Care Home: Arundel Lodge

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What the care home does well The home provides a homely setting for the persons cared for and staff are dedicated and very familiar with individual care requirements. They have recently been praised by the district nurses over the care provided to a person who required `end of life` care. Staff did not leave her side and ensured she was comfortable during her last days. The level of trained staff with a National Vocational Qualification (NVQ) in Care is good with five staff out of eleven obtaining an NVQ in Care. Two staff have NVQ 3 as well as 2 and a further three staff have enrolled for NVQ 3. The NVQ in Care is the nationally recognised qualification within the Social Care services. The cook spoken with confirmed that she is undertaking an NVQ in Multi Skilled Hospitality Services. Staff were observed to treat the persons cared for with dignity and gentleness and were very aware of individual requirements. All the persons observed were clean and tidy with newly washed hair and clean nails. The care plans are comprehensive and up to date with a great deal of detail recorded. There was evidence of liaison with other health professionals and social workers over the health and well being of the persons cared for in the home. The records contained the previous background and social history of each person cared for where this information was possible to find. This approach ensures the care plan is more appropriate for the individual concerned and makes the most of previous skills or hobbies. What has improved since the last inspection? Previously the Statement of Purpose was misleading, the manager has reviewed the documentation and made sure that it reflects the services and facilities provided by the home. The document has been well designed in an `easy read` pictorial version, the manager has also designed an Information Pack that provides a summary of the facilities provided within Arundel Lodge; several copies are available within the main hallway of the home. There were strategies in place to deal with any complex behavioural needs and risk assessments had been completed for any area of potential risk such as falling or handling any aggressive behaviour. The sit down weigh scales have been re-calibrated and a record of weight is now being maintained. Any person who is losing weight is monitored and a 24 hour Nutritional Monitoring Sheet is in operation to record daily food and fluid intake. The manager has reviewed the care plans and pulled out the most recent care requirements to provide up to date information. Cross referencing had taken place between any accidents or incidents recorded and the daily diary sheets. The information has been used to ensure that correct strategies are in place to reduce any accidents or incidents that have caused previously unexplained injuries. A new format has been devised for reporting any concerns following falls that result in bruises and what action has been taken. The manager has also implemented a Daily Report Sheet that staff have to complete once a day for each person cared for. The report covers diet, appointments/contacts, medication, activities, behaviour, bath/shower and any bruises noted as well as whether the bed has been changed and the bedroom cleaned. A communication log for staff to complete has been implemented to ensure vital information is passed onto staff as they come on duty. Risk assessments had been conducted for any person at risk of falling out of bed and where bed rails have been installed. Another person following consultation with health professionals has had their bed lowered with a crash mattress to ensure they are not hurt if they roll out of bed. At the last inspection there was a recommendation that the storage of medication should be made more secure by the addition of drop locks. The manager has instead ordered a new metal cupboard that was due to be delivered very shortly. Activities have improved and there is now a seven day activity programme. The details of any activities undertaken are recorded within an activities log and also on the individual daily report sheets. Photographs have been taken of the various activities taking place. An activities cupboard has been established to contain the equipment and board games. There was evidence of pictures being painted by some of of the people supported. Pamper days are taking place with hair and nails being done. The manager has managed to locate a local mini bus for hire in order for outings to take place and also obtained information about a hotel in Blackpool who are offering outings at a reasonable price. The home is to have a Coffee Morning on the 25th June to promote the home and to raise funds that will help to support social activities. All staff have now received Food Hygiene training as required for staff who help in the preparation of food. Some of the vacant bedrooms including one already accommodated have been decorated with new carpets, some pictures and recently painted walls. A picture of the person accommodated within the room had been placed on the doors and some new bedroom furniture has been purchased. The manager stated that all the bedrooms currently in use are to be refurbished and they have a vacant bedroom that is being used on a temporary basis whilst each room is completed. Commodes within the bedrooms are old and were previously rusty in places but they have now been painted and are serviceable. The corridor leading to the main lounge has been painted and there is bright red border now making if far more cheerful. The flooring has been thoroughly cleaned since the last key inspection. A new manager has been appointed and is in the process of being registered with the Care Quality Commission. The manager has made significant improvements in the short time that she has been at the home and is well respected by the staff who were spoken with; comments included:`Best manager we have ever had.` and `She has taught me so much`. One of the people cared for in the home was very happy with the support the manager was providing and stated, `She`s smashing.` Staff meetings have taken place and one to one supervisions with staff and the details were seen to have been recorded. Good staff support ensures staff feel valued and provides encouragement helping them in their role. A meeting has taken place with Social Services Contracts Department over the finances belonging to the people cared for in the home and arrangements have been made to ensure each person has the finance they are entitled to and What the care home could do better: The care plans are kept in the main lounge and are therefore not secure. A requirement was made that the care plans must be kept secure to ensure confidentiality of personal information was maintained. A recommendation was also made that some of the strategies recorded with regard to behaviour support could be simplified to ensure they are `user friendly` and therefore more easily understood by staff. The room where the medication is stored was very warm and a recommendation was made that the temperature of the room should be monitored to ensure that the medication is stored at an appropriate temperature. A recommendation was made that all staff should be trained in the provision of medication and that regular audits of the medication records should be recorded. There should also be regular observation of the competence of staff to ensure they are following correct medication procedures. Because of the uneven surface of the patio area outside the main lounge the majority of people cared for are unable to go outside even with staff assistance. This is an ongoing concern particularly now that the weather is warm and the people cared for would benefit from the fresh air and sunshine. A recommendation was made that some further Dementia Care training would assist staff to look at different ways to encourage the people cared for and find additional ways to occupy their time. There are ongoing concerns over the environment both inside and outside the home. A part of the home has been sealed off because the flat roof has leaked and the ceiling has caved in below causing significant damage with water dripping into a bucket and sodden plaster on the floor in one room and evidence of water penetration in others. The outside wall is rendered and the surface is cracked and bulging outwards. A number of the windows are cracked. The main lounge area below where the leakage has occurred is showing evidence of damp in the ceiling. Both the garden area at the front of the home and the back were very over grown and untidy; a hazardous nettle bush is on the patio area at the rear of the home. The manager stated that the outside area had been tidied up but had soon become overgrown again. One of the baths where a hoist is situated is badly marked where the seat of the hoist scuffs the surface. A number of the toilets appear to be disintegrating at the base and could be a source of infection. The majority of bedrooms, bathrooms and toilets are still in need of refurbishment although, gradual decoration including communal areas is now taking place. There was no evidence of Regulation 26 visits taking place for March, April and May this year; Regulation 26 requires that a report is completed by the owners of the home once a month about the conduct and performance of the home. Key inspection report Care homes for older people Name: Address: Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA     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: Susan Dale     Date: 2 1 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: Arundel Lodge 1 Station Road Wesham Kirkham Lancashire PR4 3AA 01772686343 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hexagon Healthcare (UK) Ltd Name of registered manager (if applicable) Mrs Susan Jean Hendren Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22. The registered person may provide the following categories of service only: Care home only - code 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 - Code OP (maximum number of places: 2). Dementia, over 65 years of age - Code DE(E) (maximum number of places: 20). Date of last inspection Brief description of the care home Arundel Lodge is registered with the Care Quality Commission to provide personal care for 20 older persons within the category of Dementia and 2 persons within the category of Old Age (OP). The home is situated on the main road in a residential area Care Homes for Older People Page 4 of 32 Over 65 20 2 0 0 0 5 0 2 2 0 1 0 Brief description of the care home of Kirkham and is within easy reach of community resources and facilities and is located on a bus route. Accommodation is arranged over three floors. There are fourteen single and four double bedrooms. There is a passenger lift to each floor of the home, and ramped access to the garden and patio area. Currently the home is in need of renovation and some major work is required to the roof, and interior and outside areas of the building. There is a Statement of Purpose and Service User Guide that provides information about the services provided by the home available in the foyer. A manager has recently been employed who is in the process of registering with the Care Quality Commission. The current fees are £386:50 per week rising to £463:50 per week, further Information about fees can be obtained from the registered providers. 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: The inspection was unannounced and and focused on key standards and areas of concern from the inspections carried out over the last eighteen months. Various persons were spoken with including the manager, one of the directors of the home, care staff and people cared for in the home. A tour of the home took place. The last key inspection was on the 5th February 2010. A random inspection took place on the 26th April 2010 to see what progress had been made with regard to the requirements and recommendations made at the key inspection and also to check on an enforcement notice. There have been two enforcement notices sent to the registered provider since the last key inspection. One enforcement notice was with regard to risk assessments, accidents and incidents and monitoring processes and the requirements had to be met by the 10th April 2010. The other enforcement notice was with regard to the roof and building Care Homes for Older People Page 6 of 32 defects, furniture and equipment and needed to be addressed by the 19th June 2010. The majority of requirements to be met by the 10th April 2010 within the Statutory Requirement Notice had been met at the Random Inspection that took place on the 26th April 2010. The Statutory Requirement Notice that was due on the 19th June 2010 had not been met. The required work had not been carried out or commenced on the necessary remedial work to the roof and surroundings. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Previously the Statement of Purpose was misleading, the manager has reviewed the documentation and made sure that it reflects the services and facilities provided by the home. The document has been well designed in an easy read pictorial version, the manager has also designed an Information Pack that provides a summary of the facilities provided within Arundel Lodge; several copies are available within the main hallway of the home. There were strategies in place to deal with any complex behavioural needs and risk assessments had been completed for any area of potential risk such as falling or handling any aggressive behaviour. The sit down weigh scales have been re-calibrated and a record of weight is now being maintained. Any person who is losing weight is monitored and a 24 hour Nutritional Monitoring Sheet is in operation to record daily food and fluid intake. The manager has reviewed the care plans and pulled out the most recent care requirements to provide up to date information. Cross referencing had taken place between any accidents or incidents recorded and the daily diary sheets. The information has been used to ensure that correct strategies are in place to reduce any accidents or incidents that have caused previously unexplained injuries. A new format has been devised for reporting any concerns following falls that result in bruises and what action has been taken. Care Homes for Older People Page 8 of 32 The manager has also implemented a Daily Report Sheet that staff have to complete once a day for each person cared for. The report covers diet, appointments/contacts, medication, activities, behaviour, bath/shower and any bruises noted as well as whether the bed has been changed and the bedroom cleaned. A communication log for staff to complete has been implemented to ensure vital information is passed onto staff as they come on duty. Risk assessments had been conducted for any person at risk of falling out of bed and where bed rails have been installed. Another person following consultation with health professionals has had their bed lowered with a crash mattress to ensure they are not hurt if they roll out of bed. At the last inspection there was a recommendation that the storage of medication should be made more secure by the addition of drop locks. The manager has instead ordered a new metal cupboard that was due to be delivered very shortly. Activities have improved and there is now a seven day activity programme. The details of any activities undertaken are recorded within an activities log and also on the individual daily report sheets. Photographs have been taken of the various activities taking place. An activities cupboard has been established to contain the equipment and board games. There was evidence of pictures being painted by some of of the people supported. Pamper days are taking place with hair and nails being done. The manager has managed to locate a local mini bus for hire in order for outings to take place and also obtained information about a hotel in Blackpool who are offering outings at a reasonable price. The home is to have a Coffee Morning on the 25th June to promote the home and to raise funds that will help to support social activities. All staff have now received Food Hygiene training as required for staff who help in the preparation of food. Some of the vacant bedrooms including one already accommodated have been decorated with new carpets, some pictures and recently painted walls. A picture of the person accommodated within the room had been placed on the doors and some new bedroom furniture has been purchased. The manager stated that all the bedrooms currently in use are to be refurbished and they have a vacant bedroom that is being used on a temporary basis whilst each room is completed. Commodes within the bedrooms are old and were previously rusty in places but they have now been painted and are serviceable. The corridor leading to the main lounge has been painted and there is bright red border now making if far more cheerful. The flooring has been thoroughly cleaned since the last key inspection. A new manager has been appointed and is in the process of being registered with the Care Quality Commission. The manager has made significant improvements in the short time that she has been at the home and is well respected by the staff who were spoken with; comments included: Care Homes for Older People Page 9 of 32 Best manager we have ever had. and She has taught me so much. One of the people cared for in the home was very happy with the support the manager was providing and stated, Shes smashing. Staff meetings have taken place and one to one supervisions with staff and the details were seen to have been recorded. Good staff support ensures staff feel valued and provides encouragement helping them in their role. A meeting has taken place with Social Services Contracts Department over the finances belonging to the people cared for in the home and arrangements have been made to ensure each person has the finance they are entitled to and are able to access their money. What they could do better: The care plans are kept in the main lounge and are therefore not secure. A requirement was made that the care plans must be kept secure to ensure confidentiality of personal information was maintained. A recommendation was also made that some of the strategies recorded with regard to behaviour support could be simplified to ensure they are user friendly and therefore more easily understood by staff. The room where the medication is stored was very warm and a recommendation was made that the temperature of the room should be monitored to ensure that the medication is stored at an appropriate temperature. A recommendation was made that all staff should be trained in the provision of medication and that regular audits of the medication records should be recorded. There should also be regular observation of the competence of staff to ensure they are following correct medication procedures. Because of the uneven surface of the patio area outside the main lounge the majority of people cared for are unable to go outside even with staff assistance. This is an ongoing concern particularly now that the weather is warm and the people cared for would benefit from the fresh air and sunshine. A recommendation was made that some further Dementia Care training would assist staff to look at different ways to encourage the people cared for and find additional ways to occupy their time. There are ongoing concerns over the environment both inside and outside the home. A part of the home has been sealed off because the flat roof has leaked and the ceiling has caved in below causing significant damage with water dripping into a bucket and sodden plaster on the floor in one room and evidence of water penetration in others. The outside wall is rendered and the surface is cracked and bulging outwards. A number of the windows are cracked. The main lounge area below where the leakage has occurred is showing evidence of damp in the ceiling. Both the garden area at the front of the home and the back were very over grown and untidy; a hazardous nettle bush is on the patio area at the rear of the home. The Care Homes for Older People Page 10 of 32 manager stated that the outside area had been tidied up but had soon become overgrown again. One of the baths where a hoist is situated is badly marked where the seat of the hoist scuffs the surface. A number of the toilets appear to be disintegrating at the base and could be a source of infection. The majority of bedrooms, bathrooms and toilets are still in need of refurbishment although, gradual decoration including communal areas is now taking place. There was no evidence of Regulation 26 visits taking place for March, April and May this year; Regulation 26 requires that a report is completed by the owners of the home once a month about the conduct and performance of the home. 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 11 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 12 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 good 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 has been reviewed and corrected and now provides good information about the services and facilities provided within the home. An assessment process is in place to ensure that the services provided by the home would be suitable for the individual concerned. Evidence: The manager has reviewed the Statement of Purpose and made sure that it reflects the services and facilities provided by the home including staff and their qualifications. The document has been well designed in an easy read pictorial version and is available to any interested person. The manager is going to consider producing the document in other formats such as another language or Braille and has also designed an Information Pack that provides a summary of the facilities provided within Arundel Lodge. Several copies have been placed within the main entrance to the home so that they can be accessed easily. Care Homes for Older People Page 13 of 32 Evidence: There have been no new persons referred to the home since the last inspection; a comprehensive format is in use for an initial assessment. All necessary information including the background and previous history of the individual concerned are taken into account in order to help compile an effective care plan. Liaison has previously taken place with family and other health professionals as well as the person to be cared for over how the care is to be provided. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate records and procedures are in place with regard to care planning, health and medication. The people cared for in the home are treated with privacy, dignity and respect by staff. Evidence: Several care plans were examined, they contained the previous background and social history of the individual concerned where this information was able to be accessed and included previous relationships and hobbies. The information gathered covered areas such as sleep, dental, skin, continence, mental health, sight, hearing, mobility, personal safety, medical history and medication, diet and weight and relationships. The care plan was person centred in that the care was to be provided in the way the individual chooses to be cared for and individual preferences are recognised, for example with regard to food and nightly routines. There were strategies in place to deal with any complex behavioural needs and risk assessments had been completed for any area of potential risk such as falling or Care Homes for Older People Page 15 of 32 Evidence: handling any aggressive behaviour. A record had been kept of health professional visits including General Practitioners, District Nurses, Dentists, Chiropodists and Occupational Therapists. Close liaison had taken place with Social Workers as well as health professionals. There are currently six people being cared for and all of them looked well cared for with clean clothes and manicured nails and hair washed and set. The district nurses were visiting the home at the time of the inspection visit and were working closely with the homes staff on any continence issues. The district nurses have been very impressed with the care and dedication provided by the staff over the care of a person who recently died within the home. Staff did not leave her side during her last days and with the assistance of the nurses made her as comfortable as possible so that she could die in familiar surroundings. A record of weight is now being maintained following a re-calibration of the sit down weigh scales. Any person who is losing weight is monitored and a 24 hour Nutritional Monitoring Sheet is recorded with daily food and fluid intake. The manager has reviewed the care plans and pulled out the most recent care requirements to ensure they provide up to date information. Cross referencing had taken place between any accidents or incidents that had taken place and the daily diary sheets. The information has been used to ensure that correct strategies are in place to reduce any accidents or incidents causing previously unexplained injuries. A new format has been devised for reporting any concerns following falls that result in bruises and what action has been taken to reduce any falls. The manager has also implemented a Daily Report Sheet that staff have to complete once a day for each person in the home. The report covers diet, appointments/contacts, medication, activities, behaviour, bath/shower and any bruises are noted as well as whether the bed has been changed and the bedroom cleaned. A communication log for staff to complete has been implemented to ensure vital information is passed onto staff as they come on duty. A risk assessment had been conducted for a person at risk of falling out of bed and bed rails had been installed. Another person has been assessed following consultation Care Homes for Older People Page 16 of 32 Evidence: with health professionals and had their bed lowered with a crash mattress to ensure they are not hurt if they roll out of bed. It was noted that the care plans are kept in the main lounge and are therefore not secure. Previously the care plans were kept secure within the office and with previously no manager, staff kept them in the lounge area for ease of use. The manager confirmed that she would ensure the care plans are kept secure within the office in future. A recommendation was also made that some of the strategies recorded with regard to behavioural support could be simplified to ensure they are user friendly and therefore more easily understood by staff. At the last inspection there was a recommendation that the storage of medication should be made more secure by the addition of drop locks on the door. The manager has instead ordered a new metal cupboard that is due to be delivered very shortly. The room that the medication is stored within was very warm and a recommendation was made that the temperature of the room should be monitored to ensure that the medication is stored at an appropriate temperature. There is a fridge in place for the storage of medicines that require this facility and there were records showing that the temperature is checked on a regular basis. There are currently four staff trained to provide medication and the manager has ensured that there is always a staff member trained in medication on duty. Additional staff are to attend medication training on the 15th July 2010. The Medication Administration Records were examined and there were a couple of unexplained gaps in the records. The manager stated that she does monitor staff to ensure they are competent but had not recorded the details. A recommendation was made that regular audits of the medication records should be recorded as well as regular observation of the competence of staff to ensure they are following correct medication procedures. There is a good system in place to ensure stock control of medication that is monitored by the manager. A recommendation was made that any person requiring pain relief as required but, not on a continuous basis, should have a formal plan in place to ensure that staff provide pain relief medication appropriately and at the correct times. Care Homes for Older People Page 17 of 32 Evidence: All staff are familiar with the individual needs of the persons cared for within the home and were observed to care for them in a gentle and caring way that respected their privacy and dignity. Care Homes for Older People Page 18 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. Activities are improving and initiatives are taking place to improve links with the local community and to commence outings. Access to the garden is still restricted and hazardous due to uneven paving. Evidence: The staff understand the importance of treating each person as an individual and time has been taken to record the previous background and social history of the persons cared for where the information could be obtained. Activities has improved with the manager establishing a seven day activity programme. The details of any activities undertaken are recorded within an activities log and also on the individual daily report sheets. Photographs have been taken of the various activities taking place. An activities cupboard has been established to contain the equipment and board games. There was evidence of pictures being painted by some of of the people supported. Pamper days are taking place with hair and nails being done. A sign has been placed on the wall in the main lounge with pictures detailing the day, date and current weather. Care Homes for Older People Page 19 of 32 Evidence: The manager has managed to locate a local mini bus for hire in order for outings to take place and also obtained information about a hotel in Blackpool who are offering outings at a reasonable price. The home is to have a Coffee Morning on the 25th June to promote the home and to raise funds that will help to support social activities. With the exception of two persons who are physically more mobile, the people cared for are still unable to access the garden area. The path is uneven and hazardous immediately outside the doors in the main lounge that leads down to the garden. Meals are provided within the main lounge area and one person who resides on the top floor has her own dining room. The meals are nutritious and the persons spoken with had no complaints about the food. Some of the people cared for are on special diets or have to have their meals prepared in a certain way in order to eat them. Choice of food is available. All staff have now received Food Hygiene training. A recommendation was made that some further Dementia Care training would assist staff to look at different ways to encourage the people cared for and find additional ways to occupy their time. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to that provide protection to the people supported in the home including the investigation of any concerns. Staff have received training in the safeguarding of vulnerable adults from abuse. Evidence: The complaints procedure is contained with the Statement of Purpose and has been altered with the correct contact information as required at the last key inspection. There have been no further complaints since the last inspection and the manager is ensuring that all complaints are being investigated appropriately and the details are recorded with clear outcomes. All staff have received safeguarding training on the protection of vulnerable people from abuse. Any new staff member is checked prior to commencement to ensure that they are not on the list that bars them from working with vulnerable people as well as a check with the Criminal Records Bureau (CRB). Care Homes for Older People Page 21 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is poor and needs urgent attention particularly to the flat roof and bedrooms below. The majority of bedrooms, bathrooms and toilets are still in need of refurbishment although, gradual decoration including communal areas is now taking place. Evidence: There are ongoing concerns over the environment both inside and outside the home. A tour of the home took place. A part of the home has been sealed off because the flat roof has leaked and the ceiling has caved in below causing significant damage with water dripping into a bucket and sodden plaster on the floor in one room and evidence of water penetration in others. The outside wall is rendered and the surface is cracked and bulging outwards. A number of the windows are cracked. A professional survey has been provided previously to the Care Quality Commission with regard to the damage caused by water damage to the flat roof and the rooms directly below. The survey clearly stated that there was significant damage to the building and that it was unsafe for use. The main lounge area below where the leakage has occurred is showing evidence of damp in the ceiling. There have been concerns that the water seepage could cause problems to the electrical systems and a wiring check has been undertaken since the Care Homes for Older People Page 22 of 32 Evidence: last key inspection that took place on the 5th February 2010. The wiring check provided evidence that there was no current risk to the people in the home however, there is a need for further investigation to the hidden electrical joint boxes once the damaged ceiling has been pulled down. In other parts of the home, some of the vacant bedrooms have been decorated with new carpets, some pictures and recently painted walls. A picture of the person accommodated has been placed on the doors and new bedroom furniture has been purchased. The manager stated that all the bedrooms currently in use are to be refurbished and they have a vacant bedroom that is being used on a temporary basis whilst each bedroom is completed. The furniture and fittings in the majority of bedrooms are old and worn but serviceable. There are no facilities within the bedrooms to lock any medication or valuables. Commodes within the bedrooms are old and were previously rusty in places but they have now been painted and are serviceable. One of the bathrooms is a wet room. There was evidence that equipment such as bath hoists and the weigh scales have been serviced recently. One of the baths where a hoist is situated is badly marked where the seat of the hoist scuffs the surface. A number of the toilets appear to be disintegrating at the base and could be a source of infection. The corridor leading to the main lounge has been painted and there is bright red border now making if far more cheerful. The flooring has been thoroughly cleaned since the last key inspection. The patio area immediately outside the main lounge area remains hazardous to walk upon or be pushed in a wheelchair. The patio has uneven crazy pathing as well as an uneven area where the rotary clothes dryer has been removed. Both the garden area at the front of the home and the back were very over grown and untidy; a hazardous nettle bush is on the patio area at the rear of the home. The manager stated that the outside area had been tidied up but had soon become overgrown again. One of the windows in the lounge area has a gap in the seals around the window and at previous inspections was taped up. Both lounges have large digital televisions and additional pictures have been placed on the walls. England Flags have been purchased and displayed in recognition of the world cup football taking place. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have been recruited appropriately and provided with training that helps them to provide good care to the people supported in the home. Evidence: There are currently six people being cared for in the home and five require more support because they have dementia. There are plenty of staff on duty with two care staff, the cook and the manager. Staff have received training in the past on the care of people with dementia but a recommendation was made that some further more extensive training would be beneficial. As previously stated, dementia training would help staff to provide a more stimulating environment and provide ideas for recreational activities. Two staff have recently left and one new member of staff has commenced, another was awaiting security checks. The recruitment was examined and all necessary checks had been undertaken including, references and checks with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) register. The new member of staff was spoken with who confirmed that she was loving her job and had been provided with all necessary information at her induction training. Ongoing support had been provided and she was looking forward to further training. Care Homes for Older People Page 24 of 32 Evidence: The level of trained staff with a National Vocational Qualification (NVQ) in Care is good with five staff out of eleven obtaining an NVQ in Care. Two staff have NVQ 3 as well as 2 and a further three staff have enrolled for NVQ 3. The NVQ in Care is the nationally recognised qualification within the Social Care services. The cook spoken with confirmed that she is undertaking an NVQ in Multi Skilled Hospitality Services. All staff have recently undertaken Food Hygiene training as required for any person who assists or prepares food. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has improved following the appointment of a new manager. The overall management of the home is poor because of the lack of action over repairs to the roof and the interior and exterior of the building. Evidence: A new manager has been appointed and is in the process of being registered with the Care Quality Commission. The manager has done a great deal in the short time that she has been at the home and is well respected by the staff who were spoken with; comments included: Best manager we have ever had. and She has taught me so much. One of the people cared for in the home was very happy with the support the manager was providing and stated, Shes smashing. The manager has made improvements with regard to the care plans and ensured that Care Homes for Older People Page 26 of 32 Evidence: all factors are taken into consideration including any falls and unexplained bruises at the monthly reviews. Action has been taken to obtain specialist advice over the care of some particularly vulnerable people cared for in the home. The manager is trying to promote the home within the local community and has invited them into the home for a coffee morning and fund raising event. More activities are taking place and the staff are feeling far more motivated in their role within the home. Staff meetings have taken place and one to one supervisions with staff and the details were seen to have been recorded. A meeting has taken place with Social Services Contracts Department over the finances belonging to the people cared for in the home and arrangements have been made to ensure each person has the money they are entitled to and that they are able to access the money. Whilst the management of the home has improved there is still a need to improve the overall management of the home with regard to the building itself and the overall environment. The work required to the roof has been outstanding for over twelve months and the lack of action is unfortunately causing additional problems such as dampness within the main lounge. Checks have been undertaken with regard to the electrical systems and fire safety and there appears to be no immediate danger. However, it is difficult to ascertain the extent of the damage caused by the water seepage and is a risk to the health and safety of the people cared for in the home and staff. The Statutory Requirement Notice that was due on the 19th June 2010 had not been met. The required work had not been carried out or commenced on the necessary remedial work to the roof and surroundings. This places the people being cared for and staff at potential risk with regard to their health and safety. The manager stated the the registered provider has been very supportive in the time that she has been employed at the home. There was no evidence of Regulation 26 visits taking place for March, April and May this year; Regulation 26 requires that a report is completed by the owners of the home once a month about the conduct and performance of the home. One of the directors of the home present at the inspection stated that he had not had time to complete the reports but, had undertaken the visits as required. 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 19 23 As at previous inspections, the bedrooms belonging to the persons with dementia require decoration and refurbishment. To ensure a welcoming environment. 30/09/2010 2 19 23 The outside area must be made safe to allow safe exit by the persons cared for as well as staff. To ensure the health and safety of the persons cared for as well as staff. 19/06/2010 3 19 23 Repairs must be made to the 19/06/2010 roof where leakage is occurring, the bulging exterior wall and all necessary remedial work including the furnishings of the affected rooms. To ensure the health and safety of the persons cared for as well as staff. 4 33 26 Evidence must be provided 25/06/2010 of written reports by the registered provider for March & April 2010 about the conduct of the home as detailed under regulation 26 of the Care Homes Regulations. Page 28 of 32 Care Homes for Older People 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 To ensure the facilities and services provided meet expected standards of care. Care Homes for Older People Page 29 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 7 12 The care plans and any personal information should be kept secure at all times. To ensure personal documents are confidential and the privacy of the individual concerned is protected. 31/07/2010 2 33 26 As well as previous 31/07/2010 outstanding regulation 26 reports for March and April 2010, there is also a need for a regulation 26 report for May 2010. To ensure the facilities and services provided meet expected standards of care. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plan documentation should be in clear user Page 30 of 32 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations friendly language with regard to staff dealing with challenging behaviour in order to ensure the instructions are clearly understood. 2 9 The temperature of the room in which the medication is stored is very warm and should be monitored to ensure it is suitable. All staff should be provided with medication training and afterwards a formal competence check undertaken regularly and recorded on the staffs ability to provide the medication within safe guidelines. Staff would benefit from Dementia Care training that would assist them in devising and promoting recreational activities and stimulation that is suitable for the individuals cared for in the home. 3 9 4 12 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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