Inspection on 08/12/08 for Briar House Care Home

This inspection was carried out on 8th December 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Briar House Care Home 28/05/09

Briar House Care Home 18/06/08

Briar House Care Home 21/11/06

Briar House Care Home 18/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ     The quality rating for this care home is:   zero star poor 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: Ruth Hannent     Date: 0 8 1 2 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 33 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 33 Information about the care home Name of care home: Address: Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ 01553760500 01553760510 briarhouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashbourne (Eton) Limited care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Briar House is a care home providing residential care for up to 62 older people. Within its registered numbers the home offers services to 52 people with dementia. The home is situated in a residential area in the North of Kings Lynn approximately one mile from the town centre. The home was purpose built in the late 1990?s. The accommodation is provided on two floors serviced by stairs and shaft lift. All rooms are built for single occupancy and there are only two rooms that do not have integral en-suite facilities. The home is situated in its own grounds and provides ample parking space. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Briar House is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for care at the home is #417 to #550. 2 0 Over 65 50 62 Care Homes for Older People Page 4 of 33 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: zero star poor 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: This inspection has been carried out 6 months after the last key inspection completed in June of this year. The information used for this inspection has been obtained from the past inspection report, the Annual Quality Assurance Assessment (AQAA) completed my the Manager, notifications received regarding accident or incidents, notes from strategy meeting held, any comments from staff, residents and families and a day spent in the home over a period of 8 hours. During this site visit the Lead Inspector was also accompanied by the Pharmacist Inspector who looked solely at the medication processes throughout the home. Three Senior Managers from within Southern Cross arrived at various times during this inspection and in the absence of the Manager, assisted the Inspectors at different times throughout the day. Care Homes for Older People Page 5 of 33 Care Homes for Older People Page 6 of 33 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 240 7535. Care Homes for Older People Page 7 of 33 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 8 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does have information to circulate to potential customers that will give them a picture of the service available. The home does have an assessment process but information written is not always clear to ensure all needs can be met within the service available. The home does not offer intermediate care. Evidence: The home has a detailed service users guide and statement of purpose that assists potential customers in deciding if their needs could be met at Briar House. Complaints procedures are shown in various documentation so people know how to complain and an inspection report is available on request. Care Homes for Older People Page 9 of 33 Evidence: The home has a comprehensive format that is used to assess the needs of residents to ensure their needs can be met. As the home is registered to accommodate people who have dementia, the samples of assessment seen, did not show enough detail to make clear how the assessment of need could be met within the service of the home. The details on personal care and social needs were comprehensive and the care required evident. Care Homes for Older People Page 10 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents whole care needs are not clearly set out in an individual care plan. The residents health care needs are not always met timely and appropriately. The residents are not always protected by the procedures carried out when dealing with medication. Residents are treated with respect and their right to privacy is upheld. Evidence: The residents throughout have a care plan folder that holds some relevant information. The details of three were looked at, two on the ground floor and one in the Lavender unit. The home is registered to care for people with dementia yet it was difficult to find any reference to the specialist care that residents should be receiving. This has been mentioned in the previous inspection report and is a past requirement. Nothing is mentioned by the Manager who completed the Annual Quality Assurance Assessment Care Homes for Older People Page 11 of 33 Evidence: of improvement in this area of the service and no evidence could be found. On the day of this visit a resident was heard shouting in what appeared a distressed manner and due to our concerns the two Operation Managers who were in the building were asked to witness the distressed noise. The person had been quiet before the personal care by two staff began and although the staff were approaching the tasks to be done in a manner that appeared suitable, it was evident through this type of behaviour that something was very wrong. On looking for any behavioural management support record or any outside professional service involvement such as the CPN, none could be found. The person had been a resident for a number of years and daily records tell of the shouting and swearing on a regular basis yet nothing had been done to address the problem. this person is always like this stated a senior staff member. Pre admission paperwork from 2006 showed a full history of behaviour and how a named CPN had been involved and that a local specialist NHS unit had also been involved yet since admission no records could be found of any support for the mental health needs of this person. The format for a dementia care plan was in the care plan folder and looked at between the Operations Manager and the Inspector. Written on this document was a summary of the personal care required and not the details of how to help this person with their dementia. There was noted some review dates carried out in the care plans but as the care plans do not give a full picture of needs and the full support required, the reviewing process is not beneficial. On the day of this visit it was noted that one person has an alarm mat placed by the bedroom door so staff can be aware of this person leaving the room. This could be seen as an infringement on the person rights to move freely around the home as they wished. The home Operations Manager has now made Social Services and the CPN aware that due to the needs of this person the home can no longer care for this person appropriately. Unfortunately this has only been actioned after a meeting with the local authority that was attended by a number of professionals and the Inspector over concerns about the home not meeting various needs that included the mentioned alarm mat. During the walk around the home residents were noted not to be wearing any tights, stockings or socks and two residents stated how cold they were and a request for a blanket was made by the inspector to cover the legs of the person who was sitting all the time. Noted on the last inspection report is the missing socks and stockings. The corridor and lounge in the Lavender Unit felt cold and a draught was blowing through a gap to the side and top of the fire door. The radiators felt tepid to touch and the Maintenance Officer was called to check the boilers and nothing was found to be at fault. All three Senior Managers within Southern Cross visited the unit where 10 people reside and all felt the area was at an unsuitable temperature. Action was to be taken straight away to contact someone to replace the fire door and get engineers in to check the heating. The records held show the boilers had been serviced on the 19/08/08. The health care needs of the residents has caused concern between the local District Care Homes for Older People Page 12 of 33 Evidence: Nurses and the Community Psychiatric Nurses. The home has had a high number of admissions into hospital in 2008 due to residents falling and delayed responses to acting when problems arise causing more problems for the individuals. Examples given by the professionals are no records of bowel movements for someone who was so impacted they needed to go to hospital. Another situation reported was of a person refusing to eat and drink for a long period but was not referred to the GP. There has also been records of pressure sore concerns that have been discovered on a residents admission to hospital. The home has now provided profile beds for many of the residents who are in bed most of the time and one senior staff member reported the health needs are improving and the care support the staff can give is more manageable with these new beds. The inspection of the medication standard was conducted by the Commissions pharmacist inspector Mr Mark Andrews. We looked at how medicines are managed on the first floor of the home and we discussed issues arising and checked audit findings with Nicky Bassingthwaite during the inspection. When we arrived for inspection the senior carer on duty said all medicines scheduled for the morning medicine round had already been given to people. However, when we checked records of medicine administration, we identified that none had not been completed for one person. Shortly following this, the senior carer arrived to collect that persons insulin that was scheduled to be administered at 08.00hrs. She confirmed that their oral medicines had been given despite having not completed the records to confirm this. The senior carer completed the records but we later found that the record for one of these medicines had still not been completed. When we looked at this persons care notes we found a care plan relating to their diabetes and reference to blood glucose testing but there was no indication of the higher and lower blood glucose levels and action to be taken when levels fall outside these levels. There was also no indication of the frequency of blood glucose monitoring needed. When we discussed this with the manager she said this should take place once weekly but confirmed that this had not been done for this person since 23rd November 2008. When we looked at current and immediately previous medication charts there were few omissions in records for the administration of oral medicines but the manager confirmed that external medicines applied by carers are currently not recorded and no means of determining that these medicines are being administered as prescribed. We conducted sample audits of medicines and found there to be some where there were discrepancies and these medicines could not be accounted for. We also examined records for the disposal of medicines to check this and checked and agreed the Care Homes for Older People Page 13 of 33 Evidence: findings with the manager. The manager confirmed that the homes own audit most recently undertaken approximately 14 days previously had identified similar issues. For a person taking anticoagulant warfarin tablets there were also discrepancies. We also noted that blood testing information alongside the persons medication chart was out of date and had been superceded by further test records available in the persons care notes. The information currently alongside the medication chart indicated a dose of warfarin that differed from the dose currently prescribed and was misleading and could have led to errors. We looked at records relating to a person who the home had reported to the Commission had been administered the wrong dose of spironolactone tablets for 8 days. The report also stated this persons medication chart had referred to warfarin when the person had not been prescribed it. We also found during this inspectionthat the correct dose of spironolactone 100mg tablets had not been available from 6th to 9th November 2008 and so was not administered to the person. We found that a second diuretic furosemide 40mg had also not been available 6th to 10th November 2008 placing this persons health and welfare at risk. We found additional evidence that some medicines had also not been available at the home to administer as scheduled to other people living there. The manager confirmed that medication training had been arranged in January 2009 for all members of staff authorised to handle and administer medicines. She also said that all had also recently completed a written assessment and that the outcomes of these were still awaited. The manager was able to provide evidence of competence assessments for 5 carers trained and authorised to administer insulin by injection however for a 6th named carer who currently administers insulin there was no recorded evidence of an assessment. Throughout the visit, by listening to staff interacting with residents and on talking to residents it was clear that privacy and respect is given by staff as they carry out their duties. Comments listened to were polite and all doors were knocked on before anyone entered the bedroom. The doors to each room was closed as personal care was carried out and conversations were calm and appropriate. Care Homes for Older People Page 14 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not always find the home meet their expectations and preferences in their interests and needs. Contact is maintained with families friends and the community if wished. Choices and control is not always evident in the day to day lives of residents. Meals are wholesome and enjoyed but could be presented to offer more choice at the times that suit the individual. Evidence: On the day of this inspection visit the main downstairs lounge was not available for residents as it was being used by an outside agency for training. One resident could not understand why they were not allowed in and, according to staff, likes to sit in that room as they can look out at their old house. The lounge area in Lavender was bare of any stimulation or activities. The TV was on and two people were facing the set but four others were not and had nothing to occupy themselves with tables placed at their Care Homes for Older People Page 15 of 33 Evidence: sides but nothing on them. The two staff members caring for the 10 residents were still busy carrying out care tasks in residents bedrooms (11.15am). The activities staff were not in this unit. Two people wandering around were appearing lost and saying I want to go home or looking for their loved one. There was no evidence on display to show the activities that could be provided for the residents in this unit and there was limited recordings in their daily notes or care plans to show what is suitable for the individuals. The home does employ activities staff but they were only evident in the main part of the building and not in Lavender. Visitors were noted to be coming and going and appeared to interact with staff to be updated on their relative. Comments received prior to the June 2008 inspection talk of families responding to surveys in a fairly positive manner when asked about the support the resident receives. No surveys have been received at the Commission since June. Staff do say that relatives can visit the home at any time and are made welcome. The staff talked of the visiting catholic priest who calls to some residents and that a visiting spiritualist also visits when requested. To evidence how the residents are offered autonomy and choice is difficult with limited input of how choice is offered in care plan records or daily notes. The staff were heard asking if they would like to go upstairs to listen to the singing and those who said no, after encouragement, were left in the downstairs areas. It was noted that some of the bedrooms appeared personalised and homely showing residents had the opportunity to bring in their own possessions if they wanted to. Although the mealtime was not seen on this occasion three residents were asked if they had enjoyed their lunch. Each one said they had eaten a nice meal but could not remember what they had. (Comments received in the June inspection talk of food being good with comments such as cant fault the food and very nice lunch. The Senior staff spoken to stated the meals always offer a choice and that the residents are asked the day before what they would like. The meal is provided in three hot trolleys to the three dining areas and plated for the residents. In the lavender Unit no details could be found to show how the residents could look at or discuss the meals and as they have the meal plated for them they do not see what the choice is. On talking to one Senior Staff member the meal times are quite difficult as a number of residents require assistance with eating and quite a number of those are in their own bedroom. With only a limited number of staff on duty the meal times are sometimes rushed. Care Homes for Older People Page 16 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and families should have their complaints listened to and acted upon. Residents are not always fully protected from potential abuse. Evidence: The home has a detailed complaints procedure and the information on how to make a complaint is detailed in the Service Users Guide issued when a new resident is admitted to the home. This guide was discussed with one resident who happened to be reading it when seen. This person had noted the complaints information and felt able to complain if necessary. On asking to see the complaints received since the last inspection the file was found but appeared to contain accident forms. Two letters of complaint were eventually found among the accident forms but no outcomes of the complaints were within the record. The Senior Manager from Southern Cross made a phone call and the evidence of the outcomes was sent across from the companys head office. There did not appear to be any further correspondence from the complainants so the outcomes should have met expectations. The home does have a whistle blowing policy, and two staff members asked, did understand how to report any concerns if they were at all concerned about potential abuse. The Commission has received notification on safeguarding concerns and strategy meetings have been held relating to delayed health support, inappropriate Care Homes for Older People Page 17 of 33 Evidence: placement of resident and poor care practice. Numbers of staff who have received training in the protection of vulnerable adults was not checked on this visit but at the June inspection 57 of staff were trained and that a further training session was taking place during that week. Care Homes for Older People Page 18 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is of average condition but is now safely maintained. Bathroom facilities are not suitable for the residents living there. Adaptations and equipment is not in place to help maximise the residents independence, choice and well being. Residents bedrooms are not all comfortable. Improvements need to take place for the people who live there to have ownership of that room. The home has some areas where the heating and lighting does not make it a comfortable place to live in. The home is in need of improving some areas of the home to ensure good infection control procedures are in place. Evidence: On arrival at the home it was apparent that some general cleaning had not been done over the weekend with areas in need of cleaning seen in the entrance and corridors. The domestic staff were around and had started their duties with three seen Care Homes for Older People Page 19 of 33 Evidence: throughout the day. The home recruited a new Maintenance Officer in July of this year and records of maintenance and servicing history has greatly imroved. All records seen were up to date and servicing receipts all in order. Noted were fire service tests and replaced items 17/10/09. Extra water temperatures checked and control valves serviced in various areas and all recorded between 41 and 43 degrees. Boilers were serviced 19/08/08. Gas safety checks 24/11/08 and lift serviced on the 18/1108. The fire record book had not been completed prior to August 2008 but since have been completed in all areas. One concern was noted where the record stated the home has no oxygen stored but on discussing this with the Senior Manager there is one resident with a cylinder, so the records need updating and a risk assessment in place. The overall picture of the home is of bare long corridors and as this home is registered to care for people with dementia related problems there was little or no prompts, sign or guidance for residents to find their way about. People were seen throughout the day wandering about appearing lost and calling out. One lady was going around in circles looking for her home. With some bedroom doors with no names on and no recognition for this person the anxiety level was rising. In the corridor of Lavender Unit there has been plaques attached to the wall of tactile items that are related to door knobs, knockers, key locks and handles. All these are clumped together and are quite high on the wall and not easy to see for anyone who is short in height. In the lounge of this unit there are the basics of furniture with chairs, tables and carpet. the curtains have the lining hanging down and the room is bare of any warmth, stimulation or items to occupy the residents. In the corner of the room there is a cot with a doll in it but no cot mattress or blankets to wrap the doll in. In this lounge residents stated they were cold. One lady said she would like a blanket and another said we could feel her feet, which on touching were cold. Throughout the building the home has three bathrooms and one shower room. The bathrooms all have baths that are low to the floor and will not allow a hoist to get close enough to the bath for people to be transferred and then lowered into the bath. One toilet seat in the downstairs bathroom was noted to be cracked. According to the Senior staff member the baths have been limited to the residents who do not require the equipment to help them have a bath. The home has two functioning hoist to use for a large number of residents. The need for more equipment was apparent when staff were still helping people to have a wash and get dressed at 11.15. Partly due to not enough equipment to carry out the job safely and correctly. Care Homes for Older People Page 20 of 33 Evidence: Some rooms have been decorated but some bedrooms are still in need with chipped paint and scuffed walls. The light shades are unsuitable as they are uplighters and do not give off a bright light. In two bedrooms in Lavender the shade looked black in parts and gave off very little light. As mentioned previously in this report the areas around the poorly fitted fire door appeared to low. A cold draught was noted and the temperature felt cold to us, Senior Managers and care staff. The radiators felt tepid to touch and were also felt by the staff at the home. This area is always cold said the staff member. We have said. Another Senior shared concerns about the exit fire doors being so near the road and are opened by a push bar. The alarm does sound when the door is opened but staff have not always been available to guide the resident back into the building straight away. The need for an alarmed key pad system would make these doors much safer and would still release if the fire alarm rings. The laundry appeared suitable clean and fairly tidy. The machines have a sluice cycle and washing is separated appropriately and follows good infection control practices. The one downstairs sluice room is not so clean and had items stored in there such as wheelchair footplates, old bags and flower vases. Care Homes for Older People Page 21 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the residents are not met by the numbers of staff required at all times. The home does ensure that at least 50 of the staff are NVQ qualified to ensure residents are cared for by skilled staff. The home does follow a safe procedure when recruiting to ensure residents are cared for by appropriate staff. The home does offer regular training but sometimes practice carried out from the training is not always seen. Evidence: The staffing throughout the home appeared inadequate. Residents were wandering aimlessly and at least three residents were seen not to have received help to be washed and ready for the day until 11.15. Curtains were still drawn and the light was off. In Lavender Unit 2 staff were on duty to care for 10 residents. The level of care support for the residents in this unit was high due to the number of people cared for in bed plus the number who were wandering and staff were working as quickly as they could. The home, had on the day of the inspection, according to the senior on duty 22 residents upstairs with 2 main care staff and one agency, 25 residents downstairs with Care Homes for Older People Page 22 of 33 Evidence: three main care staff and 10 in the Lavender Unit with 2 main care staff. There were three cleaners, one kitchen assistant, one cook, one maintenance officer, one administrator and two activities organisers. The ancillary staff are not all working at the weekends and on talking to the Senior Carer it was clear that more staff are required. Its as if Saturdays and Sundays are not recognised. This is just as busy and nothing should be different at the weekends, but it is. Although records were not checked on this occasion as to how many staff have the NVQ qualification it was noted that over 50 were qualified on the June report. On seeing different staff members it was noted that the NVQ badge was being worn on their uniform. The administrator holds the staff personnel files in the main office in a locked cabinet. Three were looked at and included one recently recruited staff member. The files were in neat order and the correct paperwork was in the files. During the checking of these files the administrator was in the process of calling a referee as one was outstanding. We do not allow staff to commence work without all the paperwork being in the home. This was certainly evident in the there files seen. The home does have a comprehensive training programme according to the staff spoken to. Training posters for future dates were on display and named staff were on the lists to attend. The two staff member spoken to said the difficulty was to be able to attend when the home is so short of staff. This has improved lately as we have been allowed agency cover. The home has offered training in dementia and certificates were noted on the personnel files. This was difficult to evidence in practice with the residents wandering with nothing to do and behaviours that needed understanding and managing not recorded in the residents care plans. Care Homes for Older People Page 23 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home needs to improve to ensure standards are raised. The home needs to ensure the best interests of the residents are taken into consideration by carrying out quality monitoring. Residents own money is safeguarded by good financial procedures. Staff need regular supervision to ensure residents are cared for appropriately. Health ans safety procedures need improving to safeguard the health and welfare of staff and residents. Evidence: The Manager of the home has been absent for four weeks. The company have sent Senior Managers to manage the home in the interim. The inspection in June has not Care Homes for Older People Page 24 of 33 Evidence: been acted upon with limited improvement. An improvement plan was sent to the Commission by the Manager but very little has changed since the last inspection. The earlier completed Annual Quality Assurance Assessment is limited in the information and does not offer the information required to assist with the inspection. The information about quality assurrance was not see. Residents who were spoken to said they were happy at the home and staff who were offered one to one time with the inspector felt the home had changed a little since the Senior Managers had been involved and hoped this would continue. One staff member commented I am worried the home will go down hill again.Communication has been poor. No surveys were received prior to this visit but comments from the June inspection showed favourable comments and that the home and Manager were good. The administrator has clear records within a locked cupboard of residents fianances and were seen. All transactions are completed with two people signing. All receipts for money or purchases are clipped in the residents financial folder. The home has a bank account that pays interest to the individual resident on a monthly basis. Receipts looked at showed taxis paid for for residents and hairdressing fees. The cash tin holds approximately 300 pounds and was seen locked in a safe in a locked cupboard. Staff were talked to about their supervision sessions. One staff talked of only having one in June and some in 2007 but has not had regular sessions for a long time. Another Senior stated she had not had regular supervision sessions either. The notes of supervision were not seen and were not within the personnel folders of staff files that were looked at. As previously mentioned in this report some areas of health and safety have cause for concern. Hygiene in the sluice, poor heating and lighting, lack of suitable equipment and poor stafing levels. The staff have had training in all health and safety areas and certificates are seen on personnel files but some of the practices learnt arent always evident. The Maintenance Officer recently recruited has a good record system of servicing carried out with dates and all the safety records such as fire, water temperatures and emergency lighting are up to date. Care Homes for Older People Page 25 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 14(1) & 17(1) Prospective people to use the 18/06/2008 & Schedule 3 service must have their needs fully assessed in order that they receive the correct support to meet their needs. 16(2)(m)(n) People who live in the home must have their social and emotional needs assessed and written into an individualised plan so that staff know how their needs should be met. 31/07/2008 2 7 3 7 15(1) & 15(2) People who live in the home (b) must have their needs fully assessed, reviewed and written into care plans so that staff know how needs should be met. 12(4)(a) People who live at the home must be supported where necessary in maintaining their personal care needs. This is to ensure the dignity and support health and welfare of residents. 30/06/2008 4 7 18/06/2008 5 12 16(2)(n) People who use the service 31/08/2008 must be provided with facilities for recreation to suit their individual needs. Care Homes for Older People Page 26 of 33 6 18 13(6) People who live in the home must be safeguarded from harm so they are protected. People who live in the home must have an environment that is free from hazards to their safety so that they are protected from harm. People who use the service must be provided with an adequate number of bathrooms with suitable equipment. So that their needs can be met. The premises and any specialist equipment used must be suitable for the assessed needs of the residents. People who live in the home must be safeguarded by suitable arrangements to prevent the spread of infection. 18/06/2008 7 19 13(4)(a) 18/06/2008 8 21 23(2)(j) 30/09/2008 9 22 23(1)(a) &(2)(c) 30/09/2008 10 26 13(3) 18/06/2008 11 27 18(1)(a) People who live in the home 30/09/2008 must have their needs met by adequate numbers of competent staff so that their health and well-being is promoted. Care Homes for Older People Page 27 of 33 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 3 14 Potential Customers must have a full assessment of need. (Repeat Requirement). To ensure the full needs of the potential resident can be met, 01/01/2009 2 7 15 The reponsible person must ensure that full details of care are recorded in the residents care plan to include the support required for their mental health needs. (Repeat Requirement). To ensure the staff have details of how to care for the person correctly. 01/02/2009 3 8 12 The registed person must ensure the healthcare needs of residents are met. (Repeat Requirement). To ensure that medical support is sought in a timely and proactive manner and 01/02/2009 Care Homes for Older People Page 28 of 33 hopefully prevent health deterioration. 4 9 13 The responsible person must 01/02/2009 ensure that records for the administration of medication is completed at all times. This must includemedicines prescribed for external administration To ensure the safe management of medication protects the resident. 5 9 13 The responsible person must 01/02/2009 ensure medicines are administered in line with prescribed instructions at all times To demonstrate good recording practices that enable medicines to be accounted for. The responsible person must 01/02/2009 ensure that medicines are promptly obtained and made available for administration to residents as scheduled. To ensure people receive the needed medication as prescribed. 7 12 16 The responsible person must 01/02/2009 ensure that recreational facilities that occupy and stimulate residents is available for all. (Repeat Requirement) To ensure that all residents are offered suitable occupation and not left 6 9 13 Care Homes for Older People Page 29 of 33 sitting with nothing available. 8 14 12 The responsible person must 01/02/2009 ensure that residents are offered choices enabling them to make decisions about their daily lives. (Repeat requirement). To ensure choices are available and offered to the residents. 9 18 13 The responsible person must 01/02/2009 ensure that residents are safeguarded and protected from potential abuse. (Repeat requirement) To ensure no resident is subjected to any forms of abuse and procedures are carried out to safeguard these vulnerable people. 10 19 23 The responsible person must 01/03/2009 ensure the fire doors are suitable for the safety of residents. The residents opening the outside fire doors places them at risk. 11 19 23 The responsible person needs to ensure the environment meets the needs of the residents it cares for To ensure the residents can orientate around the building and have recognisable signage to help them. 01/04/2009 Care Homes for Older People Page 30 of 33 12 21 23 The responsible person must 01/03/2009 ensure that the residents have suitably equipped bathrooms allowing them to bathe appropriately. (Repeat Requirement). The equipment is required to ensure people can have a bath when required. 13 22 23 The responsible person must 01/03/2009 ensure that suitable equipment is available for residents to be assisted with their care needs appropriately and timely. (Repeat Requirement) To ensure residents are not waiting for long periods of time to be assisted with care needs. 14 25 23 The responsible person must 01/02/2009 ensure that suitable lighting and heating is throughout the whole home. To ensure residents are safe, warm and comfortable. 15 26 13 The responsible person must 01/02/2009 ensure that all areas are kept clean to prevent the spread of infection. (Repeat Requirement). The sluice rooms are in particular need of cleaning to prevent the spreading of infection 16 27 18 The responsible person must 01/02/2009 ensure that adequate numbers of suitable staff are working at the home at all Care Homes for Older People Page 31 of 33 times. (Repeat Requirement) Residents must be offered person centered care that meets their needs. 17 30 18 The responsible person must 01/02/2009 ensure that competent and trained staff can deliver the care required, especially for residents with dementia. To ensure that outcomes for residents is recorded and the care given is appropriate . 18 31 9 The reponsible person must ensure a fit manager is in post To ensure the residents and staff are led by a suitable and knowledgable manager. 19 33 24 The responsible person should ensure that a regular reviewing and improving procedure is in place. To ensure that the home is meeting quality outcomes. 01/02/2009 01/03/2009 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 staff need support in understanding the care plan formats that are complex and not very user friendly. Care Homes for Older People Page 32 of 33 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. 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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