Care Home: Blakesley House Nursing Home

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What the care home does well Prospective residents are fully assessed prior to admission to ensure that the home is appropriate for and able to meet their needs. Overall medications are being well managed. The home has an open visiting policy and visiting is encouraged. Feedback we received indicated that visitors are made welcome. The home has information available in respect of advocacy services. There is a complaints procedure and complaints received by the home had been investigated and recorded.Systems are in place for the management of residents monies. What has improved since the last inspection? The home has been working to address the shortfalls identified at the last key inspection. Falls risk assessments had been updated along with the service user plan. The Manager stated that consents for bedrails were now being obtained. Work had been undertaken to provide a comprehensive medications policy for the home. The controlled drugs register had been signed by two members of staff. Controlled drugs storage was complying with the Misuse of Drugs Act. Medications were being disposed of in line with European Waste Regulations. New chairs have been purchased for the residents as a result of immediate requirements being made at the last key inspection. The lounge area is now supervised by a member of staff. A senior nurse is on duty on each shift. Some improvements have been noted in ascertaining residents wishes in respect of health deterioration. Further work is required in this area. What the care home could do better: We identified several shortfalls at this inspection which have a direct impact on the outcomes residents experience. Service user care plan documentation is in place, and this needs to be developed to be person centered. No follow up action had been taken when it appeared that a resident had weight loss. Issues around residents dignity and staff interaction must be addressed promptly. Little progress had been made in developing and implementing an activity programme based on the needs, interest and preferences of the residents. Food provision at the home is satisfactory. Further work is needed in this area to ensure that residents mealtimes and food provision is meaningful and enhances the quality of life for residents. We were concerned that a safeguarding incident had not been reported correctly and that not all staff had received safeguarding training. Shortfalls in the environment and lack of equipment to assist residents with personal care and infection control must be addressed as a matter of priority. We set an immediate requirement around staffing at the home. Induction and foundation training does not meet the Skills for Care Common Induction Standards. The overall management of the home is adequate and quality assurance systems are not robust to identify and address shortfalls in all aspects of the running of the home. The information contained in the AQAA was, in some areas, very brief and did not give a clear picture of how each key standard is being addressed. We found that not all staff had undertaken moving and handling training and this must be addressed promptly to ensure the safety of the residents. Key inspection report Care homes for older people Name: Address: Blakesley House Nursing Home 7 Blakesley Avenue Ealing London W5 2DN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rekha Bhardwa     Date: 1 3 0 4 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 31 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 31 Information about the care home Name of care home: Address: Blakesley House Nursing Home 7 Blakesley Avenue Ealing London W5 2DN 02089912364 02089915256 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Margaret Nyambura Lane Name of registered manager (if applicable) Mrs Margaret Nyambura Lane Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category 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 Physical disability - Code PD (E) Date of last inspection Brief description of the care home Blakesley House is a care home for twenty-two older people. There are sixteen beds for older people who need nursing care and six beds for service users who require personal care. The Manager is also the owner of the home which is a four storey detached house located in a quiet residential area of Ealing. The home is close to Ealing Broadway, with its shopping centre, buses, and underground and main line Care Homes for Older People Page 4 of 31 Over 65 22 0 0 22 1 0 0 8 2 0 0 9 Brief description of the care home station. There are eleven shared bedrooms and five bathrooms within the home. The lounge, separate meeting room, kitchen and conservatory, which is also used as a dining area, are situated on the ground floor. There are no communal areas on the upper floors. The home has a passenger lift and it can be accessed from the lounge via steps or a portable ramp. Laundry facilities and a food store are within an outbuilding that is located in the rear garden. The fees are approximately £500 per week for personal care and £600 per week for nursing care. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out as part of the regulatory process. A total of 14 hours was spent on the inspection process, and was carried out by 1 Inspector plus an Expert by Experience. The Expert by Experience is a person who has experience of care services for older people. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and a visitor were spoken with as part of the inspection process. The Annual Quality Assurance Assessment (AQAA) document completed by the home has also been used to inform this report. We sent out a selection of surveys for residents and staff. Comments received within the surveys have been fedback to the Manager in general terms and have also been included in this report. A random inspection was carried out by the Pharmacist Inspector in August 2009, to follow up on concerns raised at the April 2009 key inspection. At the time of the inspection there were 16 residents and ten of them required nursing Care Homes for Older People Page 6 of 31 care. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 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 31 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 31 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. Residents are assessed prior to admission to the home, to ascertain that the home is able to meet their needs. Evidence: The home has a pre-admission assessment that is carried out for all routine admissions to the home. These were seen in some of the service user plan documentation viewed. The pre-admission assessment gave details of the residents needs. Copies of Social Services assessments were also available. Most of the permanent residents have been at the home for several years. More recent admissions to the home had been for respite care. Care Homes for Older People Page 11 of 31 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. Overall the service user plans were reasonably completed, however inconsistent information could lead to individuals personal and healthcare needs not being fully met. Medications are being well managed, thus safeguarding residents medication needs. Shortfalls should be easy to address. Shortfalls identified in relation to dignity and privacy could lead to residents needs, preferences and wishes not always being identified and respected. Information regarding end of life care wishes is available and progress is being made in this area to ensure that residents wishes are ascertained, recorded and respected. Evidence: Since the last inspection the home has introduced new care plan documentation in the form of a booklet.We viewed two of these at the inspection. The service user plan documentation contains an assessment which is completed monthly on the residents activities of daily living. From this assessment a care plan is developed for identified needs. We noted that the documents had been signed by the residents. We are not clear as to their actual involvement in the development of the plan. No life history information had been completed. Whilst both plans contained information on the Care Homes for Older People Page 12 of 31 Evidence: residents needs further work was required to ensure that they are person centered and detail the aspirations of the residents. For one resident the care plan detailed that the resident liked a weekly bath, in the record of bath and showers it stated that the resident liked to have a strip wash and refused to have a bath. Risk of falls assessments had been completed and these were being reviewed monthly. Moving and handling assessments, skin care assessments, continence and nutritional assessments had been completed and were being reviewed monthly. For one resident it appeared that there had been a significant weight loss one month. There was no evidence that this had bee questioned or the resident referred to the a GP or dietitian. When we asked the Deputy Manager he confirmed that the weight was accurate. When speaking with the Manager she stated that the resident had been weighed using new scales that had been purchased. We suggested that the resident was weighed again. We were informed that there were no wounds or PEG feeds at the time of the inspection. We were informed that the home has two GPs who visit as requested. The Deputy Manager confirmed that bedrail assessments and consents were available for those residents who required bedrails. Medication management was viewed.The home uses a Monitored Dosage System for medication management. Lists of staff initials were available.We recommended that the list be updated to include staff signatures. Appropriate single use lancing devices for blood glucose monitoring were in use. Administration records were complete. Receipts and records of disposal were available. Liquid medications had their date of opening recorded. Minimum and maximum temperatures of the medication fridge were being recorded. There were no actual temperature readings being recorded and the need to have this recorded was discussed with the Manager and the Deputy Manager.We noted that the fridge was dirty and required cleaning. The Manager stated that it would be cleaned by the end of the day. Entries in the controlled drugs register had been completed and stock balances checked at the time of the inspection were correct. Two signatures were available. Only controlled drugs were being stored in the controlled drugs cupboard. Since the last inspection the home maintains a running balance of medication on the Medication Administration Record. A weekly audit is also carried out by the Deputy Manager. We were also informed that Boots the pharmacy supplier also undertake 3 monthly inspections. Allergies had been recorded om the MAR. Each resident had a photograph.The deputy manager stated that staff at the home are undertaking Boots medication distance learning course. For one resident who was self -medicating a risk assessment was in place. Information leaflets for the medication in use were available. Staff were observed to treat residents with respect. Interaction in most cases was Care Homes for Older People Page 13 of 31 Evidence: minimal with limited conversation. The Manager stated that she was introducing the dignity challenge into the home. Some residents commented that on occasions that they had been dressed in other peoples clothes. On the first day of the inspection some care staff were putting make-up on some of the female residents. We were not clear as to whether their permission had been sought and whether the residents had agreed for this to take place in the lounge. On several of the bedroom doors residents names did not correspond with the actually resident in the bedroom. We received comment from a resident that the lounge was the saddest picture ever. The Manager informed us that she was still in the process of introducing the Gold Standards Framework for end of life care. The home is undertaking the final seminar for the Gold Standards Framework and were due to receive accreditation in 2011. The Manager informed us that the staff had also received training from a specialist palliative care nurse who was also a mentor in this area for all nursing homes in the area participating in the Gold Standards Framework. Both service user plans viewed contained some details on the residents wishes in the event of death. However the end of life care plan for both residents had not been completed. The AQAA states that staff working at the home have received end of life care training.It is acknowledged that this is a sensitive area of care, and if people do not wish to discuss it as yet then this can be recorded. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are not supported to live full and active lifestyles, this effects the outcomes that they receive. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available thus, ensuring the residents right to independent representation is respected. The food provision in the home is satisfactory, offering some choice, to meet residents residents needs. Further work is needed in this area to ensure that meals and food are seen as a meaningful part of the day. Evidence: We were informed that the care staff undertake activities with the residents. There is no specific member of staff responsible for activities. The home has on display a activity programme for the year. There is no weekly activity programme. There is some information on residents social interests in the service user care plan Care Homes for Older People Page 15 of 31 Evidence: documentation. Life history information in the two service user plans viewed had not been completed. The Expert by Experience observed that: Most residents knew there was an entertainer on Thursday mornings, this person comes in to play a keyboard and sing. However, the residents who chose to stay in their rooms all said they would not want to take part. When Expert by Experience asked if they would enjoy any other activities, comments ranged from the staff are too busy to take me downstairs to its too much trouble to leave my room. There did not appear to be any other form of entertainment provided although the Manager said that one resident sometimes plays the piano. One resident said that they would like to see a newspaper sometimes but never had one.This was fedback to the Manager. No activities take place outside of the home. One resident said that staff sometimes try Bingo but residents find accents/language difficult or couldnt hear, so its not worth it. A church service is held at the home once a month. No communal newspapers are available. No activities outside of the home take place. The home has an open visiting policy and visiting is encouraged. We spoke with a visitor who confirmed that they was happy with the care being received by their relative. We were informed they are sometimes short-staffed. Residents who are able exercise choice regarding their daily living routine, such as when they get up in the morning, go to bed and where to eat their meals. The Manager said that information on advocacy services is available. We viewed the kitchen. Most of the cupboards internally were dirty and grease marks were seen on the outer doors.The silver fridge was dirty. These had been cleaned by the next day. The majority of cupboards were empty and the Manager said that she was due to go shopping. We did not see any fresh fruit in the lounge area. We found some fresh fruit locked in the food store at the end of the garden. We were given copies of menus and some residents commented that they had a choice most days though one said its always the same thing. The menu indicated that fresh fruit was available daily. It is not clear from the comments received whether the food offered is the food as detailed on the menu. To lunchtime meal offered on the first day of the inspection was not on the menu for that day. The cook was also responsible for cleaning the home. Further comments on staffing have been made under Standard 27.The home had received a 4 star rating for the Scores on Doors Food Hygiene Scheme. Kitchen records viewed were up to date. Care Homes for Older People Page 16 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures for safeguarding people who use the service are in place but not up to date, not all staff have received training in safeguarding procedures, which could mean that individuals maybe put at risk of harm or neglect. Evidence: In the AQAA the home states that The home has a clear complaints procedure in place for the management of complaints and adult protection issues. These are rigorously adhered to thus safeguarding the service users in the home. The home has a complaints procedure. The surveys returned by residents living at the home confirmed that they or their representative knew how to make a complaint. The AQAA stated that the home had received 2 complaints since the last inspection. Both had been investigated and recorded. We were informed that the home follows the London Borough of Ealing Safeguarding Adults procedures. Most staff spoken with were aware of whistle blowing procedures. We viewed the training matrix provided by the Manager. This did not evidence that all staff had received training in safeguarding. The AQAA informed us that there had been no safeguarding investigations since the last inspection. However when we spoke with the Manager we were informed that there had been two safeguarding referrals made to the Ealing safeguarding team since the last inspection and that these had been investigated. We had been notified by the Deputy Manager under Regulation 37 that a Care Homes for Older People Page 17 of 31 Evidence: resident had received an injury. When we received the Regulation 37 notification we asked that the Ealing safeguarding team also be informed. The Deputy Manager stated that that the referral had been made. However when we followed this up with the safeguarding team it appeared that they had not been informed and that the home had used an incorrect fax number to send the information too. This is being followed through by the safeguarding team. We requested that the information be faxed to the Ealing safeguarding team, using the correct fax number. We discussed with the Manager the importance of having an up to date policy with the correct contact information within the policy. We also discussed issues of confidentiality of information. Care Homes for Older People Page 18 of 31 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. The home environment is satisfactory, shortfalls identified could place residents at risk. Policies and procedures for infection control are available, but shortfalls in providing essential equipment for infection control and residents personal care needs place residents at risk. Evidence: The home is a converted residential property . There is one passenger lift and a stair lift. The Manager stated that their is a programme of redecoration. We carried out a tour of the home. Some of the residents bedrooms had been personalised. There is a garden at the rear of the property which can be accessed by the residents through the lounge area. A requirement was made at the last inspection to remove the plastic covered armchairs and replace them with appropriate seating for the residents. This had been actioned by the Manager. We noted that in one bedroom the chest of drawers were broken along with the handles of the wardrobes. In bathroom 1 the shower attachment had come away from the wall. The drain area was dirty and there was pooled water in the drain. Several of the shortfalls identified on the tour had not been picked up in the environmental audit carried out by the Manager in January 2010. Care Homes for Older People Page 19 of 31 Evidence: The home has a laundry room that is located at the end of the garden. There is one washing machine and a tumble drier. We were informed that there is no designated laundry person and that the care staff also undertake laundry duties. We looked at a sample of clothing and those viewed had not been labelled. Residents had commented that they are sometimes dressed in other peoples clothes. Aprons and gloves were available, however we did not see any wipes for staff to use when undertaking personal care. When the Manager was asked about this she stated that the wipes were stored in the laundry room as none could be located in the bathroom and toilet areas. When we checked the laundry store room no wipes were available. We were also informed that toilet areas regularly run out of paper towels, soap and toilet paper. Staff are expected to use wet tissues when addressing residents incontinence needs. Care Homes for Older People Page 20 of 31 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. Shortfalls in staffing do not ensure that the residents needs are fully met. There is a risk that staff shortages may affect the quality of care they can provide for the residents living in the home. Systems for vetting and recruitment practices are in place and protect residents. There is a training programme, providing staff with the knowledge and skills to meet the needs of the residents. However shortfalls in induction training have been identified, and need to be addressed. Evidence: In the AQAA the Manager states Our staffing levels are appropriate to meet the assessed needs of our service users living in the home. Duty rotas are made on a weekly basis and are reviewed daily to ensure that staffing levels are adequate to meet the needs of our clients. The Manager informed us that there was one Nurse and three carers on duty on the first day of the inspection. When asked about domestic staff we were informed that the cook was also the domestic on duty. On the tour of the home we met a member of Care Homes for Older People Page 21 of 31 Evidence: care staff who the Manager said was the domestic, this person had also been rostered to work as a care staff. We examined the duty rota and found that one member of night staff stayed on duty for an extra hour to carry out cleaning duties. Residents told us that the domestics crash around for a few minutes, either early in the morning or late about 9:30 in the evening. Another said the room gets a daily mop and bed linen is changed once a week so its OK. The duty rota showed that one member of staff worked 8-2 and did 12 hours domestic work. This was the same person doing the cooking.The duty rota did not indicate who the cook was on the remaining days. When we asked the Manager she said that for Saturdays one member of night staff prepared the lunchtime meal. On a Sunday the Nurse on duty also prepared the Sunday lunch meal. Some residents informed us that they are sometimes short staffed.The duty rota was the same for each week with all the staff working a set shift pattern. We were concerned about the staffing and left an immediate requirement. Following the inspection we received a copy of the proposed duty rota. The rota indicated that from Tuesday to Saturday a member of night staff would work for one hour between 8am and 9am as a domestic. On a Monday and Sunday a domestic would be working between from 8am to 12pm. We asked for 4 weeks rota and we received a rota dated 19/4/10 to 17/5/10. It appeared that all the staff worked the same hours each week. A requirement was made at the last key inspection in relation to staffing. We were informed that 90 of the staff have completed their NVQ 2 or equivalent. We viewed two staff employment files. With the exception of one photograph both files contained the information required under the Care Home Regulations 2001. The home has an induction programme. This is not based on the Skills for Care Common Induction Standards. The Manager informed us that the staff undertake basic induction training which includes a tour of the home, fire procedures and emergencies. We were shown a training matrix for training that had been completed by staff. The information was not clear and there was evidence that some staff had not received training in moving and handling and and safeguarding adults. Requirements in relation to this training have been made under standards 18 and 38. Other training that has taken place is end of life care, medication and catheterisation. Staff spoken with said that they do have access to training. Care Homes for Older People Page 22 of 31 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. The home is not being effectively managed, and shortfalls identified at this inspection may place residents living at the home at risk. The systems for quality assurance are not robust enough, and have led to shortfalls not being identified and addressed. Residents monies are being managed and securely stored. Systems for the management of health and safety throughout the home are in place, however shortfalls with staff training in moving and handling identified could place residents, staff and visitors at risk. Evidence: The Manager of the home is also the Registered Provider. She is a first level nurse who has also completed her Registered Managers Award. The overall management of the home is adequate. We identified several shortfalls with the activity provision, some aspects of food provision, safeguarding adults, staffing, induction training, quality assurance monitoring and health and safety training. These shortfalls do not promote positive outcomes for the people living at the home. The AQAA completed by the Care Homes for Older People Page 23 of 31 Evidence: Manager gave us little information on how the home was meeting outcomes for people living at the home. It did not contain information regarding all the key standards and some information was very brief. We were informed at the inspection that annual surveys are carried out. The results of these surveys need to be collated and published. Staff meetings take place. Medication audits were being undertaken weekly. There was no evidence that care plans were being audited. Audits of the environment are carried out, however the last audit had not identified some of the shortfalls we found during the inspection. A robust system of audit and review must be implemented to ensure that residents have good outcomes in all aspects of their lives.The Manager needs to improve the current systems of quality monitoring to incorporate all aspects of the service. Quality monitoring must be undertaken on a regular basis. A robust system of quality monitoring would have identified shortfalls that we found at this inspection at an earlier stage in order to reduce the risks to people using the service. The home holds records of income and expenditure for residents for whom monies are held on their behalf. Receipts were available for all expenditure and the records were accurate and up to date. Samples of installation, servicing and maintenance records were viewed and those seen were up to date. A fire risk assessment was in place and the LFEPA had visited the home in 2008. Fire drills were being undertaken for both day and night staff and fire alarm checks are carried out weekly. Residents files also contained individual risk assessments. The training matrix viewed by us reflected that not all staff had received training and updates in some health & safety topics to include moving & handling within the required intervals. Care Homes for Older People Page 24 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 The Registered Person must make sure that a range of activities in which residents are able to take part are organised in the home and also within the community. This is to ensure that their social needs needs are being met. 30/06/2009 2 27 19 The Registered Person must 17/06/2009 make sure that suitably qualified, competent and experienced staff are at all times employed at the home. This is to ensure that the needs of residents are being met. Care Homes for Older People Page 25 of 31 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 1 27 18 The Manager must make sure that suitably qualified, competent and experienced staff are at all times employed at the home. To meet the needs of the residents safetly. 10/05/2010 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 The service user plan must be further developed to ensure that the residents choices, wishes and decisions are clearly recorded and met. To ensure that the residents individual needs have been identified, 18/05/2010 2 8 13 Residents weight loss must 18/05/2010 be monitored and input from the GP and Dietician must be sought. To ensure that residents healthcare needs are being met. Care Homes for Older People Page 26 of 31 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 3 9 13 The actual temperature of the fridge must be recorded on. So that medications are stored at safe temperatures. 18/05/2010 4 10 12 Staff must receive training in the areas of dignity and privacy. To ensure that residents receive better outcomes in these areas. 18/05/2010 5 11 12 Further progress must be made with obtaining information regarding residents wishes in the event of deterioration in their health, plus their care in their final days must be ascertained and recorded. To ensure that the residents wishes are respected. 31/05/2010 6 12 12 The range of social activities and opportunities must be further developed and recorded in the service user plan. To ensure that residents are supported to have a full and active lifestyle. 25/05/2010 Care Homes for Older People Page 27 of 31 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 7 15 12 The Manager must ensure that the food provision meets the needs and preferences of the residents in the home. To ensure that residents mealtimes are meaningful. 25/05/2010 8 18 13 All staff working at the home 18/05/2010 must receive training in safeguarding adults. Policies and procedures must be up to date. To ensure that residents are not put at risk of harm or neglect. 9 19 19 The Manager must ensure that the environment is well maintained and shortfalls identified are promptly addressed. To ensure that the environment is safe for the residents. 18/05/2010 10 26 6 Residents clothing must be labelled in order that the residents wear clothing that is there own. To maintain the residents dignity. 18/05/2010 Care Homes for Older People Page 28 of 31 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 11 26 19 The Manager must provide 18/05/2010 equiment required for residents personal care needs and for the prevention of infection. To protect the residents. 12 30 18 The home must have in place an induction programme that meets the Skills for Care Common Induction Standards. To ensure the best possible care is provided to the residents living at the home. The home must be effectively managed. To ensure that residents needs are fully met in all aspects of their daily lives. 31/05/2010 13 31 10 18/05/2010 14 33 24 The Annual Quality Assurance Assessment must be completed in accordance with the available guidance. In order to provide a comprehensive assessment of the home. 18/05/2010 15 33 24 There must be a more 31/05/2010 efficient and effective quality monitoring system in place for every aspect of the service. Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that all areas of the service are monitored and any shortfalls identified are addressed promptly. 16 38 18 All staff working in the home 31/05/2010 must receive training and updates in health & safety topics to include moving & handling at the required intervals. In order that the staff have the knowledge and skills to care for the residents effectively. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 We recommend that the staff signature list is updated to include initials and a signature. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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