care homes for older people...the report of this inspection is available from our website . you can...

Key inspection report

Care homes for older people

Name: Holly Bank House

Address: Royston road ChurchinfordTauntonSomersetTA3 7RE

The quality rating for this care home is: one star adequate service

A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection.

Lead inspector: Date:

kathy McCluskey 1 3 0 5 2 0 1 0

Care Homes for Older People of 36

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 stars - excellent• 2 stars - good• 1 star - adequate• 0 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. They reflect the things that people have said are important to them:

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.


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 Inspection report

Author Care Quality Commission

Audience General public

Further copies from 0870 240 7535 (telephone order line)

Copyright © Care Quality Commission 2010This 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.

Internet address www.cqc.org.uk

http://www.tso.co.uk/bookshop


Information about the care home

Name of care home: Holly Bank House

Address: Royston road ChurchinfordTauntonSomersetTA3 7RE

Telephone number: 01823601447

Fax number: 01823602816

Email address: [email protected]

Provider web address: www.alutarius.com

Name of registered provider(s): Alutarius Ltd

Name of registered manager (if applicable)

Type of registration: care home

Number of places registered: 22

Conditions of registration:

Category(ies) : Number of places (if applicable):

Under 65 Over 65

old age, not falling within any other category

0 22

Additional conditions:

The maximum number of service users who can be accommodated is 22.

The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP)

Date of last inspection 0 8 1 2 2 0 0 9

Brief description of the care home

Hollybank Nursing Home is situated in the village of Churchinford which has a pub and small shop. The town of Taunton is approximately 7 miles away. The home is registered with the Care Quality Commission to provide general nursing care to up to 22 older people. The home is not registered to provide a service to people where their primary care needs are their dementia or other mental health


Brief description of the care homeproblems. The registered provider is Alutarius Ltd. The responsible individual is Mr Neil Plummer. The home does not currently have a registered manager. Up to date information about fees should be obtained from the home.


SummaryThis is an overview of what we found during the inspection.

The quality rating for this care home is: one star adequate service

Our judgement for each outcome:

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 unannounced key inspection was conducted over one day (7hrs) by regulation inspectors Kathy McCluskey and Shelagh Laver. The home's last key inspection was carried out in December 2009. A further unannounced random inspection was carried out in January 2010 to monitor the home's progress in addressing the concerns raised. The registered person was also required to submit an improvement plan which identified how the concerns raised would be addressed. The home did not complete its Annual Quality Assurance Assessment (AQAA) and return this to the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information.


As part of this inspection we sent comment cards to a number of people using the service, staff and health care professionals to seek their views on the quality of the service provided. No completed comment cards were received by the Commission. We were informed that, at the time of this inspection, 13 people were residing at the home, 8 of which were receiving nursing care. During this inspection we were able to meet with the majority of people using the service and staff on duty. The acting manager was available for the majority of the inspection and all records requested for this inspection were made available to us. We would like to thank all those involved for their time and cooperation with the inspection process. The term 'we' used throughout this report refers to 'we the Commission'. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report.


What the care home does well:

Holly Bank provides people with a comfortable and homely environment. People have their own bedrooms which they can personalise. The home is located in a quiet village with views over the surrounding countryside. The standard of cleanliness was found to be good and procedures are in place to reduce the risk of the spread of infection.

What has improved since the last inspection?

At the last inspections, serious concerns were raised regarding the home's care planning procedures and of the arrangements to ensure that peoples' health care needs were met. At this inspection we found significant improvements. Clear care plans were in place which identified peoples assessed needs including psychological needs. Instructions for staff were clear and peoples preferences and abilities had been documented. This promotes a more person centred approach to care and also ensures that staff can be consistent in their approach. We found appropriate assessments in place relating to reducing the risk of pressure sores and falls, nutrition, moving and handling and health and safety. We were able to see that care plans had been raised to address any concerns identified and that the advice and input of appropriate health care professionals had been sought in a timely manner where required. People were being weighed on a monthly basis. We found care plans and assessments to be up to date. We examined the home's procedures for the management and administration of peoples medication and found that the home had taken appropriate action to address the requirements and recommendations raised at the last inspection. Further improvements are needed in this area so that excess stocks are not held and that there is a clear audit trail of medicines received into the home. People are benefiting from an increase in care staffing levels and ancillary staff. This allows care staff to focus more on the needs of people using the service. Since the last inspection many areas of the home have benefited from redecoration and refurbishment including new carpets, curtains and furniture.

What they could do better:

Staff recruitment procedures again require improvement so that people are not placed at risk of harm or abuse. The registered person needs to ensure that all staff receive an appropriate induction on commencement of employment. Deficits in staff training were again noted. This related mainly to mandatory training for existing staff at the home. Registered nurses are yet to receive any specialised training. The registered person needs to ensure that effective procedures are in place to review, monitor and improve the quality of the service delivered.


The registered person needs to ensure that the newly appointed acting manager receives the training and support needed to carry out this role. Procedures also need to be in place to ensure the acting manager is appropriately supervised.

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 [email protected] or by telephoning our

order line 0870 240 7535.


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


Choice of home


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.


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 using the service, people who are thinking about using the service and visitors to the home need to have access to up to date information about the home. Procedures are in place to ensure that people are appropriately assessed before a placement is offered. The home are unable to demonstrate that all staff have the skills and training needed to meet the needs of older people who require general nursing care.

Evidence:

The home have a Statement of Purpose and Service User Guide which detail about the home and services offered. These documents were seen to be available in peoples' bedrooms though were not seen to be available in the reception area of the home for visitors.


Evidence:

As identified at the last inspection, these documents need to be updated to reflect the current management arrangements. The acting manager informed us that these documents are in the process of being updated. Pre-admission procedures are in place though there have been no admissions since the last inspection. At the last key inspection we were able to see evidence that a new admission had been appropriately assessed before a placement was offered. A staff training matrix is yet to be developed by the home though we were provided with individual training records for some staff. As identified at the last inspection, we were unable to confirm that all staff had received up to date mandatory training. Records did not contain evidence that registered nurses had completed any specialist training.Information about staff training is provided in more detail under the 'staffing' outcome group.


Health and personal care


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.


Judgement:

People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.

Care planning procedures have improved and these now ensure that peoples' needs are clearly identified. Care plans now promote a more person centred approach to care. The home's arrangements for ensuring peoples' health care needs are met have improved. The home's procedures for the management and administration of peoples' medication have improved though further improvements are needed so that stocks held are not excessive and that records demonstrate a clear audit trail.

Evidence:

We were informed that 13 people were residing at the home, 8 of which were receiving nursing care. We were told that there was currently nobody being treated for a pressure sore and that there was no one who required any specialised nursing care/intervention.


Evidence:

We examined four care plans at this inspection and improvements were noted. We were able to see evidence that the home had taken appropriate steps to address the requirements relating to care planning procedures raised at the last two inspections. Care plans contained clear information about peoples' assessed needs, including psychological needs, abilities and preferences. There were clear instructions for staff on how peoples' assessed needs should be met and of how peoples' independence should be promoted. Care plans were up to date and had been reviewed monthly. During the inspection we were able to speak to the three care staff on duty and all confirmed that they were encouraged to access peoples' care plans. Care plans contained a range of up to date assessments including reducing the risk of falls and pressure sores, health and safety, nutrition, oral hygiene and moving and handling. We were able to see that a plan of care had been raised to address concerns identified. Care plans demonstrated that people were now being weighed at least monthly. We were able to see evidence that people had access to a range of health care professionals and that the advice/input of professionals had been sought where required. Care plans contained documented evidence of each persons' contact with a health care professional. During this inspection we were able to meet with the majority of people using the service. People looked comfortable and well attired and we found staff interactions with people to be kind and respectful. The atmosphere in the home appeared relaxed. People told us that the staff were 'kind' and that they were 'able to make choices' about their lives. People also told us that staff responded to call bells in a timely manner. Staff told us that 'things at the home had improved' over the last few months and that following an increase in staffing levels, felt more able to meet peoples' needs and to be able to spend more quality time with people. We examined the home's procedures for the management and administration of peoples' medication. We found that the home had taken appropriate action to address the requirements raised at the previous inspections.Medicines have been moved to another room so that the room temperature remains within safe limits. The home are now monitoring the temperature of the room and of the fridge storing medicines twice a day.We examined all available medication administration records (MAR) and found these to be appropriately completed. We did note that two people had an excess stock of paracetamol tablets and that the number of tablets brought forward on the current


Evidence:

MAR chart had not been recorded. The home need to ensure that stock levels remain appropriate and that brought forward amounts are recorded so that there is a clear audit trail.We were informed that at the time of this inspection, nobody using the service was currently prescribed controlled dugs.


Daily life and social activities


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.


Judgement:


People are given the opportunity of social stimulation which includes external entertainers. Visitors are made to feel welcome. People are provided with a wholesome and varied menu with choices available.

Evidence:

The home employs an activity worker who works weekdays between 1000hrs and 1600hrs. A programme of activities is in place and the home's completed AQAA told us that 'all activities are researched and person centred to best meet service users needs'. During this inspection we observed staff spending quality time with people. The AQAA also told us that, 'New equipment has been purchased including musical instruments and a Nintendo Wii'. It also told us, 'The piano has been tuned and a volunteer comes in regularly to play to service users'. Visitors are welcome at the home in line with peoples' preferences. People using the service told us that their visitors were made to feel welcome and were 'always offered refreshments'. To ensure the safety of people using the service and in line with fire


Evidence:

regulations, visitors are required to sign the visitors book when they enter and leave the home. The home employs a cook who works 0900hrs to 1500hrs weekdays. We were informed that the supper and weekend cook had recently left employment and that care staff were currently providing cover where they could in addition to their care hours.We were shown a four week menu which appeared wholesome and varied. Choices were available. A daily menu is displayed in the dining room for people.People spoke with during the inspection told us that the food was good and that there was 'plenty to eat'.The cook told us that they were made aware of any special diets and that they were currently working on compiling information about peoples' preferences which will be kept in the kitchen. The home should ensure that this is completed as soon as possible.


Complaints and protection


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.


Judgement:


The home displays a complaints procedure though complaints are not always investigated and responded to in line with its' procedures. The home have some procedures in place to reduce the risk of harm or abuse to people using the service though the 'whistle blowing' policy needs to be updated so that staff know how to contact external agencies.

Evidence:

A complaints procedure is displayed in the reception area of the home. The home's completed AQAA told us that the home have not received any complaints. The Commission received two complaints about the home which were passed to the registered person to investigate. Despite reminders from the Commission, we have not received a response into the concerns raised and no records were available at the home. The registered person must ensure that all complaints are fully investigated and responded to in line with the home's complaints procedure. Staff and people using the service told us that they would feel confident in raising concerns if they had any. No concerns were raised with us during this inspection. Staff spoken with confirmed they had received training in the protection of vulnerable adults/abuse.The home confirmed they had an up to date copy of Somerset's policy on


Evidence:

Safeguarding Adults which was readily available to staff. The home need to update their 'whistle blowing' policy to include the contact details of external agencies.


Environment


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.


Judgement:


People live in a comfortable and homely environment. There is evidence of on-going improvement to the decor and furnishings within the home. People have their own bedrooms which they can personalise. The standard of cleanliness is good and procedures are in place to reduce the risk of the spread of infection.

Evidence:

Improvements have been made to the home's environment since the last inspection. New carpets and curtains have been fitted to communal areas and corridors and a number of bedrooms have been redecorated. Additional seating has been provided in the reception area. We viewed a number of bedrooms and these were found to be comfortably furnished and pleasantly decorated. It was apparent that people were able to personalise their bedrooms. Some people had chosen to bring items of their own furniture with them. Although storage remains limited, we did not observe any risks to the health and safety of people using the service. Storage arrangements should continue to be kept under review.


Evidence:

The home appears to have an adequate supply of equipment to assist people with their moving and handling needs. People have access to nurse call bells and they told us that these were responded to promptly by staff. On the day of this inspection we found all areas viewed to be warm, clean and free from malodours. There was evidence that staff had access to a good supply of protective equipment. Staff hand washing facilities were seen to be appropriately sited. At the time of the inspection we asked for boxes of disposable gloves to be securely stored so that they did not pose a risk to some people using the service. Since the last inspection the garden has been landscaped. A ramp has been installed so that the garden can be accessed by wheelchairs.


Staffing


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.


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.

Staffing levels have improved and this will have a positive outcome for people currently using the service. Some training has taken place for staff though the home must ensure that all staff receive up to date mandatory training at the least. Staff recruitment procedures are not robust and therefore do not ensure that people are protected from the risk of harm or abuse.

Evidence:

Since the last inspection staffing levels have improved and the home have been successful in recruiting more permanent staff thus reducing the use of agency staff. We were informed that 13 people were residing at the home, 8 of which were receiving nursing care. We were informed that a registered nurse was on duty for 24hrs a day and that 3 care staff were on duty during the morning, 2 in the afternoon and 1 at night. Ancillary staff are also employed which include a cook, housekeeper and domestic. An activity worker is also employed. During the inspection we spoke with a number of staff and people using the service. Staff were positive about the increase in staffing levels and of the recruitment of more


Evidence:

permanent staff. They told us that they were better able to meet peoples needs. They also confirmed they had time to spend quality time with people. People using the service commented on the kindness of staff. They also told us that staff were available when they needed them. The AQAA told us that of the 8 permanent care staff employed, 4 have achieved a minimum of an NVQ level 2 in Care. This equates to 50% which meets the recommendation of the National Minimum Standards. At the last inspection, serious concerns were raised regarding the home's procedures for staff recruitment. At this inspection we found that improvements were still required to ensure that people are protected from the risk of harm or abuse. We examined four staff recruitment files and our findings were as follows; File 1 - we found that the individual had commenced a period of induction before references had been received and had worked a shadow night shift when only one reference had been received. The ISA First had not been received at this point. We also found that a reference had not been obtained from the last employer and that only two character references had been obtained. A copy of the CRB was not available in the file. No employment history had been recorded on the application form from August 2009. A CRB from another care home was seen in the file but there had been no reference to this care home made on the application form or on the CV available. A photocopy of the employee's nursing pin number was available in the file, but there was no evidence that this had been verified with the NMC. The file contained no documented evidence of an induction for this employee. There were no training records or evidence of any mandatory training for this individual. FILE 2 - We found that one reference was dated nine days after employment had commenced. An enhanced CRB was seen though this was dated 17 days after employment. Although an ISA First had been obtained, there was no documented risk assessment in place. This is required so that restrictions on the employee and arrangements for how the employee will be supervised during this period are clearly documented and signed by the employee and employer. There was no documented evidence that issues raised on the CRB had been discussed or considered. The application form did not contain 10 years employment history. We were unable to see documented evidence that the employee had undertaken a period of induction. We were only able to see evidence of a 'brief introduction to the company' which had been completed by a management representative from the company. No supervision records were available. FILE 3 - The application for employment form only requested 5 years employment


Evidence:

history. The employee was recruited from overseas though we were unable to ascertain how or where they were interviewed for the post as there was no documented evidence. References were in place. An enhanced CRB was seen though this was dated 24 days after employment started. A risk assessment was not in place which would have identified the restrictions on the employee during this period and of the arrangements for ensuring the individual did not work unsupervised. We asked for the employee's induction record and were informed that 'workbook' was currently with the employee. We were provided with a training record which confirmed mandatory training had been completed. FILE 4 - As before, this employee was recruited from overseas though there were no documented records of interview. As previously mentioned, the home's application for employment form only requests 5 years employment history. As before, an induction programme was not available and we were informed that this was with the employee. A training printout confirmed that the employee had received mandatory training. We were informed by the acting manager that he was in the process of developing a training matrix and that deficits in staff training had been identified. We were provided with individual printouts of training which had taken place for staff. On analysis of these records we found that records were only available for 4 registered nurses. The duty rota made available to us identified 7 registered nurses 2 of which were bank nurses employed by the home. We also found that 2 registered nurses, 1 domestic, 1 cook and 4 care staff did not have up to date mandatory training. The acting manager informed us that there had been no specialist training for registered nurses though this was something that he was planning on arranging. We were able to see that some staff had completed online training in dementia care, the mental capacity act and deprivation of liberties.


Management and administration


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.


Judgement:


There have been failings in the registered providers arrangements for ensuring the home is appropriately managed in the absence of a registered manager. A new acting manager is now in place so improvements are anticipated. Quality assurance procedures are yet to be developed. Action has been taken to ensure that staff are appropriately supervised though the registered person needs to ensure that this is also in place for the acting manager. The home's documentation was able to demonstrate that servicing records were up to date. Health and safety procedures need further improvements. The home need to ensure that all staff receive up to date mandatory training.

Evidence:

Since March of this year, a new acting manager has been in post. We were informed that the acting manager has previous experience of managing care homes and has a


Evidence:

management qualification. The Commission have not yet received an application for registered manager though we were informed that this is in the process of being completed. As the acting manager is not a registered nurse, the Commission must be informed of the arrangements regarding a clinical lead for the home. Staff spoken with were positive about the acting manager and of the support they received. As previously detailed in this report, we could not ascertain whether the registered person had systems in place to ensure that the newly appointed acting manager received appropriate support or supervision. It was however positive to note that the acting manager was working in addition to nursing and care staff. This is an improvement from the last inspection. The home have not yet developed quality questionnaires though the acting manager stated that this was something he would be developing. We were informed that meetings for people using the service have taken place though documented minutes could not be located. As required at previous inspections, we were able to see that a company representative was visiting the home and completing reports in accordance with Regulation 26 of the Care Homes Regulations 2001. The registered person must ensure that these unannounced visits are conducted on a monthly basis as there was only evidence of one visit made by a company representative in March 2010. The registered person was required to complete the Annual Quality Assurance Assessment (AQAA) and forward to the Commission by 5th January 2010. As this was not received two further reminders were sent with an extended deadline of 26th March. A completed AQAA was eventually received by the Commission on 30th April 2010. This had been completed by the acting manager who had only been in post for three weeks when the AQAA was completed. We were able to examine records for 3 individuals' who were receiving assistance from the home to manage small amounts of 'pocket money'. Appropriate records were seen to be in place and receipts had been obtained for all transactions. Two staff signatures confirmed each transaction. We were able to see evidence that the acting manager had started formal supervision sessions for staff. A matrix had been developed to ensure that all staff receive at least 6 formal supervisions a year. The registered provider needs to ensure that regular supervisions are also provided for the acting manager. At the last inspection we made a requirement that the registered person fowards some health and safety records to the Commission as they were not available for the


Evidence:

inspection. These were not received. Records requested for this inspection were made available to us. There was evidence that hoists had been serviced on 17/02/10. Records showed that the home were conducting weekly checks on the home's fire alarm/detection systems and monthly checks on emergency lighting. The home need to follow up on a letter which should have been received following a visit from the fire officer on 12/10/09. Records confirmed that monthly checks were being made on wheelchairs, walking frames and nurse call bells. The Commission are now receiving notifications from the home advising us of significant events at the home. As previously mentioned in this report, we found some deficits in mandatory training for staff which needs to be addressed.


Are there any outstanding requirements from the last inspection?

Yes R No £

Outstanding statutory requirementsThese 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 27 18 (1) The registered person must ensure that the status of registered nurses is checked with the Nursing and Midwifery Council (NMC). This is so that at all times, suitably qualified nurses are on duty at all times.

31/01/2010

2 29 19 &Schedule 2. The registered person must ensure that staff do not commence employment until all required information has been obtained. This is so that people using the service are not placed at risk of harm or abuse.

08/12/2009

3 29 19 (1) The registered person must ensure that staff do not commence employment until two satisfactory references have been applied for and obtained by the home and that the employer is satisfied to the authenticity of the references. This is to ensure robust staff recruitment procedures are followed and so that people are not placed at risk of harm or abuse.

05/01/2010

4 30 18 (1) The registered person 31/01/2010



action

must ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers as are appropriate for the health and welfare of people using the service. This relates to the completion of an appropriate induction programme and mandatory training for newly appointed staff.

This is so that the needs of people using the service are fully met.

5 33 26 (2-5) The registered person must ensure that a responsible individual visits the home on a monthly unannounced basis in accordance with this regulation. Written reports must be maintained at the home. PREVIOUS TIMESCALE OF 31/12/2009 and 15/02/2010 NOT MET This is to ensure the quality of the service is monitored and reviewed.

15/02/2010

6 33 24 (1) The registered person shall establish and maintain a system for reviewing and improving the quality of the care provided. The home should seek the views of people using the service and other stakeholders. This is so that people receive an improved quality of

19/02/2010



action

service.

7 38 13 (4) The registerecd person must ensure that all existing staff receive up to date mandatory training. This is to ensure the health, safety and welfare of staff and persons using the service

31/03/2010


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 9 13 (2) The registered person must ensure that stocks of medicines held at the home are not excessive and that the amount of any brought forward medicines is clearly recorded on the medication administration records (MAR). This is to ensure that there is a clear audit trail of medicines received into the home and that stock levels remain within acceptable limits.

30/05/2010

2 16 22 (3) & (4) The registered person must ensure that all complaints are fully investigated and responded to in line with the homes procedures. Records must be maintained at the home.

30/05/2010




action

This is so that complaints are appropriately investigated and responded to.

3 27 18 (1) The registered person must ensure that the status of registered nurses is checked with the Nursing and Midwifery Council (NMC). Previous timescale of 31/01/2010 not fully met. This is so that at all times, suitably qualified nurses are on duty at all times.

30/05/2010

4 29 19 &Schedule 2. The registered person must ensure that staff do not commence employment until all required information has been obtained. Previous timescale of 08/12/09 not met This is so that people using the service are not placed at risk of harm or abuse.

30/05/2010

5 29 19 &Schedule 2. The registered person must ensure that staff do not commence employment until two satisfactory references have been received and that the

30/05/2010




action

employer is satisfied as to the authencity of the references. Previous timescale of 08/12/2009 not met. This is to ensure robust staff recruitment procedures are followed so that people are not placed at risk of harm or abuse.

6 30 18 (1) The registered person must ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers as are appropriate for the health and welfare of people using the service. This relates to the completion of an appropriate induction programme and mandatory training for staff. Previous timescale of 31/01/2010 not met. This is so that the needs of people using the service are fully met.

15/06/2010

7 33 26 (2-5) The registered person must ensure that a responsible individual visits the home on a monthly basis in accordance with this regulation. Written reports

30/05/2010




action

must be maintained at the home. Previous timescales of 31/12/09 and 15/02/10 not fully met. This is to ensure the quality of the service is appropriately monitored and reviewed.

RecommendationsThese recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.

No Refer to Standard Good Practice Recommendations

1 1 Information about the home should be updated to reflect the current management arrangements at the home.

2 18 The home should update the whistle blowing policy so that staff are able to follow the correct procedures and so that they know how to contact appropriate external agencies.

3 29 The registered person should ensure that any issues raised on an employees CRB are discussed and that where appropriate, documented risk assessments are developed.

4 29 The registered person should review the current application for employment form so that it requests applicant to provide at least 10 years employment history. Any gaps in employment should be explored and reasons documented.This was also raised at the last key inspection.

5 29 A documented risk assessment should be in place for staff who commence employment on an ISA first pending a full CRB. This should include the restrictions imposed on the employee during this period and the arrangements for ensuring the employee is supervised at all times. This should be signed by the employee and employer.


RecommendationsThese 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

6 30 The registered person should ensure that staff undertake a 12 week induction programme which follows the skills for care common induction standards.This was also raised at the last key inspection.

7 33 The home should further develop its quality assurance procedures so that the views of people using the service, relatives and health care professionals are sought.

8 36 The registered provider should ensure that procedures are in place to ensure that the acting manager is appropriately supported and supervised.


Helpline:

Telephone: 03000 616161

Email: [email protected]

Web: www.cqc.org.uk

We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website.

© Care Quality Commission 2010

This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010.

care homes for older people...the report of this inspection is available from our website . you can...

Documents