Care Home: Christopher Grange (Rhona House)

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What the care home does well The home provides service users with a calm and pleasant environment. read. Care staff are caring and positive comments regarding them were received from service users and relatives. Health and safety issues are well managed to ensure that service users, staff and visitors to the home are protected. A choice of meals is offered to all service users and special diets are provided. A high number of training opportunities are provided for staff to increase their knowledge, understanding and skills. All necessary equipment is provided to give service users comfort and to assist with mobility. What has improved since the last inspection? The new format used for assessing prospective service users now provides an effective means of identifying care and social needs together with individual preferences. The updated brochure is informative and easy to read. The programme of redecoration and refurbishment has improved the environment for service users. What the care home could do better: Care plans require to contain full information regarding care needs, abilities and preferences to enable staff to provide the appropriate level of care and support in a way that suits the individual service users. Attention is required to the management and handling of medications to ensure that these are dealt with in accordance with the homes policy and procedure. An individual programme of activities should be prepared for each service user based on their abilities and preferences to provide stimulation and to promote social interaction. An effective management system is required to oversee the day to day running of the home, to supervise staff and ensure that care is provided appropriately. Key inspection report Care homes for older people Name: Address: Christopher Grange (Rhona House) Youens Way East Prescot Road Liverpool Merseyside L14 2EW     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: Jeanette Fielding     Date: 2 7 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 29 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 29 Information about the care home Name of care home: Address: Christopher Grange (Rhona House) Youens Way East Prescot Road Liverpool Merseyside L14 2EW 01512202525 01512201972 angelaprice@christophergrange.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Catholic Blind Institute Name of registered manager (if applicable) Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 sensory impairment Additional conditions: The home may accommodate five persons aged over 50 years for nursing care. The home may accommodate one named person aged over 50 years for nursing care. The home may accommodate one named person aged under 50 years for nursing care. Date of last inspection Brief description of the care home Rhona House is part of the main Christopher Grange Home, but is registered separately. Rhona House is currently registered to provide nursing care for elderly persons who have a sensory impairment. A total of 28 beds are available, with five of these being available for the care of terminal illness. The home forms part of the Christopher Grange Home that was purpose built for providing services to visually handicapped people and provides all facilities on the ground floor thereby providing full access to all areas. It is situated in Liverpool 14, close to local shops and amenities. Care Homes for Older People Page 4 of 29 Over 65 0 28 Brief description of the care home The home is set within a residential area, close to shops and major transport routes. The home is owned by the Catholic Blind Institute and has its own chapel in which a daily mass is held. However, residents are accepted from any faith and local ministers of other religions visit to provide pastoral support. Care Homes for Older People Page 5 of 29 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: The unannounced key inspection was undertaken in one day over a period of seven hours. As part of the inspection process, all areas of the home were viewed including some of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. the care files of four service users were case tracked to evaluate their care. Discussions took place with Lesley Colby the Responsible Individual, Andrea Madden the Registered Manager, nurses, care staff and service users. The Manager completed an annual Quality Assurance Assessment form to give additional information regarding the home. Questionnaires were sent to staff and service users to obtain their views about the home. Comments made in the response to the questionnaires are incorporated within this report. As a result of concerns identified during the initial visit, an inspection of medications was undertaken by a Pharmacist Inspector. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 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. Prospective service users are assessed before admission into the home to ensure that identified needs can be met. Evidence: All prospective service users are now fully assessed prior to their admission. The form used to record the information gathered at the time of the assessment has been reviewed and re-written and now ensures that all necessary information is gathered regarding the service users needs and also their preferences. The assessment form for one service user who had recently been admitted to the home was inspected. The form was clearly laid out and the person undertaking the assessment had recorded the nursing needs, personal care needs and had identified equipment necessary for moving and handling or pressure relief. Some details had been recorded regarding their past health and personal life and some preferences. The information provided sufficient detail to enable the initial plan of care to be produced. In the Annual Quality Assurance Assessment (AQAA) form, completed by the manager prior to the Care Homes for Older People Page 10 of 29 Evidence: inspection, the manager states that all necessary documentation for the completion of a care plan is available and ready for the service users admission to the home. No new service users were due to be admitted at the time of the visit and so it was not possible to verify this. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users care needs are not clearly identified so staff have no clear instruction about how to look after them properly. Evidence: The home provides long term nursing care for eighteen older people and palliative care for five people. A care file is prepared for each individual service user. A selection of care files were viewed. The care files lacked some of the information that staff need in order to meet service users needs and preferences. Little information is recorded with regard to personal care. Staff are not provided with details of bathing needs or if the service user prefers a bath or a shower, whether service users have teeth or dentures and how to provide care, or how their hair is to be cared for. Some service users are able to visit the hairdresser, who works in the home, but others are unable to do this due to their health or frailty. The care file for one service user states if the service user becomes very aggressive or annoyed, attempt to diffuse the situation. No risk assessment for aggression is in place and no details as to whether this is verbal or physical. No details are recorded as Care Homes for Older People Page 12 of 29 Evidence: to the triggers for the aggression or information on the action to be taken to diffuse the situation. One service user has diabetes but no plan is in place to inform staff of the frequency when blood sugars are to be taken or of how high or low blood sugars present and the action to be taken in these events. The file states that the site for the insulin injection should be rotated but no information is recorded regarding the site used for each injection. One service user requires to be fed by an enteral system but the information recorded in the care file is incorrect. The file states that 100mls is to be given overnight when in fact, the service user requires 1000mls. Medications for this service user are given via the feeding system but there is a lack of information regarding this. The file also states that barrier cream is to be applied to vulnerable areas but does not state what type of cream, the frequency of the application or the areas that are at risk. Nurses spoken to during the visit stated that, in the past, a dedicated file was maintained with regard to the dressings that service users required. They stated that the use of this folder had been discontinued which had resulted in them having to search a high number of care files to identify which service user required wound care during their shift. The wound care plans for service users lacked essential information such as the type of dressings to be used, the frequency of the change of dressings or up to date photographic evidence of the improvement or deterioration of wounds. The file for the service user who had recently been admitted to the home was viewed. The pre-admission assessment identified care needs and preferences but much of the information regarding lifestyle preferences had not been incorporated into the plan of care. Staff were therefore not able to meet the service users chosen lifestyle. The home provides aids and equipment necessary to meet service mobility needs but the care files lack risk assessments to identify when these aids are required. Staff spoken to during the visit confirmed that they had been given training in the use of equipment to ensure service users safety. Audits had been undertaken on three care files during the last few months. These audits indicated that all necessary information was in place, however, inspection of the care files showed that they contained a lack of information and discrepancies. The audits could not therefore, be deemed to be an accurate reflection of the documentation held on service users. On arrival at the home, it was observed that the medication room door was left Care Homes for Older People Page 13 of 29 Evidence: unlocked. This was raised with one of the nurses who explained that the number lock on the door was broken but had been reported. Discussion with the maintenance man confirmed that the broken lock had been reported to him a week previously and the necessary parts had been ordered. He also confirmed that he had advised the staff to use the alternative key lock to ensure security. This was raised with one of the nurses who said that there was only one key for the lock and this would present as a problem due to their being two nurses on duty who required access to the room. The matter was raised with the manager. The door was observed at regular intervals during the visit and was found to be locked for a period of ten minutes only during the seven hours of the visit. Nurses, carers and domestic staff were observed to enter the room during this time. The two medicine trolleys were locked and secured to the wall at all times when they were not in use. The cupboards in this room were locked but a set of keys for the cupboards were found in an unlocked drawer within the room. During the visit, it was observed that a contractor who was attending to another matter within the home opened the door to the room to look for a member of staff. He was observed to only open the door and to look inside. The matter regarding the security of the room was raised three times with one nurse, twice with the manager and once with two other nurses, but all failed to ensure that security was maintained. Two domestic staff were observed to leave the room with black plastic bags but it is not known what the contents of the bags were. The matter was raised with one nurse who said that it was probably just rubbish, but both bags were seen to contain very little and there are not two rubbish bins in the room. Requests were made to inspect the contents of the medicine trolleys and cupboards on six separate occasions but on each occasion, the nurses said that they were too busy attending to service users to deal with this. The home employs two qualified nurses during the day and the home can only accommodated twenty eight service users. The Medication Administration Record sheets (MARs) were inspected. Handwritten entries on the MARs did not always give the full information that is required or would be printed on the medication container. Some handwritten entries on the MARs were not written sufficiently clearly to prevent the risk of error. One entry for ear drops does not identify which ear in which the drops are to be applied. No information is recorded as to where creams are to be applied. No information is recorded as to which eye that one service users eye drops are to be applied. Nurses are signing to indicate that they have applied creams to service users which have in fact been applied by care staff. In view of the concerns raised at this visit, an inspection by a pharmacist inspector was undertaken subsequently and the findings are as follows. Care Homes for Older People Page 14 of 29 Evidence: We looked at medicines administration. Medicines are administered by qualified nurses except some barrier creams and moisturisers which are applied by care staff. People choosing to self-administer medication are supported to do so, although we were concerned to find a lack of individual information about how this was supported in practice. This needs to be addressed to help ensure people always receive any support they may need to manage their medicines safely. The home has a policy for the use of home remedies but current none are kept at the home. Consideration should be given to implementing this policy to enable people to receive prompt treatment for minor ailments, without a prescription. We looked at how information within peoples care plans supported medicines administration. We saw that written advice was sought from doctors where medicines needed to be crushed, for example when they are given through a PEG (feeding) tube, or because of swallowing difficulties. But, we were concerned that for someone with swallowing difficulties clear information about the support they needed when taking their medicine was not included in their care plan, or within their medication administration records. We spoke with the two nurses on duty and found inconsistency in the way this person was supported when taking their medicines. This needs to be addressed and any decisions kept under review, to help ensure medicines are administered in the safest and best way. We compared a sample of medicines records and stocks and found that although very recent records were better completed, we were not always able to account for (track) medicines handling at the home. On occasion we found that records showed that more doses had been given than actually received into the home. There were also occasional gaps in the record keeping which meant it was not possible to tell if the medication had been given. In one case it was evident that a bottle of medicine labeled for one person had been used for everyone prescribed the same medicine. To reduce the risk of errors prescribed medicines should only normally be administered from each persons own supply. Most medication administration record charts were pre-printed by the pharmacy but where handwritten charts were made by nursing staff these were not so well completed, on occasion these did not include the month and year of administration. Separate charts were in place for recording when creams were applied by care staff but although it was evident that creams were being used, these records were not kept up-to-date. This meant it was not possible to tell whether they were being used correctly, when needed. Additionally, we were concerned to find that expired, stopped or otherwise unwanted creams were not always promptly sent for safe disposal. Since our previous visit the main lock to the medicines room had been mended and the door was kept locked helping to ensure medicines security. Medicines keys were Care Homes for Older People Page 15 of 29 Evidence: seen to be kept with nursing staff. We saw that generally adequate stocks of medication were maintained to enable continuity of treatment, without overstocking. But, we were concerned that action could probably have been taken more promptly when a new order for a prescribed nutritional supplement did not arrive at the home when expected. Instead, a different supplement, originally prescribed for someone else, was given for two weeks. The home keeps a record of medicines ordered but should look at the systems in place to ensure that action is taken if medicines fail to arrive when expected. We saw that all eye drops were kept in the medicines refrigerator; this included a bottle that should not be refrigerated. Care needs to be taken to follow the storage instructions to ensure medicines quality is maintained. Regular written audits of medication handling were not currently being completed at the home. It is recommended that these are re-started to help ensure that should any weaknesses in the handling of medication arise, they can be promptly addressed. Care Homes for Older People Page 16 of 29 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. There is a lack of provision of social activities that means that people to not have the opportunity to participate in stimulating and meaningful activities of their choice. Evidence: Christopher Grange employs an activities co-ordinator and two mornings each week are allocated to Rhona House. Activities take place in each of the houses within the overall home and those service users who are able to, are free to attend these. The activities records for the week prior to the visit were checked. They showed that on the Tuesday morning, three service users were involved in a reading morning. On the Thursday morning, two service users had a one to one chat with the co-ordinator. There is no evidence of any other activities or stimulation for service users. Some of the service users are clearly unable to participate in group activities but no evidence was available to indicate that they are provided with one to one stimulation. Service users who are bedfast have their televisions or radios on in their room but no record is held of their individual preferences. One service user said that they did not go to any of the activities in other houses and was not offered any stimulation within Rhona House. The care files did not give details of service users preferred activities or identify their individual ability to participate in social events. Care Homes for Older People Page 17 of 29 Evidence: Services are held each day in the homes Chapel. Services can be held for service users who are unable to attend the Chapel and the home provides a Pastoral team who can provide spiritual and personal support. Visitors are welcome at the home at any time and one visitor said that she visited most days and was always welcomed by the staff who were kind and caring. Meals are prepared in the main kitchen in the home and delivered to each house in heated trolleys. Meals are served by the staff. Service users can take their meals in the dining room, the lounge or their own bedroom as appropriate. Staff were observed to assist service users with their meals in a dignified and unhurried manner. Dining tables were attractively laid. Special diets are prepared by the catering staff according to the service users identified needs. Service users who are able, choose their meal from a list of options and can choose a meal alternative to the main menu if they wish. The menu was not displayed on the day of the visit and staff said that this was an oversight. The meal looked and smelled appetising. Rhona House has a small kitchen where snacks and drinks can be prepared and all areas were found to be clean with a good supply of cereals and snacks. The kitchen is restocked daily from the main kitchen. The main kitchen was extremely organised and the chef provided full information regarding menus, special diets and cleaning schedules. All foods are appropriately stored and a good supply of fresh fruit and vegetables were seen. Care Homes for Older People Page 18 of 29 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. Staff have been given training in the protection of vulnerable adults and have are aware of action to be taken to ensure that service users are safeguarded from abuse. Evidence: The home has a robust complaints procedure which is displayed in various areas throughout the home and also detailed in the service user guide. Two complaints have been made against the home in the last twelve months. One was upheld and the other is currently awaiting an outcome. One service user said that they had no complaints but would talk to relatives about any areas of concern. Staff spoken to confirmed that they have been given training on the protection of vulnerable adults and were able to demonstrate that they understood the different types of abuse and the action they should take in the event of abuse being suspected. Evidence of this training is held on the staff personnel files. Care Homes for Older People Page 19 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the premises to provide service users with a pleasant and comfortable environment in which to live. Evidence: Since the last key inspection, considerable work has taken place to improve the environment for service users. An extensive redecoration and refurbishment programme has now ensured that all areas are bright and welcoming. Each service user is accommodated in a single bedroom and efforts have been made to personalise rooms with pictures, photographs and memorabilia to reflect the service users lifestyle. The home provides a large lounge with a quiet area off this and a small lounge which is located near to the entrance of the house. Funds are being raised to purchase additional reclining chairs for service users. The dining room is large with sufficient dining facilities for all service users. All service users have now been provided with a hospital style, or profiling bed according to their needs. Bedroom doors are not fitted with a name plate to identify the occupant, and one comment from a member of staff in the survey forms, stated that name plates would be beneficial to both service users and staff in identifying rooms. Maintenance staff are employed by the home and attend to all maintenance issues. A Care Homes for Older People Page 20 of 29 Evidence: new system of reporting repairs has been introduced to formalise the procedure to prevent a breakdown in communications. One bathroom door was found not to close and this was reported to the manager who said that she would use the new reporting system to inform the maintenance team. One shower room was malodorous and staff said that this was probably from the drains and had been like this for some time. This had not been reported as requiring attention. Linens and personal clothing are laundered carefully within the home. Since the last inspection, three new washing machines and a new dryer have been purchased. The laundry room was clean and organised and systems for ensuring effective infection control are in place. Care Homes for Older People Page 21 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a staff team who have gone gone through a thorough recruitment process to ensure that they are protected from harm. Evidence: Rhona House employs qualified nurses and care assistants to provide care and support to the service users. Domestic staff attend to the housekeeping. Catering, laundry, maintenance and administration staff are employed by Christopher Grange and their work encompasses the whole building which includes a residential care home and day care facility. During the morning, two qualified nurses are supported by six care staff, with two nurses and four care staff during the afternoon. At night, one qualified nurse is supported by three care staff. A registered manager oversees the care of the service users and some of her hours are supernumerary. The home has a robust recruitment procedure and inspection of the staff files shows that this has been followed. Checks are made on prospective staff from previous employers, the Criminal Records Bureau and the Protection of Vulnerable Adults register to ensure that service users are protected. Care Homes for Older People Page 22 of 29 Evidence: Training is given to all staff and evidence of training is held on the staffs personnel file. Staff records were found to be clear and organised and all necessary information was recorded. On the day of the visit, the manager was providing moving and handling training to some of the staff. Staff meetings are held and a record of issues discussed are held. A team meeting was planned for the day of the visit but cancelled by the manager. Three staff had arrived at the home for the meeting and were annoyed that they had not been informed of the cancellation. The home employs agency staff to cover for vacant posts, annual leave and sickness. The AQAA, completed by the manager, shows that a high number of agency staff are used by the home. Comments from service users and relatives who completed the surveys said The staff are friendly and helpful, The home reflects a welcoming, careing and receptive attitude by the whole staff, The staff look after my relative very well. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management system does not ensure the efficient running of the unit and the ongoing improvement of the service. Evidence: On the day of the visit, the Responsible Individual stated that the registered manager, Andrea Madden, had submitted her resignation and was due to leave the home at the end of the week. Ms Madden also confirmed that she was leaving. No deputy manager is in post and no information was available regarding the day to day management of the home for when the manager left. Subsequent to the inspection, the Responsible Individual has advised CQC that a new manager has been identified and will commence working at the end of June 2010. During the visit, Ms Madden, was providing training to staff during the morning and was at a meeting during the afternoon. Only one hour was spent with her as she was also dealing with other matters at this time and so it proved difficult to have access to Care Homes for Older People Page 24 of 29 Evidence: some of the secure or confidential information. At the end of the visit, it was found that the manager had left the home before feedback from the visit could be given. Feedback was given to the Responsible Individual. The Responsible Individual works within the home and can provide support where necessary. Additional support can also be provided by the manager of the residential care home which is located within Christopher Grange. Regular quality monitoring surveys are undertaken within the home to seek the views of service users and other stakeholders to provide information to enable the home to further develop and improve. Safety certificates for the premises and the equipment within the home were all found to be well maintained and up to date. Fire detection equipment is tested regularly and findings are recorded. Staff receive fire instruction on a regular basis to ensure that they are aware of the action they should taken in the event of fire being suspected. Some of the necessary information that the home is required to inform CQC of, under Regulation 37, has not been submitted. It is essential that information is submitted as required. Care Homes for Older People Page 25 of 29 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 7 15 Care plans must contain full 27/09/2009 information as to how the service users needs in respect of his health and welfare are to be met and to ensure staff are made aware of these to enable them to provide the appropriate level of care and support. Arrangements should be made to ensure that service users are enabled to engage in local, social and community activities and a programme of stimulating activities prepared. 27/09/2009 2 12 16 Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Detailed care plans should be prepared for all service users, identifying their needs and preferences in respect of their health and welfare. to provide full information for staff regarding the care and support that they are required to provide 14/06/2010 2 9 13 Where people are supported to self-administer medication, assessments and written information about how this is supported must be completed to help ensure people always receive any help they may need to safely manage their medicines. 14/06/2010 3 9 13 Complete, clear and accurate medication records must be maintained And, where people need 14/06/2010 Care Homes for Older People Page 27 of 29 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 additional support to take their medicines this must be clearly recorded and kept under review to support and evidence the safe administration of medication. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 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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