Care Home: Haven House

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What the care home does well Staff were observed to be friendly and caring towards people living in the home. We were told "X is very good, they all are, the girls work hard and are very helpful" Visitors are able to visit the home at any time so people can continue to enjoy their enduring relationships. Staff training is ongoing to help ensure people can be cared for safely and appropriately. What has improved since the last inspection? There had been some improvements in the way medicine is managed within the home including people receiving this at appropriate times and the introduction of a medication audit sheet. This had been introduced to help check that medicines in boxes had been given to people as prescribed. Seating arrangements in the home had been rearranged to accommodate the fewer numbers of people in the home and to encourage social interaction. Care plan reviews were taking place to help identify changes in people`s needs. What the care home could do better: All people living in the home must have a care plan in place which accurately reflects their needs so that it is clear what actions are required to ensure these are met. Risk assessments need to fully consider all risks to the person to keep them safe and help prevent them coming to harm. Specialist support and advice such as that from GP`s needs to be sought promptly when health problems are identified by staff to enable appropriate actions to be advised to meet the person`s needs. Complaint records need to demonstrate the investigation process, agreed outcome actions and monitoring mechanisms to help prevent any reoccurrence. The service need to demonstrate compliance with the required health and safety standards so it is clear the environment is safe. This includes demonstrating compliance with the fire precautions. All accidents within the home must be appropriately recorded, reported and acted upon to reduce the risk of reoccurrence. Key inspection report Care homes for older people Name: Address: Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 0 7 0 6 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN 01926641714 01926641714 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Haven House Residential Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 20 Date of last inspection Brief description of the care home Haven House is a conversion of three period houses in the large village of Kineton. There are twenty single bedrooms, nineteen of which have en-suite facilities. There is a shaft lift as well as two staircases, one at each end of the home. There is a sitting room and a dining room and there is level access to the garden at the rear, which gives access to the car park. Haven House is within a few minutes walk of the village Care Homes for Older People Page 4 of 33 Over 65 20 0 1 5 1 2 2 0 0 9 Brief description of the care home centre of Kineton which has three churches, hairdressers, a variety of shops, restaurants, pubs, banks and a post office. There are also two doctors surgeries, a chiropodist, an optician and a dentist nearby. There is a limited bus service to Stratford-Upon-Avon, Banbury, Leamington Spa and surrounding villages. Nursing care is not provided. People in need of attention from a nurse have access to the community nursing service, as they would in their own homes. At the time of this inspection the fees for the service were not published. Details of the fees should therefore be obtained by contacting the service direct. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. We carried out an unannounced random inspection to the home in April 2010 to check compliance against requirements that were issued at a key inspection in December 2009 and found that some of the requirements had been met during this inspection. This unannounced key inspection was carried out on 7 June 2010 from 9am till 6pm. As the inspection was unannounced the registered owner, manager and staff did not know we were coming. Before the inspection we looked at all the information we had about this service such Care Homes for Older People Page 6 of 33 as information about concerns, complaints, allegations or incidents and information collected during previous inspections. Two people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Information from the AQAA has been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, financial records, complaint records, quality monitoring records and medication records. People were observed in the lounge/dining areas to ascertain what daily life in the home may be like. A brief tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 33 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. Care Homes for Older People Page 8 of 33 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 9 of 33 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 10 of 33 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. Information about the home is not sufficiently detailed to ensure people have all the information they need to make an informed decision on whether to stay. People can be confident that their needs will be assessed but less confident that the care home are able to meet these needs. Evidence: At the last key inspection we recommended that the home produce a Service User Guide containing all of the required information to help people make a choice on whether to stay at the home. In the Annual Quality Assurance Assessment (AQAA) provided to us by the service it states Information is provided to prospective service users in the form of a Statement of Purpose and a Service Users Guide along with a brochure of the home. We were told that a Service User Guide was now available but there was no brochure. Care Homes for Older People Page 11 of 33 Evidence: The Service User Guide was found to contain limited information about the service. There were no details of the homes complaints procedure, statement of terms and conditions, sample contract or the summary inspection report produced by the Commission as required. This means that people may not have all the information they need to make an informed decision to whether to stay. Since the last inspection there have been no new admissions to the home and it was therefore not possible to evidence peoples experiences of moving into the home. The AQAA stated that a Pre Admission Assessment form is completed prior to Service Users admission and is used alongside the social services assessment, where applicable, for building a Care plan. It was evident that there were systems in place to enable peoples needs to be assessed prior to their admission and we were told that people can visit the home for a meal or to stay for the day to help them make a decision on whether to stay. Records viewed showed that peoples needs are not always appropriately reviewed so that staff have up-to-date information on peoples needs to ensure these can be met appropriately. At the time of this inspection, placements were not being made by social services to this home due to health and safety concerns. The provider gave a commitment to address these. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not benefit from having a detailed and accurate care plan necessary for making sure their care needs are met. Evidence: In the Annual Quality Assurance Assessment (AQAA) it states: Care Plans are detailed and specific for all service users. Records are kept when any health professional is contacted. Daily reports accurately record any change in health or wellbeing of a Service User. To find out whether this was the case the care files of two people who were living at the home were reviewed to see whether the home are recording, reviewing and acting upon identified care needs. Conversations were held with these two people to see if they felt their needs were being met in a way which they preferred. Conversations were also held with the deputy manager and staff to identify their knowledge of the needs of people under their care. The deputy manager stated that since the last inspection the care plans had been Care Homes for Older People Page 13 of 33 Evidence: rewritten by the recent manager who had been in post for only a short period of time. It was evident through discussions with staff that they felt ill prepared to use and update the new care plans. They felt that in some cases the care plans did not accurately reflect peoples needs and they found some of the information difficult to interpret or understand. This had resulted in staff not using the care plans as often as they should when delivering and reviewing peoples care. In some cases changes in peoples health had been recorded by crossing out information that was applicable earlier in the year to record information that was applicable now. This meant there was no clear audit trail of when a persons health had improved or deteriorated and what actions staff were required to carry out at that time. For example one person had been identified to be immobile and making no attempt to get up by themselves. This had been crossed out and changed to tries to get up and staff to be vigilant at all times, hospital bed/side for safety. There was no clear date when this change occurred. In some cases when changes had occurred they were recorded in one area within the care plan document but not in other relevant areas. This sometimes meant there was conflicting information. For example in a falls risk assessment a person was identified to have no agitation which could place them at risk of falls but in the manual handling risk assessment there was information suggesting the person would shout and lash out at people suggesting the person did have periods of agitation. The deputy manager told us there had been a recording error in the falls risk assessment. If information recorded is not accurate this could mean that staff do not provide the right support to ensure peoples needs are met. The Deputy Manager has subsequently advised that all care plans will be re-written so that carers are more comfortable with them and they are easier to follow and that these will be completed by 1 July 2010. A care plan referred to staff completing a turn chart and for the persons pressure areas to be checked at every turn. There were no records in place to demonstrate this was happening or to show which position the person had been changed to. Records should show if they have been repositioned on their right, left, or back to relieve the pressure on their skin to prevent pressure sores. Staff said there were no turn charts in place and they just repositioned the person when toileting them during the night. As there were no records it was not clear if the persons pressure relief care was being managed appropriately. Care Homes for Older People Page 14 of 33 Evidence: A pressure sore risk assessment stated that the person had a poor appetite and had suffered weight loss as a result but staff reported that the person was eating well. This demonstrates that risk assessments are not being updated when changes in health occur. Daily records seen did not make it clear which shift they were reporting on and did not show that all care needs identified were being met consistently. Risk assessments for bedrails mainly referred to risks about the bedrails and not risks to the person using them. Bedrails are considered a form of restraint and people should therefore consent to their use. There were no signed records of consent or evidence that risks relating to their use had been explained to the people using them. The deputy manager stated that there was no policy or procedure relating to the use of bedrails and this was something she would need to address. A member of staff explained that one person who had bedrails on their bed used to shuffle to the end of the bed where the bedrails ended to get out of the bed. This could have placed the person at risk of falls but this information was not indicated in the falls risk assessment. We were told that recently this person had been moved to another room and due to needing a different bed did not initially have a bedrail fitted. During this interim period the person had fallen out of bed on more than one occasion. This demonstrates that the risks associated with this person falling were not fully considered and managed appropriately. We were told that one person was at risk of self halm and they were unsettled at night and did not sleep well. We observed that the person had wounds and bruising to their skin. There was no care plan in place showing how these injuries should be managed or to indicate how or why they might have occurred. Records showed that the district nurse was applying dressings to wounds. Staff explained that the person had experienced some traumatic events during the year and was suffering with depression but there was no evidence in the records that this had been followed up with the GP. We were told that attempts had been made to arrange counselling for this person but the organisation contacted had not responded. There were no records seen to confirm contact with a counselling organisation had taken place. The Deputy Manager said that these may have been in the old records and agreed to review all care plans to make sure they contained up-to-date information. A member of staff spoken to said that the GP had been contacted on the day of Care Homes for Older People Page 15 of 33 Evidence: inspection for advice in regards to this person and they had been given details of an alternative counselling service that they could approach for advice and support. During the inspection of medicines it showed that the person was taking a medication that could affect the skin in that it could cause it to bruise more easily. Staff were not aware of why the person was on this medication or the effects this could have on their skin. Staff confirmed they would not treat this persons skin any different to anyone else in the home as they stated everyone they cared for had delicate skin. Staff should have some awareness of what medicines are for and the side effects these can have so that they can make sure these are followed up and acted upon appropriately. In some cases the medicine dosage had been changed to a lower dose but because staff had continued to use the same medicine chart, it was not clear when the lower dosage had started. Pain relief medicine was not always being given as prescribed. For example the GP had prescribed two tablets to be given when required but staff were giving one or two when required. Medicine needs to be administered as it has been prescribed to make sure this is effective in managing the persons symptoms. Any changes to dosages need to be agreed with the GP as appropriate. Medicines were on the whole being managed well. Since the last inspection new audit sheets had been implemented which involved counting medicines in boxes to make sure the amount received, given and remaining were correct for each person. The privacy and dignity of people was generally found to be respected, people were suitably dressed for the time of year and were assisted with personal care in private. One person who was sitting in a reclined chair did have most of their legs exposed and said they felt cold. We also established that one person was receiving their personal care during the morning in a way that could compromise their dignity. This was discussed with the deputy manager with a view to ensuring this was the preferred option of the person. People spoken to during the inspection stated They look after us well, good staff, but trying sometimes with the older ones, I get a lot of fuss and there are those who cant do anything, I am happy here. Care Homes for Older People Page 16 of 33 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. People have limited access to social activities to maintain their recreational interests and needs but enjoy a varied diet. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the service states Activities are currently on an ad hoc basis relying on the choices made by residents. There is a list of activities to help prompt staff and service users as to possible options. Staff interact with residents throughout the day chatting, reading newspapers, magazines, helping with puzzles, giving manicures and hand massages etc. During the inspection people were seen watching television and talking to staff. Staff said that social activities still included opera twice a week. This is an external organisation that helps people to undertake gentle exercises to music. One person who had been sitting alone for much of the day became frustrated when they went to join other people in the conservatory who then left. Staff offered to take them out for a walk in their wheelchair which they were very grateful for. When they came back it was evident their mood had lifted and they were much happier. Staff told Care Homes for Older People Page 17 of 33 Evidence: us they take people into the village but confirmed there had been no specific trips or other outings arranged. Another person commented that it was very quiet and they were looking forward to going home. Social activity records had been completed and these demonstrated very little variation and frequency in social activities being provided to people. The AQAA states that Menus are planned in advance enabling the residents to see the forthcoming choices as to meals. Due to the nature of the Home residents are only asked to make their choice of meals at the mealtime as they would not always remember they had previously made a choice. Since the last inspection menus had been updated but we were told that menus were not being followed due to the low numbers of people in the home. Staff said that people were asked if they would like the meal that had been planned and if they did not, something different was prepared for them. Care plans held details of peoples likes and dislikes and comments received from people about the food included alright very good for a home. One person said there was a choice and another said there was not. Care Homes for Older People Page 18 of 33 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. There are systems in place to respond to complaints or allegations of abuse although recruitment processes may not always be sufficiently robust to help make sure people living in the home are protected from harm. Evidence: Following the key inspection to the home in December 2009 a requirement was made to keep a written record of complaints. Following this inspection we received an improvement plan which stated We have set up a complaints procedure and new posters have been put up to include names and addresses of who to write to. We have a book in the office for all complaints to be recorded. During a compliance visit in March 2010 we were given a folder containing correspondence relating to complaints. This contained details of a complaint received and a copy of a letter of response written. There was no book detailing the complaint, what investigations had been carried out or what action had been taken such as a monitoring mechanism to prevent a reocurrence. During this inspection visit, this information remained the same. There was a complaints procedure available in the home although this was not included in the Service User Guide to ensure people were aware of this. We were told there had been no safeguarding allegations since the last inspection. Records showed that most of the staff had completed abuse awareness training but it Care Homes for Older People Page 19 of 33 Evidence: was unclear when others had completed this. The deputy manager said she would check training completed and update the training matrix. During this inspection we found that care records including risk assessments were not accurate and staff were not always aware of information contained within these records or how to use them. This could mean that risks to peoples health may not always be fully considered and managed to ensure the health, wellbeing and protection of people is maintained. A recruitment record checked did not contain references from the persons most recent employer. This means recruitment systems may not be as robust as they could be in securing the protection of people living in the home. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable and clean environment but which is subject to ongoing improvements to meet with health and safety requirements. Evidence: The home has one communal lounge and one dining room both of which were comfortable and homely. People are able to access the garden at the back of the home via a ramp and can view the garden from the dining area. Seating arrangements in the lounge had been changed since the last inspection so that people could sit together in smaller groups. The dining room seating arrangements had also been changed following the number of people living in the home reducing. Staff told us that everybody in the home now had their meals in the dining room. During the last key inspection a requirement was made for the home to be maintained in a clean condition consistently. We received an improvement plan from the home which stated, We have employed a full time cleaner and laundry lady and are advertising for another so we can ensure all days are covered and the home is kept clean and fresh. During a compliance visit in March 2010 the manager told us that they had two members of staff who were completing cleaning between them seven days a week. Bedrooms and communal areas viewed were found to be clean with no Care Homes for Older People Page 21 of 33 Evidence: unpleasant odours. Since this date a fire inspection identified concerns relating to fire safety. This resulted in people on the first floor moving out of the home while the works required could be completed. Due to the numbers of people living in the home reducing to six, we were told that the numbers of staff working in the home had also been reduced and care staff were now completing the cleaning and laundry tasks. There remains a number of areas that need to be improved if the home are to comply with fire precautions. The provider confirmed that work was ongoing to ensure these are addressed. We were also told that improvement work was taking place in the new building so that people can use this area. During our visit we viewed the new build and it was evident that some of the work we had identified as needing to be addressed had been done. On the day of inspection there was also a maintenance person working in the home addressing the issues raised in the fire risk assessment provided to the home by a fire consultant. The laundry is located in two separate buildings outside of the home, one area is for washing and one for drying. Gloves and aprons were available to maintain good hygiene. Care Homes for Older People Page 22 of 33 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. People are being supported by sufficient numbers of staff to help ensure their needs can be met. Evidence: We were told during this inspection that there was no longer a manager at the home and the deputy manager was managing the home. We were told there were six people living in the home. The deputy manager said that the current staffing arrangements included two carers plus herself or a senior during day up to 8pm and at night, one carer who is awake and one who is asleep who can be called upon if needed. We observed the day staff numbers to be available as stated. The home employs a cook who works seven days per week and we were told care staff were doing any cleaning and laundry as required. Duty rotas seen showed that the number of staff on duty each day was as we had been told by the deputy manager. Staff spoken to said that they felt there were enough staff on duty and they were able to complete the laundry and cleaning duties without this impacting on the care of the people living in the home. People were observed to be supported by staff when required. Some people needed assistance to the dining room or with personal care in their rooms. Care Homes for Older People Page 23 of 33 Evidence: We were told that staff training had continued to take place for the eleven staff working at the home. A training matrix was seen and this showed that all staff had completed fire and moving & handling training and all but one member of staff had completed food hygiene training. We were told that six of the staff have achieved a National Vocational Qualification (NVQ) 2 in care and others were in the process of completing this. This training helps staff to develop skills in identifying and responding appropriately to peoples needs. Staff spoken to confirmed they had completed the training as detailed on the training matrix and were aware when specific training was due to be updated. They also told us they were not clear on how to use the new care plans devised by the previous manager who was in post for a short period of time. This suggests there is a training need around the compilation, reviewing and updating of care plans so that staff can ensure the needs of people are met effectively. We were told that all new staff employed had left due to the reduction in numbers of people at the home. It was therefore not possible to audit the recruitment files for new staff. A file for an existing member of staff was viewed to determine the process used by the home for recruitment. This contained all of the required documentation such as a Criminal Records Bureau check and references. It was found that both references obtained appeared to be from work colleagues as opposed to the employer. To ensure robust recruitment practices references should always, where possible, be sought from the most recent person who employed them. During the last inspection we advised the home to review their induction training to ensure this was being provided in accordance with the Skills for Care Common Induction Standards. It was not evident that actions had been taken to pursue this to ensure any new staff were able to complete this training. This training enables staff to build up their competencies over a number of weeks so they can care for people safely and effectively. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that the service will always be managed in their best interests. Evidence: The manager that was in post at the last key inspection had left. Following the last key inspection to the home a new manager was appointed however we were advised during this inspection they had also left. The deputy manager advised that she was supporting the provider with the management of the home. We found during this inspection that a number of improvements were still required in regards to the management of the home. This included the service acting swiftly to seek professional advice when people develop health problems, ensuring accurate care records are in place to meet peoples needs, completing risk assessments which fully identify the risks to people to prevent them coming to harm and ensuring staff are clear on what they are required to do to meet the needs of people. Care Homes for Older People Page 25 of 33 Evidence: Action will need to be taken to appoint a suitably qualified and experienced manager so that people who use the service can be confident the service will be managed in their best interests. It was evident that the recent departure of people from the first floor had impacted on the other people living in the home as well as the staff. People commented the home was very quiet and this was observed. Some of the people expressed a wish to go home. We were told that once actions had been taken to address the work required to meet the fire precautions on the first floor and assuming peoples needs could still be met, people could be given the option to move back into the home. It was not clear how long this work would take to be completed. A fire risk assessment had been provided to the home by a fire consultant and included numerous items that had to be addressed in the home. Dates of completion or action taken had not been fully recorded so it was not clear what had been done and what remained outstanding. This information needs to be recorded so that it is clear that appropriate actions have been/are being taken to minimise any potential risks to people living in the home. A commitment was given to forward this information to us by 11 June 2010. (At the time of writing this report this had not been received). During March 2010 the service had undertaken their own quality surveys with relatives to assess their views on the care and services provided. One hundred per cent said their relative seemed happy and content and said they were always informed of changes in their relatives health. Ninety per cent said they were happy with the social activities and ten per cent said there could be more choices. Actions had been identified to address these including plans to recruit an activities person but it was not evident this had been pursued due to recent changes in numbers of people living at the home. Seventy five per cent of people living in the home said the food was very good and twenty five per cent said it was satisfactory. Actions identified included the introduction of new menus but we found these were not being followed although alterative options were being offered. A staff meeting had taken place which identified a number of areas that staff would like to see improved including information being carried over more and staff need to work better as a team. Care Homes for Older People Page 26 of 33 Evidence: It was not evident that any actions had been identified to address these issues. People spoken to were generally happy with their care comments included:X is very good they all are, the girls work hard very helpful I am happy here but then stated they wanted to go home to see their parents. A trip would be nice to lift spirits. Asked about meals choices, one person said I wouldnt call it a choice but its nice. The home holds small amounts of money to purchase items on behalf of people who use the service. We viewed the personal financial records for two people and found records and monies kept were accurate. Receipts were not available for all transactions to confirm that items or services had been purchased on behalf of the person. The deputy manager advised that in some cases the representative of the resident had asked to keep the receipts. If copies are not maintained in the home then it is not possible to audit records effectively to demonstrate their money is being managed appropriately. It was evident that some of the accidents where people had fallen in the home had not been recorded in the accident records. This information was found to be recorded in other areas of the homes care documentation. If a central record of accidents is not maintained then the risks associated with people falling may not be fully recognised, considered and acted upon. Health and safety checks were in the process of being completed as part of the fire risk assessment and improvement plan for the home. We did tour the home to view some of the improvements in the new building that had already been undertaken but it was evident there were still more to be completed. It was therefore agreed that in addition to the fire risk assessment, an improvement plan would be forwarded to the Commission to confirm the home were complying with health and safety requirements. Care Homes for Older People Page 27 of 33 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 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Each person must have a 05/07/2010 care plan which accurately reflects their needs and how these are to be met by staff. This is to ensure their needs are identified as well as the staff actions required to maintain their health. 2 7 13 Risk assessments relating to 05/07/2010 the use of bedrails must include any potential risks to the person and demonstrate their use would be in the persons best interests. This is so people who have bedrails fitted are not placed at risk of entrapment, falls or other injuries. 3 8 12 Specialist support such as 05/07/2010 the advice of GPs must be sought promptly when problems are identified in persons health. Records are to demonstrate any Care Homes for Older People Page 29 of 33 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 specialist support sought and given. This is to ensure peoples health care needs are managed effectively. 4 9 13 The start dates for any changes in dosage to medicines must be clearly recorded on medication records. This is so it is clear what medicine people have received to maintain their health. 5 37 37 All accidents within the 30/06/2010 home must be appropriately recorded, reported and acted upon to reduce the risk of any reoccurrence and ensure risks are appropraitely managed. This is to help ensure people living in the home are not placed at any unneccessary risk of harm. 6 38 13 The service must take action 11/06/2010 to demonstrate compliance with fire the precautions. This is to include completion of the fire risk assessment action plan showing dates of works completed or proposed to demonstrate this. 05/07/2010 Care Homes for Older People Page 30 of 33 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 This is so people can feel confident the home is safe to live in. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 A Service User Guide which contains all the necessary information about the home needs to be available to people so that they can make an informed decision on whether to stay. A clear policy and procedure needs to be developed for the use of bedrails. Where a person is assessed as needing bedrails, signed consent for their use should be sought from them or their representative so it is clear they are in agreement for them to be used and understand the risks associated with their use. The service should ensure that people are involved in decisions relating to the way their personal care is delivered. Care records should clearly demonstrate any agreements to show that peoples privacy and dignity is being maintained in a way that they are happy with. The range and frequency of social activities being provided needs to be reviewed to ensure people are able to spend their day doing something that is of interest to them. Following the receipt of a complaint, there should be clear records of the investigation processes, agreed outcome actions and monitoring mechanisms to help prevent any reoccurence. The complaints procedure should be included in the Service User Guide so this is easily accessible to people who use the service and their representatives. 2 7 3 10 4 12 5 16 6 19 The service should ensure that there is a detailed maintenance plan showing all works completed and Page 31 of 33 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 planned in the new building to demonstrate the building is safe and suitable for people to live in. 7 29 Recruitment records should demonstrate that references have been sought from the last employer (where appropriate) as opposed to work collegues. This is to help ensure systems are robust in protecting people living in the home. It is advised that staff complete training around the compilation, reviewing and updating of care plans so they are clear on what is required of them in meeting the needs of people safely and effectively. The provider needs to confirm the proposed arrangements for the ongoing management of the home. This is to ensure the home is effectively managed and peoples needs are met. The service needs to demonstrate that the comments made as part of the homes quality monitoring surveys have been acted upon so that people can feel confident their views have been listened to and taken seriously. 8 30 9 31 10 33 Care Homes for Older People Page 32 of 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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