Care Home: The Promenade Residential Care Home

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What the care home does well Peoples health care needs are met by the home; appropriate advice is sought from health care professionals and equipment is provided for continence care and pressure care. Managers have started to develop patient passports for people living at the home. Visitors are made welcome at the home; people living at the home and their visitors tell us that they enjoy spending time in the garden. People tell us that they know who to speak to informally if they have any concerns and that they know how to make a formal complaint. Staff have an understanding of the policies and procedures on safeguarding adults from abuse and most have done appropriate training to assist them with following the homes policies and procedures. People are provided with information about advocacy and other relevant services, and people were being supported to take part in the forthcoming general election. There is a staff rota in place that records the details of all of the staff on duty and evidences that there are sufficient staff on duty to meet the care needs of the people living at the home. Staff working at the home have attended a variety of training programmes that have equipped them with the skills needed to support the people living at the home. National Vocational Qualification achievement is high. All documentation to evidence that equipment and systems in place at the home are safe were found to be in place. What has improved since the last inspection? Care plans are now more detailed and personalised and provide staff with more specific information to guide them on how to provide support to the person concerned. Care plans are now accompanied by risk assessments for any identified areas of concern, such as pressure care and nutritional screening. More consideration is now given to privacy and dignity; the home no longer has personal information displayed in communal areas of the home. Some areas of medication management have improved; the MAR chart records the strength of the drug and the times that the drug is to be administered, MAR charts are only used for a 28 day period and any handwritten entries are signed by two members of staff. However, some areas of concern remain. There is now a true choice of meal at all meal times so that people are able to choose from a variety of options.The complaints log now records full details of the complaints investigation and the outcome. The areas of the home identified at the last inspection that created a health and safety hazard have been dealt with. Cleaning materials are now stored safely and securely. There is evidence that staff undertake induction training that meets Skills for Care recommendations to prepare them for their role at the home. What the care home could do better: There must be no gaps in recording on MAR charts as this results in a lack of evidence to demonstrate that people have received their prescribed medication. If people do not receive their medication for any reason, the appropriate code should be recorded on MAR charts to explain the reason why. When it has been agreed that someone can manage their own medication, this should be accompanied by a risk assessment to evidence this. Some care plans do not include a photograph of the person concerned; a photograph is needed to assist new staff with identification and to help the emergency services should someone go missing from the home. Care plans do record details of a person`s social network and leisure interests, but there is no record of how a person spends their day, for example, activities taken part in or visitors seen etc. This results in there being an incomplete picture of how a person`s care needs are being met by staff. Application forms must be fully completed by prospective employees as this is the first stage of a safe recruitment process. References addressed to `To whom it may concern` cannot be accepted as evidence that applicants are suitable to work with vulnerable people; references should be requested by and returned to the home to ensure that they are authentic. The quality assurance system in place at the home is not fully operational and does not currently give people the opportunity to express their views about the care provided. The carpets in the hallways are in need of replacement as they currently create a trip hazard. Key inspection report Care homes for older people Name: Address: Promenade Hotel Marine Drive Hornsea East Yorkshire HU18 1NJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Wilkinson     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Promenade Hotel Marine Drive Hornsea East Yorkshire HU18 1NJ 01964533348 01964537868 julia@promenaderch.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Continuing Care Services Limited Name of registered manager (if applicable) Mrs Irene Phyllis Poole Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One (1) named service user under 65 years of age may be accommodated within the maximum number. The condition is to cease when the named Individual ceases to live at the home. Date of last inspection Brief description of the care home Promenade Hotel is a privately owned care home that is registered to provide care and accommodation for twenty-four older people, including those with dementia related conditions. The home is located on the sea front in the town of Hornsea, in the East Riding of Yorkshire; it is close to local amenities and public transport facilities. The building originally comprised of three houses that were converted into a hotel and restaurant, and later into a care home. Accommodation is provided on three floors; the Care Homes for Older People Page 4 of 34 Over 65 24 24 0 0 Brief description of the care home first and second floors are accessed via a stair lift. There are two lounge areas and a dining room on the ground floor, and private accommodation is provided in fourteen single rooms and 5 shared rooms. The home has an extensive garden at the rear and car parking is available at the front and rear of home. Information about the home is available for prospective and current users of the service in the homes service users guide that is available from the registered manager. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on the 25th August 2009, including information gathered during a site visit to the home. The unannounced site visit commenced at 10.15 am and ended at 5.05 pm. On the day of the site visit the inspector spoke on a one to one basis with three people who live at the home, two members of staff and the registered manager. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered provider submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 6 of 34 As part of the inspection process we sent survey forms to some people living at the home and to staff; eight were returned by people living at the home and seven were returned by staff. Responses in surveys and comments from discussions with people on the day of the site visit were mainly positive, for example, carers are pleasant and polite and spacious back garden with aviary, pond, two summer huses plus covered area with table and chairs. Other anonymised comments are included throughout the report. The manager told us that the current fee for residential care is from £369.25 to £420.42 per week. At the end of this site visit feedback was given to the registered manager on our findings, including requirements and recommendations that would be made in the key inspection report. We have changed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Care plans are now more detailed and personalised and provide staff with more specific information to guide them on how to provide support to the person concerned. Care plans are now accompanied by risk assessments for any identified areas of concern, such as pressure care and nutritional screening. More consideration is now given to privacy and dignity; the home no longer has personal information displayed in communal areas of the home. Some areas of medication management have improved; the MAR chart records the strength of the drug and the times that the drug is to be administered, MAR charts are only used for a 28 day period and any handwritten entries are signed by two members of staff. However, some areas of concern remain. There is now a true choice of meal at all meal times so that people are able to choose from a variety of options. Care Homes for Older People Page 8 of 34 The complaints log now records full details of the complaints investigation and the outcome. The areas of the home identified at the last inspection that created a health and safety hazard have been dealt with. Cleaning materials are now stored safely and securely. There is evidence that staff undertake induction training that meets Skills for Care recommendations to prepare them for their role at the home. 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. 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 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 1 and 3. We did not assess Standard 6 as there is no intermediate care provision at the home. People tell us that they received helpful information about the home before they made a decision to move in. Care needs assessments take place but they are not always thorough. Evidence: Eight people living at the home returned a survey to the Care Quality Commission (CQC) and five of them told us that they received enough information about the home prior to their admission to help them to make a decision. We checked the care records for three of the people living at the home. They all had signed a form in their care plan to record that they had received relevant and helpful information about the home prior to their admission, including a copy of the homes Care Homes for Older People Page 11 of 34 Evidence: service users guide. We noted that, when the placement is commissioned by a local authority, the home obtains a copy of the community care assessment and care plan produced by them. The home undertakes its own care needs assessment for people who are privately funded but we noted that these do not always include appropriate information. One of those seen recorded the persons personal details, financial details, their wishes about advocacy and information about risk taking but nothing about the persons need for assistance with personal care, their emotional needs or about their social and leisure needs. This information should be obtained at the time of a persons admission to the home to assist with the development of a thorough and detailed care plan. Information obtained from both assessments is is used to start to produce an individual plan of care for the person concerned. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 7, 8, 9 and 10. Peoples care plans provide staff with detailed information about them and how they should be supported, and incude appropriate risk assessments. Health care needs are met apart from the safe administration of medication, which does not currently ensure that people receive their prescribed medication. Evidence: We checked the care records for three people living at the home; two included a photograph of the person concerned but one did not. A photograph is needed to assist new staff with identification and to assist the emergency services should someone go missing from the home. Care plans are now more detailed and include information about personal support, diet, moving and handling, continence, medication, mental health, personal safety/risk, social contact and family relationships, management of monies and mental capacity/deprivation of liberty/decision making. We saw that care plans include Care Homes for Older People Page 13 of 34 Evidence: special reminders such as, staff to escort x downstairs to prevent falls and key worker duties at least 2.5 hours per week. Care plans also indicate the areas of care where a risk assessment is needed and appropriate risk assessments have been undertaken, including those for moving and handling, nutrition, pressure care and the risk of falls. Individual risk assessments have also been completed for such areas as low mood, anxiety, drug abuse, self neglect and management of money. These risk assessments include details of the individual risk, any triggers and how to minimise the risk. Information has been obtained about personalisation and there is a document in place that records personal information about the individual concerned, such as what is important to me, things I want to make my life better, how am I going to get the support I need and My Best Day, My worst Day, My Best Night and My Worst Night. A summary of this information has been included in Patient Passports; these are documents that record important information about a person that can be taken to the hospital in the event of an admission. They are intended to inform medical staff about a persons needs and wishes, and are especially useful if the person has communication or cognitive difficulties. We saw that care plans record sufficient details to guide staff on the support or assistance a person requires to enable their individual care needs to be met, including specific wishes about bathing and other personal care tasks. Care plans are reviewed on a monthly basis to ensure that staff are working with up to date information, and we saw that formal annual reviews of a persons care plan also take place. People are weighed as part of nutritional screening and we saw that there are food and fluid intake charts in place when this is an identified area of concern. Although the home use a nutritional assessment tool, we advised them that they may want to obtain a copy of the MUST nutritional screening tool. The manager told us that they have risk assessments in place for the use of bed rails that follow the guidance published by the Medicines and Health Care Regulatory Agency (MHRA). Bed rails are checked for safety each month by the homes handyman and by a health and safety company every 6 months. All of the people living at the home who returned a survey told us that the home makes sure that they receive the medical attention they need. We saw that any contact with doctors, district nurses and other health care professionals is recorded. This includes the reason for the contact and the outcome. Care Homes for Older People Page 14 of 34 Evidence: We received a copy of a report completed by two pharmacy technicians from East Riding of Yorkshire Primary Care Trust (PCT). They visited the home on 25/2/10 to see what changes had been made to medication policies, procedures and practices following recommendations made at their last visit. They recorded that a new medication policy had been written but that it still needed to be expanded, and that the following areas needed attention: ordering, storage of medication, controlled drugs, homely remedies, the returns process and MAR charts. They found errors in the controlled drugs register and on MAR charts, that staff are not recording the date they start to use items with a shortened expiry date once opened, that the policy on Warfarin needs to be expanded and that there should be a prescription audit trail. On the day of the site visit we observed the administration of medication and also checked medication administration record (MAR) charts, the storage of medication, medication returned to the pharmacy and staff training. The member of staff who administered medication followed the correct procedure. She informed us that inhalers, eye drops etc. are now adminstered after meal times (rather than whilst people are sitting at the dining table) to respect their privacy and dignity. The book holding individual MAR charts includes the homes medication policy, a risk assessment about drug dispensing and a list of sample signatures for staff who have responsibility for the administration of medication to enable medication records to be checked for authenticity. Each MAR chart is accompanied by a photograph of the person concerned to assist staff with identification. We saw that the quantity of medication received from the pharmacist had been recorded, signed and dated and that any hand written entries made on MAR charts had been signed by two members of staff to reduce the risks of errors occurring. On most occasions the pharmacist supplies the home with a spare label to place on MAR charts so that staff do not have to make hand written entries. We checked a sample of MAR charts and found that there were some gaps in recording; it was not possible to determine if people had been given their medication and it had not been signed for, or if medication had not been given. In one instance records indicated that a service user had not been given their prescribed medication on 24/4/10 and had taken two Movicol instead of one on 24/4/10, 26/4/10 and 27/4/10. In another instance it looked as though a service user had not been given medication on 24/4/10 and 26/4/10. At the previous inspection we highlighted that any alterations to MAR charts must only be made following written instruction from the persons GP. On this occasion we noted Care Homes for Older People Page 15 of 34 Evidence: that the number of alterations made to MAR charts had reduced but that further improvements need to be made. In one instance staff had recorded to be given at 8pm, which was different to the information recorded on the MAR chart, and in another instance the bedtime dosage had been crossed out by staff, again with no reason recorded. A further two alterations were found that were not accompanied by a written explanation. We asked to see the returns book on the day of the site visit. Staff told us that they return unused medication to the pharmacist but that the pharmacist holds on to the book until they have had time to check the details of the returned medication. They then sign the book and return it to the home, but this means that the returns book is actually at the pharmacy more than it is at the home. We advised staff to go back to the pharmacy the day after they return medication to collect the returns book. We saw that one person manages their own medication and it is right that people be encouraged to do so. However, there was no risk assessment in place to evidence that the person is considered safe to hold their own medication. One person told us in a survey that they would like a private room; they may have been referring to the fact that there is no private room where people can meet with visitors or health care professionals. At the last key inspection we recommended that more consideration should be given to respecting a persons privacy - we were concerned that some personal information was displayed in one of the toilets that was also used by visitors. We did not see any personal information displayed in communal areas of the home on the day of this site visit. A new accident book has been purchased that allows individual records, rather than communal records, to be made so that the requirements of the Data Protection Act 1998 are met. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 12, 13, 14 and 15. People have regular visitors and activies are made available but, because these are not recorded in care plans, this results in an incomplete record of care provided. People tell us that they like the meals at the home. Evidence: On the day of the site visit we observed that routines of daily living are flexible. People told us that they could get up and go to bed when they choose and that they could spend the day in an area of their choice, i.e. in one of the lounges, in their own room or in the garden. We checked the care records for three people living at the home and noted that there is a record of a persons previous lifestyle, their family relationships and any hobbies or interests. The care plan for one person recorded, offer activities and encourage x to take part, ensure x speaks to family when they ring and tell x when hymn singers are coming in. However, the activity/social recording sheet, the social visits sheet and the key worker activities sheet for this person were all blank. In another persons Care Homes for Older People Page 17 of 34 Evidence: records these forms were also blank. Eight surveys were returned by people living at the home and responses in surveys indicate that some people do not feel that there are appropriate activities available to them, although one person told us, I love the day trips out. Some staff also suggested that more time could be spent with people undertaking leisure activities. One person said, Wider choice of activities for those who are able, by having extra staff on duty to spend time with residents and another said, Spend more quality time with residents doing things with them other than just the minimum care needed. Most of our residents are confused so rather than play quizzes that many of them cant do or join in with, we should look into other stimulants like sensory, touch and textures. The quality assurance folder records that hymn singers attend the home once a month, Holy Communion is held on alternate months, there were mini bus outings in March and April and two entertainers visited the home during April. There was an entertainer present on the day of the site visit and several people had visitors or went out for a walk. One staff member told us, The home makes family and friends most welcome which is often commented on - creates a friendly, homely atmosphere for residents. It may be that activities have taken place and that people have had visitors but this has not been recorded; this results in care plans being an incomplete record of the care provided for people and how they live their day to day lives. We saw that bedrooms have been personalised to reflect a persons personality and previous lifestyle and that people have been encouraged to bring small items of furniture, photographs, pictures and other items that are special to them into the home. Care plans have a section that records information about mental capacity, the deprivation of liberty, decision making and voting. On the day of the site visit we saw a list that had been prepared about the forthcoming elections - fifteen people had expressed a wish to go to the polling station and the manager told us that this would be organised. Assessment information includes details about a persons wishes to be supported by an independent advocate and we noted that information about advocacy is also displayed in the home, along with a wide selection of other leaflets including information about the mental capacity act and financial advice. Care Homes for Older People Page 18 of 34 Evidence: We saw the serving of lunch on the day of the site visit. There was a choice of meal on offer and we saw that both hot and cold drinks were available, with people being asked if they would like more food or drink. Care plans record information about a persons nutritional and dietary needs, including appropriate risk assessments, and we noted that the need for food supplements is also recorded. We saw that staff offered appropriate assistance with eating and drinking and that mealtimes were unhurried, with people being given sufficient time to eat. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outomes for Standards 16 and 18. People tell us that they know how to express concerns but some people may need reminding of the complaints procedure. People are protected from harm by the staff training arrangements on safeguarding adults from abuse. Evidence: We received surveys from eight people who live at the home. They all told us that they know who to speak to if they have any concerns but two people told us that they do not know how to make a formal complaint. We also received seven surveys from staff and they all told us that they know what to do if someone expresses concerns about the home. We checked the complaints log on the day of the site visit and noted that complaints are recorded appropriately and that there is a record of the outcome. We saw that action had been taken as a result of some complaints. For example, some people living at the home complained about poor TV reception in their bedroom and the manager recorded in the Annual Quality Assurance Assessment (AQAA) that a new ariel has been obtained to correct this. The manager told us that she and the deputy manager did the managers awareness training on safeguarding adults from abuse in April 2009 and that most carers have Care Homes for Older People Page 20 of 34 Evidence: now attended this training. Records evidence that six care staff have not done this training; three of these are newly appointed staff. We were told that a course has been arranged for the 18th June and that all of these staff will be expected to attend. In addition to this, most care staff at the home have undertaken National Vocational Qualification (NVQ) Level 2 in Care and abuse is one of the topics covered in this training. One safeguarding incident has occurred at the home since the last key inspection and this was reported appropriately to the local authority safeguarding adults team; this information was recorded on the AQAA sent to the Care Quality Commission in preparation for this inspection. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 19 and 26. The home provides clean, comfortable and mostly well maintained accommodation for the people who live there and the garden provides a pleasant area for people to use. Evidence: The location and layout of the home is suitable for its stated purpose. We toured the premises on the day of the site visit and noted that the premises were safe, comfortable and well maintained. Although we did not see a maintenance log, there is a maintenance check list in place. At the last key inspection we highlighted some safety aspects of the premises that needed to be addressed, i.e. uneven floor tiles in one of the toilets, access on the stairs that include the stair lift and the location of call bells; these had all been actioned. We did see that the carpets in both hallways were worn, especially on a ramped area. These should be replaced as they currently create a trip hazard. The grounds are kept tidy, safe, attractive and accessible to people living at the home and allow access to sunlight as well as providing more sheltered areas. People told us Care Homes for Older People Page 22 of 34 Evidence: that they and their visitors enjoy spending time in the garden. One person told us in a survey, spacious back garden with aviary, pond, 2 summer houses plus covered area with table and chairs - well kept garden. We saw that the premises are kept clean, hygienic and free from unpleasant odours and that there are systems in place to control the spread of infection. Disinfecting gel was available in various areas of the home. Eight people living at the home returned a survey and they all told us that the home is fresh and clean. There is evidence that the home complies with the Water Supply (Water Fittings) Regulations 1999. Laundry facilities are satisfactory although we did receive a comment from someone living at the home about their clothes being ruined in the homes laundry. The manager told us that there had been a problem with the tumble dryer which has now been repaired,and that some people have been compensated for clothing that was damaged. Cleaning materials are now stored in a locked cupboard or similar to protect people living at the home from the risk of harm. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 27, 28, 29 and 30. People are cared for by sufficient numbers of staff who are recruited properly and trained to undertaken their role but this is compromised by some stages within the recruitment process not being robust. Evidence: We examined the staff rota on the day of this site visit. This evidences that there are sufficient numbers of staff employed to support the people living at the home. In addition to this, there are cooks, domestic staff, kitchen assistants and a handyman employed. This enables care staff to concentrate on care duties and not undertake catering and cleaning duties, and reduces the risk of cross infection. There is a code recorded on the staff rota that enables a persons role to be identified. Sixteen care staff have achieved NVQ Level 2 in Care and the three remaining care staff are working towards this award. Ten care staff have also achieved NVQ Level 3 in Care and another member of staff is working towards this award. Domestic staff are undertaking NVQ training in housekeeping and both Cooks are working towards an award in Catering. This is excellent practice. Care Homes for Older People Page 24 of 34 Evidence: We checked the recruitment records for three members of staff. These people had completed an application form but one application form did not include a criminal conviction declaration or the names of two referees. The two references in place for this person are addressed to To whom it may concern and neither are dated; there should be evidence that references have been requested by the home and returned to the home so that a check can be made about authenticity. In one instance the Criminal Records Bureau (CRB) check arrived prior to the person commencing work at the home and in the two other instances the CRB check arrived shortly after the Protection of Vulnerable Adults (POVA) first or Independent Safeguarding Authority (ISA) first checks. However, there are no records to evidence that staff worked under supervision until their CRB checks were received at the home. One person commenced work at the home in August 2009 and we noted that their application form did not record their employment history. The manager told us that the new application form in use at the home asks people to record their employment history, and we saw this on the day of the site visit . We noted that staff sign to record that they have received instruction on key working, that they have received the code of conduct produced by the General Social Care Council and that they have read the homes health and safety policy and other key policies and procedures. Someone living at the home told us in a survey, Carers are pleasant and polite. We saw that these three care workers had a basic training record in place; this is a record of the persons introduction to the home as part of their induction training. In addition to this, we saw Skills for Care workbooks in two of these records; the manager told us that the newest member of staff was still working through their induction training and that their supervisior had their workbook. We noted that, when new staff are employed at the home, a record is kept of any training courses undertaken as part of their previous employment. We checked the training and development plan in place. This recorded the date that staff have undertaken training courses plus the dates of any refresher training. The plan records that there are two fire safety training sessions per year and we noted all but three staff had undertaken this training recently; the manager told us that one person is on maternity leave and the other two are new employees. There is evidence that staff have undertaken training and/or refresher training on moving and handling, first aid, dementia awareness, continence, drugs awareness and safe food handling. Care Homes for Older People Page 25 of 34 Evidence: Staff training booked for the near future includes fire safety, infection control, safeguarding adults from abuse; all have a morning and an afternoon session so that as many staff as possible are able to attend. In addition to this, the manager has arranged for a nurse working with people with Parkinsons to run a training session for staff. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 31, 33, 35 and 38. The home is usually managed in the best interests of the people who live there but some areas still need improvement, such as medication, peoples involvement in quality assurance systems and peoples access to their own money. Evidence: The manager told us that she completed NVQ Level 4 in Management in July 2005 and that she takes part in in-house training when possible to keep her practice up to date; she recently attended fire safety training at the home. The manager has attended recent training organised by the local authority on personalisation and other developments in the care sector. In addition to training, the manager keeps her practice up to date by taking part in a care home forum that is attended by local GPs and other care home managers in Hornsea. Since the last key inspection care planning has improved, patient passports have been Care Homes for Older People Page 27 of 34 Evidence: developed and recruitment practices have improved. However, some improvements still need to be made to the medication policies, procedures and practices at the home to ensure that staff are aware of good practice guidelines. There should be monitoring systems in place to ensure that the policies and procedures in place are being followed by staff. We examined the quality assurance folder on the day of the site visit. This included the minutes of staff meetings and service user meetings. The most recent staff meeting took place on 1/3/10, when eight staff attended. There was a team leader meeting in February 2010; seven staff attended and topics for discussion included appraisals and care plans. The most recent residents meeting was held in February 2010 and the minutes recorded that two ex carers assisted in the collation of information from residents in preparation for the meeting, acting as independent advocates. Topics discussed were food, activities and personal care. Audits take place as part of quality monitoring - a quality audit that was undertaken between 20/3/10 and 30/3/10 was on the topic of peoples satisfaction with the arrangements for bathing or showers but we did not see any evidence that this information was collated or acted upon, or that it is used in the preparation of an annual development plan. We saw no evidence of quality surveys being used as part of quality monitoring. The completion of surveys would enable people living at the home and their friends and relatives to give feedback about the service provided and how this could be improved. We were not able to check monies held on behalf of people living at the home or the associated records. The homes administrator undertakes this role and she was not present on the day of this site visit. We asked the manager how people are able to access their money during the administrators absence from the home and we were told that petty cash is used and then records reconciled on the administrators return to work. We advised the manager that people living at the home should have access to their monies at all times so they may need to reconsider the arrangements currently in place. We checked a selection of health and safety documentation on the day of the site visit. There were current certificates in place for gas safety, portable appliance tests, the fire alarm system and fire extinguishers. In house fire safety checks also take place, including 2 monthly checks on emergency lighting, fire drills (the last one took place in November 2009) and weekly fire alarm tests. The Fire Officer visited the home in February 2010 and found them to be broadly compliant with fire regulations. Care Homes for Older People Page 28 of 34 Evidence: Accidents and incidents are recorded appropriately and the manager told us that she now monitors entries in the accident book to identify any patterns or areas of concern. When we observed lunch being served we saw that staff used a large metal teapot to serve tea; they leaned across people at one side of the table to pour out hot tea for people at the other side of the table. This is poor practice as it creates a risk of scalding. We discussed this with the manager on the day of the site visit and she agreed that domestic style tea pots would be used in future. We observed that people living at the home are capable of using a domestic teapot and that would seem to be more appropriate in promoting dignity and independence. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 The decision making around self medication must be supported by a risk assessment. This is needed to evidence that associated risks have been assessed. 11/06/2010 2 9 13 Alterations must only be 31/05/2010 made to medication dosages and times of administration recorded on MAR charts following instructions received from a GP or other health care professional, and must be supported by a written explanation of why the changes have been made. This is to ensure that information recorded on MAR charts is accurate and that people receive the right dosage of medication at the correct time. Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 9 13 There must be no gaps in recording on medication administration records. This is needed to evidence that people have received their prescribed medication and that a reason is recorded on any occasions when they do not. 31/05/2010 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 3 Care needs assessments undertaken by the home should include information about personal care, diet and weight, mobility and dexterity, medication, continence, mental health, the history of falls and social/leisure interests. It is good practice to include a photograph of the person concerned with care plans. This assists new staff with identification and assists the emergency services should someone go missing from the home. This was a recommendation at the previous key inspection. The policies and procedures on the administration of medication should be reviewed to ensure that the content meets curent good practice guidelines. This was a recommendation at the last key inspection. Any leisure activities that people take part in should be recorded in care plans so that there is a full record of the care provided to each person, including how they have chosen to spend their day. This was a recommendation at the last two key inspections. The manager should remind people living at the home of the complaints procedure in place to ensure that everyone is aware of how to make a complaint. The carpets in both hallways should be replaced as they Page 32 of 34 2 7 3 9 4 12 5 16 6 19 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 currently create a trip hazard. 7 29 Applications for employment should be fully completed by prospective employees so that the information they have recorded can be checked out at interview and via safety checks. There should be evidence of the supervision arrangements in place whilst someone is working at the home but their CRB clearance has not been received. Employment references should be requested by the home and returned to the home to evidence authenticity. The manager should ensure that there are appropriate policies and procedures in place at the home on the safe use of medication, and that these are being followed by staff. The registered person should make sure that the quality assurance system is fully operational so that people can be supported to be involved in the development of the home. This was a recommendation at the last key inspection. People should have access to their own money at all times. The use of domestic teapots instead of a large metal teapot should be reconsidered to reduce the risk of scalding for people living at the home. The use of domestic style tea pots also promotes a persons independence and dignity. 8 29 9 10 29 31 11 33 12 13 35 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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