Care Home: Croft, The

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What the care home does well The expert by experience spent time talking to people who live at the home and their visitors. Relatives stated to the expert that they were very happy with the home and stated that any complaints were dealt with promptly. One relative stated that it was `like a big friendly family`. Service users also stated that they were `very happy` stating that they were allowed to spend time where they wanted in the home. One stated that they were `very happy as they were allowed to stay in bed until lunchtime as they enjoyed resting in bed`. Relatives also commented that people had `freedom of movement` and could spend time where they wished in the home. The home works with families to ensure that admissions to the home are as smooth as possible for the service users with one relative staying at the home for their relatives initial few days at the home. Privacy and dignity are respected at the home. A range of activities is provided either in groups or individual to meet people`s needs. Service users, visitors and the expert by experience stated that meals were of a good quality and support is provided for people who require assistance with their meals. The new parts of the home are well decorated and furnished to a high standard suitable for the people who live at the home. Equipment required to support service users is available. Staffing levels are appropriate to the number and needs of the people who live at the home and positive comments were made about staff and the manager by service users and relatives. Care staff stated that the home is a nice place to work. What has improved since the last inspection? There were no requirements made following the previous inspection. The Isle of Wight Social Services safeguarding team undertook a safeguarding investigation in 2009. The home worked with social services and health staff and addressed the issues. The safeguarding investigation is now concluded. The home completed an extension in April 2009 and registered an additional six en suite bedrooms with the Commission. The extension also included bathing facilities and a lounge dining room. Outside space was also improved with the provision of a pleasant courtyard area and accessible garden. At the time of the previous inspection work to provide a relaxation room and a larger manager`s office was almost completed. These rooms are now in use and the previous office is now a care office providing care staff with private space to complete paperwork and more room to store items they require. The managers office is large enough to also provide a private space for for meetings which was not previously available. What the care home could do better: Requirements were made following this inspection. The manager stated that she has yet to update the written information that is provided to service users or their relatives. The registered provider must ensure that written up to date information about the home is available for service users and their representatives. Although most people had a care plan incorporating risk assessments one person who had recently moved into the home did not. The registered provider must ensure that all service users have a plan of care that identifies all needs and risks and how these are to be met. Whilst viewing the arrangements in respect of the management of medication inconsistencies were noted between the medication administration records and blister packs containing medication. The medication keys were also not stored securely. The registered provider must ensure that medication is appropriately stored, administered and that full and accurate records are maintained. Following the inspection the manager undertook a review of the way medication is managed in the home. Staff files could not evidence that all pre-employment checks had been undertaken prior to people commencing working in the home. This could place service users at risk. The registered provider must ensure that all pre-employment checks are completed before staff commence working at the home and that records as listed in schedule 2 are held. Although all existing staff completed training in the summer of 2009 staff employed after this time had not completed all mandatory and service specific training. The registered provider must ensure that all staff undertake mandatory and service specific training to ensure that service users have their needs safely met. The home`s registered manager resigned in July 2009 and the providers daughter, a registered mental health nurse, is now managing the home, however she has not yet registered with the commission as the homes manager. The registered provider must ensure that a manager is registered for the home. The provider should undertake monthly visits of the home to assess the quality of the service provided. These are called Regulation 26 visits and have not been occurring since July 2009. The registered provider must ensure that regulation 26 visits are undertaken and a report made following the visits. Care staff have not been receiving formal supervision. The manager is in the process of implementing this. The registered provider must ensure that staff receive formal, recorded supervision at least six times per year. Key inspection report Care homes for older people Name: Address: Croft, The Hooke Hill Freshwater Isle Of Wight PO40 9BG     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: Janet Ktomi     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Croft, The Hooke Hill Freshwater Isle Of Wight PO40 9BG 01983752422 01983752422 carolione.metcalf@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Patricia Anne Foster Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 22 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection Brief description of the care home The Croft is an extended detached house in a residential area of Freshwater, close to all amenities. It is registered as a care home for a total of 22 residents who have either dementia or mental health needs and are over the age of 65 years. The home is on two levels and as there is no passenger lift the residents in the four upstairs bedrooms need to be mobile. With the exception of one twin room all bedrooms are for single Care Homes for Older People Page 4 of 36 Over 65 0 0 22 22 Brief description of the care home occupancy, some of the bedrooms are en-suite. The home is owned by Mrs P Foster and at the time of the inspection did not have a registered manager. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report contains information gained prior to and during an unannounced visit to the home undertaken on the 13th January 2010. All core standards and a number of additional standards were assessed. The home had a key inspection in March 2008 and an Annual Service Review, which did not include a visit to the service in February 2009. This report follows a visit to the home which was undertaken by one inspector and lasted approximately seven and a half hours commencing at 11.am and being completed at 6.30pm. An expert by experience from Help the Aged was present for part of the inspection spending time with service users and visitors to gain their views about the service they receive. The inspector and expert by experience were able to spend time with staff on duty and Care Homes for Older People Page 6 of 36 were provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Information was also gained from the notification of incidents in the home, from other information sent to the commission and from the local social services safeguarding team. Information from the Annual Quality Assurance Assessment (AQAA) completed by the manager is also considered. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? There were no requirements made following the previous inspection. The Isle of Wight Social Services safeguarding team undertook a safeguarding investigation in 2009. The home worked with social services and health staff and addressed the issues. The safeguarding investigation is now concluded. The home completed an extension in April 2009 and registered an additional six en suite bedrooms with the Commission. The extension also included bathing facilities and a lounge dining room. Outside space was also improved with the provision of a pleasant courtyard area and accessible garden. At the time of the previous inspection work to provide a relaxation room and a larger managers office was almost completed. These rooms are now in use and the previous office is now a care office providing care staff with private space to complete paperwork and more room to store items they require. The managers office is large enough to also provide a private space for for meetings which was not previously available. Care Homes for Older People Page 8 of 36 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. Care Homes for Older People Page 9 of 36 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 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people are assessed prior to moving into the home to determine that their individual needs can be fully met however the failure to ensure that a care plan and risk assessment are completed as soon as people move into the home may place people at risk that their needs will not be met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. The home must update the statement of purpose and service users guide. Standard six is not applicable as the home does not provide intermediate care. Evidence: The manager explained the homes admission procedure and one pre-admission assessment was viewed for a person who had moved into the home shortly before the inspection visit. The expert by experience was able to talk with a person and their Care Homes for Older People Page 12 of 36 Evidence: relatives who had recently moved into the home and whose assessment had been viewed. The inspector discussed admissions with care staff and the manager. The homes AQAA completed by the manager is also considered. The manager stated in the AQAA that they were in the process of improving the homes brochure and developing a website to incorporate the main points in the statement of purpose. The inspector asked the manager about information such as the statement of purpose and service users guide that would be provided to new people. The manager stated that these required updating and reviewing however this had not yet happened. The manager stated that they are also planning to produce a brochure for the home. The manager showed the inspector contracts for private service users and itemised invoices for people. These clearly showed what people were being charged for and what services such as chiropody or hairdressing were being billed as extras. The manager stated that if an initial inquiry from either social services or from a person or their family indicated that the home would be able to meet the persons needs the manager will arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where possible members of the persons family and professionals involved in their care. The person is provided with information about the home and where practicable is invited to visit the home before making the decision as to whether to move in on an initial six week trial basis. When the person is unable to visit the home a relative is invited to view the available room and facilities at the home. The manager stated that should people be admitted to hospital that she would reassess them prior to discharge to ensure that the home continued to be able to meet their needs. The manager was clear about the level of needs the home can accommodate. The care plan including assessment information for a person who recently moved into the home was viewed. The assessment had been completed by the manager and provided comprehensive information about the persons needs. There was also information from the health unit the person had been in prior to moving to the home and additional life history information provided by the persons family. Records completed by care staff following admission indicated that specific dietary needs included on the pre-admission form had been met. The person had been living at the home for a week however there was no care plan or risk assessments in the persons care plan file. This places the person at risk that their needs will not be met. This was Care Homes for Older People Page 13 of 36 Evidence: discussed with the manager who confirmed that these had not yet been completed. Discussions with care staff on duty confirmed that they had enough information about new people admitted to the home. The home does not provide specific accommodation for intermediate care and therefore standard 6 is not assessed, however the manager stated in the AQAA that short stay could be available if a suitable room were vacant at the time required. The manager stated that the same pre-admission procedures would be undertaken as for long term admissions. Care Homes for Older People Page 14 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a care planning system that incorporates risk assessments and these were in place for most service users however these were complex and not easy to use on a day to day basis. The home has failed to ensure that medication has been stored securely or administered as prescribed by the persons medical practitioner placing people at risk. Evidence: Three care plans were viewed, one for a person recently admitted to the home and the others for people who had been living at the home for a longer time. The inspector discussed with staff and the manager how care needs are met and viewed equipment in use at the home. The expert by experience discussed with service users and visitors how peoples privacy and dignity is maintained and care needs met. The storage and recording systems in place for the management of medication in the home were assessed. In April 2009 the home was investigated by the Isle of Wight social services safeguarding team following concerns in relation to poor manual handling and care Care Homes for Older People Page 15 of 36 Evidence: practices at the home. The investigation also looked at care plans and records relating to care and staff training. External professionals from health and social care provided support and advice to the home. The safeguarding team has now concluded its involvement with the home and are now satisfied that the home is meeting peoples health and personal care needs. The manager stated that the care planning systems in use in the home have been changed as a result of the involvement of social services. The manager stated that she has now realized that there is a need to reorganise the care plans into two files one for active current information and the second, which will be readily available, will contain information that whilst important is not required by care staff on a day to day basis. This work has yet to start but the inspector saw the new files ready for this process to commence in the managers office. Two care plans were viewed for people who had been living at the home for several years and had more complex needs and one was viewed for a person who had recently moved to the home. The care plans for the people who had lived at the home for a longer period of time contained alot of information including relevant day to day information and older information. The amount of information contained in the files made them quite heavy and difficult to identify the important up to date information. Care plans appeared to identify peoples needs and how these should be met covering all activities of daily living for personal and health care. Risk assessments were also present for moving and handling, nutrition, skin integrity and other individual risks. Care staff record care provided on a daily recording sheet that is a combination of tick boxes for daily care such as bathing, dressing and a space for other information as to what the person has done during the day. The space for the additional information is limited and it is not clear where care staff would record if any significant incidents or accidents occurred. The complexity and amount of information in the care plans could mean that staff miss relevant day to day needs such as when the person last has a bowel movement. This was noted in one care plan and when cross referenced to other records held it was identified that care staff had recorded this elsewhere. The third care plan viewed was for a person who had only recently moved to the home. Although there was alot of information gained pre-admission about this person there was no care plan or risk assessments in the persons care plan file. Daily records indicated that the person was receiving personal care however without a care plan the person was placed at risk that their needs would not be known by staff and therefore not met. This was identified and discussed with the manager who agreed that a care plan and risk assessments should have been in place. Care Homes for Older People Page 16 of 36 Evidence: One of the people whose care plan was viewed had complex needs relating to increasing disability. The inspector visited this persons bedroom with the manager. The person had in place a pressure relieving air mattress which had been supplied by the district nurses. It was noted that fitted corner sheets were in use which decreases the effectiveness of the mattress. It was also noted that the mattress was hard and on checking the setting box the mattress was set at the highest setting. Pressure mattresses are set depending on the persons weight and for the weight of the person this was set far too high. The manager stated that this had been set by district nurses and on looking at the box the manager worked out the correct setting and decreased this. The manager telephoned the inspector several days after the inspection to inform that the person was no longer getting reddened areas on their skin. The manager and staff had not received any training in the correct use of the pressure mattress and staff must receive training for any equipment that is to be used in the home. The manager stated following the inspection that staff have now received training for the use of airwave mattresses. Discussions with care staff confirmed that they had sufficient time to meet peoples needs and observations throughout the inspection indicated that there were sufficient staff to meet peoples needs. No concerns in respect of peoples privacy or dignity were raised during the inspection. Most rooms are single with the one twin room seen to contain screens for use when both people are in the room and personal care is required. The expert by experience noted that following lunch people were not left in clothing with food on it or with food around their mouths. Care staff were observed to be respectful in interactions with service users. The inspector observed part of the tea time medication round. Care staff confirmed that they had undertaken medication training and that staff did not administer medication until they had been deemed competent including being observed doing this by a senior staff member. Medication is stored in a locked medication trolley however it was noted that at the end of the medication round, the medication keys were placed in an unlocked drawer in an unlocked care office. This was done in front of the manager and inspector and therefore appeared to be common practice as the staff member did not seem to feel this was inappropriate. The home has a fridge for medication that must be kept cool, again this was not locked neither was the room in which it was kept. The failure to ensure that medication is stored securely places people at risk, medication may be tampered with or people with dementia may take medication not intended for them. Care Homes for Older People Page 17 of 36 Evidence: Medication administration records (MARS) were viewed. These contained a number of gaps where staff had not signed to confirm that medication had been administered and also some places where medication had been signed as being given when not due. The home uses a blister pack (pre-dispensed) system and therefore these were cross checked to the MAR sheets. These showed that in some cases medication remained in the blister packs but had been signed as having been given and in others were not in the packs and had not been signed as being given. In one case a medication that should be given weekly appeared from the MAR sheet to have been administered three times in one week. The blister packs showed that all of these tablets for the month had been administered when two for the remaining two weeks of the blister should have remained. The manager contacted the persons GP during the inspection to discuss this and undertook a full review of the medication management in the home following the inspection. Some people had been prescribed medication on an as required basis. There were no guidelines for care staff as to when these should be administered. The prescription stated that these could be given up to four times a day but did not state how soon after one dose another could be administered. Staff had administered this medication and recorded this on the MAR sheets however they were no stating the exact time given and there is a risk that staff may give subsequent doses too soon placing the person at risk. There was also no guidelines to help staff to decide when to administer the as required medication. A requirement is made that medication must be stored securely and administered as prescribed by the persons medical practitioner. Medication administration records must be fully and accurately maintained. Guidelines must be in place for the administration of as required medication. Care Homes for Older People Page 18 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. Evidence: The expert by experience spent time talking with people in the homes lounges and met people who had chosen to remain in their bedrooms, observed part of the lunch time meal and met with relatives and visitors. The inspector viewed care plans and observed how people spent their time throughout the inspection visit and during the evening meal. Information from discussions with staff, the manager and the AQAA are also considered. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. Residents and visitors confirmed to the expert by experience that they are able to choose where in the home they spend their day, many were seen to spend their time in either of the homes lounge/dining rooms with others remaining in their rooms. One service user stated to the expert that they was allowed to spend any time they wanted in their room which they enjoyed and another stated that they were very happy that they were allowed to stay in bed until Care Homes for Older People Page 19 of 36 Evidence: lunchtime as they enjoyed resting in their bed. One relative stated to the expert by experience that their relative had freedom of movement. People were observed moving around the home independently throughout the inspection. Care plans contained individual information such as times people like to get up and retire to bed. Many of the people living at the Croft have age related memory loss and care plans contained life history information and recorded peoples likes and dislikes. Care plans also contained information about leisure activities, hobbies and interests, catering and religious needs. The manager stated in the AQAA that there are regular visits from external professionals in craft and music entertainment as well as a visiting hairdresser, with pedicure, manicure and massage also available. The home has a small sensory room adjacent to one of the lounges which had soft music, sensory equipment and a bed for aromatherapy. The expert by experience looked at the activities occurring in the home. They identified that these take place daily and are tailored to the individual needs of the people at the home. Information about religious needs is included in care plans and the manager stated that she has contact details and would arrange visits from appropriate ministers/clergy if this were requested/identified as a need. The expert by experience met with several visitors who all stated that they are made to feel welcome when they visit and kept informed about any issues relating to their relatives. The inspector observed interactions between visitors and the manager and visitors clearly felt able to raise issues and seemed confident that any would be addressed. The home now has two lounge dining rooms with the expert observing the lunch time meal and the inspector the evening meal. Most people were seen to have chosen to have their meals at the dining tables although some had their evening meal in their rooms and others remained in their lounge chairs. One person who was having their evening meal in their room stated that this was their choice as they wanted to watch television. People stated to the inspector that the food is always/usually good and choice provided. The expert by experience observed the lunch time meal and stated that the meal looked hot, varied and very appetizing. People who required assistance with their meals were seen to receive this in an unobtrusive manner. Drinks and snacks were seen to be available throughout the day. The pre admission assessment for one person stated that they required a special diet and notes in the persons care file and comments from their relative confirmed that they were receiving the correct Care Homes for Older People Page 20 of 36 Evidence: diet. The home has a large, well equipped kitchen. The manager stated that the home has been awarded five stars (the maximum) for food hygiene by the local environmental health department. Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon.The home could not locate the complaints log during the inspection visit. People should be protected from abuse although the home must ensure that recruitment procedures are robust to ensure that unsuitable people do not work at the home and some care practices such as medication and use of pressure relieving equipment places people at risk. Evidence: The AQAA completed by the manager, discussions with the manager and staff are considered as are discussions the expert by experience had with service users and visitors. The manager stated in the AQAA that people are encouraged to talk to the manager if they have any concerns and she would aim to resolve these before they became formal complaints. The previous report identified that the complaints policy was in the service users guide, the manager is in the process of updating the service users guide and stated that this will continue to include the complaints procedure. The manager stated in the AQAA and during the inspection that the home has not received any formal complaints in the past year. The manager could not locate the complaints record book and stated that a new one would be organised to ensure that should the home receive any formal complaints that these would be recorded and Care Homes for Older People Page 22 of 36 Evidence: evidence of how they had been investigated and resolved recorded. The expert by experience spoke with relatives who stated that any concerns or complaints are dealt with promptly. Care staff stated that if any issues were raised to them they would either try to solve them immediately or pass them onto the manager for investigation and resolution. In April 2009 the home was investigated by the Isle of Wight social services safeguarding team following concerns in respect of manual handling and care practices at the home. The safeguarding team have now completed their investigation and are satisfied that people are now safe. Some concerns were identified during the inspection in relation to the management of medication at the home and that staff may not be aware of how to use some equipment in use in the home. Both issues may place people at risk. Care staff confirmed that they have undertaken safeguarding and other relevant training and that they are not asked to undertake any tasks that they have not been trained to undertake. Discussions with care staff indicated that they had a good understanding of safeguarding vulnerable adults and what they should do if they suspect that abuse may have occurred. The safeguarding team have also looked at the way the home supports people with their personal finances and although some records could have been better they did not have any concerns that people had been at risk of financial abuse. Some concerns were identified in respect of the homes recruitment procedures and pre-employment procedures. This is further discussed in the staffing section of this report but inadequate recruitment procedures places people at risk that inappropriate people may gain employment at the home. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe, well-maintained home that meets their individual and collective needs. Evidence: During the inspection visit to the home the expert by experience viewed all bedrooms and communal areas with a member of staff. The inspector viewed communal areas, certificates relating the equipment in the home and considered how equipment is used. The croft is an older property that has been extended at different times and is located in a residential area close to the shops and other facilities in Freshwater. The Croft is domestic in style and provides comfortable and homely accommodation. There is limited off road parking to the front of the home with additional parking available in the road outside the home. Despite the various extensions the home still has outdoor space for service users including a courtyard area and accessible gardens to the rear of the property. At the time of the previous inspection the home was not employing a cleaner with care staff undertaking the domestic tasks as well as care. The home now employs a cleaner and the home was clean with no unpleasant odours. The home was warm throughout during the inspection visit. Care Homes for Older People Page 24 of 36 Evidence: In April 2009 the home completed an extension providing six additional en suite bedrooms, additional lounge/dining room and assisted bathrooms. The home now provides accommodation for up to twenty-two people mainly in single bedrooms with one twin room. The expert by experience viewed all bedrooms with a member of staff and stated that these were nicely furnished, odour free, clean and tidy. The new section was very tastefully furnished with rooms en suite. Some of the bedrooms have en suite facilities and the manager stated in the AQAA that they are looking at how bedrooms in the older part of the home can be provided with en suites. With the exception of four bedrooms all are on the ground floor. There is no lift to the these four first floor rooms therefore people admitted to these must be able to manage stairs. The home has a portable stair lift should there be a need in an emergency. The home now has two lounge/dining rooms with additional communal space in a conservatory sensory room. The manager has an office to the front of the home and there is a care office in the middle of the home. There is seating suitable for everyone who lives in the home. The home has the necessary moving and handling equipment and the baths are fitted with hoists. Grab rails to aid mobility are available around the home. When required the home is able to access additional equipment via the district nurses for the management of people who are at risk of developing pressure injuries. As previously identified staff must have training to use all equipment in use in the home. The homes laundry is appropriate and fit for purpose with machines capable of washing to disinfection standards. Some staff spoken with confirmed that they had undertaken infection control training. Later during discussions with the manager she confirmed that infection control training had been organised for staff in mid 2009 however staff employed after this had not undertaken this training. Staff confirmed that they had adequate supplies of infection control equipment such as disposable gloves and aprons. Substances hazardous to health (COSHH)were stored securely at the time of the inspection visit. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs appropriate numbers of care staff that ensure that the needs of people living at the home are met. The homes recruitment and training procedures for new staff have not ensured the safety of service users. Evidence: Records relating to the recruitment of new staff, staff training and duty rotas were viewed. Also considered are discussions with care staff, the manager and information in the AQAA completed by the manager. Staff were observed in their interactions with service users by both the expert by experience and the inspector throughout the inspection visit. Interaction observed by the inspector between staff and service users appeared warm and friendly. Service users appeared relaxed in the company of staff and some able stated that staff are very nice. No concerns were raised by the expert by experience in respect of staff and service user interactions. Duty rotas were seen during the visit to the home. Duty rotas stated that one senior and three care staff are provided throughout the day and two awake care staff at night. The home also employs kitchen staff, cleaning staff and a handyman. The provider and manager are also available most of the time and are in addition to these Care Homes for Older People Page 26 of 36 Evidence: numbers. During the inspection visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet peoples needs and throughout the inspection care staff appeared to have time to meet peoples needs and spend time sitting with them chatting or doing activities. The manager provided training and qualification information during the inspection and on the AQAA. The home has a high number of care staff with an NVQ and some additional staff undertaking NVQs in care. The home employs seventeen care staff of whom eleven have an NVQ and four are undertaking their NVQ. The manager stated in the AQAA that the homes staff training plan is extensive and of a high standard through the IW College and IW Council and that they also provide in house training. There was a safeguarding investigation in April 2009 and following this staff working at the home undertook a range of training. The home has since registered the additional beds and increased the staffing levels at the home and new staff have been employed. The recruitment and staff files for new staff were viewed. These showed that although existing staff had completed all mandatory training following the safeguarding investigation new staff had not completed mandatory training such as manual handling, infection control, fire awareness and health and safety. There was also no evidence that new staff had undertaken additional training to meet the specialist needs of the people living at the home such as dementia and mental health. Some of the staff files for new staff confirmed that they had commenced employment at the home in August, September and October 2009 and had therefore been working at the home without mandatory training for a number of months. All staff had completed safeguarding training in October 2009 and two of the new staff files viewed showed that staff had undertaken medication training via a distance learning pack and observed practice. The manager stated that all staff are doing a distance learning course in either medication, equality and diversity, dementia awareness or palliative care. The manager also stated that mandaory training was booked with the college and council however some had been cancelled. People have been placed at risk by the lack of staff training. The manager stated that some mandatory training was booked including fire awareness, manual handling, infection control and three staff were doing health and safety training on the day of the inspection visit. The AQAA stated that the homes recruitment procedure is designed to protect service users and strict guidelines adhered to. Three recruitment records for new staff were Care Homes for Older People Page 27 of 36 Evidence: viewed. None could evidence that all the required pre-employment checks had been completed prior to staff working in the home. The manager stated that whilst she had been away from the home an administration assistant had reorganized some aspects of the office and she could no longer find some documents such as printouts to confirm that Criminal Records Bureau (CRB) and POVA first/ISA (the list of people unsuitable to work with vulnerable adults) had been received. There were also some references missing and in one instance the previous employer had not been requested to supply a reference. The manager showed the inspector the induction booklet that new staff complete which meets common induction standards. Care Homes for Older People Page 28 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the necessary experience to run the home in the best interests of the people who live there but must register with the commission and obtain a recognised management qualification. This report has identifed some failings which are the result of unsatisfactory organisation to keep people safe such as medication, recruitment and training of staff. Staff must receive regular formal supervision and the registered provider must ensure that quality assurance stems are in place including monthly reports about the service are completed. Evidence: Information in the AQAA completed by the manager, discussions with the manager and records viewed are considered. The homes registered manager resigned in May 2009 and since that time the home has been managed by the providers daughter who is qualified mental health nurse and who previous managed the home before returning to work in the NHS mental health services approximately ten years ago. The manager stated that whilst working for the Care Homes for Older People Page 29 of 36 Evidence: NHS she completed all necessary training to maintain her nursing registration and is planning to undertake a management qualification. Throughout the inspection visit the manager demonstrated a knowledge of the people who live at the home and an awareness of areas that the home could improve on. Where issues, such as with the medication, were identified during the inspection visit the manager was clear that these were unacceptable and aware of the action that she needed to take to rectify the situation. The manager commenced working at the home during the safeguarding investigation and has worked with the safeguarding team to address issues. Although the manager has been managing the home since May 2009 she has not yet commenced the registration process. Until now the manager has been unable to travel to London to undertake the CRB with the commission. The manager stated that she will now be able to do the CRB and apply to become the registered manager. The registered provider lives near the home and is regularly at the home. The manager stated that the registered provider has some responsibilities such as for the homes finances but otherwise the management of the home is left with her. Where a registered provider is not in day to day charge of the home the provider must undertake a monthly visit to the home and write a report about the service to ensure the quality of the service provided. These are called Regulation 26 visits and reports. The inspector asked to see the Regulation 26 reports and was provided with the file. These should be completed monthly but the file evidenced that these had not been completed since July 2009. The registered provider must recommence Regulation 26 visits and copies of reports must be available in the home. Requirments have been made as a result of the inspection and these are the result of a failure of the homes managmement to ensure the quality of the service provided. The manager completed the homes AQAA. This was received after a reminder had been sent. The AQAA contained relevant information about the service and generally presented an accurate picture of the home. At the previous inspection the registered provider was the appointee for one person living at the home. The manager stated that this was no longer the case and that the home no longer becomes involved in peoples personal finances. The home does not hold money on behalf of service users and any additional services such as hairdressing or chiropody are added to invoices and sent to the person responsible for paying the fees. The inspector viewed several invoices and any extras are clearly identified stating what they are for. Care Homes for Older People Page 30 of 36 Evidence: Staff files indicated that staff have not been receiving regular supervision. The manager stated that she completed supervision training whilst working for the NHS and that she intends to develop a cascade supervision system in the home with senior staff supervision junior staff. Care staff stated that they felt they did receive adequate supervision although records seen in staff files showed that staff had not received supervision since September 2009. Care staff stated that if they had any concerns that they felt able to approach the manager or registered provider. Various records were viewed during the visit to the home. Generally these were stored appropriately and adequately maintained. Concerns in respect of the medication administration records and recruitment records have been discussed in previous sections of this report. There were no health and safety concerns in respect of the environment during the inspection visit. The servicing certificates for fire equipment, gas supplies and the testing of electrical equipment were viewed. Concerns that staff have not completed all health and safety training have been identified in the staffing section of this report. Care Homes for Older People Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered provider must ensure that written information about the home is available for service users and their representatives. So that people are fully aware of the services that the home provides to enable them to decide if the home is right for them. 01/04/2010 2 7 15 The registered provider 01/03/2010 must ensure that all service user have a plan of care that identifies all needs and risks and how these are to be met. So that peoples needs are met and they are safe. 3 9 13 The registered provider 01/03/2010 must ensure that medication is appropraitely stored, administered and that full and accurate records are maintianed. Care Homes for Older People Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people receive their medication as prescribed and do not become ill. 4 29 18 The registered provider must ensure that all staff undertake mandatory and service specific training. So that staff have the necessary skills to meet peoples needs and service users are safe. 5 29 19 The registered provider 01/03/2010 must ensure that all preemployment checks are completed before staff commence working at the home and that records as listed in schedule 2 are held. To ensure that people are safe. 6 31 9 The registered provider 01/06/2010 must ensure that a manager is registered for the home. To comply with regulations and ensure that the service is run in the best interests of the people who live there. 7 33 26 The registered provider 01/03/2010 must ensure that regulation 26 visits are undertaken and a report made following the visits. 01/05/2010 Care Homes for Older People Page 34 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To monitor the quality of the service provided and ensure that service users are safe. 8 36 18 The registered provider 01/04/2010 must ensure that staff receive formal, recorded supervision at least six times per year. To ensure that service users are safe. 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 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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