Care Home: The Whispers Care Home

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What the care home does well Staff working at the home were seen to be kind and caring towards the service users. Service user`s basic care needs were seen to be met on the day of our visit. What the care home could do better: We previously visited the home on 11 May 2010 to carry out a unannounced key inspection visit and had undertaken a further unannounced visit on the 25 May 2010 to assess the urgent requirements that had been issued on the provider to ensure the safety and welfare of the service users. The second visit was to assess compliance with those urgent requirements which were found to have been complied with. Eighteen legal requirements were served on the registered provider following the key unannounced inspection visit on 11 May 2010. We made regulatory requirements because of our concerns that people living in the home were at risk of poor outcomes to their health and well-being. Following our visit in May 2010 the home sent us an improvement plan on the action they had taken to improve practice in the home for the benefit of the residents. During this inspection visit to the service we reviewed these actions and that of progress in respect of the requirements that had been made. On this inspection visit we found that the first and second floors had been taken out of use, although a room is made up on the first floor for a resident who, at the time of the inspection, was hospitalised, and would therefore be accommodated on this floor if discharged. There were seven residents living in the home on the day of the inspection who are all privately funded. They are accommodated on the ground floor only. We received notification from the proprietor that the registered manager has left. The consultant employed by the proprietor is now the acting manager of the home and was present during this visit, as was the proprietor for the majority of the day.The registered provider was required to ensure that information in the Statement of Purpose and Service User Guides must be reviewed and updated to ensure they accurately reflect services and facilities, in order to ensure residents have accurate information about services and the facilities provided. The Home`s action plan stated that both these documents had been revised and "tested against current criteria" and they would be reviewed monthly. We found that the updated Statement of Purpose and Service User Guide did not provide an accurate picture of the environment and described social activities that were not available for example the Service User Guide stated that there was a visiting musical performer on a two weekly basis. We asked the acting manager and proprietor about this information, and were advised that there is no such arrangement in place. It also stated in the guide that there was weekly physiotherapy to music, we were told by the acting manager that there was no activities programme currently in place. The guide also provided information regarding meals, choice and availability of home cooking that was misleading for residents. For example the Service User Guide stated that `The cook provides a varied selection of home cooked meals and choice for individual likes`. We inspected the kitchen and on viewing the products available in the fridge, freezer and larder did not see sufficient evidence of fresh produce to enable the preparation of home cooked meals. Ready meals were in evidence, and included such items as quiches, fish fingers and other pre-prepared products. Furthermore the soup which is served as a starter everyday is made from a packet, to which water is added. The service user guide also stated that the Home provides a four course lunch with prelunch sherry drinks. We viewed the menu on display for the week and menus outlined in a book used to record service user selection. There were no four course meals described on the menus viewed. When we asked the acting manager and proprietor about the offering of Sherry, they advised that none of the current residents want this, though it would be available if required. Service users are informed that accommodation is over three floors, even though the first and second floors are not in use at present. In relation to the second floor the changes needed to reflect the use of velux windows and limited access to the floor. Although the first and second floors were not in use on the day of the inspection, the guide provides information of the accommodation including the dementia unit and second floor, but there is no mention of the velux windows or the restricted access via the platform lift. In respect to access to the garden, the guide indicates that there is a view and safe access to the garden, although the rear garden is not in use and has not been maintained to a standard ensuring users would be safe. The service user guide is not dated, and therefore it is difficult to know if it was the most up to date version available to service users. We were told by the acting manager that it was. In conclusion both the Statement of Purpose and Service User Guide are not reflective of the service provided in terms of the environment in relation to the 2nd floor and in the activities and food provided. Therefore the Random inspection report Care homes for older people Name: Address: The Whispers Care Home 30 Rambler Lane Langley Slough Berks SL3 7RR zero star poor service 11/05/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Stella Franklin Date: 1 9 0 8 2 0 1 0 Information about the care home Name of care home: Address: The Whispers Care Home 30 Rambler Lane Langley Slough Berks SL3 7RR 01753527300 01753527300 hyaremoni@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mohanjit K Hyare Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 21 Number of places (if applicable): Under 65 Over 65 0 21 dementia old age, not falling within any other category Conditions of registration: 9 0 The maximum number of service users to be accommodated is 21 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Dementia (DE) Date of last inspection 1 1 0 5 2 0 1 0 Care Homes for Older People Page 2 of 26 Brief description of the care home The Whispers is a small independently owned residential home for 21 service users situated in a quiet cul de sac off the A4 Bath Road linking Slough and Langley. This home is a converted domestic house, which still retains some of the original structural and decorative embellishments when built and is set in a moderate sized garden encompassed by large residential properties. The fees charged range from GBP420 to GBP500 per week and include basic hotel costs of staffing, meals, drinks, laundry and accommodation. Additional charges are made for hairdressing and chiropody. Care Homes for Older People Page 3 of 26 What we found: We made an unannounced visit to the Whispers Care Home on Thursday 19 August 2010 as part of our monitoring processes. Two inspectors were in the home between 08:45am and 07:30 pm. The inspectors spoke to residents, care staff, and the cook. We also spoke to a visiting representative of Age Concern. The proprietor, Mrs. Mohanjit Hyare and the acting manager, Mr. Steve Carroll represented the establishment. During our visit we made observations of the environment and looked at various documents, including care plans and care records, medication records, staff training and recruitment records, health and safety records, policies and procedures, menus and quality assurance systems. The inspectors gave feedback about their findings to the proprietor and the acting manager. The inspectors spoke of their concerns regarding the lack of improvement to meet the outstanding actions in relation to the requirements issued at the key inspection visit on 11 May 2010. Whilst some steps have been taken to address the requirements, the level of action is insufficient to provide assurance of compliance with the regulatory requirements, and therefore does not meet the quality and safety standards necessary for the care and welfare of service users. Action must be taken to comply with regulatory requirements in order to demonstrate that improvements have been made in the interests of people receiving a safe and organised service, and to meet their individual care needs. The registered persons must ensure that any improvements are sustained and embedded in the practice of the home. This will ensure that people can be confident that they will receive a service that provides good outcomes for their health and well being, and that this is sustained on a continuous basis. All areas of the home environment are in need of upgrading, for example, the decoration, soft furnishings and lighting require attention. Aids to assist mobilisation around the home are required on corridors and in some service user rooms. The registered person is in the process of developing systems for monitoring all aspects of the service they provide. This needs to be further developed and continually reviewed to ensure that there is a constant process of internal monitoring, review and improvement. This will demonstrate a commitment to ensuring a good quality service where improvements are part of the ongoing process of responding to service user feedback and compliance with regulatory requirements.The home must also ensure that their quality monitoring systems demonstrate compliance with relevant health and safety legislation. The registered person must ensure that infection prevention and control guidance is in place to enable the staff caring for residents to understand their responsibilities, and in order to minimise risks to the service user and the staff members. This must include instructions for the appropriate cleaning and decontamination of each area of the home, decontamination guidance for cleaning of equipment used by residents. Equipment used by residents must be checked for damage and decontaminated in accordance with Care Homes for Older People Page 4 of 26 guidelines. Infection prevention and control audit processes must be identified as part of the governance arrangements. The checking of equipment and facilities must form part of the audit process. A designated lead for infection prevention and control should be identified, and their responsibilities included in their role profile. Staff are required to receive information on infection prevention and control as part of their induction, and this must be evidenced in their records. Cleaning schedules which detail the required standards, frequency of cleaning and methods to be used must be developed and implemented. Cleaning processes and equipment to be used must reflect the national cleaning standards. The management of waste, clinical and non-clinical must be improved in order to minimise risk of infection and other health and safety concerns. The content of these must reflect best practice guidance. The registered manager must ensure that where hand wash basins are provided that the supply of paper towels is maintained and that access to such basins is always available. What the care home does well: What they could do better: We previously visited the home on 11 May 2010 to carry out a unannounced key inspection visit and had undertaken a further unannounced visit on the 25 May 2010 to assess the urgent requirements that had been issued on the provider to ensure the safety and welfare of the service users. The second visit was to assess compliance with those urgent requirements which were found to have been complied with. Eighteen legal requirements were served on the registered provider following the key unannounced inspection visit on 11 May 2010. We made regulatory requirements because of our concerns that people living in the home were at risk of poor outcomes to their health and well-being. Following our visit in May 2010 the home sent us an improvement plan on the action they had taken to improve practice in the home for the benefit of the residents. During this inspection visit to the service we reviewed these actions and that of progress in respect of the requirements that had been made. On this inspection visit we found that the first and second floors had been taken out of use, although a room is made up on the first floor for a resident who, at the time of the inspection, was hospitalised, and would therefore be accommodated on this floor if discharged. There were seven residents living in the home on the day of the inspection who are all privately funded. They are accommodated on the ground floor only. We received notification from the proprietor that the registered manager has left. The consultant employed by the proprietor is now the acting manager of the home and was present during this visit, as was the proprietor for the majority of the day. Care Homes for Older People Page 5 of 26 The registered provider was required to ensure that information in the Statement of Purpose and Service User Guides must be reviewed and updated to ensure they accurately reflect services and facilities, in order to ensure residents have accurate information about services and the facilities provided. The Homes action plan stated that both these documents had been revised and tested against current criteria and they would be reviewed monthly. We found that the updated Statement of Purpose and Service User Guide did not provide an accurate picture of the environment and described social activities that were not available for example the Service User Guide stated that there was a visiting musical performer on a two weekly basis. We asked the acting manager and proprietor about this information, and were advised that there is no such arrangement in place. It also stated in the guide that there was weekly physiotherapy to music, we were told by the acting manager that there was no activities programme currently in place. The guide also provided information regarding meals, choice and availability of home cooking that was misleading for residents. For example the Service User Guide stated that The cook provides a varied selection of home cooked meals and choice for individual likes. We inspected the kitchen and on viewing the products available in the fridge, freezer and larder did not see sufficient evidence of fresh produce to enable the preparation of home cooked meals. Ready meals were in evidence, and included such items as quiches, fish fingers and other pre-prepared products. Furthermore the soup which is served as a starter everyday is made from a packet, to which water is added. The service user guide also stated that the Home provides a four course lunch with prelunch sherry drinks. We viewed the menu on display for the week and menus outlined in a book used to record service user selection. There were no four course meals described on the menus viewed. When we asked the acting manager and proprietor about the offering of Sherry, they advised that none of the current residents want this, though it would be available if required. Service users are informed that accommodation is over three floors, even though the first and second floors are not in use at present. In relation to the second floor the changes needed to reflect the use of velux windows and limited access to the floor. Although the first and second floors were not in use on the day of the inspection, the guide provides information of the accommodation including the dementia unit and second floor, but there is no mention of the velux windows or the restricted access via the platform lift. In respect to access to the garden, the guide indicates that there is a view and safe access to the garden, although the rear garden is not in use and has not been maintained to a standard ensuring users would be safe. The service user guide is not dated, and therefore it is difficult to know if it was the most up to date version available to service users. We were told by the acting manager that it was. In conclusion both the Statement of Purpose and Service User Guide are not reflective of the service provided in terms of the environment in relation to the 2nd floor and in the activities and food provided. Therefore the requirement has not been met. A requirement was issued at the last key unannounced inspection to ensure that all residents prior to admission or in an emergency are fully assessed, and that they have an Care Homes for Older People Page 6 of 26 updated monthly risk assessment. We were not able to fully assess this requirement at this visit, as no new residents have been admitted to the home. However, we did view the pre-assessment tool that has been updated by the new acting manager (dated 30/05/10). Although the admission assessment covers peoples basic needs, the assessment template does not enable the assessor to record areas of potential risk. This could lead to shortfalls in the risk assessment process. This requirement remains unmet. The registered provider was asked to ensure that all care plans contain sufficient information to meet the identified needs of service users and to review all care plans and update them so as to accurately reflect the needs of the service users. This should include health care needs of service users, particularly those with with diabetes or dementia. Care plans must include risk assessment and risk reduction measures. To ensure that all residents are provided with safe effective care that meets their needs. We reviewed the care files for three of the residents and their care plans; one pertained to a service user with diabetes, one to a service user with dementia, and one to a service user with elderly care needs. There was little evidence of consultation with residents in the planning of their care, as notes written did not reflect this. Where individuals indicated their wish to engage in certain social activities, none of these activities were evidenced in care plans. Daily notes did not make reference to these activities. For example one residents file had a social activities sheet which preferenced home care, cooking, gardening, flower crafts, knitting, pets, music/concerts, reading, arts/crafts, day trips/holidays as activities they would like to undertake. There were no care plans relating to any social activities and in the daily notes most entries stated that the resident stayed in her room and enjoyed watching television or on some occasions talking to another resident that she is friendly with. In most care files we found that staff frequently refer to quality time being spent with residents but there is no description or definition of what quality time consisted of. Care plans provided basic information about care and support needs for each resident. The action plan sent to the Commission by the proprietor states that all care plans will be person centred and outcome led. That all care plans had been reviewed and updated and that all staff have been instructed in the new approach and understand the principles involved. The care plans appeared to be task orientated rather than person centred. For example one residents care plan regarding their personal care gave a list of actions to meet the residents needs like give resident a wash daily, give full assistance while giving care and also promote independence at the same time, staff to provide all personal hygiene care. There was no detailed description on how this resident prefers to have their personal care needs met, what time, the products they like to use and in the areas in which they can meet their own personal care needs, even though the progress and evaluation of the care plan shows that there are only a few areas in which the resident requires assistance. Various risk assessments were present in the files and covered such risks as manual handling, pressure areas, slips, trips and falls, nutrition, diabetes, mental health and medications. The completion of these risk assessments was inconsistent and did not always reflect the required outcome. For example a moving and handling risk assessment for one resident that was not dated stated that there was no risk of pressure sores although the pressure area monitoring tool assessment for this resident indicated that Care Homes for Older People Page 7 of 26 she was at risk of developing pressure sores. A second resident file indicated a high risk of falls, though the personal resident risk assessment scores a low risk. It is therefore unclear what the risk is and if the necessary interventions are implemented to minimise the risk. In general, there is a lack of evidence of how the risks are assessed, as detail of the assessment is insufficient. The content of resident files describes individual needs but not the risks and how these are being minimised. Staff interviews regarding risk assessments suggested a limited understanding of risk assessments, with a general reliance on senior staff to identify and manage these risks. We noted that monthly evaluation of care plans is taking place. However, the daily reports made in respect to care plans are not specifically aligned to each plan and dates are not associated with each entry. There is no full signature and therefore it is difficult to know who made the entry. The name of the service user is not always entered onto each page. We observed that in the main staff are reviewing documents, but usually this consists of a date being entered on the risk assessment or care plan and no change is written. There was no evidence that a full review of a residents needs had been undertaken and who has been involved in the review. For example, for one resident their assessment of mental health was dated with the initial assessment and at the bottom of the sheet review dates are specified, all stating no change. This was the same for the physical assessment and nutritional screening assessment, even though the weight chart stated a weight loss over the period of review. This residents care plan did not make any reference to the weight loss in the review. A diversional therapy plan contained within the notes of a resident who has dementia does not identify the type or frequency of activities to use as part of user engagement. Where the needs of the diabetic service user changed some of these needs are documented; however, on occasions where additional information was provided in conjunction with the family about meals, this was not added to the care plan. We interviewed three staff, two of whom indicated that they did not look at care plans prior to carrying out care. Therefore, they would not know if the service users needs had changed. One member of staff advised that they were not involved in the reviews or planning of care, though they would tell a senior member of staff if they felt that the service user needs had changed. A second interviewee indicated that he is involved in writing care plans. He said that service users and their relatives are sometimes involved in reviewing plans, and that they may tell staff if things have changed. The third member of staff stated that reviews of care plans are done monthly and if changes have been noted these are put in. Risk assessments are completed by the senior staff and manager together. The registered provider was required to have in place a programme of activities to ensure that residents have access to a range of activities suited to their assessed needs. The action plan sent to the Commission by the proprietor states that the service users rights and best interest will be met by ensuring all activities are relevant to choice, identified need and age appropriate and that an individualised person centred Care Homes for Older People Page 8 of 26 programme would be in place by 01 August 2010. We observed a notice board in the lounge, which stated that activities were coming soon. This included manicures, movies, popcorn, reminiscence, arts/crafts, exercises, games, quizzes and bingo. The acting manager told us, when asked about whether these activities were occurring, said that they had not yet been introduced. During our observations, there was little or no evidence of activities being undertaken. We observed interactions between staff on duty and some of the residents in the lounge area. This included both the service users diagnosed with dementia. In the main these activities were very repetitive, such as stacking wooden blocks in a tower and card games. One resident who has dementia was noted to be seated for long periods in the lounge and only moved for toileting or meal purposes. We spoke about our concerns regarding this resident to the acting manager and the lack of appropriate social activities for people with dementia. We observed one resident user who was provided with music of her choice, and as reflected in her care plan. In relation to the other care plans reviewed, there was no evidence that activities had been provided in the daily notes. The three care staff that we spoke to indicated that the activities they undertake are sitting and talking to residents, playing games, and that they sometimes go out in the garden with the residents too. This requirement has not been met. Service users do not have access to a range of social activities that take into account their personal needs and likes. Care plans do not contain sufficient information to assist the carers to know what activities to engage in with each resident. The registered provider was required to ensure residents are provided with a choice of wholesome and nutritious food in comfortable, hygienic surroundings. To ensure that residents have a choice of nutritious foodstuffs suited to their needs and preference. The action plan submitted by the provider states that personal likes and dislikes are accounted for and that diabetic diets are in place with appropriate monitoring. A diabetic review carried out 28 June 2010 concluded that all outcomes were satisfactory and that regular monitoring will be carried out as part of the homes new monthly review programme. During our observations and discussions, we found that the quality of food had not been improved since the last inspection. The majority of the food is still ready prepared. The dining area was dark and a number of place mats were stained with food residue. On the day of the inspection, the meal served was of three courses, not four as stated in the Statement of Purpose and Service User Guide. On the day of the inspection visit the meal observed to be given to residents consisted of packet soup, requiring the addition of water, a main meal and dessert. A menu book is kept which states the meals for the day and details what the residents have eaten. We were told by the proprietor that the chef goes round to all the residents each morning to find out their choices. However, the book did not detail the choice made. The record in the book just showed what people had eaten. From the information seen it Care Homes for Older People Page 9 of 26 appeared that the choices are limited and in the main are not home cooked. We could not see a separate menu to pick from for diabetics, and during interview with a diet controlled diabetic resident we were informed by this individual that selection is made from the normal menu, but avoiding the sweet. There is no evidence that there is a choice of a sweet that takes into account the needs of a diabetic person. There is no evidence of alternative menu where a person may prefer an alternative type of meal, such as Asian food or specially prepared food. A diet controlled diabetic resident who prefers Asian food frequently had only vegetables with potato for her main meal or packet soup and bread. This resident regularly supplemented her diet with cereal during the night, and her family were bringing in Asian food for her. The care plan does not indicate the reasons for this. We found that this requirement has not been met, as there are inaccuracies in the service guide. There is also a lack of home cooking, choice for service users, and in particular those with specific dietary needs, or personal preferences. The registered provider was required to ensure that all staff are trained in safeguarding adult procedures. To protect residents from abuse and exploitation. The action plan sent to the Commission by the proprietor stated that the induction package had been introduced and included safe guarding modules. That all current staff are now up to date. We found that the Induction pack has been revised to include safeguarding but we did not see completed induction packs in the two staff records viewed, other than the front page tick list that was seen at the last inspection visit; however, the acting manager advised that these records had been completed. A training matrix was viewed and this indicates that 12 out of 16 staff have received training in safeguarding. One of the staff who has not received training is currently not in work, two other staff are designated as cooks and have not as yet received safeguarding training. The training matrix was not up to date as the proprietor advised us that one individual had received the training, but this was not indicated on the matrix. During interview with two of the staff, the inspector was advised that one had received safeguarding training at college. This training had given him an awareness of the protection of vulnerable people. The second member of staff identified that he had received his training 2-3 months ago on site, though he could not be specific about this. He found the training to have enabled him to manage service users safely. This requirement has not been met, as not all the staff have attended training and the records are not up to date. The registered provider was required to review the complaints procedure and update to ensure it meets the requirements of the regulation, and is clear to service users. To ensure residents and other stakeholders can express their concerns effectively. The action plan sent to the Commission by the proprietor stated that all concerns, complaints and suggestions reviewed and the systems discussed with service users, staff and advocates. In addition that the complaints policy would be reviewed as part of Care Homes for Older People Page 10 of 26 Regulation 26 visits. There is information as to how to make a complaint available to residents, family or visitors. Care staff when interviewed demonstrated less confidence as to how to deal with any complainant and there is a reliance on reporting to a senior person. They could not describe the process for documenting a complaint either in the residents notes or on a separate form. One complaint has been noted in the complaints log, and this had been resolved to the satisfaction of the complainant. The complaints log in its current form does not facilitate the inclusion of detailed information about the handling of the complaint from receipt of complaint, until its resolution. The service provider was asked to ensure that the dementia unit is developed in line with best practise guidance. To aid orientation and recognition for people with dementia. The action plan submitted to the Commission by the Proprietor stated that The service users rights and best interests will be met by ensuring all assessed needs and planned outcomes are kept under constant review. Changes to the physical environment are currently at the planning stage. This process will be monitored monthly by the Providers representative (Independent adviser) and the regulation 26 Report. Improvement plan to be a part of the providers updated business plan. This to be agreed by 01/08/10. At the time of the inspection we found that the dementia unit is not currently being used. No further developments have taken place since the last inspection to improve the outcomes for residents who have a diagnosis of dementia. Two residents who have dementia are living in the home. Their bedrooms have not been altered in anyway to meet their specific needs. There has been no development in the care practices or activities provided to ensure that the care given is in line with good dementia practice. We were told that Age Concern have been into the home to advise on activities. Furthermore the training matrix showed that only 5 members of staff have received dementia training. This was pointed out to the acting manager and the proprietor and they did not give any explanation to why not all staff have received the training. We made observations of a number of service user rooms, including the two rooms used by dementia residents. Observations of a bedroom accommodated by a resident with dementia, showed that the room is dusty with cobwebs and wall paper was coming away from the wall. Furniture was damaged including a soft chair, with inadequate seating, with staining present. A separate chair was very dirty under the cushion and heavily contaminated, with what appeared to be food in origin. The acting manager and proprietor said that the chair had been taken outside and the debris noted was soil. The toilet is separate and located off the corner of the main room. It was small, unclean and unpleasant in odour. The toilet seat was damaged when lifted to inspect on the underside. The wooden seat was found to be split and damp with evidence of contamination. There is an absence of curtains on some windows in this room and the paintwork is old and not in accordance with best practice guidance. The sink built into a vanity unit was situated by the bed, well away from the toilet area. Care Homes for Older People Page 11 of 26 The second room was found to have unclean toilet facilities with dust on the floor and dirt upon a stacking unit seen in the corner of the room. A raised toilet seat was tipped up to inspect the underside, and was found to be heavily contaminated. It did not appear to have been cleaned for some considerable time, although there is a list of daily activities that the staff are to undertake, including the cleaning of commodes. There was no cold water coming from the basin cold water tap. Door signage was tatty and stuck to the door with old tape. This requirement has not been met as the actions have not been addressed. The service provider was asked to ensure that all areas of the home and gardens are maintained effectively and made safe. To ensure that all service users are able to safely use the garden. The action plan submitted to the Commission by the proprietor stated that risk assessments had been carried out and reviewed and updated and maintain all areas as agreed plan. We exited the home from the rear of the building in order to check the garden and facilities provided. The external environment remains unsafe to the rear of the home, though we were told by proprietor and acting manager that it is not used. Care staff spoken with implied that the residents do go into the rear garden area. One resident informed the inspector that she sits in this area on nice days to eat her meal, gaining access in a wheelchair. We noted during our observations that some of the fence panels have been repaired in the back garden, though some still have holes, reducing privacy between residents and the immediate neighbours. Some work had started on planting flowers, but where areas had been weeded the weeds and an empty can of drink were left on the gravel. Numerous planters were identified in the garden area, either to be empty of content or to have dead plants still present. The seating and tables were worn and old in appearance. A tin was placed on one table and this contained old cigarette ends. A shed present in the area had been cleared and tidied but tools, including a saw, were seen in the shed, which did not have a lock on the door. The fire escape remains open and the levels within the garden remain the same as previous inspection still posing a risk to residents. The acting manager stated that none of the service users access the back garden, instead they use the front garden and are supervised with staff. Internally, there are areas within the home that are not suitable for residents. This includes the toilet under the stairs, with poor flooring and limited space to assist residents. There is an absence of grab rails in corridors. Many areas were found to be dirty, particularly bathrooms, toilets and floor areas on the ground floor. A shower room was found to be unclean, with build up of dirt and dust behind items stored in the room and behind the basin pedestal. The stacking unit in the corner was dirty and hair was identified upon the shelves and items stored. A commode was located over the toilet and when lifted up to inspect the underside was found to be heavily contaminated with bodily excretions. The member of staff was questioned, and advised that the commodes are cleaned by domestic staff. On checking the daily responsibilities list, it suggests that commodes are cleaned by the night staff. There is no policy or guidance for the cleaning of these items or other specific service user equipment Care Homes for Older People Page 12 of 26 items, making the risk of infection to users a concern. The acting manager informed the inspector that unoccupied areas including the other two floors are cleaned once a month. During our observations on the two unoccupied floors we found dirt and dust, cobwebs and remnants of previous occupants, including old soap, towels, a urinal in one room and a water jug which still had water in it. Beds were made up and some had the linen from previous user upon them. Over toilet chairs were contaminated and a soiled chair was identified in one room. With regard to the cleaning arrangements in the home, the acting manager advised that a domestic attends three days a week to undertake cleaning. This person only cleans occupied areas. Unoccupied areas, including the upper floors are cleaned once per month. When questioned around the arrangements for maintenance, the manager indicated that there is day to day maintenance from an external contractor. He attends once a week or on call out. There is a formal programme for upgrade, but this has not been actioned or updated. A copy of this document was viewed, and found to be limited in the content. Target dates were indicated for a number of activities and all dates had been exceeded, with no comments made as to why this had not progressed. The acting manager advised that there is a process for reporting damage, ware and tare and this is actioned by a responsible person or the maintenance contractor. One care worker spoken with indicated that they would clean items of equipment if dirty and report damage or broken items to a senior person. Signage is limited throughout the home, though the acting manager advised that a review had taken place and signs are on order. We did not observe locks on rooms on the ground floor, and were advised by the proprietor that they are trying to source an appropriate type of lock. This requirement has not been met, as the home has not been subject to any improvements or upgrade. The registered owner was asked to repair or replace all worn and damaged furniture, fixtures and fittings in the dementia unit. To provide residents in the dementia unit with a pleasant environment in which to live. The action plan submitted to the Commission by the proprietor details that various activities discussed with Age UK visitor and her suggestions implemented, Additional staff training input being researched and daily and weekly monitoring by Home Manager and regulation 26 visits. Our observations showed that no action has been taken by the owner to replace or repair damaged furniture, fixtures or fittings in the dementia unit, or indeed the rooms currently in use for dementia service users. The exposed wire in a bedroom of the dementia unit had been repaired since the last inspection visit but the finishing was not of a good standard. One of the bedrooms on the ground floor which accommodates a resident with dementia was in a very poor state of repair. There is no formal system in place for planned preventative maintenance and this was confirmed by the acting manager. This requirement has not been met, as there are still items of furniture that require replacement and the fixtures and fittings have not been upgraded. Care Homes for Older People Page 13 of 26 The registered provider was asked to review all lighting in the Home and provide lighting levels which are safe and sufficiently bright to enable all service users to access the home safely, and to read in their rooms should they wish to. To ensure the comfort of service users. The action plan from the proprietor states that Reading lamps provided as requested by residents following an assessment of need. Planned outcome sufficient light to read by in their room. To be kept under constant review via monthly regulation 26 visits. Although this requirement related to the dementia unit, we found other parts of the home with insufficient lighting. For example When we arrived at the Home a resident who has dementia was sitting in the lounge on the ground floor on their own with no lights on, the lounge was dark and the resident appeared anxious. We turned on the lights on in the downstairs lounge, but could not locate the light switch control in the dining room. The lighting was poor for service users who wish to read or undertake other activities. The level of lighting would make it difficult for a resident with visual impairment. Lamps where provided in the lounge were dirty and dusty on the shade. This requirement has not been met, as the lighting has not been improved in the dementia unit or in meeting the needs of service users who are now accommodated on the ground floor. The registered provider was asked to produce an action plan detailing how you are going to ensure that all rooms have ventilation suitable for service users as required by the occupant, to ensure the comfort of service users. The action plan submitted by the proprietor stated that work is in progress. The plan states that all rooms are aired daily and where available extractor fans are fully utilised. We did not find this to be the case on the inspection visit. The plan also states that room 24 is closed as the home is planning for a window to be put in place but this work has not been completed. Our observations on arrival identified that in the lounge on the ground floor windows were not opened, and corridor leading to the bedrooms off the dining room had a strong adverse odour present. As we went up to the first and second floor windows had been opened, in order to provide some ventilation. We did not view any specific action plan or evidence of work in progress in this area to ensure bedrooms on the first and second floor provide adequate ventilation. This requirement has not been met as we have not seen any changes implemented or plans for future upgrade. The registered provider was asked to consult with the local environmental health authority regarding the laundry room and follow guidance given to ensure the risk of cross infection is minimised. To protect users from risk of cross infection. The action plan sent to the Commission by the proprietor stated that action was taken as recommended. That the COSHH policy and procedure had been updated and a continuous review programme put in place. That a monthly review had commenced as part of the regulation 26 visits and that the corridor carpet to be replaced by water resistant flooring. Care Homes for Older People Page 14 of 26 The laundry room was inspected and found that the floor has not been replaced, the present vinyl flooring does not cover the floor surface. The walls were still permeable and can not be cleaned fully. There had been no improvements to the laundry area since the last inspection visit. A laundry bag was placed on the floor in the boiler room blocking the access to the hand sink. There were no paper towels on which to dry hands in the vicinity of the basin. In relation to the management of soiled linen, the acting manager advised in interview that soiled linen is placed in a basket and taken to the laundry via a service corridor and does not go through the kitchen. There is no protocol for the management of soiled or contaminated linen and no formal guidance for washing of such items at higher temperatures. The infection prevention and control guidance is limited and there is no one in overall responsibility for this area. Where hand basins are provided in communal areas there is often absence of hand towels. There were no hand towels located by the hand basin in the kitchen or ground floor shower room. Further issues of concerns relating to infection control, including the condition of pressure cushions. A number of pressure cushions were unzipped to check for quality. Out of three pressure cushions in the lounge, one was very badly stained inside, all were dirty on the outer cover. A number of pressure cushions were located around the home, in service user rooms, the shower room on the ground floor and unused rooms on the upper floors. Most were unclean on the outer cover, and two further cushions were found to have staining from the leakage of bodily fluid through the cover, making them unfit for use. Commodes and over toilet-raised seats were checked on all floors and all were found to be contaminated with bodily excreta on the underside. It was clear that staff are not following best practice guidelines for the cleaning of commodes and that raised toilet seats are being missed off the cleaning list of daily duties. The armchair situated by the ground floor office had a split in the seating cover posing an infection control risk. Most armchairs in the lounge area were clean; however, a number of chairs inspected in service users rooms were found to be dirty and contaminated. Debris was found when the cushion was removed in one room. The cleaning cupboard under the stairs was found to be unlocked, with lots of cleaning products contained in the cupboard. On checking the regulatory guidance on controls of substances hazardous to health (COSHH) file, guidance for some of the domestic products was not present. The provider subsequently advised that this document was under review. The downstairs toilet under the stairs had a bottle of toilet cleaner on the shelf. The toilet itself was very small and would be difficult for a resident with limited mobility to access. This requirement has not been met as no improvement has been made to the laundry area. Furthermore other areas of concern have been raised at this inspection visit in regard to the standard of cleanliness of the environment, decontamination of equipment Care Homes for Older People Page 15 of 26 used by clients and a lack of awareness in respect to infection prevention and control. The registered provider was required to ensure that all staff receive training in dementia care appropriate to their role. To ensure effective care and support is provided. The action plan sent to the Commission by the proprietor stated that training and updates for current staff commenced and further resources were being researched with the aid of Age UK and that all new staff would have the training included in their induction programme. We asked to see the training records for staff and a training matrix was supplied. It was noted that only 6 out of 16 staff have received training in dementia and one of those staff is currently absent, leaving 4 staff working in the home who have received the necessary training. A member of staff who works as the cook at the weekend has indicated a request to attend the next dementia training session. A representative from age concern was spoken to and she advised that either herself or a colleague visit the home and talk to clients. This may be ad hoc, or as a result of a direct referral. They also undertake some training of staff. The training that was recently delivered included a brief outline of dementia and forms of activities to engage with service users, using a person centred approach. Handouts were provided for attendees. Interview with a member of the senior care staff indicated that the training had been useful, enabling her to sit and talk to service users with dementia and play games. From observations on the day of the inspection the service users with a diagnosis of dementia were not engaged in meaningful activities. There was no reference to good practice guidance. One dementia service user was noted to be sat in the same chair for long periods of the day. The only activity she was engaged in was knocking down structures made out of blocks of wood. When staff were not with her she sat on her own looking anxious. There were no objects of interest for her to look at or touch and feel to self occupy while she was on her own or involving her in daily living activities. She was not taken out or moved to different areas of the home during the day, except at meal times or for toileting. This resident is not able to mobilise and is totally dependent on staff to assist her with a hoist into her wheelchair and move her around the home. This requirement has not been met, as not all staff have attended the training. Additionally, we saw little evidence as to how the skills and knowledge acquired was enhancing the care of service users who have dementia. The registered provider was asked to ensure that at all times there are sufficient numbers of staff on duty to effectively meet the needs of residents. The rationale for this is to protect service users from harm. The provider is complying with the urgent requirements to have two staff on duty and a team leader. Both the acting manager of the provider and the proprietor act as the team leader on each shift. However, the acting manager stated that there is not enough staff for engaging in 1:1 activities with service users. This statement was in direct contrast to the response given by a senior care worker, who indicated that the low service user numbers means that there is plenty of time to engage with service users. Care Homes for Older People Page 16 of 26 This requirement is partly met, though the acting manager stating that there are insufficient staff to enable 1:1 social activities outside of the home leads us to suspect that the staffing levels are insufficient. The registered provider was asked to have in place a robust system for the recruitment of staff to ensure that all documentation required by regulation is available. The rationale for this is to protect service users from harm. The action plan sent to the Commission by the proprietor stated that a robust system was in place and was now standard practice. Of the two staff files viewed, two were found to contain a copy of the induction checklist, with a completed tick list. There was no full induction document in the files, though the acting manager said these had been completed. The induction checklist for the second member of staff was completed but not signed or dated, with no evidence of whether the programme had been completed. The new induction documentation does not cover specific areas such as dementia and diabetes or infection prevention and control. Some sections of the required documents were incomplete, such as the application form, training and continual professional development and relevant work/other experience. Names of preferred referees were included on application forms, though the reference received were not from these persons. Where references had been supplied by the educational college that the three of the staff employed by the Home were attending, the content of the reference was identical in wording, and could not be used as a valid reference. Two criminal records bureau records were checked and noted to have been received some time after the commencement of employment, however the Independent Safeguarding Authority checks had been carried out prior to commencing working at the Home. In relation to supervision, the acting manager indicated that he has met with all staff members at least once since commencing at the home. There were no supervision notes in one file checked. This requirement has not been met as the recruitment processes are not yet sufficiently robust to ensure that only appropriate staff are employed at the home. The Proprietor must carry out quality monitoring visits unannounced, at least once a month. The visits should seek the views of residents and other stakeholders about the quality of services provided. A report of the visit must be made, and a copy provided to the manager. To ensure that the service is monitored effectively. The inspector asked to view the Regulation 26 folder. This showed that two regulation 26 inspections have taken place, one on the 26/06/10 and the second on 23/07/10. The acting manager Mr. Steve Carroll has completed both reports and it also states that he conducted the visit on behalf of the directors. When we questioned this the proprietor said that the inspections are undertaken together, but the acting manager completes the report. In June the report states, on inspection the home was clean tidy and welcoming. There were some odours, staff to review continence management plans This action was also written again a month later in the July report. There is no evidence to evaluate if staff took the required action. Care Homes for Older People Page 17 of 26 This requirement has not been met, in that the inspection must be carried out and reported by the proprietor. In addition observations made at the two inspections do not reflect the findings of our inspection. The registered provider was asked to have a system in place for health and safety audits, to include examining the fabric of the building for risks and hazards. This is to protect residents from harm. The action plan sent to the Commission by the proprietor stated that all policies and procedures are kept under constant review. Health and safety audits have been carried out for the occupied rooms, but have not been undertaken for all areas used or accessed in the home or externally. The acting manager said that this was work in progress. This requirement has not been, as not all areas within the home have been assessed and actions put in place to address the audit outcomes. The registered provider was recommended to make consultation with appropriately qualified persons to ensure that medication is stored at a safe temperature. On inspection medications were noted to be stored appropriately and the drugs trolley was found to be locked and chained to the wall. The administration of medication was done safely and correctly. This recommendation has been met. 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 set out on page 2. Care Homes for Older People Page 18 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 The information in the 01/07/2010 Statement of Purpose and Service User Guides must be reviewed and updated to ensure they accurately reflect services and facilities provided. To ensure residents have accurate information about services and facilities provided 2 3 14 Have a system in place to 01/07/2010 ensure that a comprehensive needs assessment is undertaken prior to admission, which identifies all the individual care needs. To ensure service users needs are fully evaluated and that those identified needs can be met within the home. 3 7 15 Ensure all care plans contain 01/07/2010 sufficient information to enable staff to meet the identified needs of the service users. Service users must be involved in the planning of their care and their input is recorded. To ensure residents are provided with effective and Care Homes for Older People Page 19 of 26 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action safe care. 4 8 15 Review all care plans and update them so as to accurately reflect the needs of the service users, including health care needs of service users, including those with diabetes or dementia. Care plans must include risk assessment and risk reduction measures. To ensure that all residents are provided with safe effective care that meets their needs. 5 12 16 Have in place a programme of activities to ensure that residents have access to a range of activities suited to their assessed needs. To provide mental and physical stimulation. 6 14 16 Ensure residents are 01/07/2010 provided with a choice of wholesome and nutritious food in comfortable, hygienic surroundings. To ensure that residents have a choice of nutritious foodstuffs suited to their needs and preference 7 16 13 Ensure that all staff are 01/08/2010 trained in safeguarding adult procedures To protect residents from abuse and exploitation Care Homes for Older People Page 20 of 26 01/07/2010 01/07/2010 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 8 19 23 Ensure that the dementia 02/08/2010 unit is developed in line with best practise guidance. To aid orientation and recognition for people with dementia 9 20 23 Ensure that all areas of the home and gardens are maintained effectively and made safe. To ensure that all service users are able to safely use the garden 02/08/2010 10 24 23 Repair or replace all worn and damaged furniture, fixtures and fittings in the dementia unit. To provide residents in the dementia unit with a pleasant environment in which to live. 02/08/2010 11 24 23 Review all lighting in the 01/08/2010 Home and provide lighting levels which are safe and sufficiently bright to enable all service users to access the home safely, and to read in their rooms should they wish to. To ensure the comfort of service users. 12 24 23 Produce an action plan 01/07/2010 detailing how you are going to ensure that all rooms have ventilation suitable for service users as required by Page 21 of 26 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action the occupant. To ensure the comfort of service users. 13 26 16 Consult with the local 01/07/2010 environmental health authority regarding the laundry room and follow guidance given to ensure the risk of cross infection is minimised. To protect users from risk of cross infection 14 27 18 Ensure all staff receive training in dementia care appropriate to their role. To ensure effective care and support is provided. 15 27 18 Ensure that at all times there 01/08/2010 are sufficient numbers of staff on duty to effectively meet the needs of residents. To protects users from harm 16 29 19 Have in place a robust 01/07/2010 system for the recruitment of staff to ensure that all documentation required by regulation is available. To protect users from harm 17 33 26 The Proprietor must carry 01/07/2010 out quality monitoring visits unannounced, at least once a month. The visits should seek the views of residents and other stakeholders about Page 22 of 26 01/08/2010 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action the quality of services provided. A report of the visit must be made, and a copy provided to the manager. To ensure that the service is monitored effectively. 18 38 13 Have a system in place for health and safety audits to include examining the fabric of the building for risks and hazards To protect residents from harm 01/07/2010 Care Homes for Older People Page 23 of 26 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, 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 30 23 The registered provider must 26/09/2010 ensure that the premises are kept clean, hygienic and free from offensive odours throughout and that policies, procedures and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. To minimise the risk of infection for service users and staff working in the home. 2 35 18 The registered provider must 30/09/2010 ensure that staff receive infection prevention and control training. To minimise the risk of infection for service users and staff working in the home. Care Homes for Older People Page 24 of 26 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 Care Homes for Older People Page 25 of 26 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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