Care Home: St Catherines Nursing Home

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What the care home does well People living at the home, and relatives, made positive comments about the care provided. These included, "I am happy with the care". "No grumbles" "The staff are kind and friendly". Some staff interacted well with people living at the home, in a caring and respectful manner. What has improved since the last inspection? No improvements were noted at this key inspection. What the care home could do better: Serious issues that posed a risk to people`s well being were identified during this inspection. Care plans and risk assessments had not been completed in full, or reviewed. This meant that staff did not have access to important information. Staff were not familiar with people`s plans. This meant that they did not know the actions required of them. Staff were inconsistent in delivering care. Some care practices observed conflicted with the guidance identified in individual care plans to ensure needs were met. People`s choices were limited with regard to daily activities and food. Staff did not respond to all requests for assistance. Staff showed a lack of understanding of people`s needs. This meant that people`s lives and choices were restricted and their dignity was not promoted. Medication administration records had not been fully and accurately completed to uphold people`s safety. The environment was not clean or well maintained so that people had a pleasant and comfortable place to live. Gaps in staff training posed a risk to people`s safety and well being. Staff recruitment files did not contain all of the required information to ensure full and safe procedures had been adhered to. Systems within the home had not been audited or monitored, which meant that poor practice had not been managed and people had not been protected. Key inspection report Care homes for older people Name: Address: St Catherines Nursing Home 152 Burngreave Road Sheffield South Yorkshire S3 9DH     The quality rating for this care home is:   zero star poor 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: Janis Robinson     Date: 2 6 0 8 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 32 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 32 Information about the care home Name of care home: Address: St Catherines Nursing Home 152 Burngreave Road Sheffield South Yorkshire S3 9DH 01142723523 01142796094 none www.regalcarehomes.com Regal Care Homes (Sheffield) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Kathleen Margaret Winstanley Type of registration: Number of places registered: care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 70 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE and Mental Disorder Code MD Date of last inspection 2 7 0 4 2 0 1 0 39 31 0 Over 65 0 0 39 Care Homes for Older People Page 4 of 32 Brief description of the care home St Catherines consists of two large units. Both are three-storey buildings consisting of a converted existing building and a purpose built. The home has single and double rooms, each provided with en-suite facilities. Each unit has a lift, communal lounge and dining areas. The home is set in pleasant gardens and has a car park. The home provides nursing care for older people, people with Dementia and Mental Disorders. The home is situated in the Pitsmoor area of Sheffield, within easy reach of the city centre and close to local amenities. On the 26th of August 2010, fees ranged from £343 to £540 per week. Written information about the home is provided in a Service User Guide. Copies of these are available from the home. Care Homes for Older People Page 5 of 32 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero star. This means that people who use this service experience poor quality outcomes. A Random inspection was carried out on the 27th of April 2010 to comply with our regulatory processes. The purpose of the visit was to look at how the home managed concerns, complaints and protection. No requirements or recommendations were made as a result of this visit. This inspection was undertaken in response to concerns raised regarding the quality of care provided at the home. These concerns were identified during a routine visit by the Primary Care Trust (PCT) on the 16th of August 2010, and subsequent visit by the Local Authority and PCT on the 18th of August 2010. A serious Incident meeting was held by the Local Authority contract team on the 23rd Care Homes for Older People Page 6 of 32 August 2010. A decision was made to suspend all new admissions to the home until identified improvements had been achieved. This was an unannounced inspection carried out by Janis Robinson and Sue Turner, Compliance Inspectors. The visit to the home took place between 9am and 4pm on the 26th of August 2010. Staff were observed undertaking their care duties. A partial inspection of the environment was undertaken and records relating to care and the running of the home were inspected. Some people living at the home, and two relatives, were spoken with about their experiences of the care provided. Some staff were spoken with about their roles and experiences of working at the home. The managers were spoken with about the management and monitoring of the home. At the time of this inspection the registered manager, Kate Winstanley, was on sick leave. The homes area manager, Trish Kelly, operations manager Sue Fox, and a manager from another home within the same organisation, John Hudson, were providing management cover and support. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 32 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 32 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 32 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. Assessments were carried out prior to admission to make sure identified needs could be met. However, concerns regarding the quality of care provided had led to a suspension on admissions. Evidence: At the time of this inspection the local authority had suspended all placements to the home. This was a result of concerns raised on a monitoring visit that took place by them on the 16th of August 2010, and a follow up visit on the 18th of August 2010. This meant that no people were being admitted until appropriate action had been taken by the home to resolve identified concerns. Four peoples care plans were checked. They all contained a written assessment that had been undertaken prior to the person moving into the home. The plans also contained a written assessment undertaken by the local authority. This ensured peoples needs were identified and could be met at the time of their admission into the Care Homes for Older People Page 11 of 32 Evidence: home. Care Homes for Older People Page 12 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor care practices did not meet peoples basic needs or promote dignity. Evidence: Four peoples care plans were checked in detail. They were poorly organised which meant that important information was difficult to obtain. The care plans had not been updated to make sure they contained relevant information. They included very basic details and did not give a clear picture of the person, or fully identify their needs so that they could be met in a way that the person preferred. Parts of the plans had not been completed so that full information was available. The staff spoken with were unclear about peoples care plans, and could not describe what they contained. One staff spoken with said that carers never looked in care plans, and they had never seen one. When asked how they became aware of peoples needs, one staff responded, We just find out for ourselves as we go along. The information recorded in care plans conflicted with the care practices observed. For example, people were being assisted to move by one staff, when their care plans Care Homes for Older People Page 13 of 32 Evidence: stated that they needed the assistance of two people. One person was heard to request assistance to move. One staff told us that this person required two people to help them, another staff said, I just manage on my own. One person was observed being pulled backwards in a wheelchair, without footplates in place. Staff explained that this was normal practice, as the person found footplates painful to use. However, this persons care plan clearly stated that footplates must be in use at all times. Whilst staff wrote some daily records, those seen contained very brief detail, such as wet and changed. This meant that there was no clear record about the persons well being and how they had spent their day. The care plans contained some written risk assessments. However, most seen were not dated and there was no evidence to show that they had been reviewed to keep them up to date. One persons plan contained a moving and handling risk assessment that was inaccurate. It stated that the person managed to move around the home independently with a frame. However, this person was seen using a wheelchair. The management of the home were aware that the care plans required updating so that peoples needs and preferences were identified and could be met. The area manager was in the process of updating all care plans so that important information was available. People spoken with said that they could see their GP when they needed, and a chiropodist and district nurses visited the home. However, lack of information in care plans created the potential for risk. One persons care plan stated that a referral to a local hospital had been made for specific tests relating to a health issue. There was no clear record made of the outcome of this visit, but a loose letter from the hospital relating to this was found in the back of the care plan file. The managers confirmed that a policy on medication was in place and available to staff. Qualified nurses administered medication and part of a medication round was observed. Medication was administered safely and the records were signed after staff had made sure medication was taken. Some medication administration records (MAR) were checked. The majority had been fully completed. However, two records seen had not been signed to say that medication had been administered or refused. Staff explained that they were waiting to see if the medication could be administered later in the day. However, this delay meant that two lots of medication could be administered within a short space of time, which posed a risk to peoples health. People living at the home, and relatives spoken with said that they were happy with Care Homes for Older People Page 14 of 32 Evidence: the care provided. Comments included, My relative has responded well to the care here. They are always clean, sometimes their clothes dont match. The staff are friendly and helpful. The staff are nice and friendly. I had to complain last year but Kate (the manager) sorted it out. She is easy to talk to. The bedroom is nice and clean. (My relative) is well cared for. The staff are good. I have no grumbles. Some interactions observed between people living at the home and staff appeared caring and respectful. However, other staff appeared dismissive of peoples needs , which were disrespectful. One person was heard to request a drink. They were told that the tea trolley had gone and they would have to wait. Two men were seen struggling to walk as their trousers were too large and they had to hold them up. Staff were aware of this, as they were also seen helping to hold trousers up as they walked, yet no action was taken. One person asked staff for help to go to the toilet. Staff told us that they did not respond as this person was incontinent and wore pads. One other person was in distress waiting for staff to help to go to the toilet, and said they often had to wait until it was too late. One person was observed with unwashed, matted hair. This was reported to the managers who arranged for the person to have their hair washed. They commented that sections of hair had had to be cut away, as the hair was so matted. These examples of poor practice evidenced that peoples basic human needs and rights were not routinely met, and did not promote peoples dignity. It is acknowledged that the managers have completed risk assessments in relation to dignity and personal care, skin integrity and medication in an effort to improve standards and reduce risk. These were forwarded to us on the 27th of August 2010. Training on risk assessments had been arranged for the week following this inspection so that staff had the skills to effectively manage risk and keep people safe. Care Homes for Older People Page 15 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples lives were restricted regarding activities and meals due to lack of choice. Evidence: An activities coordinator was employed at the home. However, on the day of this inspection no activities were taking place as the activities worker was on the rota as a carer due to staff shortage. There was no evidence that activities took place on a regular basis, and people spoken with said that they couldnt remember if they were provided with choices in activities. One person living at the home was overheard to ask the activities worker if they could be supported on a trip to the city centre. The activities worker said they could not do this. The interactions between staff and people living at the home were basic and limited. Staff were observed moving through communal areas, and on occasions assisting people, without acknowledging anyones presence. There were very limited choices to occupy peoples time. People were observed sitting in chairs without shared conversation or any stimulation. Televisions were switched on but no one appeared to be watching the programme, and no one had been consulted about which programme to watch. One television had a blurred reception but staff did not take any action to remedy this. Relatives spoken with said that they were free to visit the home at any time, so that Care Homes for Older People Page 16 of 32 Evidence: they could maintain contact with their loved one. Peoples choices regarding food and drink were limited. For example, the menu showed that each main meal of the day offered sponge pudding for dessert. Eight of fifteen people were diabetics, yet they were provided with mousse and were not offered any other choice. One person followed a Halal diet, and Halal meat was provided. However, the cook stated that everybody was given Halal meat to cover this. This did not respect peoples individual preferences, or promote equality and diversity. This was brought to the attention of the managers, who contacted the butcher and ensured that Halal meat was only provided for the identified individual. Part of the mid day meal was observed. In the Hallam unit people were observed sitting, in silence with limited interaction from staff, at the table for over half an hour before the meal was served. No cutlery was provided and one staff said people usually ate with spoons. On this occasion people were given knives and forks as their meal was served. One staff was overheard to say that they could not serve the gravy with the meal, as this was too lumpy to be edible. In the kitchen we observed that vegetables for the mid day meal were cooked and ready at 10.45 am. The meal was not served until after 12.30. The care plans seen did not detail peoples preferences for food and drink so that choices could be respected. It is acknowledged that the managers have completed risk assessments in relation to nutrition and hydration, and activity and occupation, in an effort to improve standards and reduce risk. These were forwarded to us on the 27th of August 2010. Care Homes for Older People Page 17 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were placed at risk of harm from inadequately trained staff. Evidence: The complaints policy in place gave details of who to contact if people had any concerns. However, the policy was not clear about when people should receive a response and gave no timescales for this. This meant that peoples rights were not upheld, as they were not provided with relevant information so they knew what to expect. The complaints record was checked. One recent complaint did not record the outcome of the complaint so that a clear trail was available and complaints could be monitored. The staff spoken with were clear about what to do if they suspected abuse or if an allegation was made. However, people were not safeguarded or protected from harm. Elements of neglect were observed, as highlighted in the Health and Personal Care section of this report. Records of staff training checked showed that twelve of the twenty nine staff had not been provided with training on Safeguarding of Vulnerable Adults (SOVA). In addition, five staff had not been provided with the training since 2007. This places people at risk. Care Homes for Older People Page 18 of 32 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. People were not provided with a clean and well maintained environment to live, which could pose a risk to health and well being. Evidence: Parts of the environment were checked. Throughout the home there was an odour of urine. Communal and individual rooms had damaged and worn decoration. Parts of the home, in particular two ground floor lounges, were very dark. Lighting was not working, or shades were dirty which restricted light. Many ceiling tiles were stained and marked. Most bedrooms checked appeared sparse. Bedroom furniture was worn and damaged. Beds were untidily made which added to the uncared for appearance. Some beds did not have headboards, and one bed base seen was damaged and torn. Towels, pillows and bed linen was old and worn. One person had slept on a plastic pillow without a cover, which could compromise their skin integrity. It is acknowledged that the managers had arranged for the ground floor corridor areas to be re decorated, and communal carpets to be steam cleaned. However, this alone would not address the poor condition of the environment. Serious attention and finance needed to be directed towards the living conditions so that people have an adequate place to live. From observations made it was evident that there were no clear routines for the Care Homes for Older People Page 19 of 32 Evidence: control of infection. Parts of the home were dirty. Some carpets were stained and sticky underfoot. Lounges were seen in the morning with debris on the floor, which remained when checked again mid afternoon. One persons bed had been made with faeces stains on the duvet cover. Dirty towels and clothing had been left in two rooms seen. Stock cupboards contained old and worn towels, one cupboard held a dirty and discarded towel on the floor. Some staff were not routinely wearing gloves and aprons to control infection. One staff did not wash their hands following a visit to the toilet. Some wheelchairs seen were marked and dirty. It is acknowledged that the managers have completed risk assessments in relation to control of infection, in an effort to improve standards and reduce risk. These were forwarded to us on the 27th of August 2010. Care Homes for Older People Page 20 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not provided with well trained staff in sufficient numbers to meet their needs. Gaps in recruitment procedures did not promote peoples safety. Evidence: Peoples basic needs were not met as there were insufficient staff on duty. On the day of the inspection the deputy manager was covering care duties in the main unit. This meant that she was not carrying out her agreed managerial duties. The activities worker was covering care duties which removed him from offering any activities to people. One agency staff was employed to cover further gaps in staffing. This meant that two carers, one of which was agency staff, the activities worker and one qualified provided care to twenty eight people. In the dementia unit, there was one qualified staff and two carers, one of which was agency staff, to provide care for sixteen people. Staff appeared rushed and overwhelmed. It is reported on in the relevant sections of this report that staff were unable to respond to peoples basic care needs. One member of staff was observed, apearing to sleep, in a communal lounge where several people were sitting. As he woke he stated that he was the kitchen assistant on a break. This practice was disrespectful to people living at the home. A programme of National Vocational Qualifications (NVQ)was in place. In the training matrix provided, six of the twenty two carers were undertaking or had achieved NVQ level 3 in care, eight staff at level 2 in care. Care Homes for Older People Page 21 of 32 Evidence: Three staff recruitment files were checked. None contained all of the required information to evidence that thorough checks had been made prior to employment, to keep people safe. One file detailed a gap in employment that had not been explored or explained. The same file contained a character reference from a colleague at their previous employment, but no reference from their previous employer. This had not been explored or explained. A further file detailed a disciplinary meeting, but the outcome of the meeting was not provided. No files checked contained a photograph of the staff. Whilst Criminal Records Bureau (CRB) checks were in place in all three files checked, one was dated 2003. More frequent checked would ensure peoples safety was maintained and promoted. One staff spoken with confirmed that they had been provided with induction training so that they had the skills they needed to do their jobs. However, the staff files checked showed no clear evidence of organised and thorough induction training. The training matrix examined showed gaps in all areas of training. Some staff had not been provided with Dementia training so that they were aware of the condition and could respond to people in a way that respected them. It is evident from issues reported on in the relevant sections of this report that staff had not been provided with sufficient training to equip them with the skills to meet peoples needs. Care Homes for Older People Page 22 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was not run in the best interest of people using the service. Due to a lack of robust systems people had their health and safety needs compromised. Evidence: At the time of this inspection the registered manager was on sick leave. Following concerns raised by the Local Authority, and subsequent Serious Incident meeting, the providers had developed an action plan to address concerns raised. This included extra management at the home. The area manager, operations manager and a manager from another home within the company were spending time in the home providing management support. A visit from the Local Authority contract team took place on the 27th of August 2010. It was identified that no management cover had been provided at weekends. As a result, further arrangements were made to provide this cover at the weekends. Staff spoken with said that they found the registered manager approachable and supportive. However, from concerns identified within this report, it is evident that the Care Homes for Older People Page 23 of 32 Evidence: home has been poorly managed. This is both within the home and from lack of external monitoring by the companies line management. Systems, procedures and records have not been undertaken or monitored. This has resulted in poor quality care being provided to people, and their dignity not being upheld. Specific examples of these are reported on in the relevant sections of this report. Whilst discussing some concerns, one manager commented, I would not be happy with my dog living here. A quality assurance system was in place to obtain and act upon peoples views. Surveys had been sent to relatives, carers and people living at the home in August 2009. The area manager confirmed that the results of the surveys had been audited, and these had been put on display in the home so that they were available to people. Health and safety systems were not fully maintained to keep people safe. The fire book checked showed that alarm and emergency lighting tests took place. However, records of fire drills showed that some staff had not participated in a practice drill since September 2009. Training records checked showed that some staff were out of date with all aspects of mandatory health and safety training. There were gaps in moving and handling, food hygiene and infection control training. This meant that staff skills were not developed or maintained so that people were kept safe and well. It is acknowledged that the managers have completed risk assessments in relation to monitoring standards, in an effort to improve standards and reduce risk. These were forwarded to us on the 27th of August 2010. Training on moving and handling had been arranged for the week following this inspection so that staff knowledge was current and people were assisted safely. Care Homes for Older People Page 24 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be undertaken and regularly reviewed. To promote peoples safety. 30/09/2010 2 7 15 Care plans must contain relevant information regarding peoples needs and preferences. All care plans must be regularly reviewed. Staff must be familiar with all aspects of a persons written care plan. This will ensure all needs are identified and can be met. 30/09/2010 3 8 12 Peoples personal hygiene must be maintained at all times. Suitable clothing must be provided. This will ensure peoples basic needs are met. 03/09/2010 Care Homes for Older People Page 26 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 9 13 Medication administration 30/09/2010 records must be fully completed and detail when a medication has not been administered, or refused. This will ensure peoples safety is maintained. 5 10 12 Peoples privacy and dignity 03/09/2010 must be respected at all times. Staff must respond to requests for assistance. All staff must be provided with training in promoting dignity and respecting people. This will ensure peoples needs are met and they are respected. 6 12 12 People must be provided with a range and choice of social activities. This will ensure peoples daily life is not limited. 30/09/2010 7 15 16 People must be provided 30/09/2010 with a choice of good quality food This will respect individual preferences and meet peoples needs 8 18 18 All staff must be provided with training on safeguarding adults. 30/09/2010 Care Homes for Older People Page 27 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will promote peoples safety. 9 19 16 All parts of the home must 29/10/2010 be well maintained and in a good state of repair. Worn bedroom furniture must be replaced. Damaged and worn decoration must be repaired. Worn and marked towels and bedlinen must be replaced. Damaged bed bases must be replaced. This will ensure that people have a comfortable living space. 10 26 13 A system for the control of infection must be maintained. All areas of the home must be kept clean. Staff must be provided with and use protective clothing. All staff must adhere to control of infection procedures. This will ensure that peoples well being is promoted. 11 27 18 Sufficient numbers of staff must be provided appropriate for the health and welfare of people living at the home. This will ensure peoples needs can be met. 11/10/2010 30/09/2010 Care Homes for Older People Page 28 of 32 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 12 29 19 Thorough recruitment 30/09/2010 procedures must be in place. All of the required documentation must be available for each employee. A full employment history, two references and a photograph must be obtained. Gaps in employment must be explained. This will promote and uphold peoples safety. 13 30 18 All staff must be provided with induction and foundation training relevant to the jobs they are to perform. This will ensure staff have the relevant skills to meet peoples needs. 30/09/2010 14 30 18 All staff must be provided with training in Dementia Awareness. This will ensure they have the skills and knowledge to promote peoples well being. 29/10/2010 15 31 12 Systems must be in place to effectively manage and monitor the home. This will ensure that people receive improved care. 30/09/2010 Care Homes for Older People Page 29 of 32 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 16 38 18 All staff must be provided with infection control, food hygiene, health and safety and moving and handling training. This will ensure staff have relevant skills and knowledge to promote peoples health and well being. 30/09/2010 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 3 7 7 13 Care plans should be organised so that information is easy to retrieve and is accessible to staff. Systems should be in place to ensure staff have regular updates regarding peoples care plans. People should have opportunites for contact with the local community as part of the activities programme so that more choice is available. People should not be left sat at dining tables for long periods waiting for meals. Tables should be set with cutlery prior to the meal. This will ensure that people are respected. People should be consulted on a daily basis regarding choices in daily living. Staff should interact more with people living at the home so that they live in a more stimulating environment. The outcomes of complaints should be clearly recorded so that they can be monitored and managed. Clear information regarding timescales to respond to complaints should be provided to people so that they are clear about what to expect. Page 30 of 32 4 14 5 14 6 7 16 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 19 A full audit of the condition of the environment should be undertaken. An action plan to address identified issues should be undertaken so that improvements are made and monitored. People should be consulted about making bedrooms more comfortable and homely. Bedrooms should be provided with easy chairs. Staff should make efforts to maintain tidiness and make beds. This will ensure people have comfortable private space. Staff should not use communal areas to nap at break times. Criminal Records Bureau checks should be undertaken at a regular frequency to promote safe practice. Induction training should be clearly recorded so that this can be managed and monitored. 9 24 10 11 12 27 29 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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