Care Home: Stilecroft (MPS) Ltd TA Stilecroft Residential Home

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What the care home does well There are suitable arrangements in place for assessing any new people who wish to come to the home. People told us they got up and went to bed as they wanted and could spend time in their own rooms. Visitors are made welcome and local clergy visit on a regular basis to give spiritual care. • “I visit as often as I can and have a good rapport with some of the carers.”Some people made positive comments about staff being ‘kind’, ‘caring’ and ‘pleasant’ and we saw some very caring and considerate interactions. This home provides very good quality food that is well prepared and well presented. Residents told us they were very happy with the catering in the home. • “I enjoy my food, plenty of it, good quality and choices at every meal.”The manager told us that over 50% of staff have National Vocational Qualifications in care. What has improved since the last inspection? We could see that an attempt has been made to improve some of the written plans of care. Records for receipt, administration and disposal of medication had improved to show the treatment received by residents. The service had reviewed its medication ordering procedures to ensure a continuous supply. The manager had started a programme of assessment of competencies of staff in the safe handling of medication. There had been some minor improvements to outings and residents said they had enjoyed a trip out to a local exhibition. People in the dementia care unit go to a club on a Tuesday. • “We had a lovely day out and a summer fete and I would like more of these.”On this visit we did not see any inappropriate manual handling so we judged that this had improved somewhat since our visits in May. We also noted that Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 all wheelchairs now have footrests and this is an improvement for peoples’ safety and well being. What the care home could do better: We asked the company to review a document called the Statement of Purpose that helps people to understand how the company and the home operate, as it has some inaccuracies and omissions. We found that many of the written plans that help staff deliver care consistently and effectively had not been reviewed monthly and continue to have gaps in information. Some plans have improved but many lack the kind of detail that helps staff care for people properly. We judged that staff need more support in helping with peoples’ health care needs. We also want the manager to make sure that communication between themselves and health care professionals is improved so that any advice or instructions are followed correctly. The manager needs to help staff to understand the nutritional needs of people in the home. Staff need training and support and good instructions need to be written into plans so people get the right nutrition. There needs to be a planned and consistent approach to other physical and health care needs. This includes the approach and support for people with dementia and other mental health needs and there is a need to improve the management of challenging behaviour. Although there have been some improvements in the handling of medication there is still further work to be done to ensure the safety of residents. There was some evidence that prescribed instructions were not always followed accurately. Care plans relating to medication require review and must be followed to ensure safe and appropriate use of medicines including those intended for ‘when required’ use. The service should make sure that audits of medication are more thorough so that concerns are highlighted and dealt with quickly. The manager should also access relevant information relating to medication such as inspection reports and audits to help identify areas where improvement is required. Staff need more guidance so that people always receive choice, privacy and dignity in their daily lives. We want the manager and the company to make sure people are secure and private in their own rooms at all times. People who live in this home need and want more activities, outings and entertainments. People who live in the dementia care unit do not have suitable activities or entertainments that meet their special needs. The company need to make sure there is a planned activities programme.Stilecroft (MPS) Ltd TA Stilecroft Residential HomeDS0000071717.V377001.R01.S.doc Version 5.2 Some complaints have been dealt with correctly. We judged that the company now needs to remind residents and visitors of how to complain and give people information about how to contact outside agencies. We had evidence to show that the senior staff in this home are unsure about how to make adult protection referrals and the company must ensure that staff understand how to make sure people are safe by following the Cumbria Adult Safeguarding protocols. The access to the garden is limited due to risks of falling. We want the company to look at this so people have the freedom to use the garden as they wish and that risks are lessened or removed. There needs to be more attention paid to the environment. Some people told us they were not always happy with the standards of cleanliness. We saw floor coverings that need to be repaired or replaced, some furniture needs replacing and some areas need improvements to decor. One window restraint was broken. Domestic staff need induction and training and given suitable resources to do their job properly. The company needs to make sure that beds and mattress covers suit the needs of residents The call bell system doesn’t work efficiently and the company need to make sure that staff always know if someone needs help or if someone enters or leaves the building. There has been a high number of staff leaving this service in the last year and only a few new staff recruited. There is a reliance on agency and temporary staff. We want the company to look again at staffing levels and ensure that there is a suitable recruitment programme in place. We discovered that staff work in both areas of the home. This means that there is inconsistent staffing for people in the home and that staff find it difficult to work as ‘key workers’ to individual residents. Staff in the home only receive a very simple induction. The home does not use the nationally recognised standards for induction or foundation training. There has been some training delivered but not all staff have received the training we asked the company to give them. There is no new training plan after September 2009. There is a manager in post but she is not registered with the Care Quality Commission. The company now needs to make sure they register a manager as soon as possible. We judged that the current manager needs much more support and assistance from the company as a number of problems have not been dealt with in the last six months.Stilecroft (MPS) Ltd TA Stilecroft Resident Key inspection report CARE HOMES FOR OLDER PEOPLE Stilecroft (MPS) Ltd TA Stilecroft Residential Home 51 Stainburn Road Workington Cumbria CA14 1SS Lead Inspector Nancy Saich Key Unannounced Inspection 10:45 4 & 7th August 2009 th DS0000071717.V377001.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 2 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 Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stilecroft (MPS) Ltd TA Stilecroft Residential Home 51 Stainburn Road Workington Cumbria CA14 1SS Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01900 603776 Stilecroft (MPS) Limited Manager post vacant Care Home 44 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (30) of places Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code 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 - Code OP (maximum number of places 30) Dementia - Code DE (maximum number of places 14) The maximum number of service users who can be accommodated is: 44 3rd September 2008 2. Date of last inspection Brief Description of the Service: Stilecroft residential care home is registered to provide accommodation for up to forty-four older people, some fourteen of whom may have dementia. Stilecroft is run by MPS Care Homes Ltd and the Registered Provider is Mr Paul Gray. The company also own another home in Workington and other care and nursing homes elsewhere in the country. The home is on the outskirts of Workington in a quiet residential suburb. The property is a large, extended older building that has been adapted for use as a care home. The home is surrounded by attractive grounds with car parking facilities. Accommodation for residents is provided over three floors and there is a passenger lift. The home provides shared accommodation in the form of two large lounges, and two dining rooms. A separate wing for people who have dementia has a small lounge/dining room, part of which is a conservatory. The majority of bedrooms have a wash hand basin and bedrooms in the newer part of the building have ensuite toilet facilities. The home has sufficient accessible bathrooms and toilets available close to all the accommodation used by residents. The home has a range of aids and equipment to assist residents to maintain their independence. The home has the use of a shared ‘people carrier’. The current scale for charging is £398 to £462 per week. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was the main or ‘key’ inspection for the home this year. We (the Care Quality Commission) completed our last key inspection on 03/09/2008 but we have made random unannounced visits since then. The reports of these visits (dated14/01/09, 01/05/09 and 19/05/09) can be obtained from the home or by contacting our help line. This key inspection took place over two days. Angela Branch, pharmacy inspector and Elaine Brayton, Local Area Manager visited unannounced at 10:45 a.m. on 04/08/09 and they looked at medication and associated care planning, staff training and development. On 07/08/09 Nancy Saich and Liz Kelley visited the home on an unannounced basis. This visit started just after seven in the morning and lasted until nearly four in the afternoon. We therefore looked at all the key standards that show that a residential home is being run appropriately. We based some of our findings on a document called the Annual Quality Assurance Audit (the AQAA) that we asked the manager to complete for us some weeks before the visit. This was completed in detail and on time. We also sent out surveys to people who live in the home, to staff and to other people who visit the house. We had five surveys returned from staff and no relatives or residents surveys returned at the time of writing the report. We also spoke with professionals who visit the home or we sent them surveys. This included social workers and health care professionals. We also had contact with the Fire Service and Environmental Health. They provided us with evidence of how things are working in the home. During the inspection visits all four inspectors spoke to people who live in the service, staff on duty, the manager and the manager from the other home the company operates in Cumbria. We also spoke to any visitors who were in the house on both days. We spent time with people who live in the home in the lounges, at mealtimes and privately in their own rooms. We also spent time observing the interactions between residents and with staff and residents. We read a range of documents that are required, by law, to be kept in a residential home. We did this so we could see evidence of what we were told or what we had observed. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 6 What the service does well: There are suitable arrangements in place for assessing any new people who wish to come to the home. People told us they got up and went to bed as they wanted and could spend time in their own rooms. Visitors are made welcome and local clergy visit on a regular basis to give spiritual care. • “I visit as often as I can and have a good rapport with some of the carers.” Some people made positive comments about staff being ‘kind’, ‘caring’ and ‘pleasant’ and we saw some very caring and considerate interactions. This home provides very good quality food that is well prepared and well presented. Residents told us they were very happy with the catering in the home. • “I enjoy my food, plenty of it, good quality and choices at every meal.” The manager told us that over 50 of staff have National Vocational Qualifications in care. What has improved since the last inspection? We could see that an attempt has been made to improve some of the written plans of care. Records for receipt, administration and disposal of medication had improved to show the treatment received by residents. The service had reviewed its medication ordering procedures to ensure a continuous supply. The manager had started a programme of assessment of competencies of staff in the safe handling of medication. There had been some minor improvements to outings and residents said they had enjoyed a trip out to a local exhibition. People in the dementia care unit go to a club on a Tuesday. • “We had a lovely day out and a summer fete and I would like more of these.” On this visit we did not see any inappropriate manual handling so we judged that this had improved somewhat since our visits in May. We also noted that Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 7 all wheelchairs now have footrests and this is an improvement for peoples’ safety and well being. What they could do better: We asked the company to review a document called the Statement of Purpose that helps people to understand how the company and the home operate, as it has some inaccuracies and omissions. We found that many of the written plans that help staff deliver care consistently and effectively had not been reviewed monthly and continue to have gaps in information. Some plans have improved but many lack the kind of detail that helps staff care for people properly. We judged that staff need more support in helping with peoples’ health care needs. We also want the manager to make sure that communication between themselves and health care professionals is improved so that any advice or instructions are followed correctly. The manager needs to help staff to understand the nutritional needs of people in the home. Staff need training and support and good instructions need to be written into plans so people get the right nutrition. There needs to be a planned and consistent approach to other physical and health care needs. This includes the approach and support for people with dementia and other mental health needs and there is a need to improve the management of challenging behaviour. Although there have been some improvements in the handling of medication there is still further work to be done to ensure the safety of residents. There was some evidence that prescribed instructions were not always followed accurately. Care plans relating to medication require review and must be followed to ensure safe and appropriate use of medicines including those intended for ‘when required’ use. The service should make sure that audits of medication are more thorough so that concerns are highlighted and dealt with quickly. The manager should also access relevant information relating to medication such as inspection reports and audits to help identify areas where improvement is required. Staff need more guidance so that people always receive choice, privacy and dignity in their daily lives. We want the manager and the company to make sure people are secure and private in their own rooms at all times. People who live in this home need and want more activities, outings and entertainments. People who live in the dementia care unit do not have suitable activities or entertainments that meet their special needs. The company need to make sure there is a planned activities programme. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 8 Some complaints have been dealt with correctly. We judged that the company now needs to remind residents and visitors of how to complain and give people information about how to contact outside agencies. We had evidence to show that the senior staff in this home are unsure about how to make adult protection referrals and the company must ensure that staff understand how to make sure people are safe by following the Cumbria Adult Safeguarding protocols. The access to the garden is limited due to risks of falling. We want the company to look at this so people have the freedom to use the garden as they wish and that risks are lessened or removed. There needs to be more attention paid to the environment. Some people told us they were not always happy with the standards of cleanliness. We saw floor coverings that need to be repaired or replaced, some furniture needs replacing and some areas need improvements to decor. One window restraint was broken. Domestic staff need induction and training and given suitable resources to do their job properly. The company needs to make sure that beds and mattress covers suit the needs of residents The call bell system doesn’t work efficiently and the company need to make sure that staff always know if someone needs help or if someone enters or leaves the building. There has been a high number of staff leaving this service in the last year and only a few new staff recruited. There is a reliance on agency and temporary staff. We want the company to look again at staffing levels and ensure that there is a suitable recruitment programme in place. We discovered that staff work in both areas of the home. This means that there is inconsistent staffing for people in the home and that staff find it difficult to work as ‘key workers’ to individual residents. Staff in the home only receive a very simple induction. The home does not use the nationally recognised standards for induction or foundation training. There has been some training delivered but not all staff have received the training we asked the company to give them. There is no new training plan after September 2009. There is a manager in post but she is not registered with the Care Quality Commission. The company now needs to make sure they register a manager as soon as possible. We judged that the current manager needs much more support and assistance from the company as a number of problems have not been dealt with in the last six months. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 9 The Quality Monitoring systems in the home are not being followed correctly and there is no quality review or annual development plan in place. We found a number of discrepancies in accounting for money held on behalf of residents. The company do not audit residents’ money or other financial procedures. Staff at all levels do not receive enough supervision on either a formal or informal basis. The staff need to have opportunities to look at their practice and be given support to improve. Recording is disorganised with some records still containing personal information about several residents on the same page. Some records are not up to date and the manager has not been reporting accidents, incidents or adult protection issues appropriately. Some records could not be found during the inspection. Records are not kept secure and confidential. There is a lack of training, supervision and checks of competence relating to how staff move and handle people and objects. The fire service has been into the home on a number of occasions as there is a fire stair that now needs to be enclosed for fire safety. They had also noticed a fire stair blocked with a piece of furniture. This was still blocking the stairs when we visited. Fire drills and instructions and emergency lighting checks were not up to date. The company need to make sure people are safe in the event of fire. 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. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More detail in the information available would help inform people to make suitable choices. EVIDENCE: We asked for and received the most up to date information that the home gives out to prospective residents. We noted that the Statement of Purpose, which sets out the intention of the company, had one or two omissions and inaccuracies. We want the company to put this right so that people will understand how the service operates. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 12 This home has not admitted any new residents for some time so we were unable to fully assess how well people are assisted to make appropriate choices about coming in to Stilecroft. We did see some paperwork about admissions from 2008 and these were in order. Key inspection reports are available but some relatives have had to ask us for copies of the random visit reports. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the 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 delivery of care in this service is inconsistent and unplanned and this means people do not have the standard of care they need or want. EVIDENCE: We read a number of the written plans of care. These documents are intended to allow people to get the kind of care and services they need and want. We looked at specific plans where we had learned of needs and we also checked on the plans developed from May to August 2009. We spoke to residents and asked them about their care needs. Very few people knew the content of their own plans. We also asked staff about the plans. We observed people in the home and then we read the plans. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 14 We discovered that although some plans had reasonably good details about the provision of personal and health care, some people had some major health needs completely missing from their plans. We also discovered that family members had requested changes to their relative’s care plan that had been agreed on but the care plan had not been changed. We had asked the manager to include some details of mental health needs in a person’s plan in May and this hasn’t been done. Staff told us they were unsure about how to approach this person and there was no plan to help them. Another person needed support with a particular health need and this was not mentioned in the care plan or in daily notes. Staff told us that some of their colleagues had never had to deal with this particular procedure and they thought that sometimes the person was very uncomfortable as they were not being given the right care. Some people in the home have behavioral problems where staff need to give them support. We saw evidence to show that one of these people had a simple plan in place. We saw night staff records showing they had followed this plan and suggested some improvements to it but this had not been followed through. We also saw that staff were sometimes (but not consistently) recording any problematic behavior but that no conclusions were drawn from this monitoring and that the plan in place had not helped to lessen the person’s distress. In general we judged that care plans for people with dementia were not specific enough about the type of approach to take with each individual but instead said things like “use reassurance... and diversion techniques”, “x responds better to closed questions”. We asked staff if they understood what these instructions meant and they were unsure. We also asked staff how often they read the care plans and they said they had time to read one or two a week. A number of plans contained assessments about nutritional needs. The kitchen staff had copies of individual forms that gave details of peoples food preferences. We learnt from the cook that one person had very specific dietary needs that were being met; however this was not mentioned in the care plan. We found at least one person who had lost a significant amount of weight and there was no nutritional plan in place. A number of people have problems that might be improved with a high fibre diet but again there was no nutritional plan in place and they were given white bread and low fibre cereal. No one had been trained in nutritional planning. The manager now needs to make sure that people have good nutritional plans that all staff can follow. Some care plans had been reviewed monthly but a number of other plans had not been reviewed for a number of months, even when there had been instructions from healthcare professionals, requests from family members or recommendations from us. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 15 We judged care planning to be inconsistent and sporadic and we did not think staff were aware of its importance in delivering planned and specific care. The requirement made in May 2009 is still unmet. Some health care matters were not followed through from reported symptoms and it was often difficult to determine from daily notes whether GPs or nurses were called out when symptoms of ill health were observed. On the first day of our visit the pharmacy inspector asked the manager to update a particular plan about medication. This had not been done by the second day of the inspection. Overall we found that the management of medication and record keeping had improved though further work is still needed to fully protect residents from the risk of medication errors. Ordering procedures had been reviewed so medicines did not run out. Records for the receipt, administration and disposal of medication were better and show the treatment received by residents and reasons why medication was omitted. We counted a sample of medicines and compared the quantities with records to check that they tally and to show that they are administered as prescribed. These samples were mostly in order with only occasional discrepancies where records were signed but medication was not given. Medication administration records were updated every four weeks. We checked that changes made on one record were accurately transferred to the next record at the start of the next four week cycle. Most of these changes were continued appropriately. However, we followed up a resident who was highlighted at the last pharmacy inspection in May who, at that time, was receiving the wrong dose of medication due to inaccurate records. We found that the resident continued on this dose from May until now and there was no evidence that this had been queried by staff or reviewed by a doctor. Records of visits by healthcare professionals and the outcomes were poorly recorded in residents care plans so that changes to medication were difficult to track. Care plans for management of medication, including ‘when required’ medication, required review as those that we looked at lacked detail. We looked at the administration of a ‘when required’ sedative for agitation whose side effects include increased risk of falls. The person who received this had records of recent falls and we also saw that its use could not always be justified. For example, the sedative was given at 6pm on a day when the daily report said “[name] fine this afternoon she has been a pleasure”. On another occasion it was given at 3pm and a chart for monitoring behaviour said “lovely mood all afternoon and very calm frame of mind”. This resident had no care plan for the management of behavioural problems or agitation, or the use of sedatives and monitoring of side effects. Staff also told us that they had difficulty administering medication to another resident. The resident’s care plans did not record this, nor did it contain any management plan to ensure Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 16 the technique employed to administer medication was safe, appropriate, and discussed with relevant parties. We checked that staff who handle medication had been assessed as competent in the task to keep people safe from errors. There was some progress and the manager had started to assess staff competencies. This must be extended to all staff who handle medication including night staff, who may be required to give ‘when required’ medication, and should be clearly documented. We were told that night staff no longer administer medication but one person’s care plan says ‘only give night medication on going to bed’. The notes show that this might be after midnight. The manager told us that she did regular checks, or audits, of medication although these need to be more thorough. Further audits were done by the Area Support Manager. It was disappointing that the manager was unaware of the outcomes of these audits. It is strongly recommended that the manager accesses relevant information relating to medication such as inspection reports and audits to help identify areas where improvement is required to provide an improved and safer service for residents. At the random visit on 01/05/2009 we were concerned about the approach of some of the staff. On this visit we saw some very kind and sensitive interactions but we also saw some interactions that showed people were not helped to live a dignified life. This was more marked on the dementia care unit. Tables were not set, people were given age inappropriate toys, no one was given a saucer with their cup and some staff didn’t really ask people what they wanted. We noticed that the staff don’t help people on this unit to have privacy. The doors have specialised locks so that it is easy to get out of bedrooms but difficult to get into. Doors are not being locked. Records show that people ‘wander’ into each others’ bedroom by day and night. One person says in his ‘Life story’ that he wants ‘people to stay out of my room’. During the visit one person was disturbed in bed by another resident who went into the room by mistake. People in the main unit were a little happier with the way staff helped them maintain privacy and dignity but we did notice that one person, ill in bed, had their door left open so staff could monitor them. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the 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 do not get enough outings, activities or entertainments and some of the activities provided do not suit peoples’ age or ability. Residents told us they were dissatisfied with what was on offer. EVIDENCE: On the second day of the inspection we arrived shortly after 7 a.m. We were pleased to see that although one or two ‘early risers’ were up and about most people were still in bed. A number of people spend a lot of time in their own rooms and this is accepted as being the norm for them. We checked the visitors’ book and spoke to visitors and we judged that the home makes relatives and friends welcome. Residents told us that local clergy visit and that there is a monthly service that some people enjoy. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 18 People in the main part of the home told us they had been out to a local exhibition and that there had been some improvements in activities. However staff surveys, discussions on the day and information from visitors all informed us that people wanted more outings and entertainments. Minutes of a residents meeting showed that people had asked for a garden plot, trips out and entertainers in the home but these things had not been arranged. On the first day of our inspection we observed people with dementia using toys and colouring books that were not suitable for their age or life experience. On the second day we were around when people enjoyed a more appropriate activity where they had hand massage and manicures. Staff told us that there were no planned activities but it depended on ‘who is on duty’ and how well staffed the unit was. On the second day the TV was on in the dementia care unit at breakfast time and one member of staff consulted residents and they were happy to have it switched off. Another staff member came along and switched it back on without asking them. Several people commented that they had preferred the quiet. Some people in the dementia care unit do go to a weekly club run by a charity organisation but they don’t normally go out although there is shared transport available. There was a discussion about places they might want to go but nothing had been organised. The reality orientation board that helps people know what is going on around them was either blank or incorrect on both days of our visit and is not within eye line so people don’t read it. We found no evidence to show that there was any planned programme of therapeutic activities for people with dementia despite the fact that the home’s Statement of Purpose says “Social activities are also tailored to the needs of people with dementia...with the aim for these...to be as person centred as possible.” One person’s notes showed that guidance about activities had been given by a specialist nurse but this had not been followed through and was not written in the care plan. People now have ‘Life story’ books completed. These give brief details of the person’s life. One with more detail had been completed by family members but unfortunately the care plan gave different interests to those the family said were important. On the second day of the visit and during the random visit of 1st May 2009 we sat with residents at breakfast and lunch and we enjoyed a well prepared and nicely presented meal. We looked at the kitchen and found it to be clean and orderly. Environmental Health officers had rated the kitchen as ‘Very Good’ in their recent inspection. We heard from residents on the day that they were very satisfied with the food provided. We checked on food in the kitchen stores and we judged it to be of high quality and the catering staff to be very competent and organised. We had evidence to show that care staff need to communicate more fully with Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 19 kitchen staff but we discuss this under ‘Health and Personal Care’ when we discuss nutritional planning. We judged that daily life and social activities might have improved somewhat but there was a lack of planning and direction for staff and that people with dementia were treated differently in terms of autonomy and choice. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the 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 company need to make sure that people are fully aware of how to complain and that staff understand how to manage matters of adult safeguarding so that people are listened to and protected. EVIDENCE: The AQAA told us that there had been no complaints received in 12 months and that there was no recording of complaints prior to March 2009. We had been forwarded a letter of complaint that had gone to the company in May 2009.The Company had dealt with at least two formal complaints as there is a log and a record. Residents were fairly sure about who to complain to in the home but not outside of it. We didn’t see copies of the complaints arrangements on display in the home but they are in the package for new residents. Minutes of residents meetings showed some dissatisfaction (for example people wanted more activities) but there had been no real action taken over this. We judged that the time is now right to remind residents and visitors that they may make complaints and suggestions and we recommend that residents, relatives and visiting professionals have improved access to the complaints procedure. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 21 The AQAA also tells us that they have made two adult safeguarding referrals since March and there have been three investigations during this period. We have not received these referrals, there was no log of the investigations and we could find no trace of them being reported to other agencies. We did discover in daily notes and other files that there had been some issues that might have come under safeguarding. There is a requirement about reporting matters of adult protection. We spoke to a number of staff about protecting vulnerable older people. They were able to respond appropriately and understood their responsibilities. Most people had undertaken training on the protection of vulnerable adults. Staff told us that nothing untoward was happening in the home and they did not think that anyone was being abused or neglected. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the 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 relatively satisfied with their home but further attention to ongoing maintenance, replacement and improvement is necessary so people will be safe and comfortable. EVIDENCE: This home is situated in a residential part of Workington and is accessible by public transport. Parking is available at the front of the property. The company owns another home in Workington and they share a ‘people carrier. The home is mainly single rooms and some of these have ensuite facilities. The main building is an older property and there are bedrooms on the first floor of Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 23 the house, with two lounges and a conservatory on the ground floor. Built on to the house is an extension with bedrooms and a further pleasant lounge that looks out to the woods behind. There is a lower ground floor and this is where the specialist unit for people with dementia is found. This is the newest part of the property. The shared area in this unit is a small lounge/diner and part of this room is a conservatory. This has French doors that are alarmed and lead out to the garden. On one of the days we visited the weather was warm and staff told us they would like to serve people with tea outside. There is a pleasant front lawn and a secure garden for people with dementia but the home has no suitable garden furniture for warm weather other than wooden benches. Very few people used the garden during the two-day inspection. Access from the dementia care unit to the garden is by a set of stone steps. At least one person has had a fall down these steps and staff are now reluctant to allow access to the garden because of this. We did not see a risk assessment in place about this potential hazard. Staff told us they were worried about the steps and could not just leave the door open for people to go out into the secure garden. This means people do not have the freedom to walk into their own garden. People in the main part of the house said they could not open the door and use the garden because some people might ‘wander off’. We want the company to resolve this operational problem. On the second day the two inspectors walked around the building and found it to be reasonably clean even early in the morning. We did judge that some areas could have been tidier and some bedrooms needed dusting. Some of the woodwork and wooden furniture was marked and would benefit from repainting. There was a tear in the dining room carpet in the main part of the house and some other floor coverings that needed repair or replacement. We were aware from surveys and discussions that people usually find the standards acceptable but there have been complaints about cleanliness. We checked on different areas of the building and looked at things like furniture and fittings. We discovered that a number of beds with waterproof mattresses also had plastic mattress covers on them. We judge this to be very uncomfortable for people and bad for their skin and we want the manager to make sure that this does not happen again. Staff told us that some beds have divan bases and they are unable to use hoists with these. The company needs to look at all the beds and bed protection in the home to make sure they are suited for purpose. We also found one window that could be opened fully because the window restraint was broken. This was on an upper floor window. We did not check all of the windows but the company need to make sure they do. The restraint is a simple chain and could easily be broken and windows can then open wide, posing a danger of falls. We want the company to look into this. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 24 The call bell system does not work very efficiently in some parts of the building. There are two systems in the building and bells ringing in one area do not show up in the other. We rang a call bell on behalf of a resident and staff within sight did not respond because it was not registering on their system. We also noted that not all external doors are wired into the call bell system. Again the company needs to look into the arrangements for summoning help. We met a new member of staff employed as a domestic and she had not been given a uniform and had not received induction or training in the role. We want the company to make sure that domestic staff are competent and trained in things like manual handling, infection control and dealing with hazardous chemicals. We judged that these things show that there is not an ongoing check of environmental quality or safety in this home. We found no evidence to show that there are routine checks by management of the environment. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29,30 People using the 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 recruitment and retention of staff and inadequate training leaves people in this service with unmet needs. EVIDENCE: On the day of our inspections resident numbers were down to around 30.We asked and received a copy of the last four weeks rosters. The AQAA tells us that in the three months before it was completed 76 care shifts had been covered by agency or temporary staff. It also tells us that 16 members of the care staff team have left the service in the last 12 months. The deputy manager told us that two care assistants had been appointed during the year. Some new housekeeping staff had been appointed and they were waiting to start a new activities organiser. Staff surveys told us that sometimes the home was short of staff but that existing staff “mucked in and the shifts were covered. We also had information stating that people were working long shifts and weeks without days off. Rosters for July showed that there were one or two people off sick, Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 26 agency staff had been used but that shifts were covered without people working excessive hours. We were told in surveys and in discussions with visitors to the home that they judged that staffing levels were not as good as they might be. Staff told us they thought there needed to be more staff so they could do more activities and spend time with individuals. This gives us a picture of an unsettled team. We also learnt from staff that despite what the Statement of Purpose states there are not two separate teams working in two separate parts of the home. Staff told us that this makes it difficult to fulfill their key worker duties. For example a part-time member of staff said that she normally worked one day in the dementia care unit and two in the main part of the home. These arrangements mean that people who live in the home may not receive consistent care. The AQAA tells us that 15 staff have National Vocational Qualifications in care at level II or above. We saw evidence to back this up and met staff who have this qualification. We did not see evidence to show that plans are in place to register any new staff for this award. We checked on the recruitment of new staff and generally found that this was in order. Senior staff told us the company are very strict about not employing people until all the background checks had been done. We found that one new member of staff’s record did not show whether the Criminal records Bureau or Protection of Vulnerable Adults list check had been done. We are prepared to accept that this is a poor record keeping rather than a procedural error. We do want the company to look at their recruitment and retention of staff and the use of agency staff as the turnover of staff has an impact on people who live in the home. We had information from the AQAA and from new staff that no one in the home has received induction that meets a nationally approved standard. The induction is a simple check list and is the same for all staff. We met new people who still had not received core training. We learn from the AQAA that no staff have had training in nutrition and only 11 people are trained in food hygiene. We only received five staff surveys and they tell us staff are unhappy with training and support provided. Some training has been delivered over the summer. This included dementia care awareness and this was a recommendation made in May 2009. However we saw staff still struggling with how to work with people with dementia and how to help individuals. One member of staff said she had received a lot of training on dementia but she still felt unsure of how to approach people and wanted more support and more specific care plans. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 27 The AQAA tells us there is a staff training and development plan. We didn’t see evidence of this in individual files or in any general records. There was a training matrix available for us. Nothing was recorded for new starters and other people had gaps in their training for the core skills needed to fulfil their role. There were more names on this than the numbers of permanent staff shown on the AQAA so some training statistics may relate to people who have left the service. There was no training plan available after September 2009. We judged that people needed training in a number of areas but this had not been recognised or prioritised by the manager. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We judged that the management systems in this home are not being followed well enough to allow people to be safe in this service. EVIDENCE: The home has a manager who took up her post some six months ago. She has a qualification in nursing and experience in nursing homes. She has not as yet applied to be registered with the Care Quality Commission. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 29 We judged that a number of issues including updates to staff development, care planning and fire safety had not been progressed by the manager despite requirements and recommendations having been made by ourselves and by the fire service. We saw evidence to show that this company do have a Quality Assurance system. They employ quality managers who come to the services and who then develop improvement plans for the managers. We were told that a recent audit had taken place. We saw some reports of previous audit visits but no action plans. These visits are the company’s way of complying with Regulation 26 of the Care Homes regulations. Unfortunately the visit reports lack detail and we were told that the manager did not have a copy of the last quality audit or report. We saw some returned surveys sent out by the manager but the information from these had not been collated. We saw some examples in the home (for instance in the kitchen with food safety routines) where good, regular audits of quality took place. We also saw some records that were not completed and some regular checks (for example monthly care plan reviews) that were not taking place. There was no annual quality report available for residents and other interested parties. The company have sent us action plans for requirements we have made over the last year and some of these are still unmet. We checked on the money kept on behalf of residents and we found that the accounts only had one signature, the cash was kept in an insecure way and that there was no running total of cash kept in the home. When we tried to balance these accounts with the cash the two figures did not reconcile. We also discovered that money had been borrowed from a sum of cash belonging to residents. The home does not have a residents’ amenity account but is keeping cash raised through events in the home without any suitable monitoring. We were told that the company does not audit accounts and cash kept in the home. We now need the company to confirm with us that their financial arrangements are suitably audited. We also need to know that this company is planning to develop and improve the home and its resources, including staff. We were concerned that there is a lack of investment in the home. We checked on the records kept relating to supervision of staff. We found that staff were not receiving formal supervision. We looked at the file for the deputy who plays a major role in the home and there was only one record of supervision since she started in December 2008. She told us that she did spend time with her manager and other managers from the company but that this was not done in a formal way. We also looked at the file of a member of staff who we had observed in May. This person had problems carrying out moving and handling tasks properly and she had not received any formal supervision about this or any other care approach. We looked at other files and found that supervision was either scant or non existent. Staff spoken to said they were observed during work but most Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 30 people were unaware of the personal development side of this and no one could remember the last time they sat down to formally discuss their work with a more senior person. One or two people asked our opinions as they felt they were not appropriately guided by senior staff. We examined a number of records relating to the care of residents, staffing and to the management systems. Most of these records were not being kept up to date. For example although senior staff told us that training or competence checks had taken place the records were incomplete. One record was only to be found in the manager’s own diary. On more than one occasion we were told a care plan with missing information was ‘being updated’ but we did not see any work in progress. Care staff had started to keep records of food intake or challenging behaviour but not all staff were completing these. Generally we found records to be out of date and completed in an inconsistent manner. We were concerned that one person had fallen 17 times in 6 weeks but we were not informed of this. One matter of concern had not been reported to us for a number of days. Some accidents, incidents and falls are not reported to us at all. Notifications of events that impact on well being (including potential adult protection issues) are not being reported as they should. We also discovered that records continue to be kept insecurely. Records of care could be easily accessed on the day. We found that communication books and handover sheets continue to be left on the desk in the entrance hall and contain details of a number of peoples’ needs. This kind of communal recording of individual details is not in keeping with the Data Protection Act and also creates multiple recordings. We also had evidence to show that information of this kind differed when recorded in more than one way. We checked on the records kept relating to health, safety and maintenance. Some of these were being done correctly but again not all records were being kept up to date (see also under ‘Environment’ in relation to call bells and window restraints). At our visit on 01/05/2009 we noted that staff were not moving people correctly and that wheelchairs had no footrests. On this visit we saw improved manual handling and all chairs had footrests. When we looked at the training matrix we found that new starters had not had manual handling training and many of the existing staff had not received updates to their training. Senior staff told us their training and competence had been checked but there was no evidence to prove this. Some training in this is planned. There is an outstanding requirement that all staff have their training updated and competence checked. This should have been completed by the end of June but there is no evidence, other than the acceptable practice we saw on the day, to show this has been done. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 31 We specifically looked at the fire log book and we could see that the manager had taken advice from the fire service but we saw that although drills and instructions had taken place, not all staff were up to date with these. We asked staff about fire safety and their responses were not as full as they might be. At least one new member of staff had not had a drill or an instruction. We had been informed by the fire service that this home has been served with two notices. In January this year they were served with a ‘Notice of Deficit’ about their maintenance of the fire safety systems. We were not told of this by the company and they had only put this right in April and May. The fire service has served them with an enforcement notice in July of this year. Part of this was to do with a staircase and we were told that plans were in hand to deal with this but we saw no evidence at inspection. The notice also states that staff have been blocking a fire stair with furniture. On the second day of this inspection this stair well was blocked at 7.30 a.m and staff told us this was common practice by day and night. We judged that this continues to put both residents and staff at risk in a fire situation and we made an immediate requirement on the day. We were concerned because staff on duty were not aware that this was a dangerous practice and we were then unsure as to whether drills and instructions given are effective. There is an outstanding requirement under the Care Standards Act about drills and instructions. We also noted that there was scant recorded evidence to prove that the emergency lighting system is checked. This means that fire safety especially at night could be seriously compromised. Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 x X 1 X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 1 1 1 1 1 Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered person must put in place effective arrangements to ensure that prescriptions and instructions from medical professionals are properly recorded and followed so that administration errors do not arise. This was to have been met by 05/07/09 and is repeated. Timescale for action 21/08/09 2. OP7 15 (2) Care plans must be written in 21/08/09 more detail so they include all of the wishes and needs of individuals. Care plans for people with mental health needs must show strategies for staff to follow if people have challenging behaviour. This requirement should have been met by 30/06/09 was still not met on 07/08/09 and is repeated. 3. OP38 13 (5) All staff must attend updates to manual handling training and DS0000071717.V377001.R01.S.doc 21/08/09 Page 34 Stilecroft (MPS) Ltd TA Stilecroft Residential Home Version 5.2 must have their competences in this checked by a person who is trained to do so. This requirement should have been met by 30/06/09 was still not met on 07/08/09 and is repeated. 4. OP38 23 (4) All staff must attend an 21/08/09 instruction on fire safety. This must include the action to be taken, managing a fire situation, evacuation and escape routes. This must be recorded. This requirement should have been met by 30/06/09 was still not met on 07/08/09 and is repeated. The registered person must make sure that there are suitable group and individual activities and entertainments on offer. The programme of activities must include suitable, age appropriate activities for people with dementia that meet with the most up to date research on dementia care. The registered person must ensure that staff know what is abusive and know how to make an appropriate referral so that any investigation is carried out following the Cumbria Adult Safeguarding protocols. The registered person must undertake a risk assessment and devise a risk management plan about how people access and utilise the outside spaces The registered person must commence an induction and foundation training programme DS0000071717.V377001.R01.S.doc 5. OP12 16 (2) (m) & (n) 30/09/09 6. OP18 13 (6) 30/09/09 7. OP19 13 (4) & 23(2) (o) 18 (1) (c) 30/09/09 8. OP30 30/09/09 Page 35 Stilecroft (MPS) Ltd TA Stilecroft Residential Home Version 5.2 for all staff that meets nationally recognised standards. Staff must have their training needs analysed and a training programme covering core skills and specialist knowledge must be devised and put into operation. 9. OP31 8 (1) The registered person must ensure that a suitably trained and experienced person applies to be the registered manager as soon as possible. The registered person must ensure that all aspects of the operation are monitored for quality, that people who live in the home are consulted and that an annual development plan is produced and shared with people who live in the home and other interested parties. The registered person must ensure that any money or valuables retained on behalf of residents or donated to the residents group are stored securely and suitably accounted for. The registered person must ensure that all staff and the manager receive formal supervision and that their practice, the philosophy of care and their training needs are discussed and recorded in these sessions. The registered person must ensure that records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up DS0000071717.V377001.R01.S.doc 30/09/09 10. OP33 24 (1) (2) & (3) 30/09/09 11. OP35 16 (2) (l) & Schedule 4 (9) 30/09/09 12. OP36 18 (2) 30/09/09 13. OP37 17 30/09/09 Stilecroft (MPS) Ltd TA Stilecroft Residential Home Version 5.2 Page 36 to date, suitably detailed and accurate. This must include those under Regulation 37 and 26. 14. OP38 23 (4) The registered person must ensure that all fire exits and fire stairs are kept clear so that these may be used in a fire situation. The practice of blocking a fire stair with furniture must stop. This was an immediate requirement made on 07/08/2009. 09/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care Plans should be developed in a person centred way so that people are treated as individuals and have their needs met in a less institutional way. It is recommended that handover and communication sheets and books only contain minimum references to individual needs and are used as a ‘sign post’ to details in individual files. Individual records need to be kept securely. It is recommended that all staff have training in core values so that they understand the rights of older people. It is good practice to check these things out through observation of practice and in formal supervision. It is recommended that the Statement of Purpose be updated and reviewed so that any inaccuracies or omissions may be put right. We recommend that the company use Schedule 1 of the Care Homes regulations to complete this exercise. DS0000071717.V377001.R01.S.doc Version 5.2 Page 37 2. OP37 3. OP30 4. OP1 Stilecroft (MPS) Ltd TA Stilecroft Residential Home 5. OP8 It is recommended that staff receive updates, information and advice about the following: • Nutritional planning • Pressure care • Stoma care • Behavioural approaches in dementia care. It is recommended that staff are observed while delivering care and are advised and supported to always give care that promotes individuality, dignity, respect and privacy. It is recommended that security is reviewed so that all residents feel they have access to keys where appropriate and have their rooms locked to prevent people invading their own private space. The review should include external doors It is recommended that care planning includes the support necessary for people to be helped to personal autonomy and choice. This should include the right to self medicate, have advocacy, manage finances and have access to their own individual records. It is recommended that the registered person remind all residents, their relatives and other visitors of how to make a complaint or voice a concern about the service. It is recommended that the call bell system throughout the home is checked to ensure that residents are able to summon help at all times. It is recommended that regular maintenance checks of all parts of the environment are undertaken. This should include beds, bedding, furniture, floor coverings, windows and doors. This needs to be done so that people are safe, comfortable and properly cared for. It is recommended that staffing levels and dependency levels are reviewed and that staff are suitably deployed to provide appropriate levels of care. Consideration should be given to dedicated teams of staff for each part of the home. It is recommended that there is plan for staff recruitment and retention and that recruitment processes are monitored to ensure that the home has suitable staffing levels and that the use of agency and temporary staff is DS0000071717.V377001.R01.S.doc Version 5.2 Page 38 6. OP10 7. OP10 8. OP14 10. OP16 11 12. OP22 OP24 13. OP27 14. OP29 Stilecroft (MPS) Ltd TA Stilecroft Residential Home minimised. 15. OP9 It is strongly recommended that care plans for managing medication, including ‘when required’ medication are developed, reviewed and followed to ensure safe and affective treatment. It is strongly recommended that audits of medication are more thorough so that concerns are highlighted and dealt with promptly. 16. OP9 Stilecroft (MPS) Ltd TA Stilecroft Residential Home DS0000071717.V377001.R01.S.doc Version 5.2 Page 39 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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