Care Home: Attwoods Residential Care Home

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What the care home does well People`s care needs are assessed prior to their admission to ensure that they can be met by the home. Care plans, assessments and risk assessments are updated each month so that care records are kept up to date. Visitors are made welcome at the home and daily routines are flexible. People`s health care needs are met and any equipment needed to promote good health are provided by the home. Most care staff have undertaken National Vocational Qualification (NVQ) Level 2 in Care and cooks have taken NVQ in Food Preparation. Meals at the home are good and there is a choice at each meal time. There is a record of all meals provided at the home. The home is generally well maintained and furniture and fittings are comfortable and homely. Monies held on behalf of people living at the home are audited to ensure that they are accurate. What has improved since the last inspection? The medication policy has been updated but this was not at the home on the day of the site visit, so was not available for staff. There is a training and development plan in place and this records the date that people need refresher training on each topic. Staff have now had training on safeguarding adults from abuse. The manager now sends out reference requests to people named on application forms to ensure that they are authentic. Policies and procedures at the home have been updated. What the care home could do better: Care plans must be formally reviewed each year to ensure that they reflect individual needs and that they are agreed by all parties concerned. Care plans should include specific information about a person`s need for support when receiving assistance with personal care tasks. More care should be taken to accurately record information on medication administration records. People who self-medicate must have a risk assessment in place to evidence that they are safe to do so. Time spent with people by key workers or when undertaking activities should reflect their hobbies and interests as recorded in their care plan. The home continues to have unpleasant odours and these should be alleviated. A risk of cross infection is posed by the facilities in the laundry room and staff toilet, and by care staff undertaking domestic duties at the home. Staff must have training on core topics such as food hygiene, infection control and fire safety on a regular basis. Refresher training is due on the administration of medication. The quality assurance system should be fully operational so that people are consulted about the service they receive and have the opportunity to affect the way in which the home is operated. Consideration should be given to the layout of the home to promote privacy and dignity for the people who live there. Information about advocacy services should be freely available so that people can access it without having to ask, promoting their privacy and independence. People living at the home must have access to their money at all times. The registered persons need to become more proactive rather than just reacting to requirements made by regulators, so that continual improvement can be demonstrated. There must be sufficient time spent on managing the home to ensure that policies, procedures and practices are adhered to. The registered manager must attend a training course specifically for managers on safeguarding adults from abuse. Key inspection report Care homes for older people Name: Address: Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ     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: Diane Wilkinson     Date: 2 8 0 5 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 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Attwoods Residential Care Home 46 Northgate Cottingham East Yorkshire HU16 4EZ 01482841133 01482876110 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ateeq Rehman Name of registered manager (if applicable) Miss Rebecca Dawn Dixon Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Attwood Residential Care Home is registered to provide care and accommodation for nineteen older people, including those with dementia related conditions. The home is situated in Cottingham, in the East Riding of Yorkshire, and is within easy reach of the village centre and local amenities, including public transport routes. The home is a large detached house and accommodation is provided over two floors. Three bedrooms are on the ground floor and all other bedrooms are located on the first floor - these can be accessed by using the stairs or the stair lift. There are six shared bedrooms, some of which are used as single rooms, and seven single bedrooms. There are two lounges and a dining room on the ground floor, and the kitchen is located Care Homes for Older People Page 4 of 36 Over 65 19 19 0 0 Brief description of the care home directly off the dining room. A paved courtyard is situated to the rear of the building and this is easily accessible for all service users, including wheelchair users. Car parking is available to the front of the home on the main road. Care Homes for Older People Page 5 of 36 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: This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on the 25th November 2009, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 9.45 am and ended at 3.35 pm. On the day of the site visit the inspector spoke on a one to one basis with the registered manager and members of staff. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. We did not ask the registered persons to complete an Annual Quality Assurance Assessment (AQAA) form on this occasion as one had been completed in October 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. In addition to this, no surveys were sent out to people living at the home or staff. Care Homes for Older People Page 6 of 36 At the end of this site visit, feedback was given to the manager on our findings, including requirements and recommendations that would be made in the key inspection report. However, feedback was not comprehensive as some documents were missing and we agreed that they would be forwarded to the inspector after the day of the site visit. The manager told us that the current weekly fee for residential care is from £318.00 to £360.00 per week. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be formally reviewed each year to ensure that they reflect individual needs and that they are agreed by all parties concerned. Care plans should include specific information about a persons need for support when receiving assistance with personal care tasks. More care should be taken to accurately record information on medication administration records. People who self-medicate must have a risk assessment in place to evidence that they Care Homes for Older People Page 8 of 36 are safe to do so. Time spent with people by key workers or when undertaking activities should reflect their hobbies and interests as recorded in their care plan. The home continues to have unpleasant odours and these should be alleviated. A risk of cross infection is posed by the facilities in the laundry room and staff toilet, and by care staff undertaking domestic duties at the home. Staff must have training on core topics such as food hygiene, infection control and fire safety on a regular basis. Refresher training is due on the administration of medication. The quality assurance system should be fully operational so that people are consulted about the service they receive and have the opportunity to affect the way in which the home is operated. Consideration should be given to the layout of the home to promote privacy and dignity for the people who live there. Information about advocacy services should be freely available so that people can access it without having to ask, promoting their privacy and independence. People living at the home must have access to their money at all times. The registered persons need to become more proactive rather than just reacting to requirements made by regulators, so that continual improvement can be demonstrated. There must be sufficient time spent on managing the home to ensure that policies, procedures and practices are adhered to. The registered manager must attend a training course specifically for managers on safeguarding adults from abuse. 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 36 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 36 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. We looked at outcomes for Standard 3. Standard 6 was not assessed as there is no intermediate care provision at the home. People have their care needs assessed prior to their admission to the home to determine whether the home is able to meet their individual needs. Evidence: One person has been admitted to the home since the last key inspection. We checked their care records and noted that a care needs assessment was undertaken prior to their admission to the home. This assessment information was brief but it did include essential information such as their medical history, any allergies, dietary requirements and current medication prescribed. There is evidence that staff at the home used this information to reach a decision about the persons suitability to be admitted to Attwoods, including whether their individual needs could be met by staff. Care Homes for Older People Page 11 of 36 Evidence: We saw in other peoples records that a community care assessment and care plan had been obtained from care management when the placement was being funded by Social Services. All of the information gathered prior to a persons admission to the home is used to develop an individual plan of care. Care plans include assessments for mental health, physical health, pressure care, behaviour, nutritional screening and falls, as well as general needs assessments and personal risk assessments. Care Homes for Older People Page 12 of 36 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. We looked at outcomes for Standards 7, 8, 9 and10 Care plans are a good record of a persons assessed needs but more care should be taken to ensure that they are effective in informing staff about a persons individual needs. Medication practices at the home need further improvement to fully protect people from the risk of harm, including the need for staff to have refresher training. Evidence: We examined three care plans in total and we noted that some care plans have now been signed by people to record their agreement and/or involvement in its development. Two of the care plans that we examined included a photograph of the person concerned but one did not - this was someone who was admitted to the home in January so there had been sufficient time for a photograph to be taken and attached to their records. A photograph is needed to assist staff with identification and to help the emergency services should someone go missing from the home. Each care plan included information about the persons family history, social and Care Homes for Older People Page 13 of 36 Evidence: leisure interests and current medication details. In addition to this, each area of the care plan includes an assessment, i.e. moving and handling, physical health, mental health, behaviour, pressure care, nutrition and falls. Where appropriate, risk assessments are included within the relevant section, such as the Malnutrition Universal Screening Tool (MUST) and a falls risk assessment. Risk levels are scored numerically and each section is updated on a monthly basis. We noted that care plans are usually updated to reflect recent events, for example, falls and hospital admissions although we did see that one visit by an Emergency Care Practitioner had not been recorded in the persons professional visitors record. Other visits from health care professionals and appointments/admissions to hospital had been recorded thoroughly. We saw that recording on monitoring forms in care plans had improved since the last key inspection, although we did see one example where a bowel chart only contained one entry. Although care plans do include information about a persons individual care needs, more information needs to be recorded about the specific support that people need when being assisted with personal care. For example, their need for help with getting in/out of the bath, whether they like to be left in the bathroom alone or accompanied, their ability to wash and dry themselves, their wish for bubble bath in the water etc. Assessments, risk assessments and care plans are updated on a monthly basis but there was no evidence that formal annual reviews of care plans had taken place, either by the local authority or by the home. Annual reviews are needed to ensure that service users and anyone involved in their care agree that care plans are still appropriate for their needs and to ensure that staff are working with up to date information. Following completion of risk assessments, we noted that pressure care equipment had been obtained to assist people with tissue viability, such as pressure care cushions and mattresses. Some people have been provided with bed rails to prevent them from falling out of bed; the manager assured us that guidance provided by the Medicines and Health Care Regulatory Agency (MHRA) on the safe use of bed rails is followed. We saw evidence that weekly safety checks on bed rails take place. We observed the administration of medication on the day of this site visit and found it to be satisfactory. The staff member responsible for this task wore disposable gloves to promote good hygiene and only signed medication administration record (MAR) charts when they had seen people take their medication. They ensured that people had a drink of water so that they could swallow their medication properly. Care Homes for Older People Page 14 of 36 Evidence: We checked the arrangements in place for the storage of medication and medication administration records. We noted that there were no gaps in recording on medication administration record (MAR) charts but we did see that one handwritten entry had only been signed by one member of staff. Two staff should always sign any handwritten entries on MAR charts to reduce the risk of errors occurring. Each MAR chart incudes a photograph of the person concerned plus information about allergies, medication prescribed and the persons GP. We did note that, in some instances, the list of medication prescribed in these records did not match the list of medication recorded in a persons care plan; this should be rectified. One persons MAR chart records that they self medicate. However, we noted that there is no risk assessment in place to support this. The manager told us that she would forward a copy of this risk assessment to us but it has not been received. At their last visit, the Primary Care Trust (PCT) pharmacy technician recommended that internal and external products should be stored separately and we noted that this has not been actioned. Other advice given by the pharmacy technician had been followed, i.e. medication is now being stored in the fridge in a safe way, fridge temperatures are being checked and recorded each day, there is an audit trail for ordering and receiving prescriptions, excess stock has been reduced and the controlled drugs cabinet is only being used to store controlled drugs. We checked the storage and records for controlled drugs at this site visit and found them to be satisfactory. We were not able to see the updated medication policy on the day of the site visit; the registered manager told us that she had it on her laptop at home and she sent it to us after the day of the key inspection. This policy should be in the home at all times so that staff have up to date policies and procedures to follow. We examined the updated policy and noted that it now contains the information recommended by the pharmacy technician. Some areas need to be expanded further; the pharmacy technician is returning to the home in July 2010 and will send us a copy of the updated report. There are sample signatures in the MAR book for staff who have undertaken medication training to enable records to be checked for authenticity. One person whose name is recorded has not had medication training; the manager told us that this person does not administer medication and that her name is recorded as she is sometimes the second signatory. Another staff member had not undertaken medication training and the manager told us that this person has no responsiblity for the administration of medication. Care Homes for Older People Page 15 of 36 Evidence: We were concerned that training records held at the home evidenced that all staff were due to have refresher training on the administration of medication in January 2010 and that there are no plans for this training to take place imminently. This could result in staff not being fully conversant with the latest good practice guidelines and could leave people living at the home at risk of harm. We noted that all bedroom doors had a sign stating knock and wait and that curtains are provided in shared rooms; there is currently only one shared room in use. All residents now sit together in the large lounge so the small lounge is available for people to have private meetings with visitors or health care professionals. We noted that two bedrooms are located directly off the large lounge; people accommodated in these rooms have to go through the lounge to get to the toilet or bathroom and this could compromise their privacy and dignity. However, the manager told us that, after looking around the home, a relative specifically requested one of these rooms as they liked the idea that the room was on the same level as communal accommodation, creating easier access. Care Homes for Older People Page 16 of 36 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. We looked at outcomes for Standards 12, 13, 14 and 15. Visitors are made welcome at the home and meal provision is good. People living at the home take part in a variety of activities but these are not always the ones recorded in their individual plan of care. Evidence: Care plans record a persons family history, social and leisure interests and hobbies. We noted that daily diary sheets in care plans record any activities undertaken and details of any visitors seen or contact with family and friends ( although these entries only seem to be made once a week and the manager could not explain the reason for this). The manager told us that the activities coordinator is currently absent from work due to sickness but staff told us that, because there are only a small number of people living at the home, they are able to organise activities on a daily basis; we saw that an activity took place on the day of the site visit. We saw that one persons care plan recorded that they would enjoy going out for a walk but that this was never recorded Care Homes for Older People Page 17 of 36 Evidence: as an activity. We saw that people are able to spend the day where they choose, to take their meals where they choose and to have visitors at any time of the day. The manager told us that they have some information about advocacy services but there is none displayed within the home. Advocacy services are available to assist people with decision making and this information should be displayed in the home so that people are able to access these services independently. Care plans now include a nutritional risk assessment and a weight chart to assist with nutritional screening. The manager told us that she is in the process of developing a standard three week menu, although only one week has been recorded so far. Standard menus help to evidence that meals provided at the home have been designed to meet residents nutritional needs. However, we did see that the cooks keep a record of all meals provided at the home and this record evidenced that ample fresh vegetables are included in daily menus. On the day of the site visit the cook was preparing home made quiches and cakes for tea. There is a daily menu displayed in the home and the cook told us that she also tells people what the meals are that day. We saw that a choice of main meal is recorded. We saw that six people had their lunch in the dining room and one person had their lunch in the lounge; this person did not require any assistance with eating and drinking. People sitting in the lounge were assisted appropriately by staff and we noted that lunch was unhurried and promoted as a social occasion. The manager told us that the three cooks at the home have either a National Vocational Qualification (NVQ) or City and Guilds qualification in food preparation; this is good practice. Care Homes for Older People Page 18 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 16 and 18. People are made aware of the process to follow should they wish to make a complaint and are protected from the risk of harm by staff undertaking appropriate training. Evidence: The complaints procedure is displayed in the home so that people living there and their relatives and friends are made aware of the process they should follow should they have reason to complain. There is a complaints book in place at the home; this is used to record minor complaints, grumbles and compliments. There needs to be a complaints log in place that records the date, details of the complaint, details of the investigation, the outcome and any action taken and the signature of the person who has dealt with the complaint. This is needed to provide a formal record of any complaints made to the home and how they have been dealt with. However, there had been no formal complaints made to the home or to the Care Quality Commission since the date of the last key inspection. Staff training records evidenced that ten members of staff have undertaken training on safeguarding adults from abuse, including the registered manager. However, the registered manager has not undertaken managers awareness training and this must Care Homes for Older People Page 19 of 36 Evidence: be organised as soon as possible. There have been no safeguarding alerts made by the home or other people since the last key inspection. Care Homes for Older People Page 20 of 36 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. We looked at outcomes for Standards 19 and 26. The premises are decorated in a homely and comfortable way but more consideration should be given to infection control; the home is not free from unpleasant odours. Evidence: There is a maintenance programme in place and on the day of the site visit we saw that the home was generally well maintained. There is evidence that the premises comply with the requirements of the local fire service and environmental health department. The premises are accessible and the accommodation is comfortable and decorated in a homely way. The main lounge provides people with access to sunlight and the manager told us that people are encouraged to sit outside when the weather is good. We toured the premises and noted that there were unpleasant odours in the entrance hall and in two bedrooms. A requirement was made at the last key inspection that there must be no unpleasant odours in the home and no improvement has been made; this must now be actioned. The laundry facilities are adequate but the washing machine has no sluice facility and Care Homes for Older People Page 21 of 36 Evidence: there is only one sink for staff to use to hand wash laundry and to wash their hands. We saw that there is now hand disinfecting fluid in place in the laundry room but there were no paper towels. We also saw that soap and a hand towel were being used in the staff toilet rather than disinfecting hand wash and paper towels - these practices increase the risk of cross infection. Four staff have now undertaken training on infection control but six staff still need to undertake this training; this must be considered as mandatory training for all staff. Care Homes for Older People Page 22 of 36 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. We looked at outcomes for Standards 27, 28, 29 and 30. There are usually sufficient staff on duty to meet the needs of the people living at the home. There is a high level of achievement in National Vocational Qualification training but some core training must be undertaken to evidence that all staff have the skills and knowledge needed to enable them to support the people living at the home. Evidence: We noted that there was no staff rota in place for the week of the site visit. The manager told us that they use a standard rota and any alterations to this are recorded and displayed on the fridge door. There must be a staff rota in place each week to ensure that all staff are clear about the hours they are expected to work and to evidence that there are always enough staff on duty to meet the assessed needs of the people living at the home. The staff rota records that there are two care staff on duty at all times and that there is a cook on duty each day. There are currently no domestic staff employed at the home; day care and night care staff undertake domestic duties. Care staff undertaking domestic duties increases the risk of cross infection so extra care should be taken to promote good hygiene practices. Care Homes for Older People Page 23 of 36 Evidence: On the day of the site visit we observed that staff start to assist people into the dining room about 20 to 30 minutes before lunch is due to be served. Staff then continue to assist other people to get ready for lunch. We were concerned that this leaves some people in the dining room unsupervised during this period. The registered persons should reconsider staffing levels at this time of day to ensure that there are sufficient staff on duty to provide the level of supervision needed by individuals living at the home. Nine care staff have achieved National Vocational Qualification (NVQ) Level 2 in Care and two staff have also achieved NVQ Level 3 in Care. In addition to this, cooks working at the home have achieved NVQ Level 2 in Food Preparation. Although this achievement is acknowledged, staff also need to undertake core training programmes to ensure that they are aware of good practice guidelines and that their practice is up to date. No new staff have been employed since the last key inspection but the manager told us that they are in the process of recruiting a new carer. We saw the application forms for two prospective employees and noted that these recorded the persons education and training, their employment history, a criminal conviction declaration and the names of two referees. The manager had sent letters to the referees and responses had been received. Because there have been no new staff starting work at the home, it was not possible to check if dates had been recorded so that there was an audit trail of a persons start date, induction training, shadowing shifts or supervision arrangements whilst waiting for their Criminal Records Bureau (CRB) check to arrive. This will be checked at the next key inspection. The manager told us that she has accessed the website for Skills for Care and has downloaded information about their induction training pack. She intends to use this training for all future employees. We looked at some individual staff training records and also the training and development plan in place at the home. This evidences that all staff have undertaken training on moving and handling, first aid, medication and safeguarding adults from abuse. No staff have undertaken training on food hygiene, six staff have not undertaken training on infection control and five staff have not done recent training on fire safety. These topics must be considered as core training and should have been undertaken by all staff; arrangements must be made as soon as possible for staff to undertake these core training courses. Some people have attended other training courses in addition to core training, such as Care Homes for Older People Page 24 of 36 Evidence: equality and diversity, challenging behaviour and sensory deprivation. The training plan identifies the date that people are due to have refresher training; this is good practice. Care Homes for Older People Page 25 of 36 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. We looked at outcomes for Standards 31, 33, 35 and 38. The registered persons must become more pro-active in their management of the home, including the monitoring of medication systems, the control of infection and the provision of staff training. There are systems designed to protect the health, welfare and safety of people living at the home and others, but more care should be taken to evidence that equipment and services are safe. Quality assurance systems are not fully operational so people are not able to express their views or to affect the way in which the home is operated, and people are disadvantaged by not having access to their money at all times. Evidence: The manager has achieved NVQ Levels 2, 3 and 4 in Care - she told us that she is not currently working towards the management or leadership award. Due to low occupancy levels, the manager is working 1 day per week as manager and she is working the remaining hours covering the staff rota (although she is still paid as Care Homes for Older People Page 26 of 36 Evidence: manager for 28 hours per week). We were concerned that this reduced level of management hours would have an adverse effect on the safe operation of the home and the manager acknowledged that tasks such as staff supervison and quality assurance are given little priority. There is also a deputy manager working at the home but the manager was not sure how many hours a week this person worked on management tasks. This home is failing to improve; at each inspection we see areas of improvement but other areas that have deteriorated. The registered persons must become pro-active rather than just reacting to issues raised in inspection reports produced following inspections undertaken by the Care Quality Commission or monitoring visits from local authority Social Services staff. The home continues to have unpleasant odours and staff training does not take place on all core health and safety topics. We looked briefly at quality assurance systems in the home. Surveys were sent out to people prior to the last key inspection but this information has not been collated. The most recent staff meeting was in October 2009 and another has been booked for the beginning of June 2010. The last residents meeting was held July 2009 and these have now been replaced by a 1:1 chat with the manager. Improvements should be made to the quality assurance systems so that people are given the opportunity to express their views and to affect the way in which the home is operated. There should also be an annual development plan in place that is based on quality audits and feedback from people living at the home and other stakeholders. All policies were reviewed in September 2009 but not all are made available to staff, for example, the medication policy was not available at the home on the day of the site visit. We checked a sample of monies held on behalf of people living at the home and the associated financial records. These were found to be accurate and we noted that two members of staff audit these accounts - they were last audited in October 2009. The manager told us that only herself and the administrator have a key to the safe so only they are able to access service user monies. We advised the manager that there must be some system in place to allow people to have access to their money when the manager is not at the home. The manager said that she does leave money out for the hairdresser and chiropodist as she knows when those appointments are due. One person has chosen to manage their own financial affairs. A sample of health and safety documentation was checked. There was an annual test of the fire alarm system in September 2009 and weekly in-house tests take place, although the test for the week of the key inspection was overdue. Records evidenced that there had been no fire drill since August 2008 but the manager sent us evidence Care Homes for Older People Page 27 of 36 Evidence: of more recent fire drills after the day of the site visit. There is a portable appliance test certificate in place, and stair lifts, mobility hoists and bath hoists have been serviced. The electrical installation was last examined in August 2007 and the test is valid for 5 years. There is no current gas safety certificate in place; the manager assured us that equipment had been serviced but the certificate had not yet been received by the home. She agreed to forward a copy to us after the day of the site visit but one has not been received. Service certificates must be obtained as evidence that systems and equipment at the home are safe. We saw no evidence of a test for Legionella in the water system since February 2007. There are areas of the home where the water system is not used on a regular basis and this creates a level of risk; the registered person must ensure that a further test is carried out. We checked the systems in place for recording accidents at the home and found these to be satisfactory. Care Homes for Older People Page 28 of 36 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 29 of 36 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 9 13 It is right that people should 30/07/2010 be supported to manage their own medication but this must be accompanied by a risk assessment. This is to evidence that the risks associated with this have been assessed and that the person is considered safe to self medicate. 2 9 13 Any handwritten entries made on MAR charts must be signed by two members of staff. This is to reduce the risk of errors being made and to ensure that people receive the medication that has been prescribed to them. 30/07/2010 3 9 13 There must be evidence that 30/07/2010 staff receive on-going training on the administration of medication. Page 30 of 36 Care Homes for Older People 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 This is to ensure that staff are aware of up to date guidance on this topic, and to ensure that people living at the home are not put at risk of harm. 4 18 13 The manager must undertake managers awareness training on safeguarding adults from abuse. The manager has overall responsibility for ensuring that staff understand and follow good practice guidelines on safeguarding adults from abuse. 5 26 13 Infection control must be considered as mandatory training for all staff working at the home. This is to ensure that all staff are aware of and are following good practice guidelines. 6 27 18 There must be a clear staff rota in place each week to ensure that staff know what hours they are expected to work and to record the actual number of staff on duty, including their specific role. 16/07/2010 30/07/2010 31/08/2010 Care Homes for Older People Page 31 of 36 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 This is needed to evidence that there are sufficient staff on duty to meet the assessed needs of people living at the home. 7 30 18 Staff must undertake training that equips them with the skills and knowlege they need to carry out their role effectively. People living at the home must be supported by staff who have the skills, experience and knowledge to meet their assessed needs. 8 31 12 The registered persons must 31/08/2010 become more pro-active in their management of the home rather than reacting to requirements made in CQC inspection reports or by the local authority. Evidence of continual improvement is needed to ensure that people always receive the best possible care. 9 35 16 People must have access to money held on their behalf by the home at all times. 30/07/2010 31/08/2010 Care Homes for Older People Page 32 of 36 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 People must be able to access their own money at all times, to promote their independence and choice. 10 38 13 A test to detect the presence 30/07/2010 of Legionella in the water system must be arranged. This is needed to reduce the level of risk to people living and working at the home. 11 38 23 The registered person must 16/07/2010 ensure that the home is safe, for example, that there is a current gas safety certificate in place. This can be evidenced by there being a copy of a current gas safety certificate on site. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 7 The medication policy in place at the home should be available for staff to follow at all times. Care plans should include a photograph of the person concerned to assist staff with identification and to help the emergency services should someone go missing from the home. Care plans should include more specific information about the support needed by people when being assisted with personal care tasks. This was a recommendation at the last 3 7 Care Homes for Older People Page 33 of 36 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 key inspection. 4 5 9 10 External and internal medication products should be stored separately in the medication trolley. The registered person should reconsider the layout of the home; two bedrooms are located directly off the main lounge and this could compromise peoples privacy and dignity. This was a recommendation at the last key inspection. More effort should be made to ensure that peoples identified hobbies and interests are promoted by key workers and are included in the day to day activities arranged by staff. The registered person should make sure that there is information available to people about advocacy services that may support them in decision making. This was a recommendation at the last key inspection. A set menu would help to evidence that the meals provided at the home are nutritionally balanced. This was a recommendation at the last key inspection. There should be a complaints log in place that records the full details of the complaint made, the investigation and the outcome. Staff should be provided with disinfecting fluid and paper towels in the laundry room and toilet to promote good hand hygiene. The home should be free from unpleasant odours at all times. This was also a recommendation at the last key inspection. Extra care should be taken to reduce the risk of cross infection when care staff are also responsible for all domestic tasks. Staffing levels should be reconsidered, particularly over the lunch time period, to ensure that people receive sufficient supervision. There should be strategies in place to assist the manager to keep her own practice up to date and consideration should be given to how the low number of management hours in place affect the safe running of the home. 6 12 7 14 8 15 9 16 10 26 11 26 12 27 13 27 14 31 Care Homes for Older People Page 34 of 36 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 15 33 Improvements should be made to the quality assurance systems in place at the home, to include the development of an annual development plan. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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