Care Home: Hadley House Nursing Home

What the care home does well The home has been managed and run by the Manager and Owner for many years. She is familiar with the needs of the residents. The majority of the staff team have also worked in the home for many years and are also aware of the individual needs of the residents. Residents benefit from the visits by the Occupational Therapists, who provide activities and entertainment. Feedback about the home from the residents and a visitor was positive. What has improved since the last inspection? The home had updated the Service Users` Guide and Statement of Purpose. Residents receive a copy of the complaints procedure. Evidence of the electrical checks were now available. What the care home could do better: The health and safety of the residents and staff need to be prioritised. Several areas were found to be in need of attention. Members of staff must not work excessive hours in a row without a sufficient break. The home needed to ensure that regular maintenance checks were in place to ensure all areas of the home were safe. Clear, tidy records and files need to be in order so that it is easy to see evidence that staff are up-to-date with training and have had all the necessary legal recruitment checks in place. Good quality checks need to be in place, such as acting on comments and remarks made in surveys that residents or their representatives complete, with an overall quality assurance report developed to show the work the home has been doing and the areas still to be addressed. Key inspection report Care homes for older people Name: Address: Hadley House Nursing Home 24/26 Jersey Avenue Stanmore Middlesex HA7 2JQ     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: Sarah Middleton     Date: 2 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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 37 Information about the care home Name of care home: Address: Hadley House Nursing Home 24/26 Jersey Avenue Stanmore Middlesex HA7 2JQ 02089077047 02089332051 nalin.joshi@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Anila Joshi,Mr Nalin Joshi care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Hadley House is a home providing nursing care for up to 14 older people. It has been operating since 1995. The owners, Mr and Mrs Joshi, also have a home providing personal care to older people situated in the same road. The home is situated in a quiet turning, close to Kenton Lane, on the edge of both Stanmore and Kenton. It is close to local shops and bus routes, with local train and underground links being around thirty minutes. walk away. Hadley House has offstreet parking at the front of the property and there is parking available in the road outside the home. Care Homes for Older People Page 4 of 37 Over 65 14 14 Brief description of the care home The home consists of two floors and there is a passenger lift to assist movement within the home. There are bedrooms, toilets and bathing facilities on each level of accommodation. Communal space is situated on the ground floor and consists of an open-plan area where there are lounge and dining area. There is a large garden at the rear of the house. There is one shared bedroom in the home and all other bedrooms are single rooms. There is a standard fee for services at the home, details of which are available from the provider on request and range from £670.00-£700 per person per week. Care Homes for Older People Page 5 of 37 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: An unannounced visit was made on the 26th October 2009. This was to focus on inspecting all of the key Standards and to check on the compliance with requirements from the last inspection visit carried out in 2007. A random visit had also been carried out in April 2009 and we also looked for compliance on the points raised from this visit. Before the visit we looked at: Information we have received since the last visit on the 7th June 2007. The Annual Quality Assurance Assessment (known as the AQAA). The AQAA gives the Care Quality Commission evidence to support what the agency says it does well and gives them an opportunity to say what they feel they could do better and what their future plans are. How the service dealt with any complaints and concerns since the last visit. The views of the residents living in the home, their relatives, staff and other professionals who visit the home. During the visit we: Care Homes for Older People Page 6 of 37 Talked with the residents living in the home, staff, a visitor and the Registered Manager, who is also the Registered Provider/Owner and will be referred to in this report as the Manager. Looked at information about the residents who use the service and how well their needs are met. Looked at other records which must be kept in the home. Checked that staff had the knowledge, skills and training to meet the needs of the residents they care for. Looked around the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Before the inspection we sent out surveys for residents, staff and social care or health professionals to complete. We made a referral to the Care Quality Commissions Pharmacy Inspector and she visited the home on the 30th October 2009. Their findings have been included in this report under Standard Nine. We told the Manager what we found at the end of the inspection visit. The Manager subsequent to the inspection informed us on areas where she had taken steps to address the shortfalls noted. These have been referred to in this report. The Inspectors would like to thank the Manager, staff and residents for their assistance with the inspection process. Care Homes for Older People Page 7 of 37 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 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided to people thinking of living at Hadley House so that they are able to decide whether or not to move into the home. More specific information needs to be included as to how the home provides a service to those residents who develop dementia. Assessments are carried out before admission to ensure the residents needs can be planned and met at the service. Intermediate care is not provided at Hadley House. Evidence: We viewed the Service Users Guide and the Statement of Purpose. It was a previous requirement that they were updated and both were seen to have been produced in 2009. There were some small amendments to be made to the information on the Care Quality Commissions address and the removal of references to the Commission for Care Homes for Older People Page 10 of 37 Evidence: Social Care Inspection. The information could be improved by including information as to how the home meets the needs of people with dementia. It was confirmed to us that people have the information when they are looking to place a person in the home and that they are able to visit as and when they wish to ensure the home is suitable for their needs. The majority of people in the home are placed by the NHS Primary Care Trust. We did not see completed contracts/terms and conditions but did see that the Service Users Guide contains a copy of these. There is also detailed information about extra costs which might be incurred, such as the hairdressers charges and chiropody, and also gives approximate charges for these. This is good practice. We advised that the lists should be attached to any contract when it is signed to demonstrate that the information has been made available and is understood. We saw that some people pay additional costs for supplements to their diet, and this should be included in the list of additional charges, where appropriate. We viewed the pre-admission assessment for a new resident who had moved in. The Manager said she visits the prospective resident to assess their initial needs. The assessment had been completed with the assistance of the next of kin. The resident would have also been able to contribute to this assessment and their views could have also been included in the pre-admission process. Information about the residents likes, dislikes and abilities were noted. There was a question on gender care preference, which is seen as good practice and it was pleasing to see that this is considered. There was also an hospital discharge summary which provided the home with an overview of the residents condition and needs. Care Homes for Older People Page 11 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are well-maintained but could be more person centred. Residents health needs are well met. People are treated respectfully. Arrangements for the handling,storage and administration of medication are good. Evidence: We viewed three care plans and saw that overall these gave some good information about the residents. The plans are reviewed each month. Information, such as the residents previous occupation, is noted which is good practice as this can often be an important part of a residents life. Information about the support the resident needs was recorded along with their likes and dislikes. We viewed information on one resident where we were made aware by their visitor, that they could communicate their likes and dislikes to staff. There was no evidence that the staff team had asked the residents for their views about the care they wish to receive and anything they might want to add to their own care plan. Some care plans did have a signature on them. As discussed at the previous inspection, it might not always be appropriate to Care Homes for Older People Page 12 of 37 Evidence: involve the resident, if it causes them distress or confusion. However, those who can communicate their needs should be encouraged to do so. This was discussed with the Manager and the nurse, who completes the care plans. It is recommended for the staff team to consider the different ways they can record the residents contributions and views. A sample of daily notes were also viewed and these provided some information to the staff team. Daily notes are important to make sure good quality information is being recorded. Risk assessments covered various areas, such as falls and pressure sores. These are also reviewed on a regular basis. We discussed the manual handling risk assessments with the Manager. This had also been discussed at the previous inspection in 2007. There was some information on moving and supporting a resident to transfer but this could be improved upon. It is recommended that there is more detail recorded about how to support the resident and staff. A lack of information could result in an accident or injury which might have been avoided if all information about the transfer was recorded. Following on from the inspection, the Manager informed us that they were reviewing the information recorded on moving and handling a resident. All the residents see health professionals, such as the Psychiatrist who visits on a regular basis, GP and dentist. Health appointments are recorded on separate forms. This enables staff to monitor the health needs of the residents. A visitor spoken with was happy with the care received by the resident they visit. This resident is supported to sit with others and not remain in their bedroom. We looked at the medication in the home. We found that it was stored in a locked and secure cupboard on the wall or in a trolley. However we could not count or audit the medication as it is recorded on to Medication Administration Records (known as MARS records) which did not record the quantities in the home and there was no dates of opening on the medication. Medication, when it is ordered and delivered, is clearly recorded. We informed the Manager that we would be making a referral to the Care Quality Commissions Pharmacy Inspector so that a full and detailed audit of this standard could take place. The Pharmacy Inspector reported from their visit carried out on the 30th October 2009: We looked at the storage of medication the homes medication policy and the recording of receipts administration and disposal of medication. The home used three month handwritten Medication Administration records (MAR) and we were able to verify these against copies of the prescriptions kept in the home. There were no gaps Care Homes for Older People Page 13 of 37 Evidence: in the recording of administration on the MAR charts. When a medicine was not given a code was used and we were able to see what the reason was. All medicine was supplied in their original packs and residents were on differing medication cycles. Medication was well organised, with current medication in a secure trolley and the following months supply in a secure medication cupboard. Records of orders and receipts were well documented in a separate register and there were weekly checks of stock so that medication did not run out and was reordered in plenty of time. It was difficult to audit medication because of the differing cycles but we were able to sample 5 new prescriptions and were able to reconcile signatures for administration with the stock held. There was evidence therefore that residents were receiving their medication as prescribed. We looked at one care plan and noted the extensive records of visits by healthcare professionals. Both the GP and the visiting psychiatrist recorded the outcome of their visits in the care plans and these notes included records of reducing dosages of medicines changes in medicines and dosages and how to manage behaviour. The Manager and a second nurse had recently received training in venepuncture and were able to take samples of blood for tests which were necessary for monitoring therapeutic safe blood levels of drugs. They were also able to be proactive with the GP and have results of several diagnostic blood results available before the consultant Psychiatrist visited the resident in the home. We checked the controlled drugs and balances were correct and the medicines stored securely. Some attention needs to be given to the correct recording procedures when an error is made to avoid crossings out. Insulin was stored in the fridge together with some eye drops. The fridge was locked when not in use and the daily records of temperature indicated that storage was satisfactory. Waste medicines were also stored securely and recorded and returned to a licensed waste disposal company. We looked at the training file and noted that the last medication training was carried out in July 2008 and all staff had received an update at the time. To further update training processes we emailed copies of MHRA alerts on safe lancing systems and the Royal Pharmaceutical Society Guidance on Handling Medicines in Social Care after the inspection. Overall, we were very satisfied that the home had safe systems in place to manage medication and maintain the individual health and welfare of the residents. Care Homes for Older People Page 14 of 37 Evidence: For their own internal quality assurance, random audits of medication would further provide evidence of good practice. Comments from some of the surveys said that Staff are a credit to the home and the management are hard-working and caring and staff have good relationships with the residents. Not everyone we spoke to was able to express their opinion, but those that did were complimentary about the home and its staff. One person said the staff are very good. We found the staff to work patiently with the residents and interacted with them throughout the inspection. The home has one double room, which has screening to ensure there is as much privacy as possible for the two residents sharing a bedroom. We were informed that those residents who are able to read it receive their own personal mail. Care Homes for Older People Page 15 of 37 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. Overall social and leisure activities are provided in the home. Visitors are made welcome in the home. Food in the home is presentable and provides meals to meet individual preferences. Evidence: We were told that Occupational Therapists, provided by the Primary Care Trust, visit the home offering an hour of activity from Monday to Thursday. On Thursday, there is also an extra hour provided in the afternoon. On the day of the inspection, we saw activities being provided in the form of a sing-a-long and a quiz. The two Occupational Therapists were encouraging all the residents in the lounge to participate. The television, which had a fault at the last inspection visit, was in good working order. It was pleasing to see that the television was not on all the time, as it was recognised that some residents did not want this on constantly. The visitor spoken with said the staff team knew the residents favourite television programmes and would ensure these were on at the right time. Staff confirmed to us that they interact with the residents and provide occupation and stimulation when the Occupational Therapists are not visiting the home. A survey returned to us from a health professional confirmed that the residents have a comfortable and stimulating environment. Care Homes for Older People Page 16 of 37 Evidence: We were informed by the Manager that one resident can now go out in the community independent of staff. This, we were told, had been introduced gradually and had been risk assessed. The Manager told us that she and the staff take people for a walk and she also takes them shopping occasionally. She said that they celebrate residents birthdays with parties and one had been held the previous week. We were informed that the Catholic Church visits and weekly communion is given to those wanting this. The visitor we spoke with said they visit every day and come at different times of the day and evening. They spoke highly of the home and staff team saying they were happy with the home and what it provided for the resident. The home has a small room leading off from the lounge, where visitors can meet residents in private. Staff said they aimed to provide choices for the residents, such as what they wore each day, when they bathed and what they ate. Residents are able to bring in personal possessions for their own bedrooms. The residents living in the home were not able to manage their own finances. We observed one of the care staff making the lunch time meal. A meal of chicken casserole, mixed vegetables, cabbage and boiled potatoes was being provided. She said that alternatives could be provided but there is no advertised alternative. One person likes curry and this is provided by the Registered Providers. Another person, who does not like chicken, was eating sausages. The dessert was jam roly poly and custard. The staff said that they do not provide diabetic alternatives, but check blood sugar levels to see if the person can have a small amount of the dessert. They said that yogurt or fruit is available as an alternative. We recommended that home looks at providing desserts which are suitable for people with diabetes. There is a four week rolling menu displayed near to the kitchen but it is is very small print. The main dish of the day is displayed on a board. Although alternatives may be available, and were seen recorded in a book in the kitchen, we recommend that the home looks at providing people with a genuine choice of meal on a daily basis, to enable them to make a positive choice rather than just choose an alternative if the meal is not to their liking. We saw a variety of meals during one week, such as sausage casserole, white fish in parsley sauce, a roast, shepherds pie, and omelette and chips. The staff member who was cooking said that home made cakes and desserts are made every other day. One person did not wish to eat the meal and was provided with a sandwich. The visitor who we spoke with, said the meals were good in Care Homes for Older People Page 17 of 37 Evidence: the home and that the resident could eat the foods they wanted to. Staff were seen to encourage residents to eat, either independently or with the assistance from staff. The dining area is part of the lounge and there is a large dining room table and a smaller one. Residents can sit on their chairs and eat their meals. One resident was seen to be drinking a can of lager with their lunch, as they like to have the occasional drink of alcohol with their meal. One survey from a resident said the food was good. Those people we spoke to, who could comment, said that they enjoyed the meals. One person said I like my food and it is good and confirmed that they had sufficient. Another confirmed they enjoyed the meals. We noted that the kitchen chopping boards were scratched and in need of replacing. Subsequent to the inspection we were informed that these had been replaced. Care Homes for Older People Page 18 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were in place and residents and their visitors felt confident that any concerns they voiced would be listened to. Staff had an understanding of the procedures to follow should they suspect any abuse at the home, so helping to ensure that residents were protected from abuse. Evidence: The home records all comments and complaints and had six recorded since the last inspection in 2007. The previous Regulator, the Commission for Social Care Inspection, also received a complaint directly to them and this generated a random visit carried out in April 2009. This visit found some areas needing attention, such as meals, staffing, activities and the handling of finances. Most of these have been addressed. Further details are included in this report on the Standards on staffing and finances. Complaints procedures were seen in the bedrooms viewed. The visitor spoken with said they would raise any concerns with the Manager. Subsequent to the inspection visit we were informed that all residents are on the electoral register for postal voting. There had been no safeguarding referrals or investigations. We were informed that staff had recently attended training on this subject. The home has a copy of the Local Authoritys safeguarding policy and procedure on safeguarding. Those staff asked Care Homes for Older People Page 19 of 37 Evidence: were aware to report any safeguarding concerns to the Manager. All of the seven returned staff surveys confirmed they knew who to report a concern to. The Manager was aware of the new Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. She had completed forms for each person looking at their capabilities, which is seen as good practice. We discussed ensuring that the staff team were aware of this new legislation and the possible implications of this on the residents and staff team. Care Homes for Older People Page 20 of 37 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. The home is kept to a good standard of cleanliness. The environment is maintained. There were some areas needing attention, which would benefit the residents if these were addressed. Evidence: A tour of the premises revealed that the home was clean and free from any unpleasant odours. The communal areas and corridors had been redecorated and fitted with new carpets. A broken curtain rail was seen in bedroom one. The Manager explained that the curtain rail had been due to be repaired but the person had not visited to fix this. We also noted that there were no curtains or blinds up at the large patio doors in the lounge and dining area, which had recently been decorated. It was sunny and warm on the day of the inspection and it would have been hot to sit near to these doors. The Manager said she was looking at having blinds put up to provide shade and privacy. The kitchen worktop was also marked and worn and we were told, after the inspection, that new worktops would be fitted the week after the inspection visit. We saw that some of the bedrooms had not been decorated for a while. The Manager Care Homes for Older People Page 21 of 37 Evidence: was aware that some of the bedrooms had wallpaper that was old and needing to be updated. She explained that these rooms would be updated in the future. A clear maintenance plan that shows the areas needing to be addressed and timescales to evidence when the work would be carried out would be beneficial. The home had applied for permission to build a conservatory, which would have provided the residents with more communal space to sit in. This was turned down due to the neighbours objections, but the Manager is considering applying again in the future. As found at the last inspection in 2007 the ground floor bathroom had a difficult lock to use and we found it was not working on the day of the inspection. The Manager said this had been fixed after the 2007 visit. Residents should be able to lock areas where they need privacy. Locks must be easy to use for residents and designed so that the staff team can also unlock a door if a resident was stuck in a room. This needs to be addressed. The home has a domestic member of staff who keeps the home clean. Care Homes for Older People Page 22 of 37 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 organisation of the rota does not allow staff sufficient time to rest between shifts. People are not protected where staff work excessive hours. The recruitment processes do not evidence good practice. Training records are not maintained to show that staff have the up-to-date training required to carry out the work they perform. Staff are able to develop their National Vocational training. Evidence: We discussed with the Manager the number of staff who are generally on duty and she said that she and her Deputy Manager would usually be available during the weekdays, and there would be three additional care staff during the mornings and afternoons. The Deputy was on holiday at the time of this inspection. The home does not currently have a cook, therefore one of the care staff prepares the food and cooks each day for the residents. On the day of the inspection, the Manager was on duty with three staff until 2pm, and three staff in the afternoon, one from 4pm. Two night staff are on duty from 9pm to 8am. There are two Registered Nurses on each shift, which includes the Manager. Many of the staff have worked in the home for many years and are aware of the needs of the residents. Care Homes for Older People Page 23 of 37 Evidence: The Manager said that she had previously employed a cook for a few weeks but she had left. The home is in the process of recruiting another cook. We discussed with the Manager that the time staff are on cooking duties need to be on the rota, as there needs to be sufficient for the purpose of providing meals. As the staff should not be available for care duties during this time, because of hygiene and infection control, the number of care hours available needs to be shown accurately on the rota. On the day of the inspection we saw that the care staff were needing to spend time in the kitchen preparing the meals, therefore they were not able to spend time carrying out their caring responsibilities. On examining the rota, we found that some staff are regularly working a waking night shift (9pm to 8am) followed by a day shift of 8am to 2pm, and then returning for another waking night duty at 9pm. One staff had worked ninety hours a week recently, following this shift pattern. The Manager said that this had been a long standing practice in the home as it was the arrangement that some of the staff preferred. We discussed with her the health and safety implications of this, particularly in regard to the work staff carry out with residents, such as transferring by hoist. We found that one staff only had a seven hour break between leaving the home and returning, before carrying out another seventeen hours on duty. Although the staff are not paid for the one hour break during the night shift, there is only one other staff, so they are on call. We discussed with the Manager the fact that she is in control of the rota and the amount of hours that staff work. She must take into account the health and safety of the residents and the staff. The Manager said that she will cease this practice. The Manager must employ sufficient staff to cover the rota hours to ensure that staff work a reasonable number of hours which do not conflict with good practice and health and safety considerations. Subsequent to the inspection, the Manager informed us that the rota had been amended and that new staff would be recruited to ensure staff do not work too many hours in a row. We did not see sufficient information in the files we examined to show that all staff had up-to-date moving and handling training. The Manager said that staff do not have a refresher course annually and the last certificates we saw were from early 2007. The file of the most recently recruited staff member had no certificates. The Manager said that the person works elsewhere and has training there. The Manager must ensure that all of the required training, to promote good health and safety, has been undertaken. There is no training chart or matrix available to demonstrate that all staff have the required training and no file contained a training and development plan to show the training undertaken and that which is required. Some information on training was in a small book which had the dates of training but did not always show who had attended. The Manager said that training usually includes all of the staff and is carried Care Homes for Older People Page 24 of 37 Evidence: out in the evenings, in the dining area of the lounge. Those staff asked confirmed that they did receive training. The returned staff surveys also confirmed that they had received an induction and ongoing training. The Manager was asked to ensure that there are clear records of staff training, and training needs, to demonstrate that there is compliance with training. Following on from the inspection, the Manager informed us that she would be introducing a form to record the training attended by staff. The recruitment files we examined were not maintained in good order and did not show us that all of the required information was in place. Most staff have been in post for some years, but the file of the last recruited member of staff was incomplete. There was no application form, only one reference and no details of training. There was a Criminal Records Bureau disclosure in place, evidence of a current Nurses and Midwifery Councils PIN, visa information and induction process. The information is not filed in a manner which provides easy access to show that everything is in place. The Manager said that the missing information might be at her own home, where she has an office. She was asked to ensure that it was made available in Hadley House. The application forms did not always show a full work history, or that any gaps in employment were explored and explained. The remaining files we examined all needed organising, to show the information was available. Not all of the references had sufficient information to demonstrate that they could be checked against the application form for verification. The information, such as dates of employment and the designation of the person completing the form, was not sufficiently detailed and there was no evidence to show that further information had been sought. There were two references for each person but they do not ask the referees to give the dates of employment, therefore they cannot be compared to the application form. The designation of the person completing the reference e.g. the former Manager, was not always shown and not all had evidence of the company such as a stamp, letter heading or compliment slip, or a follow up phone call where the reference was not clear. The Manager said that two of the files we examined belonged to people who no longer work in the home. Information on the Occupational Therapists that are employed by the PCT and who visit the home to offer activities was not held in the home. This was discussed with the Manager and it was agreed that copies of the recruitment checks the PCT carry out would be obtained and held in the home. Subsequent to the inspection we were informed that this information had been requested and the Manager was waiting for a response. Although we saw evidence of a staff induction procedure in the home, lasting for four Care Homes for Older People Page 25 of 37 Evidence: days, this did not appear to include training courses. It is not in accordance with the Skills for Care induction process, which had been referred to at the last inspection visit in 2007. There is a good rate of National Vocational Qualification training and the home supports staff to complete this qualification. Care Homes for Older People Page 26 of 37 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. Arrangements and procedures are in place for the record keeping and monitoring of residents finances. Records are not maintained in a way which makes them easily accessible. Most maintenance checks are undertaken but records are not always available. Staff are supported through some formal supervision and would benefit further from having regular staff meetings. Fire protection procedures are not sufficiently robust to demonstrate good practice. Evidence: The Manager who is also the Registered provider/owner has run the home for many years. She is a qualified registered general and psychiatric nurse and has an NVQ Level 4. Observations throughout the inspection visit showed that she is aware of the Care Homes for Older People Page 27 of 37 Evidence: residents needs and interacts with residents, visitors and staff on a daily basis. A staff survey commented that the home is always trying to do something better. The Manager needs to make sure that the records are in order and that there is ongoing quality routine checks of various areas of the home. By having robust systems in place, the Manager can then be confident that the home is meeting the current National Minimum Standards. A blank survey form is included in the Service Users Guide which can be completed by the residents or their representatives. We saw a batch of completed surveys, compiled between July and October 2009. Further forms had been printed ready to distribute. There has not yet been any report produced from the results of the surveys. There were a small number of adverse comments, on the staff and on the food. As these were obvious concerns, sometimes raised by families or friends, it needs to be shown that, as part of the quality monitoring systems, that there has been a response. We discussed with the Manager the situation regarding the residents who did not have their own bank accounts. She said that the four people now have an account in their own name and we saw evidence of this. We checked the money held for two of the residents and found that a staff member had made an error in the addition, in one of the accounts, of £100. Although two staff had signed the entry, this error had not been noted. The Manager does not indicate in the book when she has carried out an audit and count of the money. We advised the Manager to always record when counts and checks have been carried out, as this forms part of the ongoing quality assurance checks of the home. We saw quite a lot of alterations to the sums of money, possibly exacerbated by the large sums they needed to count. There needs to be monitoring by the Manager to ensure that staff who have the responsibility for recording are competent to do so. Large sums of cash are being held in the home and we advised the Manager that, in order to protect both staff and residents, the sums which are kept for items such as toiletries, hairdressing and newspapers, should be kept to a minimum. This would also help the staff when counting the money as a number of errors were seen and alterations had been made to the totals. The Manager needs to be ensuring that the insurance cover is sufficient for the amounts held. We also advised, as good practice, that the residents have separate accounts book, as although each residents finances are recorded on separate pages, there could be a lack of privacy. Care Homes for Older People Page 28 of 37 Evidence: From the records we examined of staff supervision, we saw that they do have recorded supervision sessions. However, these did not meet the National Minimum Standard of six a year and we saw that approximately four a year take place. We saw a chart to show that four a year are planned, although this did not record when they had taken place. We recommended that this is increased to six sessions and the actual dates supervision takes place is recorded. Only one staff meeting a year was seen to have taken place, from the records provided. To provide staff with information and support, these should be increased. We did not view the policies and procedures on this occasion. We found the records to be in need of streamlining, archiving and regular monitoring to ensure they are up to date. We saw a brief business plan produced by the Registered Providers. This recorded, as mentioned earlier in the report, that the plans to build a conservatory was not granted by the local authority, due to local objections. We examined a sample of the maintenance records. These showed that most were upto-date, although the way in which the information was stored did not provide easy access. The Manager was advised to try and keep the files in better order to make it easier for staff to access and for us to inspect. The Legionella testing was carried out in July 2009, the small electrical appliances were tested in January 2009 and the last five-year electrical installation test in 2007. The annual gas check was carried out in August 2009. The hoists were last checked in July 2009, as was the lift. The Manager could not find the test certificate for the fire extinguishers and they had no labels to show when last tested. She telephoned the company concerned but could not get us evidence on the day of the inspection. Subsequent to the inspection the Manager informed us that the company would be visiting the home the week after the inspection visit. We checked the water in the first floor bathroom and found the bath and hand basin hot water to be very hot. The thermometer available was difficult to read but the temperatures appeared to be around 50 degrees Centigrade. We also saw in the last water testing records that there were some over 43 degrees but no record of any action was recorded. The Manager said that the water temperatures are regulated. She was advised that they must be checked as soon as possible and that action must be seen to be recorded where they are checked and are excessively hot. Subsequent to the inspection we were informed that the home had been in contact with a plumber and they would be visiting the home to sort the water temperatures. The home would also be purchasing a new thermometer. The home informed us subsequent to the visit Care Homes for Older People Page 29 of 37 Evidence: that the valve had now been replaced. We saw, on our tour of the home, that a number of fire doors did not fully close of their own accord and had to be closed manually in order to shut properly. There were also door stops close to each door. The Manager said that the domestic staff use these when cleaning. We advised her that they affect the door closing system and this practice should cease. Following on from the inspection visit we were informed that the fire doors had been adjusted so that they close fully. The fire alarms, emergency lighting and call bells were last tested in July 2009. There was a fire risk assessment in place. There was no information about the residents ability to respond to a fire and any assistance they might require. The Manager was advised to obtain the guidance for homes from the London Fire and Emergency Planning Authoritys website. This could provide information to ensure the fire risk assessment covers all necessary areas of the home. The Manager informed us after the inspection that she had obtained the fire Regulations and risk assessment information. There was no information in regard to amount of the drills, tests and maintenance visits and no risk assessments for the evacuation of the residents. Not all of the staff were seen to have been recorded as attending the most recent fire drills, in June 2009 and April 2009. The previous drill appeared to be in September 2007. There was no evidence of a drill for the night staff when only two are on duty. Fire training had taken place in March 2009 according to some of the staffs training certificates. We saw a staff member preparing food without any protection to her clothing, such as an apron. There had been a visit recorded from Harrow Community Safety stating that staff need to wear protective clothing while in the kitchen. The Manager said that it is provided but we saw it worn only for serving the meals at lunchtime. We were informed that the home was rated as four stars on food safety. Overall, the above shortfalls show that the health and safety of the residents and staff could be compromised if not addressed. This was raised with the Manager to ensure she was fully aware of the areas needing to be addressed. Care Homes for Older People Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 37 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 4 4 That further information is added to Statement of Purpose and Service Users Guide to show how the needs of people who have developed dementia are being met. To ensure that the home can demonstate that peoples needs are being met by staffing levels, activities and the environment. 31/12/2009 2 21 23 The downstairs bathroom lock needs to be repaired or changed to ensure it works. To ensure the residents privacy is respected they must be able to lock a bathroom or toilet door. 20/11/2009 3 27 13 The Registered Manager must ensure staff do not work consecutive shifts, such as waking night shifts, followed by day shifts, and where this compromises the 31/10/2009 Care Homes for Older People Page 32 of 37 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 health and safety of the residents and the staff members. To ensure both residents and staff are protected by good health and safety practices. 4 27 18 The Registered Manager must ensure that there are sufficient staff employed to ensure that excessive hours are not worked by the staff. To ensure that staff have sufficient breaks between shifts. 5 29 19 The Registered Manager must ensure that all of the required recruitment information is in place, that the records are accssible and they contain the required information. To provide sufficient information to show that there are robust recruitment practices. 6 30 18 The Registered Manager must ensure that there are records which demonstrate that staff have all of the required training and that it is up-to-date. 30/11/2009 30/11/2009 31/10/2009 Care Homes for Older People Page 33 of 37 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 provide a full training history for the staff. 7 33 24 The Registered Provider/Manager must ensure that regular reviews of the quality of care are recorded in a report that is available for residents and inspection. To ensure that the home has a visiable quality assurance process and that the views of the residents and their representatives are seen to be taken into account. 8 37 17 The Manager must ensure that records are maintained in good order, are up-todate and easily accessible. To demonstrate that the home has all of the required information available for ready for inspection. 9 38 23 The Registered Manager must ensure that the requirements of the current fire legislation are met and all of the precautionary measures in regard to fire safety are in place and operational. To ensure that the health and safety of the residents 30/11/2009 30/11/2009 31/12/2009 Care Homes for Older People Page 34 of 37 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 and staff are not compromised and that there are robust procedures in place. 10 38 13 The Registered Manager 15/11/2009 must ensure that, where hot water is identified as being above a safe level, there is a system to shown that action is seen to be taken. To ensure that people are not at risk of scalding through water being too hot. 11 38 13 The Registered Manager must ensure that risk assessments are in place to show how people would be protected in the event of a fire, including the information on their evacuation. To protect people in the event of a fire, there must be information in place to support the procedure on safety and evacuation and how the risks might be minimised. 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 30/11/2009 1 7 It is good practice to involve the views of the residents Page 35 of 37 Care Homes for Older People 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 when completing or updating their care plans. Their contributions and opinions could be added in so that staff know what the resident expects from the home. 2 8 The manual handling assessments should include more detail about the needs of the resident, staff and the environment of the transfer. This could then protect the welfare and safety of the resident and staff. That the home carries out regular random audits of medication by writing dates of opening on packs or start dates on the MAR. This provides evidence of accurate administration of medication and is an aid to internal quality assurance. That the home keeps uptodate with current guidance on medication and medical equipment which is available both on the internet and professional sources. That people are offered a choice of main meal, on a daily basis, to enable them to make positive choices rather than choose only an alterative. There should be a clear maintenance plan with timescales to address the areas needing attention around the home. That the Registered Manager has a training and development plan for each staff member, detailing training undertaken and that which is required. These should be collated into a training plan or spreadsheet to show that all of the staff have had the required training. That a limit is made as to the amount of cash which can be held on behalf of each resident. 3 9 4 9 5 15 6 7 19 30 8 35 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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