Care Home: Ashridge House

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What the care home does well In general the maintenance of the home is good, decoration in most parts of the home is good, and there is generally good adherence to infection control procedures. All resident falls and accidents are recorded and monitored by the manager, where he has concerns these are reported directly to the residents General Practitioner. What has improved since the last inspection? Pre-admission assessments now require the signature of the prospective residents or his/her representative. There have been no new residents in the home since the last key inspection in April 2010. The care planning format has been changed to an electronic version with hard copy for the staff to use. Staff have worked hard with the residents on the care plans, making sure that residents have been able to voice the preferences, choices, likes and dislikes. Where residents have not wished to be involved the residents representative has had an input and signed the care plan. Individual risk assessments are in place with good steps for staff to take to ensure the level of risk is reduced to a minimum. Recording in daily reports has improved a little and there is evidence that staff report on each individual in a respectful manner. All external health care visits and appointments are recorded, and regular checks are made on each individuals weight. A medication requirement outstanding from the previous two inspections has been met. Three minor errors were found on the day of this inspection and the manager is aware that monitoring of the medication system needs to be more robust to ensure that administration of medication is safe for the residents. The home has recently employed an activities co-ordinator who also had sign language and can communicate with one resident using signing. The activities co-ordinator has also developed an activity plan for afternoons Monday to Friday and this includes taking residents out into the community to the local shops and places of interest. The appointed manager has worked hard with residents to develop a four week menu, that gives residents choice, takes into account their likes and dislikes and caters for people on specialised diets. There is still some work to be done in developing a pictorial set of menus so that residents can make more informed choices. It is hoped that these menus will then be displayed on each dining table. New flooring has been laid in the basement communal toilet and this makes it safer for residents to use. The appointed manager has recruited more staff since April 2010, the home now has an activities co-ordinator, a part time laundry person and an agency weekend cook. Recruitment is still taking place with a view to having further carers and a permanent week end cook. Training DVD`s have been purchased through a training consultancy. The manager is working through these with all members of staff. Once the DVD has been viewed staff take a small test to show understanding. These test papers are then forwarded to the training consultancy for marking and issuing of competency certificates. The inspector does have some concerns in regard to practical training for some mandatory trainingand this will be reported on below. The appointed manager has started work on developing a quality assurance system in the home. Residents and relatives have now received questionnaires and some have been returned to the manager. The manager has formulated a system for monitoring administration of medication, but further work is needed to ensure that the home has a robust quality assurance system in place. The questionnaires and monitoring of systems used in the home should then form the basis of an annual management report. This report would then show improvements that have been made in the last year and Improvements that are needed within the home, to ensure that residents receive a good quality of care. Further work has been completed on ensuring that those residents who do not have a representative to manage their financial affairs have an appointee-ship set up with their funding Local Authority, so that their finances are safe at all times. What the care home could do better: Staff must ensure that residents are bathed/showered on a regular basis, to keep them feeling comfortable and healthy. Staff also need to pay attention to residents appearances ensuring regular shaving takes place for both male and female residents. The complaints policy and procedure must be reviewed to reflect correct information and be produced in a format that is easier for residents to understand. Some decoration is required in the quiet lounge, and a review of furniture in this room will help make the room safer for residents to use. The appointed manager must continually review the staffing levels in the home and ensure that sufficient staff are on duty to meet with residents needs. Staffing qualifications and training need to continue to ensure that residents are cared for by a knowledgeable and skilled workforce. All new staff must receive initial induction and `Skills for Care`, related induction at the beginning of their employment. The inspector has concerns in regard to the lack of staff practical training for the Second-hand hoist that has been purchased by the home. The hoist has been serviced since arriving at the home but was not operational on the day of this inspection because the battery had not been charged, there does not appear to be a spare battery, and there is no operational handbook with the hoist. Two slings were purchased with the hoist but staff have not received training as to what sling should be used for each individual resident. Wheelchairs in the home have not been serviced over a period of time. The appointed manager made arrangements for them to be serviced, but due to the poor state of repair they have been put out of commission until spare parts can be obtained. This means the home has no usable wheelchairs for two residents who need to use wheelchairs and for emergencies. None of the radiators in the home have thermostatic valves fitted so when the weather turns warm temperatures in rooms rise to 29 degrees centigrade on average, putting residents at risk of dehydration. Key inspection report Care homes for older people Name: Address: Ashridge House 132 Dorset Road Bexhill-on-sea East Sussex TN40 2HT 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: June Davies Date: 1 0 0 6 2 0 1 0 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. things that people have said are important to them: 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: They reflect the Care Homes for Older People Page 2 of 27 This box describes the information we used to come to our judgement 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be Page 3 of 27 Care Homes for Older People acknowledged as CQC copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Care Homes for Older People Page 4 of 27 Information about the care home Name of care home: Address: Ashridge House 132 Dorset Road Bexhill-on-sea East Sussex TN40 2HT 01424222200 01424222300 ashridgehouse@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sarojini Sivayogarajah Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection: Brief description of the care home: Ashridge House is registered to accommodate up to 29 older people in receipt of personal care, the registered provider is Mrs Sivayogarajah. Ashridge House is a large detached property situated on the outskirts of Bexhill on Sea. The town centre with its shops and access to bus and rail routes is approximately a mile and a local shopping centre is approximately half a mile. Accommodation is provided on three floors and a shaft lift is fitted to assist those service users who may have mobility problems. 0 8 0 4 2 0 1 0 Number of places (if applicable): Under 65 0 Over 65 care home 29 Care Homes for Older People Page 5 of 27 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 Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out over a period of six hours on 10th June 2010 during the inspection the inspector spoke with the registered provider, the appointed manager, the deputy manager, five members of staff, one visitor and four residents. Documentation relating to the requirements made at the previous key inspection on the 8th April 2010 were also viewed to ensure compliance. A medication audit was carried out in relation to a statutory enforcement notice issued after the last key inspection. A relative visiting the home said that care for her cousin was good, but there had been times when his presentation could have been better. She said, that there are no immediate concerns regarding her cousins welfare. All the residents stated that they Care Homes for Older People Page 6 of 27 were happy living in the home, one resident was delighted that she has someone she can use sign language with, another residents said that there had been a lot of management and staff changes in the home and it was difficult to get used to people again. Staff were able to confirm that they had taken part in recent Moving and Handling training but there had been no practical training, none of the staff have up to date first aid training. Staff were rather guarded when speaking with the inspector. They did however confirm that Safeguarding Vulnerable Adults training had taken place two week ago. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? Pre-admission assessments now require the signature of the prospective residents or his/her representative. There have been no new residents in the home since the last key inspection in April 2010. The care planning format has been changed to an electronic version with hard copy for the staff to use. Staff have worked hard with the residents on the care plans, making sure that residents have been able to voice the preferences, choices, likes and dislikes. Where residents have not wished to be involved the residents representative has had an input and signed the care plan. Individual risk assessments are in place with good steps for staff to take to ensure the level of risk is reduced to a minimum. Recording in daily reports has improved a little and there is evidence that staff report on each individual in a respectful manner. All external health care visits and appointments are recorded, and regular checks are made on each individuals weight. A medication requirement outstanding from the previous two inspections has been met. Three minor errors were found on the day of this inspection and the manager is aware that monitoring of the medication system needs to be more robust to ensure that administration of medication is safe for the residents. The home has recently employed an activities co-ordinator who also had sign language and can communicate with one resident using signing. The activities co-ordinator has also developed an activity plan for afternoons Monday to Friday and this includes taking residents out into the community to the local shops and places of interest. The appointed manager has worked hard with residents to develop a four week menu, that gives residents choice, takes into account their likes and dislikes and caters for people on specialised diets. There is still some work to be done in developing a pictorial set of menus so that residents can make more informed choices. It is hoped that these menus will then be displayed on each dining table. New flooring has been laid in the basement communal toilet and this makes it safer for residents to use. The appointed manager has recruited more staff since April 2010, the home now has an activities co-ordinator, a part time laundry person and an agency weekend cook. Recruitment is still taking place with a view to having further carers and a permanent week end cook. Training DVDs have been purchased through a training consultancy. The manager is working through these with all members of staff. Once the DVD has been viewed staff take a small test to show understanding. These test papers are then forwarded to the training consultancy for marking and issuing of competency certificates. The inspector does have some concerns in regard to practical training for some mandatory training Care Homes for Older People Page 8 of 27 and this will be reported on below. The appointed manager has started work on developing a quality assurance system in the home. Residents and relatives have now received questionnaires and some have been returned to the manager. The manager has formulated a system for monitoring administration of medication, but further work is needed to ensure that the home has a robust quality assurance system in place. The questionnaires and monitoring of systems used in the home should then form the basis of an annual management report. This report would then show improvements that have been made in the last year and Improvements that are needed within the home, to ensure that residents receive a good quality of care. Further work has been completed on ensuring that those residents who do not have a representative to manage their financial affairs have an appointee-ship set up with their funding Local Authority, so that their finances are safe at all times. What they could do better: Staff must ensure that residents are bathed/showered on a regular basis, to keep them feeling comfortable and healthy. Staff also need to pay attention to residents appearances ensuring regular shaving takes place for both male and female residents. The complaints policy and procedure must be reviewed to reflect correct information and be produced in a format that is easier for residents to understand. Some decoration is required in the quiet lounge, and a review of furniture in this room will help make the room safer for residents to use. The appointed manager must continually review the staffing levels in the home and ensure that sufficient staff are on duty to meet with residents needs. Staffing qualifications and training need to continue to ensure that residents are cared for by a knowledgeable and skilled workforce. All new staff must receive initial induction and Skills for Care, related induction at the beginning of their employment. The inspector has concerns in regard to the lack of staff practical training for the Second-hand hoist that has been purchased by the home. The hoist has been serviced since arriving at the home but was not operational on the day of this inspection because the battery had not been charged, there does not appear to be a spare battery, and there is no operational handbook with the hoist. Two slings were purchased with the hoist but staff have not received training as to what sling should be used for each individual resident. Wheelchairs in the home have not been serviced over a period of time. The appointed manager made arrangements for them to be serviced, but due to the poor state of repair they have been put out of commission until spare parts can be obtained. This means the home has no usable wheelchairs for two residents who need to use wheelchairs and for emergencies. None of the radiators in the home have thermostatic valves fitted so when the weather turns warm temperatures in rooms rise to 29 degrees centigrade on average, putting residents at risk of dehydration. Care Homes for Older People Page 9 of 27 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 10 of 27 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 11 of 27 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 the service experience Adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admission assessment has now been produced in detailed format to include signature from prospective resident or representative regarding the care needs they will expect when moving into Ashridge House. Evidence: No new residents have moved into the home since the last key inspection that took place on 8th April 2010. The pre-admission assessment has been updated and includes a space for the prospective resident or their representative to sign to show that they agree to the care needs they require. Discussion took place with the appointed manager, regarding the importance of gaining detailed information prior to the resident being accepted into the home to ensure that Ashridge House has the staff knowledge and that the accommodation can meet the needs of the prospective resident. Ashridge House does not offer intermediate care. Care Homes for Older People Page 12 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are now more personalised and clearly describe the preferred care needs of the residents. Health care needs of the residents are now well met, but further improvements still need to be made in recording what aspects of personal care have been completed and to ensure that the personal hygiene needs of residents are met. Medication in the home is now safely administered and does not place residents at risk, but the appointed manager still needs to carry out regular monitoring checks to ensure that errors do not occur. Staff were observed respecting the privacy and dignity of residents, and have improved on descriptions used in daily reporting. Evidence: Care plans are now being produced in electronic format as well as hard copy. The appointed manager and staff have worked hard with the residents and their relatives to ensure that the residents preferred care needs are recorded on their individual care plans and that they have been signed by the resident or their advocate. On the afternoon of this inspection one member of staff was sitting with a relative going through the care plan, making sure that it covered accurately all aspects of this resident’s care. The inspector viewed two care plans and found them to be detailed and individual for each resident. There was good evidence that residents have been consulted in regard to their daily living routines, likes, dislikes and preferences. Risk assessments are clear and state the level of risk as well as giving staff clear steps to follow so that the level of risk can be reduced. One care plan showed evidence that professional health visits and appointments are now recorded. Two care plans showed that nutrition, weight loss and gain are checked on regular monthly basis. The Care Homes for Older People Page 13 of 27 inspector had some concerns in that the personal care matrix for two residents had not been completed by staff and suggested that neither resident had been bathed for several weeks. This concern was raised with the appointed manager who agreed that he would follow this up. The appointed manager did explain that for one resident they had not had a bath as they needed to use a wheelchair from their bedroom to the bathroom, but wheelchairs had not been safe to use. This matter will be reported on further under Management and Administration of this report. The inspector also noted that while talking to three female residents in the lounge that all had significant growth of facial hair that could have been dealt with during personal care tasks being carried out. The inspector carried out an audit of medication and found three minor errors, but on the whole medication administration has greatly improved since the last key inspection on the 8th April 2010. The errors were pointed out to the appointed manager who will take further steps to ensure they do not continue to occur. There is good evidence that the appointed manager has worked hard to ensure that processes have been put in place to ensure that medication is managed in a safe way within the home so as not to place residents at risk. There is evidence that now there is an appropriate risk assessment in place for a resident who is self medicating. The monthly administration records file has a medication alert for staff in regard to the administration of a particular medication. The manager has produced PRN (as required) administration guidance, and there are separate PRN (as required) risk assessments for each resident who has been prescribed PRN medication. There is evidence within the daily reports in care plans that staff report on residents in a respectful manner and no derogatory remarks were found. Care Homes for Older People Page 14 of 27 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 the service good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents in this home are able to make choices in regard to their daily living routines. Since the recruitment of an activities co-ordinator residents have a wider variety of activities that they can participate in. Menus have now been developed that offer residents a varied choice of nutritious meals throughout the week. Evidence: Two residents spoken to on the day of this inspection said that they are now able to choose what their daily living routines will be and that activities in the home had improved since an activities co-ordinator had been employed. The inspector spoke with the activities co-ordinator regarding activities and meeting residents social needs. She was able to confirm and show the inspector a programme of activities devised in conjunction with residents, this will offer activities throughout the week. Further activities will be added at the request of residents. The activities co-ordinator is able to communicate with one resident in sign language and is actively seeking external deaf clubs that the resident can attend. For those residents who prefer to remain in their bedrooms the activities co-ordinator confirmed that she spends one to one time with them. Two residents in the home attend the local education centre, where they take part in gardening, craft and painting tuition. There are two external entertainers that come into the home, one offers motivation to the residents, while the other plays the piano and residents sing along to the tunes being Care Homes for Older People Page 15 of 27 played. New four weekly menus have been developed by the appointed manager in agreement with residents, these take into account the residents likes and dislikes. At the present time the manager is in the process of developing pictorial menus, to assist residents in making informed choices. The new menus were viewed by the inspector who found that they offered choice and a good variety of nutritious meals. Daily menus will be displayed on dining room tables in both written and pictorial format. At the present time none of the residents require hands on assistance with eating, but do require gentle reminders by the staff at mealtimes. The appointed manager confirmed that the home would be able to cater for specialised diets as and when required but at the present time only caters for diabetic diets. Care Homes for Older People Page 16 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents need clear up to date information in relation to making a complaint to the home, and how to take the complaint further should they need to do so. Staff have now been trained in the Safeguarding of Vulnerable Adults but due to poor health and safety procedures residents are still at risk Evidence: The appointed manger said at the present time the complaints policy and procedure had not been updated. He will do this as a matter of priority and ensure that it is put into a clear format for the residents. While updating the care plans staff have explained to residents the complaints procedure, and there was evidence of complaints procedure and statement of purpose on each residents care plan. There have been no complaints made by residents or their relatives to the home since the last key inspection in April 2010. One complaint has been received in relation to the manager by a general practitioner, this has been investigated and resolved. At the present time there is an open level four Safeguarding Vulnerable Adults investigation being carried out by East Sussex County Council and the police in relation to the home. The inspector spoke with three members of staff who were able to confirm that they had received Safeguarding Vulnerable Adults training two weeks ago for which they will receive certification once their test has been marked. Confirmation was available via the training matrix that all staff have now received Safeguarding Vulnerable Adults training. There are still concerns in that staff have not received the practical training in health and safety issues as well as poor maintenance of equipment that still leaves residents at risk. Care Homes for Older People Page 17 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home is clean and tidy, but further work needs to be carried out to ensure that residents live in comfortable and safe home that is free from odours. Evidence: The home presented as being reasonably clean and tidy on the day of the inspection. The domestic employed to keep the home clean was on a weeks annual leave, and no extra staff were available to do the cleaning. Care staff are carrying out cleaning as and when they have time. There was a slight offensive odour near the notice board in the basement of the home. The quiet lounge needs redecorating and the furniture situation in this room needs to be reviewed so that residents have safe access to the room should they want to use it. New flooring has been laid in the basement communal toilet and residents can now access this area safely. The back garden of the home is still not safe for residents to use. At the present time there is a problem with the home overheating, as the radiators are not fitted with thermostatic control valves, all radiators are covered and there is no access to enable radiators to be turned off. Quotes have been obtained for thermostatic valves to be fitted, but it is unclear as to when the work will be carried out. This will be reported on under management and administration in this report. Care Homes for Older People Page 18 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels need to be kept under review to ensure that care needs of the residents can be met at all times. Staff should received the qualifications and training so that they can knowledgeably and safely meet the needs of the residents. Staff recruitment procedures are good, but new staff must be appropriately inducted into the home at the start of the their employment. Evidence: Four weeks of staffing rotas were viewed by the inspector, these showed that on occasions only two members of staff are on duty during the morning and afternoon shift, the inspector is concerned as there are two residents in the home who require two staff to help them mobilise as they are non-weight bearing. Should these two members of staff be assisting one of these residents, all the other residents are left without supervision. Since the key inspection on the 8th April 2010 the appointed manager has recruited an activities co-ordinator, a part-time laundry assistant and agency cook for weekends. There are still only 46 of staff who have NVQ level 2 or above. While the appointed manager has purchased training DVDs from a training consortium, and staff are expected to undergo a short test after viewing these training DVDs, so they may receive certification, no practical training has been carried out for Moving and Handling and First Aid. There is no member of staff within the home who has an up to date first aid certificate The inspector viewed two staff personnel files for new members of staff employed since the last key inspection in April 2010 and found them to be in order with all appropriate checks carried out prior to the members of staff taking up employment in the home. The inspector was rather concerned that one new member of staff had not Care Homes for Older People Page 19 of 27 undertaken initial induction although she had been working in the home for two weeks. The other member of staff had received initial induction. Neither member of staff have started Skills for Care induction. A requirement is being made that new staff are properly inducted into the home at the start of their employment. Care Homes for Older People Page 20 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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 appointed manager has worked hard to make improvements in the home and to meet requirements made at the last key inspection, but he must apply for registration with CQC. The quality assurance system in the home still needs further development to ensure that residents are offered a good standard of care. Health and safety systems in the home place residents at risk and must be improved upon. Evidence: The appointed manager has the knowledge and skills to ensure continued improvement in the home. At the present time he has just two units to complete towards his Leadership and Management for the Care Service Award. Since the last key inspection on the 8th April 2010, the appointed manager has worked hard to meet many of the requirements made at that inspection. Through conversation with the inspector there was evidence that the appointed manager remains committed to making improvements in the home that will enhance the residents quality of life. He has applied for registration with CQC and has had his application returned and is in the process of re-submitting for registration. During this inspection it was made clear to the appointed manager that he must submit his application for registration by the 7th July 2010. While the appointed manager has proceeded with the quality assurance system in the home he is aware that further work still needs to be done in regard to developing monitoring systems, for care planning and daily report writing, quality of food, Care Homes for Older People Page 21 of 27 domestic cleaning, quality in relation to laundering residents clothing, infection control, residents monies, staff files and competency of staff after training. There was good evidence that residents and relative questionnaires have been sent out and some received back, with clear indications that residents would like to see a more permanent staff team and have outings into the local community. Stakeholder questionnaires still need to be sent out. The registered provider is in the process of requesting that an external social health care consultant is employed to carrying regulation 26 visits to the home on her behalf, on the day of this inspection this consultant was visiting with the registered provider. It is expected that when all information and monitoring of systems is completed for several months that the home will produce an annual development plan reviewing what the home has done well, and where there is further room for improvement and what action will be taken towards making the improvements. The appointed manager has referred all residents who do not have capacity to manager their own financial affairs and who do not have a representative to the funding department of the relevant Local Authority and appointee-ships are in the process of being set up by them. Residents personal allowances are now being recorded in and out with relevant receipts kept, each residents money is kept in a separate wallet, safely and securely within the home. The inspector has concerns in regard to health and safety practices in the home at the present time especially in relation to staff knowledge and use of the mobile hoist, room temperatures due to lack of thermostatic control valves and that wheelchairs have not be kept in a serviceable condition. A requirement made at the Key Inspection on the 8th April 2010 has not been met, while a hoist with two slings has been purchased, it was inoperable on the day of this inspection, there was no operational handbook, the battery was flat, staff have not received practical moving and handling training, the appointed manager and two members of staff were unsure as to what slings they should use. There was no evidence that slings would be the correct size for all residents in the home. The home has an accident book where residents falls and accidents are recorded. The appointed manager keeps accidents and falls under review and reports any concerns directly to the residents general practitioner. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes 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 38 13 The registered person shall make suitable arrangements to provide a safe system for moving and handling service users. Staff must have access to a mobile hoist which they will use for residents who have fallen and need assistance, this is to ensure the safety of residents and staff. 28/05/2010 Care Homes for Older People Page 23 of 27 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 38 13 (4) The registered person shall ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated, and shall make suitable arrangements for the training of staff in first aid. Service users must not be placed at risk of dehydration through overheating of the building. Thermostatic control valves must be fitted as soon as possible. Staff must receive practical training in operating the Care Homes for Older People Page 24 of 27 hoist and use of slings. The hoist battery must be kept on charge so that the hoist is serviceable when needed. Each resident should be assessed to ensure that the home has the correct slings. All wheelchairs in the home must be repaired as soon as possible and kept in a good state of repair and serviceable for the residents to use. (1) The registered person 14/07/2010 shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users. Service users must be offered and encouraged to bath/shower on a regular basis, and have the aids and equipment available to enable them to do this safely. (1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service users (a) 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; (c) ensure that the persons employed by the registered person to work at the care home receive (i) training appropriate to the work they are to perform including structured induction training. 2 8 12 3 30 18 Care Homes for Older People Page 25 of 27 4 31 8 All new staff must receive initial induction training followed by Skills for Care induction training. Where relevant staff must also receive the correct practical training in relation to health and safety issues. (1) The registered provider 07/07/2010 shall appoint an individual to manage the care home where (a) there is no registered manager in respect of the care home. The appointed manager must registered with the Care Quality Commission 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 9 The manager should put in place a stringent monitoring system for medication to ensure that errors do not occur that may affect the safety the of the residents. Effort should be made to arrange local community outings for residents, as this was an issue raised by residents with the inspector and via the homes quality monitoring processes. The appointed manager has agreed to update the complaints policy and procedure and produce it in an easy to read format for the residents to enable them to voice their concerns and complaints. The quiet lounge needs attention to decoration. Furniture in the quiet lounge needs to be reviewed to ensure that residents can move safely around this room. Staffing levels in the home must be monitored to ensure that sufficient staff are employed to meet personal, health and social care needs of the residents. The appointed manager to continue developing the quality assurance system in the home so that outcomes can be monitored and improvements made to the standard of care for the residents. 2 13 3 16 4 19 5 27 6 33 Care Homes for Older People Page 26 of 27 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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