Inspection on 24/07/08 for Carrick Lodge

This inspection was carried out on 24th July 2008.

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

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

Carrick Lodge 31/03/09

Carrick Lodge 13/08/07

Carrick Lodge 19/10/06

Carrick Lodge 09/02/06

Carrick Lodge 15/06/05

Carrick Lodge 05/11/04

Carrick Lodge 20/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Carrick Lodge Belyars Lane St Ives Cornwall TR26 2BZ Lead Inspector Ian Wright and Melanie Hutton Unannounced Inspection 24th July 2008 9:30 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 Carrick Lodge DS0000008919.V365885.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. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carrick Lodge Address Belyars Lane St Ives Cornwall TR26 2BZ 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) 01736 794353 01736 798621 carricklodge@btconnect.com Mr Ronald James Cottam Mrs Lizabeth Helena Rutherford-Ainley Care Home 38 Category(ies) of Dementia (18), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (18), Old age, not falling within any other category (20) Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum 20 places Dementia (Code DE) - maximum 18 places Mental disorder, excluding learning disability or dementia aged 65 years and over (Code MD(E)) - maximum 18 places The maximum number of service users who can be accommodated is 38. 13th August 2007 2. Date of last inspection Brief Description of the Service: Carrick Lodge provides care and accommodation for up to 38 older people- 18 of whom may be diagnosed with dementia and/ or mental disorder. The registered provider is Mr R Cottam and the registered manager is Lizabeth Rutherford-Ainley. Carrick Lodge is situated near the centre of St. Ives and is in an elevated setting with views of the bay. The house is a large three-floor property with a two-storey extension. There are two communal seating areas, a conservatory, the dining room, kitchen area, laundry and two offices. Two lifts and a stair lift are provided to assist access to the upper floors. A fenced garden is situated at the front of the home. At the time of the last inspection fees range from £300-400 per week. We have not received updated information for this inspection report. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the home’s management or the CSCI website. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection took place in ten hours in one day. Two inspectors completed the inspection. All of the key standards were inspected. The methodology used for this inspection was: • To case track four people who use the service. This included, where possible, interviewing the people who use the service about their experiences, and inspecting their records. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: This inspection has resulted in fifteen statutory requirements. Suitable action must take place, within the timescales set. We may take enforcement action if satisfactory progress is not made regarding some of the requirements set: In brief improvement is required to: Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 6 • • • • • • • • • • • • • Improve care planning Improve medication procedures and training Improve arrangements to maintain the privacy and dignity of people living in the home. Improve arrangements to improve the choice of food provided. Improve facilities, furnishings, decorations and maintenance of the home. Currently these are unsatisfactory. Ensure the home is free from offensive odours Complete suitable pre employment checks when staff are employed. The operation of the medication system. Adult protection policies and procedures. Staff also need training in this area. Employment checks on staff for example regarding protection of vulnerable adults register checks and Criminal Records Bureau checks. Staff induction and training. Quality assurance systems. Health and safety precautions. The Commission will monitor suitable action is taken in these areas, and complete a further inspection to check compliance if this is deemed necessary. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 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 Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided to people who use the service, and their representatives, is satisfactory, although copies of this information should be issued to the person’s next of kin as appropriate. Assessment procedures appear satisfactory and should ensure people’s needs are fully assessed before admission is arranged. EVIDENCE: People who use the service have a copy of the service user guide in their bedrooms. This requires some minor amendment for example details of current management arrangements and current details of how to contact CSCI. If people who use the service lack capacity or have poor understanding a copy of this document should also be issued to the next of kin / representatives of the person. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 9 Copies of a contract of care / statement of terms and conditions of residency were contained in the files for each person using the service. These appeared to contain satisfactory information. Copies of pre admission assessments were inspected for some people who use the service. These contained suitable information regarding the person’s needs. The registered manager was completing an assessment on the day of the inspection for example she visited the local hospital to assess the individual and to discuss the person’s needs with professionals involved. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. Improvement is required regarding care planning, staff training regarding the management of medication and enabling people who use the service to make more choices regarding their lives. Improvement in these areas will assure people using the service that they can be confident their health and personal care needs are being met in a respectful and dignified manner. EVIDENCE: Care plans for people who use the service were inspected. Each person has a care plan and there is satisfactory evidence these are being regularly reviewed. The contents of care plans are adequate, and contain some information to assist staff to provide care. However care plans do need to contain more information. For example: 1. There needs to be a manual handling assessment for each person using the service. 2. If there are other risks either the person presents, or significant risks to that person, a further risk assessment needs to be completed. 3. The format currently used is very basic i.e. appears to be a list of tasks the person needs help with. Care plans should clearly direct and inform Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 11 care to be provided. Information, which should be included in the care plan, is outlined in NMS 7.2 /3.3. 4. There needs to be fuller and clearer information regarding medical interventions. Information regarding GP and district nurse involvement appears satisfactory, however there needs to be more information regarding other professional involvement for example chiropodist / optician / dentist. This will ensure staff can track what treatment people have received and ensure people obtain appointments at appropriate frequencies. Although people who use the service, who the inspector spoke to, did not appear to be aware of their care plans, all said care was appropriate and carried out in a manner according to their wishes and needs. All people living in the home looked clean, well dressed and well cared for. People who use the service spoke positively regarding the attitude of staff. Health care support appears to be to a satisfactory standard. People who use the service said they could see a doctor or other medical practitioner when this is necessary. The inspectors spoke to two district nurses and a social worker regarding the care in the home. All said care was to a good standard and they had no concerns about staff approaches or care given. We have outlined above how information regarding medical interventions could be better recorded. The medication policy inspected is satisfactory and appears to contain appropriate information. The medication system was inspected. Medication generally appeared to be suitably stored and locked away, although it may be better if storage is centralised. Stocks levels are generally satisfactory although the registered manager needs to watch the supply of some creams etc. kept. We also noted that some inhalers were left in the office and the office was unlocked. We also noted the keys to the medication cabinets are currently kept in an unlocked drawer in the office. Keys need to be kept secure-preferably on the person of the member of staff responsible for medication on each specific shift. Arrangements regarding the administration, and recording of medication appear to be satisfactory. We observed one member of staff administering medication, and this appeared satisfactory. Training regarding the administration of medication needs improvement. When we assessed staff training records of fourteen staff only three people had a record of training. CSCI provides information regarding what training should be provided. This can be found via the attached web link: http:/www.csci.org.uk/professional/default.aspx?page=7328&key= Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 12 People who use the service, who the inspectors spoke to, spoke positively regarding the care they received and said were positive about staff who have been employed. However we were concerned about some aspects of the support offered: 1. We do not feel people are provided with a sufficient choice of food- this is expanded on in the next section of the report. One person said to us that they used to receive a cup of tea ,sandwich and a piece of cake at night but this has now stopped. 2. People have said they now cannot have morning coffee and afternoon tea in the lounge, but have to walk to the kitchen / diner to have this. This appears to be, at least in part, due to the provision of new furnishings in the lounge. We do not think this is reasonable. One person was observed asking staff if they could have their meal in their bedroom. The person was then taken to the dining room. 3. One person was left on a commode in their bedroom with their bedroom door open. The person could be seen from the hallway. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Routines are generally satisfactory to meet the needs of people who use the service. However people need to be offered a choice where they have their meals and drinks, and there needs to be more choice of food available. EVIDENCE: Routines appear satisfactory, for example people were observed receiving staff assistance to get up and come downstairs when we arrived. Meals are primarily served in the dining room. We have expressed some concerns about this in the previous section of the report. There are some activities organised. An activities co-ordinator is in post and works four days a week. A fete had been organised at the home and everybody enjoyed this. Some external entertainers also perform at the home for example a singer comes to the home once a month. Although we raised some concerns regarding people being able to exercise choice over their lives as outlined in the previous section of the report, some people did appear to spend time in their bedrooms, be able to choose what they could wear etc. People can look after their own money if they wish. It was evident people who use the service could bring their own furniture and belongings into the home. For example bedrooms are individualised with Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 14 people’s personal belongings such as photographs and ornaments. Relatives and friends can visit people who use the service when they wish. The inspector spoke to several visitors who were all positive about the service provided by staff, and they raised no concerns. The main meal is served at lunchtime. The registered provider said the home had experimented with people being able to have their main meal from 12 pm to the evening but sadly this had not proved popular. People who use the service did not complain about the meals provided at lunch time. One person described the food provided as ‘very good’. We were concerned about the main meal provided for one person. This person appeared to have an omelette each day. Although this is apparently the person’s choice, it is not healthy to have such a limited diet. Staff should work with the person so they have a wider variety of dishes. The dietician may be able to assist with this. The record of food provided shows there is very limited options for people who do not like what is provided. Records show that where an alternative was provided this was either egg and chips for one person or a salad. People said they felt there was no choice and little variety of food provided at tea time. One person said there used to be more choice at tea time but this had now decreased. The evening tea provided generally appears to be sandwiches. At the last inspection we recommended a hot and cold option of evening tea is offered each day. We have no evidence this is available, and as people who use the service have clearly said to us they are unhappy with the current arrangement, we are making a statutory requirement regarding this matter. We believe people should be offered either sandwiches or a hot snack each evening. This would be simple, not costly, avoid waste and help to ensure people received an enjoyable balanced diet. It also would resolve this concern shared by us, and some people who live in the home. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitable policies, procedures, training and staff recruitment checks must be in place. This will assist people who use the service to have greater protection from poor and abusive practice. EVIDENCE: Information regarding what people can do if they have a concern or complaint is in the service user guide, of which a copy is available in individual bedrooms. The registered provider said he would try and resolve any complaints and / or concerns if they occurred. People who use the service were positive about staff practices and said they were not aware of any poor or abusive practice. The registered provider’s adult safeguarding (protection) policy still needs to be more detailed. Since the last inspection the registered provider has printed off some information regarding adult safeguarding (protection) from the county council. However, the registered persons need to develop a more comprehensive policy. Records show some staff have attended adult safeguarding (protection) training recently. Further staff are due to attend shortly. Other staff should attend this training as places become available. It is advisable adult safeguarding is covered during initial staff induction. For example the Cornwall County Council ‘No Secrets’ video could be shown to all new staff, before full training is received. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 16 The registered provider said no allegations of abuse had been made. No exstaff had been referred to the Protection of Vulnerable Register (POVA) list (A list of people who are considered unsuitable to work with the vulnerable). Procedures regarding the registered provider obtaining Protection of Vulnerable Adults checks (POVA First) and Criminal Records Bureau checks (CRB), as detailed in the ‘staffing’ section, are not satisfactory. This subsequently could put people who use the service at risk of abuse. Evidence of this breach of regulation is contained in the ‘staffing’ section. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Facilities at Carrick Lodge need significant improvement so people who use the service can enjoy a comfortable, clean, well maintained environment to live in. EVIDENCE: The building was inspected. Various improvements are required so Carrick Lodge meets the environmental National Minimum Standards and associated Care Homes Regulations. We issued a requirement at the last key inspection for the registered provider to improve environmental standards, and to demonstrate this by sending us a maintenance and refurbishment plan. Despite a reminder being sent for an update on outstanding requirements, we did not receive this information. The registered persons have sent us the Annual Quality Assurance Assessment (AQAA). This is required by the commission, at least annually and outlines what improvements the registered provider intends to make, and also provides us with a data set outlining various information we require. This does not Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 18 outline any improvements the registered provider intends to make to the environment in the next year. However, since the inspection the registered provider has written to us and stated some improvements had occurred to the building and this had entailed significant financial investment. This included new chairs in the lounge, new central heating boilers, new bedroom furniture, a large area of the roof has been retiled and fire precautions have been upgraded. The registered provider said it is difficult to make further improvements due to financial constraints. We are concerned that many of the concerns we have expressed do not necessarily need significant financial investment. We are also concerned that many of the issues we have raised for example increasing bathing facilities have been repeated on a number of occasions, and should have been addressed by now. The concerns we have on this inspection are: • • • The laundry floor is damaged and needs replacement. A statutory requirement has been renotified regarding this matter. Carpets: Some of these have been replaced e.g. in the hallways. However some carpets in the bedrooms are stained and /or omit an odour. Some lights did not work for example on one of the staircases and in one of the hallways. We issued an immediate requirement regarding this matter. The registered provider has said he will take some action regarding this matter. Some doors were propped open. This could create a fire risk. There are appropriate automatic closing devices on the market which mean doors can be left open, and will automatically shut if the fire alarm rings. The cleaning cupboard was left unlocked. Chemicals are stored in the sluice room which was unlocked. These items should be locked away according to health and safety (COSHH) regulations. The conservatory is currently being used for storage and does not appear to be available to people who use the service. At the last inspection, although this facility did require some upgrading, people living in the home enjoyed its use. There are no blinds on sky light windows in bedrooms, which may result in people being woken up too early in the summer. Some toilets / bathrooms contained no soap or towels. The toilet roll holder was broken in at least one toilet. We notified the registered provider regarding this matter at the last inspection. Some radiators and heated towel rails were not guarded. Decorations in some bedrooms and communal areas need upgrading e.g. peeling paint and wallpaper. We notified the registered provider regarding this matter at the previous inspection. There were no call bells in some bedrooms. DS0000008919.V365885.R01.S.doc Version 5.2 Page 19 • • • • • • • • Carrick Lodge • • • • • • • • • • Unpleasant odours were present in some bedrooms The light switch was above the door in one bathroom. The registered provider said this was fitted on purpose to prevent people leaving the light on. The compact disc player in the lounge appears to be broken as there is a sign on it stating it should not be used. Decorations in the downstairs toilet by the lounge are very poor. The shower in this room does not work. We reported this matter at the previous inspection but no action has been taken. At least two of the toilets were dirty and do not appear to be regularly cleaned during the day. Toilets near rooms 29 and 33 did not have a lid. The ‘Ventaxia’ fans in at least two of the toilets needed cleaning. Some windows did not have restrictors e.g. quiet lounge. The electric socket outside room 33 was damaged and had been repaired with tape. The enamel on at least one bath is badly damaged There was no hot water in the office /examination room at 13:15hrs The water was too hot in at least one bathroom. There was no thermometer present. When we discussed these matters with the registered provider at the end of the inspection, the registered provider said there was a system for staff for reporting maintenance issues. He said he was concerned staff were not adhering to the procedures. However, our concern is that there is not sufficient monitoring occurring by the registered persons of general standards, and a lack of any planning to bring about general improvement. Despite us requesting this at the last inspection no effective systems have been set up to address our concerns. Lack of regular maintenance, and a poorly maintained environment not only prevents Carrick Lodge becoming a homely environment, but could create a health and safety risk for people who live and work there. At the last inspection we also reported: • There are not enough bathrooms. For example there is no bathroom at all on the ground floor, and the shower facility has been out of action for at least a year. The bathroom on the second floor is not used. There are 5 bedrooms in this area. Currently the national minimum standard states there should be at least one assisted bath / shower to every eight people living in the home. We have renotified a statutory requirement regarding this matter on several occasions. It is essential people who use the service have a bathroom near their accommodation for their convenience and also as many people may have mobility problems. • The outside of the building needs some maintenance and some areas outside need tidying up. This does not create a good first impression for visitors or potential people who may wish to use the service. Most bedrooms in the home are generally to a good standard although we have outlined some issues of concern above. One bedroom accommodates four Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 20 people. It is very unusual for a bedroom occupying more than two people to still be used in a care home. The registered provider has tried to make the bedroom pleasant as possible, although screening across the room could, in part be improved. Whatever occurs this accommodation is not really satisfactory and should be reconfigured at the earliest opportunity. People who occupy this room should also be offered single accommodation as and when this becomes available as outlined in the National Minimum Standard. The home has two lifts and a chair lift to enable access to upper floors. The home has a pleasant garden which people living in the home use on a regular basis. The facility appears to be used by people safely with minimal staff support. The home was generally clean on the day of the inspection, although we were concerned about the cleanliness of some of the toilets, and odours in some bedrooms as outlined above. A pile of unwashed laundry was also left on the laundry floor. We are concerned about the general standard of facilities, maintenance and decoration at the home. Generally the home has a general air of neglect. Some of the standards are unacceptable. We are concerned that regarding some of the matters of concern we have renotified the registered provider on several occasions regarding many of these matters. However the registered provider has written to us on 29th July 2008 regarding some of the environmental issues outlined above. The registered provider has stated he believes there is currently sufficient bathrooms based on the current occupancy levels over the last year. The registered provider has stated a downstairs shower room will be installed. He has also stated the laundry flooring has be repaired and subsequently will be replaced. We do however remain concerned about general environmental standards in the home. Although the measures outlined by the registered provider on 29th July appear to address some of the concerns, we remain concerned about environmental standards. If there is not suitable improvement regarding these matters we will consider taking enforcement action. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are currently satisfactory. Recruitment procedures, staff induction and training need improvement. This will give people who use the service more assurance they will be supported by staff who are appropriately recruited and trained. EVIDENCE: On the day of the inspection the rota stated the following staff were on duty: • Three members of staff on duty from 08:00 to 14:00 • One member of staff on duty from 08:00 to 13:00 • Two members of staff from 14:00 to 20:00 • One member of staff from 16:00 to 20:00 • Two waking night staff from 20:00 to 08:00 The registered manager was also on duty during the day. On the day of the inspection the manager provided additional assistance to care for the people who use the service. While the staffing provided appears acceptable, to meet the current needs of people who use the service, we note there appeared to be one member of staff less on the afternoon / early evening of the inspection compared to when we last visited in August 2007. Staffing levels need to be kept under review and improved as necessary. We note a cook, cleaner, admin person and laundry person are also employed. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 22 People who use the service were positive regarding the support they receive from care staff. Comments were made that staff were caring and supportive. Staff practices observed by us appeared to be generally positive and helpful to people living in the home. The registered provider appears to have a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. The Annual Quality Assurance Assessment (AQAA), submitted by the registered provider, states that the majority of staff are currently undertaking various levels of NVQ training. However, we were not provided with a percentage of people who are currently qualified to at least NVQ level 2. There is evidence, on the staff files assessed, that five people have an NVQ in care. If other staff have obtained the qualification, it is important that staff bring in, at least, a photocopy of their certificate evidencing they have an NVQ in care. We inspected the recruitment records maintained regarding staff employed at Carrick Lodge. Improvement is required in this area. At this inspection we assessed the personnel files of 10 staff members. Records show there are details of individual employment histories on most staff application forms, although there was limited history for some of the staff. The information regarding whether individual staff are physically and mentally fit- as is required by the regulations-needs to be expanded. Four of the staff files assessed had two written references, and four files had one reference. There were no references on file for the other staff. There should at least be notes on these people’s files confirming the registered persons have obtained a verbal reference, and this was satisfactory. Seven staff had proof of their identity on their file, although we could not find this information for the remaining staff. We saw no evidence that staff, who have commenced employment since the last inspection, have received a Protection of Vulnerable Adults check (POVA First). This check must be completed before the potential member of staff commences working in the home. There was a record that nine of the staff had received a Criminal Records Bureau (CRB) check. The other person had a CRB check from their previous employer. Although this check had been completed quite recently, these checks are not transferable between employers, and therefore it needs to be completed. We are not clear what arrangements for the supervision of staff without a CRB check are in place. It is essential that staff without a CRB are supervised appropriately according to CSCI and government guidance. Staff without a POVA First check must not work in the home under any circumstances. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 23 We have now notified the registered provider regarding performing appropriate recruitment checks on two occasions. Failure to comply with the regulations in this area could put people who use the service at significant risk. We have subsequently issued an Immediate Requirement stating that satisfactory pre employment checks must be completed for all new staff (for example POVA First check followed by an enhanced CRB check.) If there are further breaches regarding these regulations, the commission will consider taking enforcement action. Training records for fourteen staff were inspected. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at least at appointed person level) and / or in line with a risk assessment. • All staff must have manual handling training. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. • All new staff must have an induction and there should be a record of this. At the last inspection in August 2007 we issued a requirement for the registered provider to provide appropriate training required by regulation. Records show the delivery of training is still poor: • Fire Training. There has been some improvement since the last inspection. However, due to the system currently in place it is difficult to audit whether staff have received this training or not. It appears that of 14 records assessed, ten people have received this training, although one of these people has only received this training in 2005. • First Aid. One member of staff in the sample had a first aid certificate. Despite us asking this issue be addressed as a priority, insufficient action has occurred. • Manual handling. Seven members of staff have a record that they have received manual handling training. This is delivered internally from the registered manager. We do not believe this matter has been addressed with the urgency we stated was required. • Infection control. One person has a record they have received training in this area. • Food hygiene. The records in the ‘Better food, Better Business’ logbook, and other records, state only two members of the current staff employed at the home has received training in this area. This training can be delivered internally as long as the person delivering the training is qualified to do so. The registered persons should take advice from the environmental health officer regarding this matter. We also stated staff needed to receive training regarding the needs of people with dementia, and mental health needs. Records show only one person has training regarding dementia. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 24 In regard to staff induction of the sample, seven of the staff (who commenced employment in 2008) had a record of induction. A further four staff who commenced employment in 2008 had no record of induction. If this was completed, or is in the process of completion, this record needs to be kept on the person’s recruitment / training file. The induction checklist used is to a satisfactory standard. We are concerned regarding the lack of compliance regarding requirements issued at the last inspection regarding induction and training. This is because lack of training in these vital areas could put people who use the service at significant risk. There appears to have been very little action taken-particularly in regard to staff training- since our last report was issued. Significant and urgent action now must take place. If the registered persons fail to comply we will consider taking enforcement action. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered persons are is not effective in ensuring the service is managed to meet regulatory requirements. Subsequently management systems need significant improvement and failure to do so could put people who use the service at significant risk. EVIDENCE: The registered provider, Mr Cottam employs a registered manager to manage care in the home on a day to day basis. Though the standard of care is generally adequate, we do have significant concerns regarding the management of the service particularly in relation to the environmental, staffing and management standards. We are concerned that we have had to renotify a number of requirements, and little or no action has been taken in these areas since the last inspection. There needs to be significant improvement in a number of areas. Subsequently we are including Carrick Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 26 Lodge as part of the Commission for Social Care Inspection’s Regional Improvement Strategy. If improvement does not occur we will consider taking enforcement action. The registered provider’s approach to quality assurance is poor. In the previous inspection report dated 13th August 2008 we noted that although the registered provider has a quality assurance policy, this does not appear to have been implemented. This still appears to be the case. We are concerned there does not appear to be effective systems in place to ensure compliance with the regulations or to make improvement to the service. We are therefore renotifying the registered provider regarding having a satisfactory quality assurance procedure. If satisfactory improvement does not take place we will consider taking enforcement action. We have concerns regarding the registered provider’s compliance with our Annual Quality Assurance Assessment process. The AQAA is an annual return required to be sent to the commission by registered person of each service. It provides a statement how the registered provider intends to bring about improvements to the service, and provides us with numerical data about it. The registered persons have completed the Annual Quality Assurance Assessment (AQAA). However this was not completed until on 28th July 2008 which was after the inspection. We requested it to be completed by 3rd July 2008. Section 1 of the form tells us about what improvements to be made to the service. However the completed form did not contain information how the registered persons intend to improve the service following this or the previous inspection. Section 2 (data set) was not completed so we did not have several important pieces of information to help us complete the inspection or this report. Completion of the AQAA needs to be more comprehensive in the future. Some monies are looked after on behalf of people who use the service. The registered provider has a satisfactory system to manage people’s money. When we checked cash held this matched with records. Receipts were available. Money appears to be stored securely and we have been told suitable insurance is in place. The registered persons or their staff do not act as appointee for government financial benefits, for any of the people who use the service. Records are kept of fees paid to the registered provider, although these were not inspected on this occasion. No valuables are currently looked after on behalf of people who use the service. The registered provider has a health and safety policy. An accident book is maintained. The fire alarm system was serviced in August 2008. A fire risk Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 27 assessment has been completed. There are satisfactory records of the testing of fire equipment by staff e.g. call points and emergency lighting. Health and safety risk assessments have been completed, but these have not been reviewed since June 2006. Although there is a policy regarding the prevention of legionella, this is incomplete. There is no evidence that a risk assessment has been completed or any control measures have been put in place. The lift, stairlift, hoists, stand aids and bath hoists appear to have all been serviced. Gas appliances have been serviced in November 2007. An electrician has examined the electrical circuit in April 2008, but states the system is unsatisfactory. Therefore remedial work needs to be completed, and a subsequent certificate of compliance obtained. This needs to be forwarded to CSCI. Portable electrical appliances have been tested. There is no evidence that there is either thermostatic controls fitted to control hot water temperatures or staff check the temperature of hot water when people have baths. As many of the people who use the service have dementia there is a significantly higher risk of scalding than in an ordinary domestic setting. There is no evidence that the call bell system has been serviced. We have expressed concerns about this equipment elsewhere in the report. Training in various aspects of health and safety needs to take place so the registered provider meets legislative requirements (e.g. moving and handling training, fire training). This is outlined in the previous section of the report. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 X X X 1 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement All people who use the service must have a comprehensive care plan. This needs to also include a moving and handling assessment, and records of any medical interventions. Comprehensive care plans, which are regularly reviewed, help to ensure people who use the service receive appropriate care according to their needs. The registered persons must ensure: 1. Keys for the medication cabinets are kept securely at all times. For example on the person in charge of the medication system. 2. Staff administering medication receive appropriate training (for example in line with Royal Pharmaceutical Society and CSCI guidelines) The registered person’s must ensure people who use the service have their privacy and dignity respected. People who use the service must be enabled DS0000008919.V365885.R01.S.doc Timescale for action 01/11/08 2. OP9 13(2) 01/11/08 3. OP10 12(3)(4) 01/09/08 Carrick Lodge Version 5.2 Page 30 4. OP15 OP14 7, 16(2)(h)(i) to have their choices respected for example in line with the principles of the Mental Capacity Act 2005. Instances outlined in the report, as outlined in the ‘Health and Personal Care’ section of the report need to be suitably addressed. The registered provider must provide people who use the service with a satisfactory choice and variety of food at meal times. The menu must be reviewed, and a copy of the review forwarded to the commission by the date given. 01/11/08 5. OP18 7,12, 13(6) For example: • People who use the service should know what the main meal is in advance, and be offered an alternative / variance of this if they do not like what is on offer. • A hot and cold meal needs to be offered in the evening. 01/10/08 The registered provider must have a clear and comprehensive adult safeguarding (protection) procedure. This will ensure there are clear guidelines what staff should do if there is an allegation of abuse. A copy of the revised policy must be forwarded to the commission within the set timescale. (Timescale of 01/12/07 not met 2nd Notification) 6. OP21 23(2)(j) There must be a satisfactory number of bathing / toilet facilities, near to the accommodation of people who use the service. These must be functional and safe for use by DS0000008919.V365885.R01.S.doc 01/12/08 Carrick Lodge Version 5.2 Page 31 people who use the service. This will ensure people who use the service have appropriate bathing facilities, in suitable numbers, near to their personal accommodation. [Previous timescale of 1st December 2007 not met 3rd Notification]. 13(4)(c)1 The flooring in the laundry room 6(2)(j) needs to be replaced with a suitable flooring covering. This will ensure the floor covering is impervious and there is no trip risk. [Previous timescale of 1st December 2007 not met 3rd Notification]. 16, 23 (2) The home must be: (b)(d)(l)(o (a) Kept in a good state of repair ) externally and internally. (2) All parts of the care home are kept clean and reasonably decorated; (3) Suitable provision is made for storage for the purposes of the care home. Subsequently the registered provider must: (1) Provide the Commission with a maintenance and refurbishment plan outlining how concerns outlined within the report will be addressed and within what timescales. The plan must be submitted no later than by 01/10/08 regarding how the requirement will be met within the timescale. [Previous timescale of 1st March 2008 not met 2nd Notification]. 7. OP26 01/12/08 8. OP19 01/12/08 Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 32 9 OP25 OP38 13, 23 Ensure there is an effective system in place to ensure the building is maintained to a higher standard. Lights in internal corridors / rooms, to which staff and people who use the service have access must work. Therefore: (a) The registered provider must ensure there are bulbs in hallways and on stair cases. Immediate Requirement (b) Light switches must be accessible to staff and people who use the service (2) 24/07/08 These measures will ensure people who use the service can switch on lights and subsequently the risk of them falling due to lack of light will be minimised. 10. OP26 13(4)(c)1 The home must be free from 6(2)(j)(k), offensive odours. For example 23(2)(d) there needs to be suitable cleaning routines in place to ensure any offensive odours are minimised /irradiated, in the bedrooms of people who use the service. This will ensure people can enjoy clean and fresh accommodation 18. 19 The registered persons must ensure satisfactory pre employment checks are completed on all new staff. For example two references, a POVA First check followed by an enhanced CRB check must be completed in appropriate timeframes according to statutory guidance. Appropriate DS0000008919.V365885.R01.S.doc 01/10/08 11. OP29 24/07/08 Carrick Lodge Version 5.2 Page 33 supervision must occur for any staff until a CRB disclosure is returned. Immediate Requirement [Previous timescale of 1st September 2008 not met 2nd Notification]. 12. OP30 18. 19 Staff must receive suitable training. For example: (a) as required by regulation for example infection control, food hygiene, Fire training, manual handling training and first aid. (b) Training regarding people with dementia and mental health needs. Suitable records of training e.g. NVQ and other training certificates need to be maintained and available for inspection. (Previous timescale of 1st March 2008 not met 2nd Notification. [Regarding fire training: previous timescale of 1st March 2008 not met 3rd Notification]. ) The registered provider must submit, as part of the home’s Improvement Plan, a schedule of training required by regulation that will be delivered to all staff. This needs to include: 1. A list of staff employed and what training by law they require (e.g. as outlined in the report.) 2. Specific dates when staff will attend this training, so it is all completed, in the next six months 3. Training regarding fire, Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 34 01/01/09 manual handling and first aid must be prioritised and should be delivered no later than in the next three months i.e. 01/11/08. The commission should receive the action plan by no later than 1/10/08. Suitable training will ensure people who use the service are supported by staff who are appropriately trained to meet their needs, according to legal requirements. 13. OP30 18, 19 The registered provider must ensure staff induction is documented for each member of staff. This will provide evidence that new staff working in the home have received appropriate help and support to learn the job they are employed to do. (Previous timescale of 1st March 2008 not met 2nd Notification.) 14. OP33 24 The registered provider must develop and implement a suitable quality assurance system. This will help to ensure the service meets the expectations and needs of the people who use the service, and help ensure regulatory standards are met. (Previous timescale of 01/12/07 not met- Third Notification) 15. OP38 OP21 7, 13, 16, 23 The registered persons must ensure satisfactory health and safety standards to ensure the DS0000008919.V365885.R01.S.doc 01/09/08 01/10/08 01/10/08 Carrick Lodge Version 5.2 Page 35 health and safety of staff and people who use the service. The registered persons must: 1. Complete a health and safety risk assessment regarding the prevention of legionella, and ensure appropriate control measures introduced. Control measures and any testing needs to be documented. 2. Where necessary, procedures to check the temperature of hot water (e.g. when bathing) must be introduced, and records maintained. Due to the needs of people who use the service thermostatic valves should be fitted and procedures introduced to check these work correctly. Any checks must be documented. This applies to all bathing facilities. 3. Ensure there is evidence the emergency call bell system is serviced. This must be forwarded to the Commission within the timescale set. 4. Ensure remedial action regarding the electrical circuit is completed. A copy of certification to state the electrical hardwire circuit is safe must be obtained. Copies of evidence that the above health and safety checks have been completed must be sent to the Commission for Social Care Inspection within the stated timescale. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 36 These measures will help to ensure people live in a safe environment. (Previous timescale of 01/12/07 not met- Second Notification) 5. Health and safety risk assessments need to be reviewed and updated. 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. Refer to Standard OP1 Good Practice Recommendations Where appropriate, a copy of the service user guide should be issued to the next of kin / representatives of the person using the service. Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carrick Lodge DS0000008919.V365885.R01.S.doc Version 5.2 Page 38 - 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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