Care Home: The Wight House Care Home

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What the care home does well During our previous visit to the home in August 2009, people expressed their satisfaction with the service they were receiving and this was reflected by people`s comments we saw in the home`s own survey. During this visit we also observed staff interacting with people who use the service in a respectful and friendly manner. What has improved since the last inspection? People who live in the home have received some updated information about the service they receive. Some progress has been made in making care plans more detailed and personalised. The current manager has received some training to help her in her role. What the care home could do better: During this visit the home was not able to show that previous outstanding requirements in relation to care plans, risk assessments, monitoring and renovating the environment, keeping the home clean, checking water temperatures, registering a manager, and establishing a system to review the quality of care, had been met. These requirements have been repeated in this report. Further requirements were made following this inspection: Each person who uses the service must have a detailed and complete plan for meeting their care needs and which is accessible to them. So that staff and people who use the service know how their needs will be met. People who use the service would benefit from a more structured programme of activities and mental stimulation. Further guidance must be provided for staff about how to respond to situations that may put people who use the service at risk. An accurate record of staff working in the home must be kept, to ensure that adequate staff support is always provided. Staff induction and training must be better documented and updated appropriately, to make sure that all staff have the necessary training, knowledge and skills to meet the needs of people who use the service. Monthly reports by the provider or their representative must be completed each month and be available for inspection, to ensure the conduct of the service is monitored. Record keeping must be improved so that there is a better audit trail of any actions taken to meet inspection requirements, to improve the service and protect the people who use it. The systems used for monitoring and improving the service need to be further developed and implemented, to make sure it is meeting people`s needs and the requirements of being a registered care home. Key inspection report Care homes for older people Name: Address: The Wight House Care Home 138 Portsmouth Road Lee on the Solent Hampshire PO13 9AE     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Laurie Stride     Date: 2 2 0 1 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 33 Information about the care home Name of care home: Address: The Wight House Care Home 138 Portsmouth Road Lee on the Solent Hampshire PO13 9AE 02392552291 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wight House Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The Wight House provides care and accommodation for up to 12 older persons who may have dementia or mental health needs. People who are admitted may be under or Care Homes for Older People Page 4 of 33 Over 65 0 0 12 12 12 0 0 5 0 8 2 0 0 9 Brief description of the care home over the age of 65 years. Accommodation comprises 10 bedrooms on two floors. Two rooms are capable of accommodating 2 people who use services, but these are predominantly used as single rooms unless people express a wish to share. There is a stair lift to help people reach the first floor but there are a number of areas that need people to be able to walk up a few steps. Three bedrooms are located on the ground floor. There is a communal lounge and dining room on the ground floor and a small quiet room on the first floor. There is a small garden and patio area. The home is situated very near the seafront, with views of the sea. Local shops and amenities are a short walk away. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place on 22nd January 2010 and lasted eight hours, during which we, the commission, looked at how well the home is meeting peoples needs and supporting them to have a good quality of life. We also looked at how the service is meeting the requirements from the last key inspection that took place on 26th February 2009 and from a follow up visit on 5th August 2009. During this visit we looked at samples of records, spoke with the temporary agency manager and three members of the staff team and observed staff interacting with people who use the service. Further information used in this report was obtained from the previous two inspection reports, the homes annual quality assurance assessment (AQAA) and from other agencies who have an interest in the service. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: During this visit the home was not able to show that previous outstanding requirements in relation to care plans, risk assessments, monitoring and renovating the environment, keeping the home clean, checking water temperatures, registering a manager, and establishing a system to review the quality of care, had been met. These requirements have been repeated in this report. Further requirements were made following this inspection: Each person who uses the service must have a detailed and complete plan for meeting their care needs and which is accessible to them. So that staff and people who use the service know how their needs will be met. People who use the service would benefit from a more structured programme of activities and mental stimulation. Further guidance must be provided for staff about how to respond to situations that may put people who use the service at risk. An accurate record of staff working in the home must be kept, to ensure that adequate staff support is always provided. Staff induction and training must be better documented and updated appropriately, to make sure that all staff have the necessary training, knowledge and skills to meet the needs of people who use the service. Monthly reports by the provider or their representative must be completed each month and be available for inspection, to ensure the conduct of the service is monitored. Record keeping must be improved so that there is a better audit trail of any actions taken to meet inspection requirements, to improve the service and protect the people who use it. The systems used for monitoring and improving the service need to be further developed and implemented, to make sure it is meeting peoples needs and the requirements of being a registered care home. Care Homes for Older People Page 7 of 33 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst not all of the written documentation is currently complete, people who live in the home are being kept informed during a period of changes to the service they receive. An assessment of need, completed before someone moves into the home, means people who use services will only be offered a place if the service can meet their identified needs. Evidence: The annual quality assurance assessment (AQAA) told us that the Statement of Purpose and Service User Guide had been updated, so that people have up to date information about the service they receive. We saw a copy of the Statement of Purpose and this included information about the current service provider and management arrangements. Some further minor amendments were needed in some sections in relation to the name and address of the Care Quality Commission. The agency manager told us that a new Statement of Purpose, Service User Guide and Staff handbook was being updated by the administrators representative. The minutes Care Homes for Older People Page 10 of 33 Evidence: of a residents meeting held in October showed that people who use the service had been updated about the sale of the home. The service improvement plan identified that contracts relating to peoples terms and conditions of residence cannot be updated until administration is complete. The previous key inspection report identified that no-one new had moved into the home, so there were no new assessments to view. During that visit we had seen that there was a sufficiently detailed assessment format available, which would enable the manager to gather the necessary information and make a judgement as to whether the service could meet a persons identified needs. Since the last key inspection the responsible individual had voluntarily agreed not to admit anyone new to the service. Adult Social Services have been monitoring the service under the Safeguarding protocol. This has comprised regular review meetings, visits to the home and assessments of the eight people currently living in the home. The agency manager confirmed there have been no new admissions. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff provide personal care and support in a way that shows respect for people who use the service. Work on improvements to care plans and risk assessments must be completed so that staff have detailed up to date guidance to meet peoples needs. Evidence: The requirements from the previous key inspection in relation to care plans and risk assessments had not been met at the follow up inspection visit in August 2009 and there was clearly still further work needed to meet these at the time of this visit. The agency manager told us that there was no one care plan complete as yet. The service improvement plan indicated that progress toward completing the plans had been reviewed by a clinical representative of the administrators with the acting manager, either face to face or by telephone, on a number of dates and that progress has been slow. The final entry in the improvement plan stated that the acting manager had committed to completing them by early November 2009. The home has had intensive monitoring and support from social services and other external bodies, yet still not all of the people who use the service have an up to date care plan that is fully reflective of their needs. Care Homes for Older People Page 12 of 33 Evidence: We saw that a new assessment of needs form was being used to record updated assessments of people who use the service. We saw examples in relation to two individuals, which had been completed on 19/01/10. The agency manager reported that four people who use the service have had the updated assessments since 18/01/10, when she started work at the home. During our visit additional sections of care plans for another person continued to be emailed to the home from the clinical representative of the administrators. The agency manager said the other four people who use the service are to have the new assessments carried out and one persons was being done during the day of our visit. The new care plans being created are neater and clearer than the previous ones, making them easier to read and to find information in them. The person centred format asks people who use the service what can I do for myself and about the support I need. This is followed by sections on staff assessment of need and risk assessments required. The format promotes the inclusion and participation of the individual who is being assessed. We saw a staff member had started working through the new assessment format with one of the people who lives in the home. If continued, this process will also help to ensure that staff are familiar with the new process and content of the care plans. The agency manager was working on recording mini-mental tests of people who use the service. She said that previously some of these had been completed incorrectly by staff, so she was providing further guidance on how to do them. We saw a recently developed care plan for a person with diabetes, to which the agency manager was adding some further guidelines. Daily records indicated that care tasks such as monitoring peoples weight were being done and that individuals had access to health care specialists when they needed them. We looked through the staff training file with the agency manager and saw that the acting manager had carried out competency assessments for the majority of staff administering medication. The service improvement plan had indicated that the acting manager had committed to completing these by November 2009, however the records we saw did not show that all staff had had this. A number of the staff had certificates of recent training in the safe administration of medication, while there were others whose training certificates date back to 2006. Since the previous key inspection a suitable medication storage cabinet has been fitted in the home. During the day we observed staff interacting with people who use the service in a friendly and respectful manner. We people who live in the home approach staff to ask Care Homes for Older People Page 13 of 33 Evidence: questions and that staff responded patiently and sensitively. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to exercise choice about what they eat and how they spend their time. Some activities are provided that provide mental stimulation and that people enjoy, however a more clear and structured programme developed around individual choices would be of benefit to them. Evidence: The previous key inspection report noted that people who live in the home would benefit from opportunities to join in more activities that they have been involved in choosing. The AQAA stated there is a programme of activities developed with input from people who use the service. During our visit we saw evidence of some activities taking place, although there did not appear to be any structured programme relating to individual needs and choices. As part of the assessment process, there were records of things people like to do. For example on person prefers painting to group activities, while another person likes to spend some time alone. We saw there is a separate daily records file and a sample of these showed some dates when individuals took part in activities. These included, for example, music, singing, watching films and making cakes. Care Homes for Older People Page 15 of 33 Evidence: We saw that musical entertainers had visited the home in November and one of the staff told us that they were going to book them again. We saw a poster for a house party also held in November that said families were welcome and another poster for a Christmas party. We spoke with three of the carers on duty about activities. From this discussion it appeared that care staff try to involve people who use the service in activities, usually in the afternoons when it is not so busy. However many of the people who use the service are less inclined to participate at this time of day and we discussed how late morning may be a better time for this. We observed that people moved freely around the home. Some sat in the lounge and talked to each other and staff, while others spent time in their own rooms, resting or watching television. We saw that there is a smoking policy and there was a risk assessment in place for a person who lives in the home who smokes. The risk assessment contained records of agreements and reviews in relation to the persons choices about smoking. This meets a requirement made at the last inspection visit. There is a set menu and records of this indicated that people have a choice and exercise this in relation to meals. A list of what people want to eat each day is taken by staff the evening before and staff are aware of individuals likes and dislikes about food. We saw there is a well stocked fridge and freezer. A staff member told us that if a person was not eating well this would be recorded in the care plan and monitored. We observed that lunchtime was a relaxed and unhurried event. Care Homes for Older People Page 16 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are provided with information about how to make a complaint, although alternative formats would assist people who may have difficulty understanding the procedure. Whilst staff have now received training in recognising and responding to any signs of abuse, a lack of full implementation of policies and procedures does not fully protect people who use the service. Evidence: The AQAA stated there is an updated complaints procedure on display and this is given to people who use the service. The service now have a copy of the Hampshire safeguarding procedure and is developing its own policies in line with this. The AQAA also stated the service could do better at making sure that staff continue to receive training and understand the Hampshire safeguarding procedures. The AQAA informed us that the service had not received any complaints in the past twelve months. We saw the updated Statement of Purpose, which included the Complaints Procedure. These needed some further minor updating with regard to the name and address of the Care Quality Commission. A copy of the complaints procedure is on display in the home. The complaints procedure is not yet available in alternative formats to make the information more accessible to all people who use the service. The agency manager reported she was not aware of the service having received any complaints. We saw the minutes of a residents meeting that indicated that people had been asked if they had any concerns. Care Homes for Older People Page 17 of 33 Evidence: The agency manager was unable to locate the Hampshire safeguarding procedure or the specific one for the service, so made an enquiry to the administrators representative. An email response arrived with another copy of the local authority procedures and the homes policy attached and dated 16/10/09. Also attached was a Deprivation of Liberty Safeguards policy dated 30/11/09. We saw certificates for each staff member in relation to training in safeguarding adults dated 08/12/09. One of the staff told us that the acting manager had been at the training, which was held in the home, but due to having to attend to people who use the service had not received a certificate. Staff members we spoke to said they would report any suspected abuse to the acting manager or a senior member of staff. There is currently an ongoing safeguarding investigation in the service, which has included intensive monitoring and support from social services and other external bodies. The most recent safeguarding meeting with Hampshire Adult Services was in January 2010. Shortly before our visit, we had been informed that a visiting professional from one of the agencies had visited the home on one of the coldest days and found that the home was not adequately heated and service users were wrapped in blankets. Staff stated that the boiler had broken down but in fact the thermostat had been turned right down, putting people who use the service at significant risk. If the visiting professional had not arrived no action would have been taken to remedy the situation. Social services took immediate action to ensure that the home was adequately heated. This does not demonstrate that staff are fully aware of safeguarding issues or take prompt actions to address them. Care Homes for Older People Page 18 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A programme to monitor, renovate and maintain the environment needs to be fully implemented and sustained, to ensure that people live in a safe, comfortable home that meets their needs. Evidence: The requirements from the previous key inspection about having systems to monitor the environment had not been met at the follow up inspection visit in August 2009 and there was still further work needed to evidence how these are being met at the time of this visit. The improvement plan stated that risk assessments had been completed and the acting manager was committed to completing an annual action plan by 07/11/09. During our visit we saw a copy of an annual maintenance plan for November 2009 to October 2010. It was not clear from the available records if this plan is being implemented. For example, the plan states that hot water temperatures are to be checked once a week. This was a requirement following the random inspection visit in August 2009. The actual records of checks showed a number of significant gaps, which means people who use the service may be at risk. The maintenance plan also states that one room or communal area is to be deep cleaned once a week. There was little recorded evidence available to show if and when this is done. A staff member told us that a cleaner had been employed but left after Care Homes for Older People Page 19 of 33 Evidence: one day and care staff do the cleaning on evening and night shifts. A staff member had set up a cleaning rota and a deep clean checklist. The available records of this showed that deep cleaning was not recorded after 12/10/09 and that the cleaning rota had only been signed as completed between 10/08/09 and 19/08/09. The agency manager showed us a cleaning schedule that she had been working on the previous night and said the acting manager had been doing this. We saw an infection control policy was contained in a Health and Safety in Care Homes Manual, although this related to general principles and not the actual procedures for the home. We were informed that a quote for deep cleaning by a contractor had come in. We saw that a building and room by room risk assessment relating to peoples mobility had been reviewed in December 2009. The agency manager had developed a maintenance risk assessment form for use. She said she planned to bring in a contractor to carry out any necessary jobs following the risk assessment. Later we were shown a defect and maintenance action book with entries relating to work undertaken between July 09 and 24/12/09. Service certificates for the hoist and two stair lifts were not seen, although staff members said these had been done. We were shown a double room that is used as a single, where a new carpet had been recently fitted plus vinyl flooring in the en-suite. Some odours were still noticeable. We also saw a written estimate dated 14/12/09 for renewing the front door and frame including low level wheel chair access, repairing a leak to the front bay window, felt roofing, fitting intermittent strips to five doors downstairs, and adjusting the closers on two bathroom doors. Two actual invoices dated 28/12/09 from the contractor for work completed related to easing and adjusting the existing front door, repairing a leak to the front bay window, felt roofing, and adjusting the closers on two bathroom doors. An upstairs toilet had paper towels and handwash and the agency manager said she had now ordered alcohol gel handwash. There was no toilet roll. Part of the inner lining on the window frame had come loose. Another upstairs toilet and bathroom has four steps leading down from the door. The agency manager said this toilet is now solely for staff use but a notice had not been put up yet. There is a downstairs bathroom equipped with a chair hoist, the underside of the seat is rusty and stained, which was pointed out at a previous inspection visit. The paint on the window sill is chipped and peeling. In the kitchen we saw written hand-washing guidance and a local authority food hygiene certificate dated 09/03/09 giving a satisfactory rating. The kitchen and premises appeared generally clean on the day of our visit, although the carpets in Care Homes for Older People Page 20 of 33 Evidence: communal areas are stained and the paint or varnish on the arms of armchairs is worn away. The laundry area is sited just off the kitchen. There is a sign advising staff to use another external entrance rather than taking laundry through the kitchen. The laundry walls are old and peeling making these difficult to clean. We saw Infection Control training certificates were on file for staff members. The dining room is still used to store some of the homes records and the medication cabinet is there, which can limit peoples access to the room. However an additional office space had been created in an upstairs room at the time of our visit. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Records of staffing levels are not clear, which could result in the home being understaffed. The procedures for employing staff help to protect people who live in the home. There continues to be a need to establish an effective system to monitor the induction and training of staff, to ensure that they maintain the skills they need to support people who use the service. Evidence: The AQAA stated there are sufficient staff to meet the needs of the eight people currently using the service. The staff rota showed that there are generally two staff members on duty on each of the early and late shifts. Nights are covered by one awake staff member and another sleeping on-call. We observed staff answering call bells quickly throughout the day and those staff spoken with felt there were usually enough staff on duty to provide the support needed to people who use the service. The rota indicated that the acting manager was on duty this week. The agency manager explained that the rota was a print out that may not be accurate as the acting manager may have the working rota. This meant that we were not able to accurately assess whether there are always sufficient staff in place. We asked about one of the forthcoming rota shifts that did not appear to be covered, which the agency manager was not aware of and she asked the administrative assistant to contact staff to cover the shift. Care Homes for Older People Page 22 of 33 Evidence: The training matrix indicated that two people had passed the NVQ level 2, including the acting manager and another staff member who no longer appears to work in the home. Six others had started NVQs in 2008 and two more in 2009. The AQAA told us that five staff members have completed NVQ. The AQAA stated that staff recruitment checks and procedures are in place. We looked at the personnel records for a recently recruited staff member. The records included a completed application form with employment history, CRB and two written references. A member of staff said that this person had an induction workbook, although this was not available for us to see during the visit. The training matrix indicated that this staff member had completed training in dementia awareness and safeguarding adults in December 09. We saw Skills for Care induction workbooks for two other staff members. One of the staff members had started their induction workbook in July with sections on formalities and fire safety completed, but there was no further record of this being continued. Another staff member had started the induction workbook in January 08 and sections had been signed and dated as complete until July 08, after which some sections were ticked but not signed or dated. The previous key inspection report identified that a system needed to be established to monitor the induction, training and supervision of staff. The AQAA told us that the service had developed a training matrix so that it is easier to identify mandatory training needs. The AQAA also stated that the service could do better at identifying training needs through supervision and appraisal, making sure all training is up to date and developing a training plan for the year. Supervisions had not commenced until December 2009. The service improvement plan stated that a training matrix had been developed to identify training needs for the coming year. We saw a handwritten matrix that did identify training needs, including refresher training that was overdue. The record did not make it clear when these needs will be met and some of the dates when training was said to be due did not match with the training certificates we saw. We saw a sample of moving and handling and first aid training certificates in relation to four staff members. This sample indicated that refresher updates were overdue. The AQAA stated that all staff are trained in dementia awareness and we saw recently awarded training certificates in the staff training file. Three staff members we spoke to said they found this training useful in helping them to understand the individual behaviours and needs of people who use the service. Care Homes for Older People Page 23 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are being informed about what is happening in the home but a lack of robust monitoring and sustained management action means the service cannot be assured that it is run in a way that fully meets peoples needs and the requirements of legislation. Evidence: The home has not had a registered manager since January 2008 and a requirement was made at the last key inspection to register a manager. This requirement had not been met at the follow up inspection visit in August 2009 and no application had been received at the time of this visit. The current acting manager was on four weeks leave at the time of our visit. The agency manager had told us that she will be temporary manager for two weeks. Through discussion with the agency manager, it appeared that she had not received a formal handover and felt she needed longer than two weeks to complete the work that she was informed needed to be done. For example, she had been shown the Care Homes for Older People Page 24 of 33 Evidence: improvement plan regarding the outstanding requirements and been asked to take part in updating all the care plans. As noted in the relevant sections of this report, requirements from the previous key inspection in relation to care plans, risk assessments and monitoring the environment had not been met at the follow up inspection visit in August 2009 and have not been fully met at the time of this report. Progress has been made and is noted, however the lack of effective quality monitoring to ensure the service complies with regulations within timescales is cause for concern. A requirement was made at the last key inspection that the registered person must establish and maintain a system to review the quality of care at the home in consultation with people who use the service and their representatives. This requirement had not been met at the follow up inspection visit in August 2009. During this visit we saw that people who use the service are consulted about the care and support they receive, however monitoring the quality of service provision is still an issue for the management. There is evidence that the clinical representative for the administrators provides guidance for the acting manager but there is a lack of evidence that this is followed up effectively. Combined with the evidence from previous reports and the slow progress with the services/administrators own improvement plan, this leaves a question about whether any improvements can be sustained in the longer term. We saw some of the feedback from a service user survey carried out in August 2009, which indicated overall satisfaction with the care and support people who use the service receive. The minutes of a residents meeting held on 30/10/09 showed that people who use the service had been updated about the sale of the home and given an opportunity to express any other concerns. The meeting was also used to discuss daily activities, menus and the decoration of the home. We also saw that a family and visitors survey had been undetaken in October 09, with generally positive feedback. We saw two reports of monitoring visits by representatives of the administrators, which were on the office computer and dated 13/11/09 and 07/01/10. The administrative assistant said there had been more than this. The report for November stated a previous visit had been made on 19/10/09, but the agency manager and staff member were unable to provide us with any other reports. A requirement made at the last key inspection in relation to these visits and reports had been found to be met at the follow up visit in August 2009. Due to the current concerns with how the service is being monitored the requirement has been made again. Care Homes for Older People Page 25 of 33 Evidence: The AQAA states that the service could be more organised with the administration and management systems. A requirement has been made that records required by regulation for the protection of people who use the service and for the effective and efficient running of the business are maintained, up to date and accurate. We saw records indicating that the acting manager and clinical representative had updated a number of the homes policies, including equality and diversity, whistle blowing and safeguarding adults. During the random visit in August 2009 we found that secure facilities were being provided for the safe keeping of money and valuables held on behalf of people who use the service. We saw certificates showing the acting manager had completed training in performance management, supervision and appraisal in October. There were also certificates for training in managers induction standards, risk assessment in care settings. Some supervision records were on file dated 2007/08. The improvement plan stated that the acting manager was committed to developing a supervision matrix by early November 09. We saw a supervision calendar for December 09 showing the dates when one to one staff supervisions were booked. There were some recent notes on file but it was not clear whether these had all been carried out, however three staff we spoke with said they had recently had supervision. We also saw a copy of a letter sent by the acting manager to each staff member to sign and return, outlining the supervision arrangements coming into place. A requirement was made following the random inspection visit in August 2009, that hot water temperatures are to be checked once a week. The improvement plan for the service shows this had been reviewed in September and October but without confirmation that the checks were being done. The actual records of checks we saw were inconsistent and showed a number of significant gaps. The monitoring visit report for January 2010 indicated that these records were checked by the administrators representative. Training and refresher courses for some staff in subjects such as moving and handling and first aid were overdue. At the previous key inspection in February 2009 it was also noted that mandatory refresher training for some staff had been overdue. Care Homes for Older People Page 26 of 33 Evidence: Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered person must ensure that where a risk to the persons health care needs is identified an assessment is completed that identifies the risk and gives clear guidance on how it should be minimised. The risk assessment must be kept under review. This is so all staff know what the risk is and how it needs to be managed to minise it. 30/06/2009 2 8 12 The registered person must 30/06/2009 ensure a care plan, completed from information obtained in the assessment, is put in place for the mental health needs of people who use the service so that staff have the guidance they need to manage and support the individuals mental health needs. 3 19 23 The registered person must introduce a system to monitor the environment, together with an action plan to renovate and redecorate the home. This is so people who use the service may live in a safe, 30/06/2009 Care Homes for Older People Page 28 of 33 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 comfortable environment that meets their needs. 4 26 23 The registered person must ensure that all parts of the home are regularly cleaned. This is to ensure people who use the service live in a clean environment where the risk of infection is minimised. 5 31 8 The provider must make 30/06/2009 arrangements for an application to be submitted to the Commission for Social Care Inspection for the registration of a manager so the day to day running of the home can be managed. 6 38 13 The registered person must 06/09/2009 ensure the temperature of hot water outlets on all baths is consistently monitored so that people who use the service ar protected from the risk of scalding. 7 38 24 The registered person must 30/06/2009 establish and maintain a system to review the quality of care at the home in consultation with people who use the service and their representatives This is to ensure the home is well run for the benefit of people who use the service. 30/06/2009 Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Each person who uses the 26/03/2010 service must have a detailed and complete plan for meeting their care needs and which is accessible to them. So that staff and people who use the service know how their needs will be met. 2 12 16 A clear daily programme of activities must be implemented and recorded. To meet the individual mental and social stimulation needs of people who use the service. 23/04/2010 3 18 13 Further guidance must be provided for staff about how to respond to situations that may put people who use the service at risk. So that prompt action is taken to safeguard people. 31/03/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 27 17 An up to date copy of the duty roster of persons working in the home, and a record of whether the roster was actually worked, must be kept and be available for inspection. This is to ensure that at all times sufficient numbers of staff are working in the home to meet the needs of people using the service. 23/04/2010 5 30 18 All staff must receive 23/04/2010 training appropriate to their work, including induction and mandatory updates. So that all staff have the necessary training, knowledge and skills to meet the needs of people who use the service. Monthly reports by the provider or their representative must be completed each month and be available for inspection. To ensure the conduct of the service is monitored. 26/02/2010 6 33 26 7 37 17 Records required by regulation for the protection of people who use the service and for the effective and efficient running of the 26/03/2010 Care Homes for Older People Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action business are maintained, up to date and accurate. So that the rights and best interests of people who use the service are safeguarded. 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 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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