Care Home: Elreg House

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What the care home does well Some parts of care planning were satisfactory and residents are able to get up and have their breakfast at a time of their choosing. Some activities are provided but there is no evidence they are based on residents preferred options and the activity programme is not always followed in practice. Meals are good and residents are able to have two lunches and drinks and biscuits are provided throughout the day. Staff recruitment is robust and there are some quality monitoring activities taking place. One comment from a resident was `they (staff) are all right - they look after me well`. What has improved since the last inspection? There were four requirements as a result of the last key inspection carried out on 22 January 2009, each of which had been addressed. What the care home could do better: There were significant shortfalls in care planning, risk assessments, the environment and fire safety. Additional areas of concern were the overall management, staff practice, safeguarding adults and the recording of medication. On the day of the inspection it was not possible to fully assess how complaints are handled, staff training, all quality monitoring systems, pre admission assessments, accidents/incidents and recruitment as neither the manager nor provider were available and staff were unable to access the office. Key inspection report Care homes for older people Name: Address: Elreg House 58 Rosslyn Road Shoreham By Sea West Sussex BN43 6WP     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: Gwyneth Bryant     Date: 1 1 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 32 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 32 Information about the care home Name of care home: Address: Elreg House 58 Rosslyn Road Shoreham By Sea West Sussex BN43 6WP 01273454201 01273453431 elreghouse@aol.com www.elreghouse.com. Mr Anthony Robert Brown Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Karen Hearn Type of registration: Number of places registered: care home 23 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 23. The registered person may provide the following category of service: 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 category: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Elreg House is a care home registered to provide personal care and accommodation for twenty-three older people who have dementia or a mental disorder. The home is located near to the town centre of Shoreham-by-Sea, West Sussex, with the usual amenities of a small town. Care Homes for Older People Page 4 of 32 Over 65 0 0 23 23 2 2 0 1 2 0 0 9 Brief description of the care home Elreg House is a two-storey building with a single storey extension to the rear. Fifteen of the residents bedrooms are single and four have the benefit of en-suite facilities. There is no passenger lift. There is an enclosed rear garden that is accessible to residents. Elreg House is privately owned by Mr Anthony Brown. Mrs Karen Hearn is the registered manager responsible for the day-to-day running of the home. The web site address is: www.elreghouse.com Care Homes for Older People Page 5 of 32 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Elreg House will be referred to as residents. This was an unannounced inspection which began at 08:10 and ended at 14:30. The purpose of the inspection was to check compliance with key standards and other standards. There were fourteen people in residence on the day of which one was in hospital. A number of documents and records were viewed; including medication charts and care plans. Eighteen bedrooms were visited as were two communal bathrooms, two communal toilets, the shower room, laundry, food store and the communal lounge and dining areas. The home sent us their annual quality assurance assessment (AQAA) when we asked Care Homes for Older People Page 6 of 32 for it. It was clear and gave us all the information we asked for. It had been thoroughly completed and gave us detailed information on all parts of the service, in addition to some numerical information. The part of the AQAA requesting a summary was poorly completed and merely referred the reader to the care home standards and some parts for what they could do better had been left blank. On the day of the site visit the registered manager was on sick leave and the registered provider could not be contacted and therefore a number of documents could not be inspected as staff did not have access to the office. Although the provider was required to supply the documents following the site visit they were not provided within the timescales. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 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. Pre-admission assessments must be made available for inspection when requested. The pre-admission assessment needs to include all the required information and indicate how the home will meet assessed needs. Evidence: Pre admission assessments were not accessible on the day of the inspection and the registered provider was requested to provide this information following the site visit. This information was not provided within the timescales so the pre admission process could not be assessed. Following receipt of the draft report the manager provided a copy of the pre admission assessment for one person. Some parts of the assessment were satisfactory but many of the responses were either yes or no and there was no information on the individuals past and present hobbies and leisure preferences. Care Homes for Older People Page 10 of 32 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. All aspects of service users health, welfare and care must be identified and planned for, in order to clearly direct staff in the delivery of appropriate care and improvements in the administration in medication need to be made to ensure people living in the home are not at risk. Evidence: Five care plans were viewed in conjunction with the daily notes and other relevant documents such as medication administration records. The information in care plans was variable in that all included preferred terms of address and food/fluid charts. It was disappointing to note that one person did not have a care plan at all except that provided by the placing authority. It is vital that all residents have a plan of care to demonstrate that the homes has assessed care needs and can meet them within the home. The resident was in hospital on the day so it was not possible to meet with them and ascertain how well their needs were being met. One plan indicated that at a past placement the resident had presented challenging behaviour but not since being admitted to Elreg House, however daily notes showed Care Homes for Older People Page 11 of 32 Evidence: that this person had on at least one occasion been shouting, bashing and kicking. It is important to update care plans as needs change and that where challenging behaviour is noted, staff are directed as to how to distract the person and protect other residents. It was good to note that each care plan folder included a copy of the homes complaints procedure and a residents Charter, however it was not clear how residents would access them as they are held in a cupboard and were not in a user friendly format so it is no clear if residents would be able to read and understand them. Although the care plans include basic needs they lacked detail and did not include direction to staff in meeting needs. In addition some parts were inaccurate or inconsistent with other records. For example, one plan included a list of foods that may affect the function of the persons stoma and later in the plan listed two of those foods which the person especially liked. There was no information to direct staff to monitor the resident after eating those foods or to limit the amounts of such foods. One care plan dated 25/11/09 outlined the bedtime routine of the resident and stated that they liked to go to bed when they are ready and the person with whom they shared a room to be taken up later. After searching for the other residents plan in order to ascertain if they were happy with this arrangement the senior carer on duty explained that the person had died several months ago and another person now shares the room. Therefore the plan was not accurate at the time of writing. It was observed that all residents were clean and tidy, the men were clean shaven and all residents had clean hair which was nicely styled which indicates that they are cared for. One resident was wearing a shirt that was rather worn and they complained of feeling cold. A carer found a jumper at the request of the inspector and appeared to bring it from the laundry rather than the persons room. It would be good practice for staff to ensure residents wear clothing appropriate to the time of year and that they check that residents own appropriate clothing. Daily notes were variable and many consisted of comments such as slept well or personal care given. Some were judgemental in that they had statements such as in a terrible mood or in a good mood. It is important to ensure these notes accurately reflect how people spent their day in order to inform the care plan review process and monitor changing needs. It is equally important to ensure residents dignity is respected by ensuring staff do not make judgemental statements. Although each person has been weighed there was no information to direct staff when Care Homes for Older People Page 12 of 32 Evidence: residents had lost or gained weight. One resident who had recently lost weight left part of their lunch and none of the staff encouraged her to eat it or offer something else. In addition this resident was given the same meal as everyone else even though they are diabetic which is diet controlled. It is important to ensure care plans include clear directions to staff to encourage residents to eat and for those who are diabetic full details of how the condition is managed via diet also be included in the care plan. One plan included information on a recent eye test, however from the notes in the plan and the opticians report it was not clear whether or not the individual needed new spectacles. The photograph in their care plan showed they wore them and discussion with a relative found that they wore spectacles all the time. It is crucial that staff ensure visiting opticians make it clear whether or not new spectacles are needed and to ensure they are ordered. All care plans included information on the need for chiropody but none included information in respect of oral hygiene or dental appointments. On a staff noticeboard there is a list of days and times when residents are to have a bath or shower. This indicates that the service is task orientated rather than person centred. One resident said they could not recall having a bath at all and when asked said they did not think they could have a bath whenever they liked as there may not be enough hot water. The communications book showed that the registered manager had queried whether or not a particular resident had had a shower since admission. As daily notes did not include information on baths/showers it is not possible to determine if residents have regular baths/showers. Risk assessments were inadequate as they did not fully identify hazards nor include direction to staff in reducing the risk. They were generic in format with mostly tick boxes or a direction to see care plan. Risk assessments must be relevant to the individual and take into account any disabilities and the need for aids such as spectacles and walking aids. Risk assessments for the environment were again just tick boxes and did not take into account differences in individuals bedrooms or other elements related to their personal capabilities. Medication administration sheets were viewed and there were some of gaps. Therefore it is unclear whether or not medication had been given. In addition, some signatures had been scribbled out which indicates medication had been signed for prior to administration. This is further evidenced by the fact that medication had been signed for one person on 9/1/10 but they had been admitted to hospital on 4/1/10. One record showed that the individual consistently refused medication a notes in their plan stated that the GP had given express permission to disguise medication in food and Care Homes for Older People Page 13 of 32 Evidence: then continued to state that staff must stop this as the resident will know and refuse food and fluids. There was no information to show that a Best Interests Assessment had been considered or applied for. Following the site visit the manager confirmed that action has been taken in respect of the recording of medication. It was good to note that the staff communication book included details of who had been given morning medication so the day shift will be clear on who needs medication. Care plans stated that the individual could not self medicate and this is not acceptable. A detailed risk assessment needs to be carried out to determine whether or not a resident is able to self medicate, even if it is only the application of creams. A number of residents are on PRN (as required) medication but care plans did not include information to guide staff as to the triggers for needing this medication. It is necessary to ensure staff are aware of when to administer such medication particularly in respect of pain relief as some people in the home may not be able to overtly express a need for pain relief. Medication storage arrangements are good and the senior carer on duty confirmed that two named staff are responsible for checking medicines in and out of the home. Currently no one in the home has been prescribed controlled drugs and as the home does not have controlled drugs cupboard no one with such drugs can be admitted until one is installed. Following the site visit the registered manager confirmed that action has been taken to address each of the shortfalls and that there will be on-going improvements to ensure residents welfare is maintained. The manager also confirmed that a care planning training package has been purchased to ensure all staff are familiar with good practice when recording in care plans. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience by people living in the home does not match their expectations, choice or preferences. Evidence: Although there was a programme of activities on the noticeboard, discussion with a carer found that it is not always adhered to as sometimes the advertised person does not come so staff have to do something with residents instead. It was observed that throughout the site visit only one member of staff interacted with a resident. This consisted of reading a magazine with them. Apart from this instance the only other interactions between staff and residents was when staff were providing drinks and meals or taking them to see the district nurse. Two residents spoken with said they did not think there would be any activities on the day and neither could recall joining in group activities. One care plan did include an activity sheet but the record just said that the resident enjoyed the activity. It is important to record in which activities residents participated to ascertain the most popular ones. Care plans had limited information on past hobbies and interests. One did state that the person enjoyed knitting and had wool and needles and staff were to encourage them to use it but this did not happen on the day. As care plans did not include full Care Homes for Older People Page 15 of 32 Evidence: details of preferred leisure interests and daily routines it was not possible to ascertain whether or not the activities provided were based on individual preferences. Televisions were on in both lounges throughout the day but none of the staff asked residents if they were happy with the particular programmes. There is a poster which shows a photograph of each member of staff and their roles of which one who provides activities. However, this person was not in the home on the day. The home has an open house policy for visitors and this was confirmed by the visitor spoken with on the day. The weeks menu for the main meal was viewed and it showed that meals are well balanced and nutritious. There were pictures of the days meals on the dining room noticeboard but these did not match the meal provided. It is important to ensure that residents are given the advertised meal in order to ensure they are further confused. It was good to note that on the kitchen noticeboard there were details of residents likes and dislikes and which are diabetic. In addition there were clear details of who needed aids such as plate guards and who liked two lunches. Generally, residents looked well cared for but it was of concern to note that two people who did not eat their lunch were not encouraged by staff to finish it nor where they offered an alternative. One resident told the inspector that she did not finish the meal as she didnt like it. Although the senior carer overheard this conversation she continued to write up the daily notes. This, in addition to the reluctance of staff to provide drinks outside the set times indicates a task orientated service which is further exacerbated by the list of tasks set for each carer. One carer spoken with said that staff have to provide personal care in the morning by zones rather than residents needs. In order to provide a person centred service, the home needs to be organised around residents needs rather than the homes routines. During the morning staff served residents with cold drinks but served them in brightly coloured plastic beakers instead of a glass. There were no risk assessments to show why residents could not have drinks served in a glass and at other times they were given hot drinks in china cups so there is no reason to use the type of plastic beakers usually used by children. Following the site visit the manager confirmed that plastic beakers should only be for use in the garden or for those users who have sight impairment. One bedroom visited had a jar of cream which had been prescribed for someone other than the occupant and there was no record of this person currently accommodated in Care Homes for Older People Page 16 of 32 Evidence: the home. In addition the communal shower room had three jars of the same type of cream on the shelf and again one had been prescribed for someone who was not accommodated in the home, one had the prescription label torn off and one was not named at all. In the cleaning cupboard there was bottle of suncream labelled as residents suncream. These matters indicate that creams are used communally and this is not acceptable as it does respects residents as individuals and puts them at risk of cross contamination. There were seven residents dressed and sitting in the lounge at the start of the site visit and the senior carer explained that residents get up when they choose and are given breakfast when they request it. It was observed that some residents did get up later and were given breakfast after 10am therefore there is some evidence of individual preferences being respected. Following the site visit the registered provider sent information about recent surveys in which it states that the homes ideas for activities were welcomed by those people surveyed. However, it is crucial that activities provided are based on service users past and present preferences, rather than those chosen by the home. Care Homes for Older People Page 17 of 32 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. The home has a complaints policy but there was no evidence that it is followed and service users may not be protected from abuse. Evidence: The complaints log was not available on the day so the registered provider was required to provide a copy following the site visit. It was good to note that each care plan included a copy of the homes complaints procedure and a residents Charter, however the complaints procedure included an address for the CQC which is no longer available, therefore this document has not been updated. In addition it is difficult to understand how residents would make use of these documents as the plans are kept in a cupboard and residents have dementia so may not be able to comprehend text documents. There was a record in the communications book to show that a resident had tried to leave the home but there was no record of a Deprivation of Liberty Safeguarding authorisation, nor was there evidence of a Best Interest Assessment for the resident who consistently refused medication. Following the site visit the manager confirmed that a Deprivation of Liberty Safeguard authorisation had been requested. One care plan showed that the person was noted to have a large bruise on their left wrist which they told staff had been caused by another resident. There was no Care Homes for Older People Page 18 of 32 Evidence: information to show what action had been taken nor if a safeguarding adult referral had been made. Following the site visit the registered provider was required to provide a copy of complaints received but this was not provided. Subsequently a copy of all complaints received was provided but did not include full details such as what the complaint was about and action taken to address shortfalls. The provider was also required to provide a staff training matrix to demonstrate staff had been trained in safeguarding adults but this was not provided within the required timescales. Care Homes for Older People Page 19 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of the home are maintained providing a homely and comfortable environment for people living in the home; improvements need to be made in respect of on-going maintenance and cleanliness to ensure all areas of the home are pleasing and safe. Evidence: Eighteen bedrooms were visited in addition to two bathrooms, two communal toilets, the shower room, the laundry and food store. Overall the environment is poorly maintained including gaps in the laundry flooring and carpets which present a trip hazard. Since the last inspection the use of portable heaters has ceased and although the communal areas were warm, two bedrooms were cold. Water temperatures in bedrooms and bathrooms were variable ranging from 10 degrees to 62.2 degrees. In three bedrooms the hot water just trickled out of the tap and two other rooms the hot water taps did not work at all. In one room there was no knob on the tap so it could not be used. Not all bedrooms had the required furniture of bedside tables and bedside lamps, therefore residents are at risk of falling if they are unable to turn on a light at night. Throughout the home there was a lack of grab rails and toilet riser seats and the grab rails leading to the lower dining room need painting. Care Homes for Older People Page 20 of 32 Evidence: Throughout the home hot pipes had not been covered which puts residents at risk of burning and this needs to be addressed. Two of the rooms visited were shared rooms but screens were not available in either of them, nor was there a lock on the en suite bathroom door, therefore residents privacy is at risk. Following the site visit the manager confirmed that action has been taken to address each of the shortfalls in the environment and bedside tables and lamps provided as required. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff deployed is not sufficient to meet the needs of service users and staff training needs to be improved to ensure they have the skills to meet assessed needs. Recruitment practices are such that people living in the home are safeguarded. Evidence: One of the senior carers on duty confirmed that care staff are no longer required to do cleaning and cooking, except for making and serving drinks and snacks. She also confirmed that there were three care staff on duty in the morning but none were allocated as supervising residents in the lounge. She added that in the afternoons there were four care staff, one of whom is to spend time with residents, however at the end of the site visit (1.55pm) there were still only three carers on duty. As staff could not access staff rota templates they had falsified the staff rota from the previous week by changing the dates. As a result the rota showed the manager as being on duty when she was not. It is vital that staff are enabled to have access to relevant documents in the absence of the manager to ensure there is no need to falsify documents. Similarly, the shift plan which outlines tasks that staff are responsible for was for the previous week. This would account for carers observed as carrying duties allocated to someone else. The manager has confirmed that a copier has been provided for staff use. On the day of the visit care staff confirmed they were due to receive up to date Care Homes for Older People Page 22 of 32 Evidence: training in manual handling and one person had done some training via a distance learning course. The chef confirmed that he had an up to date food hygiene certificate and two staff confirmed that they had achieved National Vocational Qualifications at level 2 in care. One carer said they had never been trained in infection control and it was a long time ago that they were trained in dementia care. Two carers could not recall when they last did safeguarding adults training, therefore it is unlikely that they will be aware of current legislation especially that related to Deprivation of Liberty Safeguards. Following the site visit the registered provider was required to provide a staff training matrix but this was not supplied. However, confirmation that of the ten care staff, five have achieved at least National Vocational Qualifications in care at level 2 and a further three are due to begin working towards this qualification, therefore the home meets the required 50 of staff with this qualification and has a plan to exceed it. The registered provider confirmed that all new staff provide the required documentation of a criminal records bureau check, two written references and a protection of vulnerable adults check prior to employment. He also confirmed that all new staff undergo an induction period. Care Homes for Older People Page 23 of 32 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. Improvements need to be made to all aspects of management to ensure staff are provided with clear leadership and direction and systems need to be put in place to ensure all aspects of service users health, welfare and safety are protected and promoted. Evidence: On the day of the site visit the registered manager was on sick leave and the registered provider could not be contacted and no one else had a key to the office, therefore it was not possible to view certain document on the day. There is a legal obligation on the registered provider to ensure all documents relevant to the running of the home are available for inspection. Subsequent to the site visit the registered provider was required to send copies of a range of documents to the CQC for inspection purposes. Not all of the documents were provided within the required timescales but the registered manager confirmed that a key to the office is now left on site and that staff have access to copying facilities. Care Homes for Older People Page 24 of 32 Evidence: The registered manager has the required qualifications and experience to effectively manage the home, however she needs to seek training in the Mental Capacity Act and the accompanying Deprivation of Liberty Safeguards to ensure this legislation is applied to residents when appropriate. Following the site visit the registered provider was required to provide information on accidents, incidents, quality monitoring, handling residents monies, regulation 26 reports, minutes from staff and user meetings and collated results of surveys, however not all were provided within the required timescales. The registered provider later confirmed that results from surveys of residents and families were positive especially in respect of food, care and activities, however he did not state how many surveys were returned. Two GPs, 1 district nurse and 1 care manager returned surveys and all were happy with the care provided. Subsequently, the manager provided copies of the minutes from staff and resident meetings and the last two regulation 26 visits from the provider. There were two incidents of poor manual handling practice noted on the day and therefore the registered manager needs to ensure all staff have regular training in manual handling and follow it in practice. While touring the premises it was noted that a number of fire doors did not close fully and one fire exit had rotted away at the bottom. The registered provider did not provide evidence of fire drills and other safeguards therefore advice needs to be sought from the local fire service to ensure the home meets the latest fire safety legislation. Subsequently the manager provided evidence of fire drills and staff training and confirmed that advice had been taken from the local fire service. Following the site visit the registered provider confirmed that the home does not handle residents monies and all expenditure is added to the monthly invoice. Care Homes for Older People Page 25 of 32 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 26 of 32 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 3 14 That pre admission assessments are available for inspection and include detailed infomation on care needs. To ensure service users needs are assessed prior to admission. 11/02/2010 2 7 13 Care plans need to include clear direction to staff in dealing with challenging behaviour. To ensure neither staff nor service users are at risk. 11/02/2010 3 7 13 That risk assessments are personalised and be regularly reviewed. To ensure risks are identified and staff directed in reducing the risk. 11/02/2010 4 7 15 That all services users have a comprehensive plan of care devised by the home 11/02/2010 Care Homes for Older People Page 27 of 32 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 that inlcudes dietary requirements, direction to staff in the delivery of care and are regularly reviewed. To ensure the home can demonstrate how it is meeting care needs. 5 9 13 That medication records are clear, accurate and up to date. To ensure is it clear whether or not medication has been administered. 6 9 13 That all creams or other externally items be used specifically for one person and labelled as such. To reduce the risk of cross contamination and ensure service users are treated as individuals. 7 12 16 That advertised activities 11/02/2010 take place and that activities provided be based on service users past and present preferences. To ensure service users have the opportunity to have a good quality life. 8 14 12 That service users are treated as individuals. 11/02/2010 11/02/2010 11/02/2010 Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the home is run in service users best interests rather than to suit the homes routines. 9 18 13 That a deprivation of liberty 11/02/2010 safeguarding authorisation is applied for. To ensure a service user is not unlawfully deprived of their liberty. 10 18 18 That all staff be trained in safeguarding adults and follow it in practice and that safeguarding alerts are made when service are noted to have bruising. To ensure service users are not at risk of abuse. 11 19 23 That all parts of the home are safe, well maintained and that an assessment of the premises be carried out by a suitably qualified person such as an Occupational Therapist. To ensure service users live in a pleasant environment. 12 24 23 That all service users 11/02/2010 bedrooms have a bedside table and lamp and that water delivery temperatures are comfortable unless a risk 11/02/2010 11/02/2010 Care Homes for Older People Page 29 of 32 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 assessment suggests otherwise. To ensure service users are able to reach a light during the night hours and are not at risk of scalds. 13 24 12 That locks be fitted to bedroom doors and service users offered keys and that screens be provided in all shared rooms. To protect the privacy and dignity of service users. 14 27 18 Staffing levels need to be reviewed and be based service users dependency. To ensure service users needs are met and they are not left unsupervised for long periods. 15 31 18 That the manager be trained 11/02/2010 in the Mental Capacity Act and the Deprivation of Liberty Safeguards. To ensure she is aware of when she needs to take action in line with this legislation. 16 38 23 That the fire service be consulted on fire doors that do not close and other fire risks. 11/02/2010 11/02/2010 11/02/2010 Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure staff, visitors and service users are not at risk in the event of fire. 17 38 13 That all staff have regular training in manual handling and that it is followed in practice. To ensure that neither service users nor staff are at risk of injury. 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 11/02/2010 Care Homes for Older People Page 31 of 32 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. 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