Inspection on 23/05/06 for Callands Care Home

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Callands Care Home 19/04/07

Callands Care Home 30/10/06

Callands Care Home 12/09/05

Callands Care Home 12/04/05

Callands Care Home 27/09/04

Callands Care Home 20/05/04

Callands Care Home 11/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Clover House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOMES FOR OLDER PEOPLE Callands Care Home Callands Nursing & Mental Nursing Home Callands Road Callands Warrington Cheshire WA5 5TS Lead Inspector Denis Coffey Unannounced Inspection 23rd May 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 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. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Callands Care Home Address Callands Nursing & Mental Nursing Home Callands Road Callands Warrington Cheshire WA5 5TS 01925 244233 01925 413433 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) Southern Cross Home Properties Limited Care Home 120 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (60), Learning disability over 65 years of age of places (1), Old age, not falling within any other category (30), Physical disability (30) Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 120 service users to include:* Up to 30 service users in the category PD (Physical disability) who may be accommodated in Lakeside Unit * Up to 30 service users in the category OP (Old age, not falling within any other category) who may be accommodated in Coniston Unit * Up to 1 named service user in the category LD(E) (Learning disability over 65 years of age) who may be accommodated in Windermere Unit * Up to 60 service users in the category DE(E) (Dementia over 65 years of age) who may be accommodated in Grasmere, Ullswater and Windermere Units * Within the 60 DE(E) beds (Dementia over 65 years of age), 2 named service users in the category DE (Dementia under 65 years of age) may be accommodated Service users who require nursing care may not be accommodated in Windermere Unit The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet dependency needs of service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 12th September 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Callands is a care home providing personal and nursing care and accommodation for 90 older people, 60 of whom have dementia, and 30 younger adults with physical disabilities. The home is located in the Callands area of Warrington, close to shops, a post office and a pub. Gemini retail park is close by, as is the Westbrook Centre which has a large supermarket, more shops, a restaurant and cinema complex. Callands is on a bus route and close to the M62 motorway. The home is a two storey, purpose built home and is divided into five units. Three of the units, including the younger adults’ unit, are located on the ground floor. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 5 All bedrooms are single with an en-suite shower. There is a passenger lift. The home has extensive grounds, which are easily accessible. The weekly fee payable at the home ranges from £347 to £700. The manager provided this information on 10th May 2006. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home took place on the 23rd & 24th May 2006 over a 12-hour period. The CSCI regulation inspectors who visited were Denis Coffey, Helena Dennett and Bernadette Rigby. All areas of the home were inspected and residents, staff and visitors spoken with. Care records and the home records were also examined What the service does well: What has improved since the last inspection? The staffing levels on Lakeside Unit have been increased to meet the particular needs of the residents accommodated on there. Following the last visit by the Commission, the weights of the residents are recorded more frequently where it has been identified that a resident is at risk of losing weight. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 7 The involvement of other healthcare professionals is recorded in the residents’ care records along with the outcomes from these visits. What they could do better: All of the residents have care records but these do not in all cases accurately reflect the current needs/problems of the residents along with actions needed to meet these needs. The management of medicines could be improved by ensuring that accurate records are maintained of all medicines delivered to the home, and of medicines administered to the residents. The security of the medicines would be improved by ensuring they are stored correctly at all times, and residents should be given their medicines at the times identified on their medicine administration record sheets. The home employs an activities organiser, but when this person is on holiday, there are no structured activities for the residents. Whilst a range of activities are provided for the residents, these do not always reflect the interests of all. Residents spoken with commented positively on the food provided for them. However, this could be improved by ensuring that the dietary needs and preferences of all the residents are catered for. Most areas of the home were clean and tidy, but there were unpleasant smells noticeable in a couple of areas. Some items of equipment used in the care of residents were found to be in need of cleaning. Some areas of the grounds surrounding the premises were in need of attention as the grass was overgrown. There is a lake adjacent to the building that needs safety fencing around it to prevent accidents to residents if they were to be in this area unaccompanied. A number of mobile hoists were being stored in rooms used by residents. The provision of adequate storage space around the home would overcome this problem. The flooring in the ensuites of two rooms on Coniston and Windermere Units, and the bathrooms on Windermere and Grasmere requires replacing to provide safe flooring for residents who use these rooms. The management of the residents’ personal monies would be improved by ensuring that receipts are obtained for all purchases made on their behalf, and by keeping accurate and up to date records. Please contact the provider for advice of actions taken in response to this Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of the residents are fully assessed before they move into the home to ensure that their needs can be met there and the contracts contain all the information residents need to know their rights and responsibilities. EVIDENCE: A service user guide is available in the reception area. The manager said that the home’s statement of purpose and service user guide were under review and that an up to date copy would be made available shortly. However, when one member of staff (unit manager) was asked where the statement of purpose was, she appeared unsure and did not appear to know what was being asked for. Four residents’ contracts were looked at as part of process of checking residents’ care. These identified the weekly fee payable, what services are included in the fee, the periods of notice required for termination of the contract, additional services not covered in the fee, and the arrangements for Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 11 insuring personal belongings. For one person, although the proprietor had signed the contract, there was no signature of the resident or their representative. The care records of six people who had moved into the home since the last visit had copies of a pre-admission assessment being carried out with them. The assessments identified the person’s needs/problems in a clear and comprehensive way, together with personal details. Callands Care Home does not provide intermediate care so Standard 6 does not apply. See Recommendation 1 Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The healthcare needs of the residents are generally well managed, but care records, risk assessments and medicines procedures need to be improved so that all residents’ needs are met appropriately and safely. EVIDENCE: As part of process of tracking the care given to residents in the home, records of five residents were examined Coniston Unit Resident A A range of risk and care assessments were documented in this resident’s records. The risk assessment for malnutrition had a score of 0 for the months February to May 2006, indicating that there was no problem in this area. However, the resident’s weight records showed that they weighed 62kg on 16th February and 59.6kg on 15th May, giving a weight loss of 2.4kg. This weight Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 13 loss had been identified and interventions were recorded as to how this was to be managed. A falls risk assessment was documented and a plan of care for this problem dated 22nd December 2005 was in place. However, there was no evidence available to demonstrate that this plan of care had been reviewed and evaluated. A risk assessment for the use of bed rails was in place, but this did not identify why they were needed, or all of the risks involved in using this equipment. Adequate daily records were kept relating to the resident’s health and welfare. Evidence was seen of the general practitioner and other healthcare professionals being involved in the delivery of the resident’s care. The inspector spoke with one of the trained nurses on duty who was aware of this resident’s needs and the care provided. The nurse was also aware that the resident had lost weight and said that this was being monitored. Resident B This resident was admitted to the home with a variety of healthcare needs. The assessment documents showed that the resident was at risk of falling, and had difficulty in swallowing. The nutritional assessment for the resident was filled in inaccurately. A score was given under the heading requires help to eat; yet the admission assessment identifies that the resident has a swallowing problem. If this is the case then a different score should have been entered on the assessment documentation. A falls risk assessment showed that the resident was at high risk of falling and an appropriate plan of care for this problem had been put in place. A full set of plans of care was in place for the identified needs of the resident. These had been evaluated regularly and updated as the resident’s needs changed. One of the care plans was for bruising that was dated 12th May 2006. A body chart of bruising dated 31st March 2006 identified that the resident had two large bruises on two areas of their body. There were seven entries relating to further unexplained bruising, and these were also documented on the body chart. However, it is of concern that no action/investigation into the causes of these bruises was undertaken until the GP liaison nurse visited on 27th April 2006 when blood samples were taken. The nurse in charge of the unit said that the resident was confused when they first moved into the home, but they are more settled now. The manager has met with the resident’s family to discuss the possibility of changing the floor covering in the resident’s bedroom as it was felt that this contributed to the problem. When spoken with the resident said that they were happy in the home and that their needs were attended to. The resident went on to say that the care staff were ‘good’, they enjoyed the food provided, they could get up in the morning at a reasonable hour and go back to bed when it suited them. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 14 Lakeside Resident C The resident’s care records showed a full assessment of needs had been carried out, and plans of care devised for identified needs/problems. One of the problems identified was that of challenging behaviour. When asked about this the nurse in charge said that the resident was verbally aggressive to a carer when she was putting the resident’s clothes away, as they liked their drawers shut and thought the carer was going through their drawers. Staff have discussed this issue with the resident, and agreement has been reached as to how and when their clothes are to be put away. Staff demonstrated an awareness of the need to ensure that the dignity and privacy of the resident is maintained. Resident D A range of risk assessments and plans of care were documented in the resident’s care records. Plans of care had been evaluated but one of the problems the resident suffers from is high blood pressure and the evaluation stated ‘is still at risk of high blood pressure, monitoring blood pressure regularly’. These evaluations did not identify what the desired outcomes should be, e.g. the range of blood pressure that would indicate the problem is under control. An incident between the resident and carer was reported upon where the resident had shown physical aggression towards the carer. Accident forms were completed for this that stated ‘ care plan and risk assessment in place’. There was no evidence of the action needed to ensure that this does not occur again. There were several entries in the resident’s daily records stating, ‘psychologically managed’. These entries require elaborating upon to inform other staff caring for the resident what is meant by them. One of the care staff spoken with said that she was fully aware of the needs of the resident, and described the distraction techniques used when providing personal care to minimise the risk of further aggressive episodes. The resident’s plan of care had not been updated to reflect this. There was no evidence available that a psychiatric review or advice from a community psychiatric nurse had been sought. Grasmere Unit Resident E The assessment documentation for this resident showed that they had a particular problem in relation to inappropriate behaviour. A risk assessment had been completed for this. An assessment with regard to skin integrity was filled in incorrectly. The assessment for mobility shows that the resident is Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 15 restless yet another assessment states that the resident has restricted mobility. Members of staff spoken with confirmed that the resident had restricted mobility. It was also identified that the resident smokes cigarettes, but this factor was not scored on the assessment. The nutritional assessment was also inaccurate. The resident was scored as losing weight in February and March this year, yet another record showed that they had gained weight. Two scores were also entered under eating; one was scored as a 2 for requiring help to eat, and 3 as unable to eat solids. The form also identified that the resident had a broken skin/wound. This was not recorded anywhere else in their records, and staff spoken with confirmed that the resident did not have any such problem. The resident requires his food to be supplied through a tube that was fitted in hospital. The plan of care for this procedure was dated 18th November 2005. This had not been updated to reflect the care needed following a visit by the dietician on 14th February 2006 and the speech and language therapist on 19th April 2006 when advice had been given that the resident could now have thickened fluids and a pureed diet. However, a risk assessment dated 13th January 2006 was still in the care records stating ‘strictly no oral fluids’. An addition that had been made to one of the plans of care regarding the risk of aspiration had not been dated. Staff spoken with said that they were providing one to one care for the resident, but this was not identified in the care records. There was no plan of care in place for the resident’s personal hygiene and oral care needs. An entry in the records for May stated that there had been an episode of physical aggression towards the staff by the resident. There was no entry in the accident record book of this. Another entry in the care records identified that there was a problem with the resident’s catheter, requiring it to be changed. A replacement catheter was not available at the home, and a nurse had to visit the local hospital to acquire one. Medicines The arrangements for the safe handling, storage and administration of medicines was inspected on Lakeside and Grasmere Units Records of receipt, administration and disposal of medicines are recorded on a sheet supplied with the by the pharmacy. The quality of the records was variable, some satisfactory, some not so good and some of concern. This makes it difficult to audit the medicines. The pharmacy produces a new sheet with each supply of medicines and the home staff record the receipt of medicines on it. They then go on to record the administration of the medicines on the old sheet. It is difficult, therefore, to be sure that residents have had their medicines properly, and that medicines are managed securely. Some items dispensed are duplicated on the printed sheet. The home staff leave these duplicated entries and then it is not clear which is the current record. Sometimes both records are used at the same time. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 16 One resident was prescribed olive oil eardrops twice a day but was only given these once a day. Another was recorded as having some eardrops twice a day. There were no prescribed directions and no evidence of advice being sought. The patient information leaflet supplied in the box recommends that the drops be applied three times a day. The records of one resident’s blood thinning tablets were not completely clear. Another resident’s records would suggest that an incorrect dose of medicine had been given. There was no record of one resident being administered their morning medicines on the day of this visit, although the medicines supplied in a blister pack had been removed suggesting that they had been given. A further resident was not recorded as having their morning medicines by 12.10pm on the day of this visit. The medicines remained in the blister pack, and there was no explanation as to why these had not been given. There were fifteen unexplained gaps in the records of giving medicines, and two residents’ records had been marked with an “F” meaning that the medicine was not given. There is a place on the recording sheet to record why medicines are not given but this had not been filled in. Another record sheet had been marked with a “G”. The medicines that should have been given at that time were found in an envelope in the cupboard marked refused. The medicine sheet did not have this recorded on it. The only records made in the “G” section were of giving homely remedy paracetamol. Another resident was prescribed a sedative twice daily. There were four additional records made at night on the administration record that had been crossed out. Medicines are administered from a medicine trolley. One resident was recorded as being given five doses of a food supplement that was prescribed to be taken three times a day. Another resident was prescribed a sedative six hourly (four times in twenty-four hours), but was given this medicine at 08.00am, 12 noon and 22.00pm. Another resident prescribed a cream that was to be applied twice a day only had it once a day, and a resident who had been prescribed a laxative twice daily had a record of this being given three times on one day. A resident’s records showed that they had been given thirteen doses of an antibiotic from a supply of ten. Three lots of medicines were recorded as being out of stock for eight, five and ten days. One resident was prescribed half a sachet of a pain killing medicine. Staff were not able to describe how this dose could be accurately measured. There was no evidence that medical advice had been sought to find a preparation that could be measured more accurately. One resident was recorded to be having a different dose of a sedative medicine than that shown on their record sheet. This had been done on the advice of the visiting pharmacist who had recommended a dose reduction some months earlier as the resident was too drowsy. The dose change had not been altered at the doctor’s surgery so the pharmacist continued to print the dose stated on the Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 17 prescription. This shows that staff do not pay close attention to the prescribed directions and some residents have been allowed to go without prescribed medicines for an unacceptable period of time. Each unit has a secure room for medicine storage with cupboards and a separate refrigerator. Records were maintained of the temperature of the refrigerators. There were some aspirin tablets in Lakeside’s trolley that had been removed from their labelled dispensing pack, and some loose laxative sachets were seen on top of the trolley on Grasmere. A resident had a box of Diazepam enemas labelled to contain five but it contained seven. This is due to staff compounding more than one container together. Another resident had a bottle of morphine liquid. It is clearly labelled to write the date of opening on the label and discard within ninety days. The records showed that the bottle was opened on 19th December 2005 and was still available for use. It would appear from these observations that staff do not understand the legalities of medicine labels and the importance of not keeping individuals’ medicines together. Guidelines on the administration and management of medicines are provided for all trained nurses, and it would be advisable for all of the trained nurses to familiarise themselves with these. Medicines subject to stricter controls Both units visited had facilities for storing such medicines. On Lakeside the cupboard contained quantities of cash and residents’ personal effects that are not suitable items to be stored in a drug cupboard. The records made for these medicines were not robust and errors were found that had not been satisfactorily identified in the home’s audit system. On Grasmere Unit staff have been measuring morphine liquids using medicine measures. This type of measure is not accurate enough for this type of medicine. The result is that misleading quantities are being included in the audit. Residents spoken with said that the staff were kind and supportive and that their dignity and privacy was maintained. Staff were observed to respond to the residents in a positive and friendly manner, address them appropriately and to ensure that their dignity was maintained when providing personal care. However, whilst walking around the outside of the building two of the inspectors observed through a window one of the staff on Lakeside Unit draining the catheter of one of the residents in one of the lounges in the presence of other residents. Two residents both of whom were wearing ‘bibs’ were observed to be sitting in wheelchairs at the dining tables on Coniston Unit at 11.30am. When asked about this, one of the staff said that one of the residents places herself there, but could not give a reason why the other resident was there. Breakfast was long over and it was at least an hour before lunch was due to be served. See Requirements 1 - 8 Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An appropriate range of activities is not provided for all of the residents to keep them active and stimulated. The main menu meals appeared varied and nourishing, but there was limited provision made to cater for the varying needs of the residents. EVIDENCE: At the time of this visit there was no evidence of the residents being engaged in leisure or social activities that would provide them with stimulus or that would address their preferences. There is a separate lounge in the building that is used for activities. There was evidence that activities are provided for some of the residents at the home. However, there are no appropriate activities provided for the younger disabled people on Lakeside Unit. Staff said that sometimes the residents will go to bingo. They have had discussions with the activities organiser about providing suitable activities for this age group. One resident who spoke with the inspector said that she enjoyed the trips out that they go on and discussed a recent trip where she and a group of other residents went to a pub for some lunch. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 19 Residents were dressed in their own clothes, and those spoken with confirmed that they choose what clothes they want to wear. Residents also said that they are offered choice with regard to their daily lives within the limitations of their conditions. Visitors can call at the home at any reasonable time, and friends and family were visiting a number of residents during the course of this visit. One visitor spoken with said that the staff made them feel welcome and that they were kept informed of any changes in their relatives condition. Another visitor spoken with said that he is very pleased with the care his wife receives, adding that visiting has enabled him to get to know the nun who brings communion into the home every week. There would appear to be little choice for the residents on Ullswater Unit as to when they are bathed/showered. There is a procedure in place where one resident is bathed in the morning and two in the evenings. On a Monday the male residents are showered and on a Tuesday, the female residents. Wednesday is back to the men and so on. One of the residents whose care was being checked closely at this visit belongs to a religion that has firmly held beliefs against certain medical interventions. When questioned about this the staff demonstrated limited knowledge with regards to these beliefs. They said that the resident’s family visit daily and would advise staff as necessary. A daily menu was on display in the main entrance and the unit dining rooms. The chef informed the inspectors that lunch was roast meat, roast potatoes, Yorkshire pudding and gravy, with trifle for dessert. She said that most of the residents liked roast dinners and had asked for these to be provided during the week as well as on Sundays. One of the inspectors observed lunch being served on Grasmere Unit and noted that finger food was provided for two residents and one resident was given a pureed meal. When asked if they enjoyed the trifle, one resident said that it was not trifle, but was jelly covered with cream. The inspector confirmed this. Two desserts were placed in bowls and left on top of the heated food trolley and were only moved when this was brought to the attention of the staff by the inspector. The dessert was sent from the kitchen in a large aluminium tray that was placed uncovered on a trolley beside a bucket that was used for the collection of uneaten food. One of the residents whose care was tracked has dementia and is a vegetarian. When asked what he had for lunch staff said that he had boiled potatoes, roast potatoes, Yorkshire pudding and gravy. They said that a vegetarian diet is not provided. Two of the residents on Windermere Unit are diabetic and the senior Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 20 carer on the unit is responsible for ensuring their meals are correctly ordered from the kitchen. See Requirement 9 & 10 and Recommendation 2 Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 21 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are managed well providing reassurance to people that their concerns are listened to and acted upon and there are satisfactory policies, procedures and staff training to ensure that residents are protected from harm. EVIDENCE: There has been a total of twelve complaints received at the home within the last year, two of which have been upheld, and five that have been partly upheld. The home’s complaints record was examined and all complaints were responded to within the appropriate time scale apart from one where there had been a change in the home manager between the date the complaint was received and responded to. The home has its own complaints procedure that is satisfactory, and residents spoken with said that they knew how to complain and who to if they had any concerns. Records were seen of referrals being made to the local authority where suspicion or an allegation of abuse had been made. All of these were documented appropriately with details of the actions taken. Action plans had been put in place where this was identified as being needed, and the manager said that all of the staff employed at the home have received training in the protection of vulnerable adults within the past twelve months. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is a comfortable environment to live in but needs redecorating in areas and action needs to be taken to get rid of unpleasant smells. A number of cross infection risks were identified that need addressing to ensure that the residents are protected. EVIDENCE: Lakeside Unit Separate lounge and dining facilities are provided on the unit and the amount of communal space provided is sufficient for the number of residents accommodated. There is an enclosed garden to one side of the unit that is well-tended and supplied with garden furniture and a barbeque. Handrails are provided in all of the corridor areas and grab rails are fitted close to toilets. Nine specialised nursing beds were provided for the residents, and alternating pressure mattresses were fitted to the beds of residents identified as being at Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 23 risk of developing a pressure sore. Mobile hoists were also provided for use with residents who are unable to walk unassisted. All of the bedrooms are supplied with the ensuite facilities of a toilet and a shower. There is one shared bathroom that has a bath fitted in it that is designed for use with residents who are unable to get into or out of a domestic style bath. The hot water supplied to the bath felt warm to the touch, but the temperature of this could not be recorded, as there was no bath thermometer available. Bedrooms were personalised to a high standard by the residents or by members of their family. The overall standard of cleanliness on the unit was well maintained but there was an obvious unpleasant smell present in one of the bedrooms. Coniston Unit Five specialised nursing beds were provided for the residents on the unit, and sufficient adaptations were in place for use by those residents who require extra support whilst walking and moving about the unit. Separate lounge and dining facilities are provided on the unit. The garden outside the unit was overgrown and in need of mowing. All of the bedrooms have ensuite facilities of a toilet and shower. Bedrooms were well personalised. The commode in one of the bedrooms had a torn seat and stained fabric. The commode pot and lid were in need of a thorough cleaning. As on Lakeside Unit there was no bath thermometer with which to test the temperature of the hot water supplied to the bath. It was observed that the bath had been used recently but not cleaned afterwards. There was a plastic jug on the side of the bath but there was no label on this to indicate what it was to be used for. A curtain has been fitted along one side of the bath from the ceiling to provide privacy for residents when they are in the bath. Three mobile hoists were being stored in one of the lounges, and staff confirmed that the batteries for these are charged overnight in the lounge. This poses a hazard and advice should be taken from the local fire brigade as to where this charging should take place. The doors to two of the lounges were wedged open posing hazard in the event of a fire breaking out. The flooring in the ensuite of one room was cracked and raised and was a trip/fall hazard for anyone entering or leaving this room. A spare wheelchair was being stored in the ensuite, and parts of the wheelchair were being stored on the floor. A sheath bag (used) that is used in continence care was found lying on the cistern lid of the toilet. The bedroom is fitted with linoleum type floor covering and the padded bars used to cover the resident’s bed rails were Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 24 being stored on the floor. Redecoration is needed in this bedroom as the bedroom door ensuite door and walls are heavily gouged. When entering one of the bedrooms, the inspector noted that there were large gaps between the bed rails fitted to the bed and the sides of the mattress. The mattress fitted to the bed was one that is used for residents’ who are at risk of developing a pressure sore. This mattress was unstable as it was placed directly on the base of the bed and was easily moved. Grasmere Unit Sensory boards were placed in the corridors for residents to touch and experience different textures. Mirrors were also placed on the corridor walls. A number of bedroom doors had photographs of the resident and members of their family on them and the home manager said that she hopes to do this on all the doors. The flooring in the bathroom was split and lifting in places. There were two plastic jugs on the side of the bath not labelled and a mobile hoist was being stored in here. The wash hand basin was dirty and in need of a thorough cleaning. Many of the bedrooms have been personalised. There was a tube of denture cleaning tablets by the wash hand basin in this room. As these contain a bleaching agent they should be stored securely unless a risk assessment has been carried out that can demonstrate the resident knows how to use these properly. Windermere Unit The communal areas of the unit appeared tastefully decorated to a good standard. The residents’ bedrooms are equipped with the ensuite facilities of a toilet and shower. The bathroom on the unit is locked with a padlock from the outside, and there is no internal privacy lock on the bathroom door for use when a resident is having a bath. The flooring in this room is unsuitable. A toilet used to be in this room and has been taken out, but a hole in the flooring has been left where the toilet used to be. There is no call alarm system in the bathroom to summon help if needed. Storage facilities are limited in the room and boxes of disposable gloves were being stored on the floor under the sink. The boxing in of the pipe work in one ensuite appeared shabby and messy, and the work on the pipe work under the wash hand basin was in the same condition. This was apparent in four other bedrooms/ensuites. There were some large cracks on the plasterwork near the window in one room, of which one measured approximately four feet. The ensuite flooring in another room Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 25 was lifting up and facilities in this room cannot be used. One of the staff told the inspector that the resident occupying this room is wrapped in towels and taken to the shower in another resident’s bedroom. The inspector was told that the manager was aware of this problem, which has been ongoing for a number of months. A number of bedrooms had incontinence pads stored under the wash hand basins in the residents’ rooms. Two residents were sleeping in a lounge at lunchtime. When asked when they would have their lunch, the senior carer said this would be about 2pm when they woke up. Two other residents were sitting in another lounge, and the senior carer said that they would eat their lunch later in this room, as they were noisy. She said this arrangement was with the agreement of the residents’ families. The shower in one of the ensuites was leaking and the inspector was told it had been like this for three days. There were a lot of structural cracks in another bedroom, and the edging around the skirting board in another bedroom was coming away from the wall. There was a noticeable unpleasant smell in one bedroom, and a smell of damp was evident in one of the ensuite rooms. Incontinence pads were stored openly in some rooms, and mobile hoists were being stored in two of the ensuite rooms. See Requirements 11 - 21 Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty to meet the residents’ needs and training is provided to enable the staff to perform their jobs as well as possible. Recruitment procedures need to be more thorough so that residents are not put at risk of harm. EVIDENCE: A review of the staffing rotas showed that the agreed staffing levels were being complied with. An extra member of staff at night has been rostered to work on Lakeside Unit since the last visit to enable the staff to meet the complex needs of the residents. A number of training initiatives have been provided for the staff within the past six months. These include; safe moving and handling, colostomy care, infection control, care and prevention of pressure sores, adult protection, fire safety and the control of substances hazardous to health. The records seen did not demonstrate that all of the staff have received their mandatory training within the past twelve months. It was suggested to the manager that she devise a training matrix that would identify who has had what training and when. The personnel records of four members of staff were examined at this visit. All of these contained completed application forms. There were two written references for three, but only one written reference, and a note made of a Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 27 verbal reference for one person. Satisfactory Criminal Records Bureau disclosures were seen for three, but there was no such disclosure for the fourth person. The manager said that such a disclosure had been sent for in April this year. Two of the records seen did not contain information on how many hours the staff were contracted for. During the course of this visit the inspector spoke with a new member of staff but was unable to communicate effectively with them as their knowledge of the English language was very poor. It would suggest that the residents would experience problems in communicating and understanding this person. The home manager said that this problem was not evident at interview and suggested that the person was nervous. The home manager provided information prior to this visit that identified that fifteen members of the care staff had attained an NVQ level 2 in care. At the time of this visit she said that three more of the care staff were currently undertaking this training and that a further twelve had been proposed to start this training. If all of these staff successfully complete this training the home will have achieved the 50 ratio of staff with a care qualification. See Requirement 22 Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 28 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is generally well managed, but the environment and financial arrangements require improving to safeguard residents so that their best interests are promoted. EVIDENCE: The home manager is a trained nurse had been the registered manager of another care home before taking up post at Callands. She has recently been interviewed with a view to becoming the registered manager at the home. Since taking up this post the manager has developed a business plan for the home, has set targets to be achieved, with the company’s regional manager monitoring these. There are weekly and monthly audit systems within the home to monitor practice and what happens in the home; for example, accidents are monitored. The records show that there had been a reduction in Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 29 the number of accidents sustained by residents within the last quarter period of the year. A representative of the company makes monthly unannounced visits to the home to review the records, talk with residents and staff, and tour the premises. Records of these visits have been sent to the Commission, but copies of these reports were not at the home. The manager was advised of the need to obtain copies of these for inspection, and she said that she would attend to this. Satisfaction surveys are sent out to relatives on a regular basis; the results of these are collated and acted upon. The public liability insurance certificate on display was not valid after February 2006. This was pointed out to the home manager during this visit; she showed a new insurance certificate to one of the inspectors, however on the second day of this visit the new certificate was still not displayed. The manager was reminded of the need to ensure that the information on display was correct at all times. At the time of this visit the home was running two different systems for managing the personal monies of the residents. A black book was being kept in the administrator’s office detailing all financial transactions that were supposed to be entered on to the computer. The information in this book had not been entered on to the computer for at least three weeks. It was also noted that some purchases were being made on behalf of residents without receipts being obtained. The inspector attempted to reconcile the finance records of two of the residents but was unable to do so because of the way in which their money was being recorded. A requirement with regard to residents’ finances was made at the previous inspection. At the time of this visit a representative from the company’s finance department was at the home auditing the arrangements for the management of money. The records for the dispersal of hot water at the correct temperatures showed that these had not been checked for January, February and March 2006 due to gauges not being fitted, and the drain valves being seized. The instructions for the storage of hot water shows that this must be stored at 61°Celsius, but this had not been checked since January 2006. Testing of the hot water taps in rooms was up to date, and records showed that the showerheads had been cleaned in March 2006. New cords for showers were needed in eleven of the rooms, but there was no evidence seen of this work being carried out. The manager checked with the maintenance staff during this visit. They were not sure that the repairs had been carried out. The call alarm system was service on 22nd May 2006; the records showed that eight units had failed, but there was no evidence available to indicate that these had been repaired. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 30 The fire alarm and emergency lighting system was recorded as being tested on a regular basis, and records showed that a total of thirty-five staff had recently undertaken fire drill training. Whilst walking around the outside of the building two of the inspectors observed a lake within close proximity to the home. The ground in which the lake lies does not belong to the home but adjoins the property. Access to this lake is across a lawn and there were no safety fence in place to restrict access to this. This could prove hazardous to residents’, particularly if they are out in the grounds of the home unaccompanied. See Requirements 23, 24 & 25 Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 31 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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 3 X 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 1 X X 2 Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 32 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 OP7 Regulation 15 Requirement The registered person must ensure that plans of care are in place to meet all of the identified needs of the residents and that these are reviewed and updated at regular intervals. The registered person must ensure that satisfactory risk assessments are carried out and documented for all residents’ who have bed rails fitted to their beds. The registered person must make arrangements to ensure that all records of medicines are clear and complete The registered person must ensure that all medicines are given to prescribed directions. The registered person must make arrangements for an appropriately trained manager to audit the administration and recording of medicines to ensure that this is being done to the required standard. The registered person must make arrangements to ensure that medicines are stored and DS0000042162.V290692.R01.S.doc Timescale for action 30/06/06 2. OP38 13 30/06/06 3. OP9 13 24/05/06 4 5 OP9 OP9 13 13 24/05/06 24/05/06 6 OP9 13 24/05/06 Callands Care Home Version 5.1 Page 33 7 OP9 13 8 OP10 12 9 OP12 16 10 OP15 16 11 OP26 16 12 OP19 23 13 OP26 13 & 23 14 OP22 23 15 OP38 23 16 OP19 16 & 23 handled to the required standard. The registered person must make arrangements to ensure controlled drug records are kept to the required standard. The registered person must make suitable arrangements to ensure that the care home is conducted in a manner that respects the dignity and respect of the residents’. The registered person must make arrangements for the provision of activities that are suitable for all of the residents accommodated at the home. The registered person must make arrangements for the appropriate dietary needs of the residents. The registered person must make arrangements to ensure that the home is kept free from unpleasant smells The registered person must make arrangements for the gardens at the home to be maintained. The registered person must make arrangements for all equipment used in the care of residents is kept clean. The registered person must make arrangements for suitable provision for storage for the purposes of the care home. The registered person must consult with the local fire brigade with regard to the location within the home where the batteries for the mobile hoists may be charged. The registered person must make arrangements for the flooring in the ensuite bedrooms and bathrooms identified within the main body of this report to DS0000042162.V290692.R01.S.doc 24/05/06 30/06/06 14/07/06 30/06/06 30/06/06 14/07/06 30/06/06 31/07/06 07/07/06 31/07/06 Callands Care Home Version 5.1 Page 34 17 OP38 13 18 OP10 12 19 OP22 23 20 OP19 23 21 OP21 23 22 OP29 19 23 OP35 17(2) Schedule. 4 be replaced. The registered person must make arrangements for the safe storage of all products that could prove harmful to the residents’. The registered person must make arrangements for the padlock to be removed from the bathroom door on Windermere Unit, and for an lock that can be overridden in an emergency to be fitted to this door. The registered person must make arrangements for the emergency call system at the home to be in good working order. Additionally, a call point for this system must be provided in the bathroom on Windermere Unit. The registered person must make arrangements for redecoration to those areas identified as requiring this within the main body of this report. The registered person must make arrangements for all of the showers at the home to be in good working order. The registered person must make arrangements for two suitable written references to be obtained for all prospective staff prior to them commencing employment at the home, and for a record of their contracted hours to be made available for inspection. Additionally, the registered person must ensure that all staff employed at the home are able to communicate effectively with the residents’. The registered person must ensure that residents’ records reflect the monies kept within the home, that transfers of funds to the bank accounts are recorded and that monies held in DS0000042162.V290692.R01.S.doc 30/06/06 30/06/06 21/07/06 21/07/06 07/07/06 30/06/06 30/06/06 Callands Care Home Version 5.1 Page 35 24 OP38 13 25 OP38 13 bank accounts are recorded on a separate sheet. This requirement remains outstanding from the last inspection. The registered person must make arrangements for the hot water at the home to be stored at the recommended temperature. The registered person must make arrangements for suitable protective fencing to be fitted where the lake by the home adjoins the premises. 07/07/06 21/07/06 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. Refer to Standard OP2 OP14 Good Practice Recommendations It is recommended that all residents or their representatives sign a copy of the terms and conditions relating to residency at the home. It is recommended that the system for bathing and showering the residents on Ullswater Unit be reviewed to ensure that the residents’ wishes as to when they are bathed/showered is taken into account. Callands Care Home DS0000042162.V290692.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 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. 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