Inspection on 03/04/08 for Bon Accord

This inspection was carried out on 3rd April 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

Bon Accord 20/08/09

Bon Accord 10/06/09

Bon Accord 03/03/09

Bon Accord 18/04/07

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bon Accord 79-81 New Church Road Hove East Sussex BN3 4BB Lead Inspector Elizabeth Dudley Unannounced Inspection 3rd April 2008 10:00 X10015.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 Bon Accord DS0000068548.V361275.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. 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. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bon Accord Address 79-81 New Church Road Hove East Sussex BN3 4BB 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) 01273 721120 01273 730983 bonaccord@schealthcare.co.uk leeminggarth@schealthcare.co.uk Southern Cross (Hamilton) Limited Mary Elspeth Elhefnawy Care Home 41 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0) of places Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 M/F Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD 2. Dementia - Code DE The maximum number of service users to be accommodated is fortyone(41). 18th April 2007 Date of last inspection Brief Description of the Service: Bon Accord is a care home with nursing and is registered to provide nursing to 41 older people with mental health needs. It is owned by Southern Cross(Hamilton) Limited. Resident’s accommodation is spread over three floors and consists of thirty-two single rooms and five shared double rooms. Twenty-one of the single rooms and three of the shared rooms have ensuite facilities consisting of a washbasin and wc. There are four assisted bathing facilities and one assisted shower facility. All staircases and the front door have a secure keypad entrance system. A shaft lift serves all floors. Communal accommodation consists of three lounges and two dining rooms. There is access to a large rear garden. The home has a large garden at the front with limited parking facilities. The roads around the home are metered parking only but the home is served by public transport and there is a train station at Portslade, which is approximately twenty minutes walk from the home. The home maintains links with the local psychiatric hospitals and local General Practitioners and associated health care professionals visit the home. The fees, as informed by the manager as of the 18 April 2007, are £624-£860 per week, with extra charges for service such as chiropody, hairdressing and newspapers. Bon Accord DS0000068548.V361275.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 unannounced inspection took place on the 3rd April 2008 over a period of nine and a half hours and was facilitated by the recently appointed manager Ms J Deacey. Southern Cross has recently appointed a projects manager and he was present for two hours at the commencement of the inspection. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, the serving of lunches and conversations with residents, staff and visitors to the home. Six residents, five members of staff and two visitors were spoken with in depth and gave their views on life in the home Documentation examined included care plans, personnel files, staff training and supervision records, catering records and health and safety files. Prior to the inspection questionnaires were sent out to relatives, residents and staff. Of these six were returned from relatives and visitors to the home, and one from a resident in the home. These gave information about the daily life in the home and helped to inform the judgements made in this report. Thanks are extended to those people who responded. The nursing home support team were also contacted to gain their views on the home. The Annual Quality Assurance Assessment, required by the CSCI, which gives an overview of what has been achieved in the home and issues to be addressed, was received by the CSCI prior to the inspection. Comments received about the home were varied, relatives showed their appreciation of the redecoration and new furniture in the home: “Encouraging signs that things are improving- brighter rooms, fresh flowers etc are all appreciated”, another relative raised concern about the central heating and lift failure “Whilst a fair amount of refurbishment has taken place it seems more expensive expenditure i.e. heating and lifts has been avoided”. Relatives and staff were concerned about the staffing levels not being sufficient for the dependency of residents currently living in the home: “Weekends are often short staffed”. “It would be nice to have time to do more than just basic care”. “Housekeeping staff have been reduced and there isn’t time to iron”. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 6 All relatives and residents spoken with praised the staff for their hard work, their empathy and the way they looked after the residents “They are always treated with dignity and patience”. Very positive comments were received about the new management of the home both from relatives and staff:“ A steady improvement over past two years and better in general over the last three months”. “The manager is doing a really good job, trying to sort the home out and it’s a lot of work but she is really supportive and helpful”. “Dynamic and is getting things done. The whole atmosphere has improved and it does make a difference”. Thanks are extended to the residents, manager and staff for their hospitality, help and courtesy during the inspection. What the service does well: What has improved since the last inspection? Many areas of the home have been redecorated and new carpets put in place. New furniture including twenty new dining chairs and twenty-four profiling beds (adjustable height beds) have been purchased, a wet room has been introduced on the first floor and is proving successful with both residents and staff. Quiet areas have been introduced into the home and the manager’s office has moved to the first floor allowing staff to use the office on the ground floor as a nursing office. This has greatly improved working for the staff. A luncheon club has been commenced which enables groups of residents or residents and relatives to sit and have lunch together in a quiet and unhurried atmosphere. Mealtimes have been designated as ‘protected times’ to enable staff to concentrate fully on assisting residents with their meals. Breakfast time has been put to the later time of 0830 therefore allowing all residents to have a cooked breakfast if they wish, with catering staff taking sole responsibility for the breakfast. Early breakfasts are still available to those who wish to have this. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 7 An activity co-ordinator who works 30 hours a week has been employed, outings to local shops and to films take place. A new care planning system has been introduced which should assist staff in the planning and delivery of the care to residents in the home. Some Staff have the training in the YTT programme (yesterday, today, tomorrow) this is a programme that encourages activity and mental stimulation through care actions, and this is being cascaded to other staff with a view to all staff practising this whilst giving the care. The manager has identified many areas for improvement over the next twelve months and is working towards achieving this. What they could do better: Improvements shown at the last inspection have not been sustained over the past year. Not all care plans were being reviewed regularly, some parts of the care plan have not been completed and signed and areas which can significantly impact on the care of the resident such as moving and handling and dementia care should be completed and included in all care plans. Activities are being provided but not in sufficient amount to ensure that all residents in the home are suitably stimulated. When the activities person takes some residents out, the other residents have nothing to occupy them. It was particularly noticeable in the conservatory that throughout the day residents were sitting in their chairs, there were no staff around except at mealtimes and therefore they did not have the benefit of one to one interaction. Staff appeared hurried and said that there were insufficient staff to enable them to give anything other than basic care. This was discussed with the manager. During the past year staff training has lapsed. Whilst staff are encouraged to achieve their National Vocational Qualification level 2 or 3 in care, mandatory training such as fire, and moving and handling training has not been attended by all staff. Fourteen of the staff have had no training in safeguarding adults and the manager has identified that staff, including registered nurses, require some training in basic nursing needs as well as the specific training for residents in the home. The homes adult safeguarding policy does not comply with the ‘National Multiagency Safeguarding Adult’ guidelines. Nine requirements were made at the last inspection and four of these have been met to a standard that would be seen as acceptable by the CSCI. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 8 Following the last inspection an improvement plan was required by the CSCI. Whilst the management in the home at this time had confirmed that the improvement plan had been complied with, this was found not to be so at this inspection. Requirements have not been made against all areas of non compliance made in the home, the manager has given assurances that some issues will be addressed and these will be checked at the next inspection. 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. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience adequate quality outcomes in this area. Information provided by the home does not reflect the changes, which have taken, place in the home. Not all residents have received a copy of the terms and conditions of residents. Lack of accurate information could impact on resident’s dignity, choice and their control over their own lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service User Guide and Statement of Purpose have not been reviewed to reflect the changes, which have taken place in the home, and should be produced in a format that is suitable for the residents in the home. This applies to the information provided in audiocassette form. The manager gave assurances that this would be addressed. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 11 The manager stated that some residents, including those admitted in the past few months have not received the terms and conditions of the home. The manager undertakes preadmission assessments and four were seen, these were comprehensive and identified the areas of care needed by the individual and form the basis of the care planning process. Residents are admitted for a three-month trial period to ensure that the home can meet their needs. Currently no resident or representative receives written confirmation that the home is able to meet their needs and this should be put in place. The manager has given assurances that this will be commenced. The home admits for respite and continuing care but not for intermediate care. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience adequate quality outcomes in this area. Initial care planning identifies the care needs of the residents, but lack of review and incomplete or absence of care planning for specific issues could result in residents not receiving the holistic care required. Lack of attention to residents grooming can affect the dignity of the residents. The standard of medication administration safeguards the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the day five (13 ) of the care plans were examined. A new care planning system has commenced; the standard of care planning and review was variable. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 13 Out of the five examined, one risk assessment for bedrails was not completed or signed and one care plan had not been completed although the resident had been in the home for some time. Not all care plans had a dementia assessment tool or a social care plan and some life histories had not been completed. Moving and handling risk assessments had not been completed on all care plans—one resident who had been admitted for 8 days had not had the moving and handling risk assessment completed Not all care plans had been reviewed on a regular basis or showed evidence that it had formed in consultation or discussed with the resident or their representative, or a reason given to show why this was not possible. This was a requirement at the last inspection and formed part of the improvement plan. Nutritional care plans were in place for all residents and there was evidence of monthly weighing of residents being undertaken, the Malnutrition Universal Screening Tool is implemented in the home. General Practitioners visit the home on a regular basis and whenever possible these are of the residents choosing. Physiotherapists, speech and language therapists and wound care specialist nurses have been involved in the home. Five residents have developed pressure damage since being at the home, but this is due to various reasons, and the home has had a mattress audit by the wound care nurse with pressure relieving equipment being put in place. Information received following the inspection was that a health care professional has raised a concern that a treatment plan for a resident has not been carried out as required. There are continence care plans in place, but these require expanding in some cases. Currently catheters are removed from residents in the home unless required for clinical reasons. This practice does not promote residents choice or maintain their dignity. Only one member of staff can undertake male catheterisations and the manager said that staff did not ‘ feel confident’ about female catheterisation. The need for training in basic general nursing care skills has been identified by the manager and a programme will now being put in place. The majority of registered nurses in the home are registered mental health nurses, although mental health care is the primary care need in this home, the majority of the residents have quite complex physical health needs and therefore knowledge of general nursing is required. Sufficient training on care needs was a requirement in an improvement plan following the last inspection and this has not been met. Twenty four new variable height beds have been purchased (profiling beds) discussions were held with the manager over the suitability of the bed rail Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 14 protectors provided with these beds, this had already been identified and the manager is considering replacing these. Surveys received from residents showed that in some cases communication about concerns or the needs of the residents were variable, that they had to ask about the resident rather than the information being volunteered. “I do have to ask to be kept informed especially in medical issues” “A monthly assessment with the relative would be nice. 15 minutes to sit and talk about any concerns about the resident – how they sleep etc, currently annual reviews take place.” Some of the care plans showed the residents preferred times of rising and retiring but this was not always present and should be put in the night care plan to ensure that resident choice is met. Residents appeared well cared for, but more care was needed to ensure that their clothes are ironed and that staff take a pride in the grooming of the resident to ensure that their dignity is maintained. The standard of medication storage and administration has improved. There was evidence of regular audit of medication and the method of administration safeguards the residents. All medications including controlled drugs were suitably stored and fully recorded. There have been instances of missing medication in the past year but regular auditing of medication appears to have resolved this. The end of life care plans have not been fully completed in the home. Staff have received some training in end of life care, and residents being nursed in bed appeared comfortable. Compliments from relatives regarding the care of residents in their last days were seen. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area. The provision of activities is not sufficient to ensure that all residents are kept mentally stimulated or involved. Menus provided are not imaginative but are nutritionally sound, residents may be prevented receiving optimum nutritional benefits by the presentation of meals particularly the supper meal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities co-ordinator has recently been appointed and works for 30 hours a week. The activities programme includes outings to a local centre for films and monthly art therapy, reflexology and music therapy. The activities programme was displayed but was not in a format suitable for the residents in this home. On the day of the inspection the activities co-ordinator had taken a few residents out to watch a film, and this resulted in the majority of residents Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 16 being left without any form of activity or stimulation. Residents in the conservatory did not have a member of staff sitting with them and had no one to one interaction or mental stimulation at all. Most residents in the home were sitting in chairs or wandering around the home with little interaction with each other. Staff do not have sufficient time to sit with residents and were seen to be very busy attending to care needs or with specific residents with behavioural needs. Parties are put on for resident’s birthdays and both Mother’s Day and Easter were celebrated this year. Provision of activities was a requirement of the improvement plan and last inspection and whilst the home has made some efforts to put this in place, it is not sufficiently met to improve the quality of life and stimulation for the residents. Staff said that residents have a choice of their times of rising and retiring but it is not always identified in the care plans which could lead to residents choices not being met. The home commenced a YTT programme (Yesterday, Today and Tomorrow) which enables staff to deliver optimised personalised care, assisting in such activities as painting nails, applying makeup and escorting residents out. Staff are very enthusiastic about this programme and several have completed the training for it. However it was evident, both on talking to staff, the general grooming of residents and the service at meal times that the staff are not having sufficient time to practise this. Visitors are made welcome and regular religious services are held. Pastoral care visits are undertaken both by local Christian ministers and an Imam. The menu variety of food offered is adequate. Menus are set up by the company and are nutritionally balanced providing fresh fruit and vegetables and allowing residents to have a choice of meals. Few vegetarian options were available and presentation of food especially at supper time, required attention. The cook had not received any training in catering for older people with mental health needs and the menus in place did not reflect the food being presented in a manner preferred by residents in this category. It is recommended that the home receive advice from specialist agencies such as the Alzheimer Disease Society. Guidelines regarding food served to older people with dementia suggest finger foods being available and high protein foods, this was not in evidence. Mealtimes are now designated as ‘protected times’ with staff being available to provide assistance with meals in an unhurried manner. Improvements have Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 17 included the formation of a ‘ luncheon club’, which gives relatives and residents the chance to take meals together in a relaxed atmosphere. Breakfast time is now from 8.30 although residents can have an early morning snack if they wish and a cooked breakfast is now included. A relative that was having lunch in the home said that he had lunch in the home most days and that the food is generally good for him but not always the taste of the resident. Residents spoken with said that the food was ‘ Good’, ‘ Nice meals’ ‘ Alright’. Fresh fruit is always available. Presentation of meals could be improved and the displayed menu was not in a format, which could be easily read by residents. Lunches were provided in a relaxed atmosphere and residents were encouraged to interact socially with tables having tablecloths and napkins in place. Supper was seen being provided and this was not to an expected standard, tables had not been set, it was noisy and this evidently upset some residents. There are 24 residents that currently require some assistance with meals and it was apparent that at suppertime staff were struggling to fulfil this role. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People who use the service experience adequate quality outcomes in this area Complaints made to the home are recorded and measures taken to ensure that repetition is avoided and that they are resolved to the residents’ satisfaction. Complaints made to Southern Cross have not always been addressed in a manner that is satisfactory to the complainant. The adult safeguarding policy in the home does not ensure that residents are adequately safeguarded and not all staff have received the relevant training in safeguarding those in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and keeps records of complaints raised along with the actions taken to resolve these and prevent reoccurrence. Eight complaints have been received since the last inspection, seven of which have been upheld. Evidence from one survey and also from a phone call from a relative stated that although the home was good at addressing any complaints made to the home, Southern Cross did not respond in a timely manner to a complaint made to them and did not address the issues thoroughly. They had made several complaints to Southern Cross regarding the heating and the lift Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 19 breakdown and also the state of some of the furniture and were not satisfied with the responses received. Requirements made at the last inspection and forming part of the improvement plan identified lack of training of staff in matters including adult safeguarding. Records at the home identified that 14 staff have not yet received adult safeguarding training. The recently appointed manager has set up a training matrix which identified this and a course is now booked; however the requirement was not complied with by the due date. The adult safeguarding policy does not accurately reflect the reporting protocols as directed by the multi agency guidelines. This has been discussed with the operations director on two occasions in the past year and with the area manager recently. Residents can be put at risk if the correct reporting protocol is not in place. A requirement has now been made around this. The Annual Quality Assurance Assessment states that 16 adult safeguarding issues have been reported. The majority of these related to incidents between residents, two related to disappearance of medication and one involved a member of the staff. During the past 12 months there were issues in which residents were abusive to staff resulting in injury to the staff, the CSCI contacted the home regarding ensuring regular review of residents in order to safeguard staff and to ask them to ensure that sufficient staff were on duty at all times. The provision of challenging behaviour training for staff was also discussed. This has not yet been put into place The home does not have a copy of the current ‘Multi–Agency adult safeguarding’ guidelines. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. People who use the service experience adequate quality outcomes in this area Substantial improvements in the décor and furnishing of the home have improved the environment for residents. Breakdown of the central heating and lift over the past six months and the lack of a bath on the first floor have impacted negatively on the care of the residents in the home. Lack of provision of call bells in some rooms could put resident’s at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Substantial improvement to the home has taken place over the past 12 months, with redecoration over most parts of the home, a wet room put in place and a new bath purchased and twenty four new beds and twenty new chairs having been purchased. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 21 Corridors and some resident’s rooms have been re-carpeted. Fresh flowers are now placed in the lounges, which add to the enjoyment of the home by residents. Several residents talked about the flowers during the inspection. Efforts to improve the homeliness have been made by the purchase of new pictures, throws and residents cups and china. There have been several problems over the past year with both the central heating and the lift, which has been an ongoing problem over the past few years and no permanent measures have been taken to address this. This has impacted on both the care and the quality of life for residents. A bathroom on the first floor has been converted to a wet room, which is successful both with staff and residents. The bath in the other bathroom on this floor is no longer working and the flooring is not impermeable. Staff have to take residents to one of the other floors for bathing. The bath and flooring in this bathroom should be made fit for purpose as soon as possible, in order for the home to have sufficient bathing facilities as directed by the National Minimum Standards and for residents comfort and dignity. Resident’s rooms were comfortable and residents are able to bring in their own possessions, there are lockable doors, but no resident has a key at present. Lockable drawers are in place with keys being given to those able to use them. Several rooms did not have call bells in place. Window restrictors are in place and the manager gave assurances that water temperatures to resident’s outlets were being monitored and were within recommended parameters. Bed linen in resident’s rooms was not ironed, with housekeeping staff saying that there was insufficient time and staff to do this. This can impact on resident’s dignity. The home has sufficient aids and equipment to enable residents to maintain their independence. There are adequate supplies of disposable gloves and aprons within the home and the home was clean and free from odours. Some staff said they had infection control training and there were policies relating to this in the home. An environmental health report recommended more extensive cleaning of floors and that the door leading from the kitchen was kept closed, this has been complied with. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience adequate quality outcomes in this area. The number of staff on duty over a twenty-four hour period is not always sufficient to meet the assessed needs of the current residents in the home. Whilst the home is proactive in encouraging staff to attain the National Vocational Qualification in care thus ensuring that basic care of the residents meets their needs, some registered nurses have not updated their skills, which could impact on the care given. Recruitment systems safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing rotas show that there are seven care staff and two registered nurses on duty during the day time hours and one registered nurse and three care staff on at night. However the CSCI have been informed on two occasions in the past four months that there have been insufficient staff on duty to ensure residents safety. One of these was by a Regulation 37 notice, which also identified that senior management had turned down a request for extra staff made by a senior nurse at the home. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 23 Care staff and housekeeping staff said there was a need for more staff on duty given the dependency of the residents in the home. Housekeeping staff said that there was insufficient staff for the house to be kept cleaned and all the laundry and ironing to be done. This was identified as the reason for the resident’s clothes or bed linen not being ironed. Staff said that they were busy attending to care needs and therefore did not have enough staff to spend time with those residents who needed one to one interaction and this was given as the reason for the treatment directed by another health care professional not to have been carried out. It was seen that there were no staff in the conservatory with residents on the three occasions that the inspector visited this part of the home during the inspection. This is where the most dependent of the residents sit. Discussions were held with the manager and the projects manager over providing staffing levels commensurate with the mental health and physical health needs of the residents in the home rather than gauging staff by the numbers of residents in the home. It was evident that at meal times staff were finding it difficult to meet the needs of the residents. The Annual Quality Assurance Assessment states that the number of agency staff used has been reduced and permanent staff employed. A requirement for review of staffing levels is being made. Staff training is recorded on a training matrix. This showed that fourteen members of staff have not had adult safeguarding training, that some members of staff have not updated on moving and handling and some senior members of staff have not had fire training over the past twelve months. Registered nurses have identified training needs, which include basic nursing training such as catheterisation and continence. Whilst the present manager is arranging training, updating on staff training was a requirement in the last inspection and included in the improvement plan but this has not been complied with. Staff are encouraged to undertake the National Vocational Qualification level 2 & 3 in care and the Annual Quality Assurance Assessment stated that 73 of staff have attained this. New staff receive an induction training. This is based on the TOPPS course and the manager must ensure that this is in line with the current ‘ Skills for Care’ recognised induction training. Four personnel files were examined, these included all documentation as required by regulation. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 24 Recently employed staff have not been given the General Social Care Code of Conduct and the manager gave assurances that this would be put in place. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38. People who use the service experience adequate quality outcomes in this area. Evidence available in the home and notifications to CSCI identify that over the past twelve months management systems in the home have not been robust. These have been identified by the recently appointed manager who is working to improve the quality of life for residents in the home, and to ensure that the safety of the residents and staff in the home is maintained and that resident’s expectations are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager has recently been appointed to the home and has been in post since December 2007, prior to this she worked in the home as the deputy Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 26 manager. She is qualified as both a registered mental health nurse and registered general nurse and is in the process of commencing the Registered Managers Award. Staff were very positive about the new management saying ‘ She is very supportive and trying very hard to make this a real home for the residents’ One relative survey stated that ‘ Great improvement seen in the past three months’ whilst another relative said ‘ I am amazed at the difference in the past few months’. The manager said that she believed a quality monitoring procedure that incorporated the views of residents and stakeholders was in place. No evidence was found of responses to surveys or views of residents and stakeholders, although the improvement plan for the home required by CSCI identified this had been complied with. Evidence of relatives meetings and monthly home audits were seen. There was evidence within the home that over the past 12 months, systems around training, care planning, safeguarding adults, and staffing have not been maintained. During a telephone discussion with the area manager she identified that Southern Cross had been aware of this through their monthly audit and Reg 26 visits (Monthly visits by the provider required by regulation) however no robust measures had been taken to address this. Southern Cross has recently employed a projects manager to help address outstanding issues in homes. Four of the nine requirements made at the last inspection have been met to a standard that would be deemed satisfactory by the CSCI. Some policies and procedures require review. It is considered good practice for these to be reviewed on an annual basis. A requirement has been made regarding the adult safeguarding procedure as this does not conform to multi agency guidelines and could put residents at risk. A business plan for the home was seen and appeared to be satisfactory. The home does not act as appointees for resident’s monies, records of financial matters that involve residents, such as their personal allowances were seen, and these were in order. Staff supervision has taken place at intervals directed by the standards. The Annual Quality Assurance Assessment showed that all utilities and equipment have been serviced on a regular basis. Not all staff have received mandatory training and a requirement has been made relating to this. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 27 Accident and incident records were seen and were in line with evidence in the care plans. The home generally notifies the CSCI of any incidents affecting residents in the home. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 2 3 x 2 2 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 3 2 2 Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 29 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 OP4 Regulation Reg 14(1)(d) Reg 15 (2) (b)(c)(d) Requirement That prospective service users are informed in writing over whether the home can meet their needs. That care plans are reviewed on a regular basis and that service users or their representatives are informed and consulted about formation and review of their care plan (This was a previous requirement, compliance date 18.05.07) That all parts of the care plan are completed within a reasonable time following a service users admission to the home and are signed by the person completing the plan. That the bathroom on the first floor is made fit for purpose. That the programme of activities provides sufficient activities on daily basis to ensure that all levels of ability are catered for. That the adult safeguarding policy shows the reporting protocols in the home to be in line with the ‘Multi-Agency DS0000068548.V361275.R01.S.doc Timescale for action 03/05/08 2. OP7 30/05/08 3. 4. OP8 OP12 Reg 23(j) Reg 16(m)(n) Reg 13(6) 30/05/08 18/05/08 5 OP18 10/05/08 Bon Accord Version 5.2 Page 30 6, OP22 Reg 13(4) 7 OP27 Reg 18 8 OP30 Reg 18 (1)(c)(i) 9 OP33 Reg 24 (1)(a) Guidelines’. That call bells are available in all service users personal accommodation under the auspices of risk assessment. Evidence of a method of ensuring service users safety to be put in place for those service users for whom a call bell is not deemed appropriate. That staffing levels are reviewed across all grades of staff to ensure that sufficient staff are on duty to meet the needs of the service users according to their dependency, and to maintain the cleanliness of the home and service users bedding and clothing. That all grades of staff receive training appropriate to the work they are to perform as identified in the main body of the report. This was a previous requirement due date 30/09/07 and has not been complied with This must include mandatory and safeguarding training. That there is evidence in the home of a quality monitoring system for reviewing the quality of service offered by the home to ensure it meets the expectations of service users and their representatives. (This was a previous requirement compliance date 30/07/07) and that views of stakeholders and visiting health care professionals are included in this. 10/05/08 10/05/08 30/06/08 30/07/08 Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 31 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 Refer to Standard OP15 Good Practice Recommendations That advice is sought from an appropriate authority regarding the provision of a suitable menu and the presentation of this to ensure optimum nutrition for service users in the category of registration of the home. Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Bon Accord DS0000068548.V361275.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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