Care Home: Pembroke Lodge

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What the care home does well The needs of prospective residents are assessed informally by the manager prior to admission. Some care plans contain a good level of detail about the individual needs and preferences of residents and how they should be met, enabling a consistent and individualised approach to their care. The home manages the medication effectively on behalf of residents who are unable to do this for themselves. A range of activities are provided within the home, in which residents can choose to take part, and their spiritual needs are met through appropriate visiting clergy. They are provided with an appropriate and varied menu and their views on the menus are sought from time to time in residents meetings. General standards of hygiene observed around the home were good and there were no unpleasant odours evident anywhere. The general staffing levels appeared to meet the current needs of residents and none complained of any undue delay in obtaining support from the staff. NVQ levels were satisfactory. What has improved since the last inspection? Following a complaint, appropriate steps were taken to obtain the views of an occupational therapist about the equipment needs for a resident, which were then provided and were seen to be in use. Some improvements to the environment and facilities in the home have been made, including the provision of air conditioning in the lounge and kitchen and a large screen TV and a broadband connection for residents` use. What the care home could do better: The service user guide and statement of purpose should be available to residents, prospective residents or their representatives, and should be reviewed regularly to ensure it is up to date. A standard format for undertaking and recording preadmission assessments would help to ensure a consistent and comprehensive process. Some of the care plans and risk assessments still need to include addtional detail about the needs and preferences of the individual and more information about how the identified needs should be met, in order to support consistent, personalised care delivery. Some improvements are needed in terms of the recording of healthcare appointments. The provision of three double bedrooms presents compromises to the privacy and dignity of residents and bedrooms should only be shared with the explicit consent of the residents themselves or where a genuine care benefit is identified and agreed by their representative. The complaints log should be available at all times to record any complaints made, and outline the action taken to address them. The shortage of appropriate and appropriately located bathing and toilet facilities in the home must be addressed as a priority. Any unsuitable commodes or other equipment should be replaced and a suitable washing machine for the needs of the home, should be obtained. Any outstanding matters from the environmental health officer and fire authority reports need to be addressed as a priority. Consideration should be given to employing a dedicated cook for the home to maximise the consistency of food handling practice and meal standards. The staff training shortfalls need to be addressed through the provision of appropriate training and ongoing refresher training to maintain the knowledge and skills of all staff. Regular staff meetings should also take place to provide support and informal training as well as a forum for team discussion. The manager needs to ensure that he keeps up to date on key areas of training and changes in legislation in order to effectively monitor practice within the home. Whoever manages the home in the manager`s absence needs to have available the necessary records in order to effectively manage the service and these records are also required to be available for inspection by the Commission at any time. More consistent and effective quality assurance and management monitoring systems need to be estbalished to maintain an overview of the home`s operation and quality issues, and enable proactive management of the service. The health and safety and fire safety issues and training needs identified need to be addressed as a priority. Key inspection report Care homes for older people Name: Address: Pembroke Lodge 32 Alexandra Road Reading Berkshire RG1 5PF     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: Stephen Webb     Date: 2 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Pembroke Lodge 32 Alexandra Road Reading Berkshire RG1 5PF 01189414200 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): enquiries@pembrokelodge.net www.pembrokelodge.net Mr Charles D`Cruz Name of registered manager (if applicable) Mr Charles D`Cruz Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Pembroke Lodge provides support and personal care for up to 20 elderly residents, within an adapted three storey detached house. The home has three double beedrooms though these are now usually used as singles. There is a passenger lift between all floors, and adapted bathing facilities are available. The Service is in a residential area that is quite close to Reading town centre. There Care Homes for Older People Page 4 of 34 Over 65 20 0 1 3 0 2 2 0 0 9 Brief description of the care home are shops and public transport services quite near by. Information about the current fees can be obtained by telephoning the manager. Care Homes for Older People Page 5 of 34 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: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This inspection included an unannounced site visit from 9.45am until 4.00pm on the 27th of April 2010. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the senior carer and other staff and some verbal feedback from residents. The inspector also observed the interactions between residents and staff at various points during the inspection. The interactions observed were positive and staff were seen to respond promptly to the needs of individual residents. Care Homes for Older People Page 6 of 34 The inspector also examined the majority of the premises. The fees, at the time of this inspection ranged between six hundred and seven hundred and fifty pounds per week. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide and statement of purpose should be available to residents, prospective residents or their representatives, and should be reviewed regularly to ensure it is up to date. A standard format for undertaking and recording preadmission assessments would help to ensure a consistent and comprehensive process. Some of the care plans and risk assessments still need to include addtional detail about the needs and preferences of the individual and more information about how the identified needs should be met, in order to support consistent, personalised care delivery. Some improvements are needed in terms of the recording of healthcare appointments. The provision of three double bedrooms presents compromises to the privacy and dignity of residents and bedrooms should only be shared with the explicit consent of Care Homes for Older People Page 8 of 34 the residents themselves or where a genuine care benefit is identified and agreed by their representative. The complaints log should be available at all times to record any complaints made, and outline the action taken to address them. The shortage of appropriate and appropriately located bathing and toilet facilities in the home must be addressed as a priority. Any unsuitable commodes or other equipment should be replaced and a suitable washing machine for the needs of the home, should be obtained. Any outstanding matters from the environmental health officer and fire authority reports need to be addressed as a priority. Consideration should be given to employing a dedicated cook for the home to maximise the consistency of food handling practice and meal standards. The staff training shortfalls need to be addressed through the provision of appropriate training and ongoing refresher training to maintain the knowledge and skills of all staff. Regular staff meetings should also take place to provide support and informal training as well as a forum for team discussion. The manager needs to ensure that he keeps up to date on key areas of training and changes in legislation in order to effectively monitor practice within the home. Whoever manages the home in the managers absence needs to have available the necessary records in order to effectively manage the service and these records are also required to be available for inspection by the Commission at any time. More consistent and effective quality assurance and management monitoring systems need to be estbalished to maintain an overview of the homes operation and quality issues, and enable proactive management of the service. The health and safety and fire safety issues and training needs identified need to be addressed as a priority. 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 34 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 34 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. It was not clear, on the day of inspection that prospective residents or their representatives would have had available the necessary information, in order to make an informed decision about the homes suitability to their needs and the services provided though the relevant documents were made available after the inspection. Prospective residents needs have been assessed prior to admission, though the process would be more rigorous if a standard assessment format was used to ensure that all pertinent information is obtained. Evidence: No Statement of Purpose was available on the day of inspection. The home has a basic brochure and an undated copy of a service user guide was available, though some of the information within it was out of date. The provider supplied a copy of the Statement of Purpose after the inspection, though this document was also undated, and it was not clear why it it had not been readily available during the inspection. The Care Homes for Older People Page 11 of 34 Evidence: manager should ensure that both documents are available within the home at any time. Both documents are also required to be kept under review and updated where necessary. It was also noted that the home was providing a day-care service for at least one individual. The provision of a day-care service is not stated within the Statement of Purpose as it should be. None of the three care files examined contained copies of detailed pre-admission assessments undertaken by the home. A basic admission information form was present but this did not contain the level of detail from which to decide whether the home could meet the prospective residents needs or to enable the development of the initial care plan for the resident. One file did contain an initial enquiry form generated by the local authority, which contained some of the expected information. The provider supplied copies of two preadmission assessments to the Commission after the inspection, though these were not completed to a standardised format to ensure all relevant information was documented. The assessments did contain some useful information about the individual and their health and social care needs though this was not as readily available as would be the case from within a standard assessment format. These documents should be available for inspection at all times. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The degree to which the needs and preferences of individual residents are reflected within care plans and risk assessments, could be improved in some cases to ensure the highest standards of consistency of care. Although the home meets the healthcare needs of residents, the quality of recording of healthcare appointments could be improved. The home manages medication appropriately on behalf of the residents who are unable to do so. Though residents are treated with dignity and their privacy is generally respected, the provision of three double bedrooms could compromise this unless explicit consent to sharing a bedroom is obtained from the resident. Evidence: The care files for three residents were examined in the course of this inspection. The files contained an admission information form which contained information about healthcare needs and any allergies. This was supported by a moving and handling data sheet, which had been recently reviewed. Although the manual handling forms contained some information about how the identified support for mobility and Care Homes for Older People Page 13 of 34 Evidence: transfers should be provided to each individual, the quality of this information varied between files. One care plan contained a good level of detail about how the identified needs should be supported by the staff, and about the residents individual preferences, this information was not as comprehensive in other files, and could be improved. Care plans had been reviewed and the date recorded thereon. There was evidence that residents had attended their reviews and been consulted. The senior carer was able to describe how staff got to know the needs and wishes of individuals and gave some good examples of this in practice, though this information would be more supportive of consistency of care if it were fully documented within the care plans. Although no mention is made of the provision of day care services in the Statement of Purpose, it was evident that one person was receiving day care on the day of inspection, which was described as including the provision of meals, together with some personal and health-care. Given the potential impact on residents, of providing this additional care, the provision of day care should be noted within the homes Statement of Purpose, and the possible impact on staffing levels should have been risk assessed. The risk assessments seen do identify some risks though they were not consistently rated as low/medium or high and the level of information on how the identified issues should be addressed for the individual, was variable. A previous concern about the appropriate equipment for assisting residents transfers had been addressed via a risk assessment and consultation with an OT. The correct wheelchair was seen to be in use appropriately during the inspection. This was an improvement in terms of the dignity and safety of residents. The home has involved external healthcare specialists such as speech and language therapist,. OTs and physiotherapists as well as GPs and district nurses, in the care of residents. Six of the residents have developed elements of dementia but the training records supplied indicate that only seven of the staff have so far received training on this area of need. This is addressed later in the staff training section. Records of healthcare appointments were maintained on individual files, though in some cases the reported regular checks were not documented. All healthcare appointments should be recorded within the residents care records. The home obtains medication from a local pharmacy. The medication records provide the necessary audit trail for the medications managed by the home. None of the residents was managing their own medication at the time of inspection. A copy of the report of the most recent pharmacist inspection of the homes medication procedures Care Homes for Older People Page 14 of 34 Evidence: and systems was not available on the day but was provided after the inspection. The report was positive about the homes systems. The residents spoken to during the inspection were happy that they were treated with dignity by the staff and that their privacy was respected. References to residents preferred form of address were noted within care records. Toilet and bathroom doors were lockable. However, the ongoing use of up to three shared bedrooms could conflict with both of these aspects. The partial screening provides only partial separation and limited sound-proofing between the two sleeping areas, and private conversations could be overheard if the other occupant was also using the room. In at least one case the resident would not have been able to specifically consent to sharing a bedroom. The manager should have written consent to sharing a room, from either the resident themselves or their representative. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can access a range of provided activities within the home and their spiritual needs are met through visits by appropriate clergy. Visiting is welcomed to support the maintenance of residents existing relationships, though visitors are encouraged to avoid mealtimes. Residents can make choices in their day-to-day lives. They are provided with an appropriate and varied diet, though any outstanding food hygiene training, or other shortfalls identified by environmental health should be addressed. Evidence: The residents have access to a programme of activities at the home, which have been set up by the part-time activities coordinator, and may occasionally be taken out by staff for short walks or wheelchair trips. Other activities outside the home tend to be where family visit and take individual residents out. Suggestions have been sought from residents and relatives about activities, and a monthly diary of planned activities is posted in the hallway. The spiritual needs of residents are addressed through visiting clergy of the appropriate faith. Visiting is encouraged but it is preferred that mealtimes are avoided. Some visitors Care Homes for Older People Page 16 of 34 Evidence: were seen to be present on the day of inspection. Residents are supported to make decisions about their day-to-day lives and were seen to be enabled to make choices during the inspection about such things as their meals and drinks and participation in activities. The manager reported that none of the residents manage their own personal allowance and that this is managed by relatives on their behalf. There is a three week rotating menu which includes a variety of dishes, and alternative options are available at each main meal. Residents have been consulted about their wishes with regard to the menus. Some residents are provided with dietary supplements and other specialist diets can be provided. However, the absence of a dedicated cook means that meals are prepared by a number of different people on different days, which could lead to some inconsistency around food storage and preparation. Not all of the staff have received food hygiene training according to the training records supplied after the inspection. The manager must ensure that only those who have received this training are responsible for meal preparation. The home was awarded a four star rating following the last environmental health inspection in October 2009. The report, which was not available during the inspection but was provided later, identified some legal requirements and also some recommendations for improvement. One requirement was to ensure that all staff involved with food preparation receive food hygiene training. The manager should address any of the identified issues which remain outstanding. The residents spoken to during the inspection were happy with the quality of the food they received. Care Homes for Older People Page 17 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an appropriate complaints procedure but the manager must ensure that the complaints log is available at all times for inspection, to demonstrate that issues raised are appropriately addressed. The home has a system in place to safeguard residents from abuse. Evidence: The home has an appropriate complaints procedure which is included within the Statement of Purpose and is posted within the entrance hall of the home. In order to make it possible for a resident or visitor to raise an anonymous complaint or concern, complaints forms could be placed in the hallway so they are available without recourse to staff. The complaints log was not available for inspection as it is required to be. A copy of the most recent page of the log was subsequently provided to the Commission, which indicated the most recent recorded complaint to be in June 2009. The matter had been appropriately addressed. This complaint was also raised with the Commission. Another way residents can be consulted, and have the opportunity to raise any issues they may have is through regular residents meetings. No copies of recent resident meeting minutes were available for inspection, those seen dated from 2008. Hand-written minutes of a meeting dated February 2010 were subsequently provided. It is not clear from the evidence provided how frequently these meeting have been held. It is good practice to hold regular meetings with residents and to minute the issues and any action taken. Care Homes for Older People Page 18 of 34 Evidence: A copy of the 2008 multi-agency safeguarding protocol for vulnerable adults was available in the home. A more recent version is available and should be obtained. The completed AQAA indicates that no safeguarding issues were raised in the home. The Commission reported one complaint/safeguarding issue to the home and this was appropriately addressed, in consultation with external agencies. Care Homes for Older People Page 19 of 34 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. There are areas of the building which do not currently meet the required standards of safety, including the requirements of the fire authority and that are currently insufficiently well maintained. The bathing facilities were also inadequate to meet the needs of residents. Laundry facilities also do not currently meet residents needs. Evidence: The communal areas of the home are pleasantly decorated and furnished and provide a homely environment for residents with good light levels. A passenger lift serves all floors. Bedrooms were personalised to varying degrees by the residents. Standards of decor were generally satisfactory though there was an area in one bedroom without wallpaper following damage due to water penetration, which needs to be addressed. The home still has three bedrooms which can be shared, though on the day of inspection. only one of these was being shared. One of the three has a partial wall between the two sleeping areas, the other two rely on old fashioned folding screens. Given the compromise on residents privacy and dignity this presents it is essential that residents only share by explicit consent. Though the manager reported that there was mutual consent by the parties concerned to sharing, no written evidence of this was provided and it was not clear that the residents themselves had consented, given Care Homes for Older People Page 20 of 34 Evidence: that at least one of them was reported during the inspection not to be able to give consent. One of the commodes seen, (which belonged to a resident), was unsuitable for use in that satisfactory hygiene would be hard to maintain owing to its construction. It appeared to be a home-made conversion of a garden chair with taped cushioning attached to the seat. Appropriate provision for supporting residents mobility about the home had now been made by obtaining a suitable wheelchair following consultation with an occupational therapist. The available bathroom and toilet facilities were insufficient at the time of inspection, consisting of a single bathroom with an adapted bath on the first floor, for the entire home, which necessitates the residents from other floors being transferred to this facility. A new wet-room shower and toilet facility was nearing completion on the second floor and some work took place on this area during the inspection. The required refurbishment of the other first floor toilet and bathroom needs to be prioritised. The kitchen is currently domestic, rather than commercial in terms of much of its equipment, and is reported to be due for refurbishment by August 2010 according to the homes 2010 development plan. Despite this it attained a four star rating from environmental health. Any issues which remain outstanding from the environmental health report in October 2009 should be addressed. The home has yet to address all of the fire safety issues raised in the most recent fire authority report, and the outstanding works must be addressed as a priority. The manager has since stated that some of these works will be undertaken in May. The most recent fire officer report was not available for inspection and, though requested, has not been provided to the Commission. These matters are also addressed later in this report under health and safety. The home has an attractive and private garden which is used by residents, one of whom told me how he likes to sit outside on warm days. The laundry facilities may well not meet the homes needs in the absence of a sluice cycle equipped washing machine. The manager has undertaken to purchase a suitable machine within three months. Standards of general hygiene observed were good and there were no unpleasant Care Homes for Older People Page 21 of 34 Evidence: odours anywhere in the home. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of residents are met by the current staffing levels of whom satisfactory numbers have attained NVQ. Recruitment records reportedly help to safeguard residents for the most part and identified shortfalls are being addressed. Care staff have not all received the necessary training or regular updates to ensure that their knowledge of best practice remains current. Evidence: The home has fourteen permanent staff, eight of whom are full-time. Eight of the staff have attained at least NVQ level 2. Thirteen of the staff are female and one is male and is the son of the owner/manager. The homes Statement of Purpose describes the usual staff deployment as five care staff in the mornings, three for the afternoon/evening and one waking night staff each night with another staff member on call off site. However, during the inspection the usual morning staffing was described as three or four staff. The rotas also show that on some nights there are two carers on duty, though the rationale is unclear. The manager stated that current night-time needs do not warrant two waking staff. A risk assessment has been undertaken for lone working, for the night staffing, which has annual review dates attached. The home does not currently employ a dedicated cook as would usually be expected in a home of this size, and meal preparation duties are undertaken by various staff. Care Homes for Older People Page 23 of 34 Evidence: Feedback obtained from some of the residents during the inspection, was positive about the support received from the staff and the atmosphere of the home in general. The home manager was out of the country on the day of inspection and therefore the staff recruitment records could not be inspected. He later provided a written statement regarding the records of recruitment, which indicated that for the most part these met the regulations, but that omissions with respect to overseas references had been identified on three files and were being addressed. The training records were not available for inspection in the home having been given to an external person who coordinates the homes training and is also an accredited trainer for some mandatory training. The current training overview was subsequently emailed to the Commission, though it listed twenty-two staff which did not accord with the other staffing complement information provided, so may include bank staff or some people who have left the home. The information supplied indicates significant shortfalls in mandatory training in several areas. For health and safety only six staff have recorded dates for training which was in 2007. For first aid, nine staff have recorded dates for training, all in May 2007. For fire safety ten staff have dates of training which was in either 2007 or 2008. For safeguarding thirteen staff have recorded dates for training but they are mostly between 2006 and 2008, with only two staff having received the training more recently. For manual handling the majority of staff had dates for the training but only four had received this within the previous twelve months. There may also be a shortfall in food hygiene training, (where only 6 staff have this training recorded, and one or two are now out of date), if other staff are involved in food handling in any capacity as is likely in a care home; and also in medication training, (where only 8 staff have dates recorded for training in 2007 or 2008), if other staff ever administer medication. It is also good practice to provide at least a basic medication training to staff who themselves do not administer, to cover such issues as side-effects and the need to report any found medication or other related issues. Given that six of the current residents are reported to have elements of dementia all care staff should also have received training in this aspect of care, but the staff training records indicate that only seven staff have done so, six of whom had the training in 2008. Training in the Mental Capacity Act and Deprivation of Liberty standards is now also required and has yet to be provided to any of the staff. Also only five staff are shown as having received training in infection control, (between 2007 and 2009). The homes pre-inspection AQAA states that all staff have received an induction in accordance with Skills for Care, but the training record gives induction dates for only ten staff. The manager has undertaken to address training shortfalls and this is referred to within the 2010 development plan for the home with a timescale Care Homes for Older People Page 24 of 34 Evidence: between August and December 2010. The manager must ensure that all shortfalls in mandatory training are addressed as a priority to ensure that staff have the necessary current training to meet the needs of residents. Updates to mandatory training should be provided with appropriate frequency to ensure that staff knowledge of best practice remains current. Ongoing staff support and informal training through regular team meetings has also been lacking with the last recorded minutes available dating from April 2009. The manager later stated that a team meeting had been scheduled for May. Care Homes for Older People Page 25 of 34 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. The management of the home has been reactive in some key areas and a more proactive response is required to ensure that all aspects of residents best interests are addressed. The manager needs to ensure that his knowledge of current good practice and changes in legislation are maintained up-to-date. A regular cycle of quality assurance and other management monitoring is required to more effectively manage the home in residents best interests. The home does not act proactively or promptly enough to maximise the promotion and protection of the health and safety of residents and staff in some areas. Evidence: The home manager is appropriately qualified and experienced to manage the home, having attained NVQ level 4 and the Registered Managers Award, though he has not maintained his knowledge in all key areas through attendance at regular refresher training or attended training in some relevant new regulatory aspects. On the day of Care Homes for Older People Page 26 of 34 Evidence: inspection a number of required records were not available for inspection as they should have been, because the manager had locked them away. Whoever is in charge of the home in the managers absence should have access to the majority of records to enable them to manage the home effectively and they should also be accessible for inspection at any time, with the exception of confidential staff records and confidential complaints investigation information. Some, but not all of the information requested for inspection was provided subsequently. Recent quality assurance survey information could not be found on the day of inspection, and the most up to date surveys on file were dated July 2008. They were accompanied by a brief summary of the action taken in response. There was no evidence of a coherent and regular system for seeking the views of interested parties on the homes operation. The manager subsequently stated that a quality assurance survey would be undertaken at the end of May. No current annual development plan was available on the day of inspection though one for 2010 was subsequently supplied, which included reference to many of the issues raised in this report. There is a sense that management has been reactive in some areas, rather than proactive, in terms of identifying and addressing issues, before they are highlighted by others. More effective systems of management monitoring and review need to be established to ensure that issues are picked up promptly and that this leads to prompt action to address them. As already identified, health and safety training for staff is not up to date, though some reviews of health and safety-related issues had been undertaken by management. For example the home has a fire risk assessment in place which had been reviewed in December 2009 and a room risk assessment, last reviewed in June 2009. However, some of the issues identified by the fire officer had yet to be addressed over an extended period, exceeding the timescale given. The manager subsequently undertook to address these as a priority. A copy of the fire authority report was not provided as requested nor was evidence of recent certification in terms of a gas safety check or electrical appliance testing. It was also not clear that all the issues raised in the last environmental health report had been addressed, though the senior carer did identify that some of the recommended equipment had been obtained. Fire safety training was also out of date and urgently required for all staff. The latest fire drill record available during the inspection was also dated September 2008, though records of a drill held in May 2010 were subsequently supplied. The manager must ensure that fire drills are held in accordance with fire authority guidance. Care Homes for Older People Page 27 of 34 Evidence: A more proactive stance on fire safety issues is required and issues, when raised need to be addressed with greater urgency to maximise the safety of staff and residents. Care Homes for Older People Page 28 of 34 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 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 The manager must ensure that the service user guide and statement of purpose are available at all times in the home and are kept under regular review. To ensure that the information therein remains current and complete. 21/06/2010 2 7 15 The manager should review the care plans, healthcare records and risk assessments for all residents. To ensure that they provide the necessary level of details to enable consistent and individualised care of residents. 16/07/2010 3 19 23 The manager must ensure 20/07/2010 that the outstanding requirements of the fire authority are addressed as a priority. Care Homes for Older People Page 30 of 34 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 In order to ensure that all aspects of the building fire precautions meet fire safety regulations. 4 21 23 The manager must ensure that the number, location and type of bathing facilities available to residents meets their needs. In order to provide suitable facilities to address the dignity of residents. 5 26 23 The manager must provide laundry equipment to meet the needs of the home. In order to reduce the risk of cross-infection. 6 29 18 The manager must ensure that all staff receive the necessary training and appropriate training updates. To ensure that they maintain their knowledge and skills and awareness of current best practice. 7 31 10 The manager must ensure 20/08/2010 that he attends appropriate training to maintain and update his knowledge of current practice and changes in legislation. 20/08/2010 20/08/2010 20/08/2012 Care Homes for Older People Page 31 of 34 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 In order to maintain current knowledge to enable effective supervision and development of practice in the home. 8 33 24 An effective quality assurance system must be established and operated by the home. In order to seek the views of residents and other interested parties in a systematic way as part of management monitoring of the home. 9 38 23 The outstanding issues raised by the fire authority must be addressed. In order to maximise the safety of residents and staff. 10 38 23 The manager must ensure that a schedule of fire drills and staff fire safety training are provided in accordance with fire authority guidance. To ensure that staff are best equipped to deal appropriately with any fire related event. 21/07/2010 21/06/2010 21/07/2010 Care Homes for Older People Page 32 of 34 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 10 The manager should review the consent obtained for residents who are sharing a bedroom to ensure that each resident or their representative has explicitly consented to this and it is in the best interests of the resident. The manager should ensure that any outstanding matters from the environmental health report are addressed. 2 15 Care Homes for Older People Page 33 of 34 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. 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