Care Home: Aquarius Lodge

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What the care home does well A relaxed atmosphere was observed at lunch time. What has improved since the last inspection? The Statutory Notices and requirements made at the last inspection visit on the 17 February 2010 have been judged as met or partially met. Care plans are now being reviewed regularly to make sure that staff have the most up to date information. A new medication fridge has been purchased to ensure that medicines are kept at the right temperature. The newly appointed manager at the time of the last inspection visit, is now the registered manager for the service. This ensures that the service is managed by a person who has been assessed by us as fit to do so. Some planned activities are now taking place on a regular basis. Menus are being changed to take into consideration people`s individual choices. The stairlift has been replaced so that it is now safe for people to use. New carpet has been laid to the stairs and hallway. What the care home could do better: The Statement of Purpose is factually incorrect. It does not give people who are considering moving to the home a true picture of what the service can provide. Nor does it comply with the requirements of legislation. The Service User Guide is not written so that the information can be easily understood by the people for whom it is intended. A comprehensive assessment of potential risks has not been carried out or recorded for all the people who live in the home. Therefore not everyone`s safety can be assured at all times. Although some additional staffing hours have been introduced to better meet people`s needs, this does not cover the period between 6.00pm and 8.00pm, when people`s dependency levels remain the same. Some essential staff training has taken place and more has been booked, mandatory training in Safeguarding of Vulnerable Adults, Moving and Handling, First Aid, Fire Safety, Health and Safety, COSHH, Infection Control and Food and Hygiene remains outstanding for some members of the staff team. Until this training has been completed it cannot be assured that the staff team have the necessary skills and competences to look after the people in their care. The home is not doing all it can to minimise the spread of any infection in the home. In order to ensure that the home is run in the best interests of the people who live in it, there needs to be an effective quality assurance system in place. There is no annual quality assurance report and the visits to the home by the provider are not in sufficient detail to assess the quality of the service being provided. Key inspection report Care homes for older people Name: Address: Aquarius Lodge 20 Approach Road Margate Kent CT9 2AN     The quality rating for this care home is:   one star adequate 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: Sandra Crosby     Date: 1 6 0 6 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Aquarius Lodge 20 Approach Road Margate Kent CT9 2AN . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aquarius Lodge Ltd Name of registered manager (if applicable) Mrs Penelope Hewett Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The home was re-registered as a new service on the 10 March 2009, due to its change in status to a limited company. This is the third inspection visit since re-registration. Aquarius Lodge is a three-storey detached building with a lower ground floor, ground floor and first floor. There are fifteen bedrooms, including two doubles. There are five ground floor bedrooms, two lower ground floor bedrooms and eight bedrooms on the Care Homes for Older People Page 4 of 30 Over 65 17 0 1 9 0 8 2 0 0 9 Brief description of the care home first floor. There is a stair lift to the first floor, but there are five additional stairs up to bedrooms on one part of the first floor landing and four stairs down to bedrooms on the other side of the landing. Service Users occupying the two lower ground floor bedrooms need to be able to manage one flight of stairs. Bedrooms have call bells and television points. There are three lounges, one on each floor, plus a dining room on the ground floor. The home is situated in the residenital area of Cliftonville (Margate) within walking distance of most local amenities. Staffing consists of a team of carers who work a rota that includes one person on waking duty at night and one person sleeping in. Information previously provided by the Responsible Individual states that the fees range from £322.00 to £650.00 per week. Care Homes for Older People Page 5 of 30 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: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This is the third key inspection visit since the home was re-registered as a new service on the 10 March 2009, due to its change in status to a limited company. The aim of the visit was twofold. Firstly to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Secondly, to check compliance with the five Statutory Notices and eight statutory requirements made at the last inspection to the service. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA). This is guidance used to Care Homes for Older People Page 6 of 30 ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. This report contains the findings of the homes key inspection and takes account of information obtained from various sources. The key inspection was unannounced and carried out by two inspectors on Wednesday 16 June 2010 between 08.30 and 14.00. During the inspection the inspectors spoke with the registered manager, staff on duty and people who use the service. Various records were seen during the visit, together with observation of interactions and a walk around some areas of the premises. At the last key inspection, on 17 February 2010, the service was quality judgement rated as poor. The registered person sent us an improvement plan, dated 09 May 2010, detailing the progress being made to address some of these outstanding areas. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose is factually incorrect. It does not give people who are considering moving to the home a true picture of what the service can provide. Nor does it comply with the requirements of legislation. The Service User Guide is not written so that the information can be easily understood by the people for whom it is intended. A comprehensive assessment of potential risks has not been carried out or recorded for all the people who live in the home. Therefore not everyones safety can be assured at all times. Although some additional staffing hours have been introduced to better meet peoples needs, this does not cover the period between 6.00pm and 8.00pm, when peoples dependency levels remain the same. Some essential staff training has taken place and more has been booked, mandatory training in Safeguarding of Vulnerable Adults, Moving and Handling, First Aid, Fire Safety, Health and Safety, COSHH, Infection Control and Food and Hygiene remains outstanding for some members of the staff team. Until this training has been completed it cannot be assured that the staff team have the necessary skills and competences to look after the people in their care. The home is not doing all it can to minimise the spread of any infection in the home. Care Homes for Older People Page 8 of 30 In order to ensure that the home is run in the best interests of the people who live in it, there needs to be an effective quality assurance system in place. There is no annual quality assurance report and the visits to the home by the provider are not in sufficient detail to assess the quality of the service being provided. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide do not provide people with all the information they need to make a decision about moving into the home. The assessment process does not make sure that the needs of the person can be met at the home. Evidence: The Statement of Purpose and Service User Guide for the service were viewed. Despite both documents being updated following the inspection visit on 17 February 2010, the Statement of Purpose remains factually inaccurate under the Care Homes Regulations 2001. For example details of the staffing ratio in the guide do not reflect what happens in practice. The Service User Guide is not written so that the information is useful for the people who read it. Both these documents require auditing to ensure factual accuracy. It was judged that the requirement made at the last inspection visit in February had been only partially met. The registered manager gave her assurances that she will audit the two documents. This prevented us from Care Homes for Older People Page 11 of 30 Evidence: taking any further enforcement action. The AQAA completed at the last key inspection states we encourage the clients to visit the home/trial visit, day visit or overnight stay before making their decision. It also reports that pre-admission assessments are recorded and will usually be discussed with staff. Pre-assessment documentation seen at the last inspection was found to be comprehensive. There have been no new admissions to the home since the last inspection visit in February 2010. No judgement could be made in respect of the requirement made in the last inspection report in relation to providing accommodation for people only within the specified registration category of older people that the home is registered for. The registered manager confirmed that she is aware that the home is currently registered to admit persons only under the older person category. The quality judgement rating for the above standards at the last inspection visit on 17 February 2010 was poor. It is evidenced that improvements have been made and the quality judgement rating at this visit for these standards is judged as adequate, as further improvements are needed to safeguard people and meet current regulation. Care Homes for Older People Page 12 of 30 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. Not all people fully benefit from care plans that show that person centred care is promoted. Service users are benefiting from improving medication practice. Not all peoples health care needs are being met. Personal care is offered by staff in a way that promotes their dignity. However, the environment does not always protect peoples privacy and dignity. Evidence: A statutory requirement notice was served following the inspection visit on 17 February 2010, to ensure that person centred care plans are regularly reviewed and updated and that all appropriate risk assessments are undertaken, recorded and reviewed. This is to make certain that residents assessed health, emotional and social needs are met and to ensure their health and welfare are safeguarded in the home. Three service user care plans were seen, and evidenced that regular reviews are now being undertaken. Although an overall improvement was seen in the care planning documentation, not all necessary assessments of potential risks had been carried out. Care Homes for Older People Page 13 of 30 Evidence: For example, for one person, a risk assessment had not been completed in relation to their diabetes and skin integrity. Therefore there were no directions for staff to follow to meet these health care needs. To be fair and proportional a judgement was made that the statutory requirement notice is met. However, it is essential that further improvements are made so that service users health and welfare are safeguarded and that compliance with the regulations are maintained. A requirement was made in the inspection report dated 17 February 2010, in relation to promoting and making proper provision for the health and welfare of service users. The documentation seen indicates that health care needs may not always be met. It was stated in one of the care plans seen if blood sugar level is high then GP need to be contacted. It was discussed with the registered manager that as this instruction did not quantify what constitutes high, and therefore staff may not take the required appropriate action when needed. It was also stated in the care plan that staff to undertake blood sugar test at least once a week. The record seen indicated that these tests were undertaken on 16 April, 25 May, 06 June and 13 June at different times of the day, therefore these tests are not being recorded as instructed. This may adversely affect peoples health and safety. Due to the registered manager agreeing to address both these issues, further enforcement is not being taken and the requirement was judged as partially met. A further issue raised with the registered manager was that documentation seen evidenced that at least two service users were unable to be weighed due to lack of appropriate equipment. The registered manager agreed to address this issue. A statutory requirement notice was served following the inspection visit on 17 February 2010, that the registered person must ensure that appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are maintained. This is to ensure that service users health and welfare are safeguarded. Medication MARS sheets were seen and indicated that these were up to date and appropriately signed. A new medication fridge has been purchased. The registered manager said that a suitable lockable container is going to be provided by the pharmacy, to enable medications to be taken around the home in a safe manner. Also awaited is a metal medication storage cupboard and a controlled drugs box. The registered manager said there are plans to move the location of the medication room. This move of location would then enable a wash hand basin to be provided in the new medication room, thereby promoting good infection control practice. The requirement is judged as met at this visit. The updated copy of the staff training matrix provided indicates that six staff have Care Homes for Older People Page 14 of 30 Evidence: completed a safe handling of medicines one day course, three staff have completed a safe handling of medicine foundation course over three months, and four members of staff are booked to attend medication training in June 2010. It was observed that staff are discreet and treated service users with dignity. The registered manager confirmed that action had not as yet been taken to enclose the toilet surround of the single toilet and adjoining sluice room, together with the provision of appropriate screening in double bedrooms as this would further promote privacy and dignity for service users. The improvement plan states that this work will be completed by July 2010, and the registered manager confirmed that this issue will be addressed. The quality judgement rating for the above standards at the last inspection visit on 17 February 2010 was poor. It is evidenced that improvements have been made and the quality judgement rating at this visit for these standards is judged as adequate, as further improvements are needed to safeguard people and meet current regulation. Care Homes for Older People Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples access to opportunities regarding lifestyle choice is developing. People are supported to maintain contacts with families and friends. People are mainly provided with a balanced and healthy diet. Evidence: A requirement was made at the last inspection visit on 17 February 2010, to ensure that people are supported to participate in activities in the home and be provided with opportunities to participate in activities outside the home if they so wish. A weekly activity planner covering a four week period of activities was evidenced and included for example bingo, ball games, card making, head to toe, and hairdressers. A person who provides an exercise session once a week, arrived during the inspection visit and commented on leaving that the service users had enjoyed the session. A notice was seen on the notice board advertising a Garden Party to be held in August 2010. Staffing hours have increased following the last inspection visit, thereby enabling a programme of recreational activities to be undertaken. Improvement has been seen in that the care home supports people to follow personal interests and activities, therefore the requirement made is judged as met at this visit. To enable the provision of the activity programme to be sustained, staffing levels will need to be maintained and/or increased dependent upon dependency levels of the people using the service. Care Homes for Older People Page 16 of 30 Evidence: Visitors are welcome at anytime, and some of the service users are enabled to go out with family and friends. The cook said that since the last inspection she has increased working hours, working 8.30am to 1.30pm six days a week and 4.00 to 6.00pm three days a week to cover the teatime period. The other teatime shifts are covered by members of staff. The cook said that the menus are changing and that the food has improved. It was seen that a service user came to the kitchen to collect their packed lunch as they were going out with friends for the day. A further example of good practice was a letter from a relative stating how pleased they were to see their relative served their lunch on two plates, one for finger food and one for soft food. The relative states it was a recognition of his individual needs, allowing him some independence. Good communication and rapport was evidenced between staff and service users, one carer was heard saying good morning, how are you. At lunchtime one service user was asked if they have had enough before staff took the meal away, another service user had their meal taken away by mistake and asked for it back. The main mealtime was observed in the upstairs lounge, and there was much laughter. Two of the staff commented it is like this every day. The quality judgement rating for the above standards at the last inspection visit on 17 February 2010 was adequate. It is evidenced that improvements have been made and the quality judgement rating at this visit for these standards is judged as good. Further staffing hours dependent on dependency levels of people using the service (see under staffing standards) may be needed if the home is to sustain this quality judgement rating. Care Homes for Older People Page 17 of 30 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 know their complaints will be listened to and acted upon. People are not protected due to lack of staff training in identifying abuse. Evidence: The home has a complaints procedure, and this was seen as part of the Statement of Purpose documentation, and was also on display in the entrance hall. Staff previously confirmed that both providers are contactable by telephone and always telephone them back if they leave a message. Service users were clearly at ease in the company of the various staff members on duty during the day of the visit. Surveys returned at the inspection visit on 17 February 2010, for people who live in a care home for older people confirmed that there was someone they could talk to informally if they were unhappy, and also confirmed that they knew how to make a formal complaint. A statutory requirement notice was served following the inspection visit on 17 February 2010, that the registered person must ensure that staff employed at the home receive training appropriate to the work they are to perform had not been met. The copy of the staff training matrix provided at this inspection visit showed that of the twenty staff, eleven had undertaken safeguarding vulnerable adults training. Four of the eleven staff who have completed the training undertook the course recently in May 2010. The list of training to be done provided by the registered manager indicates that six members of staff will be attending training when a date can be arranged. The statutory requirement notice is judged as mainly met. However, all staff Care Homes for Older People Page 18 of 30 Evidence: are required to undertake training in safeguarding of vulnerable adults to ensure service users are safeguarded in the home and to achieve compliance with regulation. The registered provider is reminded that this staff training programme must continue to prevent further enforcement action being taken in the future. The staff training matrix indicates that six members of staff undertook training in relation to the Mental Capacity Act in April 2010. The home is currently subject to a safeguarding investigation, the outcome of which is not as yet known. The quality judgement rating for the above standards at the last inspection visit on 17 February 2010 was poor. It is evidenced that improvements have been made and the quality judgement rating at this visit for these standards is judged as adequate, as further improvements are needed to promote the safeguarding of people who use the service. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not benefit from living in a home where the routine maintenance, decoration, and renewal of the fabric of the premises are well maintained. Evidence: A requirement was made at the inspection visit on 17 February 2010, for the stairlift to be replaced to ensure the safety of service users and staff. Management have taken action, and the stairlift has been replaced and the requirement is judged as being met at this time. It was observed that a table with umbrella and chairs have been purchased for the garden. The registered manager agreed to dispose of the old chairs that were seen in the garden. It was seen that overall the garden was tidy and that some planting of vegetables for example peppers, aubergines and tomatoes had been potted out by service users. At the inspection visit on 19 August 2009, the hall and stair carpet was stained and worn. The homes Service Improvement Plan for 2010 stated that quote needed but no timescale had been recorded. At the time of the inspection visit on 17 February 2010 the carpet had not been replaced and remained in poor condition. It was seen at this visit that the hall and stair carpet had been renewed. Care Homes for Older People Page 20 of 30 Evidence: The registered manager confirmed that action had been taken since the last inspection visit to replace the surface around the sink in the sluice, to promote good infection control. A requirement was made at the last inspection visit on 17 February 2010 to ensure that suitable arrangements are made to prevent infection, toxic conditions and the spread of infection at the care home thereby promoting peoples health and safety. This requirement is judged as partially met at this time due to a number of further issues in relation to poor infection control practice at the home that were evidenced. Firstly, there was a distinct odour on entering the home. The registered managed explained that there is a bedroom carpet that has an odour near the front door, and confirmed the intention is to replace all bedroom carpets. Secondly, the bath panel in the bathroom on the way to the first floor is broken, and this had been pointed out at the last inspection visit. Thirdly, the carpet is stained in the day room and needs replacing. Fourthly, there were a number of issues in the ground floor bathroom. A small amount of cut hair was seen to have been left in the bath; the paint is coming off the bathroom cabinet; and inside the cabinet white musk body lotion was seen with no name on. The paint is flaking on the bath stool and this needs replacing. The registered manager agreed to address these issues. An area of good practice seen was that appropriate door guards have now replaced the variety of objects that were seen propping bedroom doors open. This promotes peoples safety in the event of a fire. It was seen at the back of the house that all the window frames need repainting as the paint is flaking. Some windows have no paint and need to be assessed for rot. A requirement is made in relation to ensuring that the premises are of sound construction and kept in a good state of repair externally and internally. It was reported at the inspection visit 19 August 2009 that care staff time is taken up with washing up as there is no dishwasher at the home. The service improvement plan for 2010 indicated that costing for a dishwasher is to be sought in June 2010. The registered manager said that this had not as yet taken place. The area off the main dining room is the designated smoking area and there is signage to say this. There is a curtain to cut off this area, but not a sealed door. This does not comply with the current smoking regulations and action needs to be taken to address this immediately. The registered manager agreed to address this issue. The quality judgement rating for the above standards at the last inspection visit on 17 Care Homes for Older People Page 21 of 30 Evidence: February 2010 was poor. It is evidenced that improvements have been made and the quality judgement rating at this visit for these standards is judged as adequate. This is because further improvements have been identified in this report to promote health, welfare and safety of people in the home and to comply with current regulation. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are not met at all times by the numbers and skill range of the staff. The homes practice regarding the recruitment of staff ensures that people are protected. Evidence: A statutory requirement notice was served following the inspection visit on 17 February 2010, that the registered person must ensure that sufficient numbers of suitably trained staff are employed to meet the needs of residents in the home had not been met. The staff rota seen and discussion with the registered manager evidenced that there is now one extra care staff person on duty from 8.00am to 2.00pm; between 2.00pm and 4.00pm there are now two care staff and the registered manager; from 4.00pm to 6.00pm there are two care staff and a person to provide the teatime food. The home now has two waking staff working at the home from 8.00pm to 8.00am. As additional staffing hours have been implemented the requirement is judged as being met at this time. The registered manager said that she is now reviewing the 6.00pm to 8.00pm hours in relation to the dependency levels of service users as at this time there are two carers only on duty at the home. Consideration needs to be given to the deployment of staff so that people can take part in regular activities both inside and outside the home. Staffing levels also impact on the safe working practices in the home. For example, when service users are being Care Homes for Older People Page 23 of 30 Evidence: bathed, or when two members of staff are required to assist one service user. As new members of staff have started work at the home since the last inspection visit, one staff file for a new starter was viewed. It contained all the relevant components as required by regulation, for example CRB checked prior to starting work and two written references. It was evidenced that the home is undertaking a thorough recruitment procedure for all new members of staff at this time. The newly appointed member of staff had been issued with a common induction standards workbook. A list was seen on the wall in the office in relation to this, and the staff member is currently keeping the book herself as she works through the induction standards. A statutory requirement notice was served following the inspection visit on 17 February 2010, that the registered person must ensure that staff employed at the home receive training appropriate to the work they are to perform had not been met. The copy of the staff training matrix provided confirms that since the inspection visit on 17 February 2010, mandatory staff training has been undertaken for some staff in for example moving and handling, fire safety, health and safety, first aid and challenging behaviour. The statutory requirement notice is judged as mainly met. The training to be done list, indicates overall that there is still mandatory training to be completed. The registered manager said that she is making every effort to book staff on courses as places become available to ensure that the staff at the home are appropriately trained for the work they are to perform. Therefore the statutory requirement notice is judged as mainly met. The registered provider is reminded that this staff training programme must continue to prevent further enforcement action being taken in the future. The quality judgement rating for the above standards at the last inspection visit on 17 February 2010 was poor. It is evidenced that improvements have been made and the quality judgement rating at this visit for these standards is judged as adequate, as further staff training is required to ensure the health, welfare and safety of people who use the service. Care Homes for Older People Page 24 of 30 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. People are benefiting from the developing leadership and management of the home. The health, safety and welfare of service users are not always promoted and people may not always be protected. Evidence: Since the inspection visit on 17 February 2010, the newly appointed manager has become the registered manager of the service. She is qualified and has many years experience. A requirement was made at the last inspection visit on 17 February 2010 that the registered provider of the service send a copy of the monthly report they write when they visit the home to the Commission office. Reports have been received for April and May 2010. This requirement is judged to be met at this time, however the reports would be more beneficial if they provided the registered person with comprehensive information. For example met with staff DH and CH was contained in one report, but no further information was given about outcome of the discussion with staff. Care Homes for Older People Page 25 of 30 Evidence: At the inspection visit on the 19 August 2009, service users records of personal allowance monies were seen and indicated that a clear system of recording with receipts kept was maintained to safeguard peoples best interests. The registered manager confirmed that staff supervision is being undertaken. There was no evidence of a quality assurance report that identified areas needed for improvement. The quality judgement rating for the above standards at the last inspection visit on 17 February 2010 was poor. It is evidenced that improvements have been made and the quality judgement rating at this visit for these standards is judged as adequate. Further areas that need improvements have been identified in this report, the Statement of Purpose and Service User Guide; risk assessments; staffing hours; infection control practice; quality assurance; all staff are not trained in the necessary skills and competencies that they need to adequately look after the people in their care. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 7 12 The registered person shall 31/07/2010 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users Ensure that all appropriate risk assessments are completed in order to promote the health and welfare of service users 2 19 23 The registered person shall 31/12/2010 having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. Check window frames for rot, and repaint as appropriate. To ensure the premises are fit for purpose and promote safety for service users and staff. 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 Care Homes for Older People Page 28 of 30 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 Care Homes for Older People Page 29 of 30 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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