Care Home: Aarandale Lodge

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The home is clean and comfortable. When people move into the home staff will develop care plans, which describe how the person is to be cared for and supported and these plans are generally kept up to date. Staff are usually recruited thoroughly and all of the checks including references from previous employers and Criminal Records Bureau disclosures are obtained to help determine the person`s fitness to work in the home. There is a programme for staff training. What has improved since the last inspection? New care plans had been introduced and the way in which information was recorded was better for some but not all residents. There had been improvements made to the home`s environment including redecoration of some bedrooms and the installation of a new hot water and heating boiler and radiators. The way in which medicines are stored has improved and controlled medicines are stored securely and staff keep accurate records. What the care home could do better: Staffing levels in the home are not always sufficient for the needs of the people living in the home. This means that residents may be at risk as there are not enough staff to support them at times. It also means that residents do not always do the things they enjoy such as activities as staff do not have enough time to spend with them. The homes owner could adopt a more open culture within the home where staff can feel free to raise concerns with him and other parties should this be appropriate. Staff have received training in caring for people who have dementia, however there were times where we saw that they did not support residents properly. Staff must ensure that residents receive medicines as prescribed for them and that where medicines are not given that the reason for the this is recorded so as to ensure that all staff are aware of the changes. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aarandale Lodge Aarandale Lodge 2-4 St Vincent`s Road Westcliff-on-sea Essex SS0 7PR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Carolyn Delaney     Date: 2 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Aarandale Lodge 2-4 St Vincent`s Road Aarandale Lodge Westcliff-on-sea Essex SS0 7PR 01702352096 F/P01702352096 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Aunjali Johar,Mr Navneet Singh Johar care home 20 Number of places (if applicable): Under 65 Over 65 20 20 dementia old age, not falling within any other category Additional conditions: 0 0 Thermostatic valves to be fitted to all hot water taps accessible by residents. Work to be completed within three months from registration. To comply with the report of the fire brigade including the provision of a second fire escape. Work to be completed within six months of registration To relay the tarmac to the front entrance and car park area. Work to be completed within six months of registration. Twenty x older persons who may have dementia. Date of last inspection Brief description of the care home Aarandale Lodge is situated in a residential area close to the town centre of Southend, the sea front and rail and bus links. It is registered for twenty older people who might additionally suffer with dementia. Care Homes for Older People Page 4 of 32 Brief description of the care home The accommodation is on two levels with a shaft lift to enable access to both floors. It has two lounges, one with a dining area, eighteen single bedrooms and one shared bedroom. It has a large enclosed garden and there is limited parking to the front of the property. The home has an updated Statement of Purpose, Service User Guide and a copy of the last inspection report in the entrance hall. The cost of a place in the home ranges from £352.00 and £580.00 per week. Extras charged are for hairdressing, chiropody, newspapers, personal toiletries and attendance to appointments using local taxis. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a routine unannounced inspection, which included a visit made to the home between the hours of 15.00 and 17.00 on 22nd May and 11.00 to 20.00 on 29th May 2009. The last inspection was carried out on 4th April 2008. As part of the inspection process we reviewed information we had received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment, which the registered provider or owner is required by law to complete and tell us what they do well, how they evidence this and the improvements Care Homes for Older People Page 6 of 32 made within the previous twelve months. We also looked at the improvement plan that we asked the manager to send us following the last inspection. This plan described how the manager was to address the issues as identified at the last inspection. We sent surveys each to the home to distribute to residents and staff and to complete and tell us what they think about the home. At the time of writing this report we had received surveys from six residents living in the home. We received three surveys from staff members. During the inspection we spoke with two residents, two members of staff, the manger and the homes owner. When we visited the home we looked at residents care plans and information available to staff to help them support residents. We looked at how staff were recruited to work in the home and how they were trained to support residents. We looked at how the home was managed and how residents were involved in this. We also observed how staff interacted with residents when supporting them with activities such as meals and providing recreation and stimulation. As a number of residents living in the home had communication problems due to their dementia we used an observation tool to help us assess the outcomes and experiences for these people. This observation is called a Short Observation Framework for Inspection (SOFI). We observed five people in sessions of five minutes over a two hour period. We looked peoples state of being (whether they were displaying a positive, neutral or negative state). We observed any interaction or engagement between these residents and other people in the room including staff. We made observations on how staff carried out tasks and their engagement with residents. We also observed the impact this had on residents and whether this was positive or negative. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. 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.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 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home cannot always be assured that their assessed needs will be met. Evidence: The manager told us in the Annual Quality Assurance Assessment that before a person moved into the home a detailed assessment of their care needs would be carried out by two members of staff in order to ensure that they would be able to meet the persons needs. Once a decision was made to offer a place to the person they would move into the home on a twenty-eight day trial period. They told us that staff are given information about a persons needs before the person moves into the home. Two of the six residents who completed surveys with the assistance of staff told us that they had received enough information about the home before they moved in. The others said that they did not, or that they could not remember. Two people said I did Care Homes for Older People Page 10 of 32 Evidence: not know I was coming. Two members of staff who completed surveys told us that they were always given enough information about residents needs. However one person said they were not always given information about new residents if they had been admitted to the home while the member of staff was not on duty on the day of the admission. Three members of staff we spoke with also said that they did not always receive information about new residents to the home. When we visited we looked at the arrangements for assessing a persons needs and receiving new residents into the home. We looked at the pre- admission assessment for three people who had been admitted to the home recently. We saw that the manager had visited two people in hospital and had carried out an assessment of both persons health care needs. The assessment included information about the persons medical history and what support they needed to carry out daily activities of living such washing and dressing, eating and drinking and communicating. There was information about the persons mobility and risk of falls. Following the assessment the manager had confirmed in writing to each person that they could meet their assessed needs. The third person had been admitted from one of the providers other care homes. The manager told us that they had been put under pressure to assess the persons needs and to admit them to the home. They told us that when they went to assess them they found the person lying on the floor crying and that their relative was with them and extremely upset. They said that with hindsight they perhaps should not have accepted the resident but at the time they thought they were doing the best for the person. We looked at the assessment carried out prior to the person moving into the home. The manager recorded on the assessment form that this was an emergency admission. They recorded in the assessment that the person was very agitated, rolling on the floor crying. They also recorded We will give him a try to see if we can manage him better as all staff have been trained for dementia. There was no indication as to whether the persons needs could be meet by staff at Aarandale, whether extra staff would be needed or the impact this persons behaviour may have on the people already living at the home. We asked the manager how staff were provided with information about a person before they moved in so as to help prepare for the admission. The manager told us that this would be provided verbally at the handover of shift and confirmed that there was no written information given to staff. We looked at the information recorded about how a person was received and welcomed into the home. There was little information recorded about how the person was helped to settle into the home and introduced to Care Homes for Older People Page 11 of 32 Evidence: staff and other residents. The majority of people who lived in the home had dementia this information would help to improve the experience of moving into unfamiliar surroundings for residents. There was detailed information available about the home and the services provided. The manager said that this information was provided to people who were looking for a home or their relatives to help them decide whether it would be suitable for them. The home accepts people from Southend Hospital for a period of step down. These people move into the home for a short period until they are able to move home or into a permanent place in a care home. A complaint had been made to the home by a residents relative. They were concerned that their relative had been moved into a home with people who had dementia as their relative did not. We saw that the admissions process did not take into account people who do not have dementia moving into the home or the impact this may have on both parties. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home do not always receive the care and support they need. Evidence: The manager told us in the Annual Quality Assurance Assessment that residents care plans included details of their needs. They told us that residents were registered with a local doctor and that staff would support residents to attend appointments where family members were unable to this. They told us that records in respect of medication were kept up to date. We were also told that there was a screening tool to assess each persons risk of developing pressure sores, that staff had received training in prevention measures and that no residents living in the home had developed pressure sores. When we last visited the home we found that controlled medicines had not been stored in line with current regulations. We asked the owner to tell us in an improvement plan how they were to address this and they told us that a new cabinet, which met requirements had been purchased and installed. When we carried out our inspection Care Homes for Older People Page 13 of 32 Evidence: we confirmed that this action had been taken. Six residents completed surveys with the assistance of staff. Each of the six said that they always received the care and medical support they needed. One person said There is always someone around to ask for help if I need it. Another person said All the time, and a third said Staff are very good here. Three members of staff completed surveys. Of the three, two people told us that they felt that the way in which information about residents was shared worked well. One person said that it was not always so and gave examples where information had not been shared, which resulted on occasions a residents doctor not being contacted and urine samples not being collected where these actions should have been carried out. When we visited the home we looked at how staff supported residents for their health and personal care needs. We looked at the care plans for four residents. Generally care plans reflected the needs of the individual in respect of their personal and health care. Care plans were written in a way, which did not always reflect how residents wished to be supported in some instances, although this information was recorded for others. One person living at the home required a lot of support in order to minimise the risk of falls. The care plan for this person indicated that they mobilised well, however during the inspection we observed that this was not always so and that on one occasion three members of staff were involved in supporting the person to mobilise. It was recorded as part of the nominated carers views section of the care plan that this resident often became upset and cried out loudly, particularly at lunchtime. We observed this during the lunchtime meal. The resident became very agitated and upset and was crying out loud and many of the other residents complained about the noise. In the evening this person was also heard to be crying out loudly. Staff told us that this was lessened if the person had a member of staff with them. There was no information in this care plan as to how the resident was to be supported in this respect or how the impact of the persons behaviour on other people could be minimised. Staff told us that there were not enough people on duty to support this persons needs. Three members of staff who contacted us after the inspection visit raised concerns that they could not always meet the needs of residents or keep them safe due to insufficient staffing levels. They expressed concerns that a number of residents required support from two staff when assisting with personal care of escorting to the toilet. This meant that there were insufficient staff available to support other residents. One member of staff told us that personal care is rushed and we do not have time to spend with residents or take them out if they would like. Staff said that the lack of staff put residents at risk. Some relatives commented that staff appeared a bit pushed at times. We observed that at times staff struggled to support residents. One person required constant attention due to their behaviour and risk of Care Homes for Older People Page 14 of 32 Evidence: falls. Staffing levels had not been reviewed in light of the extra support which this person needed. We looked at the arrangements for minimising risks to the health and safety of people living in the home. We saw that there was a system for assessing risks of injury due to falls, developing pressure sores. There were detailed plans in place to identify and minimise risks to residents. However with regards to minimising risks of falls there were insufficient staff available to support residents at times to manage these risks effectively. We looked at notifications, which the manager had sent out about incidents that affect the welfare of residents. From these we saw that there had been three incidents within the previous year where residents had suffered serious injuries as a result of falls in the home requiring hospital treatment. We looked at how staff ensured that residents received medicines, which had been prescribed for them and the arrangements for storing medicines. We saw that all staff who were responsible for the administration of medicines had received training within the previous twelve months. Staff told us that no residents living in the home at the time of the inspection were refusing medicines. They told us that should this happen that they would contact the persons doctor for advice. We looked at how medicines were stored and found that these arrangements were satisfactory and that medicines were stored securely and safely. Staff regularly recorded the temperature in the room where medicines were stored so as to ensure that this was appropriate. We looked at how staff kept records for medicines they administered to residents. We looked at the medication administration records for two residents. Records were well maintained for one of the two people. We saw that for one person there were no signatures to indicate that they had received their Quietipine (a medicine to treat people who have schizophrenia) in the evening for a period of ten days. Staff initially could not tell us why the medicines had not been administered and there were no records in the persons care plans or elsewhere as to why the medicines had not been administered. The manager then told us that from recollection they thought the persons doctor had discontinued the medication. However there was no recorded evidence to support this. Some entries in medication administration records had been hand written by staff. We advised them that where this practice occurred that a second person should check and sign the entry as a measure of good practice to minimise the risk of error. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 are not provided with stimulation or opportunities to exercise choices about how they spend their time. Evidence: The manager told us in the Annual Quality Assurance Assessment that there are specific individual activity sheets for residents which described their level of dementia so that appropriate activities could be provided. Six residents completed surveys. Four of the six people told us that there were usually activities arranged by the home that they could take part in. Two people said that there always were. Staff we spoke with and those who completed surveys told us that residents did not have appropriate activities and there was not enough time due to the current staffing levels and the other duties they had to carry out. As part of the inspection we carried out an observation called a Short Observation for Inspection. We observed five residents who had dementia over a period of two hours. During this time we observed each persons state of being, whether this was positive, withdrawn or whether the person was asleep. We observed any interaction between Care Homes for Older People Page 16 of 32 Evidence: residents and other people in the room. We observed how staff interacted and engaged with residents and the impact this had, if any on the person. We carried this observation out in the afternoon. During this time staff spent a lot of time in the lounge area providing activities. Staff played music and while some residents appeared to enjoy this others clearly did not as indicated by their demeanour and things the things that they said. At one point we observed a member of staff attempting to engage a resident in dancing. The resident resisted. We observed that without consulting with residents as to what they would like to do a member of staff brought in post cards and proceeded to initiate a game in which residents would identify the places on the cards. However residents appeared disinterested, some staff could not identify the places depicted on the cards and the game was abandoned and the music was recommenced again without any consultation with residents. A short time later staff announced that it was time to check and cut residents nails. This was carried out even when one resident refused. Staff said No they need to be done. They then continued with the task and the resident closed their eyes. During the two hour period we saw staff laughing and joking with each other about the weather and the forthcoming air show. At one point air planes were heard as they flew over the home. The noise was loud and a number of residents looked up and around them. Staff did not explain to residents the cause of the noise. The observations we made indicated a lack of understanding of enabling people to make choices and of how to support and communicate with people who have dementia. Staff we spoke with after the inspection visit told us that they would not normally carry out these activities but were told to do so as the inspector was in the home. We looked at the activity sheets for two people. There was some limited information recorded about the things that both people liked to do such as watching television and helping around the house. We looked at records staff had made in respect of activities provided for these two people for a period of two weeks. This confirmed what staff told us. Records indicated that residents participated in music and dance, one to one and exercise. There were no records to indicate that residents were supported to go out of the home for walks or to access any amenities in the community. Reatives who completed surveys as part of the homes annual quality assurance system said that they could visit when they wished and that they were always welcomed into the home and on accasions were offered refreshments. Five of the six residents who completed surveys told us that they enjoyed the meals provided as did two residents we spoke with during the inspection. We saw that there was a planned menu with choices of meal. The menu was displayed on a white board Care Homes for Older People Page 17 of 32 Evidence: in the dining room. On the day of the inspection we saw that residents had a choice of fish and chips, fish with mashed potatoes or a beef stew and dumpling. All three options were available and residents were observed to choose what they wished. We were invited to have lunch with residents and we observed that the food looked appetising and tasted good. Residents appeared to enjoy their meal. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives can be assured that their complaints and concerns will be taken seriously and responded to. People may not always be safeguarded from harm. Evidence: The manager told us in the Annual Quality Assurance Assessment that staff listened to what residents say and acted immediately if complaints were made. They told us that there was a complaints policy for staff to follow and that staff had training to recognise and report any abuse of residents. Each of the six residents who completed surveys told us that they knew how to make a complaint. One person said I would tell the manager. Another person said they would speak with a member of staff. Each of the three members of staff who completed surveys told us that they knew what to do if a resident, relative or advocate had concerns about the home. One person said I would report it to the person in charge. Another person said I would inform the manager, area manager or CSCI. We looked at how complaints had been received and dealt with. There were three recorded complaints made and we saw that this had been investigated and responded to in line with the homes policy and procedure. We looked at the arrangements in place for safeguarding residents from abuse. We Care Homes for Older People Page 19 of 32 Evidence: saw that all staff working in the home had undertaken training in safeguarding people who may be vulnerable. However some staff had not received this training since 2005 / 2006 and one person had not undertaken training since 2004. There have been many changes in the way in which safeguarding of people is managed since this time and therefore regular training is advised so as to ensure that staff are aware of their roles and responsibilities. We looked at notifications about serious incidents at the home, which affected the safety or welfare of residents. In one incident a person fell off the bath hoist while left unattended and suffered a serious injury. This should have been referred to the safeguarding team as staff had neglected to follow procedures and safeguard the resident. However it had not been reported or dealt with as such. We looked at how staff were recruited to work in the home. We saw that checks such as Criminal Records Bureau disclosures and PoVA First checks were carried out to help determine the fitness of the individual. However references were not always obtained from a persons previous employer. Three members of staff we spoke with following the inspection told us that when they raised issues about how residents were supported such as insufficient staffing levels, lack of petty cash to buy essentials such as milk or bread, that the area manager and owner were slow to respond. They also told us that they were discouraged from speaking with the inspector during the inspection and felt had they done so they there would be recriminations. One member of staff said that they were told you better not say anything to the inspector. Staff told us that they were aware that the home had a whistle blowing policy. However three people told us that they did not feel confident that they would be protected from harassment if they were to raise concerns. This may mean that some staff would not report poor practice or ill treatment of residents and may therefore put people at risk. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not maintained so as to meet the needs of the people who live there. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home was kept clean, tidy and odour free. They told us that there was a new heating and hot water system in place. They also told us that new slings had been purchased for hoists and that some bedrooms had been redecorated as part of the ongoing programme for improving the homes environment. Each of the six residents who completed surveys with the assistance of staff told us that the home was always fresh and clean. One resident told us that the home was always lovely and clean. Another person said staff clean my room every day and the home is always clean. Staff were responsible for ensuring that the home is cleaned each day. During the inspection we looked at some communal areas such as lounges, dining rooms and bathrooms. These areas were clean and free from odours. We spoke with two residents during the inspection and they told us that they liked the home. We looked at certificates and other records and these indicated that the home was maintained and that equipment such as fire detecting and fighting equipment, lifting hoists, gas and electrical systems and installations were maintained in good working Care Homes for Older People Page 21 of 32 Evidence: order. The owner told us that there were no problems with the heating and hot water since the installation of the new boiler. However following the inspection some staff contacted us and said that there were still issues with hot water in the home and that the boilers were still not providing enough hot water to meet residents needs. They told us that there is only enough hot water available for two hours per day and that residents cannot always have a bath. One member of staff said that the laundry had been out of order for a month. Another member of staff said that the tumbler dryer was not suitable for the amount of use it received and that it constantly breaks down. We did not check these areas during the inspection and we have contacted the owner about the issues raised following our visit. Following the inspection the homes owner contacted us and told us that the boiler had been replaced with the previous seven months and during this time that hot water was available via an emersion system. Thye told us that staff has tampered with the system resulting in occasions where hot water was unavailable. However this does not change outcomes for people who live in the home and therefore the requirement made remains. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are not always met due to insufficient staff available to support them. Evidence: The manager told is in the Annual Quality Assurance Assessment that staffing levels were sufficient for the numbers of people living in the home. They told us that there was a new middle shift from 9.30am to 8pm to help support residents better. Five of the six resident who completed surveys said that there were always staff available when they needed them. The other person said that there usually were. One resident said that there were always girls around working. Another person said staff were always in and out. Two of the three members of staff who completed surveys told us that there were enough staff on duty to meet the needs of people living in the home. However one person who completed a survey and three people who contacted us following the inspection expressed concerns about staffing levels and the impact it had on their ability to care for residents. (This is described in other sections of the report). We looked at the staff duty rota for a period of four weeks. We saw that the staffing levels were one senior carer and two care staff during the day. However on a number of occasions the senior post was covered by the manager, taking them away from the Care Homes for Older People Page 23 of 32 Evidence: management duties of the home. The senior staff worked from 07.30 to 17.30. In addition there were two staff employed from 07.30 to 14.30 making the numbers three during the day. In addition to their caring duties staff were responsible for cleaning the home and in the afternoon one member of staff prepared the evening meal. This took staff away from their duties of supporting residents. From 17.30 to 21.30 there were two or three members of staff to support eighteen residents. As some people required the support of two staff this would at times mean that there were no staff available to other residents should they need help. In addition there were times where one resident needed extra support. We saw that out of the four weeks rotas provided (4th to 31st May 2009) that the extra staff as identified in the Annual Quality Assurance Assessment were only evident for two weeks. Following the inspection the manager contacted us and expressed concerns about the staffing levels and skills. They told us that senior staff were inexperienced. When we looked at minutes from the staff meeting held in January we saw that one member of staff had been promoted to a senior care role and another two members of staff acted as seniors when needed. We looked at how staff were recruited to work in the home. We looked at the recruitment files for two members of staff who had been employed at the home since the last inspection. We saw that a full employment history had been obtained and references had been posted to each persons previous employers. However for one person the returned reference had not been completed by the employer but a colleague. This had not been picked up by the manager. We discussed the importance of ensuring that references were obtained from previous employers and not candidates colleagues or friends. We saw that Criminal Records Bureau disclosures and PoVA First checks had been obtained. These checks help to determine the suitability and fitness of people employed. We saw that staff had been interviewed so as to further ensure that they would e suitable to work in the home. Once staff commenced work at the home they completed a period of induction and each person had a checklist indicating the areas covered such as policies and procedures. The induction was not in line with Common Induction Standards. These are a nationally recognised set of standards which staff work towards completing and are intended to standardise and improve the care provided. We looked at how staff were trained to meet the needs of people living i the home. Each of the three members of staff who completed surveys told us that they received training in relation to their roles, helped them meet the needs of residents and kept them up to date with new ways of working. The manager provided us with a copy of the homes training matrix. This was a record of training each member of staff had undertaken and the dates on which the training took place. We saw that some but not all staff had undertaken training in food hygiene, health and safety, fire safety, moving Care Homes for Older People Page 24 of 32 Evidence: and handling, first aid, dementia, challenging behaviour an Control of Substances Hazardous to Health. We observed some staff practices when we carried out our Short Observation for Inspection (SOFI) which indicated that staff did not always understand how to support people who have dementia, particularly in enabling them to make choices and communicating effectively with people. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always managed in the interests of the people who live there. Evidence: The manager told us in the Annual Quality Assurance Assessment that since being promoted to management post that they were keen to do their very best for residents living in the home. They indicated where improvements had been made since the last inspection and identified where improvements were needed. The manager was on duty at the time of the inspection, however they were only involved in a very limited way and a manager from one of the providers other care homes and the operations manager provided information etc during the visit. Both said that there was an induction programme and support for the manager and that their progress was being monitored. Shortly after the inspection the manager contacted us to say that they were leaving the homes employment. A number of staff told us about areas where they felt improvements were needed to Care Homes for Older People Page 26 of 32 Evidence: make life better for people living in the home. These included more staff, better quality food and an improved environment. We looked at how the views of people who use the service and their representatives were obtained and acted upon. We saw that residents relatives had been sent surveys to comments on the home. Residents had not been consulted. From the results of the relative surveys we saw that relatives were overall happy with the home. They commented that staff were very good but appeared pushed at times. One person suggested that a higher staff ratio. A number of people commented that there could be more activities provided. One person said social stimulation could be increased. There was no evidence of any plan to address the issues identified or to make improvements where suggestions had been made. At the time of the inspection there were no resident or relative meetings held. Staff meetings were held and the most recent minutes available were regarding a meeting held in January 2009. The minutes described some changes to staff roles and duties. There was also a record of some issues at weekends and that some jobs were not being done. There was no evidence as to how this had been dealt with or if there were still problems and the operations manager said that they were unaware of these issues. As described in this report there are a number of areas where the service is failing to meet the needs of the people who live there. Care Homes for Older People Page 27 of 32 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 27 18(1)(a) Staffing levels at the home 30/09/2008 must be appropriate to the needs of residents. This relates to staff preparing meals in the evening and residents left unsupported in lounge areas. 2 30 18(1)(c) and(i) All staff working in the home 30/10/2008 must receive training for the work they are to perform and the needs of residents, so as to ensure that staff practices are safe and consistent and residents are supported properly. This requirement is outstanding from the last inspection and the previous timescale of 01/01/08 has not been met. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 A person must only be admitted to the home once an assessment of their needs has been carried out and it is determined that these needs can be met by staff. This will ensure that people who move into the home will have their assessed needs met. 30/07/2009 2 7 15 Each persons care plan must be reviewed and amended so that it accurately reflects their needs and the support and care they need. This will help to ensure that staff have accurate and up to date information about the needs of the people they support. 31/07/2009 3 9 13 Staff must ensure that residents receive medicines as prescribed for them and appropriate records are 31/07/2009 Care Homes for Older People Page 29 of 32 maintained. Where a person refuses medicines or there are changes to their treatment this must be recorded. This will help ensure that residents receive the medicines as required and that all staff are aware of any changes to their treatment. 4 12 16 Appropriate activities and opportunities which suit the needs of people who have dementia and reflect the wishes of residents must be provided. This will help ensure that residents remain occupied and stimulated and that they enjoy their experience of living in the home. 5 18 13 Arrangements must be 31/07/2009 made so as to safeguard people who live in the home. This includes the appropriate reporting and managing incidents in line with the homes and local safeguarding procedures. This will help ensure that people living in the home are safeguarded from harm. 6 19 16 All of the equipment required to meet the needs of residents such as heating nd hot water and laundry equipment must be maintained in good working order. 31/07/2009 31/07/2009 Care Homes for Older People Page 30 of 32 This is to ensure that residents needs for personal care can be met by staff. 7 33 24 Arrangements must be 30/07/2009 made so as to obtain and act upon the views of residents (and other stakeholders) about how the home is run and the service they receive. This will help improve the outcomes and experiences for people who live in the home and take into account their feelings and opinions. 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 2 18 31 Staff should receive regular safeguarding training to ensure that they are aware of how to act and their responsibilities. A manager should be appointed so as to improve the running of the home. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!