Inspection on 29/11/06 for Caradoc House

This inspection was carried out on 29th November 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

Caradoc House 18/08/09

Caradoc House 25/09/08

Caradoc House 10/10/07

Caradoc House 16/04/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Caradoc House Ludlow Road Little Stretton Church Stretton Shropshire SY6 6RB Lead Inspector Janet Adams Key Unannounced Inspection 29th November 2006 09:30 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 Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Caradoc House Address Ludlow Road Little Stretton Church Stretton Shropshire SY6 6RB 01206 241 085 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) Supercare (UK) Ltd Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection September 22 2006 Brief Description of the Service: Caradoc House is a private care home registered to provide a residential service for up to thirteen older people requiring short and long term care in single and double accommodation. It is unique in that it does not employ waking night staff from 10pm at night until 8am the next morning, which means its residents need to have a certain degree of independence to live there. The home is situated in Little Stretton, one mile south of the Market town of Church Stretton. It stands in its own small grounds entered from the road onto a large forecourt, and enjoys views of ‘Ragletch’ and other nearby Stretton Hills. The residents’ private accommodation is on the ground and first floor, and a chair lift is installed to enable bedroom access. It has one double bedroom and the rest are for single occupancy. There are no en suite facilities. The second floor of the building provides living accommodation for the owner and sleep in facilities for staff. A communal lounge and separate dining room are located on the ground floor. The current fees charged vary between £340 and £350 per week depending on the care, support and accommodation required. There are additional charges for newspapers, toiletries and chiropody. At present the Registered Manager position is vacant. The home has recently undergone a change of ownership, and Mrs L.Thotapali has been the Registered Provider for the company named Supercare Ltd. since the middle of September 2006. It is the intention of the owner to let people know of the service it offers by means of a Statement of Purpose, and Service User Guide. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection visit to the home which lasted nine hours. The aim of the inspection was to follow up on the progress made since the last inspection of the home on the 22 September this year when complaints made by a relative and a social worker were investigated. A few weeks before the inspection was carried out, CSCI (The Commission for Social Care Inspection.) wrote to the home to request some necessary information to assist with this process. This meant that although Caradoc House knew the inspection was imminent, they were not aware of any date or time. The inspection was carried out by observing activity within the home, inspecting the premises, having an ‘in depth look’ at records for residents and staff, observing, talking and listening to all of the eight people living there, (1was in hospital) and the two staff on duty at the time of the inspection. No visitors were met. A variety of information from other sources confirmed what was seen at the inspection, including the results of a survey carried out by CSCI, when all 9 of the people living there, three relatives and two visiting professionals all shared information about life at Caradoc House. Four staff members and residents also made some written comments for the inspector on the day of the inspection. Discussions with the management team took place throughout the day and feedback about the conclusions of the inspection was given at the end. Management and staff were wholly co-operative throughout the day and assisted inspectors in their task, for which the inspector extends her thanks. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 6 All resident feedback told the inspector that they were very happy with the service being provided. A pleasant and respectful homely atmosphere was observed between the residents and staff during the inspection. The small core of care staff is obviously committed and those on duty were seen to be working hard to meet people’s needs. A group discussion with eight residents confirmed that they thought a lot of the care team and were appreciative of the kindness of all staff, including the new owner who lives on the premises. One resident wrote in a comment card - ‘I am quite happy.’ What has improved since the last inspection? What they could do better: A total of 21 out of 25 requirements made at the last inspection have yet to be met to make sure permanent changes are carried out at Caradoc House. A further fourteen requirements were made as a result of this inspection totalling 39 that the home has to meet to make sure it is operating appropriately. CSCI remain concerned about the management practices at this home. The home continues to lack the skills and expertise of a full time manager. The outcome of this expected inspection shows that although the home has been supported by CSCI to have more time and opportunity to get a management strategy organised, this has not been achieved. The registered person has failed to provide an action plan from the last inspection on September 22 this year to identify how the home was going to meet National Minimum Standards for Care homes for Older People. Likewise, several actions agreed to be carried out following a meeting of concern between CSCI and the home owner on September 27 have also not been followed through. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 7 There has also been a failure by the registered person to provide an improvement plan, which by law is expected. Listed below is a resume of shortfalls seen as a result of this inspection. • Information to help people decide if the home can meet their needs has not been fully devised to tell them what services the home provides, especially for night – time. • • Contracts of terms and conditions between the home owner and residents have not been issued. Lack of appropriate assessments of needs and care plan recordkeeping means that it could not be established that the home’s care team can fully meet the needs of all of the people living there 24 hours a day in a dignified manner. Medication storage and receipt systems need further improvement. Lack of meaningful activities in the home is one of the main concerns residents and relatives felt could be improved. Not all residents have access to the basic comforts of a television with a good reception. This is reported to be ‘Vital, as there is little else to do.’ Residents felt the quality and variety of meals needs to be improved. Information to let people know how to make comments and complaints about the home is not clear and easy to understand. Infection control measures need to be improved, including the provision of appropriate hand washing facilities. CSCI continue to be concerned about staffing levels, recruitment and vetting practices as well as the team training and supervision arrangements. This means resident safety and welfare is not safeguarded by thorough screening of the people the home employs. Failures in keeping staff up to date with mandatory training means there is not a qualified ‘first aider’ on duty at all times. None of the recordkeeping examined was of an acceptable standard, including the safe management of residents’ valuables. Management systems do not clearly reflect the expertise of personnel who have a good working knowledge of the legislation a care home is required to meet. Several breaches of health and safety legislation as well as the Care Homes regulations were evident on this occasion. This resulted in two written ‘Immediate Requirement’ notices being issued on this occasion, relating to fire safety and environmental safety regarding • • • • • • • • Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 8 radiator and hot water temperatures. The home had to take remedial action for these matters within 48 hours of the inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3, & 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives do not have the information needed to decide whether Caradoc House will meet their needs. Service users move into the home without having had all their needs fully assessed. This does not safeguard their welfare and may result in moving into a home, which is not suitable for them. EVIDENCE: At the last inspection, it was seen that the home had not got the appropriate information necessary to help prospective new residents decide if the home will meet their needs. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 11 One resident who had recently stayed at the home on a short term basis also commented that, ‘Social Services had arranged the stay, but could give the family no information about Caradoc House.’ Since then, the new owner has compiled a Statement of Purpose and a Service User Guide (the necessary information people need) to address this matter. Despite approaching a consultancy and purchasing information to assist her with the issue, the documents lacked the necessary detail required by law under the Care Homes Regulations. • The contents of the Statement of Purpose lacks 3 out of the 18 necessary elements of information it needs to describe about the home. It is of particular concern that there is no reference made to the night time staffing arrangements, which has a major impact on the level of care and support available at the home. The Service User Guide also lacks important information such as the details about the new owner, and the fees the home charges. Information about how to make a complaint was out of date and inaccurate. Both documents lacked information about the limited access to bedrooms on the first floor. They also lacked details about the pre admission arrangements Caradoc House carry out to confirm the people they admit will be safely cared for in a way they expect to be. • • In addition, examination of four sets of residents’ records confirmed that The owner has not yet issued a corporate contract of terms and conditions of residency between ‘Supercare Ltd’ and the individuals living at the home. Discussion of this matter with the owner, Mrs Thotapali, the director for ‘Supercare Ltd’ showed that she has limited working knowledge of this requirement, as she did not demonstrate her full understanding of the matter. This is of particular concern as the majority of the people who currently live at the home pay for their own care, and do not have the back up of a local authority monitoring the level of care provided for them. The above findings means that prospective residents as well as the people currently living at the home have not got details of the terms and conditions of living at Caradoc House, including how much it costs to live there. The existing service users have not been formally assured how the new management changes could affect them. When this matter was discussed with three residents, two were not able to confirm how much money was being paid to the home on their behalf or what their ‘contract for care’ agreement was about. In the past, Caradoc House has been successfully managed with the criteria that it can only accommodate people who do not require care and support from Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 12 staff overnight. There is no provision for staff to be awake on duty overnight in this home. As seen at the last inspection in September 2006, lack of appropriate assessments of needs and care plan record keeping means that it could not be established that the home’s care team can fully meet the needs of all of the people living there, 24 hours a day. Full assessment of peoples’ needs and suitability for a residential setting that Caradoc House offers must be carried out with urgent priority. Relevant health and social care professionals as well as the service user and any relatives or other third parties must be involved in this matter. CSCI are concerned that this issue has not been resolved during the past three months as expected. The importance of this matter was discussed at a meeting of concern held between the owner and CSCI a few days after the unannounced inspection in September. Further requirements were made for all of the above issues to be rectified as priority, as the home cannot show they can safely admit residents without appropriate admission procedures being set up. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 care plan recording does not provide staff with the information they need to satisfactorily meet all service users health and personal needs to keep them safe at all times. Personal support in the home is offered in such a way that compromises service users dignity and independence. Medication management systems need to be improved to ensure the health and well being of the people who use this service. EVIDENCE: CSCI Comment cards sent to district nurses were returned incomplete as they felt it was too early to comment about the way the service is being managed by the new owner. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 14 The home relies on a small competent team of staff. The two staff members on duty were observed working and supporting residents in a polite, caring and respectful manner. However, what was observed was not reflected in the written details about the people living there. Four sets of care plans were looked at, including those of a resident recently admitted for respite care (following approval by CSCI). The new owner has introduced a new care record system, which indicates it will be easier for people to read and understand once it is established properly. However, at present, all four sets of records lack the majority of the necessary information required to confirm people living at the home are having all of their health and welfare needs met. • There is no evidence of the resident being involved in this process, which again is necessary given the very basic level of support that the home can offer. The care records lack required information to confirm whether the person is safe and suited to being cared for in the home where there is no staff awake on duty at night. The daily records for one person repeatedly described that complete bed changes were necessary in the morning due to overnight incontinence the individual experienced. This indicates the person’s overnight continence needs are not being promoted effectively to maximise the individual’s comfort and dignity. Risk assessments to promote resident safety identified to be carried out as a priority in September have not been done. Although forms have been slotted into the care folders for this matter –all of those seen were blank. This is of particular concern, as it shows that the safety of individual service users has not been addressed. For instance, there was no information written down to confirm whether residents were fit and able enough to use the call bell at night to summon help in an emergency if required. These details are vital as there are no staff awake at night to carry rounds of the home to check on people’s well being. In the records of two people injured as a result of falls, there was not enough detail written down to show their injuries were being managed and looked after properly. Likewise there were no adequate risk assessments in their records to show the home were doing all they can to make sure the people were not at risk of further falls. One set of records show that a person is receiving medication for Alzheimer’s type illness, but there are no records to show how the home can safely meet this aspect of the person’s needs. • • • The above observations mean the content of the care records do not offer any reassurance to service users and significant people involved in their well being Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 15 that the care team know how to care for them in the way they need and desire. As reported in September 2006:Priority must be given by the homeowner to get all residents living at the home fully assessed with the support of appropriate professionals in order for accurate care planning to be developed. This process must include: • Full assessment of mobility should include a falls risk assessment, and establish whether a person can safely manage to walk up and down stairs independently. • Risk assessments must also establish whether equipment can be safely used for every individual – the stair lift being an example. • Individuals with communication challenges must have assessments to confirm they can alert staff in the case of an overnight emergency. • Residents whose care records confirm people have poor memory must have risk assessments to show that the home’s team are doing as much as possible to keep those individuals safe, especially when they are accommodated upstairs. The outcome of an audit of the systems in place to manage residents’ medications confirmed they are also in need of improvement. • On this occasion medication received into the home had not been documented appropriately. • A medication bottle seen stored in the Controlled Drug cupboard had a damaged label, which made it impossible to identify its contents. The same cupboard is also being used to store valuables. • The bulk of the residents’ medication is stored in a filing cabinet – this matter was discussed and the acting manager plans to check the suitability of this practice with the community pharmacist. • It is of note that the procedure the home has to dispose of unwanted medications, and record keeping for the administration of medications is adequate. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Limited resources and allocation of enough quality time does not enable staff to record, plan and organise regular meaningful day to day activities for everyone living at Caradoc House. Residents receive a healthy diet, which meets some of their needs and preferences. EVIDENCE: The lack of activities and social stimulation for residents is a part of the service residents and relatives commented to be one of their main concerns at present .One relative wrote, ‘I would like to see some form of stimulation. There is never any entertainment or relief from the everyday routine of getting up, eating, sleeping and going to bed. I feel some effort should be made to relieve the appalling boredom and tedium’ A resident also commented that, Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 17 ‘The TV in the lounge needs sorting out. The picture quality is very poor. Little Stretton is in a very poor reception area so needs ‘Sky ‘ or similar to give a decent picture. This is so important to residents who have little else to do.’ There was no evidence of planned activities in the home at the time of the inspection, and most residents spoken to did raise this to be an issue. It is a concern that the staff do not have quality time to spend with residents to offer them opportunities to be involved in meaningful activities. Observation of the roles and responsibilities of staff confirmed that two people are on duty at any one time, and they have to fully care and support the nine people living in the home, prepare, cook and serve breakfast, lunch and high tea, and all drinks in between, as well as carry out some laundry and housekeeping duties. This means there is very little time to spare to promote pastimes and leisure interests for residents in their working day. The acting manager confirmed he was fully aware of this matter and in order to improve activities within the home, showed the inspector a CD he had recently ordered which described a variety of appropriate suggestions for activities in a care home. However he has not had the opportunity to use it. At present the residents at Caradoc House appear to rely on external resources to provide them with some level of activity and stimulation. At the start of the inspection, one resident was met and spoken to whilst waiting for transport to take him to a local day centre. Discussion with the acting manager confirmed that another two people attended the same centre for half day sessions during the week. Residents also confirmed they had to rely on their family members to get them out and about. During the inspection itself another resident was overheard talking to another person and stating ‘what a long boring morning. On a positive note, the delivery of new books from the local library delivery service arrived during the inspection, and are obviously appreciated by those able to read. A Halloween party held in the home was also reported to have been enjoyed by all. Discussion with staff confirmed none of the residents were on special diets at present. When the topic of mealtimes was broached with the eight people having lunch in the dining room, they gave mixed feedback about the quality of the meals. Some of the comments were positive, others were not – this was also reflected in written comments received from relatives and residents. Three service users wrote to say that the food was ‘poor’, very unappetising’ ‘badly cooked’ and ‘rather tasteless’. Some commented that they ‘were not keen’ on the chicken casserole provided for the day’s lunch. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 18 The home has a residents’ nutrition book, which lists meals served in the home. This lacked specific details about which meals certain residents were offered. This meant it did not show the home was catering for people’s likes, dislikes and dietary needs. This information was not included in care records looked at. These issues were discussed with the owner and acting manager at the time of the inspection. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not have access to a robust, effective complaints procedure that assures them or their supporters’ views to be acted upon. The registered persons fail to demonstrate good employment practice that protects vulnerable service users in the home. Lack of appropriate recruitment and staffing provision puts service users at risk of harm. EVIDENCE: Mrs Thotapali stated that there had been no complaints received at the home since the last inspection in September of this year. Likewise, none have been received at CSCI. When the complaints logbook was requested for examination, the owner of the home stated the home did not have one. Mrs Thotapali was advised this was necessary in order to have robust records of all complaints, as CSCI inspectors have a responsibility to review all complaints received at the home during the past 12 months. The newly devised service user guide, which has been distributed, to all residents does have a copy of a complaints procedure attached and this does state that the home has a complaints book, which contradicts information told Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 20 to the inspector. Further examination of the contents of the complaint procedure confirmed it needed updating. It named the previous owners of the home as the persons to direct complaints to, and it did not detail necessary timescales the home has a duty to commit to when carrying out a complaint investigation. There is no evidence elsewhere in the home to welcome people to make a comment or complaint about the service. Discussion with three residents in the privacy of their own room confirmed that two of them were not aware of what information was available to inform them how to make a complaint. One person was aware of the complaint guidance written in the service user guide recently given to her by the new owner, the others said they had not read their service user guide and were not sure how to complain about the service. Some of the findings during the tour of the home show the home has not taken appropriate actions to ensure residents’ well-being is safeguarded all of the time. • Risk assessments for some residents as well as health and safety procedures need to be improved and acted upon before this standard can be seen to be met. For example, fire safety, which is recorded in the Management and Administration’ part of this report. • Review of staff vetting and training in the ‘Staffing’ section of this report shows the home is not being thorough enough to safeguarding the people living in the home. An additional issue of concern was raised at lunchtime, during a group discussion with seven residents.They were concerned about the behaviour and the table manners of one of their fellow residents. This has resulted in some aggressive outbursts from this person, which was very upsetting. The two staff members on duty were seen eating their own lunch in the kitchen whilst the residents were unsupervised, eating in the company of this person in the dining room. This issue was discussed with the owner at the end of the inspection, who confirmed she was aware of the matter. Actions must be taken to deal with this as a priority, to assure the residents they could eat their meals without risk of being upset or offended. Some of the above issues reflect similar findings in the September inspection, when the new owner was advised not to admit any further residents, until conditions had improved. These findings confirm there has been little improvement to safeguard residents in the home. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21,22,23,25 &26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Much of accommodation at Caradoc House provides a clean, comfortable environment for residents to live in. However, there are still areas requiring improvement to maximise the safety of residents. EVIDENCE: A tour of the home, which included all residents’ bedrooms, confirmed that several improvements had been made by the owner to make the Caradoc House more homely and comfortable for residents. All residents spoken to were full of praise for the owner for improving their home the improvements included: Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 22 • • • • • Five bedroom carpets have been replaced. Curtains have been replaced and coordinating bedding supplied. Pictures have been hung. A first floor bathroom has been refurbished. Flooring to the laundry has been replaced. This is a good start to the cosmetic improvement of the home. Examination of the homes business files also confirmed that a deposit had been paid for all damaged glazing to be replaced, and this was expected to be carried out before Xmas. It is positive to hear that the shower room is also being refurbished in the near future. However, from a health and safety point of view, some urgent remedial works need priority to make the home safe. • In September the radiators in the home were turned off and it could not be ascertained whether they were the low surface temperature type. On this occasion, with the heating turned on, they were extremely hot to touch, putting residents at risk of contact burns. • Random testing of hot water outlets in residents bedrooms and bathrooms confirmed that the temperatures exceeded 50Degrees Centigrade, and steam was visible when the water was turned on in two residents rooms. This again put people at risk of injury. An ‘Immediate Requirement’ notice was issued to make sure they were made safe within 48 hours. • The acting manager confirmed they were awaiting a visit from the fire safety officer for advice how to make the external wooden fire escape installed by the previous owners flame retardant. In the meantime, nonslip treads had been attached to them to promote safety in wet weather conditions. • A bathroom dedicated for use by the owner and staff who sleep in at the home, which is adjacent to residents bedrooms was unlocked. Razors and bleach were accessible. The downstairs toilet also had cleaning chemicals stored on the toilet cistern instead of being locked away. The cleanliness of the home was much improved, and only one part of the home had an unpleasant odour. When this was discussed with the acting manager, the matter was reported to be in hand. However, other infection control systems were seen to be challenged by: • Poor hand washing facilities within the home. Liquid soap dispensers were empty when tested, and household towels were in use for hand drying. Discussion of this matter with the acting manager and owner confirmed their awareness of the matter, and paper towel supplies are being sourced. • Rusted and worn commodes are still in use – one was also seen to be visibly soiled. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 23 As part of the home tour all call bells were tested and observed to be operating satisfactorily. At present the home does not have record keeping showing this necessary equipment is tested regularly. As this is the only communication link for residents to summon staff from 10pm till 8am the next day, the management team must ensure it is operating at all times. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not employ supportive staff in sufficient numbers to meet the needs of residents. Recruitment and training measures require improvement to fully offer protection to people living and working at Caradoc House. EVIDENCE: There were two staff on duty on the day of the inspection from a complement of nine staff in total, including the homeowner. The acting manager was on duty with a senior carer. Mrs Thotapali, the homeowner was also present in the building for most of the inspection. The home does not employ catering staff, which means that caring roles continue to be challenged by catering commitments for the people living there. The home does employ part time housekeeping staff, although on the inspection day the acting manager was carrying out laundry duties. Rotas seen for October, November and December were looked at and show that this small team is attempting to cover the home day shifts as well as the night-time ‘sleep in’ duties. Two staff were recorded to be on duty at all times, Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 25 and some supernumery time was seen allocated for the acting manager to carry out his managerial role. Comparison of the staff time sheets with the rotas for the month of November confirmed the hours worked by staff to be accurate. When the hours the acting manager worked in November were calculated it was seen that he has been supernumery for 69 hours in the working month. Examination of the personnel files for the acting manager confirmed he had signed a contract to work as an acting manager for 20-30 hours per week in addition to a contract employing him as a carer to total a 40 hour working week. This means that the minimum 20 hours per week as acting manager had not been achieved for the past month, due to commitments of working as a carer. These findings show that the home is still not being staffed adequately as per CSCI expectations, and as agreed in September by the homeowner. When other staff records were examined it was established that: • The recruitment information available for a new starter at home was inadequate. The individual did not complete an accurate application to confirm her full employment history. Of the two references obtained for the individual, one had been provided by the acting manager, which is not acceptable practice. The individual was seen to have been started work at the home for a month before Pova list clearance or CRB clearance had been obtained. These findings do not reflect robust recruitment practice. This is of particular concern as this matter was discussed in depth with the homeowner when CSCI held a meeting of concern a few days after the September inspection. Assurances made to CSCI at this meeting have not been carried out which means that service users are not safe guarded by these actions. Furthermore, • Two sets of records for new staff members confirmed an inadequate induction for working at the home. • • There was no record of training held for the homeowner to show she is qualified and up to date with training to carry out her role. All sets of records looked at showed that although some staff attained NVQ qualifications in 2004, their mandatory health and safety training needs to be updated. Some staff training records were blank, and only two sets of records had evidence to show the staff had up to date first aid qualifications. This means there is not a first aider on duty in the home at all times. DS0000068051.V315618.R01.S.doc Version 5.2 Page 26 Caradoc House These matters were discussed with the owner and acting manager at the time of the inspection. It was positive to be informed that efforts are being made to organise training, including management training, and that the home staff are on one training service waiting list for food hygiene, and manual handling as well as first aid. However, this matter must be prioritised as a matter of urgency. When fire safety was explored there were major concerns about the level of training staff have received for this important matter, especially for procedures for emergency evacuation and emergency response if the alarm activated at night when there are no waking staff are on duty. Discussion of this issue with the staff on duty including the owner who does the majority of sleep in duties at the home, confirmed people were not clear about their duties for such matters. As a result, an ‘Immediate Requirement’ notice was issued to ensure all staff including the Responsible Individual receive training and written instructions about their responsibilities and what to do in the case of fire. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management and leadership of the home are lacking which does not benefit service user care. Record keeping and staff safety awareness is variable in quality so that service user’s rights and best interests are not safeguarded. EVIDENCE: As recorded throughout this report there have been concerns about the management of the home since the CSCI inspection in September 2006. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 28 CSCI held a meeting of concern with the owner a few days after this inspection to ensure she was fully aware of what was expected to be put right as a matter of urgency. There has been no written feedback from Caradoc House to notify CSCI of planned actions to put things right. This has been requested by CSCI verbally as well as formally in writing. One of the agenda items agreed in September was that that an acting manager would be appointed and be issued with a contract and job description detailing his responsibilities alongside clear written guidance of the responsibilities of the home owner Mrs Thotapali. This has not been fully carried out. Information provided by the home before the inspection contradicts the information in the acting manager’s job descriptions, and does not outline the roles and responsibilities of the owner. Findings of the inspection shows that a lack of input of the full time expertise of a knowledgeable manager is wholly evident. Efforts seen to meet National Minimum Standards for Older People in this home on this occasion have not been adequate. Actions carried out indicate management’s lack of awareness of the legislation a care home is expected to meet. This has resulted in insufficient attention to detail to keep residents, their visitors and staff at the home safe and well. • Lack of supervision of staff including the acting manager continues to challenge the safety and well being of this service. • Poor record keeping was evident in all areas of the inspection process, and an incident where a resident lost a precious bangle demonstrated poor recordkeeping for valuables of people in the home’s care. Several important documents necessary for health and safety are not maintained or kept. • The new owner had discontinued the use of the home accident book, which meant necessary information about the number of accidents in the home could not be provided or reviewed. • Lack of a fire risk assessment for the home meant that the premises had not been audited by a person competent to do so to make sure the home was doing all it could to keep people safe if such an event occurred. These findings, as well the lack of staff fire safety training, and the potential hazard of the wooden fire escape resulted in the inspector immediately informing the fire safety officer, who agreed to carry out a thorough inspection of the premises at the earliest opportunity. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 29 • Environmental risk assessments for the home for issues such as Legionella need to be reviewed to reflect the living and working conditions in the home, as this information was not available at the time of the inspection or provided as part of the information requested from the manager before the inspection. Examination of routine service records and certificates showed that some of this information was not available. This included details about the electrical wiring for the home, which was reported to be in the process of being attended to. Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x 2 2 x x 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 2 2 x 2 Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4,6 Requirement The Responsible Individual must provide a Statement of purpose, which reflects the service the home is to offer, including the nighttime care arrangements. Previous timescales of 28/10/06 not met The Responsible Individual must provide a service user guide, which must be issued to current and prospective service users. Previous timescales of 28/10/06 not met The Responsible Individual must ensure each service user is issued with a contract of terms and conditions, for Caradoc House which clearly identifies who is responsible for fee payment as well as the other details listed in NMS 2 Previous timescales of 28/10/06 not met All service users in the home must have evidence of a full needs assessment by an appropriately competent professional to determine DS0000068051.V315618.R01.S.doc Timescale for action 30/01/07 2 OP1 5,6 30/01/07 3 OP2 5(1)(d) Schedule 4. 30/01/07 4 OP3 14 (1) (2) 30/01/07 Caradoc House Version 5.2 Page 32 5 OP4 14 (1) whether Caradoc House can meet their needs without waking night staff on duty. This assessment must include the service user and any interested third party. Previous timescales of 28/10/06 not met No further service users must be admitted to the home without CSCI approval. A care plan generated from a comprehensive assessment as per NMS3 must be drawn up with the involvement of each service user in Caradoc House, which includes all assessments of risk to safety, including falls risk, use of stairs, and whether they can be left unsupervised overnight. Previous timescales of 28/10/06 not met Care plans must show details that all resident’s health care needs are met as they should be, following any health care professional advice at the time it is given, as peoples needs change. Previous timescales of 28/11/06 not met Medication management systems for all drugs must ensure they are received and stored securely at all times. The Controlled Drugs cupboard must not be used for storage of any other items apart from medication. Care practices must be devised and carried out to maximise resident dignity at all times, including • mealtimes • continence promotion. The registered person must DS0000068051.V315618.R01.S.doc 30/01/07 6 OP7 15(1) 30/01/07 7 OP8 12(1)(b) 15(1 28/02/07 8 OP9 13 (2) 30/01/07 9 OP9 13 (2) 30/01/07 10 OP10 12 (4)(a) 30/01/07 11 OP12 16(2) 28/02/07 Page 33 Caradoc House Version 5.2 (m ,n) 12 OP15 16(2)(i) 13 OP16 22(3) 14 OP16 22 (1,2,3,4& 8) 15 OP18 13 (6) make sure residents are offered stimulating pastimes and activities which meet their preferences, expectations and abilities. The registered person must be able to demonstrate that meals of a consistent good quality are provided at the home to meet the tastes preferences and needs of the people living there. All complaints must be dealt with promptly and effectively and evidence necessary remedial actions to assure resident health and well being is safeguarded at all times. Previous timescales of 28/11/06 not met The home complaints procedure and record keeping must be updated to reflect appropriate timescales and in a format to show a summary of complaints made during the preceding 12 months and the action that was taken in response. The Responsible Individual must ensure all necessary evidence is recorded in staff and service user records to ensure appropriate actions have been carried out to maximise safety and well being. This includes • Resident recordkeeping for care and accident management, to make sure if peoples needs cannot be met at the home appropriate action is taken for this to be considered elsewhere. • Supervision of service users at meal times. • Robust environmental risk assessment within the home, especially for health and safety issues like fire safety. DS0000068051.V315618.R01.S.doc 28/02/07 30/01/07 30/01/07 30/01/07 Caradoc House Version 5.2 Page 34 16 OP19 13 (4) (a) Staff induction and health and safety training. Previous timescales of 28/10/06 not met An environmental risk 02/12/06 assessment must be compiled which outlines short term and long term measures to be carried out until radiators are protected permanently. Immediate Requirement issued at time of this inspection. Bathrooms and toileting facilities, including commodes must be equipped, and in good repair to meet the needs of the people living at the home. Previous timescales of 28/11/06 not met Items with the potential to cause harm, such as razors and cleaning chemicals must not be left in communal areas. Recordkeeping must be provided to show call bells are tested regularly. The temperature of the hot water supply to areas of the home accessed by service users must not exceed 43 degrees Centigrade. Immediate Requirement issued at time of this inspection. 30/01/07 • 17 OP21 23(2)© 18 OP21 13 (4) (a) 30/01/07 19 20 OP22 23(2)(b) 13 (4) (a) 30/01/07 02/12/06 OP25 21 OP26 22 OP26 23 OP27 16( c,) (k) All parts of the home must be kept clean and free from offensive odours. Previous timescales of 28/11/06 not met 13 (3) Hand washing facilities in line with Health Protection Agency infection control guidelines must be provided. 18(1) The responsible individual must ensure that adequate staffing is provided over 24 hour period, including waking night staff by DS0000068051.V315618.R01.S.doc 30/01/07 30/01/07 30/01/07 Caradoc House Version 5.2 Page 35 24 OP27 18(1) individuals who have had appropriate pre-employment screening and enhanced CRB disclosures. Previous timescales of 28/11/06 not met The responsible individual must, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. • Until all residents have been fully assessed to show the home can meet their needs without waking night staff two members of staff must be on duty at all times, with evidence of well being monitoring of residents at night time. • adequate staffing must be provided over 24 hour period, including waking night staff by individuals who have had appropriate pre-employment screening and enhanced CRB disclosures. 30/01/07 25 OP28 18 (1) 26 OP29 19(4, 5) Schedule Previous timescales of 28/10/06 not met Any new starters must receive training appropriate to the work they are to perform including structured induction training. Previous timescales of 28/11/06 not met The registered person shall not employ a person to work at the DS0000068051.V315618.R01.S.doc 30/01/07 30/01/07 Caradoc House Version 5.2 Page 36 2 27 OP30 18(1) 28 OP31 18(1) 29 OP31 8(1) (a) 30 OP33 24 care home unless the person is fit to work at the care home. Recruitment procedures must ensure all pre employment screening has been carried out. Previous timescales of 28/11/06 not met The responsible individual must, ensure that competent and trained persons are working at the care home at all times, including any person carrying out sleep in duties for the residents of the home. Previous timescales of 28/11/06 not met All staff must receive urgent fire safety training including written instructions in order to reinforce their responsibilities and what to do in the case of fire. Immediate requirement notice issued on day of inspection. The Responsible individual for the home must submit written confirmation and proposal outlining the terms and conditions of employment of a suitably qualified experienced person to be employed in the role of temporary manager for the home. This information must clearly define the supernumery administration time allocated to the person in order to carry out managerial duties without impacting on the ‘hands on’ care and support being carried out in the home. Previous timescales of 28/10/06 not met The responsible individual must provide evidence of a system to evaluate, improve, and maintain the service to show efforts made to safeguard and promote the well being of the people living at Caradoc House. Previous timescales of DS0000068051.V315618.R01.S.doc 30/01/07 02/12/06 30/01/07 30/01/07 Caradoc House Version 5.2 Page 37 31 32 OP35 17 18 (2) OP36 33 OP38 13, 4(a)(b)(c) , (8) 34 OP38 13 (4) (c) 35 OP38 13 (4) (c) 36 OP38 13 (4) 28/10/06 not met Robust systems must be in place for the management of residents’ valuables in the home. The Responsible individual must make arrangements for suitable supervision of all staff, including the acting manager. The registered person shall ensure that risk assessments are carried out for all safe working practices including the use of all equipment used by residents. Previous timescales of 28/11/06 not met An accident log book must be kept which fully complies with health and safety as well as data protection legislation The home accident/ incident recording system must realistically reflect all accidents/incidents which affect service user well being, and must show effective remedial actions are carried out to maximise resident safety. Previous timescales of 28/11/06 not met Environmental risk assessments incorporating the homes responsibility to relevant health and safety legislation including, Legionella must be developed and implemented. 28/02/07 28/02/07 30/01/07 30/01/07 30/01/07 30/01/07 37 OP38 23(4)(b) 38 OP38 23 (4)(a) The home fire safety records 30/01/07 must show evidence that the newly installed wooden fire escape meets the approval of the local fire officer Previous timescales of 28/11/06 not met A fire risk assessment must be 30/01/07 carried out by an appropriately qualified competent person in line with the fire safety regulations. DS0000068051.V315618.R01.S.doc Version 5.2 Page 38 Caradoc House 39 OP38 13 (4) The registered person must ensure appropriate servicing and maintenance of alll essential services and equipment in line with necessary health and safety legislation, including portable appliance testing and 5 yearly electrical wiring installation checks. 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Caradoc House DS0000068051.V315618.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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