Inspection on 06/05/08 for Brincliffe Towers

This inspection was carried out on 6th May 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 but made no statutory requirements on the home.

Other inspections for this house

Brincliffe Towers 02/03/10

Brincliffe Towers 20/01/10

Brincliffe Towers 06/01/10

Brincliffe Towers 29/09/09

Brincliffe Towers 01/10/08

Brincliffe Towers 08/05/07

Brincliffe Towers 11/05/06

Brincliffe Towers 13/12/05

Brincliffe Towers 06/04/05

Brincliffe Towers 21/09/04

Brincliffe Towers 26/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Brincliffe Towers Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ Lead Inspector Sue Turner Key Unannounced Inspection 6th May 2008 09:20 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 DS0000046508.V362362.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. DS0000046508.V362362.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brincliffe Towers Address Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ 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) 0114 255 2821 0114 255 2821 walker-jean@btconnect.com None Ash House (Yorkshire) Limited Ms Moira Elliss Layne Care Home 35 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (11) DS0000046508.V362362.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All 24 DE(E) beds are registered `or MD(E)` and are sited in a separate wing. Service users may also be aged 60-65 years. Date of last inspection 8th May 2007 Brief Description of the Service: Brincliffe Towers is a care home providing personal care and accommodation for thirty-five older people, including care for twenty-four people with dementia. The home is privately owned, and is located in a residential area of Sheffield with nearby access to public transport. The home is a large old detached house with a modern annexe attached and has very pleasant well-established gardens, which overlook Chelsea Park. There is a small car park to the front of the house. All of the bedrooms are single although two are registered, as doubles should there be a request to share. Seven rooms have an en-suite facility. There is a passenger lift. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of monthly fees from April 2008 were £327 - £368 per week. Additional charges included newspapers, hairdressing and private chiropody. DS0000046508.V362362.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 0 star. This means that the people who use this service experience poor quality outcomes. This was an unannounced key inspection carried out by Sue Turner and Shirley Samuels, regulation inspectors. This site visit took place between the hours of 9:20 am and 4:20 pm. The registered manager is Moira Elliss Layne. Mr Zahur, is the registered provider, both were present during the site visit. As part of this visit we looked in detail at how people were protected from harm. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received back, eight people, nine relative, three professional and eleven staff surveys. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Seven staff, two relatives and six people living in the home were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in May 2007. The progress made has been reported on under the relevant standard in this report. The inspector wishes to thank the people living in the home, staff, and relatives for their time, friendliness and co-operation throughout the inspection process. DS0000046508.V362362.R01.S.doc Version 5.2 Page 6 What the service does well: People living in the home were asked about the care they were receiving. They made comments such as: “The staff are very pleasant, hard working and a pleasure to be with”. “I am comfortable”. “The food is generally good and I eat most of it”. “The staff vary, some are very good, and for some it’s an effort”. “Everyone’s always alright with me”. Comments received from questionnaires and from talking to relatives included: “I can’t fault the home or staff”. “I really like the ‘pets policy’, this gives people a lot of comfort”. “My relative is looked after very well, the staff are very caring”. “I have no experience of other care homes, but Brincliffe Towers seems very reasonable”. “The staff are very friendly and appear to be fond of the residents”. “The staff respond to difficult behaviour with patience and humour. The home provides as homely and welcoming atmosphere as is possible”. “I feel my relatives are treated in a kind and sensible way”. “The building is quite homely the food is nice and having pets is great. It is good that a hairdresser and others including entertainers come in”. “The level of care is what we were led to expect and seems quite adequate”. “The care home meets our relatives needs for nurture and protection. Having other people around them meets some of their needs for stimulation and conversation”. Professionals that visit the home said: “The staff are caring and concerned about their residents”. “The staff are always supportive”. DS0000046508.V362362.R01.S.doc Version 5.2 Page 7 “The home provides a welcoming environment and warmth towards the residents. There are some really excellent team leaders”. “The standard of peoples personal hygiene differs depending on which staff are on duty”. People’s health care was monitored and access to health specialists was available. Staff were observed being respectful towards people. People said that they had a choice of food and that the quality of food served was “well cooked”, “enjoyable”, “satisfactory” and “alright”. Systems were checked and serviced to maintain a safe environment. What has improved since the last inspection? What they could do better: The information in the homes AQAA was brief. They did not tell us very much about the views of the people living at the home, how the manager finds out DS0000046508.V362362.R01.S.doc Version 5.2 Page 8 what they want or what they are doing to make sure their service provides good outcomes for them. At present people were living in a home that did not provide a high standard of care. The service was not well organised or managed and this was having a detrimental effect on people living in, working in and visiting the home. Information that was necessary to ensure that people’s individual needs were consistently met had not been reviewed and updated. Examples of this were care plans and risk assessments. Out of date information could mean that staff did not know how to best care for people which could result in people’s health, safety and welfare being put at risk. The manager was not carrying out monitoring of such things as medication administration. This meant that mistakes in medication records were not being rectified. Some bad practices were observed, which did not protect people’s dignity. For example people were walking around in wet clothes and some had food spillages on them. Two people were sharing a room, which was not in their best interests. The mealtimes needed to be better organised to meet people’s needs and maintain their dignity. The EMI unit needed to be better staffed to meet people’s higher dependency levels. Some people need better access to social activities and visits to the outside community. Complaints were not always recorded so it was not possible to measure if complaints were investigated properly. Adult protection procedures and training records were not available for inspection. Because these records could not be checked it was unclear whether the service had good procedures for safeguarding people. Some décor, furnishings and flooring did not promote good standards of cleanliness and some areas of the home needed redecoration or repair, to ensure people were living in a clean and homely environment. Staff needed up to date training to make sure people were offered safe support and consistent care practices. The homes recruitment process was not thorough enough and could place people at risk. DS0000046508.V362362.R01.S.doc Version 5.2 Page 9 Some of the homes working practices, policies and quality assurance practices do not protect and promote people’s safety and welfare. This was due to poor management systems and a lack of leadership at the home. The home needed to improve how it monitored the quality of care to people by having a development plan and producing a monthly report on the homes progress to meet this plan. Staff training records, could not be checked as the manager could not find them. This was due to a lack of organisation and management of records in the home. This does not promote peoples safety. Staff should have made sure people in wheelchairs were safe by making sure they had footplates attached to wheelchairs when moving people. 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. DS0000046508.V362362.R01.S.doc Version 5.2 Page 10 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 DS0000046508.V362362.R01.S.doc Version 5.2 Page 11 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): Standards 1 and 3. Standard 6 is not applicable to this home. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient information to inform people about their rights and choices. EVIDENCE: The homes incorporated Statement of Purpose and Service User Guide was available and on display in the entrance hall. This included useful information about the home and the services offered. Some information was out of date and the manager was unable to say when it had last been reviewed. Prior to admission taking place professionals and staff assessed people. Pre admission assessments were seen in people’s files. DS0000046508.V362362.R01.S.doc Version 5.2 Page 12 People were invited to visit the home and spend time meeting the staff and seeing the services available. One relative said: “We had good information and the opportunity for my mum to spend some time in Brincliffe Towers before we agreed to her living there”. This home does not provide intermediate care services. DS0000046508.V362362.R01.S.doc Version 5.2 Page 13 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): Standards 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by visits to the home by health care professionals. Care provided by the homes staff was not person centred and did not promote dignity. More attention should be given to peoples changing needs. There were gaps in medication records. People are happy with the way most staff deliver their care however lack of adequate recordings put people at risk. EVIDENCE: People living in the home had an individualised plan of care. Three peoples plans of care were checked. These contained information on aspects of personal and health care needs. Care plans did not fully detail peoples emotional, personal and social care needs. This resulted in peoples assessed need (in some areas) not being met. DS0000046508.V362362.R01.S.doc Version 5.2 Page 14 The care plans did not inform staff about what they needed to do so that people’s individual needs were met. One person had suffered a number of falls. Accident forms had been completed, but no information about the falls had been recorded in their care plan. There was no risk assessment completed, this would have assisted in assessing the reasons for the falls and considered ways in which these could be reduced or eliminated. One person was prone to pushing other people, sometimes causing them to fall. Staff said they were aware of this, however this was not recorded in their care plan. No risk assessment was completed, to look at ways of dealing with this persons challenging behaviour and the impact this had upon others. Dates were recorded in the care plans of when they had been reviewed. However following reviews there was no evidence that any changes were made to the care plans. Relatives said: “The manager is always happy to chat with me if I pop in or phone but there is no formal arrangement for review and update of my relatives care”. “Staff have never asked me about my wife’s likes and dislikes and I have never been asked to contribute to a care plan”. “It would be helpful to know who the key worker of our relative is and to have the opportunity for regular contact”. Care plans identified that a range of health professionals visited the home to assist in maintaining peoples health care needs. When visited by a health professional any changes made to a person’s health needs wasn’t always transferred into the persons care plan. During the site visit we observed three people being taken by the staff to meals and activities, wearing wet clothes. Health professionals visiting the home said they had also made these observations, on other days. They had therefore assessed people for suitable products and spoke to the staff about continence and hygiene programmes. Relatives said: “My relatives basic needs appear to be well met. It would be helpful for them to be taken and supervised at the toilet more regularly. Optical and other needs have been attended to”. “Increased toileting support would be useful”. DS0000046508.V362362.R01.S.doc Version 5.2 Page 15 “The GP is sent for as soon as there is a health problem. The home seems to seek solutions to challenges”. “My relatives physical health is better that it has been for years as is their emotional health”. Medicines were securely stored in a locked trolley, which was kept in a medical room when it wasn’t in use. Medications were supplied by the pharmacists in monitored dosage. Only managers and team leaders, who had undertaken medication training administered medications. There was no evidence that the manager was auditing medication administration procedures. Some medications given had not been signed for on the MAR (Medication Administration Records) sheets. We observed a number of things that did not make sure that people’s dignity was respected at all times. People walking around in wet clothes, people with food spillage on their clothes, ladies wearing no stockings or tights, men not wearing socks and written information about peoples needs displayed on public notice boards. When this was brought to the manager’s attention she responded simply that people had made these choices about their lifestyle. Staff responded more appropriately and took action where necessary. One relative said: “We are keen that our relative is treated with dignity and respect and on the whole this seems to be the case”. DS0000046508.V362362.R01.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to maintain contact with family and friends. Little consideration was given to supporting people’s individuality and social preferences. The food was of satisfactory quality however, eating and food was not established as an enjoyable event. EVIDENCE: Seven people returned surveys. When asked, “Are there activities arranged by the home that you can take part in five people said “sometimes” and two said “always”. People said that there were some activities on offer at the home. An entertainer came once a month and there was an exercise class once a fortnight and a knitting and sewing club each week. People said they would like DS0000046508.V362362.R01.S.doc Version 5.2 Page 17 more activities to be available; above all they would like more activities and trips outside of the home. We observed that most people had minimal social contact with staff at the home. Even when staff were sitting in the communal areas observing people they didn’t use this time to interact. Relatives said: “We can visit at any time which is reassuring”. “There seems to be a good deal of freedom for the residents to choose when they get up where they spend their day etc. but I am not convinced Brincliffe Towers have nessesarly got the capacity to cater for less routine request’s e.g. If some of the residents decided they wanted to do something, e.g. go somewhere or request a different type of activity”. “Within the context of our relatives emotional physical and social condition she is supported in some choices. It would be nice if other choices could be offered e.g. listening to the music she likes and watching the programmes she likes”. “Outings in summer would be nice”. “I think they could do more to occupy, entertain and involve the residents and help them develop interests rather that assuming that the television and their newspapers keep them fully engaged”. “I think that the amount of activities they organise for the residents is limited and I am not aware of anything having been done to take them out for an occasional change of scene”. Hot and cold drinks were offered to people in between mealtimes. People said that the meals at the home were “ OK”, “good” and “fine”. We observed breakfast and lunch being served in two dining rooms. Choices were available and staff were aware of peoples meal preferences. Staff didn’t rush people but the dining room experience was one of getting the task over with. It was apparent that staff didn’t see this as an important social event for people living in the home. There were a number of people who needed assistance to eat. Low staffing numbers and inadequate staff training meant that people did not get the individual attention that was necessary. People were seen placing their food from their plate and onto the table, rather than eat it. Others were seen eating DS0000046508.V362362.R01.S.doc Version 5.2 Page 18 from someone else’s plate. One member of staff stood over a person whilst she/he assisted them to eat, other staff did sit with people. Relatives said: “My relative says the food is very good (but larger portions than they have been accustomed to) and everyone gets a Birthday party”. “In general the diet lacks fresh fruit and vegetables”. The provider said that fresh fruit and vegetables were ordered each week. On the day of the site visit the vegetable served at lunchtime was tinned peas. For dessert a choice of mousse or ice cream was served, there was no fresh fruit option. DS0000046508.V362362.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were no records of complaints kept. The home did not have an up to date adult safeguarding policy or procedure. Staff had a limited understanding of abuse and of the procedures to follow if an allegation was made. This means that people were not sufficiently protected from abuse. EVIDENCE: People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. We asked to see a copy of the complaints log. The manager was unable to provide any information about any complaints received to the home. Since last inspection we have recorded information regarding: • A complaint from a staff member. The provider investigated the issues raised and this was found to be unsubstantiated. DS0000046508.V362362.R01.S.doc Version 5.2 Page 20 • • • • A complaint from a relative who arranged to meet with the provider. The provider said that the person’s issues had been resolved. A concern from a relative, which the provider investigated and resulted in an employee being demoted and then leaving their employment. A concern from a GP who met with the provider and issues were resolved. A relative raising concerns, which were checked out during the site visit and are incorporated into this report and the requirements and recommendations made. Seven surveys were returned from people. Four people said that they did not know how to make a complaint. One person said: “I haven’t thought about that because I’m happy”. Relatives said: “We have occasionally spoken to the manager about wishes my mother has raised and they have been sorted out without difficulty”. “I had some concerns when my mother first entered Brincliffe Towers (as she was limited in her mobility and capacity after a fall) and the manager responded reassuringly”. The AQAA stated that since the last inspection staff had undertaken training in adult safeguarding and whistle blowing, delivered by the Sheffield Partnerships for Older Peoples Projects (POPP’s) team. Staff spoken to were unclear about what safeguarding meant and what their own responsibilities were in regard to safeguarding people. The manager was unable to provide any evidence that staff had undertaken training in adult safeguarding or any other subjects. The manager said that she had not had any training in adult safeguarding. The AQAA stated that the homes adult safeguarding policy and procedure had been reviewed and updated in April 08. We asked to see this but the manager could not find it. The only safeguarding document found was an out of date Sheffield Local Authority adult protection protocol. DS0000046508.V362362.R01.S.doc Version 5.2 Page 21 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): Standards 19, 24 and 26. People who use the 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 had a programme to improve the decoration, fixtures and fittings. The environment was odorous and unpleasant. The placement of two people in a double room was not in their best interests. EVIDENCE: Since the last inspection some areas within the home had been refurbished and the AQAA stated that the maintenance and renewal programme for the home would continue. We found that the furnishings, in many of the communal areas were looking very tired and worn. Carpets in the residential lounge and dining room were DS0000046508.V362362.R01.S.doc Version 5.2 Page 22 stained and marked. Some chairs had incontinence covers on them, which did not protect people’s dignity. In the EMI unit there was a strong unpleasant odour. The manager was asked to assess this, but said she was unable to smell anything. Later in the day the odour was less obvious, but still lingered. Bedrooms checked were comfortable and homely. People said their beds were comfortable and bed linen checked was clean and in a good condition. People said they “liked their bedrooms” and some said they “had lots of space”. Relatives said: “The rooms are nice and clean and there are nice grounds for if residents want to go out in the summer”. “My relatives room is very nice but I visited her at Easter and was almost violently sick as I walked into the building from the acrid smell of urine which seemed to permeate my clothes and assail my nostrils. I had to go back outside”. Two professionals visiting on the day of the site visit said that they had often observed an unpleasant odour in the home. The provider said that a housekeeper had been employed and the home was now looking much cleaner and brighter. A number of rooms were double. We observed that a person who was sharing a room was prone to pushing people over. Care records said that this person had pushed over her/his room partner. There was no risk assessment in place about this. We asked the provider to assess this risk and re consider the suitability of these two people sharing a room. Controls of infection procedures were in place. Staff were observed using protective aprons and gloves. The homes laundry was sited away from food preparation areas. DS0000046508.V362362.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient staffing levels and the shortfalls in the information obtained during staff recruitment meant that people were not adequately protected. Staff had not received all mandatory training and refreshers, which did not ensure they had the competencies to meet people’s needs. EVIDENCE: On the day of the site visit there were nine people living in the residential unit and thirteen people living in the EMI unit. Five carers were on duty. Three carers were working on the residential unit and two on the EMI unit. On the EMI unit one staff was a team leader and the other was a newly employed carer who was carrying out his/her induction. Staffing levels on the EMI unit were wholly inadequate and we observed people waiting an unacceptable length of time to be assisted with their care needs. We asked the manager why carers were organized as they were. She said it was not her responsibility to arrange where staff worked as they sorted this out themselves. When we pointed out that staffing levels in the EMI unit were insufficient, the manager asked the housekeeper to ‘help out’ on the unit. DS0000046508.V362362.R01.S.doc Version 5.2 Page 24 We had received some information from a relative that staffing levels on some days were not sufficient to meet people’s needs. Rotas were checked and it was evident that staffing numbers had dropped below adequate on some occasions. Staff interviewed said that they believed that rotas were planned to accommodate some staff and the needs of the people living in the home were not always considered. They also said that sometimes it was hard to meet people’s individual needs because staff phoned in sick or just didn’t turn up. The provider was informed of this during feedback. The AQAA stated that 57 of the care staff were trained to NVQ level 2 or above in care. This met the required minimum of 50 of the staff team trained to NVQ Level 2 in Care. Staff interviewed said that when they started work they received induction training in the first two months of their employment. Staff were able to talk about the various training courses that they had attended, however for some staff updated and refresher courses in mandatory training, for example, Moving and Handling and Adult Protection was necessary. The manager was unable to provide us with the staff training records. She said these had not been updated recently. Relatives said: “Training for some staff would be helpful in order for their personal development”. “Some of the staff seem to have the right skills”. One professional said: “There should be more consistent staffing”. Three staff records of employment were checked. There were major shortfalls in the information that should have been gathered during the recruitment process. Two people working on the day of the site visit did not have completed CRB (Criminal Records Bureau) checks or POVA (Protection of Vulnerable Adults) checks. One person only had one reference on file, which was from a personal friend. DS0000046508.V362362.R01.S.doc Version 5.2 Page 25 The provider was informed of this and agreed to arrange for CRB and POVA checks to be completed immediately. He also agreed to check all remaining staff and carry out any other checks that had been omitted during the recruitment process. Following the site visit the provider confirmed in writing that a trawl of staff files had identified other staff that had not completed CRB checks. These were immediately applied for. DS0000046508.V362362.R01.S.doc Version 5.2 Page 26 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): Standards 31, 33, 36, 37 and 38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not overall, benefiting from the leadership and management approach of the home at this point. It is acknowledged that the provider was taking action to resolve this. Record keeping, policies and procedures did not safeguard peoples rights and best interests, as they had not been followed. People’s health and safety had not been promoted and protected in some areas. EVIDENCE: The manager had a lot of previous management experience in residential care settings. On the day of the site visit the manager was uncooperative with us. DS0000046508.V362362.R01.S.doc Version 5.2 Page 27 When we brought this to her attention she said that she had resigned from her employment but had agreed with the provider to stay at the home until another manager was in place. The number of and the severity of the issues raised in this report demonstrate that the current management arrangements were not well thought-out. The management approach was having a negative impact on the people living in, working in and visiting the home. The care given to people met some basic needs, but did not meet the full range of health care needs. At present the home was not meeting peoples needs in an acceptable manner. Some policies and procedures were not being followed and in some cases there was no policy or procedure to follow. This then resulted in the manager and staff deciding themselves what was in the best interest of people which was not consistent and put people at risk from harm. The provider had made visits to the home and had met with people, relatives and staff. There was some evidence that he had taken action to sort out issues. The provider had advertised for a new manager and had arranged interviews. Following the providers visits to the home there were no reports written, that detailed any actions taken to improve the quality of the service provided. We requested that reports were completed and forwarded to us each month. Resident and staff meetings had taken place. The manager said she had not carried out a quality assurance review for some time. During the site visit the manager decided to finish her employment and left the building. We asked the provider to inform us of what the management arrangements would be in the interim. This was provided to us the following day. The deputy manager was working as acting manager until a permanent manager was in place. Records kept at the home were securely stored, however the general levels of record keeping in many areas were wholly insufficient. Staff spoken to said they were not receiving one to one formal supervision from their line manager. The equipment at the home was serviced and maintained. Fire records evidenced that weekly fire alarm checks took place. Staff said fire drill training took place on a regular basis. During the site visit we observed concerns relating to the health, safety and welfare of people: DS0000046508.V362362.R01.S.doc Version 5.2 Page 28 • • People were being moved around in wheelchairs that did not have footplates fitted. Staff were seen moving people using a moving and handling technique that is not recommended. This places people and staff at risk. DS0000046508.V362362.R01.S.doc Version 5.2 Page 29 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 2 2 2 DS0000046508.V362362.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 6 Requirement The Statement of Purpose and Service User Guide must be reviewed and updated so that it provides accurate information to people. Information within all care plans must be reviewed and updated to reflect each persons current health, personal and social needs. (Previous timescale of 15/01/07 and 21/06/07 not met). Plans of care must contain specific information on the staff action required to meet individual personal care needs. To ensure that people’s health, safety and welfare is maintained, individual risk assessments must be completed. These must consider the identified risk and look at ways of reducing or eliminating any risk to the person or others. People and/or their representative must be involved in the care planning and DS0000046508.V362362.R01.S.doc Timescale for action 01/06/08 2. OP7 OP8 15 01/08/08 3. OP7 OP8 15 01/08/08 4. OP7 OP8 14 01/08/08 5. OP7 15 01/08/08 Version 5.2 Page 31 6. OP9 13 7. OP9 13 8. OP10 12 (4) (a) 9. OP12 16 reviewing process. To ensure peoples health and welfare, MAR sheets must be fully completed and signed at the time of medication administration. There must be regular monitoring of the medication administration procedures. Following this any appropriate action must be taken to ensure that people are kept safe. Suitable arrangements and appropriate action must be taken to ensure that people’s dignity is respected. People must be consulted regarding the variety of activities offered. Further activities and trips out of the home must be provided. (Previous timescale of 15/01/07 and 21/06/07 not met). So that people are protected all complaints received in the home must be recorded in detail. Any complaint made under the complaints procedure must be fully investigated. To ensure the protection of people all staff must be trained adult safeguarding procedures. (Previous timescale of 15/01/07 and 21/06/07 not met). There must be a written policy and procedure that ensures people are safeguarded from abuse, neglect or discriminatory action. A risk assessment must be completed regarding the suitability of two people sharing a room. Following this appropriate action must be taken so that people are kept safe. DS0000046508.V362362.R01.S.doc 06/05/08 06/05/08 06/05/08 06/05/08 10. OP16 22 (3) 06/05/08 11. OP18 18 01/08/08 12. OP18 13 (6) 01/08/08 13. OP19 12 16 06/05/08 Version 5.2 Page 32 14. OP27 18 15. OP29 19 16. OP30 18 17. 18. OP30 OP31 17 (2) 30 19. OP31 OP33 9 17 26 20. OP33 26 21. OP37 17 To ensure that people’s individual needs are fully met there must be sufficient numbers of competent and experienced staff on duty at all times. (Previous timescale of 08/05/07 not met). There must be a thorough recruitment procedure, based on ensuring the protection of people. Therefore: People must not start work until they have completed a CRB/POVA check. Two written references have been obtained, one of which is from their previous employer. All staff must be provided with the relevant specialist and mandatory training for the role they are to perform. There must be an up to date record of the training undertaken by all staff at the home. A review of the management arrangements must be undertaken. Action must be taken to ensure that there is a permanent manager in post at the home. Improvements must be made in how the home is run, therefore the manager/provider must: Ensure that a thorough check is made of all aspects of the service provision following his monthly monitoring visits to the home. Action all the requirements issued within the timescales identified. Following the Regulation 26 visit, from the provider, the written report must be forwarded to CSCI. (Previous timescale of 08/05/07 not met). So that people are protected, DS0000046508.V362362.R01.S.doc 06/05/08 06/05/08 01/09/08 01/09/08 01/09/08 06/05/08 06/05/08 06/05/08 Page 33 Version 5.2 22. OP38 13 records required by regulation must be maintained, up to date and accurate. The health, safety and welfare of people must be promoted and protected at all times, therefore: Wheelchairs must have footplates fitted or be individually assessed. The moving and handling professionals/trainers guidance must be used when people are being transferred. 06/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Refer to Standard OP7 OP7 OP7 OP10 OP14 OP15 OP15 OP16 OP19 OP19 OP26 Good Practice Recommendations Care plans should be reviewed so that information recorded is person centred. Staff would benefit from receiving training in report writing and person centred care planning. People and their relatives should be made aware of whom their key worker is. Staff should undertake training in maintaining peoples dignity. People should be helped and supported to exercise choice and control over their lives. More fresh fruit and fresh vegetables should be included in the meals provided. Mealtimes should be a more social event that people look forward. People should be given further information about how/who to complain to or raise issues with. Incontinence covers should not be placed on chairs in communal areas. A planned programme of maintenance and refurbishment should continue. Satisfactory standards of hygiene have to be maintained. Therefore the cause of the unpleasant odour should be investigated and then appropriate action taken to DS0000046508.V362362.R01.S.doc Version 5.2 Page 34 12. OP36 eliminate this. Staff should receive formal supervision at the frequency of 6 times a year. DS0000046508.V362362.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 DS0000046508.V362362.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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