Please wait

Inspection on 16/02/10 for The Old Rectory

Also see our care home review for The Old Rectory for more information

This is the latest available inspection report for this service, carried out on 16th February 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

From the outcome areas we assessed at this visit we are satisfied that: There are enough staff available to support residents. Residents are safeguarded by good practise in regard to the recording of medication administration and any changes to this. Administering staff are trained to do so. Residents benefit from a sustained programme of mandatory staff training to ensure staff skills and knowledge are updated. Residents bedrooms are personalised with favourite and personal items and they have access to keys to their bedrooms although current arrangements are in need of review.

What the care home could do better:

This random assessment did not focus in depth on all outcome areas but has highlighted some serious shortfalls in some areas and requirements for improvement have been issued. These relate to the sub standard condition of the premises and the lack of sustained significant investment or planning for the upgrade of the premises. Staff have not maintained risk documentation to ensure support, interventions and risk reduction measures remain appropriate to safeguard residents from harm.There is a lack of awareness amongst management and staff of their individual responsibility to promote and protect themselves and residents from harm by actively assessing health and safety risks and acting to address them. Infection control is compromised by the general condition of the property and poor staff practise and could place residents health and safety at risk. We have required the organisation to implement improvements in these areas to improve health and safety measures in place. We have also made further recommendations and suggestions for improvement within the lifestyle outcome area where we consider outcomes for residents currently to be unsatisfactory and reminded the home of their responsibilities in regard to staff recruitment. We have made clear the need for the organisation to provide evidence that action has been taken to address the shortfalls within the timescales given and will monitor compliance with these requirements.

Random inspection report Care homes for adults (18-65 years) Name: Address: The Old Rectory Stubb Lane Brede East Sussex TN31 6EH two star good service 05/05/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michele Etherton Date: 1 6 0 2 2 0 1 0 Information about the care home Name of care home: Address: The Old Rectory Stubb Lane Brede East Sussex TN31 6EH 01424882600 01424882066 old-rectory@craegmoor.co.uk www.craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Parkcare Homes (No.2) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 16 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 16 The maximum number of service users to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Old Rectory is registered to accommodate thirteen adults with learning disabilities in the main house, and three adults in the cottage. The property is set in extensive grounds close to the village of Brede near Rye. Whilst Brede offers some amenities the village of Westfield approximately two miles away is used for shops and post office Care Homes for Adults (18-65 years) Page 2 of 15 0 5 0 5 2 0 0 9 Brief description of the care home facilities. The main property is a three-storey building and service users accommodation is now on all floors. The cottage is adjacent to the main house, is detached with all three bedrooms having en-suite facilities and a private garden area. The properties are owned by Parkcare Homes Limited, which in turn is owned by Craegmoor Healthcare Limited. The current scale of fees range from £581 to £1250 Care Homes for Adults (18-65 years) Page 3 of 15 What we found: The initial purpose of the random inspection of this service was to confirm that, areas of improvement identified at the last inspection and discussed with the then registered manager have been completed, in accordance with the assurances given at the time. Our visit confirmed that the service has made improvements to the way in which changes in prescribed medication are recorded on medication sheets, cross referencing of documentation provides evidence of appropriate authorisations for the changes. The leak previously noted from the first floor shower room, which was impacting on the carpet and flooring external to the shower, has now been resolved. Some improvement works have taken place but these have been reactive rather than planned, generally upgrading of the premises has not been maintained. Our visit highlighted a number of further shortfalls to the environment and ew have therefore revised a previous requirement to take account of the present condition of the home. Environment. When we visited the service last year we noted that lounge furniture was broken and in a poor state. At that time we were given assurances that replacement furnishings were already on order. When we visited this time we found residents sitting in the lounge on the same broken settees with other chairs and seats ,stained, discoloured and torn. We are advised the delay in supplying new furnishings has been as a result of a change in suppliers. We found loose wires running across the floor in the activity room posing a tripping hazard to residents and staff. A wheelchair was placed in the room but staff informed us this is rarely used and can be folded away. We acknowledge that this room is currently about to be decorated but was cluttered and not very appealing or well resourced to undertake activities. A free standing electric fan heater was located to the side of the door and the lead for this was located in front again posing a tripping hazard to residents and or staff. Staff were unable to locate a risk assessment for the freestanding electric fires. In the kitchen the cooker hood is marked out of use, discussion with staff indicated this has been the situation since early January 2010. Staff were unaware whether this is to be repaired or replaced and the timescales for doing so. With some minimal updating the dining room could be a bright pleasant area for residents to eat, however, one wooden table in particular is heavily scored and pitted on the table top and poses an infection risk, consideration should be given to covering the table top or replacing it. Stair carpet to the upper floors is worn on some of the treads and will need repair or replacement in the near future. On the whole bathrooms and toilets throughout the property are in a poor condition. Care Homes for Adults (18-65 years) Page 4 of 15 Ground floor: In a modernised downstairs shower room we found a pile of clean towels on a cupboard near to the toilet, for people who are to use the shower, unfortunately these are at risk from cross contamination being near to the toilet and being the only means of residents using the toilet to wipe their hands. There is a hand wash sink but no means provided to promote good hand washing by the presence of liquid soap or paper towel or hand drying facility. downstairs single toiletwe found this to contain a very rusty toilet stand with split paintwork, this was in poor condition and poses an infection control risk. The toilet which is used by male and female residents was without a toilet seat at our last visit and this remains unchanged, a portable toilet seat is available but residents cannot use the toilet independently with the seat in place because this is kept in a cupboard. 1st floorWe wished to check that repairs to a new shower room had been made to prevent excessive flooding onto the landing, we are satisfied that remedial works have been undertaken to rectify this problem, however the shower room concerned has no facility for staff engaged in personal care to wash and dry their hands or for residents to wash their hands. A radiator within the shower room is uncovered and also has an electrical earthing wire hanging down, which residents can easily access and pull off. The ceiling is in need of redecoration with split and flaking paint. A bulb in the light fitting needs replacement. We found that a small bathroom on a mezzanine level had been improved since our last visit in that a new toilet had been installed and a new light fitting, however, we found bath seals to be in a poor state, grouting was missing from tiling in some places, paintwork on the window and sill was flaking and chipped, all posing an infection control risk. A visit to a second small bathroom at the other side of the house on the middle floor highlighted cracked tiles and missing grouting, a toilet stand although in better condition has rusty bolts near the seat area and could pose a risk to residents if they scratched themselves on them. Like other areas of the house there is a an area of blown plaster and holes are forming in this. The bath panel was broken at the base. Two bulbs in the light fitting need replacement. The toilet roll holder was empty and new toilet rolls were inaccessible to residents on that floor without climbing or use of a ladder being kept on a high shelf about eight feet off the ground. Individual resident bedrooms are generally well maintained and personalised although these were not studied in detail. However: bedroom 4 - The door needs repair around the lock area where wood has been split and broken and this may be affecting the effectiveness of the fire seal on the door. Bedroom 3 top floor - extensive area of blown plaster outside bedroom door, large area of plaster has fallen away revealing the wooden lathes beneath. Care Homes for Adults (18-65 years) Page 5 of 15 Bedroom 1- The lock cover is loose and quite battered, edges are sharp and could injure the resident trying to get into their room using their key. First floor- Outside of the shower room is a large store cupboard with a door which has been pulled off, and placed inside the cupboard this is unsightly and poses a potential risk with exposed sharp edges. Infection control practises are not good within the home, on the day we visited we noted several laundry baskets located on floors which staff informed us contained residents dirty laundry, this was not sealed and other residents could have gained access to this. When we last visited the service. A new maintenance person had been appointed and was commencing a programme of covering radiators throughout the home, this is complete apart from the shower room, however none of the hardboard covers has been painted and this is unsightly. We spoke with the maintenance person who confirmed that he was commencing a programme of redecoration but only works three days per week. It will not be possible for the maintenance person to take on the sole responsibility for upgrading this property and the significant current shortfalls in the environment, in addition to the routine health and safety checks he undertakes as part of the maintenance role, and this work is being compromised as a result. During our visit we found a number of health and safety issues, highlighting the need for improved understanding and awareness at all levels of possible hazards, clear oversight by the management team is needed to ensure health and safety practise and procedures are adhered to and all staff need reminding of their responsibilities to themselves and to residents to be mindful of health and safety issues. The Cottage We found that the entrance hall radiator is tied to the wall top centre by use of a jagged piece of wire, this could be a source of injury to residents or any other staff or visitors to the home and needs a safe and more appropriate means of affixing the radiator to the wall. Downstairs toilet -this is currently out of action, the ceiling has been removed as floor boards in the room above are rotten and have been removed. Lounge/conservatory - settees very dirty with unpleasant staining on one large cushion. A large television which is no longer in use has been left on the floor of the lounge and needs removing. Downstairs bedroom - We noted a hole in the plaster of the stud wall and chipping to the plaster and paintwork on the corner of a wall. Upstairs- One resident bedroom is out of use entirely as much of the floor on one side has been removed in an attempt to resolve a long standing leak problem, this has subsequently highlighted extensive rotting of floor boards and these have been removed, the resident has been relocated in the mean time to another home. Care Homes for Adults (18-65 years) Page 6 of 15 A second upstairs bedroom still currently in use will as a result of removing a stud wall become unusable as that resident will no longer have access to their en suite toilet facilities. Alternative arrangements will need to be made to accommodate them elsewhere. In the dining area a large unsightly hole has been made in the stud wall by the door handle because a door stop has not been fitted. Although this is not an exhaustive list of deficiencies in the environment we have expressed our serious concerns at the lack of a sustained and planned programme of upgrading to the internal environment which further compromises the ability to maintain good infection control standards. Mindful of some of the improvements that have been made to the environment we have revised a previous requirement, and have issued specific timescales by which time the identified shortfalls within this report must be addressed, failure to comply with the set timescales may lead us to consider further enforcement action. Risk Assessment - during the course of examining resident files for evidence of medication change authorisation, we noted that individual risk assessments for residents we were case tracking some of whom have very challenging behaviour, have not in some cases been updated since August 2008. We discussed with the staff on duty what the present arrangements are for updating care plans and have been advised that this is happening however, the frequency of such reviews has slipped and does not routinely include re-evaluation of risk, we have expressed concerns about this and have issued a requirement for this to be addressed, and thereafter risk information to be updated in keeping with care plan frequencies or when risk levels change whichever is soonest. It is also important that the service is proactive in assessing new environmental risks where changes occur e.g the recent use of free standing electric fires, to ensure the health and safety of residents is promoted and protected at all times. Activity/educational programmes At our previous inspection of this service we recommended a review of activities for residents, concerned that they lacked adequate stimulation through activity and exercise. When we visited this time we found that despite six staff being on duty and available within the home, the majority of residents were located in the lounge without any activity other than the TV. This situation continued unchanged for the duration of our visit. From discussion with a senior staff member on duty and examination of the activity planner, it is clear that some service users are enjoying a more active lifestyle,however only one resident in the main house attends an activity every day. Four people attend 2 activities per week, and two people have one activity. Five people currently have no set activity at all. When we spoke with staff about those residents without activities we were advised that they do participate in activities in house and externally, however, when we examined the daily log for one of these residents we found that in the preceding eight days, the only Care Homes for Adults (18-65 years) Page 7 of 15 recorded activity they had participated in had been helping with their laundry, although the record of this was not clear as to how involved they are encouraged to be. Staff indicated they did not believe recording reflected accurately what was being provided for some residents and thought this to be an area that needs improvement. We have previously commented on the lack of accessible information to enable residents to have an understanding of what meals they are offered each day and to make choices and decisions about what they want to eat and whether alternatives are available. During our visit staff informed us that there is a picture version of the menu but this could not be found and clearly is not routinely used, staff also reported that they write the days menu on a white board in the dining room, but acknowledged that for most residents this would not be of little use. On the day we visited the board was not written on and showed no evidence of the previous days menu. We noted a handwritten menu for the week in the kitchen and this provided no choice or alternative options. It is our judgement that Residents experience less than satisfactory outcomes in this area overall, progress to improve things has not been made, and a staff culture exists that places the responsibility for providing residents with activities with the activities coordinator. Staff lack the leadership and guidance to help them develop a proactive and innovative approach to developing and promoting the independence of less able residents through in house and external activities over and above those provided by the activities coordinator. We have expressed our concerns at these shortfalls with the acting manager and area manager and continue to recommend that activity programmes are reviewed and a more stimulating programme of in house activities implemented to promote independence and reduce the level of boredom amongst residents. Staff recruitmentAlthough this outcome area has not been generally assessed, from our discussion with new staff we have noted that new staff continue to commence work at the home without benefit of a satisfactory CRB. Whilst ISA checks are being obtained we have reminded the acting manager that staff employment without CRB should be the exception rather than the rule, and only where the service can evidence it would be detrimental to the service if the staff member concerned did not commence work. A new staff member we spoke with reported that they unable to work unsupervised, however they were not working in a supernumerary capacity on the rota and were counted in the usual staff numbers, the home is not able to evidence at this time how supervison of staff without CRBs works in practise. We are advised that the appointed manager recently resigned and the deputy manager is currently acting up into this position. Recruitment to the post of manager will be commencing. We accept that the unsettled management arrangements at both local and area level may have attributed to the deterioration in the service with a lack of robust oversight by senior management. We have discussed the need for Regulation 26 visits to Care Homes for Adults (18-65 years) Page 8 of 15 be strengthened to ensure shortfalls are identified early and acted upon, and lines of accountability for asddressing the shortfalls made clear. We have highlighted several health and safety issues which came to our attention during the site visit, and the apparent lack of awareness among staff of possible hazards that may pose a risk to themselves and residents. Although staff have received health and safety training, there is a clear need for them to demonstrate greater understanding of health and safety issues within the working environment, and to take responsibility for implementing appropriate risk reduction measures or removing potential risks to residents. The majority of care staff and senior have received infection control training, this would not seem to have been effective as when we visited we found some poor practise from staff around management of soiled and dirty laundry, and this coupled with the deterioration in the environmental standards has placed residents at risk from poor infection control. As a result of our findings we have issued a requirement in respect of the registered person undertaking to promote and protect the health and safety of residents by ensuring that the environment is maintained in good order, potential hazards identified and risks from infection dealt with by the organisation through appropriate planning and resourcing and at local level by good staff practise. What the care home does well: What they could do better: This random assessment did not focus in depth on all outcome areas but has highlighted some serious shortfalls in some areas and requirements for improvement have been issued. These relate to the sub standard condition of the premises and the lack of sustained significant investment or planning for the upgrade of the premises. Staff have not maintained risk documentation to ensure support, interventions and risk reduction measures remain appropriate to safeguard residents from harm. Care Homes for Adults (18-65 years) Page 9 of 15 There is a lack of awareness amongst management and staff of their individual responsibility to promote and protect themselves and residents from harm by actively assessing health and safety risks and acting to address them. Infection control is compromised by the general condition of the property and poor staff practise and could place residents health and safety at risk. We have required the organisation to implement improvements in these areas to improve health and safety measures in place. We have also made further recommendations and suggestions for improvement within the lifestyle outcome area where we consider outcomes for residents currently to be unsatisfactory and reminded the home of their responsibilities in regard to staff recruitment. We have made clear the need for the organisation to provide evidence that action has been taken to address the shortfalls within the timescales given and will monitor compliance with these requirements. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 10 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 11 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered provider must 31/03/2010 ensure that assessment of risk for individual residents is routinely reviewed to ensure that risk reduction measures continue to be appropriate and relevant thereby safeguarding the individual and others from harm. Regulation 13(4)(c) The registered person shall ensure that: unnecessary risks to the health and safety of service users are identified and as far as possible eliminated so that individual service users and others are safeguarded form harm 2 24 23 The Registered Person shall 31/03/2010 undertake to implement a programme of upgrading and repair to address the environment shortfalls highlighted within this report within the given timescales. Care Homes for Adults (18-65 years) Page 12 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action A planned programme of maintenance to sustain improvement must be evidenced. Regulation 23 (2)(b) The registered person shall having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in good state of repair externally and internally. So that residents benefit from living in a safe, comfortable and well maintained environment 3 38 13 The registered person shall 31/03/2010 undertake to ensure that the health and safety of residents is promoted and protected through the manager and staff undertaking robust hazard analysis and elimination where practicable, and through good infection control. This is to be achieved by improvements to the environment and improved staff awareness and accountability, procedures and practise Regulation 13 (3) & (4)(a)The registered person shall make suitable arrangements to prevent Care Homes for Adults (18-65 years) Page 13 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action infection, toxic conditions and the spread of infection at the care home The registered person shall ensure that all parts of the care home to which service users have access are so far as reasonably practicable free from hazards to their safety. To safeguard residents from harm Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 Residents should be encouraged to develop their skills and independence through a programme of activity and occupation which may involve further education and should be facilitated by a proactive and innovative staff team New staff should not be commencing work at the home except in exceptional circumstances without a current CRB in place 2 34 Care Homes for Adults (18-65 years) Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!