Inspection on 26/05/09 for Culverley

This is the latest available inspection report for this service, carried out on 26th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Culverley 155 Culverley Road Catford London SE6 2JZ Lead Inspector Wendy Owen Unannounced Inspection 26th May 2009 10:00 DS0000071914.V375588.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Culverley Address 155 Culverley Road Catford London SE6 2JZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8265 6275 Sadanand Bunjun Chitradevi Bunjun Sadanand Bunjun Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 8 30th November 2008 Date of last inspection Brief Description of the Service: Culverley Residential Care Home changed ownership in June 2008 and is now owned by Mr S and Mrs C Bunjun, Mr Bunjun is also registered as the manager. It is registered to provide personal care for up to 8 older people (it is not registered for any other categories such as nursing, dementia or mental health care). This care home is a large domestic style family house with bedrooms on ground and first floor, most are single rooms. There is a combined lounge and dining area towards the rear of the property. It has a kitchen and toilet towards the middle of the ground floor. There is a washing machine and dryer under the lean-to at the side of the property. Upstairs there is a very small bathroom, with an adapted hip-bath. There are several bedrooms on the first floor. The house is not well adapted for residents with mobility problems but it does have a stair left. We are advised that fees in November 2008 were from £450 per week. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on 26th May 2009 with two inspectors involved in the site visit. We took into consideration information received from the Local Authority who have been involved in supporting the Providers over the last six months. We also considered information received from the Providers. During the visit to the home we spoke to all of the people living there taking into account their views, we spoke to the manager, Provider and two members of staff. We also toured the home and looked at records in relation to individuals and the running of the home. We used information supplied in the Annual Quality Assurance assessment (AQAA) which was completed in October 2008, the last key inspection report dated 30th November 2008 and the improvement plan sent to us in May 2009 in response to the requirements made in this report. The Providers have made good progress in complying with the requirements and whilst further work is still required we understand that time is still required. We also recognise that time is needed for consolidation and to achieve consistency in the quality of care provided. We also suggested that the Providers view the Key Lines of Regulatory Assessment (KLORA) to enable them to understand what is required to achieve a 2 star (good) rating. What the service does well: Culverley is a small, homely care service providing a domestic style setting for people to live in. People find the home to be relaxed and friendly and had many positive comments to make such as, “It’s peaceful and happy.” “I’m happy here – that’s the most important thing.” “Its very relaxed.” “There’s lots of laughter – I’m quite happy.” “They look after us” “I’m happy here – that’s the most important thing” “In my book they are doing a good job and I’m a picky old bat.” Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 6 People were appropriately dressed and well-groomed for the time of year and temperature. People told us they liked the food and that they had choice in what they wanted to eat. What has improved since the last inspection? At the last inspection we made a number of requirements to improve the service provided to people living. We received an action plan in response to the improvements that were required and found, during our visit, that a number of these had been met or partially met. There is still need for further improvements and these have been highlighted in the “What they could do better” section of this summary. It is very positive that the home has taken on board the comments and suggestions also made at the last inspection, including approaching a firm of consultants to support the Provider during their first year. We also note the support the Providers have from the Local Authority in making the required improvements. The health and safety issues have been addressed, including the fitting of appropriate devices on fire doors and the removal of the digilock on the front door. People living there have also benefited from more a stimulating environment including activities and interactions. There is still, however, room for further improvements in this area. There have been improvements in the information provided to people, although once again, some further work is required. Care plans and other information have improved, being more personalised and covering more of the person’s assessed needs. We also found that people are receiving more appropriate health care with medication practices also improved. People tell us that the quality of food has improved and there are now records in place so that they can be assured that people are having their nutritional needs met. The have made changes to the environment to ensure it is safer and more comfortable and people have the privacy they require. The manager/Provider are trying to include people in the way the home is run to ensure it is run in a way that meets their needs. They have sent out surveys and arranged meetings with residents and relatives over the last few months. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 7 Staff are being provided with training and more formal supervision now so that they will have the skills, knowledge and understanding to meet peoples needs. What they could do better: The manager and Provider have made some good progress over the last six month and made a number of improvements to improve the quality of care provided. There are, however, still some areas that require further improvement. Information provided such as the Service Users Guide and Statement of Purpose must be amended to ensure they give accurate information to people and contain what they are said to contain. This information should also be made available in other formats so that people can access and understand them easily. Medication practices need to be more robust to ensure people are kept safe and care plans require more information about the healthcare needs of the individuals and what action is taken to ensure these needs are met. All staff who are working in the care home must receive formal supervision on a regular basis. This includes bank staff. The recruitment practices must be more robust particularly in respect of the references obtained so that people are protected from the employment of unsuitable staff. A number of recommendations were also made, although we would expect the manager to implement them. The assessment process and forms should be reviewed to ensure information is more person-centred and covers all of the person’s identified needs, rather than focus on the physical needs. This includes the need to ensure people are able to access community activities or make external visits. The bathroom is redecorated and the recently fitted radiator covers painted to make them more homely. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 8 Records could be improved particularly the development of accurate training records and staff roster. This would give clear, accurate and up to date information. 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. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1,2 & 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The documentation provided by the home gives people some of the information required to enable them to make a decision on whether the home is right for them. Improvements in the assessment practices could not be judged during this inspection. EVIDENCE: Since the last key inspection the Local Authority had stopped making placements to the home until the service had improved. No private admissions have been made in this time. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 11 We have been made aware, since the inspection took place and before the report was sent out, that the Local Authority have lifted the embargo on the home although we are not aware of any new admissions at this stage. Currently there are five people living there and therefore there are three vacancies. Without evidence of the current assessment process we are not able to determine the quality of the procedures or the practices and therefore make a judgement on this aspect of the service. We did look at the way information would be collected during an assessment and recommend that this is improved to give a more personalised approach to assessing the individuals’ needs. The current assessment form captures information about areas such as physical status, pressure areas and mental state. ‘Other considerations’ are listed as hobbies, social activities, family support. We recommend that the home look at making assessment less clinical and more about the person, their life and things they can do – strengths. The Provider is also reminded that people must only be admitted within the category they are registered for. For clarification: the home is not registered to admit people with dementia or with nursing needs if these are their primary care needs on assessment. We have been informed since the inspection, that the manager was due make an assessment for a new admission, along with a care manager. Whilst some individuals are confused we believed that with the current numbers and staffing people are receiving appropriate care in a relaxed and friendly environment. They showed a number of signs of positive well-being. We have commented on this aspect of care later in the report. The manager must consider if they could sustain this when the home is full. The last inspection also required the information provided by the home to meet with the Regulations. We were given a copy of the Service Users’ Guide and contract to take away and view. Both documents now give much information to the reader. The Providers must however look at the two documents together as they give, at times, contradictory information. For example, rules about smoking and medication. The contract also states it takes no responsibility for management of people’s monies. However, this has now changed. We would also suggest that they look at the wording in the contract so that it does not appear as if on entering the home people have no choice on some matters. The SUG also states that the contract gives more details about possessions that can be brought in but this is not clear in the contract and only appears to mention valuables and electrical items. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 12 We would suggest that they be provided in other formats such as large print or pictorial format for those who are not able to read this information easily. We appreciate that some attempt has been made in providing photos of the home but there is a lot of test that may be hard to assimilate. A requirement also made at the last inspection was to ensure individuals had the Commissions’ address and contact details as part of the complaints’ procedures. This has now been done. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7,8,9,& 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in health care support and medication practices means people are generally safer than previously although there are still areas that place people at risk and so they cannot be fully assured that their health and social care needs will be met. Privacy and dignity are now being fully respected; EVIDENCE: At the last inspection the quality of the care planning process was assessed as poor with care plans showing little individualised care-being very generalised and non specific. The manager and Provider have, since that inspection, worked with staff from the Local Authority to improve these. Obviously the Local Authority who were making placements recognised the need for the care and the care planning to be improved. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 14 We spoke to a person from the Commissioning team who had together with his social worker colleagues been supporting and monitoring the home since the last key inspection. They told us that care practices were improving along with the records relating to the care provided. We looked at two care plans in full and one briefly to check certain areas. It appears that the care planning process has changed since the last visit with more information provided for staff to gain a better understanding of the person’s needs. Areas covered included personal care, mobility, physical health, mental health, mobility, medication, social integration and family contact, spiritual beliefs, recreational activities. One person suffers with Parkinson’s Disease, this was recorded on the care plan but said nothing about how this is managed ie through monitoring by PD nurse, review of medication etc. Other areas showed some good information. For example personal care stated guidance on what staff should do to support them and about what they could do themselves. The plan would benefit from more information in areas such as continence where the individual is on lactulose for constipation but not recorded on the care plan. The person told us that they also suffered with dry eyes and had “lacrilube” prescribed for this condition but this was not on the care plan. One part of the care plan detailed about the person’s mobility and implied they had a specific exercise routine. However this is something the person has motivated themselves to do informally. The second plan We found risk assessments in respect of moving and handling and falls in those viewed. Risk assessments, in respect of pressure sores “waterlow” assessments, had been developed in one of two files viewed. These must be carried out for all people living there. Moving and handling assessments are quite basic and do not cover any areas that may impact on the moving and handling of the individual. For example: the person may be confused, have behavioural or mobility problems that impact on how they are to be moved. There is evidence that they are reviewed regularly. One of them showed the improvements in the person’s mobility from using a “zimmer” frame to no longer requiring one. The falls risk assessment, however, when reviewed did not show this change continuing to record “no change”. The manager has taken on board the comments made previously in respect of the individual’s right to privacy and communal items are no longer stored in individual’s private room. We also saw locks on doors and curtains for privacy where people shared a double room. It is also positive that safes have now been installed in each person’s room to enable them to keep belongings safe. The last inspection commented on the lack of private room available for people to meet in private, in particular those that share a bedroom. The Providers should continue to investigate how they could address this. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 15 We inspected the medication procedures and practices and found that these had improved since the last inspection where the visit by the Pharmacy Inspector found a number of issues. A local pharmacist Lloyds dispenses prescribed medication for each person every four weeks in the form of a blister pack. They also produce a pre printed medication administration record (MAR). The medication is stored in a locked trolley and there is a list of names of staff authorised to administer medication with signatures and initials as used on MAR. MARS were completed in full with allergies and photographs in place. Photographs had the age of the person recorded on them, although the date of birth would be preferable. Medication records showed the prescribed medication was appropriately signed for in most cases. However, they need to ensure medication that remains from previous months are carried over to the next record to ensure accurate auditing. Also there is a need to ensure eye drops have the date of opening recorded on them to ensure they are discarded within the timescales advised to prevent the risk of infection. For example we found both lacrilube and eye drops without a date of opening recorded. They must also make sure that where changes are made and there is medication remaining but no longer used they are returned to pharmacy. A person was prescribed omezrepole and this was initially prescribed boxed but later came in the form of a blister pack. On checking the blister pack that morning the medication remained for that day but the medication record was signed as administered by Mr Bunjun. Mr B said he took one from the box by accident as both medications continued to be stored in the trolley. This system makes it unsafe and we cannot be assured that the person had their medication or they may have it duplicated. Mr Bunjun was advised of the need to return medication no longer required to the pharmacy. There is a homely remedy policy in place dated 19/12/08 with a number of items on the list. This did not tally fully with what was in the trolley. Ie cough mixtures and they had run out of paracetemol. The current system for recording is on a homely remedy record sheet. One person had a record in place with paracetemol administered in April, although there was no record in place for any other person as this is put in place when the medication is needed. However, this system allows for mistakes and would probably benefit from a record being placed for each person in readiness. There is no system for recording homely remedy medication when it comes into the home ie date, medication and quantity. This needs to be put in place to allow for auditing. The manager has developed a system for auditing medication and we found appropriate records of prescribed medication that had been disposed of by the Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 16 pharmacist. We were also informed that the dispensing pharmacy would be undertaking an audit on 1st June 2009. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12,13,14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a varied and healthy diet to ensure their nutritional needs are being met. Progress has been made to ensure people are supported in social and recreational life that suites them. EVIDENCE: Since the last inspection the manager/Provider have been proactive in improving the routines in the home, along with the activities on offer. We found an activity schedule on display and one member of staff now allocated on the shift to organise them. Arrangements have been made for a mobile library and talking books to be received. Magazines and newspaper in Polish have also been arranged for a Polish speaking person with an individual who speaks polish visiting them in each week. There is also a regular prayer service with someone from a Bromley church. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 18 Feedback from people living there was quite mixed with comments such as “I play the piano here.” “We just sit here” “It’s very quiet – it can be very boring.” “We used to get out more, I’d possibly like to get out more.” “I’d like to get out more.” One person told us that “We talked about outings in the meeting the other day.” We looked at the care plans for two people. One of which we were told by manager and provider that they go for a walk regularly outside the home. However, there was little evidence of this and the person in question told us “I want to get out more – go for a walk. I did go out to Catford recently – a few weeks ago.” There was evidence of a person doing their own exercises and taking a walk in the garden (they confirmed this) also watching TV etc. One persons care plan under social integration said “X is to be encouraged to o out shopping on a weekly basis and buy personal items.” We viewed the social activity sheet and found very little record of this event. So whilst this is an area that has improved there is a need for activities to be worked on. The service should look at involving people more in the life of the home and with the local community and to look at flexible staffing to enable people to achieve the things they would like to do -these are realistic expectations. We spoke to two people about the routines of the day and times for getting up and going to bed. We were told by one person that they came to their room when they chose to and got ready for bed when they wished. Because they were quite independent they were able to do this. Staff did not tell them when they should be getting up or going to bed. Another person who was able to give us reliable information also confirmed this. It was clear from our visit and interaction with people that they were quite willing to chat and to joining impromptu dancing and playing of the piano if given the opportunity, which they were with the inspectors. There were very positive signs of well-being when we interacted even for a short time. The manager, Provider and staff should take this onboard and grasp such opportunities. The mealtime we saw was a pleasant unhurried occasion. Staff helped individuals with their meal as necessary but there could be scope for improvement by using napkins instead of bibs; staff taking off their blue plastic aprons and hats when sitting with people; using pictures of meals instead of just writing on a whiteboard and involving people in food preparation / cooking. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 19 Meal provision is organised through a four weekly menu choice and on this visit the week 2 choices were on offer with the days choice of cottage pie and chicken stir fry. This was provided. One resident doesn’t eat red meat but likes chicken stir fry which they had. Whilst alternatives are on offer they need to be aware of offering a vegetarian option if people require this. People spoken to about the food made comments such as “It’s alright – it’s nice.” “I have a big breakfast.” “If somebody says I used to like something, they bring it the next day.” “It’s improved – no alternatives when I first got here.” Certainly people appeared to be enjoying their meal whilst we were there. We saw evidence of fresh fruit and vegetables in the kitchen. Perhaps it would be nice for the fruit to be located in the lounge for people to access it when they chose to. They now record the meals provided for each person so that they can be assured that they have a healthy and varied diet. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel they are listened to and can raise concerns. They are now adequately protected by the safeguarding procedures and by staff who understand their role in this. Recruitment procedures could be more robust to ensure people are protected from the employment of unsuitable caring for them. EVIDENCE: Safeguarding procedures now in place with changes made to the home’s policy and procedures, a copy of the Lewisham Local Inter-Agency guidelines in place and a copy of the government’s No Secrets guidance. Not all residents have been placed by Lewisham authority and therefore the manager is reminded of the need to obtain the Local Inter-Agency guidelines from other authorities who have residents living there. We spoke to two staff who understood their role in safeguarding people, as did the manager. There is evidence of the manager and one member of staff attending safeguarding training with Lewisham. There has been lots of work Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 21 with the Local Authority to ensure the manager and Provider are aware of their responsibility and to ensure they report any issues/concerns in this area. They also told us that they are now more aware of the need to report incidents under Regulation 37. We need to be assured that they will follow the guidance when such incidents arise. The manager/Provider also now must ensure they are fully aware of their responsibility under the Mental Capacity Act and Deprivation of Liberty. At the last inspection the complaints procedure was not accurate and did not give people the full information they may require to make a complaint about the quality of care provided. They have now amended this to reflect the requirements of the Regulations and a copy of the procedure is now in place in the Service Users’ Guide and on display in the hallway. People spoken to did not have any major concerns and felt that they could raise issues. Since the last inspection the Commission has not received any complaints which they or the manager has had to investigate. We have commented in the staffing outcome group our findings on the recruitment practices. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19,25 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely place that is clean, quite comfortable and generally safe. They would benefit from a home that is well maintained and decorated. EVIDENCE: We looked around the home, particularly to confirm that the requirements from the last inspection relating to the environment had been complied with, as stated in the improvement plan sent to us by the Provider. We found that the standard of the environment was adequate although there are some areas that need to be addressed. There is decoration required in places, the radiator covers that had been fitted over the last few months Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 23 should be painted. The first floor bathroom showed the repairs of tiles have taken place, screws taken out but needs further re-decoration to make it a nicer place for people to bathe or shower and there is still no bath for the able bodied person. Room 4 needs some re-decoration and one curtain needs replacement as it is in a poor condition. We saw that there is a maintenance programme in place 2009-2010 which we hope will be put into action throughout the coming year. The other bedrooms viewed were in good decorative condition and personalised. Two people sharing a ground floor room had some privacy by using a wardrobe to separate areas. Both individuals said they were happy with this. The lounge and dining room provide a nice homely space although the carpet needs replacing and this is in maintenance programme for 2009. The requirements relating to the fire doors and the wedging open of fire doors have been met. The manager/Provider have also put safes in people’s rooms to ensure personal belongings and money is kept safe. We also looked at the covered area in the room adjacent to kitchen. At the last inspection the inspectors required the manager to discuss with environmental health whether the proximity of the fridge freezer to the boiler was appropriate. They have covered the boiler and the inspector has seen the area and not made any requirements. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27,28 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in training mean that people are more supported by staff who have some understanding of their needs and are, in general, able to keep them safe. Recruitment practices need to be more robust to ensure people are protected from the employment of unsuitable staff. EVIDENCE: Staffing has not changed since the last inspection but what has changed is the number of people currently living in the home. With five residents there are generally two staff providing the care and support required. However, on this day there was one other staff member on shift as their training had been cancelled at the last minute. What must be remembered is the need to ensure that staff numbers are appropriate to the number of residents allowing for care, domestic and catering requirements. Also as important is the need to ensure that staffing levels enable flexibility in routines to ensure people receive the activities and stimulation they require. Whilst current levels are satisfactory this must be reviewed when the vacancies are filled. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 25 When we viewed the staff roster we found first names recorded only and it was not always clear who they are because they used different names to the names on the personal file. The manager said he would make the necessary changes to ensure it is clear. The roster also used an asterix to show staff responsibilities on each shift such as domestic and catering duties. We also noted that staffing in the home comprises in the majority of people from different ethnic background to those living there. The manager should where possible recruit some staff whose backgrounds meet those of the people being cared for. People were generally happy with the support and care provided by the staff working there. We received comments such as. “The staff are quite good they do what they can” “They’re nice people.” “The staff are very good – always very willing” “and If you need help, you get help.” People from the Local Authority who have been supporting the home told us that training has been accessed and continues to be accessed by the staff working in the home. We spoke to two staff on duty, plus the manager. They had an adequate knowledge and understanding of adult protection and food hygiene. The Environmental Health Officer also told us that they looked at food hygiene training for some staff but not all had yet undertaken. As most staff would be involved in food preparation at some time this is needed. When we looked at the training records we found there was no certificate in relation to the care staff member working that day and she was assisting in the kitchen. Training records are available on each staff file. However, once again it was not clear as to whether the training has been undertaken or training that is booked for people to attend. We discussed this matter and the manager has agreed that he will amend the records to make this clear. We found evidence of induction training with Lewisham, moving and handling, food hygiene and medication training. We advised the manager of the need to ensure bank staff also receive training, including refresher training. The record keeping would benefit from a training matrix to make clear who has done what training, when and when updates are required. They also need also to look at alternatives for training ie other training providers, perhaps working with other “small” homes to obtain training so that they are not reliant on the Local Authority, especially when there have been problems with training being cancelled at times. We looked at some staff files including new staff and a bank worker to determine the quality of the recruitment practices. These were adequate but need to ensure they are scrupulously checked. Checks had been completed with evidence in the files, including Criminal Records Bureau checks, proof of identity, photograph and references. In one of Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 26 these one of the references came from the niece of the applicant. This is not good practice. In the second one the references came from the previous employer but not clear as the designation of the referee which should be from someone in Human Resources or the manager rather than work colleagues who are perhaps friends. The references should also be validated. In the third which happened to be the son of the manager/owner one of the references was from a previous employer in care, stating he was a senor carer but this was not shown on application form and did not state where. Whilst we acknowledge that this is a relative we must be assured that robust screening and checks are completed and with consistency. We saw some records of supervision for staff with the exception of the bank worker. They must ensure these are also part of the process and that all staff supervised are formally every six weeks. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31,33,35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Providers have worked with other agencies to improve the way the home is managed and run so that people living there receive an improved quality of care. EVIDENCE: The previous inspection found that although the manager of the home had relevant qualifications he lacked management experience which impacted on the service provided. The manager and Provider have had the support of the Local Authority and firm of consultants over the last six months to improve the Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 28 quality of care as required at the last inspection. This support has been invaluable to them and has enabled them to progress well over the last six months and move from a zero star to one star rating at this inspection. With this progress the Local Authority agreed to continuing placements in the home. They will, however, still monitor the service to ensure they sustain the progress made and continue with their improvements. An improvement plan was sent to us telling us how they are planning to meet the requirements made at the last inspection. Many of these have now been met with the manager assuring us that they are working to ensure all are complied with. Those not yet complied with remain as requirements with timescales amended. We noted an improvement in record keeping, medication and recruitment practices and care planning since the last inspection. There are still improvements required but progress has been made therefore improving peoples’ safety and the care provided. Currently external consultants are monitoring the home. They are contracted for one year. The manager and Provider must look at other ways of monitoring the service, perhaps implementing an external quality assurance system. Questionnaires had been sent out to users and relatives in April and whilst no report compiled some of the comments made included: “I am glad that they can be in a small friendly place.” “There could be more 1-1 contact.” “The staff have always been very kind and friendly.” The manager/Provider must use the information to collate findings and report on the outcome detailing what action they will take to make any improvements required. We saw that there had been a residents meeting held on the 24th may 2009. Minutes displayed included discussion about the menus, plans for trips out and attendance at the local Church. Also discussed was a “happy hour” where people could have a sherry before dinner. A relatives meeting is planned for June 2009 and invite letters seen for this. The completed AQAA states that all the equipment used has been serviced and maintained as per the manufacturer or regulatory body requires. We spoke to the Environmental Health Officer who visited the home recently. They told us that they will achieve 3 “stars on the doors.” And that they need to have a proven management track history to score a higher rating. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 2 2 X X X x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 2 x 2 3 Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 6(a)(b) 5 Requirement The Statement of Purpose and Service Users’ Guide must be revised so that they both provide accurate information. Each resident must have a plan of care that reflects their healthcare needs and how these are to be met. This is so that peoples’ needs are clearly identified and addressed by staff working in the home. Medication practices must be improved to ensure peoples’ healthcare needs are met. This includes the recording of any medication carried forward from one medication period to another; that any prescribed medication has the date of opening, medication is disposed of in a timely manner and the practice for recording the use of homely remedies is improved. Support and Restraint: Provision must be made for complying with the Mental Capacity Act. DS0000071914.V375588.R01.S.doc Timescale for action 01/12/09 2 OP3 15(1) and (2) 01/12/09 3 OP9 13(2) 01/08/09 4 OP17 12(3) 01/12/09 Culverley Version 5.2 Page 31 This is so that the capacity of residents can be assessed by a competent person according to each decision to be made on their behalf. This requirement is repeated with the timescale of 30.03.09 not yet met. All staff working in the home, including bank staff must receive regular supervision. This is so that residents can be assured that staff are receiving proper supervision and appraisal of their work. Accounts: The Commission is to be provided with the owner’s annual accounts and business plan so as to demonstrate the viability of this care home. This is a repeated requirement with the timescale of 03/09 expired. Recruitment practices must improve by ensuring the required checks are made. Specifically, the references supplied are from legitimate sources and not family or friends and there is a system in place for validating the references. This is to ensure people are protected from the employment of unsuitable staff. 4 OP36 18(2)a 01/12/09 5 OP33 25 01/08/09 6 OP29 17 & 19 01/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Culverley Refer to Good Practice Recommendations DS0000071914.V375588.R01.S.doc Version 5.2 Page 32 Standard 1 OP2 OP3 2 3 4 5 6 7 8 OP13 OP19 OP21 OP27 OP27 OP33 Information should be made available in other formats The assessment format should be reviewed to ensure it contains information about all the information required by the standards People should be provided with more opportunities for community activities and visits outside of the home. Radiator covers should be painted to make a more comfortable environment. The bathroom should be redecorated to make it a more comfortable environment for people to bathe in. Staff rosters should include the full names and designations of staff employed in the home. Training records should have accurate details of the training that staff have undertaken. The manager should investigate the implementation of an external quality assurance system. Culverley DS0000071914.V375588.R01.S.doc Version 5.2 Page 33 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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