Care Home: Ashleigh Rest Home,

What the care home does well The manager understands the needs of the residents. Interaction between the staff and the residents is warm and respectful. The home meets the health needs of residents. Residents enjoy the well prepared hot lunches which the cook provides. What has improved since the last inspection? The fire alarms have been serviced, and health and safety checks are carried out. Ground floor toilets now have locks. What the care home could do better: The home has not met most of the requirements which were made at the last inspection. The home needs to appoint a permanent manager and have them registered with CQC. They need to supervise this person regularly and make regulation 26 visits to the home. They need to train their staff in safeguarding, medication, challenging behaviour and core basic topics. They need to staff the home adequately so that staff are not working alone. The practice of using the cook as a carer should cease. Staff should be supervised appropriately. Appropriate risk assessments must be undertaken. The home needs to address the maintenance and decor issues which were raised and the issue of hazards in the home which have been pointed out to them. One of the two registered providers needs to open a separate bank account for a resident and cease paying his monies into her own personal bank account. She needs to make full financial records available in the home for inspection. The home needs to develop a quality assurance system which takes into account the wishes and views of residents. The statement of purpose must be amended to be accurate and reflect the services the home currently offers. The registered providers must demonstrate that that all residents have access to a copy of the Statement of Purpose. New cookware must be purchased to replace that which is worn out. Enforcement action is being undertaken with regard to Regulations 13,18,24 and 26 and further details can be found within the body of the report and the requirements section. Key inspection report Care homes for older people Name: Address: Ashleigh Rest Home, 19 Upper Walthamstow Road Walthamstow London E17 3QG     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: Anne Chamberlain     Date: 2 6 0 2 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 39 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 39 Information about the care home Name of care home: Address: Ashleigh Rest Home, 19 Upper Walthamstow Road Walthamstow London E17 3QG 02085200671 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Yusuf Oomar Jooma,Mrs Rooksanah Jooma Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category 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 Date of last inspection Brief description of the care home Ashleigh Rest Home is a privately owned care home registered to provide support and accommodation to 10 service users over the age of 65. The home is in a quiet residential road in the London Borough of Waltham Forest with easy access to local shops, transport networks and local amenities. 2 7 0 2 2 0 0 9 0 Over 65 10 Care Homes for Older People Page 4 of 39 Brief description of the care home Accommodation is provided on two floors with one shared bedroom on the top floor. Care Homes for Older People Page 5 of 39 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 inspection was undertaken on behalf of the Care Quality Commission and the terms we and us will be used throughout. The inspection took place over two short days. We spoke with residents and were assisted by the manager and both of the registered providers. We viewed residents personal files and staff personnel files, we inspected key records and policies and procedures. We viewed the environment of the home and the arrangements for the administration of medication. We would like to take this opportunity to thank all who contributed to the inspection for their co-operation and assistance. Care Homes for Older People Page 6 of 39 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. Care Homes for Older People Page 7 of 39 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 39 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 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available for prospective residents needs amendment. Some pre admission assessment of needs is undertaken but could be improved. Evidence: The home has a statement of purpose. However there was only one copy and the manager stated that the residents do not have individual copies. The statement of purpose is out of date, giving the name of a previous manager and outdated information about the CQC inspector and his contact details. The statement of purposes states that personal social interests can be maintained and individual and group outings are arranged along with concert and fun evenings. There was little evidence to support the above statement. The manager stated that she wants to arrange for a resident to attend a culturally appropriate day centre and he wants to attend too, but there is no staff available to escort him. Care Homes for Older People Page 10 of 39 Evidence: The statement of purpose states that there are two staff on at night one awake and one asleep. This is not correct, we were told by the manager that there is one waking night staff and staff rotas confirmed this. The complaints section of the statement of purpose wrongly states the name of the previous inspector and incorrect details for CQC and also the name of the previous manager. The statement of purpose needs to be amended to make it accurate and to reflect the services the home actually provides. The home has a service user guide, which had been updated on 25/3/10. However it was inaccurate and out of date and needs to be revised and amended. The service user guide states that two annual inspections are performed each year by the NCSC which is incorrect, the complaints section referred to CSCI with an old address. The home does not currently provide intermediate care, so standard six was not inspected. Since the previous inspection there has been a new admission to the home, seven months ago. We inspected the new residents file. There was some evidence of pre admission assessment in the form of a document entitled Multi Professional Patient Handling Assessment. The document had not been signed but there was some handwriting on it which the manager stated belonged to one of the registered providers. There was little information about the mental health needs of the resident and his mood was described as medium. We felt that given the history and the complex needs of the resident the pre admission assessment was inadequate. We were told however that one of the registered providers visited the prospective resident at his previous placement and he had a visit to the home, which is good practice. Care Homes for Older People Page 11 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meets the health care needs of the residents and medication practice is fairly sound. Risk assessments need to be developed. Privacy and dignity are respected. Evidence: Residents have care plans and person centered plans where care planning information is located, and which identify areas of risk. There was a lack of risk assessments to support and minimise aggression and challenging behaviours and this has led to two incidents when staff have been injured. The manager confirmed that these incidents had not been appropriately recorded in the incident book or reported to CQC, as required by Regulation 37. The manager wrote a risk assessment for one individual during the course of the inspection. However this was still considered to need further development to identify strategies and reduce identified risks. Another resident has needs in the areas of vulnerability in the community and abuse of alcohol. This individual did not have risk assessments in place to support or manage these needs. Care Homes for Older People Page 12 of 39 Evidence: Evidence was seen of monthly review of care plans although this was rather brief and not detailed or sectioned. Residents at the home do not have health action plans but there was a variety of evidence to show that they are supported to access health professionals including specialists. One resident who has diabetes has regular visits from the district nurse. The chiropodist, optician and dentist also visit the home. Separate sheets are kept to record visits to the GP and consultants and we were satisfied that there were systems to ensure return appointments are kept. We viewed the arrangements for the administration of medication. The storage arrangements are secure with a locking trolley. Medications are recorded coming into the care home and being disposed of to the pharmacist. The medication folder has staff specimen signatures at the front, however these included staff who have left, and should therefore be updated. We balanced several medications and found no discrepancies. The Medication Administration Record (MAR) sheets were generally well completed. However two residents have prn medications. An F should be recorded when the medication is not taken but this had not been done and the boxes were left empty. We advised the manager the boxes should be completed with Fs for non administration. One resident is on a medication which means he should not eat an identified substance. This is clearly stated by the pharmacist on the MAR sheet but had not been written into the persons care plan. We asked a staff member who administers medication if there was any substance which the person on the medication could not eat or drink and she said No there was nothing prohibited. The home were not able to produce any evidence of recent medication training of the staff who administer medication. We noted from staff files that one staff member had had medication training in 2003, another in 2004 and another in 2005. Staff who administer medication must have up to date training. This was a requirement of the last inspection. One member of staff told us she had had medication training a few years ago. We felt that the privacy and dignity of service users was generally respected. Interaction witnessed between staff and residents was generally warm and positive. Care Homes for Older People Page 13 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home caters for the social needs of residents in a limited way. Community contact is minimal. Autonomy and choice are respected. Meals are nutritious and tasty and mealtimes are pleasant. Evidence: Relatives and friends are made welcome at the home. Opportunities which residents have for accessing community activities are limited. As previously mentioned the manager told us that one resident would like to attend a culturally appropriate day centre but lack of staff to escort him has prevented this. This resident would benefit from joining the library as he likes to read but this has not been possible either, we were told, for the same reason. On the two days of the inspection all four residents sat in the lounge all day with either the television on or music playing. One resident read a newspaper. We were told that once every two weeks an individual visits to do chair exercises with the residents. The hairdresser also calls. Staff consult with residents and asked for their choices in regards to whether or not they wanted a drink and what drink they would like. Only one resident chooses to sit Care Homes for Older People Page 14 of 39 Evidence: up to the table to eat his meals, but this is respected. Our view was that opportunities in the home for expressing autonomy and choice are limited. We observed lunch being served on two occasions in the home. It looked wholesome and tasty and the residents appeared to enjoy both courses. The cook told us that she does not follow a menu plan but does know what foods the residents like, and ensures that a variety of dishes are served over the weeks. The food eaten is recorded by the cook or the staff who cook at the weekends. The shopping is done by the proprietors from a list prepared by the cook. We noted positively that residents were encouraged to drink cold drinks and tea throughout the day, to maintain good hydration. The cook said she needed some new roasting trays and saucepans, and jugs. Some of the cookware she was using did look very old and worn. Care Homes for Older People Page 15 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints would be taken seriously by staff. The safeguarding policy needs to be amended and the home needs to acquire a local authority safeguarding policy. Evidence: The home has a policy and procedure for complaints. We felt that they would be taken seriously by the staff. We viewed the safeguarding policies at the home. Three amendments are needed: to state that the first action which must be taken in the event of an allegation or suspicion of abuse is to advise the local authority social services, a policy must not state that a service user can veto a referral to social services, also that the homes policy will be followed in conjunction with the local authority policy. The home has a copy of the local authority adult protetion policy and guidance but it is dated January 2005. The manager stated that they followed this and it was pointed out to him that it was out of date. The safeguarding policy advises staff that they must inform all agencies but does not specify who these agencies are. We viewed the arrangements for the protection of the residents monies. We were not satisfied with this and our evidence and views are reported under the outcome area for Management and Administration. Care Homes for Older People Page 16 of 39 Evidence: Enforcement action is being taken with regard to adult protection and staff training and a breach of regultion 13. Care Homes for Older People Page 17 of 39 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. There are many shortfalls in the environment of the home. The home is clean and generally hygienic. Evidence: We viewed the environment of the home including the front and back gardens. The front garden had an old toilet and other furniture left out in it. On the first day of the inspection the side gate to the premises was broken and a neighbor was seen by us going on to the registered premises uninvited. This caused an incident as on that same morning the cook found her cigarettes to have been stolen. A new gate was on the premises waiting to be fitted and a workman arrived to do it in the afternoon. We noted that the manager had not made out a report of the above incident by the time we returned to the home for the second part of the inspection two days later. She had not completed a regulation 37 notification for the CQC either. A requirement has been made in another section of the report regarding reporting of incidents and notifications. The rear garden is long and has two sheds. There were two old chairs and some pieces of metal lying around. This garden is used for smoking by a resident and should be tidy. Care Homes for Older People Page 18 of 39 Evidence: On the ground floor of the home is the kitchen which was in good order. The home has a comfortable lounge downstairs, a small dining room and a conservatory where office work is done. There is a heated towel rail in this bathroom which was really hot to the touch but has no cover. The home must undertake risk assessments to demonstrate whether this presents a risk to residents and take appropriate action. There is a toilet on the ground floor which is in a poor state of decoration and needs redecorating, and a lampshade. A radiator cover in a hallway was warped and needs replacing. The acting manager told us that she has to dry laundry on the radiators as the tumble drier broke down six months ago and has not been repaired. We did indeed observe laundry hanging on a radiator. In the same hallway the floor has a trip hazard where flooring is lifting. There are two ground floor rooms which are full of old furniture and cannot be used. On the two days of the inspection the lift was out of order. Fortunately the two residents who cannot use stairs both sleep downstairs. A repair man was present on the second day of the inspection, attempting to repair the lift. We saw two residents bedrooms on the ground floor which were of an adequate standard. In a hallway downstairs a ladder has been left behind a door. The acting manager and proprietor stated that the ladder is not in regular use. It must therefore be stored appropriately, perhaps in a shed. On the first floor of the home there are a further two unused rooms where furniture is stored. Two residents have their rooms upstairs. One room is in a reasonable state of decor and we were told that this resident purchased flooring and blinds for himself. The other residents bedroom was in an extremely poor state. The wall behind the wash basin was very damp and the paper was falling off up to the ceiling. (We noted that this was reported in the communication book in November 2009). There were no curtains or blinds at the window. There was a commode in the room which the resident does not need, and a bed head and ottoman which are also of no use to him, the ottoman being full of linen. There was also an item of furniture with shelves, which was broken. There were two fittings on the stairs which we were told are a hangover from when a resident with dementia lived at the home. One is a gate at the top of the stairs. This Care Homes for Older People Page 19 of 39 Evidence: does not open all the way back to the wall on the stairs and could be a hazard in evacuating the house from a fire. As it serves no useful purpose it must be removed. At the bottom of the stairs a full size door is fitted with a keypad locking device. The manager stated that the door is never locked. However it makes the stairs dark and should it ever be accidentally locked would prevent people leaving the house from upstairs in the event of an evacuation from fire. The home was warm and generally clean. However we were concerned to hear that in addition to their other duties care staff at the home are expected to clean it. The home does have issues with hygiene and control of infection due to the behaviors of one resident. It manages these with aprons and gloves and disinfectant. However we did note what appeared to be faeces marks on the architrave of one toilet door which is used by the resident. These were pointed out to the manager. Laundry facilities are of an appropriate scale, however as mentioned elsewhere the tumble drier is broken. A summary of the health and safety environmental issues in the home follows : Ground floor toilet redecorated and a lampshade fitted. Risk assessments regarding the hot towel rail in the ground floor bathroom. Damp lifting wall paper absence of curtains and inappropriate furniture in residents room as identified. Radiator cover in ground floor hallway Tumble drier needs to be repaired or replaced Ladder to be stored away safely Lifting flooring in hallway downstairs to be repaired or replaced. Gardens front and back to be cleared of old furniture and rubbish. Care Homes for Older People Page 20 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are an adequate number of workers to staff the home but the staffing level of the home is inadequate and staff have not had up to date training. Evidence: The home employs a number of carers most of whom are part time and also work at a sister home. On the first day of the inspection the staff rota for the current week was missing and the manager said she could not check who would be on duty that afternoon. Staff rotas must be kept in the home. In addition a signing in book must be used by staff when they come on duty for cross referencing purposes. The manager and cook are both full time. In discussion with the manager and by studying the staff rotas we observed that there are periods of time when one worker is on her own in the house. For example the acting manager is on her own regularly in the mornings between 8 and 9.30a.m., which is a busy time when breakfast is served and medications dispensed. In the afternoon of the first day of the inspection the care staff who came on duty at 2pm was to be on her own until 4.30p.m. when another member of staff started a shift. There would be two staff on duty from 4.30 - 7.30 and then down to one again. In our view the needs of the four residents in the home cannot be adequately met by Care Homes for Older People Page 21 of 39 Evidence: one staff member on her own. One resident is fully dependent on staff support to meet all her needs, another has mobility needs and two need support with their mental health and behaviours. The manager told us that she is assisted by the cook and this was witnessed. We were also told that at times the manager leaves the cook in charge. The cook is not trained or qualified in care and whilst she is pleasant and kind to the residents, her lack of knowledge and training in care was apparent and observed by us during the inspection. It is totally unacceptable for the cook to be left in charge of the care home. As previously mentioned lack of staff to support him has prevented one resident from attending a culturally appropriate day centre or joining the lending library. One resident has a weekly appointment to which a carer must accompany him. Staffing levels are not adequate to meet the social needs of residents. The staffing rotas did not indicate that a handover time between staff was allowed for. This was pointed out to one of the registered providers who stated that staff stay late or come early for their shifts to facilitate a verbal handover. This is poor practice and relies on the goodwill of staff. The home takes students on placement from the local college. Supervising them is also part of the duties of the manager. We asked the manager for a training matrix which she was not able to produce. The proprietor produced a training plan called a Staff Progress Plan. The proprietor was able to produce some training certificates for some individuals, but most of these were several years old. The home was not able to produce any evidence of up to date training of staff in the usual mandatory areas e.g. health and safety, food hygiene, manual handling, safeguarding,first aid,fire and medication. The cook had undertaken food hygiene in 2006. One member of staff who administers medication told us she had done medication training but it was a few years ago. In order to meet the needs of one resident at the home the staff need training in challenging behavior. It is acknowledged that two part time staff have undertaken NVQ 3, but we pointed out to the registered provider that NVQs do not replace basic training. The last two inspections made requirements regarding training and these have not been met. Care Homes for Older People Page 22 of 39 Evidence: We viewed two staff files. There was evidence of Criminal Records Bureau (CRB) checks and references being taken up. There was evidence of appraisal and some supervision by the manager of the staff, however this was not undertaken with sufficient regularity or frequency, being a couple of times a year. There was no evidence of supervision of the manager. Enforcement action is being taken with regard to staffing, staff training and supervision and a breach of regulation 18. Care Homes for Older People Page 23 of 39 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 home has been without a registered manager for over a year and continues not to have one in place. There is not an adequate quality assurance system and the monies of one resident are not properly protected. Evidence: There is still no registered manager at the home despite this being a requirement made at the previous inspection. We asked the home for evidence of their quality assurance programme. They produced a business plan, but this was out of date being for 2007-2008. There was no business plan for 2009 or 2010. The home also had a file of surveys completed by stakeholders and one by a relative but unfortunately none of these were dated. There was evidence of one regulation 26 visit to the home by one of the registered providers in June 2009, although monthly visits were a requirement of the previous inspection. A copy of the reports of regulation 26 visits must be retained in the home. Care Homes for Older People Page 24 of 39 Evidence: There was no evidence of residents meetings for 2009 or 2010. The acting manager did say that residents are asked informally by staff if everything is alright. In our view the residents are not given an opportunity to contribute to quality assurance in the home and there is no formal quality assurance system in place. We asked for evidence of regulation 26 visits by the registered provider to the home. We were shown a report of one visit undertaken by one of the registered providers in June 2009. No other reports of visits were available. One of the registered providers stated that formal monthly visits in line with Regulation 26 were not undertaken. We viewed the arrangements for the protection of the residents monies. At present one resident has some monies paid into the personal bank account of one of the registered providers of the home. This is not acceptable practice and the registered provider has been told that she must open a separate account for the resident. A complete audit trail is needed for inspection in the home, with comprehensive records including how much money residents receive before money is brought into the home. A requirement has been made. We viewed the evidence of safe working practices. The gas safety was checked on 14/10/09, the electrical circuits certificate was in date, the Portable Appliance Testing (PAT) certificate was also in date. the emergency lighting had been checked on 23/11/09. The fire extinguishers were checked on 9/10/09. A fire system check was undertaken by an outside contractor on 18/10/09. A record is kept of the weekly testing of the fire alarm and the lift has a visual check weekly, the temperature of the water in the taps is checked weekly and we viewed the evidence of this. We were satisfied that some safety measures are being taken in the home, however we are concerned that there was no evidence that the staff have up to date health and safety training. Enforcement action is being taken regarding quality assurance and a breach of Regulation 24. Enforcement action is also being taken with regard to Regulation 26 visits and a breach of Regulation 26. Care Homes for Older People Page 25 of 39 Evidence: Care Homes for Older People Page 26 of 39 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 18 13 The registered person must 30/04/2009 ensure that comprehensive records are available for inspection within the home around service users finances, including how much money service users receive. To help ensure that service users are safeguarded from the risk of abuse. 2 30 18 The registered person must 30/06/2009 ensure that all staff working at the home receive training appropriate to the work they perform, including all required statutory health and safety training. To help ensure that staff are able to support service users as appropriate. 3 31 8 The registered person must ensure that a permanent manager is appointed to the home, and that they apply for registration with the CSCI. (Timescale 31/08/07 not met) 30/06/2008 4 33 24 The registered person must 31/05/2009 ensure that the home implements quality assurance systems which includes seeking the views of Page 27 of 39 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 service users. To help ensure that the home is able to meet the needs of service users. 5 33 26 The registered person must ensure that monthly unannounced Regulation 26 visits take place, and that a copy of the report of these visits is forwarded to the CSCI, and a copy retained within the home. To help ensure the home is meeting service users needs. 6 36 18 The registered person must 30/04/2009 ensure that all staff, including the homes manager, receive regular formal supervision as appropriate at least six times a year. To help ensure that staff have a good understanding of their roles and responsibilities, and to give them a chance to discuss matters of relevance. 30/04/2009 Care Homes for Older People Page 28 of 39 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 1 5 The service user guide must 11/06/2010 be revised and amended and new copies distributed to residents. So that residents have up to date, accurate information about the home. 2 1 4 The statement of purpose must be amended to be accurate. All residents must have access to a copy of the statement of purpose. So that it properly reflects the services that are available in the home and residents have access to that information. 11/06/2010 3 7 37 Incidents in the home must be notified to CQC. To comply with regulation 37. 11/06/2010 Care Homes for Older People Page 29 of 39 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 4 7 13 Unnecessary risks to the 11/06/2010 health or safety of service users must be identified and so far as possible eliminated. To ensure proper care of residents and protect staff. 5 7 17 Incidents in the home must be properly recorded and a regulation 37 notification sent to CQC. To inform the regulator and comply with regulations. 11/06/2010 6 9 13 Important medical information, including foods prohibited by certain drugs must be recorded and available to staff. To ensure that staff are aware. 11/06/2010 7 9 17 MAR sheets for prn medication must be completed to indicate whether a medication has been administered or not. So that medication can be properly accounted for. 11/06/2010 8 13 18 Arrangements must be 11/06/2010 made to support residents to access community activities. So their cultural and social needs are met. Care Homes for Older People Page 30 of 39 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 9 18 13 All staff must receive service 11/06/2010 specific core training which must include first aid, manual handling and adult protection as rwequired by Regulation 13. Enforcement action is being taken. So that safeguarding procedures protect residents. 10 18 13 An Adult Protection policy 11/06/2010 and procedure which follows current guidelines must be developed and implemented. Staff must be appropriate trained in the policy and procedure. Enforcement action is being taken. So that safeguarding procedures protect residents. 11 19 13 The registered person must 11/06/2010 ensure that the environmental issues which are detailed in the report are addressed. For the safety and wellbeing of residents. Care Homes for Older People Page 31 of 39 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 12 27 18 Adequate numbers of staff should be on duty at all times to ensure that service users needs are met. So that service users social needs are met. 11/06/2010 13 27 18 The registered person must 11/06/2010 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. So that the needs of service users are met. 14 27 18 The registered person must ensure that a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked are kept in the home. So that it is clear who is on duty and what the level of staffing is. 11/06/2010 15 30 18 The registered person must ensure that the care offered to service users is provided by persons who are employed, experienced, trained and skilled to do so. 24/07/2010 Care Homes for Older People Page 32 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the safety and wellbeing of residents. 16 30 18 The registered person must implement a system which ensures that all staff are provided with appropriate training in line with their role and responsibilities. Enforcement action is being taken. 11/06/2010 So that the needs of service users are met. 17 30 18 The registered person must 11/06/2010 ensure that a training plan is developed and implemented for all staff. Enforcement action is being taken. So that the needs of service users are met. 18 30 18 The registered person must 11/06/2010 ensure an evaluation of staff training and skills are undertaken to identify gaps in knowledge and appropriate training requirements. Care Homes for Older People Page 33 of 39 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 Enforcement action is being taken. So that the needs of service users are met. 19 30 18 The registered person must implement a system which ensures that all staff are provided with appropriate formal supervision which is recorded and available for inspection. Enforcement action is being taken. So that the needs of service users are met. 20 30 18 The registered person must ensure that the care offered to service users is provided by persons who are employed, experienced, trained and skilled to do so. Enforcement action is being taken. So that the needs of service users are met. 21 31 8 The registered person must demonstrate that the manager has the qualifications, skills and experience necessary for managing the care home. 11/06/2010 11/06/2010 11/06/2010 Care Homes for Older People Page 34 of 39 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 As required by regulation. 22 33 24 The registered person must 11/06/2010 implement a quality assurance system which meets the requirements of Regulation 24 and provide written confirmation to the Commission that the system has been implemented. Enforcement action is being taken. To ensure that the home meets the needs of the service users. 23 33 26 The registered manager 11/06/2010 must put in place a system whereby an unannounced visit to the home is carried out at least once a month, in accordance with Regulation 26 (1), (2) (a) (b) and (c) and (3) of the Care Home Regulations 2001. Enforcement action is being taken. This is required by regulation. 24 33 26 The registered person must 11/06/2010 ensure that a copy of the report referred to is supplied to the Care Quality Care Homes for Older People Page 35 of 39 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 Commission, the manager of Ashleigh Rest Home and each of the two registered providers in accordance with Regulation 26 (5)(a) (b) and (c) of the Care Home Regulations 2001. Enforcement action is being taken. This is required by regulation. 25 33 26 The registered person must put in place a system whereby an unannounced visit is recorded in the form of a written report in accordance with Regulation 26 (4)(a) (b) and (c) of the Care Home Regulations 2001. Enforcement action is being taken. This is required by regulation. 26 33 24 The registered person must 11/06/2010 implement a quality assurance system which meets the requirements of Regulation 24 and provide written confirmation to the Commission that the system has been implemented. 11/06/2010 Care Homes for Older People Page 36 of 39 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 Enforcement action is being taken. To ensure that the home meets the needs of the residents. 27 35 20 A separate bank account must be opened for the resident whose monies are paid into the personal bank account of the proprietor. A clear audit trail must be available for inspection in the home including how much money service users receive before money is brought into the home. 11/06/2010 To protect the residents monies. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 7 We recommend that more in depth pre assessments are made before residents are offered placements at the home. We recommend that the risk assessment for challenging behavior for an identified individual be developed further in the area of strategies to reduce risk. The specimen signatures for staff who are no longer at the home should be deleted from the medication folder. 3 9 Care Homes for Older People Page 37 of 39 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 4 5 9 13 Staff who administer medication should have up to date training, which is within the last two years. New cookware should be provided where it is needed. Jugs should be provided as the cook needs them. Care Homes for Older People Page 38 of 39 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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