Inspection on 20/09/05 for Caroline House

This inspection was carried out on 20th September 2005.

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

Caroline House 14/06/07

Caroline House 02/05/06

Caroline House 19/04/05

Caroline House 07/09/04

Caroline House 04/05/04

Caroline House 30/12/03

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Caroline House 7 Ersham Road Hailsham East Sussex BN27 3LG Lead Inspector Nigel Thompson Announced Inspection 20th September 2005 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 Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 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. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Caroline House Address 7 Ersham Road Hailsham East Sussex BN27 3LG 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) 01323 841073 Mr Thuraisamy Ravichandran Mrs Radha Ravichandran, Mr N Suganthakumaran, Mrs S Suganthakumaran Mrs Pamela Hodger Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users must be older people aged sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is twenty four (24). 19 April 2005 Date of last inspection Brief Description of the Service: Caroline House is a large, detached three storey Victorian house situated in a quiet residential area of Hailsham, close to the town centre.It is registered to provide care and accommodation for 24 older people, not falling within any other category. Menus are varied, well balanced and nutritious. Meals are served either in the dining area or in the resident’s room. Service users’ rooms are equipped with a TV point, telephone and alarm call system. Rooms that do not have en-suite facilities are fitted with washbasins. There are two lounges and a dining area on the ground floor. A passenger lift provides access to all floors. At the rear of the house there is easy access to a large, landscaped garden, which is both safe and secure. There are ample car parking facilities at the front of the home Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over six hours in September 2005. It found that only six of the eighteen National Minimum Standards assessed had been met and there were several requirements still outstanding from the previous inspection. Requirements and recommendations made as a result of this inspection reflect the current shortfalls, where standards that were assessed were found to have not been or only partially met. Service users and relatives spoken to during the inspection expressed general satisfaction with the home, the staff and the service provided. However there was some apprehension within the home amongst service users, relatives and staff, with concerns being expressed regarding the imminent departure of the registered manager. A tour of the premises took place and documentation, including service user and staff files were inspected. Two of the service users’ relatives, all the staff on duty and seven of the eighteen residents were spoken with. What the service does well: What has improved since the last inspection? The home’s staff recruitment procedure has been improved and now protects service users, by ensuring that all necessary checks are completed prior to a person starting work at Caroline House. These include two written references and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. Ongoing improvements to the physical environment include a new carpet in the main lounge and the redecoration of several service users’ rooms. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 7 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 Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 8 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, 4 & 5 Documentation, including a comprehensive ‘Statement of Purpose’ and ‘Service Users’ Guide’ ensures that prospective service users and their relatives have sufficient information about the home and the services provided. However this information is not always made available. There is a potential risk for service users and staff as the individual care and support needs of prospective service users are not always comprehensively assessed before they move into the home. EVIDENCE: The Statement of Purpose and the Service User Guide have been thoughtfully and imaginatively produced to a high standard and are both comprehensive and informative. However it is evident that this information is not always provided to prospective service users or their relative or representative and is not routinely made available to people moving into the home. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 9 As discussed with the registered manager, it is also important that the details contained in these documents are kept under review, so as to accurately reflect the services provided and the current situation within the home. As a result of a recent situation when a service user was admitted to Caroline House without sufficient planning or adequate assessment of his care and support needs, the home’s admission policy and procedures are to be reviewed and significant changes made. The pre-admission assessment documentation is to be adapted to include more detailed information regarding the physical, emotional and social care needs of prospective residents, to enable the manager to make a more informed decision as to whether needs can be met at the home. A formal written contract is to be provided to each new service user or their representative, as part of the admission process. This contract incorporates a statement of terms and conditions of residency detailing the placement arrangements and clarifying mutual expectations around rights and responsibilities. As part of the current admission process, the manager confirmed that prospective service users are invited to visit the home, to look around and meet with staff and existing residents. They also have the opportunity to stay overnight before moving in. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 10 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 Care plans remain unsatisfactory and poorly maintained with no clear or consistent system in place. As a result, staff do not have the necessary information to meet the individual care and support needs of service users. EVIDENCE: Care plans for several service users were examined and despite previous requirements were found to be poorly maintained. There was no evidence that plans had been reviewed or updated to reflect significant changes in individual needs or circumstances. It was noted that plans do not contain sufficient detail regarding action to be taken by staff. As a result of this, where health care and support needs have been identified they are not being met in a structured or consistent manner. In one care plan examined, a service user was reported as having developed a pressure sore. However there was no action plan or details of staff intervention to address this situation. In this case, as with other service users’ plans, daily ‘progress notes’ continue to be poorly maintained. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 11 There is still little evidence of service users or their relatives being involved, as required, in developing or reviewing individual care plans. These issues were discussed with the manager and deputy manager, who readily acknowledged that little progress had been made with improving the care planning system since the previous inspection. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 12 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 Despite previous requirements, social and recreational activities are not well managed or creative and do not provide daily variety, stimulation and interest for people living in the home. EVIDENCE: There is still no structured programme of activities at Caroline House. A member of the care staff is currently employed for two hours, three afternoons a week, playing random games, including cards and bingo. In addition to this, there are three planned sessions of musical entertainment each month. On the afternoon of the inspection, many residents were clearly enjoying a ‘sing-song’ with an entertainer in the lounge. However, service users and a relative spoken with during the inspection confirmed the general lack of stimulation and activities in the home: ‘There’s hardly anything goes on here. People just sit around looking bored’. ‘My mother would like more in the way of activities and mental stimulation’. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 13 The manager confirmed that interviews are being held this week and she is hoping that this unsatisfactory situation will soon be resolved with the appointment of an ‘Activities co-ordinator’. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 14 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 The current complaints process in the home is poor with little up to date information available to service users, their relatives or other visitors to the home. EVIDENCE: Service users, members of staff and a relative spoken to during the inspection, confirmed that, although generally unaware of the formal procedure, they would have no hesitation speaking to the manager or making a complaint if necessary and each person was confident that they would be listened to. However it was noted that the complaint policy and procedure, made available for inspection, had not been reviewed or updated since July 2003. As previously documented, it is evident that information for new and prospective service users is not routinely provided. Consequently important details, including the home’s complaints procedure are not always made available to new service users or their relatives. In line with other policies in the home, it is recommended that the current complaints procedure be reviewed to include up to date contact details for the CSCI. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 15 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, 24 & 25 Service users benefit from pleasant accommodation that is comfortable, generally well maintained and decorated to a satisfactory standard. EVIDENCE: As with many of the environmental standards, the situation at Caroline House regarding service users’ accommodation remains largely unchanged and levels of cleanliness and hygiene remain generally high throughout. Infection control procedures are in place and are closely adhered to. Service users rooms were found to be clean, comfortable and generally well maintained. It was evident that many of the rooms have been personalised, with pictures, family photographs and other small items of furniture and personal belongings, to reflect individual taste, choice and preference. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 16 Since the previous inspection the programme of redecoration and partial refurbishment has continued, with several service users’ rooms having been redecorated and one bedroom carpet replaced. However, the carpet in one service user’s room has still not been replaced, despite unsightly bleach stains, which were noted at the last inspection. This was discussed with the manager, who confirmed that this carpet is to be replaced. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 17 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 There are sufficient staff on duty at all times to meet the assessed, low dependency needs of the service users. Improved recruitment procedures help to ensure the safety and protection of service users. EVIDENCE: Appropriate staffing levels are in place, with a minimum of two care staff being on duty at all times during the day and at least one member of the management team. The manager or the deputy manager is on call at all times outside normal office hours. This includes during the night, when there is one waking night staff on duty. Since the last inspection, an improved staff rota has been developed, showing details of which staff are on duty at any time and their designation. Recruitment procedures have been reviewed and improved, as required, since the previous inspection. Staff files that were examined were found to be generally well maintained, containing all necessary information, including two written references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 18 All new staff are provided with and sign a written contract, including a statement of terms and conditions. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 19 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 & 36 Service users are being adversely affected by imminent and significant changes within the home. Apprehension and anxiety among residents, relatives and staff is being compounded by a lack of information and effective communication. EVIDENCE: It was confirmed during the inspection that the deputy manger is leaving Caroline House at the beginning of October and the registered manager is due to leave at the end of that month. It is clear that these forthcoming major changes are having an unsettling effect on the service users and their relatives, who expressed their concerns and apprehension during the inspection: ‘I’m not happy that the manager is leaving and I’m worried about what is going to happen here after she goes’. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 20 ‘We know the manager is leaving - but we don’t know why’. ‘Nobody seems to know what is going on‘. Anxieties were also evident amongst the staff, where morale is being affected and the situation is not helped by poor communication and a general lack of information. It is hoped that this unsettling situation can be handled sensitively and professionally, with the minimum amount of disruption and trauma for the service users and staff. The proprietors have a key role in controlling this increasing level of anxiety, by more effective and improved communication and consultation. It is a legal requirement that where the proprietors are not in ‘day to day charge’ of the home that they will visit at least once a month, unannounced, inspect the premises, speak with service users and staff and prepare a written report on the conduct of the home. A copy of this report is then to be supplied to the CSCI. Feedback from service users, regarding the care they receive, is sought by the use of satisfaction questionnaires. However there is still currently no organised system for sending out questionnaires or collating responses. The format of the questionnaires, which consist of simple tick box question and answers is very basic and should be amended and improved. It was also noted that the views of relatives, friends and other visitors to the home are not being sought and, in view of current events and following discussion with the manager, the home will be now be reviewing their quality assurance systems and addressing this issue. Despite a previous requirement, formal staff supervision is still not currently being carried out. This was acknowledged by the manager and confirmed by other members of staff. For supervision to be effective, it is essential that the manager has the relevant experience, has undertaken specific training and is confident and competent to provide such supervision. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 21 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 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 X X X X 2 X X STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 X X Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 22 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 1 Regulation 4 (2) Requirement It is required that a copy of the home’s statement of purpose shall be made available to each service user and their representative. It is required that a copy of the home’s service users’ guide shall be provided to each service user. It is required that each service user be provided with a written statement of terms and conditions, in respect of accommodation to be provided. It is required that new service users are only admitted to the home on the basis of a full needs assessment carried out by a person suitably qualified and competent to do so. It is required that the registered person is able to demonstrate the home’s capacity to meet the assessed needs of individuals admitted to the home. It is required that a care plan, generated from a comprehensive assessment, be drawn up with the involvement of the service user, sets out in detail the action DS0000021067.V249158.R01.S.doc Timescale for action 31/10/05 2 3 1 2 5 (2) 5 (1) (b) 31/10/05 31/10/05 3 3 14 (1) 30/09/05 4 4 12 (1) 31/10/05 5 7 15 (1) 30/09/05 Caroline House Version 5.0 Page 23 6 7 15 (2) 7 12 16 (2) (m) (n) 8 31 9 (2) 9 32 12 10 33 24 (1) 11 33 26 (1,2,3,4 & 5) 12 36 18 (2) to be taken by staff and provides the basis for the care to be delivered. It is required that that the service users’ care plans, including risk assessments, be kept under review and updated to reflect changing needs. (Previous timescale of 30/06/05 not met). It is required that service users be given the opportunities for stimulation through recreational activities, which suit their needs, preferences and capacities. (Previous timescale of 30/06/05 not met). It is required that the registered manager is qualified, competent and physically and mentally fit to manage the care home. It is required that the registered manager communicates a clear sense of direction which staff and service users understand. It is required that an effective quality assurance system is developed and implemented to seek the views of service users family, friends and other visitos to the home, on how care services are provided. (Previous timescale of 30/06/05 not met). It is required that the registered providers visit the home at least once a month to inspect the premises, monitor the conduct of the home and prapare a written report. A copy of this report is to be forwarded to the CSCI. It is required that all care staff receive formal supervision at least six times a year. (Previous timescale of 30/06/05 not met). 30/09/05 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 24 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 16 24 Good Practice Recommendations It is recommended that the home’s complaint’s procedure be reviewed and amended to include up to date contact details for the CSCI. It is recommended that the bleach stained carpet in a service user’s room be replaced. Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. Extracts may not be used or reproduced without the express permission of CSCI Caroline House DS0000021067.V249158.R01.S.doc Version 5.0 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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