Care Home: Moorlands Residential Home

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well The home provides good information for people who are considering moving there. One person who had recently move in felt that they had received enough information about the home. They told us they are happy and that staff do things the way they like. People told us that visitors are made to feel welcome. We observed people being offered choices during the inspection. People told us they were happy with the food provided at the home. Meals appeared to be of a good quality. We observed that the environment is nicely decorated and overall well maintained. Bedrooms were homely and had been personalised with peoples possessions to match peoples tastes and interests. People who live in the home told us that it`s nice and homely. What has improved since the last inspection? The home has introduced a comprehensive information pack for people who are considering moving there. The flooring in the laundry room has been replaced. This means the area can now be kept clean and hygienic. What the care home could do better: We are concerned that issues that we have highlighted at previous inspections and meetings have arisen again. This includes care plans that do not reflect peoples assessed needs or provide information for staff to follow; poor management of medicines; lack of safeguarding awareness; people with a dementia presenting challenging behaviour; one identified person exiting the home and going missing; not notifying us of what is happening in the home when required. This indicates that the home lacks direction and leadership which leads to inconsistent practice and recording. As a result of this inspection, we have made 8 requirements. Some people who live in the home have dementia care needs which require specialist input. The registered manager must ensure that staff are available in sufficient numbers and have the appropriate skills and knowledge to meet the specialist care needs of people who live in the home. When peoples` needs have changed the home has not updated their care plan. Care plans we looked at were missing falls risk assessments and up to date moving and handling plans. This potentially places people at risk of harm. The registered manager must ensure that each care plan is reflective of the person`s assessed needs and provides appropriate information for staff to follow. This is so that peoples needs are met appropriately and consistently. We found that at least four people who live in the home have shown episodes of aggressive behaviour. There was no clear guidance or recording systems in place. The registered manager must ensure that they develop a care plan in relation to peoples` aggression where this has been identified. This is so that staff know how to manage incidents effectively and to protect people from risk of harm. We found unsafe medication practices. The registered manager must ensure that medicines are only given to people from the container that the pharmacist or dispensing GP has provided and that only trained staff administer medication. The home had not reviewed the staffing levels in relation to peoples`changing needs. The registered manager must ensure that there are sufficient staff on duty at all times to meet the dependency needs of the people living in the home. We found that a new member of care staff did not know the emergency fire procedure. The registered manager must ensure that staff are given clear guidance and instructions. The registered manager is required to ensure that care provided at the home is recorded appropriately, monitored and audited. We have made a further seven good practice recommendations. Key inspection report Care homes for older people Name: Address: Moorlands Residential Home Moorlands Road Merriott Crewkerne Somerset TA16 5NF     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: Alison Philpott     Date: 0 8 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 32 Information about the care home Name of care home: Address: Moorlands Residential Home Moorlands Road Merriott Crewkerne Somerset TA16 5NF 0146074425 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): jayne@moorlands-care.co.uk Darbyshire Care Ltd Name of registered manager (if applicable) Mrs Jayne Marie Dadzitis Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Moorlands is a residential care home for up to 16 older people. The provider is Darbyshire Care Ltd. The manager who has day-to-day responsibility for the home is Mrs Jayne Dadzitis. She leads a small team of staff. The home is situated in the village of Merriott. Local facilities including post office, church and pubs are available in the village. The home has pleasant and comfortably furnished communal areas. Bedrooms are arranged on the ground and first floor of the home. First floor accommodation is accessed by stairs and there are stair and passenger lifts. En-suite WC facilities are provided in all bedrooms. A small number of rooms have en-suite bathing facilities. The home has a pleasant patio area. Steps and a ramp provide access to the attractive garden. The current fee range is £406 to £530 per week. This does not include Care Homes for Older People Page 4 of 32 Over 65 16 0 Brief description of the care home toiletries, hairdressing and costs arising at some outings. For further information, please contact the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 unannounced inspection was conducted over one day (8 hours). On the day of the inspection, 12 people were living in the home and one person was staying for a respite break. When we arrived at the home, we were greeted by the care supervisor. The registered manager was on sickness leave but came in during the inspection. We were given unrestricted access to all parts of the home and most of the records requested for this inspection were made available to us. We observed care practice and interactions, met with people living in the home and spoke with staff. The home sent us its completed Annual Quality Assurance Assessment (AQAA) and this was received by the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people living in the home. It also provides us with some numerical information. Care Homes for Older People Page 6 of 32 We have received some concerns from members of the public that these peoples needs are not being met appropriately. This was looked at during the inspection. We would like to thank all involved for their time and cooperation with the inspection process. The term, we used throughout this report, refers to we the Commission. The focus of this inspection visit was to inspect the relevant key standards under the Inspecting for Better Lives 2 framework. This focuses on outcomes for people living in the home. The quality of the service is measured under four ratings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: We are concerned that issues that we have highlighted at previous inspections and meetings have arisen again. This includes care plans that do not reflect peoples assessed needs or provide information for staff to follow; poor management of medicines; lack of safeguarding awareness; people with a dementia presenting challenging behaviour; one identified person exiting the home and going missing; not notifying us of what is happening in the home when required. This indicates that the home lacks direction and leadership which leads to inconsistent practice and recording. As a result of this inspection, we have made 8 requirements. Some people who live in the home have dementia care needs which require specialist input. The registered manager must ensure that staff are available in sufficient numbers and have the appropriate skills and knowledge to meet the specialist care needs of people who live in the home. When peoples needs have changed the home has not updated their care plan. Care plans we looked at were missing falls risk assessments and up to date moving and handling plans. This potentially places people at risk of harm. The registered manager must ensure that each care plan is reflective of the persons assessed needs and provides appropriate information for staff to follow. This is so that peoples needs are met appropriately and consistently. We found that at least four people who live in the home have shown episodes of aggressive behaviour. There was no clear guidance or recording systems in place. The Care Homes for Older People Page 8 of 32 registered manager must ensure that they develop a care plan in relation to peoples aggression where this has been identified. This is so that staff know how to manage incidents effectively and to protect people from risk of harm. We found unsafe medication practices. The registered manager must ensure that medicines are only given to people from the container that the pharmacist or dispensing GP has provided and that only trained staff administer medication. The home had not reviewed the staffing levels in relation to peopleschanging needs. The registered manager must ensure that there are sufficient staff on duty at all times to meet the dependency needs of the people living in the home. We found that a new member of care staff did not know the emergency fire procedure. The registered manager must ensure that staff are given clear guidance and instructions. The registered manager is required to ensure that care provided at the home is recorded appropriately, monitored and audited. We have made a further seven good practice recommendations. 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a comprehensive information pack for people who may be considering moving there. The recent admission had not been made until a full needs assessment had been undertaken. People with specialist needs who live in the home may not receive good quality of care due to a lack of skilled staff. Evidence: We looked at the information pack the home provides for people who are considering moving to the home. This includes a brochure, newsletter and the Statement of Purpose. We spoke with one person who had recently moved into the home. They felt that they Care Homes for Older People Page 11 of 32 Evidence: had received enough information about the home. They told us they are happy and that staff do things the way they like. We looked at the pre-admission assessment which was supported by the assessment carried out by the local authority. This contained a good level of detail. The home had not signed or dated their pre admission assessment. We found that the health of some of the people who live in the home has deteriorated. Some people have dementia care needs that require specialist input. The home told us that many staff have completed or are in the process of doing dementia training. Staff told us that they have not yet completed training in challenging behaviour. The home told us that they are working with health professionals to monitor people who live in the home. The registered manager must ensure that staff have the appropriate skills and knowledge to meet the specialist needs of people who live in the home. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans sampled did not reflect the needs of the person. Record keeping is not consistent. Action is not always taken when peoples needs change. Current medication practice places people who live in the home at risk of harm. Staff respect peoples privacy and dignity. Evidence: We looked at three peoples care plans in detail; The first person moved into the home on 28/05/10. This persons pre admission assessment stated that they were concerned about falling. They fell at home on 08/03/10 and were admitted to hospital. Information from the pre admission assessment had not been transferred into the care plan. The home had not completed a falls risk assessment. This person told us that they have poor mobility and walk slowly with a frame. The manager confirmed that the home had not completed a resident handling assessment or moving and handling assessment. This means that staff have been working with the lady for over a week with no information to follow. Care Homes for Older People Page 13 of 32 Evidence: The second person was being cared for in bed. This person has a dementia. The care plan had not been updated to reflect their changed needs. The accident records showed us that they had sustained 9 falls between 12/04/10 and 01/06/10. There was no evidence that the accidents had been audited. The information had not been transferred to the care plan. The home had not placed an up to date falls risk assessment in the care plan and there was no information on how staff could have minimised the risk of falls. The persons changed mobility had not been reassessed and the handling assessment in their care plan was dated 28/01/09. We asked staff how often they turn this person. They seemed unsure, first saying every hour then when we go in. No record was maintained. We looked at weight records. On 30/12/09, this persons weight was 10 stone 5 lbs. They were not weighed again until 04/05/10 when they weighed 8 stone 4 lbs. Aprils care plan review states not eating very much. The person is now prescribed a nutritional supplement. It was not clear from the records why this person was not weighed, how they were being monitored and how the home had met their nutritional needs. This person had presented aggressive behaviour. Records stated that x becomes very aggressive when having hair washed, sometimes aggressive with staff. We found entries stating not cooperative lashed out at nurse; very aggressive with staff - hitting and kicking;agitated. The day before the inspection, this person was reassessed. The outcome was that the person needs to move to a nursing home. The third person has a dementia and often goes out of the building. Staff told us that this person regularly goes out and they have to look for them; they were recently found in someone elses home. They were concerned that it was difficult to manage when there is only two care staff during the weekends and evenings. We discussed this with the manager who told us that she would be on call. This person was observed to try and leave the building during the inspection. Staff told this person they were not to go out. The care plan states staff know if they feel there is a risk of x attempting to leave the home it is best to lock doors and try to divert..attention. The manager and staff told us that they do lock the door for brief periods. Records stated few aggressive moods, shouting. The daily records had a gap of four days. As this person clearly presents challenges to the service, the home should be keeping regular daily records. Further to the inspection, the provider informed us that social services have reassessed this person and remain satisfied with the placement. We found evidence that a further two people who live in the home have shown aggression. One person had entries written that they were cross and shouting at staff. Abusive to other residents. Another persons records stated violent, pulled away from staff violently banging front and back doors. We observed that during the inspection Care Homes for Older People Page 14 of 32 Evidence: this person was very confused and appeared distressed and tearful at times. This person was being reassessed on the day of the inspection. There was no individual care plan in place for these people so that staff knew how to manage peoples aggressive behaviour effectively and when to seek advice, to protect the person and them selves. There was no clear records of incidents and it was not clear how the home was monitoring or reviewing these. Staff told us that they have not received training in dealing with challenging behaviour and that they try to calm the situation in their own way. The daily records that are kept within the care plans are not being written on a daily basis and gaps of several days were seen within all care plans. We found several entries where staff had used tipp ex to cover information in records. The home should not cover incorrect entries but place a single line through them so that they are still legible. We looked at records that showed us that people have access to health professionals including doctor, consultant psychiatrist, district nurse, opticians and chiropodist. We looked at the homes medication and records. The home uses a monitored dosage system. The Medication Administration Record Sheets (MAR) were fully completed. Where MAR Sheets had been written by hand, two staff had signed the sheet to evidence that checks for accuracy had been made. The manager told us that the home does not currently store any controlled drugs. The manager confirmed that she had potted up medicines prior to the round and that she did not dispense and administer them from the monitored dosage system. Medicines must only be given from the original container. By placing the medicines in a different container for a different care worker to give out at a later time, the home is secondary dispensing. The Royal Pharmaceutical Society consider this unsafe practice that can potentially cause drug errors. The registered manager had signed that the medicines had been administered. This should not have happened as the manager did not administer the medicines herself. This potentially places people who live in the home at risk of harm. We observed staff knocking on peoples bedroom doors before entering. This shows that staff respect peoples privacy and dignity. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are provided within and outside of the home. Meals in the home are good quality. The mealtime experience appeared to be task orientated. Staff did not encourage one identified person to eat or offer support to them. Evidence: The home employs a dedicated activities co-ordinator. There is a weekly activities schedule on the noticeboard. On the day of the inspection, the activities included bingo, one to ones, skittles and darts. One person told us I would like more social interaction. The provider told us Moorlands offers a very comprehensive range of activities in and outside of the home, we promote religious freedom and have regular services in the home. We have great interaction and support from the family, we have theme days, like the recent fundraising event where we had dancers and majorettes come to the home. This was open to and attended by members of the community helping to foster external links to the home. We looked at activities records and the homes newsletter. Activities included bingo, Care Homes for Older People Page 16 of 32 Evidence: skittles, darts, games, one to one sessions, and quizzes. The newsletter contained photographs and people had celebrated birthdays, been to the pub, and visited Montacute House. Before the day of the inspection, the last recorded activity was 27th May 2010. We spoke with the staff member who had covered activities and she confirmed that activities had taken place. People told us that visitors are made to feel welcome. We observed people being offered choices during the inspection. We observed lunch. The tables were nicely laid and music was playing. Eleven people were eating lunch in the dining room. There were no staff in the dining room. We observed that staff came in to serve, check if people had finished and take plates away. There was some interaction between staff and people. We found that one person had choked two days before the inspection. Staff on duty at that time had attended to this. On the day of the inspection, this person was not in a good seating position to enable them to comfortably eat their meal. Their meal had been liquidised and placed in a bowl. Staff came in asked how this person had got on. We observed that the bowl was still over three quarters full. The person indicated that they didnt want anymore. Staff said you didnt like it? and took the plate. There was no encouragement or offer to assist this person. We spoke with other people sitting in the dining room who told us that they had enjoyed their lunch. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure which is available to people who live in the home. The local safeguarding adults policy was not available within the home. Staff were not fully aware of whistleblowing procedures and which external agencies they could contact. Evidence: The home has a complaints policy and procedure. The home told us that they have not received any complaints since the previous inspection. Staff do not start work at the home until the appropriate checks have been carried out to prevent the risk of harm to people who live there. We spoke with staff who told us they had completed distance learning training in Safeguarding Vulnerable Adults. Staff were not aware of the Somerset Safeguarding Adults Policy & Procedure and were unsure of who they could contact outside of the home. During the inspection, we asked the registered manager if the home had a copy of the Somerset Vulnerable Adults Policy. The manager told us that a copy wasnt available and asked where it could be obtained from; a copy was ordered during the inspection. Care Homes for Older People Page 18 of 32 Evidence: After the inspection, we submitted a safeguarding alert to Somerset Social Services as we had concerns relating to one persons placement at the home. We telephoned the manager to let her know what action had been taken. Previous to this, the Commission met with the provider and the registered manager on 3rd November 2008. We told the home to access the Somerset Policy and ensure they were aware of the role of the Safeguarding Vulnerable Adults team. The home were also strongly advised to make sure staff received training in abuse awareness which includes the local policy so that staff were aware of the procedure to follow if an allegation was made. The evidence found at this inspection indicates that this advice was not followed. It is strongly recommended that the registered manager attends formal training in Safeguarding Vulnerable Adults. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained, nicely decorated and provides a comfortable environment for the people who live there. Evidence: The home told us on the AQAA the home has pleasant and varied communal areas and well maintained gardens. People who live in the home told us that its nice and homely. We looked at lounges, dining room, laundry, a sample of bedrooms, and bathrooms. We observed that the environment is nicely decorated, homely and overall well maintained. A choice of three lounges and the dining room are available on the ground floor. The gardens looked attractive. People told us that they enjoy spending time in the garden and we observed several people sitting outside during the inspection. There are stairlifts and a passenger lift to provide access to the first floor. All areas of the home are fitted with call bells. Care Homes for Older People Page 20 of 32 Evidence: Two people who live in the home showed us their bedrooms. These were homely and nicely personalised to match peoples tastes and interests. We observed two cracked windows and a badly stained carpet in one of the bedrooms. We observed that other bedrooms were homely and well maintained. We observed that the carpet in one of the bathrooms was badly stained. The flooring in the laundry has been replaced since the previous inspection. This means it can now be kept clean and hygienic. The home was clean throughout. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is not clear whether there are enough care staff on duty at all times to meet peoples assessed needs. The homes recruitment procedures generally protect people from the risk of harm. The home has a comprehensive training programme. The distance learning package used is not tailored to the home so that staff know how to put their knowledge into practice in the workplace. Staff carry out procedures before they are given the appropriate training. Evidence: On the day of the inspection, we were met by the supervisor. There were two care staff working in the home (one of these was new and shadowing the other); a member of staff doing activities, a member of staff doing administration, a cook, a cleaner and maintenance. The registered manager was on sickness leave but came in to take part in the inspection. One person who lives in the home told us there are two or three really good staff, some staff are not so good and staff dont have much time, some make time. Care Homes for Older People Page 22 of 32 Evidence: There appeared to be enough staff on duty during the inspection. Staff told us that they are sometimes stretched in the evening and at weekends, as there are only two members of care staff on duty. At the previous two key inspections, we identified that the home needed to keep staffing levels under review. At this inspection, one person was being cared for in bed. Their needs had changed recently and the home had stated that two staff were now needed to move this person. We were told that staff were spending time with another person who had recently moved into the home with very poor mobility. Due to the level of needs of other residents, it would appear that there may be insufficient staff on duty at times. The home had not reviewed the staffing levels in relation to peoples changing needs. Our guidance states The home needs to make sure that staffing levels meet the dependency needs of people living in the home. When assessing staffing levels a range of factors should be considered including the changing needs of people living in the home, layout of the building, ratio of carers to support staff, staff skills, and variations through the day. We looked at four staff files. These contained most of the required information. One file did not contain a copy of the CRB disclosure. The staff member confirmed that they had received their copy and the manager confirmed that the provider had the homes copy and would bring it to the home. The dates of employment written on one persons application form did not match the employment dates given by the previous employer on the reference. We discussed this with the manager and she was not aware of this; she said she would check this with the staff member. Another person had a gap in their employment history. We checked this with the manager who told us they had explored this but had not documented it on the file. There was a new member of care staff on duty during the inspection. This was their first day and they were shadowing a more experienced member of staff. They told us that the home is planning training for them. We asked the staff member about fire procedures in an emergency. They told us that they had not been informed of this yet. Staff must be given clear guidance and instructions about what they should do if the fire alarm sounds. We looked at the homes training matrix. The home uses the Red Crier system for training. This includes induction training, training in safe working practices (such as food hygiene, first aid, moving and handling, infection control, fire safety), and other relevant subjects. Staff training was up to date according to the training matrix. One member of staff told us they had not completed training in safeguarding of vulnerable adults. Care Homes for Older People Page 23 of 32 Evidence: We found that a staff member who had carried out a medication round had not completed an appropriate training course. This potentially places people at risk of harm. The home uses a distance learning package for training. The manager needs to ensure that where appropriate staff are given additional information that is tailored to the home. This is so that staff know how to put their knowledge into practice in the workplace. For example, staff had completed training in protection in vulnerable adults but were not aware of the local policy and what action they should take. Eight staff have completed an NVQ in care at Level 2 or above. The manager told us that further training is planned. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a registered manager. We found that the managers practice in relation to administration of medication is unsafe and potentially places people at risk of harm. The home lacks direction and leadership leading to inconsistent practice and recording. The registered manager does not inform the Commission of notifiable incidents as required by Regulation 37 of the Care Home Regulations. Evidence: Jayne Dadzitis is the registered manager. She has managed the home for a number of years and has completed the Registered Managers Award. As a result of this inspection, we are concerned about the number of shortfalls identified. This includes the ability to meet peoples needs appropriately; care plans and recording; medication administration; awareness of safeguarding of vulnerable Care Homes for Older People Page 25 of 32 Evidence: adults; keeping people safe; informing the Commission of what is happening in the home. After the inspection, the registered provider sent us a copy of the homes quality audit. This collates responses from people who live in the home, relatives and health professionals. The provider identifies reasons for comments and any action that needs to be taken. The home stores small amounts of monies for some of the people who live in the home. We checked the monies for two people. These are stored individually. Written records are maintained and two people sign to confirm financial transactions. Some of the entries recorded in the homes communication book include peoples personal information. This does not promote confidentiality. During the inspection, we found information that told us the home should have submitted Regulation 37 Reports to us in relation to using the missing persons procedure; a resident being stuck in the lift when it broke down. We have not received these notifications and the registered manager did not have copies of these notifications. The registered manager needs to submit Regulation 37 Reports about any occurrences which are outlined in the scope of notification. This is so that we know what is happening at the home. We looked at accident records. The home does not audit the accident records. The home should audit accident records so that patterns and trends can be identified and to prevent further occurrences where possible. We looked at some health & safety and service checks including electrical installation, portable appliance testing, gas safety, fire alarm system, and lift. These were all found to be up to date. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 12 The registered manager must ensure that staff have the skills to meet the needs of the people who live in the home. This is to make sure that people are not placed at risk of harm. 31/08/2010 2 7 15 The registered manager must ensure that they develop a care plan in relation to peoplesaggression where this has been identified. This is so that staff know how to manage incidents effectively and to protect people from risk of harm. 16/07/2010 3 7 12 The registered manager 31/08/2010 must ensure that each care plan is reflective of the persons assessed needs and provides appropriate Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action information for staff to follow. This is so that peoples needs are met appropriately and consistently. 4 9 13 The registered manager 18/06/2010 must ensure that medicines are only given to people from the container that the pharmacist or dispensing GP has provided. This is to ensure that people are not at risk of harm from drug errors. The home must ensure that 31/08/2010 there are sufficient staff on duty at all times to meet the dependency needs of the people living in the home. This is to ensure that peoples needs are met appropriately and to protect people from risk of harm. 6 30 23 The registered manager must ensure that staff are given clear guidance and instructions in relation to emergency fire procedures. (This relates to one identified new member of staff). 30/06/2010 5 27 18 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is so that they know what to if the fire alarm sounds and to protect people from risk of harm. 7 30 18 The registered manager must ensure that medicines are only administered by designated and appropriately trained staff. This is so that staff have the skills and knowledge to administer medication. 8 31 12 The registered manager is required to ensure that care provided at the home is recorded appropriately, monitored and audited. This is to ensure that good practice is maintained. 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 18/06/2010 31/08/2010 1 2 15 18 Staff should offer encouragement and assistance to people at mealtimes, where appropriate. It is strongly recommended that the registered manager attends formal training in Safeguarding Vulnerable Adults. Staff need to be made aware of the local policy. -It is recommended that repairs are made to the two cracked windows identified during the inspection. -It is recommended that the two identified badly stained carpets are replaced. 3 19 Care Homes for Older People Page 30 of 32 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 4 29 . -The home should ensure that the employment history for new staff is checked and the reason for any gaps documented. 5 37 -Personal information should not be recorded in the homes communication book. This does not promote confidentiality. -The home should not cover entries in written records with tipp ex. The registered manager should submit Regulation 37 Reports about any occurrences which are outlined in the scope of notification. This is so that we know what is happening at the home. The home should audit accident records so that patterns and trends can be identified and to prevent further occurrences where possible. 6 38 7 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!