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Inspection on 25/09/08 for Aquarius Nursing and Residential Care Home

Also see our care home review for Aquarius Nursing and Residential Care Home for more information

This inspection was carried out on 25th September 2008.

CSCI found this care home to be providing an Adequate 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

The service employs two activities co-ordinators who are available to plan and arrange a wide variety of entertainments for people on both a one-to-one basis and in groups.

What has improved since the last inspection?

The home`s record keeping has improved generally, with clearer care plans, accurate medication files, up to date and accurate staff recruitment files and the amended and revised statement of purpose all seen as part of the inspection process. People are being appropriately supported to access both health and social care services outside of the home. Staff are being provided with access to training that should ensure they become more familiar with the process for safeguarding people`s wellbeing and welfare. Staff training records and staff recruitment files as mentioned indicate that a more structured and robust approach is being taken to the management of staff.

What the care home could do better:

The staff should consider whether or not they require the consent of relatives/representative of the service users when implementing a risk assessment or whether using them as a source of information is more appropriate. The service must also review its practice of using generic risk assessments for people, as this ignores their unique traits and their individuality, which means each situation or risk faced by the person will require a different and individual management plan. The nursing staff also need to ensure effective systems are established for monitoring requests from external professional for changes to people`s health care management, staff having no process for tracking or reminding them to chase up external agencies. Efforts must be made to ensure that all aspects of the service users rights to privacy and dignity are promoted. The service must seek to recruit a permanent manager and to submit an application in support of this person`s Registration as Manager. The home`s quality assurance system needs to be developed so that it informs and improves outcomes for people living at the service.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Sims     Date: 2 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Aquarius Nursing and Residential Care Home 4 Spencer Road Southsea Hampshire PO4 9RN (023)92811824 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Qualitycare Management Ltd Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 38. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home The Aquarius Nursing and Residential Care Home is a care home providing nursing care for up to 38 people over the age of 65 years who suffer from mental frailty, mental disorder, excluding learning disabilities. The Aquarius is the only care home owned by Care Homes for Older People Page 4 of 34 Over 65 0 0 38 38 38 0 Brief description of the care home Quality Care Management Ltd. The home is located in a residential area of Southsea, close to the sea front and the local amenities of the city of Portsmouth. The home consists of three large houses that have been joined together as a large town house. There is a pleasant courtyard at the front of the house and an enclosed patio area at the rear of the home. Nine of the eighteen single bedrooms have en-suite facilities. There are ten double rooms seven of which have en-suite facilities. There is a passenger lift fitted from the ground floor to the first floor only. Chair lifts are in place on some of the other flights of stairs that access other floors. Rooms that have been identified as having only access via a flight of stairs can only accommodate service users who are fully mobile. There are extra charges for items such as chiropody, hairdressing, toiletries, which are not included in the fee. The current fee charged is £560 - £870 per week. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over 9 hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, the Commission’s database and the Annual Quality Assurance Care Homes for Older People Page 6 of 34 Assessment information provided by the service provider/manager. What the care home does well: What has improved since the last inspection? What they could do better: 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 34 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives are being provided with the information needed to choose a home that will meet their needs. Evidence: At the time of the inspection a representative of the provider organisation informed us that the statement of purpose document had not yet been reviewed and updated. However, the improvement plan returned to us following the last inspection, indicated that the service would be producing a new statement of purpose document and forwarding a copy to us by the end of the week commencing the 22nd August 2008. A copy of this document was emailed to us, indicating that the statement of purpose had been revised and updated on the 20th August 2008. A review of this document established that it provides an appropriate level of information for the service users, Care Homes for Older People Page 11 of 34 Evidence: their representatives and visitors to the home. During the inspection we reviewed the tool used when assessing new or prospective service users and considered information gathered on people already residing at the home. The care plans of five people were reviewed during the fieldwork visit, although none contained a pre-admission assessment, the staff indicating that information from the service users files was archived when no longer required on a day-to-day basis, the assessments were not requested during the visit. However, a range of assessment documents were being used by the home to ensure the care being delivered was meeting the service users needs: waterlow tissue viability assessments, Malnutrition Universal Screening Tool (MUST) and the Barthel dependency assessment. The plans also contained correspondence from professional sources; discharging hospital wards, care managers and reviews undertaken with the acting manager, the service user and their families, to ensure the service was continuing to meet their needs. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are being put into practice but are not as yet firmly embedded in practice. Evidence: As stated above five ‘service user plans’ were reviewed during the fieldwork visit and found to contain a variety of assessment tools, including: the Barthel dependency assessments, MUST nutritional assessments, moving and handling assessments, a waterlow tissue viability assessment, mini mental test, and weight and Body Mass Index (BMI) calculations. The acting manager had also re-introduced the daily care plan or personal preferences document, which provides an overview of the persons’ daily routine and their known likes and dislikes; and a night plan, which sets out their even or bedtime routines. These documents were found to be a useful tool, which provided a great deal of insight Care Homes for Older People Page 13 of 34 Evidence: into the care and support required by the service user on a day-to-day basis. The ‘service user plans’ also contained photographs to aid staff identify the person the plan related to, a sheet which sets out the core principles of the Mental Capacity Act, although none of the individual care plans reviewed during our visit contained an assessment undertaken in accordance with this Act, the care plans and risk assessments. The care plans are relatively detailed documents, which are divided into daily activities, i.e. activities, personal care, management of continence. The plans provide a reasonable level of instruction for the care and nursing staff around the support required by the person, an example being an activities plan which, identifies the persons’ known likes and perceived enjoyment of company and which has resulted in the staff being directed to assist the person to come to the lounge most mornings, although they are reminded via the plan to ask and/or attempt to establish the persons’ wishes each day. This is a big step or improvement for the service user, whose records indicate that previously the person had been confined to bed rest and had little social stimulation other than that supplied by a radio, family visits and staff. The care planning files also contain documented evidence of the reviews being arranged and carried out by the acting manager, the reviews involving the service user, their relative or advocate and the acting manager, who runs through the persons’ current care needs and ascertains everyone’s agreement to the plans produced. Risk assessments are being completed, although a more individualised approach could be used, with many of the plans reviewed noted to contain generic risk assessments, for the use of the stair climbers, wheelchairs, etc. The staff are also failing to consider the action or activity the person is involved in, which is contributing to an increased risk of harm, an example being the bedrail assessments, which often do not consider why the person needs a bedrail or their suitability to have a rail fitted, i.e. are they mobile and therefore able to climb over the rail. The staff have also adopted the practice of seeking or gaining consent from relatives and/or advocates when using equipment like bedrails, etc. Care Homes for Older People Page 14 of 34 Evidence: The assessment process is a professional activity, which should take into account the person’, their representatives and external professionals views or observations but which ultimately remains the decision of the professional carrying out the assessment based on the information or evidence gathered. People are being well supported with their health care, the records documenting people’s involvement with opticians, incontinence nurses, general practitioners, dentists, community nurses, dietician, occupational therapist and chiropody/podiatry services. Within the nursing office was a list of people assessed as requiring fortified drinks and meals, the five people’s care plans reviewed were all on the list and each contained evidence of their involvement with the community dieticians and the recommendations made by this professional team. One issue was identified whilst reading through the plans, where the dietician had asked or suggested that the introduction of ‘Sanatogen Gold’ would benefit the person. However, the general practitioner had advised that this medication was not available in a liquid form and requested that the staff ask the dietician to recommend an alternative. The records indicate that the staff team contacted the dietician and that they said they would arrange, via the general practitioner for an alternative medication/supplement to be prescribed. However, since the 15th September 2008 nothing has happened and no one has chased up the general practitioner or dietician, our visit occurring on the 25th September 2008. The staff nurses spoken with said they would address this issue and did ensure it was entered into the diary for chasing up the next day. It is important given the homes’ recent history that such occurrences be avoided, as potentially such events could be detrimental to the persons’ wellbeing and reflects that whilst improvements have been made the need to embed good practice in general practice remains. The review of the homes’ medication system established that all medications are correctly held and secured. The medication administration records (mar sheets), were generally well maintained and accurate. Medication stocks are kept to a minimum and records indicate that the home’s Care Homes for Older People Page 15 of 34 Evidence: medication fridge is checked on a daily basis to ensure it operates within safe and acceptable parameters. Staff observed administering medicines did so safely and appropriately, taking the medication to the service user, administering the medicine and then returning to sign the medication record. The quality manager is now undertaking random weekly audits of the homes’ medication system over a four week cycle, one week reviewing the records and practice of staff administering medicines on the floor. Then reviewing the management and security of the controlled drugs and finally undertakes a complete audit of the system on the fourth week, records were available to verify or confirm that the checks had been undertaken. The quality manager has also introduced a running total checking system for all medications that are not subject to the normal twenty-eight day cycle, this enabling the home to monitor its stock levels and maintain an accurate balance of the medicines received against those used. A ‘Homely Remedies’ system is also in place and details of the medications agreed for use by the service users general practitioner was available, the listed including: Paracetamol, Senna, Benylin, Vicks Vaporub, Merocets, Lemsip, Gaviscon, Rennies, and Dioalyte medications. Efforts to promote both privacy and dignity for service users was evident throughout the fieldwork visit with all bedroom doors now fitted with locks, that can be secured internally but opened externally in the case of emergencies. The locks should meet the needs of the majority of the people to reside at the home, as their design is simple and the locking device large enough to be usable and/or suitable for people with dexterity problems. Shared bedrooms were noted during the tour of the premise to contain screens for use during the delivery of personal care. Staff were also observed during the fieldwork visit helping a person up from the floor after they had slipped from their chair. Prior to commencing and/or completing the lift the staff placed a screen around the area to restrict other peoples view, promoting privacy and dignity for the person throughout the incident. Care Homes for Older People Page 16 of 34 Evidence: The service user plans also contain details of peoples preferred terms of address and the files are maintained within the nursing office, although this room is accessible to everyone in the home. However, some additional issues, which underpin the fact that any improvements have yet to be embedded in practice, were observed during the fieldwork visit. Peoples health monitoring tools/charts found outside their bedrooms in the corridors during the tour of the premise. Some communal toilets have two doors, one of which leads into the service users bedroom, whilst the other opens on the corridor, which if you were planning to use the facility means remembering to lock two doors in order to prevent other people accessing the room during use. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are making limited choices about their life style. Social and recreational activities are being provided that are meeting peoples individual expectations. Evidence: The service now employs two activities co-ordinators who were both on duty during the fieldwork visit and were observed interacting with the service users. Efforts are being made by the staff to develop individualised social activities care plans, with each of the five plans reviewed containing an activities plan. The plans seen are still being developed however, the staff are managing to think about people’s social care needs and identify the need to support them achieve their own goals or wishes, even if these are not readily communicated. An example being that already quoted above, which ‘identifies the persons’ known liking for and/or perceived enjoyment of company, which has resulted in the staff being directed to assist the person to come to the lounge most mornings, although Care Homes for Older People Page 18 of 34 Evidence: they are reminded via the plan to ask and/or attempt to establish the persons’ wishes each day. Another example is that of a person who is perceived to be isolated within their bedroom as they ‘prefer to spend time in their room watching telly, regular checks are required as they cannot use the call-bell system due to memory loss, the activities coordinator has been involved with the person (was named) on a one-to-one basis. In addition to providing direct stimulation for people the activities co-ordinators are also involved in planning and arranging events and visits by external agencies or entertainers. During the fieldwork visit the co-ordinators were observed setting up and decorating the lounge for a service users birthday and escorting a visiting Aroma Therapist around to see their clients. During a discussion with an activities co-ordinator it was established that recently they have introduced theme days, which they hope to arrange or organise every third month, the theme days being large events involving the entire household. A recent theme day being red, white and blue, when everything was as the day states, red, white and blue, which apparently was a huge success and enjoyed. The co-ordinators have also commenced the process of negotiating with the local theatre company in order to secure places at the opening night of their Christmas Pantomime performance. Results of surveys conducted by the home indicate that generally people are happy with the level of entertainment and stimulation provided at the home some people did indicate that more outings would be nice. During our visit a number of visitors were observed arriving at the home and being welcomed by the staff team, all visitors are required to sign in and out of the home. Details of the homes visiting arrangements are contained within the statement of purpose document, sent to us on the 20th August 2008. In discussions with staff it was established that visiting arrangements are open and that people are welcome to visit at times that meet their and their next-of-kin’s needs. Relatives are provided with the opportunity to discuss issues of concern either at the Care Homes for Older People Page 19 of 34 Evidence: relative meetings or to make comments via the home surveys; records from both sources indicate that people are generally happy with the home’s visiting arrangements. The fieldwork visit was conducted over nine hours, which enabled us to observe both lunch and teatime routines. Meals are served both in the main dining room, which is unable to seat all of the home’s occupants, a second smaller dining area which is situated off the main lounge, people’s bedrooms and the lounge. Staff were noted to be deployed in teams with some people assigned to support those people who require assistance eating, whilst the remainder of the team served the service users. Details of the days’ meal are advertised on a notice board outside the kitchens, although not everyone can access the area to refresh or remind themselves of the daily choices. Meals looked appetising and well balanced with pureed or soft diets served in individual portions. Staff did report when asked that the residents’ were asked about their choice of meal in the morning, which helps remind people of the daily choices. During the observation of the lunch period one service user was seen to leave his dinner without having eaten anything. The staff serving the meals also witnessed this and approached the person to ask if there was a problem and if they would like something else. A little while later the service user was observed being provided with cheese on toast. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to an effective complaints procedure. Staff are being trained to protected people from abuse and promote their rights. Evidence: Service users are provided with information about the home’s complaint process, via literature provided for them in their bedrooms, which contains details of the process. When looking around the home it was established in each room that we visited that copies of the homes’ literature was available to the service users and/or their relative, visitors or representatives. The home has a complaint logging system, which indicates that two complaints have been received since the last inspection and that these concerns have been investigated, responded to and resolved. A concern identified during the last inspection was the lack of training provided to staff on the ‘safeguarding of vulnerable adults’. On arriving at the home it was noticed that an advert in the nurses office indicated that a training and development event had been arranged for 14:30 that day, 25th Care Homes for Older People Page 21 of 34 Evidence: September 2008 and the topic to be addressed was: ‘Abuse in the Elderly POVA’. On checking through the staff training and development records it was established that several staff had completed safeguarding or adult protection training earlier in the year. However, given the homes involvement with the Local Authority and the requirement made by us to ensure that all staff receive updated safeguarding training, it was surprising to note that training around this subject was staggered and not delivered in or around the sametime to ensure all staff were appropriately skilled and aware of their role in safeguarding the welfare and wellbeing of the service users. It was noted in the main administration office that details of the Local Authority ‘Safeguarding Adults’ policy and procedure are available to staff. However, the home’s recent involvement with the ‘Local Authority Safeguarding Team’ has not come about due to reports made by themselves but as a result of our intervention and concerns with the day-to-day delivery of care. The Local Authorities involvement with the home, at the time of writing this report had not been concluded and whilst we feel improvements have been made these, as stated previously need to be embedded in practice and sustained. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the contributes to restrictions in mobility and freedom of movement, however, it is clean, comfortable and well maintained. Evidence: During the fieldwork visit we looked around the home in the company of one of the provider organisation directors. The home was generally well maintained throughout with the décor in the bedrooms, corridors and communal areas of a reasonable standard. The service offers a mix of single and shared accommodation. Rooms that are shared have access to additional screening to ensure privacy is promoted during the delivery of personal care. All bedroom doors have been fitted with locks, that appear suitable for use by the occupant should they wish and which still allows the staff to gain access in case of emergencies. Several rooms have second doors that open straight onto or into a communal toilet, which in the past might have been considered a form of en-suite. Care Homes for Older People Page 23 of 34 Evidence: However, as discussed with the representative of the provider, having two or more doors leading into a communal bathroom or toilet could lead to invasions of privacy and it would be advisable to permanently block of the second doorways to avoid this occurring. The service users accommodation is provided on three different levels, the result of the home having been created by joining previously individual dwells to create one premise. This has lead to a large number of stairways being located around the home, which can for less mobile service users restrict their independence. In order to combat these restrictions the service has had a passenger lift installed, which covers the ground and first floor and a series of stairlifts, which cover additional floors. There are however, a series of smaller steps around the home, which are neither covered by the lift or stairlift and which can only be negotiated by some service users via a stair climber. The communal lounges provide adequate social space for the service users, although dining room space is a little inadequate and not suited to sitting all of the service users in one sitting. The home is generally clean and tidy throughout and people’s bedrooms free from odours or unpleasant smells. A separate domestic staff team is employed to keep the home tidy and members of the team were observed working around the home during the fieldwork visit. The home also employs a separate laundry person and the laundry is sited externally of the home, with access via a door that passes through a corridor adjacent to the kitchen. This issue has been raised with the service previously and steps taken to ensure that cross contamination is not possible. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and provided in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: The homes duty rosters were reviewed during the fieldwork visit, indicating that seven care staff and two nursing staff are on duty each day shift and three carers and one nurse at night, for 29 residents. The rosters also establish that day staff work twelve-hour shifts, commencing work at 07:30 hrs and end at 20:00 hrs, whilst the night staff work from 20:00 hrs to 08:00 hrs. In addition to the care and nursing staff the roster also indicates that a member of the management team is often available within the home, either the acting manager or quality manager and that a one of the activities co-ordinators is available five days a week. The home has a separate roster for ancillary staff, which maps out the working patterns of the catering staff, domestic staff and laundry personnel. Care Homes for Older People Page 25 of 34 Evidence: Observations made throughout the day tended to support the fact that sufficient staff are employed at the home and that the needs of the service users are being meet, with nursing staff, care staff, domestic, laundry, catering and administration staff all seen around the home during the fieldwork visit. Training records are now being maintained and five records were scrutinised during our visit. The records inspected indicate that staff training is still an issue for the home with one persons records only indicating that they had completed moving and handling training this year, whilst other staffs records established that they had accessed a variety of courses: continence management, Mental Capacity Act training, Fire Safety, Equal Opportunities and Diversity training, Dysphasia Awareness, First Aid, Sensory Impairment, Health and Safety and Dementia Awareness. As mentioned earlier in the report it was also noted on arrival at the home that a staff training session was planned for that day on safeguarding adults, an advert observed on display in the nursing office. The dates of the training events recorded by the staff indicate that work has been undertaken on improving access to training since out last key inspection, with over 60 of the courses documented occurring after May 2008. The staffing files of three newly recruited staff were reviewed during the fieldwork visit. The files of these new employees were found to contain all of the required checks, Criminal Records Bureau (CRB), Protection Of Vulnerable Adults (POVA) and two references. The files also contained completed application forms, health declarations, photographs of the employee, job descriptions and terms and conditions of employment and information used to support the CRB application process and establish the persons’ identity. The pre-employment files of two prospective staff were also considered, as the administration manager had indicated that a new checklist was in operation, which was designed to document when information was requested, i.e. the references and when they were either received back or due to be chased up. These file were in the early stages of being processed however, there was evidence that work permit applications had been submitted and that requests for the staff to Care Homes for Older People Page 26 of 34 Evidence: complete CRB applications sent out. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not have a registered manager, which has been the case over a long period and can be a contributory factor to a services historic poor performance and inability to sustain improvement. Evidence: The service continues to operate without a Registered Manager in post, despite the efforts of the organisation to recruit a suitable person. The Responsible Individual, for the provider organisation had undertaken to submit a managers application following the last inspection, however, this has not occurred and it is understood that they have now reconsidered this option. The Responsible Individual indicates that it is her intention to continue acting as an unregistered manager, until a prospective Registered Manager is recruited. The Responsible Individual is being supported in the role of unregistered manager by the provider organisation, the administration manager, the support services manager and Care Homes for Older People Page 28 of 34 Evidence: the quality manager. Whilst this management team is in place, it remains a fact that there is no one, in overall day-to-day managerial control of the home who is legally accountable for practice issues and the delivery of the service. However, each member of this team, led by the Responsible Individual has worked to ensure that there are improvements in key areas of care practice, as reflected within this report. The Responsible Individual has reviewed each service users care plan in consultation with families and external professionals to ensure that care planning responds to peoples needs and choices. There are also significant improvements in the recruitment of staff, their supervision, and the organisation of the day-to-day running of the service in the best interests of people living in the home. The Responsible Individual continues to work to recruit a suitable prospective Registered Manager for the service. The Responsible Individual and quality manager have been involved in overseeing improvements in the home’s management of service users medications, as discussed earlier and also the auditing and tracking of accident and incident trends. Records associated to both these events containing evidence of review and analysis by the quality manager. The services general approach to quality assurance is reasonable with staff involved, as indicated above, in auditing medication records, accident and incident records and care planning records. There is evidence, in the form of minutes and forthcoming schedules, of meetings having been arranged for residents, their relatives and the various staff team groups. Surveys are also being circulated to service users and their relatives and copies of their responses retained, by the management team, for reference purposes. What is unclear is what all of this useful and informative data is used for, as there is no apparent evidence that the information is interrogated or used at any later date, leading to a situation whereby the quality assurance system becomes ineffective, as it does not inform practice, although the Responsible Individual does say that reviews of trends in accident and incident, etc, are discussed at management meetings. It has been established and reported via previous inspection reports that the service Care Homes for Older People Page 29 of 34 Evidence: does not become involved in supporting service users to manage their personal monies. Health and safety has been a concern at previous inspections due to the poor handling of chemicals used within the home and breaches of the COSHH regulations. Issues associated with the cross contamination of bodily materials/waste by using and sharing creams and lotions and the poor moving and handling practices of the staff. During this visit none of the those issues were identified as causes for concern, during the tour of the premise no substances, chemicals or medications were observed anywhere other than in their rightful places and appropriately secured. No cleaning agents were observed having been left unattended by the domestic staff team, even whilst involved in cleaning rooms, etc. Moving and handling practise was noted to be good, with staff observed assisting one person off the floor, this process involving the staff reassuring the person, collecting a hoist to undertake the move and providing screening to promote dignity and privacy throughout the process. At lunchtime a ramp was noticed to have been put down to ease the transfer of people from lounge to dining room and the movement of the heated trolley from the kitchen to the lounge/diner. During the tour of the premise no immediate health and safety concerns were noted and whilst in the administration office it was observed that a file is accessible to staff, which contains details of service contracts and people to contact in the event of an emergency or equipment breakdown. Care Homes for Older People Page 30 of 34 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Individual risk assessments must be undertaken and a plan to manage any identified risks initiated and kept under regular review. The service presently use a generic approach to risk assessment. 09/11/2008 2 31 8 The service must seek to recruit and submit an application for a registered manager. The service has been without a registered manager, which has contributed towards unstable leadership. 09/11/2008 3 33 24 The service must ensure that information gathered during its quality audits is used effectively to review and where necessary improve practice. 09/11/2008 Care Homes for Older People Page 32 of 34 There is no evidence of the information gathered being used to effect change or sustain changes in practice. 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 7 The manager should work with staff to ensure that they appreciate that they do not need to seek consent from relatives or representatives of the service user when implementing a risk assessment document and focus on using these people as sources of information, which informs the assessment process. Care Homes for Older People Page 33 of 34 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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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