Inspection on 03/08/06 for Carr Croft Care Home

This inspection was carried out on 3rd August 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

Carr Croft Care Home 19/08/08

Carr Croft Care Home 21/02/08

Carr Croft Care Home 12/09/07

Carr Croft Care Home 25/01/07

Carr Croft Care Home 17/03/06

Carr Croft Care Home 13/12/05

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Carr Croft Care Home Stainbeck Lane Leeds West Yorkshire LS7 2PS Lead Inspector Catherine Paling Key Unannounced Inspection 3rd August 2006 10:10 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 Carr Croft Care Home DS0000066259.V304064.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. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carr Croft Care Home Address Stainbeck Lane Leeds West Yorkshire LS7 2PS 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) 0113 2782220 0113 2782220 Carr Croft Care Home Limited Ms Jacqueline Waters Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2006 Brief Description of the Service: Carr Croft is a large converted Victorian house, providing personal care for up to 28 service users of either sex over the age of 65. The garden area to the front has had some landscaping following completion of the extension. Residents have access to this area. The number of registered places at the home has recently increased with the completion of the building works. These were carried out to a good standard. Refurbishment of the existing building has to be finished before the final increase in the number of registered beds is granted. Accommodation is provided in single and shared rooms. Some of the shared rooms have en-suite facilities, as do the new bedrooms in the extension. Communal areas are on the ground floor, with a large lounge/dining area; a smokers’ lounge and other seating areas. The home is situated close to the local amenities of Meanwood. The provider completed and returned pre inspection information including the current charges, which range from £375 for local authority funded placements to between £390 and £460 for privately funded residents. Additional charges are made for chiropody, hairdressing, daily papers, toiletries, some activities and transport. Information about the services provided by the home in the form of a Statement of Purpose and Service User Guide is not available to current or future service users. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way care services are inspected. They are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example, Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate”, and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes and copies of past inspection reports are available on our website – www.csci.org.uk Information about the home is gathered from a variety of sources, one being a site visit. Additional site visits may be made that will concentrate on specific areas such as health care or nutrition called random inspections. A random inspection of this service was carried out on 6 July 2006 to assess progress in the final part of the refurbishment programme at the home. A number of requirements were made following that visit. This visit was unannounced and carried out by two inspectors on 3rd August 2006 starting at 10.15am and ending at 7.00pm. An inspector and regulation manager made a further visit on 16th August 2006 and were at the home from 07.20 to 09.20. The purpose of the first inspection was to inspect all the key standards, (the key standards are identified in the main body of the report), to assess how the needs of people living in the home are being met. The second inspection was to follow up on issues of immediate concern about staffing levels, the laundry and fire precautions. The methods used in both inspections included looking at care records, talking to residents, observing care practices in the home, talking to staff and management, looking at the environment and looking at other paperwork including staff and maintenance records. The home completed a pre-inspection questionnaire (PIQ) to provide additional information about the home. Comment cards were left at the home for residents and their relatives. None had been returned at the time of writing the report. What the service does well: Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 6 The manager and staff develop good and supportive relationships with residents and their families. One visitor spoke very highly of the care and support both they and their relative had received from staff in the home during the end stage of life. Visitors said that they are welcomed into the home and staff kept them informed of any changes. Residents were happy at the home and three said that they would not want to live anywhere else. Staff treat the residents with respect and residents are able to choose how they wish to spend their time. For example when to get up, go to bed and if they want to stay in their room or join other residents in the lounge. What has improved since the last inspection? What they could do better: An Immediate requirement notice was left with the manager following the inspection on 3 August. This was for three issues of serious concern that the manager was told must be dealt with immediately and related to: a) The home not admitting any more residents with dementia or mental health needs. The registered provider and registered manager must be clear about the registration category of the home. Assessments must be thorough and provide detail of why the home feels that individual residents care needs can be met. Residents with dementia or mental health needs must not be admitted as the staff do not have the skills or training to care for these client groups. b) Disposing of food that was not frozen and contacting the environmental health officer for advice. The arrangements for food storage must be Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 7 reviewed to make sure that the food provided to residents is of a good quality. c) The laundry facilities were not adequate. These must be reviewed to make sure that the risk of cross infection is kept to a minimum. The provider must make sure that the laundry is fit for purpose and contact the infection control nurse for advice. The fire safety officer had also visited the home following the inspection and issued a report containing a number of requirements and recommendations. One of those related to staffing levels at night until an additional fire door was fitted to reduce the number of residents in each ‘compartment’ of the building. The registered manager made a verbal agreement that there would be three waking staff on duty until the work was done. There were only two staff on duty at 07:20 on 16 August. Staff rotas showed that there had been no increase in staffing levels after the agreement had been made. This places residents and staff at risk in the event of a fire. Up to date copies of the Statement of Purpose and Service User Guide must be available at the home for current and prospective residents. The CSCI must also be provided with this information. These documents must provide detail of the services and facilities provided reflecting the recent changes at the home. This will provide current and prospective residents with clear information about the type of care they can expect to receive. The provider has given details of the staffing levels required to meet the needs of the residents. On both inspections these were not being met. On 16 August there should have been 3 care staff on duty from 08.00 with another starting at 09.00. One member of staff did not arrive at 08.00 and did not contact the home to let them know why. However, the person due to start at 09.00 arrived early. In addition, it was unclear if the staff member who did not turn up for duty still worked at the home. It was clear she had not been on duty the previous day although the rota indicated that she should have been. Of greater concern was the night staffing levels. As already stated there were only two staff on waking duty, however the rota showed that for the 16 and 17 August there was one carer on duty. This was completely unacceptable and placed staff and residents at great risk. Staff were told they must find additional cover and if necessary agency staff must be used to protect people. Later in the afternoon of the 16 August staff confirmed that agency carers had been booked for the two nights. There was some improvement in ancillary staff with a kitchen assistant employed, however this person was due to start back at college and it was unclear what hours she would then be able to work. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 8 The staffing levels and skill mix must be reviewed in order to protect, safeguard and meet the needs of the residents. Care staff must not be taken away from caring for residents to carry out domestic duties such as cleaning, laundry or kitchen work. They must be able to concentrate on meeting the care needs of residents. Dedicated domestic, catering and laundry staff must be employed. Staff must be properly trained to carry out their roles, including the manager. This should make sure the needs of resident are being met. Management systems in the home are not effective and must be reviewed. The manager spends much of her time working with care staff to make up the numbers; the deputy manager cooks 2 or 3 times a week and can not support the manager. Steps must be taken to allow the manager time to properly manage the home. The provider should make sure that the manager receives sufficient support to do this. Care plans must provide detailed guidance for care staff on how to care for each resident. They should provide a clear picture of the individual, their abilities, needs, likes, dislikes, preferences, health, personal and social care needs and how to meet them. Residents and/or their relatives should be involved in the development of these plans. The lack of good care planning does not make sure residents needs are being met appropriately. Thorough risk assessments must be in place and where risks have been identified strategies must be in place providing staff with guidance on how to manage the risk. Particular attention must be made for those residents at risk of falling, losing weight and maintaining safety for those who smoke. This should make sure the needs of residents are being identified and action is taken to address them. Residents spend large parts of the day with nothing to do. They must be consulted about their social and leisure interests and suitable programmes of activities must be developed to provide and encourage interest and stimulation. These were disappointing inspections and the outcome was that the overall quality of the service is poor. The serious issues raised place residents and staff at risk. The provider has been asked to provide an improvement plan to the CSCI detailing the actions that will be taken to improve the service provision. Twenty-nine requirements and three recommendations have been made and these can be found at the back of this report. Steps must be taken to resolve the issues raised otherwise advice will be sought about enforcement action. Further detail on the findings of the visit can be found in the body of the report. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 9 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. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. (Standard 6 does not apply to this home) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Prospective residents and their families cannot make an informed choice whether the home can meet their needs because there is no written information available to them. Documentation showed that residents are admitted with care needs outside the home’s agreed registration category. Staff have not had the appropriate training to meet the needs of residents with dementia or mental health needs and there is a risk that their requirements will not be met. EVIDENCE: Visitors who had come to see their mother spoke with the inspectors. They had chosen the home after talking to mum’s social worker and paying a visit to the home. They said they had been given a full tour of the premises and the manager had given them all the information they had asked for. They did not remember being given a brochure. They said the manager had been to visit mum at the hospital before admitting her to the home. They were very happy Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 12 with the way mum had settled into the home and the good progress she was making. Mum said she was happy, liked the staff and her bedroom. The manager agreed to admit this resident and she came to live at the home in May 2006. From discussions with the relatives and looking at the pre admission assessment the registration categories do not allow for the home to provide care for them as they have mental health problems. When this was pointed out to the manager she was not aware that the resident was under a guardianship order or that she should have spoken to the inspector about it. The care plans looked at showed that the manager had been agreeing to admit residents whose identified care needs did not fall within the home’s registration categories. For example there were two residents with a main diagnosis of dementia and two with mental health needs. There is a risk that their needs will not be met as the staff have not had the appropriate training to look after them. Staff were not clear about how to look after a person with dementia. There was no Statement of Purpose or Service User Guide available. The manager said that it was at the printers. There were no documents to provide up to date information about the home for prospective residents. An immediate requirement was made that the home must not admit any more residents with dementia or mental health problems. In addition, the manager was asked to reassess all the residents and review the reasons for admission to the home. The information must be provided to the CSCI and the necessity to apply for a variation to the conditions of registration will be considered and discussed with the provider. Carr Croft Care Home DS0000066259.V304064.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Care plans are poor and the lack of detailed information about individuals needs provides the opportunity for care needs to be overlooked. Some medication practices are unsafe and place residents at risk. Service users are treated with respect and their dignity is upheld. EVIDENCE: A number of individual resident records were looked at. These records were poor and did not provide a clear picture of the resident, their needs, or how to meet them. The care plan for the resident recently admitted contained the basic information from the pre admission assessment. But the admission information pack, care plan documents and assessments had not been completed, even though this resident had been living at the home for two months. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 14 Other records had an initial care plan about introducing the resident to the home but there was little detailed information about meeting residents personal, health or social care needs. One plan for a resident at risk of leaving the home did have a risk assessment in place which said that the front door should be kept locked and staff to be aware of their whereabouts. During the visit the front door was propped open and staff were too busy to stay in the communal area. The manager said that leaving the building was no longer an issue. If that is the case, then the risk assessment should be reviewed and changed. Two residents smoked and spent all their time in the separate smoking lounge. They were left to smoke unsupervised and it was clear that one had problems lighting and holding a cigarette and the other could not put them out properly. Only one resident had a risk assessment in place around smoking, which said that they should smoke only in designated areas and use correct ashtrays. There was nothing about them actually smoking safely to reduce the risk of injury to themselves. The manager said that there should have been a similar assessment in the other residents care plan. The manager was advised to seek further advice about risk assessments and safety when smoking in order to revise the risk management strategies properly. Two of the care plans were for residents who looked underweight and at risk of losing more weight. Only one had a care plan to address this risk. Their visitor said that the family were aware of the nutritional problems and their relative’s reluctance to eat. They had not seen the care plan but said the manager kept the family up to date with changes. There was a care plan about weight loss, which stated: • • • Supplement drinks should be given – but not what type or when Snacks were to be encouraged – but not what type or when The resident should be weighed weekly – but there were only two weights recorded for 18.7 and 20.7. As the resident had been admitted in July 2005 it was not possible to establish if the dates were for this year or last year. There was no evidence to suggest that residents’ food preferences, likes or dislikes had been asked about. There was no reference to the nutritional assessment which when looked at said the resident was at low risk, despite their low weight and frail appearance. Information found in the plan and received from the family suggested that the risk was medium. This raises questions about the accuracy of the tool being used. There was nothing to show that staff were monitoring food intake or that extra snacks were being given. There was no information about how the foods given were being enriched or if the GP had been asked to request input from the dietician. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 15 There was no evidence of resident and/or their representative involvement in the development of the care plans, even though one visitor said that they had seen the care plan and discussed it with the manager. One carer who is now involved with writing care plans has not had any training to do so. The manager is a registered nurse but said it was some time since she had updated her skills in writing care plans. When person centred care planning was talked about she did not appear to have much knowledge about it. The care plans seen showed that there were a significant number of residents at the home with mental health needs. These were either current problems or the original reason for admission to the home, for example, following a ‘relapse of a psychotic illness’. There was no information or guidance for staff about the mental health needs of the residents and how to recognise any symptoms if a further relapse occurred. A resident who had been admitted to hospital following a fall at the home that had resulted in a fractured hip did not have a falls risk assessment in place. The accident and resulting hospital admission had not prompted a review of their care needs. The records did not make any clear reference to the accident, the resulting injury and what treatment had been given in hospital. At 10.30 five residents were sat at a table waiting for their morning tablets. They had their breakfast earlier and said they had been waiting an hour or more. The senior carer doing tablets left the room and locked the trolley safely, but later left the room again leaving a rack of tablets on the table and the trolley open. About 10 minutes later another carer came in locked the trolley – leaving the tablets on the table – and took the keys away. This is unsafe practice and places residents at risk. The senior carer said that this was not normal practice. When the carer was giving tablets she checked the MAR (Medication Administration Record) charts, took the tablets to the resident and then signed the charts. They said that they had done a distance-learning course about administration of medications in care homes through a local college. The daughter of a resident who had died on the day of the visit spoke very highly of the support that they and their relative had had from the manager and staff. The family had arranged with the home, General Practitioner and the District nursing service for the resident to be moved back to the home from hospital so they could die in their own room. But the care plans did not provide staff with guidance for caring for somebody in the end stages of their life. Daily records did show that staff gave very frequent support and care to Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 16 the resident and their family with half hourly input overnight prior to their death. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 17 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Residents are able to make choices about their day-to-day lives and are supported in maintaining contact with their family and friends. Visitors are welcomed at the home. Residents have little to occupy them through the day and there is poor provision of planned activities. Some practices connected with food preparation put residents at potential risk. EVIDENCE: On arrival at the home a rock music station was playing on the radio. When asked residents said this was not the type of music they wanted to listen to. The manager changed it to play a CD saying that when it stopped playing it automatically reverted to a radio station. Staff should make sure that music played is what the residents choose to listen to. The home does not employ anybody to make sure that residents’ social and leisure needs are met. Care plans seen did not make any reference at all to residents’ social care needs. There is no regular programme of planned Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 18 activities in the home other than a lady who visits twice a month to do ‘Motivation sessions’ and once or twice monthly bingo sessions. Staff said that when they have time they will sit with residents and chat or play games such as dominoes and ‘connect 4’. These games were seen on a table in the afternoon but nobody was being encouraged to join in. The residents who were sat at the table waiting for their tablets at 10.00 were still sat there between 11:30 and 12:00. They did not have anything to do to occupy their time. Staff were too busy and did not have time to interact with residents. There was no stimulation for residents in the lounge/dining room. The TV was turned on but it couldn’t be heard and most residents were sat looking bored and disinterested. There was nothing seen in this room that could be used to stimulate residents and encourage them to fill their time. Books were kept in the smoking lounge that was used by two residents. Staff and residents said that there were no set times for getting up or going to bed. A lot of residents liked to have breakfast in their rooms and get up later. It was clear that residents could choose whether or not to stay in their rooms or come to the communal areas, this included mealtimes and staff took lunch to those who stayed in their rooms. Visitors said that they could visit at any time and were always made to feel welcome. One who came later in the day was offered a hot drink by the manager and they said this was the norm. But this was not seen to be the case for other visitors that were spoken to. The deputy manager was preparing lunch and said that at least three days a week she is the cook. She has done basic food hygiene training. Afternoon care staff serve teas and prepare meals and snacks. The carers on duty were not up to date with basic food hygiene training. The student working as a kitchen assistant was not wearing protective clothing. All the staff were seen going in and out of the kitchen throughout the day, including the manager and none wore protective clothing. There is a phone in the kitchen, which means that staff have to go in to answer it. This should not happen as it presents a risk to preventing cross contamination. Consideration should be given to relocating this phone. The senior carer did a drinks round at 11am offering tea or coffee and biscuits. There were jugs of squash available to residents throughout the day. The food store is in the basement. Some of the fresh produce was on the floor. Fresh fruit and vegetables were stored with bags of rotting produce for example, pears, carrots and onions. The manager said that the fruit and vegetables had been delivered the day before and would be expected to last a full week. Eggs were not being stored in the fridge. The dried food store was in a muddle with bleach and cleaning fluids stored with foodstuffs. Cans of Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 19 paint were also stored in this area and a bucket of dirty water was seen with a mop standing in it. The large chest freezer was full but the top layer of food was not frozen. There were no temperature records for this freezer. The temperature of the freezer was taken twice during the day with two thermometers. Both times a recording of -10° to -12°C was taken rather than the recommended temperature of between -18° and -20°C. An immediate requirement was made for the manager to destroy all the food not properly frozen and take advice from the Environmental Health Department regarding the safety of the rest of the food in the freezer. She was also asked to arrange a maintenance visit to check the freezer. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 20 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Overall residents are protected from abuse with the majority of staff aware of adult protection procedures. Residents feel safe at the home. The absence of complaints procedures for all residents provides the opportunity for concerns to be overlooked. EVIDENCE: The complaints procedure is not freely available to all. There was one copy in the home displayed on a notice board in an area of the home not accessed by relatives or residents. There was no additional guidance available to advise staff if someone wanted to make a complaint. Records of complaints were kept on plain sheets of paper in a file and it was difficult to see if a record was kept of all complaints received or how concerns were dealt with. There was no overall log or audit of complaints received. Information regarding a complaint made about the hot water provision from earlier in the year was not seen. Care workers said they had not done any adult protection training but were aware of the adult protection procedures. They said that they would not hesitate to report suspected or actual abuse. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 21 A copy of the local authority adult protection (LA AP) procedures was on the notice board in the entrance hall and contact numbers were on the front cover. The manager has attended a ‘train the trainer’ course about adult protection provided by the LA AP unit. This training must be given to all staff. Three of the residents spoken to said that they felt safe in the home and would not want to go anywhere else. Since the last inspection visit the manager has dealt appropriately with a potential adult protection issue. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 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, 23, 24, 25 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Some work has been carried out on the environment but further work must be done to make sure that a safe and comfortable environment has been provided for the residents. The laundry system was not adequate and provided the opportunity for cross infection. EVIDENCE: The grounds have now been cleared and the outlook from the home is much improved. Builders’ rubble has been removed although there are still some items or furniture and other rubbish on the site waiting for removal. The fire safety officer has not visited the home since November 2005 when a full inspection was not carried out due to the ongoing building works. Following observations made on the day of the visit the fire safety officer was asked to Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 23 visit the home. For example, several fire doors were not properly closing and paint was being stored in the basement next to the electrical fuse box. There were no smoke or heat detectors seen in the basement corridor where the fridge freezer stood and main fuse boxes were. The fire exit near the kitchen had a chair on the step directly outside and an ashtray on the wall. The faulty fire door on the upstairs corridor had been brought to the attention of the provider at the site visit of 6 July 2006 and had still not been repaired on 16 August. This continues to places residents and staff at risk in the event of a fire. When the second visit was made on 16 August the fire safety officer had been to the home. A report with required and recommended actions was sent to the provider and the CSCI. Some of the requirements needed an urgent response from the provider and related to making sure that all fire doors closed properly and that the ground floor corridor was divided into smaller compartments by the addition of a fire door. Staff said that a joiner had been in to start work on repairing the fire doors and later in the day the manager confirmed that the new fire door on the ground floor corridor would be completed the same day. One resident who was part of case tracking agreed to let her room be looked at, as she was very happy with it. The room had not been redecorated and there were marks on the wall where pictures had been taken down. A new wardrobe and chest of drawers had been put in the room but three drawer fronts were missing. The relative said the manager had told them the supplier had sent the wrong drawer fronts and was waiting for replacements. On looking in other rooms this problem had occurred in at least two more cases. The manager was asked why incomplete furniture had been put into use in residents’ rooms. She said she had been told to do it and that the person putting the flat pack furniture together had had to do it all while they were there. They had found that parts were missing. They were expected during the next week and would be fitted as soon as the person could be brought back to finish the job. One of the double bedrooms is very small and not big enough for two residents to spend time in there comfortably. Only one resident had a cabinet at the side of their bed, there was only one chair and there were no privacy curtains between the beds. Two new wardrobes had been put in side by side against the wall. The one nearest the bathroom door was not straight and stood away from the wall. It could be moved very easily and presented a significant risk to people in the room. The manager was told that steps must be taken to make sure that it cannot fall. This wardrobe also had not been put together well and the back was coming away as a result of people pushing things to the back of it and it was blocking access to a double electric socket. Visitors said clothes were always clean and rooms kept tidy. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 24 Care workers also have to do domestic duties as well as helping out in the kitchen to supplement the low number of hours that domestic staff actually work. On the day of the visit the one domestic had not come in to work. Some of the bedrooms appeared tidy but the carpets were dusty and badly in need of vacuuming, there were underlying odours of urine in some areas, one bed had a badly stained valance sheet left on it and a soiled cushion was on top of another bed. The new lounge and dining area is spacious but looks stark and lacks homely touches. Not all the planned refurbishment has yet been completed. There are still no curtains in the smoking lounge (first noted January 2006) and other curtains and carpets have yet to be replaced. The carpet in the new lounge is already badly stained. The laundry was dirty and untidy. There was a plastic bin with no liner and containing what looked like clinical waste. This area smelt. There was a mop bucket with dirty water and mop standing in it. Care staff carry out laundry duties. There was a notice on the wall about laundry procedures – ‘if soiled to be sluiced and then washed in accordance with labels’ suggesting that hand sluicing is carried out. However, a member of staff described the correct procedure for dealing with foul linen. The existence of the notice suggesting poor practice could be confusing to inexperienced staff. There is only one washer and one drier with another washer on order; a hand iron and ironing board is available. The only access to the laundry is via steep laundry steps or from outside with a consequent manual handling risk for staff carrying bags of laundry down the steps. This area is not adequate to cater for the needs of the proposed 35 residents. It does not provide enough space to properly separate clean and dirty laundry. An immediate requirement notice was left with the manager to clear out the laundry to allow it to be properly cleaned before suitable flooring was put down. And to the seek advice from the Control of Infection Nurse about the suitability of the laundry, equipment and practices followed. When the second visit was made on 16 August the infection control nurse had visited the home. The laundry had been cleaned, tidied and cleared of any broken or unnecessary equipment. Work on the floor had not started, but it was found that there is a water leak. Staff said this has been happening for some time and they cannot see where it is coming from. This must be dealt with before the flooring is replaced. The external exit door for the laundry was left open which poses a security risk. Staff said they do this to vent the dryer as the vent through the wall was blocked up when some of the building works were done. This must be put right. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 25 The toilet next to the laundry was being used as storage area. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The recruitment procedures are not robust and do not always ensure that residents are protected. The numbers and skill mix of staff are not sufficient to meet the needs of the residents. Staff do not have the skills to effectively meet the needs of the residents. EVIDENCE: The staffing rota and the numbers of staff on duty on the day of the visit demonstrated that the staffing proposals produced by the provider were not being followed for the number of residents currently at the home. This includes ancillary staff. The care staff continue to work without the support of a dedicated ancillary staff team. At the time of the visit the deputy manager was allocated to the kitchen with the support of a student, there was no domestic or laundry staff on duty. Some of the staff said they only had enough time to provide basic personal care and cover the kitchen and cleaning duties, that more staff were needed on shift to be able to spend quality time with residents. The shift times do not allow for an overlap of staff for a detailed handover between shifts. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 27 The fire safety officer had also visited the home after the 3 August and issued a report containing a number of requirements and recommendations. One of those related to staffing levels at night until an additional fire door was put in place to reduce the number of residents in each ‘compartment’ of the building, the provider made a verbal agreement that there would be three waking staff on duty until the work was done. On the visit made 16 August there were only two staff on duty at 07.20 and staff rotas showed that there had been no increase in staffing levels after the agreement had been made. The staff rotas seen did not correspond with the staff actually on duty during the visit and night rotas showed that there was only carer allocated for the night shift. The senior on duty was told to make sure that there were at least two staff on the night shift and a letter stating that there were serious concerns was hand delivered to the home in the late afternoon. Confirmation was received that an agency care worker had covered the night shift. The student working as a kitchen assistant had commenced work at the home on the day of the first visit and was working under the supervision of the deputy manager. No induction programme had been arranged for her. Recruitment records were looked at for recently employed staff. Some of the application forms were incomplete in that they were not dated or signed in every case and one did not provide a full job history. It was not always clear who had provided the references and therefore it was not possible to establish if the referees were appropriate. There was no evidence on the individual files that checks had been carried out against the Protection of Vulnerable Adults (POVA) register or by the Criminal Records Bureau (CRB). The manager said that this information was held elsewhere. Photographs were either not included or were of poor quality. There were no copies of job descriptions or signed terms and conditions. A pre-interview questionnaire was used but this tool had not been used to full advantage. One carer had not answered the questions in any sort of detail or had not provided any answer. There was no evidence that this had been explored at interview. The interview record was a checklist with a scoring system for personal attributes such as appearance, attitude and knowledge base. Evidence had not been provided where necessary of individual’s right to reside and work in this country. Training records were poor and no detailed training plan has been provided. The file contained handwritten notes of training with no information of who had provided training. In the front of the file was a handwritten list of forthcoming training, which included manual handling for September; abuse August and September; YMCA August & September NVQ 2 & 3; food hygiene 2006; RMA September 2006 with no additional details of who was to attend and who was to provide the training. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 28 Staff said they enjoyed working at the home because they were part of a good team that worked together to provide good care to the residents. One carer said that over the last twelve months she has done moving and handling training and was part way through a distance-learning course about health and safety. Another carer said that she had completed a National Vocational Qualification in care at level 2. There is 38 of staff with NVQ level 2. Staff spoken with had not done first aid or basic food hygiene training even though they would be involved in food handling in the absence of dedicated kitchen staff. They had not had any training about the care of residents with dementia or mental health needs. One carer did not think that people with dementia needed different caring skills to meet their needs. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 29 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, 33, 35, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The management of the home is not organised. This results in practices that do not promote and safeguard the health, safety and well being of the residents. EVIDENCE: The manager has yet to enrol to undertake the Registered Managers Award (RMA). This is her first managers’ post and she must pursue this training to equip her to carry out her role effectively. The manager was struggling to manage the home in the absence of effective support. The deputy manager is an experienced carer but does not have any formal qualifications and on two or three days a week has to carry out kitchen duties. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 30 There were no records of residents meetings available at the home. The manager said that the provider had the notes of the most recent meetings at home for typing. Records of staff meetings were seen. Records showed two meetings last July (05/07/05 & 25/07/05) with no further records until 6th 7th and 10th July 2006. There is a ‘Quality assurance’ file, which held completed survey forms. These were sent out to relatives, residents, GPs, district nurses and others in May/June 2006 and are due for return by 31st August 2006. The district nursing team for the local GPs had completed the ‘suggestions to improve the home’ section with the following comments: • Improved staff training e.g. catheter care/continence management; pressure area care; communication skills with the confused elderly with dementia; mental health. • Other comments from the district nursing staff – ‘renovations have improved the environment etc Other comments from professionals visiting the home were positive and included: • staff ‘always appear pleasant’; ‘happy atmosphere’; • ‘staff always helpful’; ‘residents clean and contented’. One relative’s questionnaire raised concerns about the security at the home as his relative has wondered out of other establishments – ‘already discussed attention to security which we expect to have been implemented’. On the day of the visit the front door was often wide open and the manager said this was no longer a concern. The home looks after personal money for residents but does not act as appointee for any residents. The records of residents’ monies were not clear. For example, signatures were not clear. Receipts are kept for all transactions but receipt of money into the home did not have two signatures. It was recommended that the whole system be reviewed. The majority of the money held by the manager was for such items as hairdressing, chiropody and newspapers. A safer more efficient system would be for such items to be invoiced. There is no administrator at the home and the time consuming task of managing the monies and keeping the records falls to the manager. Not all records required to be kept were available and these have been detailed in other sections of the report. I t was found that residents care plans were being kept in a cupboard in the yellow lounge, which could not be locked, staff kept it shut by putting a chair in front of the doors. This is not in keeping with maintaining confidentiality and making sure that records are stored securely. Accident records are kept but the standard of the records was poor with a lack of relevant information recorded about the accident both on the accident forms Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 31 and in the daily records. For example, one accident report had been made on the back of an earlier report; another had been recorded on the back of a staff time sheet. The daily records of one resident noted that an accident had occurred. The information was poor with no time last seen, no detail of any injury, the position in which the resident was found or if any first aid was given. The resident was taken to hospital but there was no detail of the outcome. This accident was cross-referenced with the daily record to see if full detail had been recorded elsewhere. The accident was noted very briefly. It was recorded that the resident was to stay in hospital and have an operation without any indication of the injury. The hospital discharge sheet included the abbreviation ‘DHS’ which when asked the manager confirmed was a dynamic hip screw. The homes own records did not include any indication that this resident had in fact broken their hip. The CSCI had not been informed as required under Regulation 37. The manager said that the provider visited the home regularly and that these visits are recorded in the homes diary. However, no regulation 26 reports have been received by the CSCI or were available at the home. There were still no policies and procedures available to guide and support staff in the work they do. The manager said that these had been finalised and had gone to the printers. Maintenance records were not made available. There is no maintenance support at the home. The recently fitted stair lift was not operational, on either visit. Staff said that the battery had been drained. Staff needed training in order to use it. Risk assessments must be put in place to provide staff with clear guidance on using the stair lift safely. Records seen indicated that fire points were being checked but without an overall list of all the points in the home in was not possible to fully audit this. Records could be seen of the annual check of the fire extinguishers and the emergency lighting but not of the alarm system. The home must have procedures in place for making sure the alarm systems are checked and maintained by appropriately qualified people and that a designated person carries out weekly fire safety and alarm checks and that records are kept. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 32 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 1 X 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 2 X X 2 2 2 1 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 X 2 1 Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 33 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&5 Requirement The Statement of purpose and service user guide must be updated to reflect the changes at the home. These must be made available to current and prospective residents and the CSCI. The registered manager must make sure that the pre-admission assessments documents are completed as fully as possible and the information is used to decide whether or not the home can meet the residents assessed needs. Residents must not be admitted to the home outside the registration category of the home i.e. with dementia or mental health needs. An immediate requirement notice was left at the home on 03 August 2006 that residents with these needs are not admitted and that residents in the home already must have their needs reassessed. The Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 34 Timescale for action 19/09/06 2. OP3 14 30/09/06 3. OP4 14 03/08/06 4. OP7 15 registered provider must then consult with the CSCI about a variation to registration. Care plans must set out in detail the action, which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the service users are met. The plan must be drawn up with the involvement of the service user, recorded in a style accessible to the service user; agreed and signed by the service user whenever capable and/or their representative. The care plans must be reviewed at least monthly. 30/10/06 5. OP8 13 and 15 Timescale of 31/07/06 not met Effective risk assessments must be carried out and appropriate care plans put in place providing guidance to staff as to how the risk will be managed. Particular attention must be paid to the risk of falling, losing weight and safety when smoking. The registered manager must make sure that all staff are aware of the medication policies and procedures and follow them. Particular attention must be paid to the safe storage of medication and locking medication in the drugs trolley when it is left unattended. The registered manager must make sure that clear and detailed care plans are in place to provide carers with guidance on caring for a dying resident. The provider must consult with the residents about their social DS0000066259.V304064.R01.S.doc 30/10/06 6. OP9 13 19/09/06 7. OP11 15 30/10/06 8. OP12 16 06/11/06 Page 35 Carr Croft Care Home Version 5.2 interests and develop a programme of activities providing interest and stimulation for the residents. 9. OP15 16 Timescale of 31/07/06 not met. The arrangements for food storage must be reviewed to make sure that they are safe. Storage in the large chest freezer must be reviewed and the freezer must be inspected to make sure that it is safe. An immediate requirement notice was left at the home on 03 August 2006. The provider must make a written complaints procedure available to all residents. There must be written guidance for staff on how to receive and handle a complaint. Staff must receive training in adult protection. The registered provider must make sure the home is well maintained and safe. This must include making sure that adequate precautions are taken against the risk of fire following consultation with the fire safety officer. The registered provider must make sure that safe, suitable and pleasant outdoor areas are provided and accessible to residents. The registered provider must make sure furniture used in the home is safe and fully constructed. Risk assessments on larger items of furniture must be carried out and appropriate action taken to reduce the risk of accidents. DS0000066259.V304064.R01.S.doc 03/08/06 10. OP16 22 19/09/06 11. 12. OP18 OP19 13 23 06/11/06 16/10/06 13. OP24 13 and 23 30/09/06 Carr Croft Care Home Version 5.2 Page 36 14. OP25 23 15. OP26 13 Steps must be taken to make sure that each resident has access to at least two electric sockets. The provider must make sure that heating that is provided throughout the home is suitable and safe for residents. The laundry area must be refurbished, reorganised and kept clean. Action must be taken to identify and repair the source of the water leak, the floor must then be sealed and the new equipment installed. The air vent for the dryer must be opened up again. Action must be taken on advice given by the infection control nurse and appropriate policies and procedures put in place. An immediate requirement notice was left at the home on 03 August 2006 Action must be taken to make sure that there are enough care staff on duty at all times to meet the needs and numbers of residents living in the home. This must include making sure that care staff are not taken away from caring duties to carry out domestic and catering duties. 30/09/06 07/08/06 16. OP27 18 19/09/06 17. OP28 18 18. OP29 19 Ancillary staff must be employed in sufficient numbers to meet the demands of the home. NVQ training must continue for 31/12/06 care staff to ensure that the target of 50 trained members of care staff is reached by the end of 2006. The manager must make sure 30/09/06 that application forms are fully completed, dated and signed, DS0000066259.V304064.R01.S.doc Version 5.2 Page 37 Carr Croft Care Home that a full employment history is asked for and explanations recorded for any gaps in employment. The manager must make sure that two written references are in place, one of which must be from the most recent employer and that satisfactory POVA and enhanced CRB disclosures are in place for all prospective employees. Evidence of an individuals right to reside and work in this country must be available if applicable. The manager must make sure that staff receive appropriate training in order to carry out their role. 19. OP30 18 30/10/06 20. 21. OP31 OP33 9 24 This must include induction training to Skills for Care common induction standards; health and safety related training as well that specific to the needs of the residents. Records must be kept. The manager must obtain a 30/09/06 relevant management qualification. Effective quality assurance and 19/09/06 quality monitoring systems, based on seeking the views of service users, must be implemented to measure success in meeting the aims, objectives and the statement of purpose of the home. Policies and procedures must be reviewed to ensure staff have access to relevant and accurate information. Timescale of 1/04/05 not met) Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 38 22. OP33 24A 23. OP33 26 The registered provider must 30/10/06 produce an improvement plan setting out the methods and timetable of how they intend to improve the services provided at the home. The registered provider must 30/09/06 ensure that monthly visits to the home take place and that reports are kept, copies of which must be sent to the CSCI. They must make sure that when visits are conducted under this regulation they speak with residents and staff to form an opinion of the standards of care being provided. Arrangements must be in place to enable staff to inform the registered person and/or the CSCI about the conduct of the home as it may affect the health and welfare of residents. All records as outlined in schedules 3 and 4 of the Regulations must be available. Records must be kept securely as required by the Data Protection Act. The fly nets at the kitchen windows must be repaired or replaced. Staff must be trained in the use of the stair lift. Detailed risk assessments must be in place prior to any resident using the stair lift. The registered manager must make sure that all notifications required by this Regulation are made to the CSCI as soon as practicably possible. Procedures must be in place for making sure the fire alarm systems are checked and maintained by appropriately DS0000066259.V304064.R01.S.doc 24. OP37 17 30/09/06 25. 26. OP38 OP38 13 13 19/09/06 19/09/06 27. OP38 37 30/09/06 28. OP38 23 30/09/06 Carr Croft Care Home Version 5.2 Page 39 29. OP38 13 and 17 qualified people and that a designated person carries out weekly fire safety and alarm checks and that records are kept. Detailed accident records must 30/09/06 be kept which provide clear information about what happened, who saw it happen or when the resident was last seen and by who, what injuries were sustained, what action was taken and what the outcome was. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP21 OP23 OP35 Good Practice Recommendations Consideration should be given to making the bathrooms less clinical in appearance. The provider should review the suitability of the shared rooms for occupancy by two residents. Two signatures should be recorded for all transactions involving residents’ personal allowances. Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Carr Croft Care Home DS0000066259.V304064.R01.S.doc Version 5.2 Page 41 - 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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