Care Home: Somerset House

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What the care home does well People at the home told us that during their admission to the home, their care needs are discussed with the staff. Their relatives are welcome at the home and are informed about important issues that affect their health. We were also told that they know who to approach with complaints and feel confident that their concerns would be taken seriously and acted upon. When we asked about the staff, we were told that overall they are competent and knew how to meet their needs. What has improved since the last inspection? The manager and service provider told us that an Occupational Health therapist (OT) was employed to provide individual and group activities. An external training company was used to provide refresher statutory training and other specific training that meets the changing needs of the people at the home. A consultant was also used to review the standards of care at the home and where necessary introduce changes that are meaningful to the people at the home. The person centered approach to meeting needs shows the managers` commitment to placing people at the center of their care. Some staff told us that they recognised that they must use a more empowering approach to meeting care needs. This shows that staff have insight into the changes that need to happen to develop personalised care. What the care home could do better: At this inspection we made eleven requirements, two were Immediate requirements where action had to be taken within 48 hours and repeated one requirement from the previous inspection. Requirements arising from the findings of this inspection are mainly about care planning processes, medication and staffing. While the care planning system of the home has improved further action is necessary to develop a personalized approach to care. Care plans must be kept under review to meet the changing needs of the person and must guide the staff to consistently meet the identified needs. Risk assessments must be undertaken where activities present an element of risk, this is to assess the level of risk so that an action plan that lowers the level of risk can be introduced. Medication systems must improve medications must be securely stored and at the correct temperate. Records of medications administered including food supplements must be maintained to ensure the safety of people at the home. Comments made by staff during the inspection and through surveys raised concerns about the safety of people. The manager must investigate these concerns and provide the Commission with detailed reports of the investigation with an action plan about the way people at the home will be safeguarded from abuse. Key inspection report Care homes for older people Name: Address: Somerset House 157 High Street Yatton North Somerset BS49 4DB     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: Sandra Jones     Date: 2 6 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Somerset House 157 High Street Yatton North Somerset BS49 4DB 01934832114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Wendy Rita Hiles Name of registered manager (if applicable) Mrs Julie Denise Jones Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 26 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Somerset House provides personal care for up to 26 people over 65 years of age. The home is a pleasant period property situated off the main road through Yatton, with walled gardens that are well kept. The property has been extensively improved and extended. A majority of rooms are situated on the ground floor. Rooms on the first floor are accessed by a stairlift. for people with mobility difficulties. The premises also have a small satellite home. This is suitable for people who wish to use the support Care Homes for Older People Page 4 of 35 Over 65 26 0 1 5 0 5 2 0 0 9 Brief description of the care home offered by the home, but desire a more private form of accommodation. The provider makes information available through a brochure and information pack. The information pack contains the Statement of Purpose and Service User guide and all relevant information about the home. Inspection reports are displayed in the entrance to the home and available for all to read. The fees range between 380 and 440 pounds a week with additional charges being made for hairdressing, chiropody, newspapers, and toiletries. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was conducted unannounced in over three days in March 2010 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from the staff, people living in the home and visitors. Prior to the visit some time was spent examining documentation accumulated since the previous inspection including the Annual Quality Assurance Assessment (AQAA) and this information was used to plan the inspection visit. Have your say surveys were sent to the people living at the home and health care professionals and three surveys were received from staff in advance of the inspection. Care Homes for Older People Page 6 of 35 There were twenty-two people living at the home and four people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people living at the home and other related documents. The homes policies and procedures were also used to confirm the findings. People at the home were invited to make comments about the standards of care and four staff, three people and one relative agreed to give feedback. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: At this inspection we made eleven requirements, two were Immediate requirements where action had to be taken within 48 hours and repeated one requirement from the previous inspection. Requirements arising from the findings of this inspection are mainly about care planning processes, medication and staffing. While the care planning system of the home has improved further action is necessary to develop a personalized approach to care. Care plans must be kept under review to meet the changing needs of the person and must guide the staff to consistently meet the identified needs. Risk assessments must be undertaken where activities present an element of risk, this is to assess the level of risk so that an action plan that lowers the level of risk can be introduced. Medication systems must improve medications must be securely stored and at the correct temperate. Records of medications administered including food supplements must be maintained to ensure the safety of people at the home. Comments made by staff during the inspection and through surveys raised concerns about the safety of people. The manager must investigate these concerns and provide the Commission with detailed reports of the investigation with an action plan about the way people at the home will be safeguarded from abuse. Care Homes for Older People Page 8 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose does not include sufficient information for people to make a decisions about moving into the home. People at the home cannot be fully reassured that the admission process will ensure that staff are able to deliver the services it undertakes to provide Evidence: There is a Statement of Purpose in place and it says that the aims of the home is to provide comfortable sheltered accommodation for elderly people. There are gaps in the information provided, the range of needs that can or cannot be provided and the admission procedure that says the way the staff will ensure the needs of the people wishing to live at the home is missing. The deputy told us that copies of the Statement of Purpose and contracts of residency are provided to each person. There are 22 people currently living accommodated and the care files of the two people that most recently moved into the home were examined to check the Care Homes for Older People Page 11 of 35 Evidence: admission process followed at the home. We found social workers needs assessments in place for people funded by the Local Authority, with assessments completed by the staff for people wishing to live at the home. Overall the assessment undertaken by the staff include personal care needs, health, social and cognitive needs. People at the home told us that before moving into the home, a discussion about their needs and the way they were going to be met took place. The deputy manager told us that people wishing to live at the home are assessed before their admission and is based on the individuals ability to move around independently. Accommodation cannot be offered to individuals that may be at risk in the community and will leave the home without staff support or people with nursing needs. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are not at the center of their care and care planning is not essential to the delivery of care. Risk assessents are in place for activities that may involve an element of risk, however, the plan does not say the way the risk level is lowered. Improvements are needed to ensure that medicines are handled safely and peoples health is protected. Evidence: The case files contain admission details that seek information about personal details, with health care and communication needs along with dietary likes and dislikes. The deputy manager said that during the admission process, long term assessment forms are completed with the person. There is a clear person centred approach used to meeting needs, the persons abilities and the way the care is to be delivered is described. Once the long term assessment forms are completed a more in-depth care plan is then devised which is signed by the person or their relative/advocate to indicate agreement with the care plan. Action plans arising from the needs listed say the way Care Homes for Older People Page 13 of 35 Evidence: the person needs are to be met. The deputy manager told us that care plans are monitored monthly by the keyworker with the person. However, structured meetings, where the identified needs and changing needs are discussed do not currently take place. This means that all areas of the persons changing needs are not discussed to then update the care plan. The manager said that for people funded by the Local Authority, postal reviews are undertaken. This is where a form is completed by the manager to confirm that the staff can meet the needs of the people they fund. We spoke to staff about their responsibilities towards care planning. One care assistants told us that they are not keyworkers and mainly undertake personal care, read care plans and write daily reports. Keyworkers consulted told us that they undertake special responsibilities for certain individuals, make assessments of need, compile and update care plans. Individuals consulted told us that during their admission process, staff discussed their needs and confirmed that staff know how to meet their needs. It is evident from the daily reports that individuals changing needs are not part of the care planning process. In addition, there are significant gaps in the recording. For example, the intervals between entries and the progress made when people are ill. While people with dementia and short term memory are accommodated, care plans do not specify the way the individuals dementia manifests. Reports from staff also indicate that people that may at times exhibit aggressive behaviours are accommodated. For individuals that may use aggressive behaviour to communicate, care plans that indicate the triggers and the actions that must be taken to diffuse or divert aggressive behaviour must be developed. This will ensure a consistent approach from staff. The deputy told us that that people must be able to walk independently or with aids and for people to maintain their independence there are hoists and a stair lift available. Hoists are available on each floor for people that may fall and need assistance and there is a stair lift to the first floor. Risk assessments are formulated for people that have a history of falls and the format used identifies the level of risk which then leads the staff to undertake a more detailed assessment. However, risk assessments are not detailed about the techniques to be used for moving and handling. The manager said that manual handling belts, discs and hoists are available in the event that an individual is unwell or a fall and not for regular use. For this reason, assessments by health care professionals to use aids have not occurred. In Care Homes for Older People Page 14 of 35 Evidence: terms of the slings for the hoist, people will be weighed to ensure the correct sling is used in the event of a fall. Reports from health care professional show that people access district nurses, GPs and visit specialists. Outcome of the visits are then recorded in the daily reports. However, there is little evidence that advice given is consistently followed by the staff. Feedback about the way the individuals health care is monitored was sought from the deputy. We were told that concerns about people are discussed and if appropriate senior members of staff will make decisions about whether a GPs is visit necessary. Daily reports examined raised concerns about the way staff record the progress made by people who are ill. Daily reports contain staffs observation of the persons health, but there is no record of action taken or if the GP was contacted as a result of their observations. Daily reports must include the progress made by individuals that are ill and where a GP was contacted details of the advice given must be incorporated. Feedback was sought from people at the home about their health care needs and they told us that staff contact their GP when they are unwell. Individuals health care needs are not always part of the care plan, for example, people with diabetes and continence problems. Members of staff are then not guided on the way the care needs are to be met or the triggers that are an indication of deteriorating health. The pharmacist inspector looked at how medicines are looked after in Somerset House. Staff told us that they had made a number of improvements to the way they look after medicines in the home, since the last inspection. A person has been to the home to provide training about handling medicines and staff told us that she also gave them advice about improvements. However we saw that further improvements are needed to ensure that peoples health is protected. We left an immediate requirement for some of these issues to be addressed.These included: Arranging for a suitable cupboard to be obtained to store medicines called controlled drugs, which need additional security. Ensuring that medicines awaiting disposal are locked away. Ensuring that the temperature of a fridge used to store medicines is monitored daily to make sure that it is safe for storing medicines. Confirming that the medicines given to one person are the correct, up to date prescription. Recording all prescribed food supplements given to people living in the home. Care Homes for Older People Page 15 of 35 Evidence: People living in the home are registered with a local doctor and medicines are supplied by a local pharmacy using a monthly blister pack system. Staff told us that they order all their medicines through the pharmacy and do not see any part of the prescription. This means that they cannot check that the correct medicines have been supplied and we recommended that they take action to address this. Several people look after some or all of their own medicines. There was no policy in place for this to make sure it is done safely and appropriately. We saw that one person had not taken one of their medicines for four months and itwas not clear why it had been prescribed for them. This medicine has been supplied to the home each month, so it would appear to the doctor and pharmacist that the medicine was taken. Another person looks after two of their own medicines. We discussed with staff the need to ensure that medicines are always supplied in suitably labelled containers including the dosage instructions. This person had recently been ill and unable to look after their medicines for a short time but it was not clear that staff had checked that the person was well enough to safely look after their own medicines before giving them a new supply. There is no homely remedy policy in place to allow staff to treat minor ailments. If homely remedies are to be used a policy must be available, with an approved list of medicines. This should be agreed with each individuals doctor. Supplies of medicines for this purpose must be purchased by the home. We talked to staff about how they give medicines. The current system involves putting everyones medicines out into labelled pots before starting to give them and does not follow good practice guidance. Staff took action, while we were there, to address this. The homes medicine policy should include information about how the medicines are to be given so that all staff are aware of the safe policy to follow. One person living in the home told us that staff are very particular about dealing with medicines. Staff told us that they had received medicine training from a person who visited the home in November 2009. We saw one persons certificate. The pharmacy provides monthly medicines administration record sheets for staff to complete when they have given medicines. Systems are in place that allow medicines to be audited to check they have been given as prescribed. Two medicines we looked at could not be checked because the audit system had not been followed. We checked several packs of sachets used to treat constipation and found that these agreed with the administration records. Care Homes for Older People Page 16 of 35 Evidence: Some improvements are needed to the records made by staff to make sure that they are accurate. Some handwritten additions to the records had not been signed, dated or checked by a second person. We saw two errors. In one case the dose of Paracetamol was different to that on the medicine label so the person was not given the Paracetamol as prescribed. In the other, the wrong strength of medicine had been written on the record sheet so staff were signing they had given 50mg when they had given 100mg. One person has been prescribed food supplements but staff have not recorded whether these have been given or not. Records are kept of the medicines received into the home. Records need to include the date of receipt and details of the medicines supplied in weekly boxes. Records are also kept of the disposal of medicines. This should include details of refused medicines.It is good practice to include the reason for disposal and for a second member of staff to check the record. This is so that there is a clear audit trail to show that medicines coming into the home have been used safely. Secure storage is available for medicines. However medicines awaiting disposal and medicines kept in the fridge must also be kept securely. Staff must record the temperature of the fridge daily to make sure that it is always in the safe range for storing medicines. A minimum /maximum thermometer should be used for this. Suitable storage must be arranged for medicines called controlled drugs, which need additional security. This must conform to the Misuse of Drugs Act (Safe Custody) Regulations 1973. A suitable register is used to record these medicines. Improvements are needed to ensure that these records are accurate and complete. We looked at four peoples care plans to see if they had information to help staff look after peoples medicines correctly. It would help ensure that medicines are given safely if there were more information available for staff. For example for one person who had recently moved to the home there was no confirmed list of their current medicines in their records. This is important to ensure that they receive the correct medicines. Two people who look after some of their own medicines did not have clear care plans in place for this. One person is prescribed a medicine which needs regular blood tests to check the correct dose. Staff told us that the results of these tests and the dosage instructions are given to them by phone. Staff should request that all information about dosage instructions is confirmed in writing to reduce the risk of mistakes being made, as recommended by the National Patient Safety Authority. Care Homes for Older People Page 17 of 35 Evidence: The Privacy and Dignity policy are included in the Statement of Purpose and says that way the rights of the people at the home will be respected by the staff. Members of staff were consulted about the way they ensured individuals rights are observed. We were told that asking permission before undertaking personal care, knocking on doors before entering and speaking to people were ways people were respected at the home. Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home can participate in a wide range of activities and there are individual sessions for people that prefer not to socialise with the group. The staff ensure that people maintain contact with family and friends. People at the home are not always offered three meals per day. Evidence: We understood from the manager and staff that there is an entertainer that visits every four weeks, weekly church services and an Occupational Therapist (OT) that visits twice weekly. In addition to this activity programme there are outings arranged and Bingo. The OT programme of activities includes cooking, gardening and quizzes and the record of the activities includes the people who attended. Individual sessions are on a monthly basis and records support that individual and group activities take place. People visit places of worship in the local community and one person is independent to leave the home without staff support. There is an expectation that families assist people at the home to purchase toiletries. Care Homes for Older People Page 19 of 35 Evidence: People giving feedback said that they were able to take their personal possessions into the home so that their bedrooms could reflect their lifestyle. We discussed with people at the home how they spend their time and follow their interest and pursuits. Two individuals said it is their choice not to socialise with others and to stay in their bedrooms. The visitors policy is included in the Statement of Purpose and says that visitors are welcome at all reasonable times. A visitor was at the home during the inspection and the opportunity to seek feedback was taken. We spoke to a relative with their family member living in the home about the care received at the home. The relative said that they are involved in the care of their family member, the same standard of care is observed whenever they visit and there is a homely environment. Dietary needs are part of the care plans, individuals likes and dislikes are sought during the admission process into the home. However, there is little evidence to show that the menus are changed when meals are not liked by the individuals. For example, people that dont eat certain meats are not always provided with a hot alternative. From comments made by the staff it is likely that people who wish to eat hot meals but dont like the meat served have little choice but to eat the meal provided. We received an anonymous call and three surveys from staff which told us that people who do not go to the dining room for lunch and tea are not offered a meal. We spoke to the deputy manager and three care assistants who confirmed that people who did not want to go to the dining room for meals did not get offered a meal. Where individuals have chosen to remain in their rooms during mealtimes, daily report state that a cup of tea was offered. For example, reports state that individuals have gone without a hot meal over the weekend because they have not gone to the dining room. We spoke to the manager and service providers who deny that this occurs, the manager said that people are encouraged to eat their meals in the dining room, people who are ill get their meals in their rooms and only those individuals that say they are not hungry and refuse to go to the dining room are offered a cup of tea. We looked at the menus and noted that people have a continental style breakfast, a choice of two meals at lunchtime and a lighter tea. A new cook was recently appointed and their views were sought. The cook said that the there was a good food budget, the home has been without a cook for sometime and the menus were formulated by the staff. We understand that the menus will be re-done and will incorporate the suggestions from people living at the home. This member of staff also said that trays will be taken down to people who wish to have their meals in bedrooms. Care Homes for Older People Page 20 of 35 Evidence: As a result of our findings an Immediate Requirement was issued for the manager to offer people at the home three meals per day including people who are in their bedrooms. The service provider gave us their reassurances that where people did not wish to eat their meals in the dining room, a meal will be offered in their bedroom. The service provider took immediate action and wrote to the people in the home to confirm that meals can be had in their bedrooms. This policy must also be reinforced to staff; the manager and service provider must ensure staffs awareness and agreement with the policy. Three people were asked about the meals served at the home. One person said that there is an expectation that people eat their meals in the dining room and they go to the dining room for meals. Another told me that they like staying in their room and that some of the food is good. The third person consulted said that they did not enjoy eating and preferred the food supplements prescribed. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home can be reassured that their views are taken seriously and acted upon. However, they cannot be certain that they will be safeguarded from abuse. Evidence: The Complaints procedure is included in the Statement of Purpose which is provided in bedrooms and displayed in the notice board within the home. The manager said that copies will be provided to relatives because of recent survey responses. Relatives stated that they were not aware of the Complaints procedure. The Complaints procedure is clear and reassures people that their views are important and will be taken seriously and acted upon. The three people and relative consulted knew who to approach with concerns; they told us that they would discuss their complaints with the manager. They said that they felt confident that their complaints would be taken seriously and acted upon. There was one complaint received at the home since the last inspection and appropriate action was taken to resolve the concern. Since this complaint the manager has introduced a policy that bans staff from bringing mobile phones to work. Whistle blowing and Safeguarding Adults procedures were examined to establish the commitment for ensuring the people at the home are safeguarded from abuse. The Whistle blowing policy requires some updating to fully convey the essence of the Care Homes for Older People Page 22 of 35 Evidence: policy which is to reassure staff who report poor practice will be protected from reprisals. The implications for staff that witness poor practice and do not report it must be specified and incorporated into the policy. While the Safeguarding Adults policy is clear about the commitment to protect people from abuse, the actions that must be taken by the staff when alerting alleged abuse must be described. Also the actions that the manager will take if allegations of abuse are made against staff. Contact details for agencies that must be alerted for alleged abuse must be included within the policy. We received three staff surveys and an anonymous call about standards of care provided to people at the home. One survey said that some members of staff were cruel and humiliated people at the home. When we consulted staff, we sought their feedback about the comments received through the surveys. Three staff said that they had seen staff shout at people in the dinning room, nurse call pull cords were removed at night and continence aids were refused. One member of staff said that as far as they knew people used the nurse call when they wanted. When we asked these staff why these concerns were not raised with the service provider, we received a variety of responses. Staff said that they had told the service provider in the past and nothing has happened and other staff did not recognise these issues as factors of abuse. The concerns raised through surveys and the comments made by the staff were discussed with the service provider and the manager. We were told that they were unaware of these concerns and as a result of our finding they were invited to a Service of Concern meeting. We also completed a Safeguarding Adults Alert to the Local Authority who act as the lead for Safeguarding Adults from abuse. The service provider has given their reassurances that these concerns will be investigated under the Whistle blowing and Safeguarding Adults procedures. Members of staff will be interviewed and given the opportunity to report poor practice and where appropriate refer to the appropriate agencies. The manager must then provide the Commission with a detailed report of the investigation which must include the findings, an action plan and any referrals or further disciplinary action that will be taken. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment. Evidence: Somerset House is a Georgian, Grade 2 listed building with many of its original features remaining. Its arranged over three floors with communal space on the ground level and bedrooms two floors, with the office on the third floor. A large extension of bedrooms with en-suites has been added to the back of the house The home has been decorated throughout that was of a good standard. There are toilets near the communal areas and an accessible bathroom A stairlift is in place that is frequently used by a number of people with upstairs bedrooms (although the majority of bedrooms and communal space are on the ground floor). The dining room is large and bright and leads to a conservatory overlooking the garden. This is used as extra dining space. The lounge is also of a good size. However, people like to spend time in their rooms and we met them there. Bedrooms are single and furnished with a combination of the homes furniture and individuals personal belonging. We saw peoples bedrooms that looked homely, personal and cosy. The home was very clean and smelled fresh. Staff were seen cleaning all areas. No cleaning materials that could be dangerous for people were seen left out. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be reasured that the staff employed are suitable to work with vulnerable adults. Training is provided to ensure the indivdiuasls changing needs are met and staff are subject to ongoing monitoring Evidence: The manager was consulted about the methods used to determine the existing staffing levels. We were told that the staffing levels were set by the time it took the staff at the home to assist people to get-up and dress in the morning. The rotas in place were examined to establish that the staffing levels in place are appropriate to meet the needs of the people accommodated at the home. The rotas show that between 8:00 am and 2:00 pm there are three staff rostered with the manager acting as supernumerary. Staffing levels then fall to two staff on duty, with the manager acting as a care assistant until 6:00pm when the shift changes and two staff are rostered until 8:00 pm when the two waking staff come on duty. Also employed at the home is an Occupational Therapist, catering and ancillary staff to keep the home clean. There are three staff undertaking vocational qualification, this means the staff team will be qualified to NVQ level 3 and above. Care Homes for Older People Page 25 of 35 Evidence: There is a training matrix in place and staff attend First Aid, Food Hygiene, Mental Health, Safeguarding Adults, Dementia, Medication and Infection Control training. The manager said that at present there is no formal process for implementing the training attended. There must be a system for introducing the knowledge gained and the manager must consider developing a process where training undertaken is discussed with the staff to reach decisions about the way the training is then part of new ways of working. We asked staff about the training that had taken place since the last inspection. We were told that training had increased in the last 12 months and refresher training was attended. The people at the home consulted said that the staff knew how to meet their needs. The recruitment process was checked against the most recently employed staff. Completed application forms that seek personal details, employment history and the names of two referees are held in personnel files. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home can be reassured that leadership will be tightened to ensure they are protected from abuse. Standards of care are subject to ongoing monitoring and people live in a safer environment. Evidence: We discussed with the manager the changes that have occurred since the last inspection. The manager said that a Person Centered Care approach is being developed and believes that this is heading is in the right direction. Regulation 26 reports from the service provider about the conduct of the home were not checked at this visit. Feedback was sought from people at the home about the way their needs are met by the staff and from the staff about the leadership of the home. One person said that their needs are met by competent and experienced staff. Another said that while the staff were good some had been nasty, they were told by staff that they were using Care Homes for Older People Page 27 of 35 Evidence: the nurse call too frequently which was for emergencies only. We were also told about conflict between staff and that more or less staff were respectful. One member of staff said that there are inconsistencies about meals, when certain staff are on duty people can have meals in their bedrooms. There are staff that bully other staff and one member of staff felt it was about who has more authority. Another member of staff said that some staff have no patience and should not be working with older people. A fourth member of staff acknowledged that often there were differences of opinion between staff. The manager and service provider are aware that these issues must be investigated and appropriate action must be taken to ensure that staff working at the home are suitable to work with vulnerable adults. The home operates a Quality Assurance Systems; questionnaires about the standards of care are used to seek feedback from people at the home, their relatives and representatives. A report is then compiled from the feedback received which includes the way their comments will be addressed. The manager also told us that house meetings are the forums used to seek group feedback from the people at the home. Meeting happen monthly and records show that there are opportunities to make suggestions that benefit the group. Separate surveys will be used for the staff, the service provider will be analysing the comments. The service provider told us that 6 surveys were returned and suggestions about physical issues were received. The Annual Quality Assurance Assessment (AQAA) is also used to assess the way the home meets the standards of care and where appropriate the information sought from the staff and people at the home will used. Fire Risk assessments were completed by an external company which looks at the potential of fire in the premises to then develop an action plan that lowers the level of risk. The manager ensures that the people living in the home and staff have a safe environment and systems are serviced annually to ensure they function effectively. The stair lift, portable electrical equipment and gas boiler are checked annually by contractors to ensure these systems function safely and comply with associated legislation. However, at the time of the inspection, the radiators in bedrooms were excessively hot to touch. An Immediate Requirement was issued for the service Care Homes for Older People Page 28 of 35 Evidence: provider to conduct a risk assessment on the radiators. The purpose of the risk assessments are to assess the potential of people at the home burning themselves to then devise an action plan that lowers this potential. Action was taken to rectify this during the inspection. Because of issues raised in this report to do with the behaviour of staff and safety (medication and radiator temperatures) we had serious concerns about the way the home was being managed. However, having met with the providers and manager we are reassured that urgent action is being taken to address these failings. Consequently we have not judged this section of the report poor. We will carry out random unannounced inspections to monitor improvements and if concerns remain bring forward the next key inspection There are facilities for the safekeeping of cash and valuables and details of each transaction, with receipts of purchases made show that records are accurate and up to date. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 Risk assessments must be put in place where there are clearly identified risks to the health and safety of people living at the home. This will make sure people are kept protected from risk. 10/08/2009 Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 15 16 People at the home must be provided with adequate quantities of food that are wholesome and nutritious which are varied and available at such times that are reasonable. People at the home must be offered at least three meals each day that are varied and nutritious. 12/04/2010 2 38 13 Unnecessary risk to the 13/04/2010 health and safety of people at the home is identified and so far as possible eliminated The manager must risk assess the level of risk from radiators that are too hot to touch. An action plan must then be devised to lower the level of riks. 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 registered manager must review the Statement of Purpose This will ensure that people have up to date information about the home. Information 06/08/2010 Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action to be included must meet the requirements of Schedule 1. 2 7 15 Care plans must be kept under review. Once care plans are reviewed, the changing need must form part of the care plans 3 7 15 The manager must prepare a written care plan about the way the individuals health and welfare needs are to be met. Care plans must include the individuals health, social, physical and emotial care needs. This care plan must guide the staff to consistently meet the needs identified. The triggers, signs and symptoms must be incorporated into the action plans. 4 9 13 The registered manager must make arrangements for the safehandling of medications Controlled drugs must be stored in a cupboard that meets the requirements of the Missuse of Drugs Act (safe custody) regulations 1973 01/06/2010 12/07/2010 12/07/2010 Care Homes for Older People Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 9 13 The registered manager must make arrangements for the safehandling of medications. The manager must ensure tha mediciens are administered safely and that accurate records are kept of all medicines given by staff, including prescribed food supplements. 01/05/2010 6 9 13 The registered manager must make arrangements for the safehandling of medications. The manager must ensure that all medicines are stored securely and at the correct temperature. 01/05/2010 7 18 37 The registered person must 12/05/2010 inform the Commission of any allegation of misconduct by the staff working at the home. A detailed copy of the investigation along with an action plan arising from the investigation must be sent to the Commission. 8 18 6 The registered provider 12/05/2010 must make arrangements to prevent people at the home being harmed or suffering Care Homes for Older People Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action abuse of being placed at risk of harm or abuse. The registered persons must investigate the concerns raised by the staff at the home. 9 29 19 The registered person muse ensure that the staff are not employed unless they are of good character and integrity. Application forms must then request from staff disclosures of criminal historiy. 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 14/08/2010 1 9 The ordering system used in the home should enable staf to check that the correct medicines have been prescribed and supplied. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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