Care Home: Oaklands Country Rest Home

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What the care home does well The staff assess the needs of those people who are thinking about moving into Oaklands. This gives everyone a good idea as to whether the home will be able to meet these needs. People are given written information about the home. This helps those unable to visit, to see whether they like it, and whether they would like to live there. Lunch looked tasty and nutritious. People can choose in advance what they would like to eat, because staff ask them what they would prefer, from the menu choice. This allows people to look forward to a meal they know they will enjoy. Staff know they must pass on complaints to someone more senior, or any suspicions they may have that people are not being treated properly, so these can be dealt with. This helps to protect people from harm. The home has a pleasant garden area which people can use at their leisure. It is attractive and well tended. People`s clothes look well cared for. This helps to maintain their self respect. Various ways of collecting people`s views about the way the home is being run are used. This helps to make sure that more people can comment on what they think the home does well, and where they would like to see improvements. People`s personal allowance is managed safely, where the home has been given this responsibility. Staff also make sure these people can have access to their money at all times. This helps to maintain people`s independence and also some control over their affairs. What has improved since the last inspection? People`s doctors have now been consulted, to check what instructions the staff are to follow before administering certain medication, where sometimes the pulse is checked before hand. At this site visit, there was sufficient medication in stock for those people whose care we looked at. An action plan has been put into place so people receiving nursing care experience more continuity from agency nursing staff, because the company tries to use the same staff regularly. Fire doors were shut at this visit, and staff have recently been reminded in a meeting about the importance of this, to reduce the risk to people from the spread of fire. What the care home could do better: Records about people`s care needs and the management of their medication could be improved, to reduce the chance of individuals receiving inconsistent care. And where any issues arise in these areas, staff could alert the appropriate professionals more quickly, so they can help to maintain the person`s health. An activities programme could be re established to help meet people`s individual social needs. Staff could be available at all times, to assist and appropriately support people during their mealtime. To maintain their dignity and independence, meals which need to be chopped up for the person could be prepared in this way before their meal is presented to them. People could be offered regular fluids, in sufficient quantity, to help make sure they remain well hydrated, and do not become thirsty. And thought could be given as to whether drinks could be provided in the communal areas and bedrooms, so people can help themselves to drinks when they want one. A record of all complaints made to the home could be kept. This would help people to have confidence that their complaints are taken seriously, and acted upon, and so action can be taken to put things right where people have not been satisfied. All staff could receive an update in compulsory training, so they know how to work in a safe way. Safeguarding training could also be given to those who have not received it recently, and the company policy reviewed, so people can have confidence that concerns will be reported quickly to the appropriate professionals. All areas of the premises could be kept clean and tidy, well maintained and free from offensive smells, so it remains a pleasant, safe environment for people to live in. The company could check to make sure the hot water temperatures to the baths are pleasant and suitable for people to bathe in. Staffing levels, skills mix and lines of management accountability within the home could be reviewed, to make sure that there are enough suitably skilled staff, who communicate effectively with each other, to ensure people`s overall needs are met successfully. The recruitment procedure and subsequent induction of new staff could also be improved so people can be assured that these staff have been thoroughly checked to make sure they do not pose risk to those living at Oaklands, and trained so they know what is expected of them. Staff could always act and communicate in a professional way when in the presence of people living at the home. Bed safety rails could be checked regularly by someone who knows how they should be fitted, to make sure they remain safe and fit for use. The company could check that actions required following the last health and safety visit have been completed. This will help to maintain a safe environment for people. Key inspection report Care homes for older people Name: Address: Oaklands Country Rest Home Oaklands Country Rest Home Gilsthwaite Lane Kirk Hammerton York YO26 8DS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 1 9 0 5 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 35 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 35 Information about the care home Name of care home: Address: Oaklands Country Rest Home Oaklands Country Rest Home Gilsthwaite Lane Kirk Hammerton York YO26 8DS 01423330609 01423331111 oaklands@mmcg.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Maria Mallaband Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 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 accommodateed is: 44. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Date of last inspection Brief description of the care home Oaklands Country Rest Home is owned by Maria Mallaband Limited. It is registered to provide care for up to forty four older people, who may have nursing needs as well as personal care needs. The home is situated approximately ten miles west of York, close to the village of Kirk Hammerton. There are gardens attached to the home. There is also car parking space for visitors. Care Homes for Older People Page 4 of 35 Over 65 44 0 2 0 1 0 2 0 0 9 Brief description of the care home Services are provided within a two storey building, which has previously been extended to include a purpose built annexe. There is passenger lift access to all first floor areas. We were told on the day of the site visit that weekly fees range from £530 to £740. Prices are reviewed annually. People pay extra for the provision of clothing, hairdressing, newspapers and magazines, personal toiletries, eye testing, dentistry and chiropody, personal taxis, long distance telephone calls, alcohol and cigarettes. People get a copy of the service users guide, which explains what the home provides, before they move in. People can also request from the home a copy of the Care Quality Commissions previous key inspection report. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. This includes concerns raised, and information from other professional agencies. An unannounced site visit to the home, carried out by one inspector, over approximately eight hours on 19 May 2010. During the visit to the home, some people who live there, some staff, relative and the human resources manager were spoken with. Some care plans were looked at, as well as two staff recruitment files, some records about health and safety, and some other general records the home is expected to keep. Care Homes for Older People Page 6 of 35 We spent considerable time sitting with the people who live at Oaklands, whilst observing how the staff work, and the general activity there. The human resources manager was available throughout the day, and was provided with detailed feedback both during and at the end of our visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only where it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Records about peoples care needs and the management of their medication could be improved, to reduce the chance of individuals receiving inconsistent care. And where any issues arise in these areas, staff could alert the appropriate professionals more quickly, so they can help to maintain the persons health. Care Homes for Older People Page 8 of 35 An activities programme could be re established to help meet peoples individual social needs. Staff could be available at all times, to assist and appropriately support people during their mealtime. To maintain their dignity and independence, meals which need to be chopped up for the person could be prepared in this way before their meal is presented to them. People could be offered regular fluids, in sufficient quantity, to help make sure they remain well hydrated, and do not become thirsty. And thought could be given as to whether drinks could be provided in the communal areas and bedrooms, so people can help themselves to drinks when they want one. A record of all complaints made to the home could be kept. This would help people to have confidence that their complaints are taken seriously, and acted upon, and so action can be taken to put things right where people have not been satisfied. All staff could receive an update in compulsory training, so they know how to work in a safe way. Safeguarding training could also be given to those who have not received it recently, and the company policy reviewed, so people can have confidence that concerns will be reported quickly to the appropriate professionals. All areas of the premises could be kept clean and tidy, well maintained and free from offensive smells, so it remains a pleasant, safe environment for people to live in. The company could check to make sure the hot water temperatures to the baths are pleasant and suitable for people to bathe in. Staffing levels, skills mix and lines of management accountability within the home could be reviewed, to make sure that there are enough suitably skilled staff, who communicate effectively with each other, to ensure peoples overall needs are met successfully. The recruitment procedure and subsequent induction of new staff could also be improved so people can be assured that these staff have been thoroughly checked to make sure they do not pose risk to those living at Oaklands, and trained so they know what is expected of them. Staff could always act and communicate in a professional way when in the presence of people living at the home. Bed safety rails could be checked regularly by someone who knows how they should be fitted, to make sure they remain safe and fit for use. The company could check that actions required following the last health and safety visit have been completed. This will help to maintain a safe environment for people. 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 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they are admitted to make sure these can be met. Evidence: People have an assessment completed by the home, before they are told whether the home will be able to meet their current needs. People are invited to look round before they are admitted, and are given written information about the home. This helps those unable to visit to see for themselves what the home offers, and whether they would like to live there. The pre admission assessment is available in peoples files, for staff to refer to when they begin to develop the more in depth care plans. This helps to make sure that current needs are not overlooked. Intermediate care is not provided, therefore standard 6 is not applicable. Care Homes for Older People Page 11 of 35 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. Shortfalls in care planning and medication practice may result in inconsistent care and avoidable error. Evidence: A number of care plans have been re written. Those seen were of varying quality. Information still relevant had sometimes been removed, but had not been replaced with new plans for staff to follow, where issues were still apparent. Some did not describe in enough detail how the person would wish to receive their care, or how staff should work, to ensure the persons care would be offered in a consistent way. Daily records were often impersonal, giving basic information which focused only on how peoples physical needs had been addressed. Information about peoples current social and emotional needs, and how staff could meet them, is not detailed enough, and does not always consider their individual interests. Important information given about what made a person feel afraid, had not been considered in their care plan, to alert staff to their fears. Care Homes for Older People Page 12 of 35 Evidence: Information the home said they would include in one care plan following a safeguarding investigation had not been completed. This leaves the person at risk from receiving help to move in a way which is unsafe. There was no information for staff to follow to help them assist a person to move who had been identified as suffering from pain. Some people did not have a nutritional risk assessment completed, despite staff recording they were at risk from weight loss. One persons choices were not being followed. Their care plan said they liked to eat with others, yet they had received their breakfast in their room, and their breakfast was untouched when we visited them mid morning. This suggests they had not received the right support their care plan said they needed. Staff did not know where to find old weight charts. So we, and they, were unable to assess whether people were maintaining their weight. Fluid intake is not properly recorded. Staff do not record on fluid charts how much fluid a person has taken, and the results were not tallied. It appeared that nobody is currently reviewing these charts, to make sure people are having sufficient fluids. Where care plans said the person should be referred to the tissue viability nurse for advice about their skin condition, there was no evidence that this had been done. And there was conflicting information about whether one person did, or did not have sore skin, because the care plan had not been updated. The staff had not been completing peoples daily records to reflect how often, and when, people had been bathed. So we were unable to tell whether this happens regularly, although staff assured us it did. These sort of shortfalls pose unnecessary risk to people, especially as agency staff, who are still used, will rely on peoples records to understand what their current needs are. We saw little interaction between staff and people living at the home, because staff were very busy. Whilst we sat with people, we heard staff complaining about their work, or being told off by more senior staff. This is not professional. However, people we spoke with said things like I like it here - Im happy and settling well. The staff are nice. Someone said We cant grumble. They continued that there were usually staff available if they needed them. Another said people and staff all get on well together. And a relative told us they were happy with the care. There is only one trained nurse on duty at any time, who has assumed responsibility Care Homes for Older People Page 13 of 35 Evidence: for the medication, as well as the management of staff duties over the course of the shift. The medication round took a long time to complete, because she was often needed for advice. She is also carrying out routine nursing tasks for those people admitted for personal care only. The minimum number of nursing staff available reflects the fact that there are only four people admitted for nursing care. She does not have time to complete all these tasks, some of which would ordinarily be completed by the community district nurse. Better systems should be organised so people get their care from the right people by making the best use of the resources available. We looked at the medication systems, and found some areas which needed attention: Out of date and dusty containers containing prescribed creams, some of which were not named, were found in communal bathrooms, and were not locked away. This is not safe practice. It may also mean people are receiving medication which is no longer effective. They were removed at the time of our visit. Some people had not received their medication for some time. We were told this was because they had refused it. This had not been discussed with their doctor. One person whose care plan said they suffered pain, had not been given their pain relief, for the same reason. Where people are prescribed a variable dose of medication, staff do not record how much has been given to the person. This makes it more difficult for their doctor to see whether their prescription is effective, and whether any changes are needed. Some regularly prescribed medication was not signed for at all, but the remaining stock balance suggested it had been given. The medication trolley was not used during the medication round we observed. This increases the chance of the nurse becoming distracted by staff who may not realise she is busy. It also means medication cannot be locked away safely if the nurse is called away in an emergency situation. Where people are prescribed when required medication, staff do not record anywhere the reason why it has not been given, and there is no explanation in the care plan to say whether the person has the capacity to tell staff when they do and do not want it. In one case there were two medication charts in use for one person, with the same medication listed twice. This increases the risk of error. Care Homes for Older People Page 14 of 35 Evidence: Hand written medication instructions had not been checked and signed by a second member of staff. And in one case, staff had not signed the controlled drugs register to show they had administered the persons prescribed medication. A more thorough audit of the medication system needs to take place, so discrepancies can be discussed with the staff members concerned, and acted upon. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of activities could mean that peoples social needs are not fully met. People may not consistently receive sufficient fluids, or get the right support at mealtimes. Evidence: The activities person has recently left, and there are no organised activities for people, other than visits from the hairdresser, local religious denominations, and occasional visits from outside entertainers. People had little to occupy them on the day we visited other that the television, or the company of others living there. One person confirmed Theres no activities really - just the telly. There was a daily routine on public display. This directed staff to get people up, and take people to the toilet, within certain times. This does not respect individualised care or choice, and the human resources manager disposed of this as soon as we brought it to her attention. We asked people whether they were able to make choices in their lives, for instance, about when to get up and go to bed. Although staff say they always try to give people choices, one person said They come and wake you up at 8am. People can have visitors when they wish. We observed the lunchtime meal. People were offered a three course meal with Care Homes for Older People Page 16 of 35 Evidence: choices, which they appeared to enjoy. It looked hot and appetising. People we asked said they liked the food. However, the mealtime was not well organised. At one point, staff left the area unobserved to help assist someone out of bed. Peoples cold drinks were not replenished during their meal, which was of particular concern as they had not been offered a drink mid morning. Although they were offered a cup of tea when they had finished their meal. Staff chopped up food for those who were unable to do this for themselves, at the table. This does not help to maintain peoples dignity. We spoke to the cook. They explained how they add extra ingredients to meals so that people get good nutrition. Fresh food deliveries are regularly made to the home, and there was a supply of fruit in the dining areas, so people could help themselves to this if they wished. However, there were no drinks available for people in the communal areas to help themselves to. Neither did we see drinks available in peoples bedrooms. Care Homes for Older People Page 17 of 35 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. Peoples concerns may not be taken seriously, and acted upon. Evidence: Recent complaints made to the home had not been recorded, so we were unable to see whether they had been dealt with appropriately, and acted upon. This should always be done, so people are reassured that their complaints have, or are being, dealt with. It also allows more senior members of the company to monitor complaints made, so that common themes can be looked into further, and general improvements made. The complaints procedure is displayed at the home, and also included in the service users guide. People we asked said they had someone at the home to speak to if there was something they were not happy about. Staff knew they had to pass on complaints, and knew they had to report straight away things they may witness, or be told about, which may affect peoples welfare. They were very clear about their responsibilities in reporting abuse. They knew they could not keep secrets, and understood the importance of supporting other staff who may need to report something about their colleagues. They also said they would report to the local authority any concerns they felt had not been dealt with properly, or which they felt they could not go to the management about. Though not everyone knew how to contact the local authority. Staff should have contact details to hand, for use should they ever need them. Care Homes for Older People Page 18 of 35 Evidence: There were some gaps noted on the staff matrix, which identified who has received training in safeguarding adults. The management needs to check that everyone has now received this training. The local authority is currently investigating some safeguarding matters in relation to the home, which has raised concerns about whether information both they and the commission need to know about, has been passed on quickly enough bymore senior management. Key member of staff must be aware of their responsibilities, and must always pass on information quickly, so it can be looked into without delay. Care Homes for Older People Page 19 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Areas of the environment, although homely, could be kept cleaner for people. Evidence: The home is set in pleasant grounds, which people can access. Accommodation is provided on two floors, with lift access to the first floor. This helps people to access their bedrooms independently, if they wish. The home was not clean in some areas, particularly in the bathrooms, where we found communal toiletries, a hazardous chemical, used discarded razors and dirty urine bottles. In one, the floor was sticky and marked. The door to one unused bathroom would not open. We were told it had come off its runners. The carpets were not vacuumed on corridors. There were discarded items which had not been put away in communal areas, and also in the staff office. This made the home feel untidy. There was an unpleasant smell on two of the corridors, and also in one of the lounges. We have received concerns prior to the site visit that someones bedroom was not kept clean. The home is currently advertising and recruiting for cleaners. Sometimes there is no cleaner on a weekend. The home would benefit from a deep clean, so available staff can then maintain a satisfactory level of cleanliness until more cleaning staff have been recruited. Care Homes for Older People Page 20 of 35 Evidence: There are three bathrooms, each of which has a hoist to assist people in and out of the bath. Although two of the hoists, noted to be in need of repair at the last inspection, have been replaced, the seat to a third at this visit was worn, and may be difficult to keep clean. People have been routinely bathed in water which is much cooler that body temperature, which they may find very uncomfortable. There were no records to show that this had been addressed, or audited, by the home, although were told that the company is taking steps to remedy the problem. However, the bath temperatures in each of the bathrooms, when last checked by the maintenance man, were too low. This needs to be improved, and staff need to know about what temperatures are acceptable for individuals to bathe in, and when they may need to report faults about the hot water supply. We visited the laundry. There was a good supply of gloves and aprons for staff to use to protect themselves, and to reduce the risk from cross infection. Peoples clothes looked well cared for. Care Homes for Older People Page 21 of 35 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. Staffing at the home is disorganised, and may lead to inconsistent care. Recruitment procedures do not fully protect people from unsuitable workers. Evidence: Fifteen staff have left the home since the beginning of the year. The company has recruited some new staff. There is still a cook, cleaner and two care assistant posts vacant, which are advertised. Many of the staff are therefore new, and are still getting to know each other and the people they care for. Staff are trying hard to cover shifts. For instance, the cook was carrying out cleaning duties, because the cleaner was on leave, so an agency cook had been employed to work in the kitchen. Agency staff receive a basic induction before they start their duties, so they have a general overview of how the home runs, and of their responsibilities. Staff said that are very busy. We observed that staff had little time to spend with people. As stated in Health and Personal Care, the fact that staff were busy had impacted on the attention they were able to offer people. The trained nurse was also busy, so found it difficult to observe staff practice. She said she had allocated staff tasks, but these had not all been completed by them, and she was not aware of this until we brought this to her attention. Whilst completing the medication round, the nurse had to look for another staff member because someones call bell rang for a long time. Someone said they were uncomfortable because they had spent too long in Care Homes for Older People Page 22 of 35 Evidence: their wheelchair. We alerted staff who moved the person into a more comfortable seat. We looked at the recruitment files of two recent starters. Some improvement to this process is needed to make sure people are protected from potential unsuitable workers. For instance: By exploring a candidates employment history, so the candidate has the opportunity to account for any gaps in their employment. By making sure two satisfactory references have been obtained before the staff member is allowed to work with people. By only accepting references which are current, and requesting them directly from the referee, rather that accepting undated To whom it may concern references. And by ensuring that areas of concern within references are explored. By making sure, when a staff member is deployed before their full police check is returned, that they are supervised at all times, and a record of how this is achieved kept. In one instance, one staff member had began to work without this happening, and they have not received any formal induction either. There is a rolling programme in place to train staff towards National Vocational Qualification in Care awards. This will help to make sure staff understand what good care is. There are also plans to provide staff with other training to help them understand more about the current needs of people living at the home. However, priority is first being given to making sure compulsory training is up to date. Care Homes for Older People Page 23 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear lines of accountability and management need to be established at the home so it operates in the best interests of those who live there. Evidence: There is currently no manager at the service. The day to day management is being overseen by the area manager and the human resources manager for the company. They still have continued responsibilities connected to their established post, but are present at the home during the week, and are contactable each day. Staff say they, and the administrator, are providing them with some good support, during a period of considerable management changes. These changes have had some effects on the general staff morale, and day to day operations there. However, staff we spoke to said this had improved recently. One person said that the door is always open under the current senior management arrangements, and that the home is moving in the right direction. The company intends to recruit a new manager as soon as possible. Care Homes for Older People Page 24 of 35 Evidence: The immediate lines of accountability however are currently not well established. It appears that the nurse in charge of the shift has assumed overall responsibility for the day to day management of the staff. Because of the way the nursing staff are deployed, there is little opportunity for them to communicate face to face with each other, so they can pass on important information. The continued use of agency nurses makes this a challenge for this level of staff in maintaining continuity at the home. The company is currently looking at how this can be improved. People, wherever possible, and their families, are sent surveys periodically by the home to check they are satisfied with the service and care they receive, The results of the most recent survey have not yet been published. However, the management said they refer to this when deciding what changes need to be made at the home. The home can look after peoples money if this is their choice. The administrator keeps good records so people can see at a glance how much money they have, and what has been spent of their behalf. Cash is available at all times, so people can have access to their money when they want it. People who wish to look after their own valuables have a lockable drawer in which to store these safely. Major equipment at the home is regularly serviced, to make sure that it remains safe. The electrical wiring test is due, and the company is taking steps to get this organised. There is now a maintenance man in post, who carries out weekly checks, and looks after the general maintenance of the home. There were some health and safety matters which needed some attention: One persons care plan said that the new maintenance man had responsibility to check bed rails, to make sure they were safe. He was not aware he had this responsibility, so they had not been checked. The rails we saw were not safely fitted. The staff took immediate steps to correct this. A person who has the knowledge to do so, must now check all safety rails regularly, and make a record that this has been done. The bin in the kitchen area is not suitable. Staff have to lift the lid, which was not properly cleaned beneath, in order to deposit waste. We were told that the kitchen is due to be deep cleaned at the end of May. The bin should be replaced. The most recent health and safety visit raised a number of actions for the home to address. The human resources manager was not aware whether these had been actioned, but is checking these have been done. Care Homes for Older People Page 25 of 35 Evidence: There were some gaps in compulsory training for staff. The management need to check that everyone is refreshed with regards to training in fire safety, moving and handling and infection control. Care Homes for Older People Page 26 of 35 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 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans and associated risk assessments must be completed in sufficient detail. This is so staff are alerted to current risk, and so that they provide care in a safe and consistent way which meets all aspects of that persons needs. 30/06/2010 2 8 12 Staff must make sure they ask for professional guidance when it has been identified they need support and advice to keep the risk from pressure damage to people to a minimum. This is so the right treatment and advice is sought and provided to maintain the persons well being. 30/06/2010 Care Homes for Older People Page 28 of 35 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 3 9 13 The systems in place for the storage, administration, recording and auditing of medication must be improved. This is so the risk from avoidable error is kept to a minimum. 30/06/2010 4 9 13 The doctor of people who regularly refuse their medication must be alerted. This is so the doctor has the opportunity to assess the risk to the persons health, and to review the medication prescribed. 30/06/2010 5 10 12 Staff must act and 30/06/2010 communicate in a professional way when in the presence of people living at the home. This is so people live in an environment where their right to respect and dignity is fostered. 6 15 12 People must be offered regular fluids, in sufficient quantity. This is so they remain well hydrated, and do not become thirsty. 30/06/2010 Care Homes for Older People Page 29 of 35 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 7 16 17 A record of all complaints made to the home, and details of the subsequent investigation, and outcome, must be kept. This is so people have confidence that their complaints are taken seriously, and acted upon, and so that common trends with regards to shortfalls can be identified early, and the right action taken to make sure improvements are made to put these right. 30/06/2010 8 18 13 The company policy about reporting allegations to the local authority must be reviewed. This is to make sure that it is very clear to all levels of staff that they have a responsibility to pass on any allegation of abuse to the local authority for investigation without delay. 30/06/2010 9 18 13 All staff who have not received this, must be provided with safeguarding training, to include contact details they will need to report any concerns directly about suspected abuse. 30/06/2010 Care Homes for Older People Page 30 of 35 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 concerns can be addressed quickly by the appropriate professionals. 10 21 23 The lack of hot water supply 30/06/2010 to the bathing facilities must be investigated and rectified. This is to make sure people have a choice of bathing facilities which provide hot water at a temperature which remains safe and acceptable for them to bathe in. 11 26 16 The premises must be kept clean and tidy, and free from offensive smells. This is so it remains a pleasant, safe environment for people to live in. 12 27 18 Staffing levels and skills mix must be reviewed. This is to make sure that there are suitably qualified, competent and experienced staff available at all times to meet peoples overall needs successfully. Also to ensure that staff have sufficient time and supervision to ensure they complete their designated tasks over the course of the shift. 30/06/2010 30/06/2010 Care Homes for Older People Page 31 of 35 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 13 29 19 The recruitment procedure must be improved. This is to make sure the full and proper employment checks are carried out before anyone is allowed to provide care to people, so the risk to them from potentially unsuitable workers is kept to a minimum. 30/06/2010 14 38 13 Checks must be made to make sure that the required actions following the discussed health and safety report have been taken. This will help to keep the environment safe for people. 30/06/2010 15 38 13 Gaps in staff complusory training must be filled. This is so people can be assured that staff have up to date knowledge about how to work in a safe way. 31/07/2010 16 38 13 There must be clear systems 30/06/2010 in place for the management of bed safety rails, to include who is responsible for the monitoring of this equipment, and recording that regular checks of the equipment have been completed. Care Homes for Older People Page 32 of 35 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 will ensure that the rails remain safe, fit for use, and do not pose danger to the person to whose bed they have been fitted. 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 7 Daily records should be written in a more descriptive way, to reflect all aspects of a persons care, and how they have been supported by staff to meet their overall needs. Better systems should be planned and organised so people get their care from the right professionals, and by making the best use of the resources available. Where the doctor has prescribed a variable dose of medication for people, the amount given by staff should be recorded, so the doctor, on review, can see how effective it has been. Hand written medication instructions should be checked and countersigned by a second member of staff. This will reduce the risk from error. 2 8 3 9 4 5 12 15 An activities programme should be re established to help meet peoples individual social needs. Staff should be available at all times to assist and appropriately support people during their mealtime. To maintain peoples dignity and independence, meals should be prepared so they are manageable for the person before their meal is presented to them. Thought should be given as to whether drinks could be provided in the communal areas and bedrooms, so people can help themselves to drinks when they want one. Care Homes for Older People Page 33 of 35 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 6 26 The hoist seat identified at the site visit should be checked, to make sure it can be be kept clean, and the risk from cross infection when used kept to a minimum. All new staff should receive a thorough induction so they understand how the home operates, and how they can work effectively in the provision of good quality care. The lines of day to day management and accountability should be made clearer, so all levels of staff are clear about their roles and responsibilities. As part of the deep clean of the kitchen, the bin should be replaced, so that the risk from cross infection is reduced. 7 30 8 31 9 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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