Care Home: Springfields Residential Home

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• The Shelley
• Springfield House
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What the care home does well Residents are cared for by staff that treat them with kindness and respect. They benefit from good sized bedrooms and access to sufficient comfortable shared areas in the home. People using the service say they are happy with the care they are receiving. There is a good choice of meals in the home and people using the service said they enjoy the food. What has improved since the last inspection? Since the last inspection some people`s care plans have been reviewed and are now more person centred, however, this work still needs to be completed for some. There are more choices on the menu and residents tell us the quality of the meals has improved. There are more activities for residents to participate in and the manager has introduced a system for recording how people`s social needs are met. Some risk assessments have been completed for residents within their care plans. Staff have completed further training and new staff have been recruited using robust recruitment procedures to ensure residents safety. The manager has begun implementing supervision arrangements for staff. The lock has been replaced on the toilet door and a new call bell system has been installed. Residents no longer have to share bathroom facilities with staff members. The temperature of water in the bathrooms is being monitored to ensure residents safety. The registered provider of the home has started to carry out some audit visits of the home and is recording these. What the care home could do better: Some care plans still need to be updated to reflect changes following review and some care plans need to be developed to be more person centred. Risk assessments need to tell staff what action they need to take to manage the risk. The systems for report writing need to be reviewed to ensure that information is not lost through duplication and that staff do not have to spend unnecessary time writing reports. All staff must have easy access to the care plans to enable them to care for residents. A policy for the management of medication needs to be developed and the manager must ensure that her training and skills assessment in this area is up to date. Residents social needs should be further explored to find out what they enjoy doing and to ensure they are appropriately occupied. People should be supported to maintain contact with their local community and to participate in community based activities. The complaints procedure needs to be amended to make clear the timescales for resolving complaints. The statement of purpose for the home must contain all the required information. A training plan needs to be developed to ensure that the necessary training is scheduled for all staff. Training must be delivered by a person qualified to do so. The manager of the home is still not registered with the Commission despite being in post since March 2009. The manager is included in the numbers of staff working on shift and as such the registered provider must ensure that the number of staff available to care directly for residents does not drop when the manager is required to carry out other management duties. The registered provider must be proactive in the monitoring of the quality of the home and identify issues that need improvement. A development plan for the home must be drawn up to show that issues have been identified and action taken to remedy them. The registered provider must seek advice from the local Environmental health department with regard to the hygiene in the kitchen. There must be a supply of suitably hot water to the kitchen and the replacement of the boiler, as recommended in the recent gas safety inspection, must be included in the development plan for the home. Key inspection report Care homes for older people Name: Address: Springfields Residential Home Hengist Road Westgate On Sea Westgate Kent CT8 8LP     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: Jo Griffiths     Date: 0 8 1 2 2 0 0 9 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 33 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Springfields Residential Home Hengist Road Westgate On Sea Westgate Kent CT8 8LP 01843831169 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Macari Homes Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Springfield is a detached three-storey property, which provides personal care and support for up to twenty older people, who may also have mental health needs. Accommodation is provided in both single and double bedrooms. There are two lounges and a dining room. Communal areas are large and furnished in a domestic nature. There are gardens to the front, side and rear of property. The home is Care Homes for Older People Page 4 of 33 Over 65 0 20 20 0 2 8 0 9 2 0 0 9 Brief description of the care home located within a short walk from the sea front and local amenities. £328.00 - £500.00 per week. Fees range from Care Homes for Older People Page 5 of 33 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 was a key inspection of Springfields residential home, which took place on 8th December 2009. Inspectors Jo Griffiths and Anne Butts carried out the inspection. The manager of the home and the registered provider were present during the inspection. Some staff and residents were involved in the inspection and the inspectors had a look around the home. Records and documents for the purpose of running the home were inspected. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Some care plans still need to be updated to reflect changes following review and some care plans need to be developed to be more person centred. Risk assessments need to tell staff what action they need to take to manage the risk. The systems for report writing need to be reviewed to ensure that information is not lost through duplication and that staff do not have to spend unnecessary time writing reports. All staff must have easy access to the care plans to enable them to care for residents. A policy for the management of medication needs to be developed and the manager must ensure that her training and skills assessment in this area is up to date. Residents social needs should be further explored to find out what they enjoy doing and to ensure they are appropriately occupied. People should be supported to maintain contact with their local community and to participate in community based activities. The complaints procedure needs to be amended to make clear the timescales for Care Homes for Older People Page 7 of 33 resolving complaints. The statement of purpose for the home must contain all the required information. A training plan needs to be developed to ensure that the necessary training is scheduled for all staff. Training must be delivered by a person qualified to do so. The manager of the home is still not registered with the Commission despite being in post since March 2009. The manager is included in the numbers of staff working on shift and as such the registered provider must ensure that the number of staff available to care directly for residents does not drop when the manager is required to carry out other management duties. The registered provider must be proactive in the monitoring of the quality of the home and identify issues that need improvement. A development plan for the home must be drawn up to show that issues have been identified and action taken to remedy them. The registered provider must seek advice from the local Environmental health department with regard to the hygiene in the kitchen. There must be a supply of suitably hot water to the kitchen and the replacement of the boiler, as recommended in the recent gas safety inspection, must be included in the development plan for the home. 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 8 of 33 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 9 of 33 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. People are provided with some of the information they need to make a decision about the service, but some of the information needs to be updated. There have been no new admissions to the home. The people currently using the service have had their needs assessed. Evidence: The Statement of Purpose and Service User Guide were seen for the home. The Service User Guide contained the information specified in regulation 5 of the care homes regulations 2001 to ensure that people that move to the service have the information they need about the services provided. The manager said that the Statement of Purpose had been reviewed and produced a copy that was on the wall in the entrance hall. This was a mission statement for the service and not a Statement of Purpose that meets the requirements of regulation 4. The registered provider produced the previous version of the Statement of Purpose which was more in line Care Homes for Older People Page 10 of 33 Evidence: with the regulations but was showing the previous owners details. There have been no new admissions to the home since the last inspection. One resident was having their needs reassessed by a local authority care manager at the time of the inspection visit. The assessment was seen on file for one resident and this had been recently updated. Care Homes for Older People Page 11 of 33 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. Some of the care plans are beginning to be drawn up in a person centred way, but there are still gaps in the information that staff need to effectively support residents. Staff do not have easy access to the care plans. People that use the service have their health needs met. They would benefit from a review of the medication practice in the home and the implementation of a clear medication policy to ensure safe handling of their medicines. The privacy and dignity of residents is maintained. Evidence: Care plans are now kept locked in a cupboard within the staff room. Staff and the manager told us that the senior person on duty holds the key and that, due to concerns about report writing, only senior staff are now permitted to write the daily report entries. The manager said that training had been arranged and that all staff, except three, had completed this. Staff told us that it can be difficult to keep up to date with the care they are to provide as they cannot easily access the care plans. Care Homes for Older People Page 12 of 33 Evidence: The manager was asked what arrangements are in place to ensure that the information that care staff have about residents well being is recorded in the plans. The manager told us that staff complete a separate record sheet and that the information is then transfered into the files by the senior carer. This results in duplicated work that places additional time constraints on the senior carer and has the potential for loss of information during this transferring process. On the day of the inspection the deputy manager was seen to be spending quite a significant amount of time completing all the required reports. Two care plans were seen. One had been recently written and was person centred providing information about how the persons needs are to be met and what is important to them in their care. One care plan was not written in a person centred way. it had been recently reviewed and some changes to the way care was to be delivered had been agreed. However, this was recorded only in the review section and the actual care plan had not bee updated. This may be confusing for staff who may not be clear on the changes to the plan. Both care plans contained a section for social needs, but did not evidence that alternative interests had been explored where the person does not enjoy the scheduled activities in the home. The registered provider must ensure that staff strive to understand what interests and hobbies the person has and how they like to spend their time. The care plans must evidence ongoing work with residents to ensure they are meaningfully occupied and that their care plans give direction for staff on how to do this. The health records in the care plans were up to date and gave information about any action that needed to be taken by staff. One resident spoken with said that they are supported to see their GP when they need to and that staff will arrange an appointment or home visit. Risk assessments had been completed for the two residents whose care plan files were seen. The risk assessments cover a wide range of risks, including the risk of isolation and loneliness, but some of them only describe the risk rather than outline a strategy for managing it. Medication is stored in a small lockable cupboard and there is a dedicated and locked medication fridge. Records showed an audit trail and that administration of medication was double signed. The manager had recently discovered gaps in the signing of the medication record sheets and had placed a note on the front of the records telling staff Care Homes for Older People Page 13 of 33 Evidence: to complete the gaps and that they would be subject to disciplinary action if this happened again. The manager was advised that it may not be considered good practice to get staff to complete records retrospectively as they may not accurately recall giving the medication, particularly as one of the incidents had occurred approximately a week previously. The manager must refer to the Royal Pharmaceutical guidelines for record keeping and it would be good practice to consult with the homes pharmacist to gain their opinion. There were no policies and procedures available for medication including action that should be taken if any errors are identified. The manager said that she has last completed training in medication in May 2008 and had not completed any updates since. The manager was asked if she an assessment of her competence to manage medications had been completed, but she said this had not been done. The deputy manager told the inspectors, during the inspection, that she had cancelled a meeting with the pharmacist as we had arrived to do the inspection. We advised the deputy manager that she should not have done this and must always put the needs of the service first. It was noted the pots used to administer medication are washed in a basin in the kitchen that is identified for hand washing use only and then left to dry in the side near dirty implements. Residents spoken with said that the staff treat them well and that they have privacy in their bedrooms. The locks that were missing on the bathroom doors at the last inspection had been replaced. Staff were observed to interact positively with residents and to respect their choices. Care Homes for Older People Page 14 of 33 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. Residents are supported to undertake activities in the home, but would benefit from more consultation about their interests and opportunities for engagement in daily living activities. Resdients would benefit from more activities that support them to be engaged with their local community. Residents enjoy their meals and have plenty of choice. Evidence: The home has a programme of activities displayed on the wall. The range of activities appears includes the hairdresser being advertised as an activity. The programme is subject to change without warning and on the day of the inspection the hairdresser was due to visit in the morning but did not arrive until the afternoon and this meant that the scheduled hand massage session did not happen. A member of staff told us that service users were not informed of the change of time for the hairdresser and kept asking where she was. The activity schedule includes art sessions and quizzes and states that every Monday Care Homes for Older People Page 15 of 33 Evidence: afternoon a PAT dog and its owner visits the home. The manager said that this did not happen every Monday. One resident said they enjoyed it when the owner and dog visited. Staff were seen to be talking with residents and doing table top activities with some people during the afternoon. It was noted during the day that the television was on with childrens programmes and none of the residents appeared to be watching this. There is now a record of the activities that people do maintained within the care plan. Recent activities that were recorded in one persons plan included a Halloween fun day, a 1940s day and quizzes. An activities coordinator is employed in the home for two days per week and does some 1-1 work with residents on these days. None of the residents were seen to be engaged in any daily living tasks during the inspection. They may benefit from opportunities to do this to promote a sense of value for The manager said that residents have been offered the opportunity to go out somewhere of their choosing over the Christmas period, but that they had not wanted to. Two of the residents are able to go out independently and do so to visit friends, go to church and go to the shops. The records for two residents that are dependant on staff to support them to go out do not show any activities outside of the home. Two residents told us that the food had improved at the home recently and that there was no more choice and a better quality of meal. Residents who were previously supplementing the food in the home with items of their own said that they no longer had to do this as their preferred foods are now supplied. The menu has been updated and offers a choice of two meals at each mealtime. The menu record shows that people are making a choice of meal. The lunchtime meal was seen to be served and looked pleasant. Residents had chosen their meal in the morning. Care Homes for Older People Page 16 of 33 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 that use the service would benefit from staff undertaking training in safeguarding adults that is provided by a competent and qualified instructor. The complaints procedure for the service is does not provide clear information about the timescales for investigating concerns and complaints. Evidence: Since the last inspection of the home some of the staff have completed training in safeguarding adults and the manager said this would be arranged for the remaining staff in January 2010. This training consists of a DVD and answer book. It is recommended that external training is provided by a qualified instructor. The staff recruitment files showed that no staff are employed into the home with an appropriate check having being made against the Independent Safeguarding authority register. Where the manager is awaiting the full CRB (criminal records) check and references for staff they are working under the supervision of another carer. Staff that have recently been employed confirmed that they are working under supervision. Evidence was seen to confirm that two of the three safeguarding alerts that were raised following the last key inspection have now been closed. One is still under investigation. Care Homes for Older People Page 17 of 33 Evidence: There have been no complaints received by the home. The complaints procedure has been updated and displayed in the entrance hall. This states that complaints will be responded to within 7 days, but does not state whether this is to acknowledge the complaint or to investigate and resolve it. Care Homes for Older People Page 18 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable in the areas that residents use, but the kitchen is dirty and unsafe in areas. Evidence: The home was clean and some areas were in the process of being redecorated. The registered provider said that it is planned that all areas of the home will be redecorated. We asked the registered provider if there was a written plan for the decoration and maintenance of the home for the forthcoming year, but they said there was not. There is one double bedroom that is currently used as a single. Some bedrooms had been personalised. one bedroom did not contain many personal belongings and had not been decorated for the person that was currently using the room. This was noted at the last inspection but has not been actioned. The fire doors have been connected to the call bell system for the home. One residents likes to access the garden and has a swipe tag to deactivate the alarm. the deputy manager told the inspectors that the other residents in the home would require staff support to access the garden. There are sufficient numbers of bathrooms for use by residents and these are no Care Homes for Older People Page 19 of 33 Evidence: longer used by staff living in the home as all staff have now moved out. The locks on the downstairs toilets had been replaced. The light pulls in the upstairs bathrooms were dirty and unhygienic. There were serious concerns about the state of the kitchen environment and a number of issues were noted as below: The ceiling was greasy and dirty. Cupboards were stained yellow with cooking and greasy to the touch. Cupboard doors were loose and drawers needed repairing. There was chipboard around different parts of the walls and there were holes in these leaving exposed chip wood. Tiles and grouting especially around the sink area were dirty and grimy. The extractor fan was covered in dirt and grease. There was a portable fan on the side and the blades were again covered in dirt and black grease. There were no paper towels near the hand wash sink and medication pots were being washed in this sink. Dirty yellow bucket on the floor and the bin was also dirty. The boilers were old and dirty the cook said that one had been condemned. Water was hand hot temperature only. The inspector ran it for a few minutes and it did not heat up. The cook said that this was the hottest it got and it was a permanent problem. She said that she had to boil pans of water to ensure that the water was hot enough to wash up as there is no dish washer. Coloured food chopping boards but all very old and ingrained with scratch marks. Milton kitchen spray had been secondary dispensed into a clear spray bottle with handwritten identification on bottle that was partially rubbed off. The registered provider was advised that the Environmental health department must Care Homes for Older People Page 20 of 33 Evidence: be contacted for advice and that refurbishment of the kitchen must be included in the maintenance plan for the home. Care Homes for Older People Page 21 of 33 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 that use the service would benefit from staff completing training that is provided by a qualified trainer. New staff have an induction to the service. People that use the service are now safeguarded by the home procedures for recruiting new staff. Residents would benefit from at least 50 of the staff team holding an NVQ award. Evidence: Some staff have undertaken training in fire safety, infection control, moving and handling and safeguarding adults since the last inspection. The fire training was provided by the fire officer, but other training courses have been conducted by the manager of the home. The manager does not have a qualification as a trainer in the subjects taught, but has used a training package that includes a DVD. It is recommended that training is provided by external qualified training and that DVD training is only used as an awareness session prior to full training courses being attended. All new staff are currently working on a Skills for Care induction and this was seen for the staff recently employed. Some staff have left the home since the last inspection and this means that there are no only three staff employed who have an NVQ. Care Homes for Older People Page 22 of 33 Evidence: A new housekeeper has been employed and she said that she sometimes undertakes care duties in addition to her role. the manager confirmed this. The housekeeper has not yet completed the training she needs to undertaking a care role in the home. There rota shows that there are three staff on duty in the morning and two in the afternoon. The manager is included in these numbers. A staff member told us that this often means that two staff are left to work with residents as the manager has other demands in relation to running the home. On the day of the inspection there was one care staff on duty, the deputy manager and the manager. The manager was meeting with a care manager and the deputy manager was meeting with the pharmacist when we arrived for the inspection. This left one member of staff to supervise all residents in the home. One resident said that the manager is in the office for most of the day. This concern was discussed with the registered provider who was advised to ensure that the manager and deputy manager have sufficient time allowed to carry out the management duties in the home without having to take time out from working directly on shift doing care duties and leaving care staff working alone supervising all residents. This may require employing more staff to work on shift to allow for this. The inspectors also discussed with the provider concerns about the current report writing systems in the home and that this means the senior carer has to spend much of the shift duplicating written reports. Three staff files were seen during the inspection for staff that had been recently recruited to the home. These showed that the required checks had been made prior to the staff being employed in order to allow them to work under supervision. The staff members did not yet have references or a full CRB and therefore were working under supervision. The registered provider must ensure that staff do not work alone with residents until all these checks have been received. Care Homes for Older People Page 23 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not currently being run by a manager that has been registered with the Commission. Resdients would benefit from the manager having more time to carry out management duties without this impacting on the direct care for resdients. The registered provider has begun monitoring the home, but needs to be more proactive and identify all issues that require development. The health and welfare of residents is at some risk due to the lack of cleanliness in the kitchen. Evidence: The manager of the home is still not registered with the Commission, but stated that an application will be made as soon as the CRB and medical certificate are received. The manager has been in post since March 2009. The manager of the home is required to work on shift and staff report, as the manager has other duties relating to the management of the home, they are often left working alone on shift. Care Homes for Older People Page 24 of 33 Evidence: The registered provider is now completing monthly regulation 26 visits and reports. The most recent two reports were seen. These do not identify any of the issues that have arisen in this inspection, for example the state of the kitchen. There is no action plan from the regulation 26 visit reports. Residents meetings have started to take place and the manager said it is aimed that these will be every six weeks. There were some areas of health and safety concern, mainly in relation to the cleanliness of the kitchen, and these have been reported elsewhere in this report. The maintenance man is now undertaking monthly health and safety checks of the home and weekly water temperature checks. Where issues are identified there must be a clear action plan for resolving thee. For example is identified that there are issues with the boiler and a Gas safety certificate recommended that this is replaced. There is no action plan to show went his will be done and the provider did not have this scheduled. Water temperature recording charts were seen in the bathrooms and shower room. These were being completed for baths but had not been completed for showers since February 2009. If staff are not recording the temperature of showers this chart should be removed. If residents require support with the shower, and the temperature is not regulated, the temperature must be checked and recorded prior to them using it. Some staff have had supervision sessions with the manager since the last inspection, but the manager acknowledged that there was still work to be done to improve the frequency of these. Some concerns have been identified in previous sections of this report about the record keeping processes in the service. Care Homes for Older People Page 25 of 33 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 7 12 Care plans must be 23/10/2009 completed in a person centred way that ensures that indidivuals preferences about their care and support are included and respected. To ensure indidivuals receieve their care and support in the way they prefer. 2 19 23 The registered person must ensure there is an ongoing programme of maintenance and redecoration for the home and external grounds. To ensure a pleasant and safe environment for service users. 23/10/2009 3 30 18 The registered person must 23/10/2009 ensure that a training programme is in place that ensure all staff are trained and competent in their roles. To ensure staff are trained to meet service users needs. 4 33 24 The registered provider must 23/10/2009 ensure that effective systems are in place for the monitoring of the quality of the service and that an annual development plan is in place. Page 26 of 33 Care Homes for Older People 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 To ensure the home provide quality care and support to service users. Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 1 The registered provider must ensure that the statement of purpose is up to date and contains the information required by regulation 4. To ensure that people are provided with the information they need about the care home. 31/01/2010 2 7 17 The registered provider 31/01/2010 must ensure that the processes for recording information in the care plans are robust. To ensure that information is not lost during duplication. 3 7 14 The registered provider must ensure that individuals care plans direct staff how on to meet their social needs. The care plan must be updated if their are any changes to the persons 31/01/2010 Care Homes for Older People Page 28 of 33 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 needs. All staff must be able to access care plans. This is to ensure that staff have the necessary information to meet residents holistic needs. 4 9 13 The registered provider must ensure that the home has a clear and appropriate policy for the safe management of medication. To ensure that residents medication is managed safely. 5 12 16 The registered provider 28/02/2010 must ensure that residents are consulted on their preferred activities and that they are provided with sufficient opportunities to be appropriately occupied during the day To ensure people are suitably occupied doing the things they enjoy. 6 13 16 The registsred provider must 28/02/2010 ensure residents have regualr opportunities to engage with their local community. To ensure they have the opportunity to play a valued role in their community 31/01/2010 Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 16 22 The registered provider must ensure that the complaints procedure gives clear timescales for investigating and resolving complaints. To ensure that residents know how any complaints will be handled. 31/01/2010 8 19 23 The registered provider must ensure there is a programme of maintenance and redecoration for the home. To ensure that residents benefit from a well maintained and comfortable environment. 31/01/2010 9 19 23 The registered provider 31/01/2010 must ensure that the kitchen is hygienic, clean and safe. To ensure residents well being and safety 10 23 16 The registered provider 28/02/2010 must ensure that residents are supported to personalise their bedrooms with their own belongings. To ensure that residents bedrooms are comfortable and homely. Care Homes for Older People Page 30 of 33 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 11 25 23 The registered provider must ensure that there is sufficient hot water supply to the kitchen. To ensure that residents are not at risk from infection through poor hygiene. 31/01/2010 12 27 18 The registered provider must ensure that there sufficient numbers of staff on duty to meet residents needs. To ensure residents needs are met. 31/01/2010 13 30 18 The registered provider must ensure there is a written training plan for the home and that training is provided by a person qualified to do so. To ensure that staff receive high quality training to enable them to meet residents needs. 31/01/2010 14 31 8 The registered provider must ensure there is a registered manager for the service. To ensure the home is run by a person assessed as competent and fit to do so. 31/01/2010 15 33 23 The registered provider must ensure that they 31/01/2010 Care Homes for Older People Page 31 of 33 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 undertake proactive monitoring of the home and develop an action plan for developing and improving the service. To ensure that the quality of the service is monitored and improved without reliance on CQC identifying issues. 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 2 7 28 All care plans should be reflect person centred approaches to residents care. It is recommended that at least 50 of staff complete the NVQ award at level 2 or above. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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