visitors were observed entering and leaving the home. All visitors were warmly welcomed. We looked at the visitor book to evidence who was Care Homes for Older People Page 17 of 34 Evidence: visiting and who had recently been in to the home prior to our visit. The entry before ours was the 9/11/09 some six days before our visit. In total for the year 2009 there had been 14 entries prior to our visit. Whilst carrying out general observations and talking with those who live at the home many people entered and left without signing in or out. It was clear from looking at this record that people who enter or leave the building do not as a rule sign in or out. This point was also brought up in responses in questionnaires. We spoke with one relative who felt that their relative was being well cared for but wished there was more to do. One person who resides at the home informed us that some play bingo, carpet bowls and do exercise. They went on to explain that there is plenty to do for us that can informing us that some do not have the capacity to join in or to have self directed interests. Another person we spoke with could not remember the last time that they had gone out of the home except for health care reasons. Whilst evaluating the returned questionnaires it was also noted that staff and people who use the service wanted more opportunities for activities. We spoke with a small group of people who use the service. They informed us that they did not have residents meetings as there were to many people who were confused. Whilst sampling the care plans available we did not see any evidence to suggest that activities, peoples interests or aspirations were noted in the care planning documentation. We were informed by those who use the service that the food was always good and that choices were available. People told us that the staff knew peoples likes and dislikes and as such were able to cater for their needs. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service felt confident that any complaints or concerns would be listened to and taken seriously. All staff should receive training with regards to the Protection of Vulnerable Adults Evidence: The people who we spoke with informed them that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the manager and staff are very approachable and will deal with any issues, no matter how minor, there and then if they could. The feedback received via questionnaires broadly reflected the above but many people informed us that they did not know what was in the complaints policy. It may therefore be helpful if the management considered re issuing an abridged version of the policy to those who live and work at the home. The home keeps a record of any complaints made. There have been no issues recorded at the home. We looked at the staff training records and found that not all staff had received training with regards to Safeguarding Vulnerable Adults, the deputy manager agreed with our observations. Care Homes for Older People Page 19 of 34 Evidence: We looked at the homes policy with regards Safeguarding Vulnerable Adults and found that it is out of date and needs to be updated to reflect the Local Authorities expectations Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More needs to be done to ensure the safety of those who live at the home. People who use the service can personalise their private space and contribute to the decor. Infection control procedures need to be improved upon in order to protect those who live at the home. Evidence: People informed us that they are able to bring personal possessions with them into the home. We looked at a sample of the bedrooms used by people who use the service and found that they had been personalised with pictures, furniture and photographs to reflect the individuals taste. We noted in the lounge that there were three clocks but all showed different times. The clock in the conservatory to the front of the building also showed the wrong time. This may disorientate people with memory problems. We looked around the premises shortly after entering the home and again later in the day. This large home does not lock its front door and so people have free access to come and go as they please, many people we spoke with appreciated this. However as Care Homes for Older People Page 21 of 34 Evidence: the home provides accommodation and care for people with enduring mental health problems which can result in them wandering, the risk of this happening was not documented. As already discussed people do not sign in and out of the building and so this may put people at risk of harm on several levels for example; if people who live at the home go out for day and a fire breaks out there is no record of them leaving and so fire services may put their officers at unnecessary risk looking for people who are not there. During our tour of the building we were informed the home has updated one of its communal showers. In general terms the home was clean and appropriately furnished but more attention needs to be paid to infection control practices within the home as we observed issues such as staff carrying dirty commode pots down the corridors without wearing an apron or gloves and cloth hand towels in communal bathrooms. Although liquid soap had been provided there were no paper towels to dry your hands in many of the communal toilets observed. In one communal toilet there was seven rolls of toilet paper in the area but no toilet roll holder, there was no foot operated pedal bin and the call bell to raise assistance if required was inaccessible. We looked in a number of peoples rooms and noted that not all windows had there opening restricted, radiators and associated pipe work were uncovered. Whilst there was risk assessments in relation to unguarded radiators these were out of date, there was no evidence that the issue of unrestricted windows featured in the homes risk assessments. We left an Immediate Requirement instruction the registered manager to address this issue. We returned to the home three days later and found that the issues had been addressed. We looked at the persons room who was mentioned earlier in the report (following a recent room move, personal care section). The room had an en suite facility with bath. The hot water temperature was in excess of 50 degrees centigrade. The window in the bathroom was unrestricted and the radiator was uncovered. No risk assessments had been made in relation to the suitability of the room to meet the persons needs. The risks identified were acknowledged by the deputy manager when this was pointed out and arrangements were made to move the person to a downstairs room. There was evidence of regular checks of fire escapes and the fire alarm procedures. From carrying out a tour of the building it was clear that there has been some inward investment. However it was also noted that some areas now require attention for Care Homes for Older People Page 22 of 34 Evidence: example some of the carpets are showing signs of wear and will become a tripping hazard in the near future. It would therefore be prudent if the manager draw up a plan that identified areas that require improvement and dates that it was hoped that these improvements will be made. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is enough staff on duty to meet the current needs of those who live at the home. Not all staff have the necessary training with to provide a safe service to those who live at the home. The recruitment of new staff does not fully establish the fitness of those who wish to work at the home and may put people at risk of harm. Evidence: We looked at the rota which evidenced that there are sufficient staff on duty to meet the needs of those who live at the home. A positive feature of the staff deployment is that there is always a member of the management on duty 24 hours a day. (either one of the two deputies or the registered manager) We sampled the files of the last members of staff to take up employment. Prospective staff had completed an application form, and attended an interview. In order to assess their fitness to work with vulnerable adults Criminal Records Bureau checks had been carried out. However the statutory checks required to ensure people are fit to work with vulnerable adults had not been robustly established. Care Homes for Older People Page 24 of 34 Evidence: In one case there was found to be issues in relation to the dates of the persons employment that were not explained for example, the dates provided on the application form would mean that a person had been a stock control manager at the age of 15. In one file it was declared by the applicant that they had been dismissed form their previous employment. However the persons file did not make any reference to this issue and it did not appear that management had explored this issue. Another persons file did not have a full employment history. Only one reference had been taken up which indicted that there was an issue and informed the reader to ask the prospective member of staff about it. The file did not contain any documentation in relation to this issue or evidence that this had been explored by the homes management. Another persons file did not contain full evidence of the persons rights to work in this country. These issues were pointed out to the deputy manager. Whilst some of the staff had evidence of having had an induction not all did. Through discussion with the deputy manager we were told that a high percentage of training is carried out through the use of distant learning materials provided by a training company. At the last inspection a requirement was made that stated that the The registered manager to make sure that persons employed to work at the care home receive training appropriate to the work they are to perform. We looked at the training records available that did not evidence that all staff have received the necessary training required. The staff we spoke with were knowledgeable with regards to the people they care for and impressed as professional and compassionate. Through discussion with the staff group and by observing the people who use the service it is reasonably clear that the staff team have empathy for the people who live at the home. There were many good examples observed of staff interacting positively with the people who use the service. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management need to introduce systems to ensure the National Minimum Standards are established and maintained at all times. Failure to do this will put people at risk of unnecessary harm. The Health and Safety of people who live and work at the home is not protected due to the lack of risk assessments and action to minimise risks. The registered manager must ensure that records required by regulation are robustly maintained. Evidence: The manager has extensive experience of working in a care home. They have not completed managers training but continues to update their own training in areas such as Safeguarding, Mental Capacity Act, NVQ 2 and other areas associated with care of older people. The people we spoke with continue to be positive about their approach and described them as someone we can talk too will listen to what we have to say. Care Homes for Older People Page 26 of 34 Evidence: The manager is supported by two deputies who demonstrated knowledge of peoples needs. However as reported under care needs assessments and risk assessments sections, staff who are responsible for carrying out these assessments need to have the necessary training in order to ensure all of the persons needs are understood, assessed and plans drawn up to met these needs. A quality assurance system is in place with questionnaires being sent to individuals who live in the home. Health and Safety records continue to evidenced the maintenance of equipment in the home such as hoists, lift and electrical installation. We looked at the records relating to the management formally supervising the staff group and found that they were generally being kept up to date. The staff we spoke with stated that they felt supported by the manager and could take an issue to them for consultation. The Fire Risk Assessment was completed in June 2008 and found to require further attention at the last inspection, this has now been addressed and there did not appear to be any further outstanding actions. As discussed earlier risk assessments in relation to the environment have not been kept up to date. Staff have received fire safety awareness training and drills held as part of this training, inspection and servicing of fire system and emergency lighting is up to date. We looked at a number of records in relation to running the home. As already discussed the visitors book is not maintained. The accident book was sampled in conjunction with the care records; we found that not all accidents are recorded. This needs to be addressed to ensure that all information is recorded and available with which to guide and inform the reviewing process. As already discussed within the main report aspects of the Health and Safety of those who live at the home are not fully protected. The Registered Manager needs to introduce systems to ensure the National Minimum Standards are established and maintained at all times. Failure to do this will put people at risk of unnecessary harm Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 13 The manager to make sure there are suitable arrangements to provide a safe system for moving and handling individuals. This refers to the need to undertake moving and handling assessments for all individuals in the home. 01/03/2009 2 9 13 The registered manager to make sure there are arrangements for the recording, safe administration of medicines received in the home. This refers to the need to have written guidance as to the use of variable dosage of medication and the accurate recording of variable dosages. 31/01/2009 3 30 18 The registered manager to 31/03/2009 make sure that persons employed to work at the care home receive training appropriate to the work they are to perform. This refers to all staff having moving and handling and Safeguarding training. Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 13 The registered manager must ensure that people are not at risk of harm through environmental factors such as hot water temperatures, uncovered radiators and unrestricted window openings To ensure people are protected form harm 22/01/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered manager must ensure that intial assessments of need are carried by people trained to do so In order to ensure people do not have unmet needs. 19/02/2010 2 7 15 The registered manager 19/02/2010 must ensure that all care plans and reviews accurately reflect the needs of the person and give enough detail to guide and inform staff as to how to meet the agreed needs Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the person is not at risk of having unmet needs 3 9 13 The registered manager 19/02/2010 must ensure that the receiving, administration, recording of and returning of medication is carried out in accordance with the National Pharmaceutical requirements So as not to put people at risk of harm 4 10 12 The registered manager must ensure that all care practices treat people with respect and dignity. To ensure people are treated with respect and dignity 5 12 16 The registered manager must ensure that there are opportunities for all to be involved in meaningful activities based on peoples assessed needs and aspirations To ensure that person have sufficient opportunities for social stimulation 26/02/2010 05/02/2010 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 18 10 The registered manager must ensure that the homes policy with regards to Safeguarding Vulnerable adults is updated In order to protect those who use the service 22/02/2010 7 18 10 The registered manager 26/02/2010 must make arrangements to ensure that all staff have had Safeguarding Vulnerable adults training In order to protect those who use the service. 8 26 13 The registered manager must ensure that infection control policies are adhered too so as to promote the well being of those at the home. To ensure people are protected form harm 12/02/2010 9 29 19 The registered manager must ensure that those who work at the home are fit to do so To protect people from harm 26/02/2010 10 30 18 The registered manager to make sure that persons employed to work at the care home receive the statutory training 26/02/2010 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action appropriate to the work they are to perform. In order to ensure staff have the training to meet the needs of those who live at the home. 11 37 17 The registered manager must ensure that records required by regulation are maintained In order to protect those who live and work at the home 12 37 13 The registered manager must ensure that all environmental risk assessments are kept up to date. To ensure people are protected from harm 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 12/02/2010 12/02/2010 1 3 It is recommended that when carrying out initial assessments the assessor has had the necessary training to interrupt the results of the assessment tools used. It is recomeneded that intial assessments of need document issues relating to the persons ethnicity or sexuality The registered manager should consider re-issuing an abridged version of the compliants policy to those who live Page 32 of 34 2 3 3 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and work at the home 4 19 The registered manger should consider drawing up a plan that identified areas of the home that require improvement and dates that it is hoped that these improvements will be made. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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