Care Home: Astoria Park

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What the care home does well Medicines were stored securely for the protection of residents. The rooms where medication was stored are temperature controlled to ensure medicines were of suitable quality and records were kept of the temperatures. Medicines were given to people with regard to their dignity and personal choice. People can have pet budgerigars in their rooms if they so wish. People we spoke with said that the staff were `Very good`. We saw how the staff interacted with the residents and this was done in a respectful and caring manner. A resident said in their survey that `The meals are good.` According to the AQAA there are twenty permanent care workers and thirteen of these have a National Vocational Qualification, level 2 or equivalent, in care i.e. 65%. What has improved since the last inspection? The information within the Statement of Purpose and Service User`s Guide have been amended to provide up to date information, about the home and the services that it can offer. This information was available throughout the home and should help prospective residents in their decision where they would like to live. The requirement, about caring for people at risk of developing pressure sores and/or who have acquired such conditions of the skin, has been met. The requirement, about making sure any person at risk of choking is to be given the right food and drink, has been met. There have been ongoing improvements with in the environment to include providing locks on bathroom/shower doors and repairing the outer casing of one of the baths. Corridors and the main dining room have pictures of film stars and pictures of food and drink from `past times.` The morale of the staff has improved following a change of home Manager. Due to the positive outcomes for people we have considered that a requirement has been met with regards to the staff training and staff competencies in caring for people who are at risk of developing pressure sores and who may have acquired a pressure sore, whilst living at the home. What the care home could do better: Care plans that we looked at were not up to date and were not accurate because of this. Care plan evaluation of someone`s nutritional status was not based on evidence, rather the care plan was evaluated `intuitively. We have made a requirement about care plans. Records made when medicines are given to people must be accurate and complete. We have made a requirement about this. Staff should be provided with a level of training of medication which meets the standards of Skills for Care and staff should be assessed that they are competent to handle and administer medicines safely. We expect this to be managed by the home and have not made a requirement on this occasion. External and internal areas of the home environment must improve with regards to maintenance and fire safety. This is to ensure that people are valued and respected and are safe from the risk of fire. The recruitment procedures of the home must improve to ensure no resident is placed at risk from unsuitable staff. The induction training of all staff must cover mandatory training to ensure that people receive safe care from suitably trained staff. The quality assurance of the home must improve to ensure that any improvements made are sustained and that improvements are made with no reliance on our inspection and regulation activities. This will ensure that people receive safe and proper care and support. Key inspection report Care homes for older people Name: Address: Astoria Park 15 Park Crescent Peterborough PE1 4DX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elaine Boismier     Date: 2 1 0 1 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 34 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 acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Astoria Park 15 Park Crescent Peterborough PE1 4DX 01733555110 01733898497 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Healthcare (Focus) Limited care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 59 The registered person may provide the following category/ies of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Astoria Park is a registered care home to provide care, mainly for people over 65 years of age, some with nursing and mental health needs. The home is in a converted building with accommodation arranged on three floors. There are fifty-three single bedrooms and three double bedrooms. Fifty-five bedrooms have en suite facilities and one bedroom has the sole use of facilities situated a short distance away. Astoria Park is situated in a suburb of the city of Peterborough approximately ten minutes walking distance from the city centre and overlooking a large public park. Range of current fees range from £387.03 to £606.00. Information about the fees, including those for Care Homes for Older People Page 4 of 34 Over 65 0 59 59 0 2 5 0 8 2 0 0 9 Brief description of the care home additional costs, can be obtained from the home. A copy of the inspection report is available at the home or via our website at www.cqc.org.uk Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, The Care Quality Commission (CQC), carried out this unannounced key inspection (KI), by two Inspectors, between 10:00 and 15:40, taking just under six hours to complete. Before the inspection we received surveys from ten of the residents and one from the staff. We looked at information that we have received about the home since our last Ki, of 25th August 2009, including notifications, complaints and information about safeguarding, which was previously known as protection of vulnerable adults against abuse (POVA). The home sent us, as requested, an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 34 During this inspection we looked around the premises and looked at some of the documentation. We case tracked two of the twenty-three current residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager. For the purpose of this inspection report people who live at the home are referred to as people, person,resident or residents. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care plans that we looked at were not up to date and were not accurate because of this. Care plan evaluation of someones nutritional status was not based on evidence, rather the care plan was evaluated intuitively. We have made a requirement about care plans. Records made when medicines are given to people must be accurate and complete. We have made a requirement about this. Care Homes for Older People Page 8 of 34 Staff should be provided with a level of training of medication which meets the standards of Skills for Care and staff should be assessed that they are competent to handle and administer medicines safely. We expect this to be managed by the home and have not made a requirement on this occasion. External and internal areas of the home environment must improve with regards to maintenance and fire safety. This is to ensure that people are valued and respected and are safe from the risk of fire. The recruitment procedures of the home must improve to ensure no resident is placed at risk from unsuitable staff. The induction training of all staff must cover mandatory training to ensure that people receive safe care from suitably trained staff. The quality assurance of the home must improve to ensure that any improvements made are sustained and that improvements are made with no reliance on our inspection and regulation activities. This will ensure that people receive safe and proper care and support. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that there is enough information that that will help the prospective resident in making their decision where they would like to live. Evidence: At our last inspection we found an out of date Service Users Guide and Statement of Purpose. At this KI, of 21st January 2010, we noted that, within the rooms we visited, there were copies of an updated Statement of Purpose and copies of a Service Users Guide: both of these required documents were of a good standard and provided the required information, to include the new management arrangements of the home; the change of contact details of the Care Quality Commission; meal times and the homes smoking policy. In our last inspection report we also said The certificate of registration was on display although this included the name of the former registered manager. A new certificate of registration can only be issued should we be formally notified that there has been a Care Homes for Older People Page 11 of 34 Evidence: change in the management arrangements of the home. Since this report was made we have received a formal notification, from Southern Cross, requesting a change of certificate of registration and this is now under consideration. We received ten surveys from residents: seven of these said the person had enough information to help them in the decision where to live; two of these surveys said the person could not remember with the remaining survey saying that the person did not have this level of information although they added that the person was satisfied with Astoria Park. Due to the serious concerns about the health, welfare and safety of the residents the local authority suspended new placements to the home, since 31st December 2008. According to the Manager there have been no new placements to the home since this date. We have, therefore not been able to assess the standard relating to the admission process of the home (Standard 3). Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there has been some improvement in the standard of provision of health and personal care people can not be fully confident that the current standard of care records will protect them from the risk of harm. Evidence: In our last KI report we said that not all the care plans met the standard and did not meet the associated regulation. For the home to demonstrate its standard of quality assurance we said We expect the home to improve the standard of care planning and to ensure that the staff use these to obtain clear guidance in how to meet the assessed needs of the people. We have since received action plans, dated 17th December 2009 and 31st December 2009, from Southern Cross, telling us what action was being taken to improve the standard of care records. The action plans noted that there was ongoing work to improve the standard of the care records. We also looked at the reports of the monthly visits, made by a representative of Southern Cross, for December 2009 and January 2010: these reports identified that the care records were not of an acceptable standard and action was to be taken by the 20th January 2010 to improve the standards of this required documentation. Care Homes for Older People Page 13 of 34 Evidence: As part of our case tracking we looked at two peoples care records, to not only assess the standard of these but also to assess the standard of the homes quality assurance. Risk assessments were actively reviewed and in accordance with the change of needs of the person, such as risk of moving and handling and risk of developing pressure sores. For one of the two people we saw that their assessed needs were directly related to their mental health conditions and provided the staff with clear guidance in how to meet this persons individual and unique needs. For the second person we found that this was not always the case and the Manager agreed with our findings. For example the person was assessed, on the 5th January 2009, by a speech and language therapist (SALT) and guidance from the SALT said that the person was at risk of choking and was to be given pureed meat. We saw that their care plan also stated that the person was at risk of choking; they were to be helped with eating their food, which was to be of a soft consistency. We spoke with three members of the staff, all of whom told us that the person was on a normal diet and enjoyed eating meat, fish and chips and non-pureed vegetables. The Manager also informed us that she had provided the person with a lap table so that the person could feed themselves, when they were in their bed. It was clear from our case tracking of this person that their care plan, for the risk of choking, was not accurate. We also could find no reasoned explanation as to why the care provided had changed. Following on from this we noted that the care plan, to manage the same persons diabetes, recorded that their blood sugar was to be tested, at random once a week. The care plan provided the levels of what the persons blood sugar was to be at and we found that the record sheet with the medication administration records (MARs) recorded the levels of the persons blood sugar; these levels were within the ranges as described in the associated care plan. However the persons blood sugar was last tested on the 1st January 2010 and none since. The Manager stated that that that it was the policy of Southern Cross not to routinely test blood sugars of any person who was considered to have stable diabetes: the care plan was not updated to reflect this policy decision. For one person, who was part of our case tracking, we saw that their hair was greasy looking and untidy. The staff told us that they had encountered resistance to improve this standard of care to the person, although this was not recorded in the persons care plan. Care Homes for Older People Page 14 of 34 Evidence: We saw, as part of our case tracking, one of the people was assessed, during 2009, to be at risk of malnutrition. There were two risk assessments for this condition - only one of which was completed and this was up-to date. We noted that there was an associated care plan and this was evaluated each month. In December 2009, the last entry for the evaluation of this care plan, said that the person was putting on weight although we, including the Manager, could find no record of the persons weight to justify this judgement. This indicated that the evaluation of the persons care plan was unsound as it was based on no evidence. We have made a requirement about care plans. Following our KI, of August 2009, we made a requirement that stated Proper and safe care must be provided when giving people their food and drink. The timescale for this requirement to be met was by the 31st August 2009. The registered provider subsequently informed us what action it had taken to ensure the protection of people who had difficulties with their swallowing: this included providing additional training for staff. We also made a requirement that said Proper care and monitoring must be provided to reduce the risk of pressure sores developing. The timescale for this action to be taken was by the 28th August 2009. As part of our case tracking, and our observation of other people during lunch time, we looked at what action had been taken to meet these two requirements and we found that no person was actively placed at risk of choking. Some, but not all, of the people were provided with soft or pureed food and the staff were fully aware of who these people were, indicating that the peoples special dietary needs were safely met. We also looked, as part of our case tracking, at a persons care records and noted that their care plan noted what pressure setting the pressure-relieving mattress was to be set at; that the person chose when to be repositioned by the staff, if at all, and that their previous pressure sore was monitored, reviewed and treated: the sore was now healed. We spoke with this person who confirmed that their sore was now healed and that they chose when they wanted help, from the staff, to change their position when they were in bed. As a result of our findings we consider that both of these requirements have been met. Seven of the ten residents surveys said that the person received the care and support that they needed with the remaining three surveys stating that this sometimes was the case. Added comments indicated that the staff should be more sensitive to the individual needs of people with visual impairment by Speak(ing) when entering or leaving the room and giving their name and Personal hygiene standards are low for those residents who are unable to care for themselves i.e. teeth cleaning & nails. According to the Manager action has been taken to improve the staffs understanding Care Homes for Older People Page 15 of 34 Evidence: of peoples needs when they have a sensory impairment. The standard of personal care was, on the whole, good: people had clean hair, finger nails and clothes. All of the ten residents surveys said that the home ensured that the person had access to the medical care that they needed. At a safeguarding meeting, held in January 2010, in response to the safeguarding alert that we made, in November 2009, it was concluded that the home had not taken action to seek medical advice and possible further medical attention, when a person sustained an injury following an untoward safeguarding incident at the home (see also Standard 31 of this report). We looked at the practices and procedures for the storage, handling and recording of medication. Medicines were stored securely for the protection of residents. The room where medication was stored is temperature controlled to ensure medicines were of a suitable quality and records were kept of the temperatures. Records were made when medicines were received into the home and when they were disposed of and these were of a good standard. We looked at the records made when medicines are given to people and we found a few gaps in the records giving no indication whether medication had been given or not; we found that stock discrepancies which could indicate that medication had not been given but the records had been signed to indicate that it had been given. We saw that there had been some hand-written changes made to the dosage instructions for some medicines but the record did not indicate when this was made and so the records of administration were inaccurate and no justifiable reason for the change could be found in care plans. We also saw that when medicines are given in variable doses e.g. one or two tablets, the actual dose given was not always recorded. This could result in people receiving too much or too little medication. We saw this on our last inspection in August 2009 and expected this to be managed by the home. Given the deficiencies we have seen on this inspection we have now made a requirement for these records to be accurate. Medication was only given to people by staff who have been trained to do so, but the level of training provided is basic and we could not find evidence that everyone had had this training or been assessed that they were competent to do so. But we watched medicines being given to some people during lunch time and this was done with regard to peoples dignity and personal choice. We heard a member of the care staff ask a person if they wanted their medicines now or later with a cup of tea. We were made aware, by the Manager, of plans to assess staff competence to handle and administer medication so we expect this to be managed by the home. Care Homes for Older People Page 16 of 34 Evidence: People we spoke with said that the staff were Very good. We saw how the staff interacted with the residents and this was done in a respectful and caring manner. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that there are opportunities to live a good social life. Evidence: The AQAA told us that there are two activity co-ordinators employed to provide, in total, forty hours work, in activities, each week. Seven of the ten residents surveys said that the home always or usually provides activities that the person can take part in with the remaining three surveys saying that this was sometimes the case. One of the surveys added that the home could do better to Ensure as much mental stimulation for residents as possible indicating that the person considered there was not enough of this type of activity to promote the peoples sense of well-being. Within one of the lounges, Lily Lounge, we saw there was a programme of planned activities: for the morning of our inspection this programme noted that a game of bingo and ball exercises were to take place. Although we saw no game of bingo happening we saw that some of the residents were taking part in throwing a ball, at each other, to catch. As part of our case tracking we saw that one of the people, who did not leave their room by choice, had 1:1 sessions of activities. They, with some other residents who were not part of our case tracking, had a pet budgerigar, in a cage, in their room and they saw this pet as an activity as well as company for them. Care Homes for Older People Page 18 of 34 Evidence: People we spoke with said that they could stay in bed if they so wished and were able to make choices about how their care was provided. From our observations and from our examination of the visitors signing in book, we saw that people can receive their guests when they liked. People who we spoke with confirmed that this was the case, with one person looking forward to a visit from a family member that afternoon. The AQAA told us that of the twenty-five of the staff have attended training in malnutrition and how to help people eat their food. The AQAA also stated us that residents have a choice of what they would like to eat and this choice is offered at the time when their meal is due to be served. Providing choice in this way helps people, who have difficulties in remembering, with their decisions on what they would like to eat. Our observation of lunch time, in the main dining room, confirmed that choices are given verbally and by way of a menu displayed on the noticeboard. This included a choice of roast beef and Yorkshire pudding or fish cake, both accompanied by vegetables, and followed by fruit flan and cream. Examination of the menus for two weeks demonstrated that a cooked breakfast is available on a Wednesday and breakfast choices, for example, included cereals, toast and fruit juices, are available during the week. Lunch options provided two alternatives ranging from traditional English roast dinners, lasagne and other past choices and casseroles. Desserts were also varied to include spotted dick and custard and rice puddings. For tea/supper time the menus provided options of soup, sandwiches and at least one hot option, such as beans on toast and jacket potatoes with cheese. Seven of the ten residents surveys said that the person always or usually liked their meals with the remaining three surveys saying that sometimes this was the case. One of the surveys said that The meals are good. One person who we spoke with said that sometimes the food was good although this was not always the case with the food being average. Individual dining tables had condiments of vinegar, salt and pepper, a table decoration and matching table linen and napkins. People were asked if they wanted mustard to eat with their roast beef. Such attention to detail told us that the dining experience for people was valued and respected. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that any concern that they might have will be responded to and action taken. People can be confident that they should be safer although it is too early to be fully confident about this. Evidence: The AQAA was incomplete as it did not provide information as to how many complaints and how many safeguarding investigations the home has received and been subjected to, respectively, within the last twelve months. We know, from our records, that the home has been subjected to safeguarding investigations: for example we attended such a meeting in December 2009, before the AQAA was sent to us. The Manager explained that she had found it difficult to determine the number of complaints made against the home and the number of safeguarding alerts made before she started working at the home, in November 2009. We looked at the record of complaints and we found that the home had received, within the last twelve months, four complaints, one of which we were made aware of by the complainant and this was currently being investigated by Southern Cross. We found that all of the investigated complaints were responded to and resolved with the required 28-day time period and they were done so in a listening and sensitive manner. All of the residents surveys said that the person knew who to speak to if they were Care Homes for Older People Page 20 of 34 Evidence: unhappy about something; all of these surveys said that person knew how to make a formal complaint if they so wished; the staff survey said the person knew what to do if anyone had a concern made to them, about the home. On the 2nd November 2009 we received information from the home with regards to an incident between two of the residents. We found that the home had failed to report this incident, in line with the correct procedures, to the local safeguarding (SOVA) team and as a result we made the SOVA alert instead. Following on from this, we received a notification from the home, dated 24th December 2009, that there was a safeguarding incident between two residents: this incident was reported by the home to the local safeguarding team. In December 2009 we attended a SOVA meeting following allegations made against the home. The home had fully co-operated with the SOVA investigation and it was concluded that there was no evidence to substantiate the allegations that were made. Seven of the ten residents surveys said that the person felt the staff listened to them and acted on what was said; two of these remaining surveys said that sometimes this was the case with the final remaining survey saying that the person did not know (if the staff did such a thing). One of the residents surveys added that the Staff (are) always very helpful and approachable. The staff who we spoke with said that they had attended safeguarding training and were able to tell us what they considered constituted abuse of any resident and what they would do if they suspected or witnessed any such untoward incident. Although the staff were not fully aware where contact numbers of the safeguarding team were kept, these were available by the phone commonly used by the staff. We noted, from the examination of the staff training records, that not all of the staff have received safeguarding training, as part of their induction training and this was also confirmed by the Manager. We expect this standard of training to improve as part of the homes quality assurance. Currently the home has not carried out any assessments of peoples capacity to make decisions. Given that the home is registered to provide care and support for people with dementia this assessment process needs to take place, to ensure that no person receives care and support , unless provided on a best interest basis. According to the action plans, provided by Southern Cross, as referred to under Standard 7 of this report, arrangements are being made for the training of the staff in the Mental Capacity Act and Deprivation of Liberty, before such assessments can be carried out Care Homes for Older People Page 21 of 34 Evidence: by the home. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable home that could be a more pleasant place to live. Evidence: According to the AQAA, within the last twelve months, there has been a number of improvements to the environment of the home to include the re-tiling of bathrooms, replacing flooring and redecoration throughout the home. In October 2009 we were notified that one of the boilers was condemned and temporary arrangements were in place until a new boiler was installed. According to the AQAA a new boiler has since been installed. We also received a notification, from the home in November 2009, telling us that work was to be carried out under the floor in kitchen as a leak was causing subsidence. The Manager told us that the dining room floor was also found to be wet and this was related to a water pipe leak. Repairs had since been made to these areas. During our tour of the premises we saw that showrooms were newly decorated; flooring in some of the bedrooms had been replaced to include wood effect flooring and carpets. Locks were available on all the bathroom/shower rooms and this improvement was made since our last KI. The outer casing of one of the baths, on the third floor of the home, was repaired and this too, was done since our last KI. Care Homes for Older People Page 23 of 34 Evidence: One of the people, who was part of our case tracking and another person, who was not part of our case tracking, said that they liked their rooms and chose to spend their time there. Pictures, including those of 40s and 50s film starts and past time adverts for confectionery and food were available in the corridors and the dining area, to stimulate peoples memories and promote a more homely feel to Astoria Park. We saw, however that they were areas of the homes environment that needed attention: the inner courtyard was unsightly, to include, for example, two wheelchair cushions; two hanging baskets lying on the ground; a small plank of wood, lying on a garden area; a thin strip of carpet on one of the pathways; two used disposable barbecue sets and a guy/scarecrow, in a slumped position on one of the wooden benches. During our tour of the last inspection we noted a drain, outside one of the dining room sliding doors, facing the vegetable patch, that was not functioning as it should. We revisited this area and found that the area around this drain pipe was wet. One of the shower rooms, on the ground floor, had two tiles that were coming away from the ceiling and these were stained brown, which may have been caused by a water leakage. Behind the door of bedroom number 15 there was a hole in the wall. We pointed out these areas that were in need of attention, with the Manager, who took notes of our findings. (See also Standard 38 of this report). Records for hot water temperatures were seen for baths and showers and these were satisfactory with no hot water recorded as being delivered above 43 degrees centigrade. All of the ten residents surveys said that the home was always or usually clean and fresh and we found that this was the case. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their needs will be met by a sufficient number of staff although they can not be fully confident that the current recruitment and training of the staff will fully protect them. Evidence: There has been a high turnover of staff within the last twelve months as information provided by the AQAA has told us that twenty-five care staff, which includes registered nurses, have left their employment. One of the residents surveys added that there was a Very high turnover of staff-no continuity of care. We know, from our inspections of 2009, that the morale of the staff has been affected by the changes of home managers. We spoke with some of the staff who told us that the staff morale had improved, since the current Manager started and this, they believed, had a positive effect on the well-being of the residents. One member of the staff said that they now looked forward to coming to work. Seven of the ten residents surveys said that the staff were always or usually available when the person needed them; the three remaining surveys said that this was sometimes the case. The one staff survey said that there was usually enough staff on duty to meet the individual needs of the residents. One of the people, who we case tracked, said that they usually did not need to wait long for the staff to attend to their Care Homes for Older People Page 25 of 34 Evidence: call although they had to wait for half an hour, during the evening of the 20th January 2010: they knew that it was this length of time as they could see their clock on the wall. However they said that this was the exception, rather than the rule. The staff who we spoke with said that there was enough staff on duty to meet the individual needs of the residents. We timed the response of the staff to the call bells and none of these exceeded five minutes duration. According to the AQAA there are twenty permanent care workers and thirteen of these have a National Vocational Qualification, level 2 or equivalent, in care, i.e. 65 . We examined three files of the most recently recruited staff. We saw, for example, checks had been carried out, before the person started working at the home, and these were to see if the member of the staff was barred from working with vulnerable people. We also saw there were no unexplained gaps in the peoples employment histories and there was proof of their identification, including a clear photograph. We noted for one of these three staff that there were three written references, all provided by the persons friends: this does not allow for objective comments about the suitability of the person. According to their employment history the person had worked at a care home, although no references were sought from this former place of employment. The Manager told us why this was not pursued, based on information provided by the applicant, although we considered that the home could have tested what the applicant said to them, to confirm the truthfulness of their information. We also noted that a registered nurse started working at the home on the 16th December 2009 although the home had received no satisfactory confirmation of their nurses registration until 18th December 2009. The confirmation received was satisfactory although the home placed people at risk during this intervening period of two days. We expect the home to improve this area of staffing information to ensure that people are protected from unsuitable staff. In October 2009, as a result of a safeguarding alert, and a subsequent review of some of the residents needs, we received a copy of this review, that was carried out by a community psychiatric nurse (CPN). The CPN considered that the level of knowledge of the staff in managing peoples behaviours and assessing what may have caused such behaviours, could be better. During the safeguarding meeting, held in January 2010, we were told that the CPN had commenced the training of the staff in these areas although the training was not completed, due to staffing and communication issues within Astoria Park. The current Manager explained, to those present at the meeting, that this training has since been replaced by internal training. Care Homes for Older People Page 26 of 34 Evidence: The staff survey said that the person felt that their induction training and ongoing refresher training helped them to do their job with the skills and knowledge to meet the needs, including changing needs of the residents. According to the Manager actions have been taken to improve the recording of the staff induction training programme. She showed us one example of this programme and we saw that the member of staff had attended training in infection control, health and safety, safeguarding and dementia awareness. Currently there is no induction similar training programme for registered nurses as we found that one of the most recently recruited nurses had not attended moving and handling and safeguarding training since working at the home. We were unable to speak with this member of staff, to assess their level of knowledge about these two essential areas of knowledge and understanding, as they were not on duty at the time we were at the home. Following our last inspection we made a requirement that said Ensure that all care staff attend training in pressure care and to assess their competencies in carrying out such care practices. The timescale for this requirement to be met was to be by 30th September 2009. We were informed, by the provider, before this KI of January 2010, that this training had been attended. Although we did not formally assess this standard of training we found that, as the pressure area care and treatment of a persons pressure sore, was appropriate and that this sore had healed (see under Standard 8 of this report), this requirement has been met. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there has been some improvement in the management of the home people can not be fully confident that the home is a totally safe place to live. Evidence: The home has had an unsettled twelve months with a change of a number of managers. One of the residents surveys said that the home had had Five home managers in four years! Within the last twelve months, between December 2008 and December 2009, there have been six changes within the management structure of the home. During the same period there have been a minimum of two changes of operations managers, employed by the registered provider and responsible for Astoria Park. Such changes have posed risks to the continuity of care; risks to the overall standard of consistent management of the home and risks to the morale of the staff. We had found evidence, during the inspections of 2009, that the standard of care and standard of management of Astoria Park provided poor outcomes for the people living at the home. Although the management changes, took place throughout this period, Care Homes for Older People Page 28 of 34 Evidence: we had found that the overall star rating remained the same i.e. 0 star-poor. We have also noted, in this inspection report, other areas of concern, such as safeguarding (Standard 18) and failure to access medical attention for one of the residents following a safeguarding incident (Standard 8). In November 2009 we received a letter, from the registered provider, Southern Cross, telling us that there had been a change of Manager. This letter informed us that the current Manager was appointed to permanently work at the home, and, according to the AQAA, she has the Registered Managers Award. The current Statement of Purpose notes that she is a registered nurse and has post registration qualifications, in health studies and is a trainer and assessor for clinical care. The staff told us that they felt supported by the current Manager and said that For the first time we have the right person for the right job. The staff considered the Manager had the knowledge and skills and leadership style to improve the standard of care and standard of service provided at Astoria Park. She first started working at the home on 11th November 2009: because of the recency of her appointment and some of the areas of concern we have identified at this KI of 21st January 2010, that should have been noted by the home (such as environment; medication; care plans; staff recruitment and staff induction training for nurses) we have assessed this Standard 31 to be adequate. Since 31st December 2008 the local authority has ceased placements to the home, due to the concerns about the health, welfare and safety of the residents. As a result of this action the home has had a reduced occupancy of residents, which has resulted in a (possible) risk to the financial viability of the service. The Manager said that, although the home has not made any financial gains, there have been no budgetary restrictions imposed by Southern Cross. We were able to see evidence to support what the Manager said to us, to include, for example, the refurbishment of the home; the choice and quality of the food provided and the staffing numbers, which are supplemented by agency staff, one of whom was working at the time we were inspecting the service. Although we have received action plans (as noted under Standard 7 of this report) as part of the homes quality assurance and that there were visits made, and reports made of these visits, during December 2009 and January 2010 (as also noted under Standard 7 of this inspection report) we have found areas of the home where improvement has not been sustained, to include medication practices and the environment. In addition we expected the homes quality assurance to improve the Care Homes for Older People Page 29 of 34 Evidence: standard of care plans and this improvement was not seen within the care plans that we examined. Although there has been some improvement in the standard of care provided we are not fully confident that the existing quality assurance systems are robust enough to protect people from any risks. It is reported, under Standard 3 of this inspection report, that the home has had no new admissions to the home, during 2009 and thereafter: the home is registered for 59 places and is currently providing care for twenty-three residents, eight of whom have nursing needs. Given that the home is currently operating with less than 50 occupancy, Southern Cross needs to ensure that, should there be any new admissions to the home, this change in the increase in work, does not allow the existing adequate standard of care become, again, that of a poor standard. Unless the quality assurance of the home improves we are not confident that Southern Cross can provide a guarantee that improvements will be made and these improvements will be sustained, by the internal management systems of the home. The homes administrator was not available and, as a result, we were unable to assess how the home safeguards any personal monies that people have allowed the home to take care of. We have therefore not been able to assess this key Standard, Standard 35. According to the AQAA five of the catering staff and fourteen of the care staff have attended training in safe food handling and thirty members of staff have attended training in the prevention and control of infection. People should live in a safe place as, according to the AQAA, service checks are in date for portable (electrical) appliance equipment, fire detection and fire fighting equipment, emergency lights and hoists. We saw records for these and we found these to be satisfactory. People are not completely safe in the event of a fire breaking out. During our tour of the premises we saw that a door to room 10 was not fully closing unless pushed and therefore would not close when the fire alarm was activated. In 2009 the Fire Safety Officer noted that a fire evacuation point, via the internal courtyard, was unsafe as there was no clear exit away from the courtyard. A bolt was placed on the gate to ensure the safety of the premises but to allow this gate to be opened for evacuation purposes in the event of a fire. We were unable to move this bolt, to open the gate, and we informed the Manager about this. Care Homes for Older People Page 30 of 34 Evidence: Following on from this we noted that a fire exit, leading off from the main dining area, posed a hazard to the safety of any person using the ramp from the dining area to the outside evacuation point: the ramp had moss/lichens growing on it and the fabric of the ramp was showing signs of breaking up and had become uneven. The ramp led on to a pathway, but use of this would not be fully free from risk of harm as the pathway was littered with wet leaves. We pointed this out to the Manager to take action to ensure that people are safe in the event of evacuating the building. From the fire records we noted that a fire door, fire door number five, was not closing properly: a requisition was made for this to be replaced, by the home. The records indicated that Southern Cross agreed for the replacement of this fire door fifteen weeks after the initial requisition was made: this is an unacceptable length of time for action to be taken to ensure that the risk of the spread of fire was reduced. Some, but not all of the staff, have attended fire safety training as confirmed by the examination of the staff training records and discussion with the Manager. Fire drills were recorded as having taken place, during December 2009 and the names of the staff attending these fire safety training exercises were recorded in full. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be up to date and accurate. This is so that the staff have clear and accurate guidance in how to meet peoples needs, including changing needs. 31/03/2010 2 9 13 Records made when 15/02/2010 medicines are given to people must be accurate and complete. This will demonstrate that people receive their medicines as prescribed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 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. 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. 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