Care Home: Arncliffe Court Nursing Home

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What the care home does well Three of the houses, Speke, Childwall and Paisley provide a good level of care to the service users within a pleasant environment. What has improved since the last inspection? No improvements have been identified as a result of this inspection. What the care home could do better: Assessments of prospective service users need to contain sufficient information regarding health and social needs together with abilities. Details of equipment required to meet the needs of the service user are necessary to ensure that these can be provided prior to admission. At present, the home is unable to demonstrate that they can meet the needs of prospective service users due to the failure of adequate assessments. Care plans do not provide full information regarding needs and abilities to inform staff of the care they should provide or how that care is to be provided. Records relating to the care and support given to service users require to be up to date and maintained accurately. Where the needs of the service users change, care files require to reflect those changes. The advice of GP`s and dietitians should be sought when service users are identified as losing weight. Medications require to be handled in a safe way to ensure that service users health is promoted and they are protected. Activities require to provide service users with stimulation and social interaction based on their wishes and abilities. Regular checks on the environment should be made to ensure that service users are accommodated in a pleasant and safe manner which promotes their dignity and wishes. Appropriate supervision of service users should be given by the staff to ensure their protection. The management arrangements within the home require to be stabilised to ensure that care is afforded appropriately, the environment is maintained in a good condition and that staff are supervised. Key inspection report Care homes for older people Name: Address: Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jeanette Fielding     Date: 2 5 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 32 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 32 Information about the care home Name of care home: Address: Arncliffe Court Nursing Home 147b Arncliffe Road Halewood Liverpool Merseyside L25 9QF 01514866628 01514481934 southark@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 150 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing: Code N 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: Code OP (maximum number of places: 60) Dementia: Code DE (maximum number of places: 90) The maximum number of service users who can be accommodated is: 150 Date of last inspection Brief description of the care home Arncliffe Court is registered to provide care for 150 individuals. The Home is situated in Halewood, Knowsley, Merseyside. Arncliffe Court is on a housing estate close to all local amenities and has good links with public transport. There are local shops nearby and a main shopping area can be reached by bus or car. Care Homes for Older People Page 4 of 32 2 4 0 9 2 0 0 9 90 0 Over 65 90 60 Brief description of the care home Arncliffe Court is divided into five units all of which are physically separate and operate on an individual basis. Each unit has access to a secure courtyard garden and all the units are situated in landscaped grounds. The Units all have names and vary in function: Gateacre House: nursing care for older people who have dementia, Speke House: nursing care for older people, Childwall House: residential care (personal care only) for older people, Paisley House and Woolton House: residential care for older people who have dementia. There is a smoking policy in operation across the site and residents who wish to smoke can do so in designated areas. A site manager is responsible for the management of the home with each unit being managed by a unit manager. The fees for residing at Arncliffe Court range from £338 to £741 per week and are dependent on the level of care required. 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was undertaken over four days and a total of twenty six hours were spent in the home. As part of the inspection process, each of the five houses of the home were viewed including communal areas and many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. The care files of seventeen service users were case tracked to evaluate their care. Discussion took place with the Responsible Individual, Manager, Care Services Manager, unit managers, nurses, care staff, service users and visitors to the home. An acting manager had completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. The findings of this inspection are not typical of the standards usually provided by the Care Homes for Older People Page 6 of 32 home, and subsequent to the inspection, systems have been put in place to address all shortfalls in service provision. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admission assessments of prospective service users are, in some cases, not sufficiently informative due to the staffs failure to complete the documentation appropriately. They require improvement to ensure that service users needs, abilities and preferences are clearly identified to confirm that these can be met. Evidence: The home has produced a Service User Guide and Statement of Purpose to provide current and prospective service users with full information about the home to enable them to make an informed choice regarding their care provider. These are displayed in the foyer together with information about other BUPA homes and the recent reports in respect of Arncliffe Court. Copies of these are available from the home on request. All prospective service users are assessed prior to their admission to the home. The home uses a dedicated document which has been specifically prepared for Care Homes for Older People Page 10 of 32 Evidence: assessments and is a very good format. The form asks specific questions and requires that a separate section is completed to identify when care plans and risk management plans are to be prepared. It was evident that some staff undertaking the assessments and recording the information have not followed the procedure to ensure that all details are recorded. One assessment was observed to contain minimal information and did not identify the service users health or social needs, abilities or skills. The form did not include sufficient information to enable the home to confirm that they could meet the needs of the service user and has the potential for placing the service user at risk. Staff can not be provided with the necessary information needed to provide the appropriate level of care to service users on their admission. It is essential that all questions on the form are completed accurately together with details of the persons who provided that information. Details of any specialist equipment needed by the service user should be clearly recorded to enable this equipment to be put in place prior to their admission. Prospective service users are encouraged to visit the home prior to making a decision regarding their care provider and short stays are welcomed. Care Homes for Older People Page 11 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Many of the care files showed that they require to be reviewed and updated to inform staff of service users care and social needs, abilities, skills and preferences to enable them to have the care and support that they need and in a way that they want. The failure of staff to follow the procedure for the administration of medications in Gateacre House places service users at risk. Evidence: As part of the inspection process, a total of seventeen care plans were inspected, three or four in each of the five houses. The care plans inspected showed that many of the basic care needs have not been included in the plans or that service users individual preferences had not been taken into consideration. Little information was recorded in relation to service users bathing preferences i.e. a bath or a shower, whether they have dentures or teeth and how they liked these cleaned, or the preference to have sugar in drinks. These are of particular importance for those service users who are unable to express themselves or have dementia. Some plans identified the preferred gender of staff to provide personal Care Homes for Older People Page 12 of 32 Evidence: care but no information was provided to demonstrate that this is respected. The files concentrated on service users disabilities and no consideration was recorded as to their abilities and skills and how these were promoted or encouraged. The files lacked information about continence aids and for some service users, these were not stored in their bedroom. This has the potential for incorrect products to be used and does not provide a personalised approach to care. Some care plans had not been updated to reflect the changing needs of the service users. Some service users require fluid intake charts, turning charts and dietary intake charts to be maintained but it was evident that these had not been adequately completed. service users who have diabetes have specific information in their care plans with regard to the frequency that their blood sugar is tested. Some tests were found not to have been undertaken at the appropriate frequency which places them at risk. Gateacre House. One care file states that a service user refused to wear glasses but the initial assessment form states that reading glasses only are used. An aggression plan, completed in March 2010, states that it should be reviewed in two weeks but there was no evidence of a review. One falls plan review states that a service user had not fallen in the last month, but the daily record shows that the service user had suffered a fall. One service user requires thickener to be added to drinks but there was not information for staff as to how much to add to drinks and no evidence that it had been used. The communication file for one service user states that they have difficulty using the correct word, due to dementia, and has no hearing difficulty. The plan states that the staff should speak louder. This does not take the service users ability into consideration and is inappropriate practice. Some night time plans were found to be good and included details of how the service users room should be lit and the preferred procedure at bedtime. This inspection commenced on a Monday and the visit to Gateacre House was undertaken on this day. A further visit was made to this house on the Friday of that week. Issues had been raised in relation to the failure to complete essential records and so a further check was made on these. One service user required that a fluid intake chart be maintained but it was found that staff had not completed this for the day of this visit. A request was made to see the chart for the preceding day and after, several minutes, the house manager produced this. The chart had not been adequately completed, did not contain the service users name and had been completed on the reverse side of a completed chart for another service user. It was evident that the completion of these charts is inadequate. No evidence was found to indicate that the information gathered from these charts is used to ensure that service users are taking sufficient fluids or that appropriate action is taken when fluid intake is insufficient. Care Homes for Older People Page 13 of 32 Evidence: Speke House. The monthly review of one service user showed that they had suffered considerable weight loss but no nutritional plan was in place and there was no evidence that the advice of the GP or dietitian had been sought. No information was recorded for one service user in relation to their religious belief. No arrangements had been put in place for spiritual support and no information for staff regarding the specific care provision in relation to those beliefs. The care file for one service user who was admitted in January 2010 states that their teeth are in poor condition. There was no evidence of contact with a dentist or of how the teeth should be cared for. Childwall House. The files in this house were generally good but require additional information to be recorded with regard to service users dental care, preferred method of shaving for men, dietary needs and abilities. Woolton House. Service users who are accommodated at the home for respite care on a regular basis should be fully reviewed prior to their admission to identify changes in care needs. The file for one service user states that the service user prefers a bath two or three times each week but the daily record does not confirm that a bath has been given and on most days states assisted with hygiene. On one occasion, the daily record states that the service user was showered. This is against the preferred method requested. The plan should be changed if the service user wishes to take a shower and is able to express a preference. Some information held on the files was found to be unreadable due to poor handwriting. All information for care staff should be clear and legible. One service users file showed that there had been significant weight loss over a period of months but there was no evidence that the advice of the GP, Diabetic Nurse or Dietitian had been sought. Paisley House. The care files in this house were of a good quality. Individual preferences had been identified and more information was available for staff with regard to care needs. Information was very personalised and could be clearly and easily understood by any carer who was to provide care. Two service users care needs had changed and the senior carer was in the process of reviewing their care needs and changing the care Care Homes for Older People Page 14 of 32 Evidence: plans. It was evident that service users and their families had been involved in the care planning process and the information received had been used in preparing routines and lifestyle plans. Only two CQC surveys were responded to by service users. Both confirmed that they received the care and support that they needed and that staff were always available. They also confirmed that they enjoyed the activities provided and enjoyed the meals that were served. The home has prepared a policy and procedure for the administration of medications. Copies of these are held in each of the houses and in the managers office. In all houses, there is a lack of evidence that creams and lotions have been applied or when thickeners are added to drinks. Discussion was held with regard to these and arrangements are to be put in place for a method of recording them. Individual protocols are prepared for service users who require PRN (as and when required) medications. Some were found to require updating and more detailed information to be recorded, with specific reference to the minimum time between doses of medications and the maximum dose that can be administered within a 24 hour period. One medication that had been received from the dispensing pharmacist two days before the visit was found to be out of date. The expiry dates of all medications received into the home should be checked as part of the receiving process. Records are held of all medications receiving into the home or disposed of as required. A number of medication errors had recently occurred in Gateacre House and arrangements are being put in place for comprehensive audits of all medications to be undertaken and additional training for staff who administer these. It was evident that the procedure for the administration of medications in this house was not followed. The medication trolley was observe to be left unsupervised and unlocked in the lounge whilst medications were being administered. This is not acceptable and appropriate security measures must be observed. The 10 am medications were observed to continue until 12.20 pm which is unacceptable practice as some medications are to be administered at a designated frequency and time. This practice has the potential for impacting on service users. The medications on all other houses were found to be administered and recorded in accordance with the homes policy and procedure. All medication rooms were found to be clean and organised and air conditioning systems have been put in place where their is a risk of the room temperature exceeding safe levels for the storage of medications. 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. The number and range of activities is limited and the records relating to activities are minimal and indicate that some service users are not provided with activities or social stimulation and may become bored or socially isolated. Evidence: The home employs two activity co-ordinators to provide activities and stimulation for the service users. One vacancy exists for an activity co-ordinator and one is currently off on sick leave. This has therefore reduced the number of hours available for service users dramatically. The care files lack information regarding service users preferences and abilities in relation to hobbies and activities and so the choice of activities is not personalised or individualised. Records of activities are held in folders which are held in the office on each of the houses. The records identify the first names of service users who participate in activities but not surnames. Identification of which service users participated in the activities is difficult as some have the same first name. Details of activities are only recorded for those that are conducted by the activities co-ordinators and the records indicate that activities are not provided to some service users. Some care staff were observed to spend time with service users on a one to one basis but Care Homes for Older People Page 16 of 32 Evidence: these are not recorded. In one house, service users enjoy playing bingo and so this takes place at least once each week. Major events, based on a theme, are arranged for each of the houses on a regular basis. All staff and service users, where possible, are involved with these but little is recorded as to the involvement of service users or their enjoyment of the events. Some houses display photographs of events that have taken place to provide evidence of the activities. During the visit, one house was celebrating the World Cup football and service users were encouraged to participate, but showed considerable reluctance. Wine and beer were being served by the activities co-ordinators as part of the event. Activities co-ordinators check seek permission from care staff prior to offering alcohol to service users. Some trips out are arranged and appropriate transport is hired. The home uses the services of Knotty Ash Community Services for service users transport needs and provides taxis to take service users out as required. No charges are made for these and the home raises funds to contribute towards activities and transport to supplements the budget allocated to each house. Some service users go out with family members or with staff when possible. In Woolton House, it was observed that the television was on in the lounge, although the volume was low. Five service users were seated in this area and were watching the television. At the same time, on the other side of the lounge, the radio was playing loud music. This has the potential increasing confusion to service users who have dementia. In Speke House, a group of 9 people from a local church entered the house from a patio door. They stood around a table where six service users were doing art work. Hymns were sung and prayers were said by the group. None of the staff asked for identification and none of the service users were given the choice of whether they wanted this. Many of the care files lacked information regarding spiritual preferences or the service users wish to participate in services. The activities co-ordinators said that they had recently purchased a Wii and some TV computer games but were unable to use them until they had been PATs tested by the handyman who was on annual leave at the time of the visit. Each house is provided with a garden area and one house has actively promoted a gardening session where service users are encouraged to assist with growing plants and vegetables. Meals are prepared in the main kitchen and transferred to houses in heated trolleys. Care Homes for Older People Page 17 of 32 Evidence: On the day of the first visit, the lunch observed was of poor quality. It would appear that some foods had been kept in the heated trolley for an excessive amount of time which had resulted in food becoming dry. This was addressed by the Regional Manager and the acting Manager and subsequent meals were observed to be of a good quality. Service users in Gateacre House were not adequately supervised during the meal. Effective assistance was not given to service users and one service user was observed to drink directly from a bowl which was subsequently spilled. Staff did not offer a fresh bowl of soup to the service user to replace that which had been spilled. In the other houses, staff were observed to assist service users with dignity and meals were unhurried. The home has a protected mealtime policy and visits from doctors and healthcare professionals are not welcomed at this time. Relatives who wish to assist with mealtimes are welcomed. Service users choose their meal from a list of options. Some pictorial menus are available and are displayed in the dining areas. Special diets are provided on the advice of the GP or dietitian or at the request of the service users. Individual preferences in relation to meals is held in the main kitchen so that the meals provided for service users are in line with their needs and preferences. The home provides a Nite Bite service to provide snacks throughout the night on request. Dining tables were attractively laid with cloths and cutlery but staff should be advised how to lay cutlery properly appropriate to the needs of the service users. Knives and forks were laid out for service users who required to use spoons for their meals which resulted in a lack of dessert spoons on the table when the dessert was served. No drinks were observed to be served with the meal in one house. 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. Service users and relatives are able to complain about the home and action is taken to respond to their concerns. Evidence: The home has a comprehensive complaints procedure and details of how to make a complaint are displayed in the foyer of the Reception and in individual houses. This information is also detailed in the Service User Guide and Statement of Purpose. The home maintains full records of all complaints and these records show that complaints are fully investigated, with outcomes, findings and proposed actions being reported to the complainants. Nineteen complaints have been made to the service in the last twelve months. Service users who responded to the CQC survey reported that they were aware of how to complain. Five service users spoken to said that they would complain if they were unhappy with the service provision although two said that they would request that their relatives made their comments known to staff. Staff spoken to were able to confirm that they were aware of the action to be taken in the event of a complaint being made. All staff have been given training on the protection of vulnerable adults during their induction training and additional training and updates on this have also been given. Evidence of this training is held on the staffs individual files. Staff spoken to were able to demonstrate that they were aware of the different types of abuse and would report any concerns to the house manager or home manager. The home has a Care Homes for Older People Page 19 of 32 Evidence: comprehensive whistleblowing policy which has been issued to all staff. Policies and procedures are readily accessible to all staff. It was evident from the visit that service users are placed at risk due to the failure of staff to ensure that medications are handled and administered safely and to ensure that a risk free and clean environment is provided in Gateacre House. Records held by CQC confirm that the home manager has reported all incidents to CQC and to Liverpool Safeguarding Unit when necessary. 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. Gateacre and Woolton Houses do not provide service users with an acceptable or safe environment and disrespects their dignity whilst compromising their safety. Evidence: Arncliffe Court is a large, purpose built home which provides five separate houses for care provision and a central building for administration, catering and laundry services. Each house is on a single level and provides full access to people who have mobility difficulties or require the use of the a wheelchair. It is evident that relatives and staff have been involved in personalising service users bedrooms. All service users are encouraged to bring pictures, photographs and items of memorabilia in to make their room homely and to reflect their lifestyle. Furniture in all bedrooms is in good condition. The home employs maintenance personnel to attend to repairs and general maintenance, although he was on annual leave at the time of the visit. The standard of cleanliness within the home was variable. Speke, Childwall and Paisley Houses were all found to be clean and fresh. Bathrooms Care Homes for Older People Page 21 of 32 Evidence: were in good condition and a sufficient number of bathrooms and toilets were provided. Woolton House. On entering this house, the corridor smelled fresh and clean but the lounge and dining areas smelled extremely offensive. The person in charge said that the smell was from an armchair, but no action had been taken to remove the armchair from the room. A request was made for action to be taken and the person in charge said that it would be dealt with later, as the lunch was about to be served. This is clearly not acceptable as service users were required to eat their meal in a particularly unpleasant environment. The room was further inspected later in the day and whilst the offensive odour was reduced, the room remained an unpleasant environment. A further inspection of the room was undertaken two days later and found to be fresh. It is of concern that no action was taken to address this issue as soon as it was identified to ensure that service users, staff and visitors to the house are not subjected to an environment which is not only offensive, but places people at risk of infection. It was also noted that the floors in this unit were sticky and shoes stuck to the floors when walking. This presents as a tripping hazard and thereby placing people at risk. It was suggested that the cleaning products used on the floors had not been used appropriately. The manager said that she would speak with the housekeeping staff and request a review of the use of the products used. Gateacre House. The standards in this house were found to be extremely poor. The house accommodates service users who require nursing care due to their dementia which requires additional safety measures to be put in place to ensure that risks are clearly identified and risk managment plans are put in place to reduce those risks. The carpets and floors were found to be extremely sticky which presented as a tripping hazard. Bathroom 33 smelled of mildew. An almost empty bottle of shampoo was found on the floor and almost empty bottles of shampoo and hair conditioner were found in the sink. The home has a policy for ensuring that toiletries are placed in a secure place to prevent service users ingesting products inadvertently but it would appear that this policy was not adhered to, thereby placing service users at risk. The personal clothing for a service user were noted on an unused wheelchair at one end of the bathroom. The shower curtain was stained and dirty, the shower frame was dirty at the bottom and the shower chair dirty underneath. The toilet and toilet seat were dirty. The floor in WC 31 was wet and the emergency call bell cord was tied up which would deny its use by any person who had fallen to the floor. In bathroom 18, a pair of slippers and one odd slipper were seen. In WC 12, a pair of service users socks had been placed on the sink. In bathroom 6, an old bedside cabinet had been placed and an empty tin of deodorant had been left inside. It was evident that staff had failed to ensure that service users were provided with a safe and clean environment and had Care Homes for Older People Page 22 of 32 Evidence: the potential for placing them at risk. It was evident that service users personal property and safety are not respected by the staff and it is essential that action is taken to address these issues. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A number of training needs were identified to ensure that service users are provided with the appropriate level of support, supervision and respect. Evidence: The home employs qualified nurses, senior care assistants and care assistants to provide care and support to service users. A programme of staff recruitment has recently taken place to provide the home with a permanent staff team. A high number of bank and agency staff have provided cover for vacant posts over the last few months. The home has a robust recruitment procedure. All prospective staff are required to complete an application form prior to being called for interview. Two references and taken and checks are made through the criminal records and protection of vulnerable adults bureaux. Evidence of qualifications are required to be produced together with evidence of training undertaken in previous employments. A sample of staff files were inspected and all were found to be extremely organised and contained full information as required. Volunteers work in the home and students The Annual Quality Assurance Assessment, completed by an acting manager, states that only 39 of the care staff hold NVQ qualification. Staff files seen showed that training has been provided on a range of topics including fire safety, moving and handling, health and safety, dementia, food hygiene, the protection of vulnerable adults and nutrition. Care Homes for Older People Page 24 of 32 Evidence: Discussion was held with a number of the care staff during the visit. Two staff confirmed that they read the care plans of new service users to identify their needs, whilst three staff said that they relied on the verbal information given to them by the person in charge. Two staff said that they did not have the time to read the care files. Some staff were observed to be chatting with each other, particularly at mealtimes instead of supervising and assisting service users. Two staff were observed to be chatting and laughing together whilst prayers were being said and lacked respect for the occasion. A number of training needs were identified as necessary during the visit which would include medications, assessments, care planning, record keeping, customer care and the care and understanding of people with dementia. The staff training plan showed that arragements had been made for this training to be provided. All staff have completed the mandatory training and updated training is provided as necessary. Thirty survey questionnaires were sent to the home for completion by staff prior to the visit. Eight were returned. All respondents confirmed that checks were made on them prior to them being employed at the home but only four could confirm that the induction training covered all they needed to know about their role and responsibilities. All respondents confirmed that they were given training relevant to their job but only four confirmed that there were sufficient staff to meet the needs of the service users. Positive comments were made by some staff which include Arncliffe Court is an excellent home, Excellent relationships with both residents and families, A home in which I would be happy for any of my family to live in. Other comments include The dementia units need to be more suitable to dementia clients and the environment needs to be more adaptable for them. All respondents confirmed that they knew what to do if someone had concerns. Staff meetings are held on a regular basis and minutes of the meetings are held. These meetings provide a forum for open discussion and the dissemination of information. Staff are given supervision on a regular basis and annual appraisals are undertaken. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is no consistent level of management in this home which has resulted in a deterioration in care and practice. Evidence: Since the last inspection, a number of changes have been made to the management of the home. An application to register the manager has been submitted to CQC. Each house has their own manager who is responsible for ensuring the care of the service users and the supervision of the staff within the house. A consistent approach to the management of the home or the houses has not been provided which has resulted in staff failing to follow procedures or ensure service users protection. Audits are undertaken on medications and care files but have failed to identify shortfalls in record keeping and practice which has placed service users at risk in respect of care provision and medications. The premises and equipment within the home are checked on a regular basis and Care Homes for Older People Page 26 of 32 Evidence: certification of this is held. Where possible, service users or their relatives deal with personal financial matters. The home has an interest bearing bank account for service users which they can use on request. Detailed records are held for all money held on service users behalf and these are audited on a regular basis by the accountant to ensure accuracy. Full feedback was given to the manager and senior management at the end of the inspection. 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 7 15 Care plans must include 24/12/2009 sufficiently detailed information on how to meet the needs of the person in all aspects of their health and wellbeing. To promote the persons health and wellbeing and ensure staff are aware of what actions they need to take to meet the persons needs. 2 8 17 Records relating to a 24/12/2009 persons support with health care must be maintained appropriately and accuratley. To ensure the health and wellbeing of people living at the home is promoted. 3 12 16 People living at the home 24/12/2009 should have greater opportunity to be involved in social and recreational activities and past times as per their individual needs. To promote peoples health and wellbeing. 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 full assessment should be 30/07/2010 undertaken of all prospective service users prior to their admission and this assessment discussed with the service user or their representative. To identify the needs of the service user, to ensure that the home can meet those needs and to ensure that any specialist services or equipment can be made available prior to admission. 2 7 14 Care plans to identify how service users health and welfare needs are to be met are to be reviewed and updated to ensure they are accurate. To advise staff of the specific care needs of the service users and to advise them on how that care should be delivered. 30/07/2010 Care Homes for Older People Page 29 of 32 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 3 9 13 Arrangements are to be made for the safe handling and recording of medications. To ensure that service user are provided with the correct medication to promote their wellbeing and keep them safe. 30/07/2010 4 12 16 A programme of activities, appropriate to the wishes and abilities of the service users should be prepared and implemented. To provide service users with stimulating activities to prevent them from becoming bored. 30/07/2010 5 15 16 Evidence that a varied and 30/07/2010 balanced diet is taken by service users should be held. To demonstrate that service users dietary needs and preferences are met. 6 18 12 Service users must be protected by ensuring their health and welfare. To ensure that the care they require and receive is documented and that their dignity is respected at all times to protect their health and their rights. 30/07/2010 Care Homes for Older People Page 30 of 32 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 7 26 23 All areas of the home must be maintained in a clean condition. To protect service users from the risk of cross infection and to provide them with a pleasant and fresh environment in which to live. 30/07/2010 8 27 18 Suitably qualified and competent staff in sufficient numbers should be employed. To provide care and support to service users dependent on their needs and abilities. 30/07/2010 9 31 8 A suitably qualified and competent person should be employed to manage the home. To be responsible for the running of the home, the supervision of staff and to ensure that all service users are provided with the appropriate level of care and support. 30/07/2010 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 31 of 32 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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