Inspection on 07/08/08 for 87 Rectory Road

This inspection was carried out on 7th August 2008.

CSCI 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

87 Rectory Road 14/07/09

87 Rectory Road 14/11/07

87 Rectory Road 03/10/06

87 Rectory Road 23/03/06

87 Rectory Road 26/09/05

87 Rectory Road 31/01/05

87 Rectory Road 15/06/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE 87 Rectory Road 87 Rectory Road Pitsea Essex SS13 2AF Lead Inspector Carolyn Delaney Unannounced Inspection 7th August 2008 11:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 87 Rectory Road Address 87 Rectory Road Pitsea Essex SS13 2AF 01268 583634 01268 584347 f.winn@mcch.org.uk www.mcch.co.uk MCCH Society Ltd 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) Mr Francis Anthony Winn Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (7) 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: conditions will need to be reviewed 1. 2. To accommodate the five service users under the age of 65 years who have a diagnosed mental disorder (excluding learning disability or dementia). To accommodate the seven service users over the age of 65 years, who have a diagnosed mental disorder (excluding learning disability or dementia). 14th November 2007 Date of last inspection Brief Description of the Service: 87, Rectory Road provides accommodation, nursing care and support for twelve residents who have severe and enduring mental health illness. The home is a purpose built property with two floors and a passenger lift provides access to all floor levels. All bedrooms are single with ensuite facilities and there is a communal bathroom on both floors with a large lounge/dining room on the ground floor with a separate activities room. Residents are able to access a large garden/patio area and on-site car parking is available. The home has the use of a vehicle for transporting residents. The premises are situated in the mainly residential area of Pitsea, within close proximity of local shops and has transport links to Basildon and Southend-onSea. The current rate of fees is £1280 per week. Additional charges are made for hairdressing, chiropody, holidays, toiletries and activities. A statement of Purpose and Service User’s Guide is made available to residents. 87 Rectory Road DS0000036721.V369446.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 was a routine unannounced inspection, which included a visit made to the home between the hours of 11.30 and 19.35 on 7th August 2008. As part of the inspection process we reviewed information we have received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affect residents such as injuries, deaths and any outbreak of infectious diseases. People who live and work in the home were spoken with to obtain their views. Residents, staff and relatives were offered the opportunity to complete surveys as part of the inspection process. Five residents, two relatives and four members of staff completed surveys. During the site visit, records including residents’ care plans and assessments, and staff training files were examined. A brief tour of the premises was carried out and communal areas including lounge, dining room and bathrooms were viewed. In addition some residents’ bedrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. What the service does well: People living in the home are supported and receive care and treatment in respect of their mental health needs. The care and support that each individual receives is delivered in a way, which suits the person’s wishes. Where there are risks to a person’s health and safety these are well managed and staff intervene where appropriate but allow residents to remain as independent as their condition allows. Residents have access to opportunities for social and recreational activities within the home and the local community. Staff support residents to take holidays. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 6 People who live in the home say that they enjoy the meals provided and there is a good range of choices available. Residents also have the opportunity to eat out at restaurants and pubs if they choose. The home is clean and well equipped to meet the needs of the people who live there. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who move into the home cannot always be assured that their needs will be met. EVIDENCE: The assistant manager told us that there has been one person admitted to the home since the last inspection. This person was spoken with about their experience of the move but they could not remember details about this. Records indicate that this person had visited the home on a trial basis prior to being admitted. It was also evident that a review of how the resident had settled in to the home was carried out after the admission and that they were 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 9 settled and content. However on the day of the inspection the resident told the inspector that they ‘could not stand being there any longer’ due to the noise made by other people living in the home. These feelings had also been shared with staff and there were records made in the previous weeks that the resident was unhappy at the home. This person is younger than the majority of other people and finds it difficult to forge relationships with other residents but does have a good relationship with staff. On the day of the inspection some residents were verbally aggressive and noisy and this clearly upset the newest resident. Staff said that an assessment of this person’s needs had been carried out prior to their admission to the home. However this was unavailable on the day of the inspection so it was not possible to determine that all aspects of their needs, including their social and emotional needs had been assessed or that it had been determined how these needs would be met. Two of the three residents who completed surveys as part of the inspection said they had received a contract for their placement and had been given enough information about the home before they moved in so as to be able to decide if it would be suitable for them. The home does not provide intermediate or rehabilitative care. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home receive the medical care and treatment they require but cannot always be sure that personal care would be offered in the way that they would wish. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 11 EVIDENCE: Staff prepare a plan of care for each resident based upon the individual’s assessed physical and mental healthcare needs. The care plans for three residents were examined during the inspection. Information for how each person’s mental health needs were to be met were very detailed. These care plans described clearly how the individual’s condition manifests and how it affects their behaviour and mood. Residents’ perception and or awareness of their illness were also reflected in the care plans. Care plans for how residents are to be supported in respect of needs such as mobility, eating and drinking and maintaining personal hygiene were not so detailed or person centred. For example they did not include details of how the resident needed or wished to be supported. While most residents looked well cared for, some were noted to be wearing soiled and stained clothing and some resident’s nails were dirty which may detract from their general wellbeing and dignity. Two of the residents who completed surveys said that they get the medical support they need. Risks to residents’ health and safety were well managed and there were plans in place to minimise risks to residents of sustaining injuries from falls or accidents, developing skin damage due to reduced mobility and incontinence and risks associated with accessing the community. Residents have access to healthcare treatments and detailed records are kept in respect of treatments each person receives. There is a policy and procedure for the safe receipt, storage, administration and disposal of medicines and nursing staff who are responsible for dealing with medicines receive training periodically. The Medication Administration records for each person living in the home were examined. It was disappointing to note that these records were poorly maintained for ten of the twelve people living in the home. Staff had failed to sign medication records to indicate that residents had received medication on numerous occasions over the past three weeks. One senior nurse on duty said that this may well be due to the employment of temporary agency staff in the home who ‘forget to sign records’. Nursing staff were observed to administer medicines to residents at lunch and suppertime. Both nurses provided residents with water to take tablets with and ensured that residents had taken their tablets before completing records. It was of concern to observe the member of staff administering medicines at lunchtime leave the medicine trolley open and leave the dining room to go into a resident’s bedroom. This is unsafe and could potentially pose a risk to people living in the home. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 12 It was positive to note that residents’ preferences for the gender of staff they would wish to support them in maintaining their personal care needs was recorded and that staff mix reflected the gender mix of residents living in the home. One male support worker was spoken with and he confirmed that he supervised all residents and supported male residents with their personal care needs. Wherever it was possible information was obtained from residents as to how they would wish to be cared for if they become unwell and as they approach the end of their life as well as any specific wishes for arrangements following death. For example it was recorded for one resident where what music they would like to be played at their funeral service and where they would wish to be interred. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that their wishes for how they wish to spend their time and the activities they would like to participate in are met. EVIDENCE: The home employs an activities coordinator between 9am and 4.30pm each weekday. Residents who are capable and wish to do so have access to trips outside of the home such as meals out in local pubs and restaurants, shopping 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 14 trips and visits to Southend seafront. Each of the three residents who completed surveys said that there were activities in the home, which they could participate in. Risks to residents’ health and safety in respect of activities outside of the home are assessed and monitored regularly. On the day of the inspection two residents went to Colchester Zoo supported by staff. Both residents spoke with the inspector on their return and both said that they ‘had a good time’. One resident told the inspector that they visit family one day each week and go out shopping. Records showed that those residents who prefer to stay at home are provided with opportunities to participate in a range of activities such as painting, bingo, music therapy, and bowling. Residents are regularly asked as to what activities they enjoy and each month as part of the review of care and support give activities in which residents have participated in are reviewed and residents views are reflected in these reviews so as to ensure wishes are catered for. Some residents had recently attended a beach party at Southend and one person said ‘it was the best day out ever’. Residents who were spoken with said that they were looking forward to their garden party, which was planned for the end of the month. Resident’s birthdays are always celebrated with a party, which a number of residents said that they enjoy. Arrangements are in place so that residents who choose to have access to church services in the home on a regular basis. Menus are planned in advance and a wide choice of nutritious meals including fresh fruit, vegetables and salads is offered. The kitchen / larder was well stocked with fresh and frozen vegetables, fruits, meats, eggs and fish. At the time of the inspection the home’s cook was on annual leave and staff were taking it in turns to cook meals. Extra staff have been employed to take into account the extra demands on the team. Residents have a choice of cereals and toast for breakfast and a choice of two meals at lunch and supper. Residents who were spoken with said ‘the food is good’ and ‘yes I like the food’. Two residents who completed surveys said that they liked the meals provided. Lunch and supper meals were observed during the inspection. As a treat residents had burgers and chips from Mc Donald’s, which they all appeared to enjoy. Residents who required a soft diet due to inability to chew or risks of choking were cooked a meal of fish loins in parsley sauce, mashed potatoes and sprouts. At supper residents had a choice of Cornish pasties or scrambled eggs. Records confirmed that residents’ weights are regularly monitored and specialist advice from healthcare professionals such as dieticians and speech and language therapists is sought for individual residents as required. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are listened to and staff act to address any issues. Residents are safeguarded and protected from harm. EVIDENCE: People living in the home have information about how to make complaints and they have the opportunity to air their views at regular residents meetings. Each of the three people who completed surveys said that they knew who to speak to and how to make a complaint they if were unhappy. There has been one complaint made since the last inspection. At the time of this inspection this had not been documented in accordance with the organisation’s complaints procedure. Staff said that as they had not received complaints that they were unaware of the forms to complete. A resident’s family had made the complaint because they had not been informed of the resident’s admission to hospital. The complaint was made verbally and there was evidence that the assistant manager had apologised to the family. During the inspection the relevant documents for logging complaints were located and the complaint was recorded appropriately. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 16 There is a policy for protecting residents and safeguarding them from harm, neglect or abuse. Residents were seen on the day of the inspection to be treated in a sensitive manner by staff. In particular staff were observed to manage residents outbursts of verbal aggression in a calm and effective way, which did not aggravate the situation. It is the organisation’s policy that all staff undertake safeguarding training every three years. An examination of staff training files indicated that some staff were overdue their training updates. The assistant manager said that these staff were due to undertake this training in September. Staff who were spoken with and asked how they would deal with any witnessed ill treatment of residents said that ‘they would tell staff to stop and report the matter to the senior staff in charge’. Residents who were spoken with said that ‘staff are nice’ and ‘staff are good to me’. A review of accident records indicated that there are few falls and accidents or injuries to residents. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home enjoy comfortable and clean communal and private accommodation, which is suited to their individual and collective needs. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 18 EVIDENCE: The home is purpose built and offers residents single bedroom accommodation with ensuite toilet and hand washing facilities. Bedrooms are situated over two floors with access via stairs and a passenger lift. Residents’ bedrooms, which were viewed, were noted to be clean, and free from unpleasant odours. Residents had items of personal belongings such as photographs and ornaments. The home employs domestic staff to clean communal and bedroom areas, all of which were clean on the day of the inspection. Two of the three residents who completed surveys said that the home is always fresh and clean. There is a large communal bathroom on each floor, which is equipped to meet the needs of residents. Hot water temperatures are checked regularly so as to minimise risk of injury to residents. Staff have undertaken infection control training and there are sound measures in place so as to minimise the risk / spread of infectious diseases in the home. Visitors to the home are encouraged to use the hand sanitizer on entering and leaving the home and there are sufficient hand washing facilities for both residents and staff. Equipment in the home is well maintained and checked regularly for signs of wear and tear. Staff regularly carry out checks of the environment and equipment and report any faults etc. One of the homes heating boilers has been decommissioned due a gas leak and the ventilation duct in the kitchen requires work. While these issues do not impact directly on residents at this time they are outstanding for some months, and may cause problems when the weather becomes colder. The problem with the boiler was identified in the previous inspection report. Areas of the home, which pose potential risk to residents such as the laundry and sluice areas, are locked, as are the storage spaces for chemicals such as cleaning materials, which may be hazardous if ingested. Staff have also received training in respect of handling and storing such substances. Residents have access to a communal lounge dining area, which leads out to a secure and well-maintained garden area. Some relatives have commented that staff could encourage and support residents to make more use of the garden when the weather is good, however staff say that many residents do not wish to use the garden and prefer to stay inside. There is also a small activities room, which has a personal computer and printer for residents use. The home has a no smoking policy and residents who wish to smoke may do so in the garden area. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The shortage of permanent staff and heavy reliance on the use of temporary agency staff impacts upon the support that residents receive. EVIDENCE: The assistant manager told us that the minimum staffing levels for the home at the time of the inspection were one registered mental health nurse and three support workers in the morning, one nurse and two support workers in the afternoon / evening and one nurse and one support worker at night. A copy of the staff duty rota confirmed that so far as possible these levels were maintained. However due to two unfilled vacancies, high staff sickness levels, and staff annual leave, the home is heavily reliant upon temporary agency staff to cover. Usually the agency supply staff who are known to the home and who have knowledge and understanding of residents’ needs. Two agency 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 20 members of staff were spoken with during the inspection. One had worked at the home on a number of occasions and could demonstrate that they knew residents and how best to support them. The other had worked at the home once previously. However on occasions staff who have not worked at the home are supplied. The manager and / or assistant manager are usually supernumerary so as to manage the day to day running of the home but have had to cover some shifts where the agency have been unable to cover. Two of the three residents who completed surveys said that staff usually listen to them and are available when needed. It is the practice that permanent staff will cook to cover for when the permanent cook is on leave and agency / bank cover support residents. This can mean that people who do not know residents that well are providing support and can further impacts upon the level of work that permanent staff have to do and the support that residents receive (as described in the Health & Personal Care section of this report). Six members of staff including the assistant manager were spoken with throughout the day. It was clear that the staff team work very well and support each other. Three members of staff felt that more staff were needed due to the deteriorating physical and mental condition of some residents due to the ageing process. Two people have been recruited to work at the home in the past twelve months. There was documentary evidence of identity and a record that a Criminal Records Bureau (CRB) disclosure had been obtained for both persons as part of the recruitment process. As there is an arrangement between the Commission and MCCCH that records in respect of staff recruitment will be held centrally and not on site in the homes, it was not possible to assess this standard fully. However staff working in the home appeared to suited to their roles and to support residents appropriately. We will arrange to assess recruitment practices by checking records at the organisations head office. The organisation has a structured programme for staff development and training including training for support staff in National Vocational Qualifications in care. Training and development files for seven people working at the home were viewed and there was evidence that staff are trained in safe moving and handling practices, infection control and food hygiene, fire safety, first aid and safeguarding people from harm. In addition some staff have undertaken care planning and risk assessment training, managing conditions such as diabetes and epilepsy. Staff working at the home have or are working towards their National Vocational Qualifications and one of the nurses is a trained assessor and has time dedicated to supporting staff. Residents could not tell the inspector if they considered staff to be skilled and competent but those who were spoken with did say ‘staff are good’ or ‘I like them’ 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home generally benefit from a well-managed service. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager has considerable care home management experience and is qualified as a Registered Mental Nurse. At the time of this inspection the manager had not been working in the home for some weeks. Staff said that he had been working in one of the organisation’s other offices. However, we were informed shortly after the inspection visit that the manager had been temporarily removed from the home while an investigation was carried out as there had been some issues identified. The home’s assistant manager who was recently promoted to this position was overseeing the day-to-day running of the home. The assistant manager was available and assisted throughout the inspection. Due to the staff shortages the assistant manager was required to provide ‘hands on’ cover in the home, which took her away from other management duties and the development of her new role. During the inspection the assistant manager said that their priorities were to ensure that there were enough staff on duty and that residents are cared for. There are clear lines of communication and accountability within the staff team and they all work well together. Residents and their relatives’ views are obtained through regular meetings and the use of questionnaires. The most recent relative questionnaires were completed in January 2008. Generally comments were positive. Relatives commented that they ‘were happy with all aspects of care’ and that ‘staff are always helpful and happy’. Resident’s monies / personal allowances are held on their behalf in a secure place in the home. Residents can access their monies when they wish and there are checking procedures in place so as to minimise mishandling of monies. A random sample of residents’ monies were checked and found to be in accordance with records and receipts. There is a system in place for regular supervision of care staff. Records indicate that support staff receive regular supervision so as to monitor practice, identify any issues and assess any training or development needs. However, the manager is responsible for supervision of nursing staff and this is not carried out consistently or regularly. Generally systems and equipment necessary such as lifting equipment, fire detection and fighting equipment and gas and electrical installations for the home are well maintained, regularly assessed for signs of damage, serviced and repaired as necessary. However the boiler, which was decommissioned at the time of the last inspection due to a gas leak, has still not been replaced and smoke detectors have not been fitted to some areas of the home as 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 23 required by the local fire authority. It was reported in the last inspection that these issues had been referred by the manager to the registered provider for action on numerous occasions. It is of concern to note that these issues which could have an impact upon the welfare and safety of residents and staff have not been addressed in a timely manner. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 24 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 X 2 3 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 4 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 2 37 X 38 2 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement Timescale for action 30/09/08 2. OP27 3. OP38 Staff must ensure that they complete all records in respect of medicines administered to residents ensure that medicines kept in the home are stored securely at all times so as to minimise risk of mishandling and errors. 18(1) (a) (b) Staff must be employed to work in the home in suitable numbers for the needs of people who live there and the manager should implement systems so as to minimise the impact of the high use of agency staff on residents. 13(3)(4)23(2) Suitable temperature levels for the heating must be provided to meet residents’ needs at all times. This is to ensure that residents are comfortable in the building and the heating system is safe to use. This is an outstanding requirement from the last inspection and the previously 30/09/08 31/10/08 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 26 4. OP38 23(4) set timescale of 31/01/08 has not been met. Adequate fire prevention 31/10/08 measures must be installed on the premises in accordance with the advice given by the fire officer, including additional smoke detectors where required. This is to ensure residents and staff are able to be fully alerted against the risk of fire. This is an outstanding requirement from the last inspection and the previously set timescale of 15/01/08 has not been met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP27 Good Practice Recommendations Care plans for how residents are to be supported with their physical needs should be person centred to help promote residents choice. An additional cook should be appointed to cover weekends. This is to ensure that care staff are available to give priority to the care and support of residents. All staff in the home should receive regular supervision so as to monitor practice, provide support to staff and identify any issues. 3. OP36 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 87 Rectory Road DS0000036721.V369446.R01.S.doc Version 5.2 Page 28 - 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. 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