Care Home: Consort House Nursing Home

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What the care home does well People who are thinking of moving to the home are given sufficient information to enable them to make a decision about whether consort care centre is the home for them. People living at consort care centre have access to a range of health care services both at the home, and in the community. People have access to NHS services and routine screening programmes. Health care needs are monitored in parsley improved care plans. People appreciate the care they receive and appreciate the staff and provide that care. People appreciate the range of activities, which are arranged and enjoyed. People have access to services to maintain their spiritual needs. People are able to maintain links with their family, local community and friends. Visitors are welcome at the home at any time. Complaints are well managed at the home. People we spoke with said they would feel able to complain to the manager felt confident that she would deal with the situation. Staff have pre-employment checks performed before they are work to show that they are appropriate to work with vulnerable people. The environment is very well maintained, with a programme of routine and ad hoc maintenance and repairs. The improved standard of cleanliness has improved the spread of infection. Communication between the care quality commission and the manager continues to be good. The staff feel the manager is supportive. What has improved since the last inspection? There have been many improvements in the last inspection. It is recommended that the reader appertains previous reports to gain a full picture of events at consort care centre. Information provided by the home has been updated, this has included the statement of purpose and service user guide which have been updated. Other records in the home have also improved. The assessment process has improved and the detail of information obtained on people before they move to the home has increased and is performed to a better standard. Care plans, risk assessments and bed rail risk assessments have also been improved since the last inspection. Care plans are clearer to follow and reflect the needs of the people they are written about. People tell us that the care is less institutional. People are now called by their chosen term of address rather than referred to by their room numbers. The management of medication has also improved since the last inspection which includes storage organisation and administration. New staff are working at the home and have access to an increased training programme. Communication between the manager and the care quality commission has improved, and notifications sent to the care quality commission have increased detail. The activities organised at the home are also beginning to improve, with staff being more aware of the religious needs of people at the home. The home is more organised, clean, and tidy. Equipment has been replaced, and new beds have been purchased. A new shower room has been introduced, and work practices have improved the infection control procedures at the home. Although complaints continue about the home the number have decreased. The number of safeguarding referrals have also reduced. What the care home could do better: The manager needs to ensure that the assessment process continues to improve, by showing that further care needs are assessed before they move into the home including their age range and disability access in the rooms that they are to occupy. The safety of people should continue to be the focus of the providers and manager at the home. Systems must be in place to ensure people have access to prompt assistance when needed. This may include a review of the call bell system. The medication program should continue to improve by ensuring accurate recording of variable doses, and ensuring two staff sign any hand written medication transcripts. This will reduce the risk of errors being made. Although care plans have improved, systems must be in place to ensure that care plans are continuing to be reviewed. Systems must also be in place to ensure that staff have access to information regarding safeguarding adults until their formal safeguarding training has been implemented. Security at the home must also continue, by ensuring the access on the ground floor is is not possible, whilst providing people with adequate ventilation and security. Advice must be obtained from the fire department regarding risk assessment and means of escape all people on the top floor who are wheelchair users. Staffing levels and skill mix is must continue to be monitored to ensure people have their care needs met. The recruitment process must also improve to ensure that all unsatisfactory information is obtained on people before they work at the care home. Key inspection report Care homes for older people Name: Address: Consort House Nursing Home Consort Village Care Centre Tor Lane Hartley Plymouth Devon PL3 5TX     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: Clare Medlock     Date: 1 6 1 1 2 0 0 9 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Consort House Nursing Home Consort Village Care Centre Tor Lane Hartley Plymouth Devon PL3 5TX 01752789861 01752785884 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): XCEL Care Homes Ltd Name of registered manager (if applicable) Mrs Katie Wells-McCulloch Type of registration: Number of places registered: care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Rooms 7 and 11 on the second floor may not be used to accommodate service users until such time as the Commission confirms it is satisfied with the ensuite facilities in those rooms. The maximum number of service users who can be accommodated is 52. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following catgories: Old Age, not falling within any other category (Code OP) - maximum of 3 places Physical disability (Code PD) The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Physical disability (Code PD) Care Homes for Older People Page 4 of 35 Over 65 0 0 0 58 Until that confirmation, the maximum number of service users who can be accommodated is 56. After that confirmation, the maximum number of service users who can be accommodated is 58 Date of last inspection Brief description of the care home Consort House Nursing Home is a care home which provides nursing and personal care for up to 58 people (The figure written above is incorrect at time of writing this report) of either gender. The home is one of three homes owned by the registered Providers, XL care Homes Ltd. The accommodation is arranged on 3 floors. There is a passenger lift providing access to all floors. All bedrooms have an en suite WC and wash hand basin and built in wardrobe space. Communal facilities comprise of a dining room and lounge on the ground floor, and a further lounge, quiet room and conservatory on the 1st floor. The home is situated in its own, pleasant, level grounds and includes a pond and seating areas. There are a number of parking spaces for visitors at the front entrance of the home that is securely protected by keypad entry. The homes fees range from four hundred and fifty pounds upwards and depend on the level of care that is needed. The statement of contract lists what is included and not included within these fees. The statement of purpose and service user guide can be found in the main entrance hall. 2 5 0 6 2 0 0 9 Care Homes for Older People Page 5 of 35 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Although the rating is one star, there have been improvements at the home since the last inspection. This inspection was unannounced and consisted of a visit to the home on Thursday, 12 November 2009. During this time we spoke to the Registered Manager and Provider, many people who live in the home. We spoke at length to a number of visitors, and staff members. We case tracked six people who use the service (two on each floor). Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us or able to provide feedback. Care Homes for Older People Page 6 of 35 We inspected this service with an expert by experience. The Care quality commission consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service and spoke with six people. This helps us get a picture of what it is like to live in or use the service. A pharmacy inspector from the care quality commission attended the home on Monday, 16 November 2009, to perform an inspection on the medication systems at the home. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. During the inspection we watched interactions between staff and people living at the home. All this information helps us to develop a picture of how the home is managed and what it is like to live at Consort Care Centre. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? There have been many improvements in the last inspection. It is recommended that the reader appertains previous reports to gain a full picture of events at consort care centre. Information provided by the home has been updated, this has included the statement of purpose and service user guide which have been updated. Other records in the home have also improved. The assessment process has improved and the detail of information obtained on people before they move to the home has increased and is performed to a better standard. Care plans, risk assessments and bed rail risk assessments have also been improved since the last inspection. Care plans are clearer to follow and reflect the needs of the people they are written about. People tell us that the care is less institutional. People are now called by their chosen term of address rather than referred to by their room numbers. The management of medication has also improved since the last inspection which Care Homes for Older People Page 8 of 35 includes storage organisation and administration. New staff are working at the home and have access to an increased training programme. Communication between the manager and the care quality commission has improved, and notifications sent to the care quality commission have increased detail. The activities organised at the home are also beginning to improve, with staff being more aware of the religious needs of people at the home. The home is more organised, clean, and tidy. Equipment has been replaced, and new beds have been purchased. A new shower room has been introduced, and work practices have improved the infection control procedures at the home. Although complaints continue about the home the number have decreased. The number of safeguarding referrals have also reduced. What they could do better: The manager needs to ensure that the assessment process continues to improve, by showing that further care needs are assessed before they move into the home including their age range and disability access in the rooms that they are to occupy. The safety of people should continue to be the focus of the providers and manager at the home. Systems must be in place to ensure people have access to prompt assistance when needed. This may include a review of the call bell system. The medication program should continue to improve by ensuring accurate recording of variable doses, and ensuring two staff sign any hand written medication transcripts. This will reduce the risk of errors being made. Although care plans have improved, systems must be in place to ensure that care plans are continuing to be reviewed. Systems must also be in place to ensure that staff have access to information regarding safeguarding adults until their formal safeguarding training has been implemented. Security at the home must also continue, by ensuring the access on the ground floor is is not possible, whilst providing people with adequate ventilation and security. Advice must be obtained from the fire department regarding risk assessment and means of escape all people on the top floor who are wheelchair users. Staffing levels and skill mix is must continue to be monitored to ensure people have their care needs met. The recruitment process must also improve to ensure that all unsatisfactory information is obtained on people before they work at the care home. Care Homes for Older People Page 9 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives have the information they need to decide whether Consort Care Centre is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons medical needs but not always their individual needs. Evidence: The statement of purpose was inspected and found to contain the necessary information people need to decide whether Consort Care Centre was the right place for them to be. The provider informed us that this information had been recently updated. It was highlighted that the contact details for the Care Quality Commission (CQC) have not been updated in all areas. Case tracking confirmed that the assessment of people before they move to the home had improved since the last inspection. The document used was detailed and well completed. Care Homes for Older People Page 12 of 35 Evidence: The home is registered to care for people who have nursing needs. There is no age limit set and there were people of varying ages. The youngest person in the home said, I would prefer to be somewhere with people of my own age group and I dont join in things very much as it upsets me seeing old people who are unwell. Care Homes for Older People Page 13 of 35 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. People have their health care needs met but these are delayed because of inefficient call bell systems and staff skill mix. Documentation is improving but further changes are needed to ensure care plans are person centred and kept under review. There have been improvements to medication handling in the home, but further improvements are needed in the way medication is recorded in the home, to show that people receive their medicines as prescribed by their doctor. Evidence: The manager stated that the home had recently secured the services of a domiciliary optician, who has agreed to provide a service for the people residing at Consort Care Centre, and training for staff in eye care and how to clean hearing aids. People were complimentary about the care provided. At the time of writing this report, a relative telephoned the Care Quality Commission to tell us how impressed and Care Homes for Older People Page 14 of 35 Evidence: grateful she was for the care delivered by the staff at Consort Care Centre before her relative passed away recently. She said she couldnt praise the care staff enough. People told us they could not recall improvements since the last key inspection. Several mentioned the seemingly constant use of agency staff and the frustration of having to repeatedly tell them their particular needs and requirements. They saw this as a retrograde step. In discussion with the manager and other staff, they explained that staffing had been an issue in recent months. The manager said this was being addressed following the recent random inspection where staff levels and skill mix were highlighted as a shortfall. The provider explained that new staff from overseas had been recruited to build up a nurse bank to cover for staff sickness and absence and reduce agency usage. The night staff told us that there was no longer a handover between carers. They therefore found out about new people from the people themselves. We discussed this with the manager as handovers was an issue that was raised at previous inspections. The manager was aware that the current system is not effective and is planning implementation of a different way in which all staff can be involved in handovers between shifts. Care plans had improved since the last inspection. They were detailed, well completed and clear to follow. However, the care plans contained some documents that were not clear whether they were relevant for that person or not completed. Many records were blank. Each care plan contains the data admission, personal details, requests following terminal illness or death, property lists, advance directives, nurse assessment, dependency levels, GP and health workers records, social worker records, hospital appointment sheet, life story, activities of daily living, food likes and dislikes, and many risk assessments. Although the majority of care plans were well written and constructed many had not been reviewed each month. Some care plans had not been reviewed for up to five months. Risk assessments were well completed and photographs used to show how people should be transferred safely, and to show how wounds have been healing. specific risk assessments were seen for falls, nutrition, mental health, mobility, diet, skin viability, and dependency. Detailed and specific risk assessments were present for all people who were using bed rails. These documents had been reviewed in the last month. Despite care plans being clear to follow, there was no explanation in the care plan Care Homes for Older People Page 15 of 35 Evidence: summary as to why a person was at Consort Care Centre. An example included an explanation of a person having a specific medical condition, but no explanation as to how this condition had arisen. Care plans were written in a medical and health focused way, but the manager had stressed that eventually it was her aim to ensure that all care plans were person centred. Care plans showed that people have a wide and varied access to health care services, including NHS services and including a GP. The manager explained in recent months it has been difficult accessing a GP especially when GPs inform the home that their list is full . Health care professionals are sourced where appropriate. Healthcare professionals included speech and language therapist, reablement physiotherapist, continence specialist nurse, wound care specialist nurse, occupational therapist, community psychiatric nurse, GP, chiropodist, social worker, and outpatient appointments at local hospitals. The home have a system of recording at regular intervals baseline observations on each person, including weight, blood pressure, pulse, and temperature. People were asked about the response times to the call bells. Opinions varied with people telling us, Within seconds, Within minutes, Around five minutes, Fifteen minutes, and, Up to an hour sometimes. We performed a study of the call bells for a 45 minute period. This showed that there were many faults in the system resulting in staff not being fully aware instantly of which room was calling. Some of the ranging was caused by a fault in the system. Staff were seen to cancel the sound, which may result in urgent calls being missed if staff are not carrying individual pagers. The observation also highlighted there was no way of prioritising who had called first, resulting in the inequality of response time. This could mean that somebody is waiting for an excessive amount of time. It also highlighted that it would be impossible to undertake a regular comprehensive audit of call response times. Without exception people were happy with the medication regime with one person on four times daily medication saying, Usually spot on and never more than 20 minutes late which is quite acceptable. We looked at arrangements for storing and giving medicines in the home. We checked the records that are held in the home for medicines given to people, and discussed how medicines are handled with the manager and other staff working in the home. Sometimes people look after, and take, their own medicines, if it has been assessed as safe for them to do so. We watched some medicines being given to people in the home and saw that they are given using a safe method. Care Homes for Older People Page 16 of 35 Evidence: There have been improvements to the way medicines are handled in the home, and we found that the requirements made at the previous inspection have been met. We found that medicines are stored safely for the protection of people in the home. There are suitable arrangements for keeping controlled drugs and any medicines requiring cold-storage. Most controlled drugs are correctly signed out of the register with 2 staff signatures, but we found a few entries in the register where controlled drugs had not been signed out when they were returned or removed from the home. All entries should be signed out with 2 staff signatures. Records are kept of medicines received into the home, and of any unwanted medicines that are sent for destruction. Records are kept of medicines that are given to people, but we found some gaps in the records where staff have not signed to say that a dose has been given, or recorded a reason for omitting a dose. We also found some variable doses that had been prescribed where staff had not signed to say how much had been given. It is a requirement to record all medication administered, with the amount given if a variable dose is prescribed. This helps to show that people receive their medication as their doctor has prescribed for them. Some of the medication charts in use in the home are printed by the pharmacy, and some are handwritten by staff. We found records for one person where one of their medicines had a different dose printed on the pharmacy label from that on the handwritten chart. It is recommended that all handwritten charts are checked and signed by a second member of trained staff, and to make sure any queries over doses are checked with the doctor and pharmacist. This helps to make sure that people receive the correct dose of the medicines that the doctor has prescribed. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have increased choice of their lives and have access to a selection of organised and personal activities. Evidence: People were located in various parts of the home and were able to choose where they spent their day. Some people said they enjoy chatting and having coffee with others either in the lounge or in their bedrooms. In one particular corridor people seem to have their own small caring community, thoughtfully looking out for one another. Some people were enjoying a film in one of the lounges whilst others were spending time within their own room. Activities include a very popular weekly Prize Bingo session when a person living at the home is the caller. Other activities mentioned included quizzes, tri dominoes, and most weeks a visit from an entertainer or musical group. People told us there have been a few trips out to popular places. One person mentioned shopping trips accompanied by a carer. Others said that their families take them out. Some people talked about maintaining coffee mornings with former neighbours whilst other people had opportunities to have regular weekly home visits. Care Homes for Older People Page 18 of 35 Evidence: Staff said dedicated staff have been nominated to take on the role of activities and were due to start this role. On the day of inspection people in the day room were watching a DVD of appropriately aged music. Some people were tapping their feet and singing along. Various Ministers of Religion visit individuals from time to time. Staff said this could be arranged on an individual basis. One person commented that previously a resident voluntarily distributed the incoming post, however this task has reverted to the staff and people reported that delivery is not at a regular time. Staff told us that post is taken to residents when staff are available so times of delivery fluctuated. A visitor said I find it frustrating when the phone is not answered for a long time when the office is unmanned, but added, I understand that the carers may be with residents. Feedback from people using this service was that care is less institutional than at previous inspections. Those asked were of the opinion that they rose and retired at a time of their own choosing. Staff used the persons chosen term of address and did not refer to them as room numbers. Staff were seen to knock on bedrooms doors and wait before entering. No evidence was seen of personal care being given with doors open. Visitors said that they are made to feel very welcome and get on well with the manager who they find to be very responsive to their requests. Lunch is a choice from two set items with alternatives available. Opinions about the food varied from, Very good, Still good, No complaints about the food, to Dont like the food. Several residents commented on how much they enjoy breakfast in bed especially the bacon sandwiches.One person said the food was not so good as previously although discussion with staff confirmed that there had been no changes in the menu, kitchen staff or food providers. On the day of inspection people were offered pasta bolognaise or an omelette. The chef explained that people who required a soft or a pureed diet were provided with cottage pie and vegetables. The teatime menu showed that people who required a soft Care Homes for Older People Page 19 of 35 Evidence: or pureed diet were offered soup and mash potato. The kitchen was clean, tidy and well equipped. Fridge and freezers were well stocked. Cleaning schedules and records were present. The chef explained that she uses a nationally recognised Safer Food Better Business programme, in addition to recording extra information. Care Homes for Older People Page 20 of 35 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. Complaints and safeguarding vulnerable adult issues are well managed. Evidence: The manager explained that complaints regarding the service averaged 1 to 2 complaints per month. Records showed that the manager responds to any concerns or complaints within timescales and action is appropriate for the complaints made. The manager communicates efficiently with the Care Quality Commission regarding any allegations made, medication errors and staff disciplinaries at the home. The manager also submits regulation 37 notices informing us of notifiable incidents at the home. The Care Quality Commission has received four complaints since the last inspection. One resulted in a safeguarding alert being made and two resulted in random inspections. All responses from the home and manager have been professional and appropriate. Complaints procedures are displayed within the statement of purpose, service user guide and on posters throughout the home. Staff at the home were aware of the need to report causes of concern or safeguarding alerts to the manager. Staff that had been working at the home for longer than three Care Homes for Older People Page 21 of 35 Evidence: months have attended POVA training, new staff told us they were due to attend this training. The manager alerts the Care Quality Commission about safeguarding alerts that she makes. Any alerts made are appropriate and managed according to local guidance. During our inspection we found no forms of restraint that were not explained in care plans, such as the use of recliner chairs and bed rails. There were no examples of deprivation of liberties. Care Homes for Older People Page 22 of 35 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. Although the home is well maintained, security and safety of people is not always maintained placing people at potential risk. Peoples physical needs and capabilites is not always considered as part of the care planning process and choice of room location. Evidence: Consort Care Centre is a large purpose-built building. The home is arranged over three floors and has level access. Each floor is accessed via a passenger lift and stair case. The home is well maintained with a suitable standard of decor throughout. The home was more organised since the last inspection. Staff have also been provided with new uniforms for ease of identification. Since the last inspection a programme of replacing beds has taken place at the home providing many more fully adjustable beds. The provider and manager explained that in addition to fully adjustable beds a small number of beds that could be lowered the floor have also been provided at great expense. This should be seen as good practice for people who do not require bed rails that who are at risk of falling from bed. People were asked, Do you feel safe? Without exception the response was yes. Care Homes for Older People Page 23 of 35 Evidence: However, at a recent random inspection security of the lower floor was questioned. We were told that this had been rectified however on this inspection the same areas were found posing a security risk. We found that there was not a consistent night time round to check windows and doors were closed and locked. During our visit security lights were being fitted on the outside of the building. Staff were also aware that security had been raised as a matter of importance during the random inspection two weeks previously. Despite this, on arrival, our expert by experience was able to enter the premises unchallenged and gain easy access to all parts of the building. It was also noted that the ground floor windows do not have restrictors and being only one metre from the garden level would provide an easy entry for intruders. A visitor said that regular visitors are given the front door entry key code and pass it to their families. People were asked what it was like to live at Consort Care Centre. The consensus was that it is a peaceful place to live. Everyone said that the temperature was to their liking both day and night and several pointed out that they could adjust their thermostats if they wished and ask for extra blankets if they needed. People seen appeared clean, dressed in freshly laundered clothes and looked well cared for. One said, The laundry girls are brilliant. Another person said, The cleaning staff are a lovely band of four with too much to do. They give my room a really good going over once a week. Laundry facilities were well equipped, clean and well organised. A member of the care staff works in the laundry to cover the laundry assistants a half day. The care assistant explained that she covers regularly to ensure people receive their items of clothing promptly. The home is clean, tidy and generally well maintained. Some areas of the home had malodours present at times during the inspection, although staff knew of the reasons for these odours. Bathroom and toilet areas were clean. A tour of the premises highlighted some people on the second and third floors were wheelchair users. We were unable to find evidence from staff if any risk assessment had taken place for these people to be evacuated in the event of a fire. One person also told us that they were afraid to use the lift and it was not always convenient to call for staff to help. We found this person felt restricted to the floor on which they have their room. We were told that this was more of an issue on sunny and brighter days when it would have be ann opportunity to go outside into the grounds of the home. Care Homes for Older People Page 24 of 35 Evidence: One person told us that they were unable to use their en-suite bathroom because they are a wheelchair user. We found that all the en-suites are the same size and design throughout the home. There is a casement around the toilet and wash hand basin, presumably covering pipework. The manager agreed at the time of this inspection that she would look at this with the maintenance person to see if it was feasible to remove the casement or reduce in it in anyway thereby making the wash hand basin accessible for anyone using a wheelchair. Antiseptic gel was available at the entrance and in various places throughout the home. Care Homes for Older People Page 25 of 35 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. Staffing levels and skill mix continue to cause delays in care so improvements and monitoring is necessary. Staff recruitment practices are not robust so people cannot be confident they are protected from harm. Evidence: Without exception people told us that they thought that there were insufficient staff resulting in what they saw as long waits for responses to call bells and slow service of meals delivered to bedrooms. One person said, My contract is for two carers, I am paying top prices, frequently only one carer arrives to attend to me when I am getting up and being washed and dressed. Others said of the staff, They work very hard but there arent enough of them. Staff duty records showed that staffing levels had been lower than normal in recent weeks. Staff explained that normally there are 14 staff in the morning nine in the afternoon and six at night. (This includes the two staff that work on a 1:1 basis) A study of staff duty records showed that staffing levels had been adjusted since the recent random inspection. The manager explained that staffing levels had been difficult thing to manage because of staff sickness and staff turnover. Agency staff had been used to ensure staffing levels were safe and appropriate, however this has had a Care Homes for Older People Page 26 of 35 Evidence: negative impact on people who explained that when agency staff are present things take longer to do because of the repeated explanations that are necessary. We found that there was no system in place for staff team organisation on night shifts. Consequently permanent staff were arranging their work amongst themselves thereby leaving agency and/or new staff to work together. This resulted in people having to wait much longer because the agency/new staff were unable to advise each other because they did not know the homes routines. We suggested to the night staff that maybe the new staff, who we were told didnt know what to do, would maybe do things differently. This was therefore the purpose of an induction period so new staff could be shown and have time to learn what they are expected to do.We were told that the night before our inspection there had been one new member of staff on duty and the night of the inspection there would be two more new staff. From the rota we found that there would be three male staff on duty. The night staff told us that there are a few people who will not accept male carers, and this preference is respected. We raised our concern with the manager about the two new male staff working together on their first shift at the home, and with another relatively new staff member. We also raised our concerns about the racism shown by some night staff towards some overseas staff. We received comments from staff such as Theres a lot of bickering and stress, Come to work stressed and go home stressed. Several staff were upset about mistakes with their pay, particularly those who are the sole earner in their household. Inspection of staff files also found discrepancies in staff rates of pay. At a previous inspection staff had told us they were not happy about some staff having pay rises and not everyone. We raised this with the providers as an issue they should consider seriously and urgently, particularly in rectifying mistakes in wages. As we have found at previous inspections, there are still staff who are resistant to change their working practice. We also found there is still disjointed team work between day and night staff, and between teams on each floor of the care home. It was suggested to us by some staff that we should make an unannounced visit during an afternoon because there were times when There are only two staff on duty. We looked at the off duty rota and could find no evidence of staffing levels being so low. From discussion with senior staff and with the manager, we found that some staff only counted the number of people they worked with rather than considering the whole number of staff on duty. There appeared to be a lack of initiative between staff to divide the care between all of them if one team was struggling. This in turn seemed to Care Homes for Older People Page 27 of 35 Evidence: result in rumour-mongering amongst staff that compounded the staffing issues. We were also concerned that staff were petty-minded about workloads. One example we were given was about day staff being unable to get people ready for bed before the night staff started work. The night staff refused to complete their duties in the morning and left this for the day staff to do. Consequently it caused a knock-on effect for the people living at the home as well as reducing peoples choice. Most people were convinced that staff listened and usually acted on requests made to them if it was possible. One person said, They dont appear to listen and dont always respond. Other people were more complimentary about the staff saying, Staff, no problems, we get on very well, enjoy a little banter with them, They meet my requests and are very helpful, Staff lovely, yes, quite good, Theyre all very kind and thats the main thing, and Get on quite well on the whole. Several people commented on communication difficulties with carers for whom English was a second language although some staff struggled with people who had a strong Devonian accent. Staff working day shifts said they had access to in-house mandatory training programmes and an induction programme. Day staff also spoke of shadowing and working with existing staff and being shown emergency procedures. Staff did not speak of a written induction programme. The manager confirmed that staff are issued with an induction book and clinical supervision forms which are signed as staff work through their programme. One member of staff said he was allowed as much time as he needed to shadow until he felt confident. We also saw evidence on the duty rota of nominated staff to supervise inductions during day shifts. There was no evidence of this on the night duty rota. We looked at five staff files. One person we found had not given their last employer as a reference, instead they had given two friends, one of whom lived at the same address. Another file had discrepancies between the dates of employment given by the staff member and by the dates provided by their previous employer. Another file had no references although the staff member was working in the home. We found that the files had reference numbers for CRBs however these were the application form number not the issue number. A check list has been put in each new staff file and we suggested this be kept on the front of each file as a quick reference guide including the start date and the issue date of the CRB check. During this inspection POVA First checks were returned for all the new staff due to start work and who had not yet had their CRB check returned. Care Homes for Older People Page 28 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that it is well managed. The health, safety and welfare of the people living in the home are promoted and protected. Evidence: People living at the home and visitors alike spoke highly of the manager saying she was very approachable, listened and took any necessary action. One relative was grateful for the mobile phone number the manager had provided them, so they could contact her at any time. One person said they thought it had been a difficult year for the manager. The staff also spoke highly of the manager. Comments included I think Kate is lovely, she comes in to see us every day to check all is okay. Then when shes in the office we can go in at any time to seek advice. She says that we can page her, text, or even phone her. I dont know why staff moan, I find her great and I know where she is as Care Homes for Older People Page 29 of 35 Evidence: Ive had managers before where we dont really know whats going on. Other comments included She has been really supportive to me especially when I had a bad day last week. Shes been very approachable. Another member of staff said My managers door is always open, I see her wandering around if I have any problems but I usually go to my deputy first. Other staff said Shes been brilliant, but shes had some difficult jobs such as implementing changes that arent popular, and getting rid of some staff. Then there are the pay hassles, so staff are taking it out on her but is not really her fault. All staff spoken to knew who to speak to if they had any questions or concerns and said they felt able to suggest changes. Staff were also complimentary about the new senior who had been really supportive and organised. Throughout this inspection we found the manager was approachable and able to provide with information about the day to day management of the service. It was also evident from talking to the manager that she knew the people living in the home, and their individual needs and preferences. Staff told us of new systems to audit medicines and care plan reviews at the home. Due to the many changes quality assurance programmes have not been a priority, however staff said people are asked daily if they are happy and any issues are addressed straight away. We were shown a comprehensive system that also proved to be a quick reference system to find out who was resident at the care home, date of admission, important contact details for families, care managers, etc, and date of leaving with reason. Ten people have their money held for them by the administrator. We randomly selected three to check and found they were all correct with a deposit account showing incoming and outgoing monies. Receipts were also kept on the persons file. All the monies were kept secure in a lockable cash box kept in a lockable filing cabinet. The office is kept locked at all times that no staff are working in there. We found the fire safety log was up to date, and all other necessary safety checks completed. Eighteen staff had attended a Fire Safety training course in September 2009, and four staff had completed an intensive Fire Warden course run by an external training provider. This means there is a fire warden on each shift day and night. Care Homes for Older People Page 30 of 35 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 31 of 35 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 8 13 Systems should be in place to ensure staff are aware of and can respond quickly when people call for help. This will reduce the risk to people and avoid unnecessary delay 13/05/2010 2 9 13 All medication administered must be recorded, with the amount given if a variable dose is prescribed. This helps to show that people receive their medication as their doctor has prescribed for them. 18/12/2009 3 19 13 Systems must be in place to ensure the premises are secure and does not place people at risk This will mean that people have access to come and go but are protected from unwanted intruders. 14/05/2010 Care Homes for Older People Page 32 of 35 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 4 19 23 Systems and risk 14/05/2010 assessments must be in place to ensure that people who use wheelchairs or have mobility problems have an adequate means of escape in the event of a fire. This will reduce any risk if a person needs to evacuate the building in an emergency 5 27 18 Staff numbers and skill mix must continue to be monitored. This will mean that there are sufficient staff numbers and skill mix to meet the needs of people in the home. 23/02/2010 6 29 19 Staff recruitment practices must be robust including correlation of information and ensuring all necessary checks are in place before someone starts work at the home. This will mean that the people using this service can be confident they will be protected from harm. 23/12/2009 Care Homes for Older People Page 33 of 35 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 4 The manager should ensure the specialist needs of people, such as wheelchair access and suitability of age are considered before moving to the home. Improvements to care plans should take place to ensure they are kept under review and are person centered Systems should be in place to audit the call bells to highlight any faults All handwritten medication charts should be checked and signed by a second member of trained staff, and any queries over doses must be checked with the doctor and/or pharmacist. Systems should be in place to ensure staff have access to some training in safeguarding vulnerables adults before they commence work and whilst they wait for the formal training programme. 2 3 4 7 8 9 5 18 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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