Inspection on 18/08/08 for Brownscombe House Nursing And Residential Home

This inspection was carried out on 18th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brownscombe House Nursing And... 04/02/09

Brownscombe House Nursing And... 28/09/07

Brownscombe House Nursing And... 09/01/07

Brownscombe House Nursing And... 14/10/05

Brownscombe House Nursing And... 03/05/05

Brownscombe House Nursing And... 09/08/04

Brownscombe House Nursing And... 19/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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: Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL     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: Suzanne Magnier     Date: 1 8 0 8 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 39 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 39 Information about the care home Name of care home: Address: Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL 01428643528 01428643616 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Elizabeth Jane McAllister Type of registration: Number of places registered: Mr L K Hasham care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category sensory impairment Additional conditions: One (1) named service user within the category SI/E (Sensory Impairment - over 65 years of age) may be accommodated. One (1) named service user within the category SI/E (Sensory Impairment - over 65 years of age) may be accommodated. Up to 25 beds may be used for the provision of nursing care for elderly people from the age of 60 years Date of last inspection Brief description of the care home Brownscombe House is a care home registered to provide nursing care for up to 36 older people, over 60 years of age. The home is owned and run by Care Homes of Distinction who also run similar establishments in Surrey. Brownscombe House is a large building in Haslemere that provides accommodation Care Homes for Older People Page 4 of 39 Over 65 3 36 1 0 0 0 Brief description of the care home over three floors, which can be accessed by a lift. There is ample parking available to the front of the house. Care Homes for Older People Page 5 of 39 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: The Quality rating for this service is 0 stars. This means that the people who use this service experience poor quality outcomes. The Commission for Social Care Inspection, (CSCI) has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced Key Inspection. Some additional standards were assessed and have been included within the report. Ms S Magnier Regulation Inspector carried out the inspection and the registered manager represented the service. For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 07.00 and was in the home for ten hours. It was Care Homes for Older People Page 6 of 39 a thorough look at how well the service was meeting the key National Minimum Standards for Care Homes for Older People set by the government and has in this report made judgements about the standard of the service. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This document was not received by CSCI by the intial deadline set and following the inspection another AQAA document was sent which had not been returned to the commission before the report was published. The commission have not received any responses to questionaires sent prior to the inspection. The information contained in this report was gathered mainly from observation by the inspector and speaking with a number of residents and care staff. A full tour of the premises was undertaken and documents sampled during the inspection included some residents care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the registered manager about the findings of the visit. The commission had received a concern regarding safeguarding vulnerable adults at the home. From the evidence seen by the inspector it is considered that the home would not be able to fully provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: Some care plans sampled did not reflect the current needs of the resident. Residents or thier representatives had not been consulted regarding the formation of thier care plans. Arrangements must be made to ensure that risk assessments are completed with regard to behaviours that affect the well being and welfare of residents. Care plans were written in the form of nursing tasks and had not been fully developed to include written guidance on how residents are supported to maintain their skills including independent living skills, to identify their goals and work towards achieving them. Arrangements must be made to ensure that peoples choice, lifestyle preference, ethnic and cultural needs are identified and promoted. It is recommended that the way of recording care provided to residents by care staff is reviewed to enable the care staff to have more accountability and involvement in report writing as they are the primary care givers. Arrangements must be made to consult residents about thier social interests and the programme of activities provided by the home. Care Homes for Older People Page 8 of 39 The homes staff are supported to engage with residents in a more meaningful way and consult residents about thier social interests and the programme of activities provided by the home. The residents are not fully protected by the homes complaints and safeguarding adults procedures. Arrangements must be made to ensure that residents or thier representaives are fully aware of the homes complaints procedures. Residents rights to respect and dignity must be maintined at all times. Arrangements must be made that window restrictors are fixed to all the windows above the ground floor to ensure the safety and well being of residents. More robust arrangements must be made with regard to the control of infection in the home, to ensure residents health and welfare. Consideration should be given by the homes manager regarding the suitability of residents accomodation in respect to the individuals mobility needs and the size of the corridors. Written risk assessements must be developed regarding the choice of residents to have thier room doors open and priority given to those residents for electronic door closures to be fitted to thier doors in order to ensure thier safety and well being. Safe vetting practices concerning the recruitment of all staff to the home must be improved and maintained in order to ensure the safety and protection of residents in the home. All staff must attend an induction programme which is in line with the Skills for Care council and all mandatory training must be updated in order to ensure that the homes staff are suitably trained and competent in thier duties. The management of the home is not robust to ensure the safety and wellbeing of residents. The inspector questionned the details of the Certificate of Registration which were not current due to the change of name of the manager. The inspector has required that the manager inform the commission in writing of the changes in order that a new certificate of registration is issued. The manager must undertake from time to time such training as is appropriate to ensure that they have the experience and skills necessary for managing the care home. All substances which are hazardous must be stored in compliance with the control of substances hazardous to health (COSHH)legislation in order to ensure the safety and welfare of residents. Records of food temperatures, storage of food in the fridge and pantry and repair of the homes refrigerator be made in order to ensure residents health and safety. Unnecessary risks which affect the health and safety of residents must be identified Care Homes for Older People Page 9 of 39 and so far as possible eliminated. All fire doors must be checked and made safe in order to protect residents in the event of fire. The registered provider must visit the care home unnannounced in order to form an opinion of the standard of care provided by the home and prepare a written report on the conduct of the home. Arrangements must be made for the robust management of staff supervision in order to ensure staff are supported and managed well. All events which affect the well being and welfare of residents must be reported to the commission without delay. Following the inspection the Care Homes of Distinction registered providers met with representaives of the commission regarding the findings of the inspection. The meeting was productive in examining the shortfalls more fully with the registered providers who assured the commission that they had been proactive in addressing some of the concerns identified during the inspection and were able to supply additional evidence for example of staff training dates which were not readily avaialble during the inspection. 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 10 of 39 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 11 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission and assessment procedures ensure that residents needs are appropriately identified prior to moving into the home. Evidence: An individuals care plan who had been recently admitted to the home was sampled and evidenced that an assessemnt had been made by a qualified person to ensure that the needs of the resident could be met by the homes staff. The manager had written to the individual to confirm that as a result of the assessment the homes staff could meet thier needs. The home offers respite care for individuals and the care plan for one person currently being supported at the home for respite care included a well documented pre admission assessment with additional information from other health care professionals. Care Homes for Older People Page 12 of 39 Evidence: Care Homes for Older People Page 13 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans identified shortfalls. Peoples personal care and support plans need to be strengthenned to reflect a more person centred approach. Peoples health care needs are well met. Medication procedures are robust. Residents rights to protection, dignity and respect were not promoted at all times. The monitoring of risk assessments has not been maintained to ensure the safety of people in the home. Evidence: Four care plans were sampled and it was evident that those individuals newly admitted to the home had had their care plan developed from the pre assessment documentation which included some of the persons care and support needs. The care plans were generally well written to allow the reader to gain an overview of the persons medical and personal care needs. During the previous inspection a requirement had been made that residents care plans accurately reflect the needs of the resident in respect of thier health, social and behavioural needs. Whilst looking at the care plans it was evident that some Care Homes for Older People Page 14 of 39 Evidence: improvements had been made however whilst and talking to staff it became apparent that some care plans did not accuratley reflect the current needs of the resident for example one care plan stated that the resident had no problem with eating and drinking yet the care plan stated that staff must encourage fluids and support the person at meal times and that bed rails must be in place when the individual was in bed yet there was a document within the care plan that the family of the resident had signed to state that thier relative did not want bedrails to be used on thier bed. Another care plan stated that the person engaged in self harming behaviours yet no risk assessment could be located to demonstrate what measures were in place to minimise the hazard and no evidence of wrirtten guidance for staff to follow to ensure the wellbeing and welfare of the individual. During the meeting held with the providers following the inspection the commission were shown a new person centred style care plan which the providers advised would be introduced at the home in order to benefit the residents and staff providing the residents care. The home had met the previous requirement regarding ensuring that nutritional and mobility risk assessments had been developed and that these were linked to the care plan. There was evidence to support that risk assessments regarding the use of bed rails had also been developed since the previous inspection. The care plans documented any concerns regarding tissue viability and care of residents pressure areas. It was noted through sampling the care plans that one resident who had been admitted to the home with a pressure area had had the wound healed. Staff on duty during the inspection were vigilant to residents who required turning whilst they were in thier beds to releive thier pressure points. It was observed that residents in thier bedrooms had thier call bells available to them in order that they could ring for staff assistance if needed. A requirement had been made during the previous inspection that residents or their representaives are consulted regarding the formation of the care plans. Whilst sampling the care plans it was observed that the practice of all care plans being signed by the resident or their representative was not consistent and this shortfall must be strengthenned to indicate that the resident or their representaive have been consulted about the care plan. It was observed and discussed with staff during the inspection and the manager at the end of the inspection that the care plans were written in the form of nursing tasks and did not fully document information for example written guidance on how residents are supported to maintain their skills including independant living skills and have independant choice for example being responsible for thier own personal care. There Care Homes for Older People Page 15 of 39 Evidence: were shortfalls in recording in several care plans of individuals goals and aspirations, peoples spiritual needs, ethnicity and cultural needs, choice regarding gender specific care, likes and dislikes, personal history and social preferences. It is required that the home make arrangements to ensure that peoples choice, lifestyle preference, ethnic and cultural needs are identified and promoted. There was documented evidence that appropriate health care appointments including visits by the General Practitioner (GP) had been attended and through sampling care plans and observation it was evident that the home maintains good working partnerships with health care professionals which include visits from the opticians, continence advisors, dentists and chiropodists to ensure that residents health care needs continue to be met. It was observed that the care staff are provided with a worksheet on which they write what care they have provided to a resident and the worksheets are handed over to the registered nurse who completes the residents care plan record. On the day of the inspection an agency registered nurse was on duty and this procedure was questioned by the inspector regarding issues of accountablity. It is recommended that this way of recording is reviewed to enable the care staff to have more accountability and involvement in report writing as they are the primary care givers. The home has a medication policy and procedure in place and has been supplied with a monitored dosage system. The inspector observed that the home has good, clear procedures in place for the monitoring and recording of all medicines administered and those entering and leaving the home. Records of controlled medication were sampled and checks made were accurate. Some medication administration charts were seen which were well documented, some contained the resident’s photograph and were clear to ensure that residents received their prescribed medicines. It was confirmed that qualified staff administer medication in the home. Residents were supported to take thier medication in a supportive manner and rights of refusal to take thier medication were respected and any ongoing concerns would be reported to the residents GP. It was observed that residents responded favourably to some staff and the staff demonstrated a knowledge and understanding of the residents welfare and support needs. Throughout the day the inspector observed that residents were addressed in a polite and courteous way by staff however serious concern had been raised at the begining of the day regarding residents security and protection against harm and abuse and these matters have been referred to the local authoritys safeguarding vulnerable adults team by the inspector and the homes manager following the inspection. A requirement has been made that residents are safeguarded from abuse Care Homes for Older People Page 16 of 39 Evidence: and harm and this has been more fully reported under Standard 17 of this report. Care Homes for Older People Page 17 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights of choice about thier daily routines, range of activities offered by the home and choice of meals needs strenghtenning. Positive engagement with residents needs to be promoted. Visitors are welcomed to the home to maintain contact with their family members. The home provides a healthy and balanced diet in a pleasant spacious dining area. Evidence: The home has an activities organiser who was on annual leave at the time of the inspection. One care staff member showed the inspector the daily activities plan which was displayed on the window of the nurses office with other documents. It was not clearly displayed and was two weeks out of date. The staff member said that the manager had obviously been too busy to replace the list. It has been required that arrangements must be more robust to consult with residents about thier social interests and the programmes of activities provided by the home in order that peoples right to chioce is promoted. The activities on the list included aroma therapy, arts and crafts, senior exercise, the Pat dog, games and quizzes with staff and over the week end family visiting. The staff Care Homes for Older People Page 18 of 39 Evidence: member told the inspector that the local college had recently visited the home which was enjoyed by the residents and a garden party with barbeque had been held. Several residents said that they had family and friends that could visit the home. The television in the lounge was on throughout the whole of the inspection and only turned off for the hour that a gentleman arrived to play the organ in the lounge which was enjoyed by the residents who had been supported to the lounge. As previously documented there was little evidence to support that the home has a person centred approach to the social care needs of individuals. In some care plans the sections relating to residents hobbies, interests, and skills had not been recorded and there was no indication of the persons previous occupation. Whilst speaking with staff they confirmed that they did not know residents past occupations and confirmed that the care is generally focussed on nursing tasks than on the social needs of residents. Evidence to support if individuals liked the planned activities was found in the daily records yet it was difficult to ascertain if residents had been given the opportunity to make a choice if they attended the planned activities. These shortfalls were discussed with the manager who said that when the activities organiser returns from leave she would instruct her to make sure that a more person centred approach to individuals hobbies, interests and social needs would be put in place. As part of the inspection the inspector used and addtional inspection tool called Short Observational Framework for Inspectors (SOFI) which is a first hand experience of sitting with residents in a commual part of the home and record observations during the inspection. The inspector sat for twenty minutes in the lounge with two residents. The residents did not speak to each other and no member of staff came into the lounge area during the twenty minutes. One interaction which was initiated by a resident was made to the kitchen assistant who was working near the kitchen area. It has been required that the manager encourages and assists staff to maintain good personal and professional relationships with residents in a way which promotes their rights to live an ordinary life, in both the home and the community and to enjoy all the rights and responsibilities of citizenship. Some residents were seen to move freely around the lounge and in the hallways and the atmosphere in the home was was quiet and relaxed. Two visitors were seen in the home but the inspector did not have the opportunity to meet with them. One staff member advised that a member of the Christian clergy visits the home to support residents spiritual and religious needs however as previously documented the spirtitual or religious needs of residents from diverse Care Homes for Older People Page 19 of 39 Evidence: backgrounds need to be documented and promoted if the resident chooses. There was evidence to support that the home is visited by a hairdresser and several residents said they enjoyed having thier hair dressed as it made them feel better. The home is planning to have a separate hairdressing room, which will be equipped to offer comfort and safety to residents. The midday meal served at lunch time was well presented with each resident being able to sit up to a dining table if they chose to to have their meal. Residents who were not able to support themselves with meals had thier meals in thier bedrooms with the support from staff. All residents looked well groomed and wore protective clothing at the meal time. The conservatory dining room was bright and spacious with appropriate crockery and condiments available on each table. The care staff went around to each table to ask what people would like to eat as the menu had been changed. There was no evidence at the time of the inspection of a planned menu on display in the home which would assist residents to make chioce and decide prior to their meal what they would like. It has been required that a menu is made available for residents to see and they are supported to make informed choices about the meals the provided by the home. It was noticed that there were no napkins or doillies and that green paper hand towels were being used as napkins which staff confirmed was not a usual practice but were being used as no napkins had been ordered. Residents stated that the food was alright, but the meat had been too hard at the weekend. The meal was served hot and soft diets presented well. One residents relative had visited for lunch and staff confirmed that this was a regular arrangement. Care Homes for Older People Page 20 of 39 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. The residents are not fully protected by the homes complaints and safeguarding adults procedures. Evidence: The home has an established complaints procedure. The manager confirmed that no complaints had been received by the home. Several residents told the inspector that they would probably talk to staff or thier family members if they had any concerns or were unhappy about the home yet some residents did not know who to speak to. It has been required that arrangements must be made to ensure that residents or thier representatives are fully aware of the homes complaints procedure. Several letters of compliment and thanks were sampled in a file which reflected favourably on staff and the care they provided. The night care staff did not use the homes intercom security procedures and the inspector gained entry to the home without thier presence being known. One staff member was heard to use intimidating and a disrespetful tone and manner towards a resident and various comments made by some staff which were overheard during the inspection were regarded as unprofessional and had the potential to cause distress to residents. Care Homes for Older People Page 21 of 39 Evidence: A resident made a complaint about a night staff member in the presence of the inspector to a member of staff and it was confirmed that the staff member reported the complaint to the manager during the inspection which demonstrated the staff members awareness and knowledge regarding thier duty to report concerns and allegations in order to protect the residents in thier care. Two residents rooms, which were vacant, yet contained the residents belongings and personal affects had been left open over the weekend and the rooms had not been locked to ensure that thier personal belongings were safe. Records indicated that staff had received training in safeguarding vulnerable adults and where training needed to be updated courses had been booked. The manager confirmed that the induction training in line with the Common Induction Standards of the home includes a section on safeguarding vulnerable adults. Six staff recruitment files were sampled during the inspection and the majority of files lacked adequate documented information to demonstrate that robust recruitment procedures had been used to protect residents living in the home from harm or abuse. This standrad is more fully documented in Standard 29 of the report. The manager, the following day advised the commission that the matters of concern as detailed above had been reported to the Surrey local authority multi agency safeguarding team however it was noted that the manager was uncertain of the current protocols of reporting safegaurding matters. Care Homes for Older People Page 22 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes furnishings are of a high comfortable standard. The physical layout of the home does not meet all residents mobility needs. The control of the spread of infection and fire safety precautions in the home need to be strengtenned. Residents bedrooms suit thier needs and communal bathrooms are adequate in number. Toilet facilities need to be reviewed. Evidence: A redecoration programme was being undertaken at the home which involved decoration of hallways, communal areas and some bedrooms and bathrooms. The person in charge of the decoration plan joined the inspector on a tour of the premises. It was noted that the state of the homes decor provides pleasant surroundings for the residents. There was suitable furniture and soft furnishings throughout the home for residents to use and a well maintained garden which, the inspector was advised residents had access to. Staff were seen to use a gazebo erected in the garden during thier coffee time. During the tour of the premises it was observed that a window catch in the bay window of the lounge was broken, and two residents bedroom windows on the top and first floor did not have window restrictors on which was viewed as a potential hazard to the resident. It has been required that arrangements must be made that window restrictors are fixed to all the windows above the ground floor to ensure the safety and well being of residents. Care Homes for Older People Page 23 of 39 Evidence: The home was generally clean throughout and the inspector spent time talking to the housekeeper regarding a malodour which the housekeeper explained she was aware of and told the inspector that arrangements were in place to clean the carpet in the bedroom on a regualr basis to try and eliminate the malodour. On arrival at the home in the morning the laundry area was in a state of disarry with soiled linen left lying on the floor. There was no lid on the waste bin and the laundry door had been left propped open by a brick. It was observed that the laundry was directly opposite a residents bedroom and thier door had been wedged open by thier walking frame. During the tour of the premises the inspector was shown a room which was known as the disabled toilet. The room contained soiled linen skips which were situated by the toilet. This arrangement was considered hazardous to residents and did not reflect thier rights to dignity. It has been required that more robust arrangements are made with regard to the control of infection in the home, promote residents rights to dignity and ensure their health and welfare. Several staff told the inspector that electronic door closures were due to be fitted on several doors throughout the home but were unsure when this would happen. It has been required that written risk assessements are developed regarding the choice of residents to have thier room doors open and priority given to those residents for electronic door closures to be fitted to thier doors in order to ensure thier safety and well being. Sluice areas in the home were viewed as clean and orderly. Staff were observed to wear protective clothing, including aprons and gloves and hand washing facilities were available throughout the home. During the previous inspection it was observed that several residents did not have thier call bells within reach and it was observed that all residents seen during the day had a call bell within thier reach when they were in bed or sitting out of bed in thier rooms. Residents spoken with said they liked thier bedrooms which were viewed during the tour of the premises to be clean, well decorated, furnished with a high standard of furnishings and were personalised. Residents are encouraged to bring their own items of furniture and personal effects if they choose to. Some areas of the home have wide corridors which were viewed as suitable for residents who did not use wheelchairs however it was observed that one resident was being supported in a wheelchair from thier bedroom through an upstairs corridor which Care Homes for Older People Page 24 of 39 Evidence: was very narrow. Consideration should be given by the homes manager regarding the suitability of residents accomodation in respect to the individuals mobility needs and the size of the corridors. The bathroom facilities in the home were viewed as appropriate to meet the needs of the residents currently living in the home. One bathroom was out of order due to redecoration and staff advised that six residents were affected some of whom would be supported to use the upstairs bathroom. The person in charge of the redecoration programme advised that they bathroom would be back in use within a couple of days. Care Homes for Older People Page 25 of 39 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. Staff in the home are in sufficient numbers to support the people who use the service. A system for the induction, training and development of staff is in place to ensure residents needs are appropriatly met. Safe vetting of staff and management of recruitment practices must be strengtenned to protect the welfare and safety of residents. Evidence: The home currently employs 20 staff including the manager. Staffing levels at the home during the inspection were six carers, one supernumerary carer and an agency RGN. The manager was observed to work in an administrative role within the home. The staffing rotas were sampled in the nurses office and the numbers appeared appropriate for the current needs of the residents at the home. Staff spoken with said they felt there were enough staff and during the day the staff were not rushing about and the pace of the home was relaxed. It was observed that the home employs a multi-cultural workforce and equality and diversity issues are addressed within the homes policies and procedures and induction programme. The inspector spoke with several overseas staff who advised that they would be having English lessons that were due to start next month. Whilst the staff members command of English was quite easy for other staff to understand using a Care Homes for Older People Page 26 of 39 Evidence: variety of signs and objects of reference it was viewed that it would not be so easy for residents to be able to use this level of communication. This was viewed as a shortfall with the additional reliance on other staff who were very supportive of thier colleagues and demonstrated team work. The inspector sampled six staff files which included trained staff, carers, the housekeeper and the cook. The files sampled evidenced that the homes management do not undertake safe vetting practices concerning the recruitment of staff as five of the files sampled identified shortfalls which included lack of robust references, incomplete application forms, no reasons why the person left thier last place of work, no references and no photo of the staff member. It is required that safe vetting practices concerning the recruitment of all staff to the home are developed and maintained in order to ensure the safety and protection of residents in the home. The manager advised that the home is committed to the ongoing training and development of staff however the training matrix supplied at the time of the inspection indicated that the cook and some care staff had not received any induction or mandatory training. The records also indicated that some staff mandatory training had expired and there was no evidence at the time of the inspection that that courses had been booked for the staff to attend. During the meeting with the providers following the inspection the commission representatives were shown the updated staff training matrix which indicated that staff had received and attended an induction programme which is in line with the Skills for Care Council and mandatory training to ensure that the homes staff are suitably trained and competent in thier duties. The training records indicated that six of the overseas nurses had the equivalent to the National Vocational Qualification Level 3 training in care. One other staff member had achieved thier NVQ Level 2 whilst another was undertaking the course. Care Homes for Older People Page 27 of 39 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 and administration of the home is not robust. The home is run in the best interests of the residents yet their views and opinions and those of other associated with the home could be strengthened. Supervision arrangements for staff need to be reviewed. Resident’s general safety and welfare is not promoted and improvements need to be made regarding some health and safety concerns in the home. Evidence: On arrival at the home it was observed that the registered managers office door had a notice on it which stated Please do not disturb unless absolutley necessary important managerial work and form filling in progress requires peace and quiet. Please see senior nurse for any nursing or care issues. During the day and speaking with the homes and agency staff they confirmed that the managers role within the home was office based and staff would take thier queries to the nurse on duty. Care Homes for Older People Page 28 of 39 Evidence: The Annual Quality Assurance Assessment (AQAA) had been sent to the home by the commission in June 2008 yet the manager advised this had not been received and thus not returned. Following the inspection another AQAA was sent for a return date of one week and this document had not been received by the commission by the due date. Failure to complete this document is an offence and may lead to enforcement action. The inspector questionned the details of the Certificate of Registration which were not current due to the change of name of the manager. The inspector has requested that the manager inform the commission in writing of the changes in order that a new certificate of registration be issued. A certificate of Insurance was sampled and was confirmed as a current document. The training matrix which included the managers training and qualifications was sampled and indicated that the manager had received an orientation to the home yet had not received training in health and safety, including risk assessments. As previously documented the manager lacked awareness and a proactive response to the local authorities safeguarding protocols and reporting procedures to ensure the saftey and protection of residents in the home. It has been required that the manager must undertake from time to time such training as is appropriate to ensure that they have the experience and skills necessary for managing the care home. Several areas of concern to the health and safety of residents had been raised during the inspection which included that the door to the room where the paints and other building materials were stored had been left open and was a potential hazard for residents. Containers of carpet cleaning fluid had been left unattended in the corridors and the chemicals cupboard situated outside the kitchen had been left open. The cook later advised that the key was missing and a new padlock and key was put in place during the inspection. It has been required that all substances which are hazardous must be stored in compliance with the control of substances hazardous to health (COSHH) legislation in order to ensure the safety and welfare of residents. The homes fridge, freezer and pantry were well stocked. The homes cook advised that there had been a recent visit from the environmental health officer and one requirement had been made which had been met. Fresh fruit and vegetables were avaialble for residents. In the pantry several of the plastic containers did not have the lids securley fitted. Some foods in the fridge had not been labelled appropriatley and the fridge was leaking across the kitchen floor. Some food temperature checks were recorded however this was not consistent practice and on examination of the records the gaps were due to agency staff not completeing the checks. The manager advised that she would contact the agency and advise them of this shortfall. It has been required that records of food temperatures, storage of food in the fridge and pantry Care Homes for Older People Page 29 of 39 Evidence: and repair of the homes refrigerator be made in order to ensure residents health and safety. Whilst visiting residents in thier rooms it was observed that in one bedroom the electric flex for the air mattress had been placed across the floor in front of the doorway which was considered a trip hazard. The use of a free standing electric heater in another residents room was also viewed as hazardous and staff were unsure if a risk assessment had been completed. As previously documented several fire doors throughout the property were not closing correctly and this was brought to the attention of the manager and person in charge of the decorating. It has been required that all fire doors are checked and made safe in order to protect residents in the event of fire. A staff member advised the inspector of the homes fire procedures and assured the inspector that records were kept of weekly fire tests and equipment checks. During the tour of the premises it was observed that one residents room was directly oppposite the kitchen where the radio was on, there was a great deal of staff banter and noise from the kitchen regarding the meal preparation. It was uncertain whether any resident occupying this room may be troubled by the level of noise and staff were unclear if this matter would be addressed with a resident. There was little evidence to support that resident views and opinions of the home are actively sought as no Quality Assurance documents were made available during the inspection. It is required that a more proactive approach to the effective quality assurance of the service based on seeking the views and opinions of the residents is more fully implemented. A record of compliments was sampled which indicated that residents representaives were satisfied and happy with the care, including end of life care, provided by the home. The inspector was informed that the Regulation 26 visits take place and any shortfalls in the quality of the service would be noted by the organisation during the visits so that appropriate action would be taken to rectify the shortfalls. Records evidenced that the visits had taken place during the first three months of 2008 yet no records were avaialble from March 2008. It is required that the registered provider visit the care home unnannounced in order to form an opinion of the standard of care provided by the home and prepare a written report on the conduct of the home. The manager advised that no residents monies are kept by the home on behalf of the resident and that residents are encouraged to keep thier own money. Residents are invoiced for the services of the hairdresser and aromatherapist and any reports of any thefts would be reported to the commission. Care Homes for Older People Page 30 of 39 Evidence: The inspector requested to sample some staff supervision files and was advised by the manager that staff keep thier own records and no records were available within the home. The manager advised that she supervises the trained staff and the trained nurse supervises the care staff. The arrangements of supervision of staff were discussed in depth and the shortfalls of the management of staff raised as there was no clear evidence available during the inspection that staff are provided with or receive formal supervison. It has been required that arrangements must be made for the robust management of staff supervision in order to ensure staff are supported and managed well. Accident and incident records were sampled which indicated that not all events which affect the wellbeing and welfare of residents are reported. There was evidence of residents falling within the home which had not been reported to the commission in line with Regulation 37 of the Care Homes Regulations 2001 (as ammended). It has been required that all events which affect the well being and welfare of residents must be reported to the commission without delay. As recorded throughout the report a large number of aspects of the homes management are potentially putting the health, safefty and welfare of residents and staff at risk including lack up to date care plans, risk assessments, lack of residents choice, dignity and respect, shortfalls in staff training and supervision, lack of residents rights to protection, safety and welfare. It has been required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents in the home. Care Homes for Older People Page 31 of 39 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 3 Arrangements must be 15/11/2008 made to ensure that risk assessments are completed with regard to behaviours that affect the wellbeing and welfare of residents. To ensure the promotion of residents rights to safety and wellbeing. 2 8 12 Arrangements must be 15/11/2008 made to ensure that peoples choice, lifestyle preference, ethnic and cultural needs are identified and promoted. To ensure the promotion of residents rights to independence and choice. 3 12 12 Good personal and professional relationships with residents must be promoted. To ensure that residents have the right to live an ordinary and meaningful life in both the home and the 03/11/2008 Care Homes for Older People Page 33 of 39 community and to enjoy all the rights and responsibilities of citizenship. 4 12 16 Arrangements must be made to consult with residents about thier social interests and the programme of activities provided by the home. To ensure that residents rights to choice are promoted. 5 15 17 A menu must be made available for residents to see. To support residents to make an informed choice about their meal preferences provided by the home. 6 16 22 Arrangements must be made to ensure that residents or their representatives are fully aware of the homes complaints procedure. Residents rights to view thier opinions and complaints must be promoted. 7 18 13 Arrangements by training staff or other measures must be made to prevent residents being harmed or suffering abuse or being placed at risk of harm. Residents rights to safety and protection must be promoted. 03/11/2008 15/11/2008 15/11/2008 15/11/2008 Care Homes for Older People Page 34 of 39 8 18 12 Arrangements must be made to ensure that the care home is conducted in a manner which respects the privacy and dignity of residents at all times. Residents rights to dignity and respect are promoted. 15/11/2008 9 19 13 Arrangements must be 15/11/2008 made that a risk assessment is completed regarding prioritising the fixtures of electronic door closures To ensure the safety and well being of residents. 10 19 13 Arrangements must be made that window restrictors are fixed to all the windows above the ground floor. To ensure the safety and well being of residents. 15/11/2008 11 26 13 More robust arrangements must be made with regard to the control of infection in the home. To ensure the health and welfare of residents. 03/11/2008 12 29 19 Safe vetting practices 15/11/2008 concerning the recruitment of all staff to the home must be improved. To ensure the safety and protection of residents in the home. 13 31 10 The manager must undertake from time to time such training as is 15/11/2008 Care Homes for Older People Page 35 of 39 appropriate to ensure that they have the experience and skills necessary for managing the care home. To ensure the safety and protection of all persons in the home. 14 33 24 A more proactive approach 03/11/2008 to the effective quality assurance of the service based on seeking the views and opinions of the residents must be more fully implemented. To ensure that the views and opinions of residents and others associated with the home are listenned to and acted upon. 15 33 26 Unnannounced visits must 03/11/2008 be made to the care home in order to form an opinion of the standard of care provided by the home and a written report on the conduct of the home must be made available. To ensure that the servive provision meets the needs of the residents. 16 36 18 Arrangements must be made for the robust management of staff. To ensure staff are supported and managed well. 03/11/2008 Care Homes for Older People Page 36 of 39 17 38 13 All substances which are 03/11/2008 hazardous must be stored in compliance with the control of substances hazardous to health (COSHH) legislation. To ensure the safety and welfare of residents. Records of food 03/11/2008 temperatures, storage of food in the fridge and pantry and repair of the homes refrigerator be made. in order to ensure residents health and safety. To ensure residents health and safety. All fire doors must be checked to ensure they are closing correctly. To protect residents in the event of fire. 03/11/2008 18 38 13 19 38 13 20 38 37 All events which affect the well being and welfare of residents must be reported to the commission without delay. To ensure the safety and well being of residents. 03/11/2008 21 38 24A An improvement plan detailing how the home intends to improve the services provided in the home must be submitted to the commission. To improve the services provided to promote the safety and well being of residents in the home. 15/11/2008 Care Homes for Older People Page 37 of 39 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 8 The method of recording care provided to residents is reviewed to enable the care staff to have more accountability and involvement in report writing as they are the primary care givers. Care Homes for Older People Page 38 of 39 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. 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