Care Home: Rosehill House

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What the care home does well People were offered appropriate access to community health services to ensure their health needs were properly identified and met. People were supported to maintain close links with their families and friends. This helped them to have regular social contact with people close to them. People told us they were treated with respect by the staff and their right to privacy was respected. People had opportunities to meet their social, cultural and recreational needs. People who live at the home were encouraged to eat a healthy and varied diet. Some areas of the home were nicely decorated and furnished, which made these areas of the environment feel homely. What has improved since the last inspection? At the previous inspection three requirements were issued and these had all been fully or partly actioned. The action taken included: Some staff had already completed adult safeguarding training and all other remaining staff were booked in to complete this training in March 2010. Staff were aware of their responsibilities in reporting any allegations of abuse to the local safeguarding team. so that this could be responded to and investigated where necessary. People`s personal money and allowances were being closely monitored and only used for the purpose they are there for. Thirteen recommendations were also issued and these have all been actioned or removed from the report as they are no longer applicable. What the care home could do better: Over the last year the home had not been managed effectively. Staff had not been offered adequate leadership and support and the providers had not adequately monitored the management of the service to ensure that people were being offered good levels of safe care and support. This had placed people who lived at the home at risk of harm. The Statement of Purpose and Service User Guide had not been updated since 2007. This meant that prospective residents and their families had insufficient information on which to make a considered choice of home. People`s needs were not always being identified at the time when they were admitted to the home. This could lead to people`s needs going unmet and placing them and other people who lived in the home at risk. To ensure this does not recur the manager had introduced new pre admission assessment that would be completed for people before they were offered a place at the home. At the time of the inspection the home had agreed to a voluntary embargo. This meant that people were not being admitted into the home. The reason for this was so that everyone was assured that the issues raised in relation to safeguarding people were all resolved before any new admissions to the home. To provide people with care that meets their individual needs and preferences, care plans should be reviewed at least once a month. They should be updated to reflect changing needs and current objectives for health and personal care. Some people and their relatives had not been offered the opportunity to have input into devising care plans, to ensure their needs had been identified accurately. Accurate medication records were not being maintained. So that people`s health, safety and welfare are maintained, where a medication has not been taken the reason for this should be recorded. Risk assessments to keep people safe had not all been devised appropriately and staff needed to check these to ensure people`s safety. More care should be taken to make table settings look more appealing and make the mealtime a more enjoyable occasion. Complaints had not been recorded accurately over the last year and this did not protect people`s rights. All concerns and complaints received at the home should be fully recorded. The record should show what action has been taken to resolve any concerns and complaints. We had received a number of anonymous complaints about the service since August 2009 and this led us to believe people did not feel comfortable making formal complaints about the service to the providers. There had been 4 adult safeguarding referrals made over the last year. These referrals are made when allegations of abuse or neglect have been made. These referrals were ongoing. Due to the number and nature of the referrals, Barnsley Council safeguarding team had organised regular strategy meetings and visits to the home to look into these matters further. Some areas of the home including some bathrooms, toilets and some communal lounges needed to be refurbished as the decor was scuffed and stained in some areas. Staff were observed carrying out poor infection control procedures. Staff should receive training in infection control so that they are aware of the risks involved in the present poor practises. The registered person should ensure that all staff who are working at the home have an enhanced CRB check. The registered person should ensure there is appropriate skill mix of staff to meet the people`s assessed needs at all times. Staff need more training to develop their skills and knowledge in areas including food hygiene and first aid. So that the home is run in the best interests of the people living there, there should be a system in place for reviewing and improving the quality of care provided at the home. So that any unnecessary risks to the health and safety of people are eliminated, the doors of the cupboards that have hazardous substances and hot water (sluice room) should be kept locked at all times. Key inspection report Care homes for older people Name: Address: Rosehill House Keresforth Road Dodworth Barnsley South Yorkshire S75 3EB     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: Sue Turner     Date: 1 5 0 3 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: Rosehill House Keresforth Road Dodworth Barnsley South Yorkshire S75 3EB 01226243921 F/P01226243921 layla14rosehill@btconnect.com NONE Mr Azad Choudhry,Mr Aurang Zeb care home 27 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosehill House is situated on the outskirts of Dodworth Village. It is approximately three miles from Barnsley town centre and ten minutes drive from the M1 motorway. The home is a detached property within its own grounds, providing personal care for 27 older people. There is car parking space to the front, side and rear of the property. To the front of the property is a large patio/terrace with garden furniture. Ramps are provided to the main entrance at the side of the building and to the patio. Access to the patio can also be gained via the patio doors from the lounges. The accommodation is on two floors. A passenger lift is provided. The Service User Guide, the Statement of Purpose and the homes last inspection report were displayed in the main entrance. Prospective admissions were given a copy of them on enquiry. Care Homes for Older People Page 4 of 34 Over 65 27 0 2 1 0 4 2 0 0 9 Brief description of the care home Fees were £356.77 per week. Hairdressing, toiletries and newspapers were not included in the weekly fee and were charged separately. This information was provided on 15th March 2010. 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 that people who use the service experience adequate quality outcomes. Sue Turner, Regulation Inspector, carried out this unannounced visit to the service over one day and the total time spent on site was 8.5 hours. The manager, operations manager and provider were at the home during the site visit. In the report we make reference to `us and `we. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. Some time was spent with five people who used the service. These peoples views have Care Homes for Older People Page 6 of 34 been reflected in this report. Three staff attended interviews with us. We also received surveys from three staff. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in April 2009. The progress made has been reported on under the relevant standard in this report. At the end of the site visit the manager, operations manager and provider were given feedback. We have reviewed our practise 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 when 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 34 What the care home does well: What has improved since the last inspection? What they could do better: Over the last year the home had not been managed effectively. Staff had not been offered adequate leadership and support and the providers had not adequately monitored the management of the service to ensure that people were being offered good levels of safe care and support. This had placed people who lived at the home at risk of harm. The Statement of Purpose and Service User Guide had not been updated since 2007. This meant that prospective residents and their families had insufficient information on which to make a considered choice of home. Peoples needs were not always being identified at the time when they were admitted to the home. This could lead to peoples needs going unmet and placing them and Care Homes for Older People Page 8 of 34 other people who lived in the home at risk. To ensure this does not recur the manager had introduced new pre admission assessment that would be completed for people before they were offered a place at the home. At the time of the inspection the home had agreed to a voluntary embargo. This meant that people were not being admitted into the home. The reason for this was so that everyone was assured that the issues raised in relation to safeguarding people were all resolved before any new admissions to the home. To provide people with care that meets their individual needs and preferences, care plans should be reviewed at least once a month. They should be updated to reflect changing needs and current objectives for health and personal care. Some people and their relatives had not been offered the opportunity to have input into devising care plans, to ensure their needs had been identified accurately. Accurate medication records were not being maintained. So that peoples health, safety and welfare are maintained, where a medication has not been taken the reason for this should be recorded. Risk assessments to keep people safe had not all been devised appropriately and staff needed to check these to ensure peoples safety. More care should be taken to make table settings look more appealing and make the mealtime a more enjoyable occasion. Complaints had not been recorded accurately over the last year and this did not protect peoples rights. All concerns and complaints received at the home should be fully recorded. The record should show what action has been taken to resolve any concerns and complaints. We had received a number of anonymous complaints about the service since August 2009 and this led us to believe people did not feel comfortable making formal complaints about the service to the providers. There had been 4 adult safeguarding referrals made over the last year. These referrals are made when allegations of abuse or neglect have been made. These referrals were ongoing. Due to the number and nature of the referrals, Barnsley Council safeguarding team had organised regular strategy meetings and visits to the home to look into these matters further. Some areas of the home including some bathrooms, toilets and some communal lounges needed to be refurbished as the decor was scuffed and stained in some areas. Staff were observed carrying out poor infection control procedures. Staff should receive training in infection control so that they are aware of the risks involved in the present poor practises. The registered person should ensure that all staff who are working at the home have an enhanced CRB check. The registered person should ensure there is appropriate skill mix of staff to meet the Care Homes for Older People Page 9 of 34 peoples assessed needs at all times. Staff need more training to develop their skills and knowledge in areas including food hygiene and first aid. So that the home is run in the best interests of the people living there, there should be a system in place for reviewing and improving the quality of care provided at the home. So that any unnecessary risks to the health and safety of people are eliminated, the doors of the cupboards that have hazardous substances and hot water (sluice room) should be kept locked at all times. 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 10 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 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their families had insufficient information on which to make a considered choice of home. People who used the service had not had their initial needs assessed, to try to ensure that the staff could meet their needs before they were admitted to the service. This placed people at risk of their needs not being adequately met. Evidence: We looked at the homes Statement of Purpose (SOP) and Service User Guide (SUG) and found that they had not been reviewed and updated since February 2007. As there had been many changes to the homes management and facilities over the past three years this meant that information was out of date and therefore not useful to people who may be considering living at the home. We looked at the care plans for three people. We did not see that people had a pre assessment form completed before they were offered a place at the home. The Care Homes for Older People Page 12 of 34 Evidence: manager said that she had been unable to find pre assessment information for people. She showed us the pre assessment report that she planned to use when she carried out assessments, prior to offering people a place at the home. This would ensure that the homes managers were satisfied that they would be able to meet peoples individual needs. There had been no recent admissions to the home so it was not possible to look at a completed pre assessment report. The reason there were no recent admissions to the home was because the provider had agreed to temporarily stop people being admitted so that issues raised, that were of a safeguarding nature could be resolved. We spoke to one person who was admitted to the home several months ago. They said that they had been encouraged to visit and spend time at the home so they could meet members of staff and other people living at the home. We asked the manager if there were any people whose current needs could not be met at the home. She said that currently all people at the home were being reassessed by use of a new care plan format. The manager did not have any concerns that anyone living in the home was in appropriately placed. We asked staff if they believed that people living in the home were appropriately placed and if peoples individuals needs and preferences were being met. Staff said that they were able to provide appropriate care and support to everyone living in the home and there was no one they thought was wrongly placed. This was confirmed to us during our observations of people and staff throughout the day. The manager told us the home does not provide intermediate care. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were not always being adequately reflected in care plans. People were not fully protected by the homes medication policies, procedures and practises. Evidence: We checked three care plans and we found that each persons health, personal and social care needs were set out in individual care plans. There was little evidence to show that peoples changing needs had been reflected in individual care plans. The manager said that she had concerns about whether the care plans were being reviewed adequately. This may reflect that staff are not adequately trained. We asked three people who lived at the home and three relatives, if they knew about their (or their relatives) care plan and they told us they had not been offered the opportunity to see or contribute to the care plans or the reviews. Some people said they would welcome being invited to contribute to the care plans and reviews. The care plans we checked showed evidence that people had the opportunity to see the G.P as required as well as support from other specialist community health teams Care Homes for Older People Page 14 of 34 Evidence: such as district nurses, opticians, dentists, social workers and other specialist geriatric health support etc. This helped to protect peoples health needs. We spoke to one visiting district nurse. She told us she visits the home several times each week. She said that when she visited the staff were very helpful and assisted her where necessary. We saw that the manager and staff had a good working relationship with the nurse. Working together they were seen dealing with a person, which resulted in the persons health needs being met skillfully and with the persons best interests at heart. We checked to see whether people had risk assessments in place to protect their health and welfare. Although there were risk assessments, there were some gaps in the information that should have been recorded, to ensure that any identified risks to people were reduced or eliminated. We observed the homes storage and handling arrangements for medicines. Information detailing peoples allergies to medicines had been completed. This information is required to maintain peoples safety. We also observed medicines being given to people after their breakfast. Pots were used to hand medication to the person and water was offered to help with the taking of medicines. Time was spent with each person and encouragement given given to help them take their medication. There were a small number of unexplained gaps within the medication administration record charts (MAR). This presented a risk of medications being incorrectly administered to people. We spoke to the manager and operations manager about this. They agreed to carry out a full audit of medications in order to establish the reasons for the gaps in the records. The manager also raised concerns about the competence of one staff member who administered medication. The operations manager said she would review the training of all staff who administered medications. From this any staff who raised concerns would be stopped administering medications until they had received further training. We were told that no people were currently administering their own medication. We observed staff interactions with people and at all times saw how people were treated with positive regard. Staff were professional yet informal and friendly with people who used the service. This was very good to see and people we spoke to told us they were treated well by staff. 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. People had opportunities to meet their social, cultural and recreational needs. People who live at the home were encouraged to eat a healthy and varied diet. Evidence: We saw evidence on the communal notice boards in the home that there were some daily activities available to people. These included bingo, hair, nails and beauty care, outside entertainers, cake decorating, games and exercises with pom poms. We were advised by people who lived at the home and staff that the home employs an activities coordinator who works five days per week from 12 to 4 pm. There was evidence that activities that people had been taking part in were recorded in their care plans. The activities co ordinator had only recently started working at the home. We spoke to her and she was very enthusiastic about her role. She had many things planned for the better weather. She said people had said they were interested in gardening and plans were in place to make sure people were able to do this. She was also planning an entertainer to visit the home once a month as this had recently been well received. We wanted to find out if people who lived at the home found the lifestyle experienced in the home matched their expectations and preferences, and satisfied their social, Care Homes for Older People Page 16 of 34 Evidence: religious and recreational interests. This is what three people told us, The activities are good, I enjoy them. It would be nice to get out but the bad weather has stopped us. Weve been promised outings as soon as the weather improves. Theres not enough to do, I would like to have more activities. I choose not to be involved, its not for me. Then we asked the staff what they thought of the activities in place for people and they said, We do have activities for people but they dont always want to do things. Most people would like to go out more but its difficult having enough staff to do that. Whenever we can we take people for a walk, so that they can get out for a bit. Overall, our conclusions were that the activities currently on offer at the home were meeting some, but not everyones expectations or needs. All of the people we spoke to told us they were able to keep in contact with families and friends and that, visitors were made to feel welcome and could call at any time. This helped to support people to maintain important relationships. We asked three people who lived at the home whether they were helped to exercise choice and control over their lives. This is what they told us, Well we do have some choices, we can do activities if we want. We can choose when we get up and go to bed. Staff are always asking us what we want to eat and if we want a drink. These examples showed that people were offered basic choices and opportunities to control their lives. We asked people who lived at the home about the meals offered to them and this is what they told us, Care Homes for Older People Page 17 of 34 Evidence: Breakfasts are good they made me porridge and poached eggs this morning. The food is good. We get fresh vegetables and fruit each day. We get asked what we want and if we dont like the choices we can have something different. We also observed breakfast and lunch being served at the home and saw that people were offered a wholesome meal in pleasant surroundings. People were offered a choice of food and drinks. Tables were set with table cloths, cutlery and crockery. The tablecloths were very creased, which made the table settings look very unappealing. Staff were seen offering assistance and encouragement to people where necessary. Peoples personal likes and dislikes were documented and known by staff. Special diets were available as needed. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were not being used effectively. This did not protect peoples rights. There was a high number of adult safeguarding referrals from the home, which showed that people had not been adequately protected from being harmed or suffering abuse. Evidence: We wanted to check if people who lived at the home and their relatives and friends were confident that their complaints would be listened to, taken seriously and acted upon and this is what we found. There have been three anonymous concerns/complaints made to us since August 2009. These have been reported to adult safeguarding and investigated by the south west team at Barnsley Social Services. Some issues were unfounded others remain under investigation and have resulted in further visits being made by Barnsley. The nature of the complaints were general concerns about the quality of food offered to people at the home, concerns about staffing levels, poor relationships between the manager and staff and lack of leadership from the manager. Through the close and continued monitoring of the service two concerns were raised that were more specific and alleged specific incidents had occurred and these are currently being investigated by the police. Issues that are of an adult safeguarding nature were continuing to be monitored via Care Homes for Older People Page 19 of 34 Evidence: strategy meetings, where all professionals come together with relevant information. From this the provider had been issued with a number of actions that must be taken to ensure that people were kept safe. We saw that the service had a complaints procedure, which was on display in the entrance hall. When we checked the complaints file there were no records of any complaints that had been made to the service. No other complaints had been recorded at all in 2009. We spoke to two relatives who said they had raised a concern about missing property. There was no written evidence of their complaint, however action had been taken to try to resolve the issue. This practise demonstrated that complaints made about the service were not being recorded or actioned in a timely and accurate manner. This did not protect peoples rights or adequately address their concerns and improve standards within the home. The fact that so many anonymous complaints were made to us may indicate that complainants did not have confidence in addressing their complaints directly to the home or in the home taking their complaints seriously and acting upon them. There was evidence that since the new manager had been appointed in February 2010, people felt more confident in raising any issues. This will better protect peoples rights. We spoke to three people and three relatives to see if they knew the complaints procedure and would feel empowered to use it. People said, If I had any concerns or worries I would speak to the staff. My family would sort out any problems for me. Im very happy here, theres nothing to complain about. Relatives said, There have been so many managers recently that its difficult to know who to speak to if we had a problem. The staff are very good and always ask us if things are OK, so if we had a problem wed go to them. I did raise a concern quite a while ago and it was sorted straight away. Care Homes for Older People Page 20 of 34 Evidence: These findings demonstrated that people, in the main, where able to pass on their concerns. However the system for recording peoples complaints and concerns was not robust. From discussions with staff it was evident that some staff had a very good understanding of their responsibilities for safeguarding adults, others had a more limited understanding of this important area. This leads to inconsistent knowledge and practise within the service. We asked five staff if they had completed safeguarding adults training, they all told us they had. We then checked the staff training matrix and this confirmed to us that all staff were booked onto a refresher safeguarding adults training course in March 2010. Care Homes for Older People Page 21 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. Overall people lived in a warm and comfortable environment. Some of the communal areas were in need of refurbishment and redecoration. Staffs lack of training and poor practises were putting people at risk of outbreaks of infection. Evidence: We wanted to see if people lived in a safe and well maintained environment and this is what we found. People told us they thought the home was nice, clean and met their needs. People said they were happy with their bedrooms. Some people had brought in small pieces of furniture and other pictures and ornaments from their previous home. We identified a number of bedrooms that had a spartan appearance. Some people had not been supported to personalise their bedrooms so they could be surrounded by personal possessions and enjoy a homely setting. People had access to communal lounges, dining areas, quiet rooms and were free to use their own personal bedrooms at any time. The building was adequately maintained, however, many areas of the home were in need of redecoration. Communal rooms had scuffed and dirty walls and paintwork. Care Homes for Older People Page 22 of 34 Evidence: We looked at the communal bathroom and toilet facilities on the ground and first floors and found that most were in need of redecoration and some needed refurbishment. Bathrooms and toilets were very bare and unappealing. Some were used as storage and looked untidy. The environments of these rooms were not homely, they were institutional and stark. This did not provide people with a homely environment. The home had a laundry area in the basement of the building. Equipment was provided to ensure clothing and other laundry was washed adequately, however the room was in need of updating and painting. We checked to see if the home had effective hygiene and infection control measures in place and this is what we found. Very few of the staff team had completed training in infection control, which meant they did not have the skills and knowledge to carry out infection control practises safely. We saw staff walking in and out of the main kitchen, without using any protective wear. Staff who had carried out personal care tasks, walked freely into the food preparation areas without any consideration of the risks associated with this. This did not protect peoples health. The training matrix showed us that two staff had attended infection control training in March 2010, however the remainder of the staff had not received training. Care Homes for Older People Page 23 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. People were generally satisfied with the care they received. The provider and manager were aware of the gaps in staff training and had put in place a plan to deal with this. Staff had been appointed before important documentation had been received. Evidence: We wanted to check if the people who lived in the home had their needs met by the numbers and skill mix of staff. This is what we found. On the day of the inspection there were 14 people living in the home. There were 2 carers and one senior carer working during the morning and evening. Considering the dependency of the people in the home this would usually be sufficient. However due to staff holidays and sickness, the laundry person was working as the cook and there was no domestic assistants on duty. The activities worker had started one hour earlier to provide some support in the laundry. The manager was on duty, however the home does not employ an administrator so the manager, also had to answer the phone and carry out many administrative duties. We saw that staff dealt very well in dealing with staff shortages, however it would not be acceptable for the home to manage on reduced levels of staff for a long period. The provider and manager should consider the staffing ratio and mix so that carers Care Homes for Older People Page 24 of 34 Evidence: were not routinely expected to use the time, that was allocated to care for people, doing other tasks. We saw staff working with people and noted there was an atmosphere of mutual respect; their conversations were relaxed and friendly. The staff group were well motivated and enthusiastic about their work. People said, The staff are great, they always help me when I need it. I like all the staff, I have no problems. Relatives said, Staff are welcoming and polite, they keep us informed about our relative. The staff always go out of their way to speak and ask if things are OK. Of the 17 care staff only six had completed the National Vocational Qualification (NVQ) Level 2 award. This was less than 36 per cent of the staff team and this did not ensure that staff had been assessed as having the appropriate skills and knowledge to support peoples needs. The manager said that a further 7 staff were due to start the qualification in April this year. The staff training matrix also showed us that there were many gaps in the mandatory training provided to staff. This had been highlighted as an action point as part of the safeguarding strategy meeting. This could place peoples health and safety at risk. The provider was able to confirm a number of dates booked for staff to complete training in topics such as, first aid, moving and handling and basic food hygiene. We wanted to see if people were supported and protected by the homes recruitment policy and practises. We had been made aware at the adult safeguarding strategy meeting that there were staff working at the home that did not have two completed references. We found that on two staff recruitment files checked, only one reference for each person had been received. This had already been brought to the attention of the provider, who had requested further references for these staff. However, on one file we could not find any evidence that an enhanced CRB had been completed. This did not ensure all staff had been properly checked and could place people at risk. We drew this to the managers attention to action as a priority. The operations manager confirmed to us that the person had stopped providing care to people and had been asked to help the manager with administrative tasks, in the office, until a full CRB check had been received. 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. Adequate monitoring and quality audits checks had not been fully completed at the service. The health, welfare and safety of people had not been promoted and protected in all areas. Evidence: We checked to see whether the home was being run and managed by a person who was fit to be in charge, of good character and able to discharge their responsibilities fully. This is what we found. Since the last inspection in April 2009 there has been three managers employed at the service. The present manager is the fourth to be employed in less than twelve months. This had had a detrimental effect on the quality of the service provided. People, staff and relatives spoken to said they felt concerned about how quickly the managers leave and another person was employed. Relatives said they felt very out of touch with the reasons that managers did not stay and said they had never been offered any explanations about why this was. Care Homes for Older People Page 26 of 34 Evidence: The current manager had been in post since February 2010. She had yet to be registered with us. She had the necessary experience to run the home. She had a qualification in management/care and had planned to commence further management training over the next few months. The manager was aware of the need to keep up to date with practice and continuously develop her management skills. The service had also employed an operations manager, who would oversee the management of the home and its two sister homes. She came to the home on the day of the inspection and we were confident that her involvement with the home would be of great advantage. We asked people living in the home, staff and relatives, what they thought about the current manager. People said, Shes very nice, although I dont really know her very well yet. She seems OK, no problem at all. Relatives said, I havent had much contact with her, but Im starting to notice that things are getting much better. We have no problems, we could go to her if we had any issues. Staff said, Things are so much better now, shes approachable and always willing to listen. Shes fabulous, very understanding and very fair. I really hope she stays as improvements are already starting to happen. We found the manager was honest and motivated. However, this manager needed more day to day practical support to ensure she could manage the current issues within the home, as well as the day to day running of the service. This was fed back to the provider and operations manager during our visit, who advised us that they would address this as a priority. We wanted to see if the home was run in the best interests of the people who lived Care Homes for Older People Page 27 of 34 Evidence: there and this is what we found, Prior to the inspection we had requested that the provider sent to us the Regulation 26 reports. These are monthly reports completed by the provider, or their designated person, to ensure they are monitoring the quality of the service appropriately. These were being completed each month and had highlighted the changes that needed to be made to improve the quality of the service. The manager told us that there had not been a recent quality monitoring system in place, based on seeking the views of people and others involved in the home. She also said that resident and relative meetings had not taken place. We spoke to the operations manager about this and were assured that a quality assurance audit and meetings would be made available in the near future. It was important that this happened so that people and relatives were also given the opportunity to meet and speak to the newly employed managers. We saw that the manager handled money on behalf of some people. These were sampled. We saw that account sheets with receipts were being kept. A second person witnessed each transaction. This helped to ensure that peoples financial interests were being safeguarded. As part of the site visit we examined some of the maintenance and servicing records. All were up to date and these included, an electrical circuit check certificate and a gas safety certificate. The fire detection and fighting equipment had last been checked in July 2009. Fire drills had been undertaken and fire alarms had weekly tests undertaken. These checks helped to ensure peoples safety and welfare was protected. Whilst undertaking a check of the environment we observed some doors that should have been kept locked had been left unlocked. This meant that people had access to hazardous substances and water in a sluice room that was hot. Staff locked these doors immediately. Following the inspection the operations manager confirmed to us that action had been taken to ensure that these doors were not left unlocked. 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 Statement of Purpose and Service User Guide must be kept under review and up to date. So that people who are considering moving into the home have sufficient information on which to base their choice. 16/04/2010 2 9 13 Arrangements must be 22/03/2010 made to ensure that all staff responsible for administering medication are adequately trained. To protect peoples health, safety and welfare. 3 9 13 Accurate medication records must be maintained, where a medication has not been taken the reason for this must be recorded. To protect peoples health, safety and welfare. 22/03/2010 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 4 16 22 All concerns and complaints 22/03/2010 received at the home must be fully recorded. The record must show what action has been taken to resolve any concerns and complaints. So that peoples rights are promoted and protected. 5 26 23 All staff must receive training in infection control. So that people are not put at risk due to poor infection control measures. 26/04/2010 6 29 19 The registered person must ensure that all staff who are working at the home have an enhanced CRB check. To ensure that people are protected. 16/04/2010 7 33 24 There must be a system in 03/05/2010 place for reviewing and improving the quality of care provided at the home. So that the home is run in the best interests of the people living there. 8 38 13 The doors of the cupboards 17/04/2010 that have hazardous substances and hot water (sluice room) should be kept locked at all times. 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 So that any unnecessary risks to the health and safety of people are eliminated. 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 3 So that people can feel confident that the home is able to meet their individual needs, there should be a thorough pre assessment carried out before people are offered a place at the home. Care plans should be reviewed at least once a month. They should be updated to reflect changing needs and current objectives for health and personal care. All risk assessments should be reviewed to ensure that any risk identified has been fully considered and where necessary action taken to reduce or eliminate the risk. People should be offered the opportunity to contribute to their care plans and reviews. People should be asked their preferences in regard to social activities. These should then be made available where possible. More care should be taken to make table settings look more appealing. There should be a planned redecoration and refurbishment programme, which includes all areas of the home, so that people are living in a well maintained and comfortable environment. The registered person should ensure there is appropriate skill mix of staff to meet the peoples assessed needs at all times. The planned programme of staff training should continue. When this is completed there should be a system put in Page 32 of 34 2 7 3 7 4 5 7 12 6 7 15 19 8 27 9 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations place to ensure that staff are kept up to date with future training and refresher courses. 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. 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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