Care Home: Magnolia House

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What the care home does well The home had a warm and friendly atmosphere. Care was delivered by staff in a calm unhurried manner. We noted that staff conversed and consulted in a natural manner with residents throughout the day. The rapport between staff and residents was supportive and accommodating. Staff were very co-operative and helpful to us throughout our visit. Residents were very positive about the care they receive and spoke of the caring disposition of staff. Relatives were also positive about the care provided by the home and of the warm welcome they received. The visiting professional was positive about the care and attention given to the residents who they visit on a regular basis. They told us that the care provided to residents who had been admitted with pressure sore areas had been `excellent`. Staff on duty were knowledgeable about individual resident`s specific care needs. Residents were positive about the provision of food and the level of social activity provided by the home. Residents were cared for by a stable core group of staff. This had provided continuity of care for residents. What has improved since the last inspection? The last inspection took place in November 2007. There had been replacement of some essential utility equipment such as fridge, freezer, kitchen equipment and bathing equipment. We noted that one bedroom had been redecorated and one was in the process of being decorated. Records of what residents had eaten at all meals was improved. What the care home could do better: The external, internal decoration and maintenance of the home was poor. The appearance of the external fascia and internal decoration was unkempt, in poor condition and shabby. We were told by the manager that there was no decoration or improvement plan in place. The AQAA stated `the maintenance of the home has been neglected by the owner for a while, we need as said before a make over`. Residents, staff, relatives and the visiting professional all commented on the poor physical state of the home. This must improve to ensure that residents live in a well maintained environment. Staff on duty had a good understanding about residents` care needs. This was not supported by a robust care plan and risk assessment recording system. The care plan system was poor and residents were at risk because their care needs were not recorded. The AQAA stated `care plans are tailored to their individual needs`. This was not the findings of the inspection. Staff recruitment and training records were poor. This meant that residents could not be confident that those caring for them had been subject to all the necessary checks and had received adequate training. The lack of a robust recording system meant that the manager was unable to demonstrate that these issues met with regulatory requirements. The general management of administration and documentation was poor. There were few robust systems in place whereby the information we requested to see was not always current and in place. The AQAA stated ` (under what we do well) ensuring paperwork is up to date...create new filing systems...better organisation of office/care plans...staff find information they require`. This was contrary to the evidence we found during the inspection. There was no documentation in place to demonstrate that the provider (or a representative) visits the home on a regular basis as required by regulation. One aspect of this requirement is for the provider to be satisfied that the home is being managed on a day-to-day basis in accordance with regulatory requirements. We were shown documentation and paperwork regarding utility bills that had not been paid and official letters and reports that had not been responded to by the provider. There was no improvement plan or quality assurance system in place. There was no evidence that the manager receives support, guidance or supervision from the owner of the home. There was no process in place to monitor the day to day management of the home. The registered provider must ensure that they fulfil their legal obligations. There must be competent leadership in the home. This is necessary for the wellbeing, safety and welfare of residents. Details of our findings to support the information given in the above can be found within the body of the report. Key inspection report Care homes for older people Name: Address: Magnolia House 54 Salisbury Road Leigh On Sea Essex SS9 2JY     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: Ann Davey     Date: 0 8 0 4 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 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) © 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 37 Information about the care home Name of care home: Address: Magnolia House 54 Salisbury Road Leigh On Sea Essex SS9 2JY 01702712222 01702712222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Magnolia House Nursing Homes 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 - Code OP - maximum number of places 20. Date of last inspection Brief description of the care home Magnolia House is a detached property situated in a residential area of Leigh on Sea close to shops and the seafront. It is an older building that retains a lot of original features such as fireplaces and panelling. The accommodation is over two floors with a passenger lift for access by residents with limited mobility. There are two lounges, a dining room and a mix of individual and shared bedrooms, some of which have en Care Homes for Older People Page 4 of 37 Over 65 20 0 Brief description of the care home suite facilities. There is a small patio area with wheelchair access and garden furniture for use in good weather. The weekly fees for the home are £391.00 - £550.00 depending on the source of funding, accommodation available or requested and the level of care required. Full details of the fee structure can be obtained by speaking with the manager. 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: 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: The last key inspection took place on 21st November 2007. We completed Annual Service Reviews on 7th November 2008 and 22nd February 2010. We noted on this inspection that the provider was not displaying their current registration certificate. It is an offence not to display the current registration certificate in a conspicuous place. We are aware that the registration information on page 4 of this report requires amending. This refers to additional conditions (2) - this should read 20 not 40 as stated. This is being addressed by our registration team. This inspection took place over approximately seven hours. The visit started around 9am and finished approximately 4pm. The home does not have a registered manager. We were assisted throughout the inspection by the person designated to be in day to day control of the home. We have referred to this person as the manager throughout the report. The homes current Annual Quality Assurance Assessment (AQAA) which is required by law was undated but received by us on 27th January 2010. The document provided the Care Homes for Older People Page 6 of 37 home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. The document had been completed by the manager. We sent questionnaires to the home asking that they be distributed to stakeholders and returned to us so that we could have an understanding of how residents, staff and health/social care staff felt about the provision. The manager told us that they had been distributed to stakeholders but we have not had any responses. During the day we spoke with the manager, residents, a visiting professional and staff. We looked around the home, viewed aspects of various records and observed care practices. We suggested to the manager that they make like to inform the owner of the home that an inspection was being undertaken. The manager was unable to contact the provider and they spoke with the providers representative. Neither the provider or a representative came to the home or spoke with us on the telephone during the inspection process. We discussed all our findings during the inspection with the manager. We asked that they took notes so that immediate development work could be started where necessary. We appreciated the co-operation and assistance given to us by the residents, staff, visiting professional and manager throughout the day. 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: The external, internal decoration and maintenance of the home was poor. The appearance of the external fascia and internal decoration was unkempt, in poor condition and shabby. We were told by the manager that there was no decoration or improvement plan in place. The AQAA stated the maintenance of the home has been neglected by the owner for a while, we need as said before a make over. Residents, staff, relatives and the visiting professional all commented on the poor physical state of the home. This must improve to ensure that residents live in a well maintained environment. Staff on duty had a good understanding about residents care needs. This was not supported by a robust care plan and risk assessment recording system. The care plan system was poor and residents were at risk because their care needs were not recorded. The AQAA stated care plans are tailored to their individual needs. This was not the findings of the inspection. Staff recruitment and training records were poor. This meant that residents could not be confident that those caring for them had been subject to all the necessary checks and had received adequate training. The lack of a robust recording system meant that the manager was unable to demonstrate that these issues met with regulatory requirements. Care Homes for Older People Page 8 of 37 The general management of administration and documentation was poor. There were few robust systems in place whereby the information we requested to see was not always current and in place. The AQAA stated (under what we do well) ensuring paperwork is up to date...create new filing systems...better organisation of office/care plans...staff find information they require. This was contrary to the evidence we found during the inspection. There was no documentation in place to demonstrate that the provider (or a representative) visits the home on a regular basis as required by regulation. One aspect of this requirement is for the provider to be satisfied that the home is being managed on a day-to-day basis in accordance with regulatory requirements. We were shown documentation and paperwork regarding utility bills that had not been paid and official letters and reports that had not been responded to by the provider. There was no improvement plan or quality assurance system in place. There was no evidence that the manager receives support, guidance or supervision from the owner of the home. There was no process in place to monitor the day to day management of the home. The registered provider must ensure that they fulfil their legal obligations. There must be competent leadership in the home. This is necessary for the wellbeing, safety and welfare of residents. Details of our findings to support the information given in the above can be found within the body of the report. 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 9 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 10 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can not expect to have have access to information about the home or to have their assessed care needs fully documented. Evidence: The previous inspection report was displayed in the entrance hallway. In the hallway, there was some helpful leaflets about various aspects of life within the home. For example, there were details about the independent advocacy service, community nurse contact details and health and safety notices. The manager was not able to locate the homes Statement of Purpose or Service Users Guide. This means that information and detail about the management structure of the home and the service and activities available was not available and could not be located. Both these documents are a regulatory requirement. We looked at the pre-admission and admission records selected at random of two residents who had been admitted to the home within the past four months. There was Care Homes for Older People Page 11 of 37 Evidence: a pre-admission assessment document on both files. Some information had been recorded on the document but the detail was brief in relation to the known care requirements at that time. Both residents had specific care needs for identified health matters which were known to the manager before admission. These care needs had not been recorded on the pre-admission document. The manager confirmed our findings. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care was delivered intuitively by staff, but residents cannot expect to have their known health and social care needs recorded in a way to promote a safe and competent delivery of care. Evidence: We looked at and assessed various elements of case records selected at random belonging to five residents. In all five records, the known care needs had not been recorded. All five residents had very clear and precise health care requirements that had not been recorded on their respective care plan documentation. The community nurse was supporting the home with two of these residents, but the nature of their medical condition or the nurses involvement was not noted. On the back of these care plans was a section for review. On one care plan between 26/6/04 and 29/3/10, there were 70 entries of no change to care plan. The manager confirmed that this residents care needs had changed. We noted that within care plan documentation there were outdated body weight records for residents. The manager advised us that this was because the weighing apparatus had broken and had not been replaced. Care Homes for Older People Page 13 of 37 Evidence: We noted that one resident had been admitted to hospital but the care plan had not been updated on their return to the home. Another resident was being seen in outpatients for a current bone fracture. This was not recorded in their care plan. Another resident had received medical treatment as a result of a fall. This was not referred to within their care plan documentation. Risk assessments were either not present or inadequate. One resident was known to have a history of falls. There was no risk assessment in place. Another resident had a condition which required specific universal infection control measures to be in place. There was no risk assessment in place. One resident had three falls in one week. There was no risk assessment in place. We discussed all our findings with regard to the five records we viewed. This report contains a sample of our findings. The manager confirmed our findings as being an accurate reflection of the care plan and risk assessment documentation system within the home. We spoke with a number of staff who were on duty about the care needs of residents. Those we spoke with had a good understanding of the current care needs and how to meet them. We noted that the equipment and resources required to assist staff meet specific care needs were readily available within the respective residents bedroom or immediate surroundings. We spoke with a community nurse who visits the home on a very regular basis to undertake specific nursing duties. The nurse was very positive about the practical care staff had provided to the residents in their clinical care. They told us that (named resident) had done so well and purely down to the good care given by the home. The nurse told us that their instructions were always followed and they had a good relationship with all staff. We spoke with three relatives who were visiting the home. All three spoke very positively about the care provided to their respective relatives. Some of the comments we received were excellent care...staff knowledgeable...(home) needs makeover for sure but care is good...been to several homes, but this is the best for care. During the day we spoke with a number of residents about the care and attention they received. All were positive. Some of the comments included wonderful care...night staff are so good...staff are concerned about me and its lovely...always a laugh and a joke here...staff are lovely...yes, I have choice...they are so good when I need to use a commode, they make sure thats its all dignified if you see what I mean...I feel that staff know about my problems and that makes me feel safe. We observed various aspects of care practices during the day. Care was provided in a sensitive supportive manner and undertaken in a dignified way. Residents who were Care Homes for Older People Page 14 of 37 Evidence: being cared for in bed told us that they were very comfortable and confirmed that they had access to a call bell. Those within the lounge area in the afternoon appeared content and comfortable. We observed that communication between residents and staff was warm, friendly and supportive. We noted that the home maintained a daily communal record book which was located in the lounge area. This area was used by all visitors, relatives, residents and staff. The book was open and we noted the following entries (name of resident) is very sore under her left breast and had no cream to put on...(name of resident) no bath, unwell, strip wash...please call GP for (name of resident) as x was very weepy this evening...(name of resident) is only to be up for (time given) this is to include commode time, very strict. We advised the manager that personal information should not be left in a public area. This information is personal and private and must be kept in a secure area to uphold individual residents dignity. The manager told us that medicines were administrated by a trained member of staff. We asked to see training records to support this but they were not available. The manager said the home had not received them yet from the trainer. We asked if the training was about how to use the (brand name) recording system or how to manage the administration of medicines in a safe way. The manager was unsure about this and from what we were told, it would seem that the training was on how to manager the system and not about safe administration. The medicines storage trolley was chained to a wall in the dining area. We noted that some medicines were required to be stored not above a certain environment temperature. There was no means of the manager knowing what the temperature of the immediate environment was to ensure that medicines retain the correct components and remain safe to use. We sampled entries within the medicines administration recording system and noted no obvious anomalies. The contents of the storage trolley were orderly with no undue overstocking of medicines. We noted within the medicines records that the home had controlled medicines in stock and we asked to see the storage and recording system for them. The medicines were in a double locked metal cupboard within the office area. The cupboard was not secured in the way required by current guidance. It was secured to a stud wall. The manager was advised to access our website to obtain current guidance about the correct fixing of this cupboard. We checked the current controlled medicines within the cupboard against the record held by the home and the numbers corresponded. We noted three other bottles within the cupboard containing a liquid suspension of another controlled medicine. This medication had not been required since January 2010 and the medicines had not been returned to the pharmacist. We asked to see the audit trail of this medicine, but it was not available. Care Homes for Older People Page 15 of 37 Evidence: The manager agreed to return this medicine to the pharmacist quickly and make a record of their actions. Care Homes for Older People Page 16 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. Residents benefit from a balanced diet and an activity programme which meets their current wishes. Evidence: From the sample records we viewed, residents had been provided with choice and variety of food and drinks at breakfast, lunch, tea and supper. The records had been well maintained. The menu for the lunch was displayed in the dining area. Lunchtime tables had been attractively laid with linen cloths, place mats, cutlery neatly arranged, serviettes and a flower decoration in the centre of each table. One resident told us its always like this. Lunch looked appertising and was seemingly enjoyed by residents. We observed that residents who required assistance with their food were being assisted by staff in a sensitive and dignified way. Later in the afternoon we noted that a member of staff was speaking with individual residents about their choice of food for the evening meal. Residents told us that this was a regular occurrence. One resident told us they always come round and nothing is too much trouble, they know what I like. During the time we were in the home we noted that residents were supplied with regular drinks. We noted that some residents were required to have their fluid intake monitored. Those records seen were current. Care Homes for Older People Page 17 of 37 Evidence: It was evident that the home does not have a structured activity or social programme in place. Neither was there a designated member of staff who undertook these specific duties. We spoke to various members of staff and residents about this aspect of care. Residents told us that from time to time outside entertainers come in and this had very much been enjoyed. Other residents told us that they are taken out by their respective relatives and friends. We noted that some residents indicated that they preferred to spend much of their time in the privacy of their own bedrooms. We noted that there were a number of board games, books and other items of recreational usage in the lounge area. In speaking with the large majority of residents (some in the privacy of their bedrooms and others in small group settings), all expressed complete satisfaction about the current arrangements for their social and recreational needs. Those residents cared for in bed for long periods of time told us that they were not bored and somebody is always popping in. During the afternoon we noted that staff were engaging with residents on a one-to-one basis with other residents enjoying the occasion. Whilst there may not be a structured activity or social programme within the home, the current arrangements met the needs of all residents we spoke with. A local church holds fortnightly service within the home. Residents told us that these times were enjoyable. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may find that any complaint may not be recorded effectively and staff may not know how to manage any safeguarding matter appropriately. Evidence: The homes complaints procedure was displayed in the entrance hallway. We noted that the details to contact us was out of date and we asked the manager to amend the document. Residents and relatives told us that they would feel confident in raising any matter of concern with the manager. We asked to see the homes complaints record book. The manager handed to us a hard back book with insecure pages within it. The last entry in the book was February 2002. The manager subsequently found some more paperwork about a complaint dated August 2003. The manager told us that there had been no complaints made since that date. Whilst we accept that this may well have been the situation, there was no evidence to demonstrate that the home had a fully functional complaint record system in place. We spoke with three staff about their understanding of the term safeguarding residents and what action they would take if an incident was suspected. A carer told us that they would refer the matter to the manager. The manager and the senior carer did not demonstrate a clear understanding of the correct reporting procedure. We asked about staff training in this matter. The manager was unable to provide clear information about this. We asked to see the homes printed guidance on such matters. There was no current guidance in place. We asked the manager to immediately Care Homes for Older People Page 19 of 37 Evidence: contact the local authority and ask that guidance be sent by return. We also asked that the manager arrange and confirm a date for their safeguarding training. The manager made contact with the local authority and guidance was being put in the post that evening. We advised the manager that guidance would also be on the local authority website and they should look at this with immediate effect so that residents would be kept safe. The manager was unable to print this information off as the printer was out of action. Following their phone call to the local authority, the manager advised that they had obtained a place on the next safeguarding training session which was planned for 19th May 2010. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a poorly maintained environment. Evidence: On arrival to the home, we observed that the external decor and maintenance to the property was not of a good standard. The appearance was shabby and uncared for. During the morning we looked around the home accompanied by the manager. During the afternoon we looked around various areas of the home again when we spoke with residents in their bedrooms. Throughout the home we noted that the maintenance, soft furnishings, carpets, decor were generally not of a satisfactory standard. The environment was generally very shabby in appearance. In the rooms we visited with the manager, we made detailed notes of our findings. The areas which were noted included peeling sections of wallpaper, poor quality of beds and furniture, rusty frames for commodes, windows in bedrooms that would not open or were obscured because they had blown, poor reception on televisions, stained and rucked carpets, the poor condition of water pipes in some ensuites, there was a broken toilet cistern in one ensuite, a narrow first floor corridor was cluttered with a laundry trolley, refuse bin, lifting apparatus and a wheelchair, poor state of the staff room, there was piles of fluff behind the laundry machinery and inadequate storage space within the office area. The manager confirmed all our findings. Care Homes for Older People Page 21 of 37 Evidence: The manager showed us a bedroom that had recently been redecorated. We noted that the room had a washable floor surface in it. When we asked why there was no carpet we were informed that the previous residents did not require it. Within this room we noted that neither of the two fan light windows could be opened. This meant that the resident in this room could not enjoy any fresh air. We were taken to a second bedroom that was in the process of being redecorated. We were unsure about the responsibilities of the person undertaking the decoration as they were on duty as a senior carer. We were shown a bathroom that had recently had a new bath and hoist fitted. Whilst we acknowledge the new bath and hoist, we noted that the decor was poor, the radiator cover was broken, paintwork was poor, there was no light shade and the commode frame was very rusty. This bathroom was being used for residents. We asked to see a decoration or a maintenance programme. We were advised that there were none available. We noted that there was a hospital style bed being used in one of the rooms we viewed. The manager told us that the resident occupying the room didnt require this, but the bed had been used by the previous occupant. The manager told us that they they would like the provider to purchase more of this style of bed. We advised that the home did not provide nursing care and unless there was a particular recorded need, beds should not be hospital style as this may detract from the category of registration. We would acknowledge that although the home was shabby, we did not have undue concern about the general standard of hygiene or cleanliness within the home. The areas for which domestic staff were responsible, were of an general acceptable standard. Domestic staff were trying to keep clean a shabby environment which had not be adequately maintained by the provider. The manager showed us correspondence from the Fire and Rescue Service, Environmental Heath Department and Southend Borough Council all requiring improvements to be made. The manager told us that some requirements had not been read or acknowledged by the provider. The overall physical standard of the home was poor. We acknowledged that the atmosphere within the home mainly created by staff was warm and friendly. The lounge area although not particularly furnished and decorated well was welcoming and comfortable. Residents who were in their bedrooms told us that it could be better...shabby...needs money spent on this place...dreadful in parts. We noted that staff had made residents bedrooms homely and comfortable with many rooms containing personal and sentimental items. We noted that one resident had a private telephone line installed. Care Homes for Older People Page 22 of 37 Evidence: There was no grassed garden area at the back of the home. There was a balcony outside the lounge which led down to a relatively small paved area with shrubs and plants. The outside garden area had potential, but looked shabby and uncared for. Care Homes for Older People Page 23 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. Residents are looked after by caring staff but may be at risk because of inadequate staff recruitment and training records. Evidence: Staff on duty were pleasant and friendly. We noted that they had a good rapport with residents, relatives, a visiting professional. Staff provided good practical care in an unhurried, calm and pleasant manner. We noted that residents were responded to by staff promptly and with courtesy. We asked to see the current rota. The manager told us that they had been unable to produce it because the printer had broken down. The manager explained that staff do the same every week and showed us the previous weeks rota. We were told that staff complete a daily signing in sheet. We noted that it had not been completed for the day. The manager told us that they work six days a week and up to 55 hours a week in the home. We were advised that in the morning and afternoon there was usually the manager and three carers on duty, in the evening there was the manager and two carers and at night, two care staff were on duty. We were advised that the home employs a cook and a cleaner. The cleaner who was rostered to be on duty the day of our visit was on sick leave. During the day we noted that the above stated numbers of staff were on duty. The manager was aware that there must be an accurate record of staff on duty at any one time. Care Homes for Older People Page 24 of 37 Evidence: At the time of the inspection, the home was accommodating fifteen residents. The manager, staff and residents told us that the number of staff on duty was sufficient and adequate to meet the care needs of residents. Residents were very positive about staff. They told us they look after me so well...staff are lovely...wonderful care...always have time for a laugh and a joke...they listen to me...their concern is lovely. Relatives told us they do a brilliant job...excellent care...staff are knowledgeable. A visiting professional spoke very positively about staff. Staff spoken with told us that they they enjoyed working in the home and spoke of team spirit...we all work together...I like it here...I love the residents...the key worker system works well. We asked the manager for staff training records. They told us that there was no formal plan of future training and there was no formal record of training that had been completed. The manager told us that they had found training for staff difficult to arrange because of the providers financial constraints. There was a folder containing a random selection of training certificates. There was no index or structure to the folder which made viewing very difficult. We noted on the wall that there were a number of NVQ certificates for staff. We asked about this and was advised that the manager had completed their NVQ level 3 and was planning to commence their level 4 NVQ later this year. Four staff had completed their NVQ level 2 with another three staff undertaking it. A further two staff were undertaking their NVQ level 3 this year. This was very positive. The manager was aware that adequate staff training records must be maintained to demonstrate what training is required and planned for individual members of staff and what training had been completed. We asked to see the records of two staff who we were told had started work within the home during the past year. We noted that staff records were stored in a folder entitled accident records. The manager experienced significant difficulty in locating the two sets of records. We were advised everything is all mixed up. There was no structure or format to the way staff recruitment records were being managed by the home. The manager told us that they dealt with staff recruitment matters and there was little interest shown by the registered provider. We looked at the first set of records. This was a disorderly pile of papers and documentation which had been stored in varying places within the filing cupboard and on the desk. We noted that there was an application form, two references, a CV and a cleared criminal records bureau check. There were some completed training certificates. The manager confirmed that there was no induction programme in place for this member of staff. Care Homes for Older People Page 25 of 37 Evidence: We asked to see the second set of records. The manager told us again that this is such a mess. The manager was unable to locate the application form together with its supporting documentation. There was a Statement of Terms and Conditions and a cleared criminal records bureau check in place. The manager confirmed that there were no training or induction programmes in place. The manager was unable to locate any references. The current inadequate staff recruitment checks and records maintained by the provider means that residents could be at risk. Staff told us that they receive regular supervision and that staff meetings take place. We did not ask to see the supervision records which we were told by the manager were held on the computer. We asked to see staff meeting minutes. The only record that could be located by the manager was undated and the manager thought that this was the current one. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are at some risk because the day-to-day management of the home is not robust. Evidence: The previous registered manager left the home over a year ago and the deputy manager was appointed manager. The manager told us that this was by default. The manager demonstrated a sound commitment to providing good care to residents. They were knowledgeable about individual residents needs and requirements. We noted that there was a good rapport between staff and the manager. The manager was helpful and co-operative throughout the inspection process. The manager told us that their document and record management skills were lacking and this was evident during the inspection process. There was no evidence to support that the registered provider contributes to, monitors or oversees any aspect of the management of the home. We asked to see the monthly Regulation 26 reports (reports made by the provider or a representative following a monthly visit to ensure that the home operates in accordance with regulatory requirements) and the manager told us that Care Homes for Older People Page 27 of 37 Evidence: there were not any. They were unable to tell us when the provider last visited the home and (name) is very difficult to get hold of nowadays. We were advised that I (the manager) speak more with (named relative of the provider) more these days. The manager told us that they were not aware of the Regulation 37 notifications requirements. If certain incidents happen in a home such as a death, accidents resulting in medical attention been sought for example, the home must notify us. We have not been receiving any notifications when we should have. We asked to see evidence that the home had a quality assurance process in place. This could not be produced. We asked to see evidence of any management audit tools. These could not be produced. We were advised that residents meetings take place but there were no records available to show us. We asked to see evidence that environmental and safe working risk assessments were in place. These could not be produced. We did note that the policies and procedures had been updated in October 2009. These were in a summary form and the content did not reflect our findings. It was positive to note that there were records to demonstrate that fire alarms and the emergency lighting system had been tested on a regular basis. We were shown a letter from Essex County Fire and Rescue Service dated 30th March 2010 which outlined outstanding work to be undertaken. We were shown a letter from Environmental Health Department dated 14th October 2009 which also outlined outstanding work to be carried out. We were also shown a report dated 16th March 2010 from the contracts section of the local authority in which requirements had been made to improve identified aspects of the home. The manager told us that the provider was aware that the report had been received and a signature was required. They had not been to the home to collect the report. We were aware that there are outstanding monies owed to three utility companies and the Commission registration fee is outstanding. We have sent two recorded delivery letters to the provider. The manager told us that the provider collected the first one and although they were aware of the second one being delivered, had not collected it. The home safe keeps residents personal allowances on request. We noted that a record system was in place detailing all transactions together with the respective receipts. We saw a quality assurance statement authored by the provider dated October 2009 which stated As the managing director of Magnolia House Nursing Homes Ltd offering 24 hour care for the elderly (over 65) with varying health care needs, I consider annual quality assurance assessment to be a way of ensuring that our services Care Homes for Older People Page 28 of 37 Evidence: continue to be maintained effectively making improvements where necessary. I have worked closely with the registered manager of Magnolia House compiling a programme which will allow us to monitor the effectiveness of the service we provide. This was not evident by our findings as a result of the inspection. Care Homes for Older People Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 19 (1) (b) (i) Sch 2. Documentary evidence that 21/11/2007 new staff have had identification checks must be held in staff files to make sure the recruitment process is properly followed to protect residents. Care Homes for Older People Page 30 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 1 5 There must be a Service Users Guide in place This is to ensure that prospective residents, current residents and all stakeholders have an understanding of what the services and facilities can be provided by the home and what they can expect from the home. 31/05/2010 2 1 4 There must be a Statement of Purpose in place. This is to ensure that stakeholders have an understanding of what services and facilities can be provided by the home. 31/05/2010 3 3 14 There must be a full assessment of a proposed residents care needs undertaken before an admission takes place. The assessment of care needs must be recorded and a 09/04/2010 Care Homes for Older People Page 31 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 written conclusion made that the home can meet the assessed needs. This is to ensure that a resident is not admitted inappropriately and the home is confident that it can meet the assessed needs. 4 7 15 Every resident in the home must have a current care plan and associated risk assessments in place. These records must be reviewed and updated either when changes in the care are required or at regular periods. This process will make sure that the information about individual residents care needs is up to date. This is to ensure that all staff are aware of the current care needs of individual residents, how they are to be met, who by and the regularity. 5 9 13 There must be a clear audit trail of how the home manages controlled medicines. This is to ensure that all medicines are handled safely. 09/04/2010 31/05/2010 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 6 9 13 The storage facilities for 08/07/2010 controlled medicines must comply with current guidance which can be found on the Commissions website. This is to ensure that the storage of controlled medicines is safe. 7 18 13 Arrangements must be made by staff training or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. This is to ensure that residents are kept safe. 31/05/2010 8 19 23 The home must be kept in a good state of decoration, maintenance and repair. Work required by other agencies must be carried out within the timescales provided by the respective agency. This is to ensure that residents live in a home which is in a good and safe order. 08/10/2010 9 27 16 There must be a staff rota in 09/04/2010 place at all times. 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 This is to ensure that there is an accurate record of the hours worked by each member of staff and to identify which staff were on duty at any one time. 10 29 19 The home must demonstrate 08/05/2010 through a robust record system that all staff have been recruited in accordance with regulatory requirements. This is to ensure that residents are cared for by staff who meet the requirements of regulation. 11 30 18 All staff must receive a programme of structured induction training. This is to ensure that staff understand the homes aims and objectives and are familiar with the homes policies and procedures. 12 30 18 The home must demonstrate 08/07/2010 through a robust recording system that all staff have received adequate training to undertake their role and responsibilities. This is to ensure that residents can be confident that they are cared for by 08/05/2010 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 staff who are adequately trained to care for them. 13 31 9 The registered provider must appoint a person to manage the home who is experienced and competent to do so. To ensure that the home is managed in accordance with regulatory requirements. 14 33 24 The registered provider must ensure that the home is run in the best interest of the residents. This is to ensure that systems are in place enabling the services and facilities provided by the home meet regulatory requirements. 15 38 26 The registered person has a 08/05/2010 responsibility to promote health, safety and welfare of staff working in the home and for residents living on the premises. The provider must demonstrate through the monthly Regulation 26 reports that these matters are reviewed and action taken to address shortfalls. This is to ensure that the 08/06/2010 08/06/2010 Care Homes for Older People Page 35 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 home is run and managed on a daily basis according to regulatory requirements. Timescales provided by other agencies for compliance must be met. 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 26 There should be a programme of cleaning in place to ensure that all areas of the home are kept clean. This includes the areas behind machinery within the laundry. 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). 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