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Inspection on 27/11/06 for Castlebar Nursing Home

Also see our care home review for Castlebar Nursing Home for more information

This inspection was carried out on 27th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Castlebar Nursing Home Castlebar 46 Sydenham Hill Sydenham London SE26 6LU Lead Inspector Lisa Wilde Unannounced Inspection 04:00 27 & 29 November & 6 December 2006 th th th 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 DS0000007013.V320087.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. DS0000007013.V320087.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castlebar Nursing Home Address Castlebar 46 Sydenham Hill Sydenham London SE26 6LU 020 8299 6384 020 8299 6385 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) Castlebar Healthcare Ltd Care Home 74 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0), Physical disability (0), Physical disability over 65 years of age (0) DS0000007013.V320087.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 53 patients, frail, elderly persons aged 60 years and above (female) and 65 years and above (male), and four young disabled persons 21 residents, persons aged 60 years and above, and persons aged 55 years and under 65 years of age suffering from mental disorder 1st February 2006 Date of last inspection Brief Description of the Service: Castlebar is a care home, which provides nursing and residential care for up to sixty-six older people with nursing needs, or support needs due to mental infirmity. The overall stated aim is that of offering care in a home from home setting, meeting individual needs and striving to offer sensitive and conscientious nursing and personal care. The registered provider is Castlebar Healthcare Limited, a company associated to an organisation called ‘Excelcare’, who run over thirty homes in England. A director, to whom all the staff are ultimately accountable, directs the service. The day-to-day running of the home is delegated to a care manager, who works full time at the home and who leads a team of staff. Accommodation is provided in a large nineteenth century building, which has four floors, divided into two main units: one residential and one nursing unit. The nursing care unit is on the ground and first floors and is staffed by qualified nurses and health care assistants. The residential unit, which provides support for mentally infirm service users, is on the second and third floors and is staffed by care assistants. There is a lift. Bathrooms and toilets are located on each floor. Four of the bedrooms have en-suite facilities. All bedrooms are single rooms. There are shared dining and lounge areas on each of the first three floors. The home has extensive grounds surrounding the property. The front of the premises is paved to allow parking for visitors and staff. The front and back doors are accessible to people in wheelchairs. The home is sited on Sydenham Hill, just off the London south circular road and is accessible by bus but is some distance from local amenities or a train station. Fees for a place at this home are currently £605.33 for frail nursing if paid for by the local authority, £650 if paid for privately and £515.05 for residential if paid for by the local authority, £550 if paid for privately. DS0000007013.V320087.R01.S.doc Version 5.2 Page 5 The home makes the reports of the Commission’s inspections available in the reception area. DS0000007013.V320087.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three days in November and December 2006. The first two days were spent at the home with a third day spent telephoning relatives. The first day of the inspection was an evening/night visit due to the inspector wanting to speak with night staff and see how things were for service users at this time. The inspector spoke with service users, relatives, staff, the Registered Manager and the Regional Operations Director. She further toured the building, examined records and checked the medication stocks. The inspector was seriously concerned about the care being offered at this home and the number of standards that are not met. The home has suffered from not having a Registered Manager in post for along time and staff are working very hard to improve standards. Generally standards and levels of satisfaction with the service are better on the residential floor than the nursing floors. Relatives comments were split between those who we very happy describing the staff as excellent, extremely caring, hard working and attentive with others being very unhappy with the home feeling that their relatives were not cared for and neglected. There were no negative comments received from anyone about staff or the service provided on the residential floors. Enforcement action is not being taken at this point as there is a new Registered Manager in post and enough staff showed evidence of their knowledge and commitment during this inspection. However, the inspector spoke with the Regional Operations Director about the concerns and made it clear that another inspection will be carried out in two or three month and if significant progress hasn’t been made towards meeting the requirements made at this and previous inspections the Commission will consider enforcement action to ensure service users are protected at this home. A detailed Improvement Plan is required of the provider following receipt of this report and there may be a meeting called between the Commission and the provider to discuss that plan. What the service does well: The standards assessed during this inspection showed that: • Senior staff assess prospective service users’ needs before they move to the home. DS0000007013.V320087.R01.S.doc Version 5.2 Page 7 • • • • • • The home has adequate living and dining areas on each floor and the home is clean and hygienic throughout. There is a pleasant landscaped garden to the rear of the home. Family and friends can visit as they choose. Most staff hold or are undertaking the NVQ Level 2 or 3 in Care. The financial systems in operation in the home generally make sure that service users’ money is held safely and they are protected from abuse. Health and safety systems are generally operated as they should. What has improved since the last inspection? What they could do better: The standards assessed during this inspection showed that: • • • • • • • care plans must fully describe all areas of support that a service user needs and must always be followed consistently by staff. service users’ healthcare and personal care needs must be fully met. Medication must be administered effectively. Staff must be able to communicate well with service users. service users individual needs must be met by the activities that are on offer. all service users must be happy with their meals. Service users must be supported to complain more easily and all complaints must be investigated and monitored. DS0000007013.V320087.R01.S.doc Version 5.2 Page 8 • • • • Service users must be protected from harm service users must have all the equipment they need to move and transfer service users safely. staff must have the skills, awareness and ability to meet all the needs of service users. there are detailed plans in place to show that service users’ and their relatives’ views are gathered effectively and the home improves in the way that they want. all staff must have receive enough supervision from senior staff and staff have an at least annual appraisal of their work. record keeping must be clear and effective and staff understand why they are recording issues so that they can respond properly to the information that they are recording. • • 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. DS0000007013.V320087.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000007013.V320087.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are issued with terms and conditions that tell them about their rights and responsibilities so they know what is expected of them and what they can expect from the home. Senior staff assess prospective service users’ needs before they move to the home so that no one is offered a place without the staff team believing they can support someone. Standard 6 is not applicable as this home does not provide intermediate care. EVIDENCE: There is new legislation in place now that came into force on 01/09/06 and other changes come into force on 01/10/06 which will require services to state DS0000007013.V320087.R01.S.doc Version 5.2 Page 11 exactly what fees each service user is paying and how it breaks down into different areas, in the service user guide. (See Requirement 1) Service users have terms and conditions on file and the organisation is currently contacting all families to get them to sign these contracts if the service user is unable to. Most of the terms and conditions had not been signed by a representative of the organisation. (See Requirement 2) The senior staff at the home meet with service users and their families after a referral is received to make sure that the home can met their needs. Written needs assessments are completed and were seen on file for all new service users. Issues of equality and diversity were discussed given that all the senior staff who conduct assessments are African or Caribbean and the majority of the service users assessed are white British. The home has not considered ways of trying to match the assessor to the potential service user to assist with making the service user more comfortable and more able to talk about their issues i.e. to be sure that the home gathers more information and can conduct a more useful assessment. (See Recommendation 1) DS0000007013.V320087.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. A lot of work has been done around care planning and the plans are better than at the last inspection but they still do not fully describe all areas of support that a service user needs, are not being reviewed as required and they are not always being followed consistently by staff. This means that service users are not getting all the care they need from all staff at all times. Service users and relatives are now more involved in the care plans and have had more opportunity to comment on and change them if they wish. Service users’ healthcare and personal care needs are not being fully met which means that service users may be unhappy or uncomfortable with the support they get from staff or in the worst cases may be being put at risk of harm by the actions or lack of action of staff. Service users do not get enough exercise (or the exercise is not being recorded properly) so the home is not showing that it is meeting service user needs in this area. DS0000007013.V320087.R01.S.doc Version 5.2 Page 13 All medication procedures are not effective which means that medication may not be being administered properly. Service users are cared for when they are dying but as care is not being offered according to current best practice the home may not be doing all it can to effectively offer the most effective end of life care. EVIDENCE: There was a previous requirement that the registered provider must audit the way the reviews of care plans are conducted and recorded, to ensure that they are holistic and consistent with the stated ethos and values of the organisation. The home is in the middle of using a new format for care plans and staff said that this is proving quite hard. Files showed that some care plans are acceptable but some care plans still need a lot of work. There were also considerable problems with the recording of healthcare monitoring e.g. care plans stating that food and fluid charts must be maintained and them not being in place, care plans requiring regular turning but no turning charts being in place and weight monitoring not be recorded as per the care plan. (See Requirements 3 - 8) Some files showed that exercise is being offered and staff talked about how they offer exercise sessions but this exercise is not offered as part of a programme outlined in care plans and recorded effectively. Staff have not been trained in how to offer exercise safely to older people. (See Requirement 9) Evidence gathered from a number of sources showed that staff have been using mechanical hoists alone when moving and transferring service users, against how they have been trained to use them and thus seriously jeopardising service users’ and their own health and safety. (See Requirement 10) One of the hoists has been broken for a few months, which means that service users have had to wait longer to be moved. An immediate requirement was made to replace the hoist and this was in place by the end of the second day of the inspection. (See Requirement 11) One service user talked about how they had to go outside to smoke but they needed staff assistance to do this and sometimes they weren’t brought back in for a long time. The Registered Manager felt it would be appropriate to risk assess around this issue and allow the service user to smoke in their room as they presented no risk to themselves or others. (See Requirement 12) Service users and relatives talked about how some staff could not speak or understand English very well and this caused them problems in getting what they needed. (See Requirement 13) DS0000007013.V320087.R01.S.doc Version 5.2 Page 14 Medication stocks and records were checked on all floors. Some of the stock checked did not tally with the records, the letter F was being used for different reasons but was not being defined clearly and there were some gaps in the recording of administration of medication. (See Requirements 14 - 16) Care plans are drawn up when someone begins to die and one was seen on file for a service user who had died on the first day of the inspection. Service users are asked what they want in the event of death in terms of practical arrangements. The home does not yet work within the Gold Standard Framework or the Liverpool Care Pathway systems, which would assist with ensuring that all needs in the event of serious illness and death are met. The organisation is starting to access training and is working with the local St Christopher’s nurses to develop in this area. (See Requirement 17 & 18) DS0000007013.V320087.R01.S.doc Version 5.2 Page 15 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. Work has been done in the area of activities since the last inspection and there has been an increase in the amount of group activities that take place so service users have more chances to take part in daily activities. Service users are not however having their individual needs met by the activities that are on offer as there is little opportunity for them to take part in things that are not group based and they do not have individual programmes of activity based on what they like to do. Relatives said they can visit the home when they choose and they are always made welcome by staff. Generally service users are only part of the local community if they can get out of the home by themselves; there are occasional trips out of the home but there are not enough staff to support service users to go out by themselves regularly. There have been improvements in how service users and their relatives are involved in the home but generally service users and their relatives are not given enough information in formats that they can understand, to be able to make informed choices in their lives. Daily routines are determined by how many staff are on duty and not by service user choice. DS0000007013.V320087.R01.S.doc Version 5.2 Page 16 Menus showed that a variety of meals are offered during the week and service users said that they can eat in their rooms if they want to. Some service users are happy with the food they get but others are not. EVIDENCE: There was a previous requirement that the registered provider must ensure that individual activities or programmes of development are in place for service users, which are based on their identified interests and needs and are designed to usefully engage and stimulate them. Files showed that most social care assessments are in place that state what activities service users like to do. Records of activities that place however show that service users end up doing the same things regardless of what activities they have said they enjoy. There is one activities co-ordinator in the home who was seen talking to and singing with service users but it is not possible for one person can carry out all the activities in a home this size, care staff must be freed up to take part as well. The inspector would expect reminiscence groups or sessions to be offered to service users by staff appropriately trained to do this work. While progress has been made in this area there is still further work to do. (See Requirement 19 & 20) Some service users are happy with the food and some aren’t. The food comment book shows some recent concerns about food being cold. Service users said that in the evening all that is offered are sandwiches and soup, regardless of what the menu states. (See Requirement 21) DS0000007013.V320087.R01.S.doc Version 5.2 Page 17 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. Service users are listened to and their complaints are taken seriously and acted upon. More work can be done to monitor and address less formal complaints and concerns. Staff being trained in the issues around protecting adults from abuse and but given the problems evidenced in this report it is not possible to say that service users are being protected from abuse. EVIDENCE: Complaints are recorded, investigated and monitored. Service users reported that sometimes they have to write complaints down when all they want to do is tell staff about the problem and that sometimes they have to make the same complaint several times. One recent complaint on a service user’s file was not recorded in the central record of complaints so had not been investigated. Some service users reported that they regularly speak to staff about things but are not listened to. (See Requirement 22) Staff attend training on protection of vulnerable adults on a rolling programme and the organisation works closely with the local adult protection teams to monitor adult protection issues. One issue has been reported to the adult protection team recently, which highlighted several issues of concern DS0000007013.V320087.R01.S.doc Version 5.2 Page 18 throughout the home which are addressed under other standards. The home had not reported this issue as an adult protection issue to the appropriate services. Social services contacted the inspection while writing this report and again reported that another incident had occurred and the home had not contacted them as soon as they would expect. (See Requirement 23) As there is a new Registered Manager this issue will be assessed again at the next inspection rather than putting in place a requirement now. Given this recent issue and the issue that were highlighted within it along with the concerns around health care monitoring and some staff practice in the home, it is not possible to say that service user are protected from abuse. DS0000007013.V320087.R01.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has adequate living and dining areas on each floor. The communal areas on the upper floors of the home are too warm. On the day of the inspection, the home was clean and hygienic throughout. EVIDENCE: The home is made up of four floors and there is a lift to all floors. Bathrooms and toilets are located on each floor. Four of the bedrooms have en-suite facilities. All bedrooms are single rooms. There are shared dining and lounge areas on each of the first three floors. The home has extensive grounds surrounding the property. DS0000007013.V320087.R01.S.doc Version 5.2 Page 20 The front of the premises is paved to allow parking for visitors and staff. The front and back doors are accessible to people in wheelchairs. On the days of the inspection the home was clean and hygienic throughout and service users said this is always the case. DS0000007013.V320087.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 not adequate on the ground and first floor and service users are not having their needs met because of this. Most staff hold or are undertaking the NVQ Level 2 in Care which means that staff should know what they are doing. There are problems with some staff not being able to communicate effectively with service users. Staff receive adequate training in order for them to be able to meet the needs of service users although their training needs are not assessed annually which means they may not be receiving the best training to develop their practice. Recruitment procedures have improved significantly but there are still a few issues to address to make sure that effective checks are in place to make sure staff are who they say they are and can do the job they are hired to do. EVIDENCE: DS0000007013.V320087.R01.S.doc Version 5.2 Page 22 There was a previous requirement that the registered provider must continue to monitor staffing levels to ensure that they are adequate to meet residents’ needs and to implement the care plans. The monitoring must take account of residents, relatives and staff’s views as well as of evidence such as accidents and falls. This monitoring had not taken place. The issue of staffing levels was assessed again at this inspection and the inspector found that there were not sufficient staff in the morning to effectively meet all service users’ needs. As mentioned earlier, staff are using the hoists alone, possibly because there are not enough staff to allow two staff to use the hoists and still get all service users up in time; on the first day of the inspection one service users did not get up or washed until 12 noon due to staff being busy and she said that she regularly gets up late; service users said that they are using bed pans when they are able to go to the toilet if they are assisted to get up; staff said that they call out to staff and often staff do not come when they are in their rooms. The inspector carried out a general assessment of service users’ needs on the ground and first floor in the morning and found that the amount of time needed by all service users could not be met effectively by the night staff which meant that the day staff were regularly having to do more work than they should and were regularly delayed in getting service users up and ready for the day. Staff said that they have recently lost a floating member of staff who did a full night shift between the ground and first floors. There is now a floating shift from 6-11pm and they were promised a shift from 6-11am. This morning shift has not been introduced. (See Requirement 24) Prior to the inspection there had been problems over two nights with gaining cover for staff who had called in sick. These problems had led to shifts not being covered, insufficient staff being on the ground and first floor and service users had complained that they did not get the care they needed during this time. One service user who needed turning regularly in bed, did not get turned at all one night. (See Requirement 25) Currently just over 50 of the care staff hold or are undertaking the NVQ 2 or 3 in Care as required. Service users said that most staff were excellent, couldn’t do enough for them and were extremely caring. Service users said that some staff struggled to understand English, which was a problem. A requirement around this issue was made under Standard 8. Recruitment and personnel procedures have improved since the last inspection but files showed that there were still some areas for improvement. There was only one interview record on files for some staff interviews and although the new Registered Manager had conducted an interview with two staff and had two records and stated her intention to continue this practice, a requirement is still made given the recent poorer practice within the organisation. DS0000007013.V320087.R01.S.doc Version 5.2 Page 23 The organisation is still using the POVAFirst check as a matter of course when this is only supposed to be used in an emergency and files showed that some staff have started at the home without a CRB received back. Some application forms only had the most recent employment history in them when there were several years missing previously. There was a previous requirement that the registered provider must ensure that efforts are made to ensure the validity of references. This must include receiving references on headed notepaper or with organisational stamps and recording any verbal verification of references on the applicant’s file. This is now being done. There was a previous recommendation that management ensures that when the information (given by prospective staff on the application form for a job) or the references do not give enough evidence of the relevant skills or experience necessary for the job, a record is made on the staff file of how the person’s suitability for the position was established. This is not yet being done consistently. The interview questions for one healthcare assistant showed that they had been asked two questions about equality. (See Requirements 26 - 28 and Recommendations 2 & 3) There was a previous requirement that the registered provider must ensure that all staff have an individual training programme in place that establishes core/compulsory training and additional training necessary for them to effectively offer care to this service users’ group. This plan must be reviewed annually. These plans are not yet in place and staff have not had annual appraisals during which their training needs would be assessed. (See Requirement 29 & 30) There was a previous recommendation that management ensures that training on promoting residents’ rights, delivered by expert trainers in this field, external to the organisation, is provided for all staff. This had been done but only half the staff team had attended. This should be offered again so that most of the staff team has attended the training. (See Recommendation 4) DS0000007013.V320087.R01.S.doc Version 5.2 Page 24 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, 36, 37 & 38 Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. There is a new Registered Manager in post who has been interviewed by the Commission and who is fit to be in charge. The financial systems in operation in the home generally make sure that service users’ money is held safely and they are protected from abuse. Staff are not yet supervised regularly and effectively, which means that service users are not supported by people who receive enough support and advice from managers. Health and safety systems are generally operated as they should. DS0000007013.V320087.R01.S.doc Version 5.2 Page 25 EVIDENCE: The new Registered Manager has been in post since July 2006 and throughout the inspection she evidenced her understanding of the needs of the service users and of how staff should meet those needs. Prior to this the organisation had moved the Facilities Manager to the home to provide management cover and they had taken part in recruitment and some care practice. This manager does not have a care background and was not an appropriate manager for the care home. The Regional Operations Manager for the home stated that this would not happen again so a requirement is not made but the organisation must ensure that this practice is not repeated. The Registered Manager has not yet started her Registered Managers Award NVQ and although there are plans for her to start next year, these plans should have been made much earlier given that she started at the home four months prior to this inspection. (See Requirement 31) There were previous requirements that the registered provider must ensure that a comprehensive quality assurance tool is in operation in the home and that the outcomes of all action taken to improve care offered at the home is reviewed and recorded. The organisation carries out a lot of monitoring and surveys are sent to service users’ families. This monitoring is not part of one comprehensive system for assuring quality and effective pro-active plans are not put in place to improve the service in all areas, the action plans in place are generally reactive to problems that have already been identified. There is as yet no overall individual development plan for the home. (See Requirements 32 & 33) Service users whose money is managed by the organisation are issued with monthly statements of their accounts and the home no longer accepts money or cheques from relatives. The records and systems for giving money to service users from their accounts is open and robust with two staff checking and signing for the amounts when service users are unable. There was a previous recommendation that management ensures that equalities would become integral to any consideration of the service provided to individual residents and to the conduct of the service generally. This is a wide reaching recommendation and was discussed as part of some specific areas of care but given the problems in this home currently it would be more useful to consider these questions at a later inspection. Senior staff have been offered supervision recently now that the new Registered Manager is in post but staff have not been supervised regularly DS0000007013.V320087.R01.S.doc Version 5.2 Page 26 prior to this. Staff have recently attended training on how to offer supervision. (See Requirement 34) Previous discussions about recording of health care issues, complaints and medication show that recording is not effective in the home. All health and safety checks and documentation were in place and in order. No health and safety problems were noted on the tours of the building. DS0000007013.V320087.R01.S.doc Version 5.2 Page 27 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 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 1 3 DS0000007013.V320087.R01.S.doc Version 5.2 Page 28 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 Registered Individuals must ensure that the breakdown of each service users’ fees is put these in the service user guide/statement of purpose as required by the new legislation. The Registered Individuals must ensure that a representative of the organisation signs all the service users’ terms and conditions. Previous requirement around care plans unmet and now reworded to: The Registered Manager must ensure that care plans are in place for all areas of a service users’ need, that these plans are comprehensive, outline all action necessary to support the service users and are effective. Care must be delivered in accordance with these care plans The Registered Individuals must ensure that all fluid, nutrition, weight, wound and other healthcare records relating to all relevant service users, are kept DS0000007013.V320087.R01.S.doc Timescale for action 31/12/06 2. OP2 5 (b) & (c) 31/12/06 3. OP7 15 (1) (2) 28/02/07 4. OP7 OP8 12 (1) & 17 (1) (a) 28/02/07 Version 5.2 Page 29 5. OP7 15 6. OP7 15 7. OP7 OP8 12 (1) contemporaneously, in sufficient detail and are accurate. The Registered Manager must 28/02/07 ensure that all care plans and risk assessments are reviewed monthly as required. The registered provider must 28/02/07 ensure that placement reviews take place as planned (including initial 6 week review) and that service users and their representatives are involved in those reviews should they so choose. The Registered Individual must 15/12/06 employ a full-time suitably qualified, experienced and skilled practitioner to work on the ground and first floors of the home to effectively review all service users’ health and personal care needs and ensure that clear, detailed instructions for staff on how to offer care and support are in place. Following this the practitioner should remain on these floors to offer ongoing supervision, training and advice to staff to ensure that they: • understand the illness and conditions of all service users, how these conditions present and what action staff should take to manage these conditions. • understand the other health and personal care needs of all service users and how they are to meet those needs. • understand the purpose of the written tools they are using. • understand what information to record, DS0000007013.V320087.R01.S.doc Version 5.2 Page 30 • • • when and how to record it. understand what information should be shared with other professionals and when it should be shared. can respond appropriately and effectively to situations to proactively avoid further deterioration in service users’ health and well-being. can be certain that their behaviour minimises and does not escalate situations of challenging behaviour and potential aggression. 8. OP8 15 9. OP3 14 (1) (c) 10. OP8 13 (6) & 18 (1) (c) (i) 11. OP8 12 (1) This person must be in post by 15th December 2006 and must remain in post for a period of six weeks. The Registered Manager must ensure that exercise is offered in accordance with care plans and is recorded and monitored effectively. All exercise must be offered by staff trained in how to do so safely. The Registered Manager must ensure that the Life Reviews are completed as fully as possible (by staff if not the service user or their relatives) for all service users and relevant sections do not state “Not Applicable”. The Registered Manager must ensure that all staff operate the mechanical hoist in accordance with their training and are clear about the serious dangers involved in operating these hoists alone. The Registered individuals must replace the broken hoist. (Immediate requirement that was met by the second day of DS0000007013.V320087.R01.S.doc 28/02/07 28/02/07 08/12/06 27/11/06 Version 5.2 Page 31 12. OP8 12 (1) & 15 13. OP8 OP27 12 (1) & 18 (1) (a) 13 (2) 13 (2) 14. 15. OP9 OP9 16. OP9 13 (2) 17. OP11 15 18. OP11 15 & 18 (1) (c) (i) 19. OP12 12(1)(a) 15 18(1)(a) the inspection). The Registered Manager must ensure that risk assessment procedures are used to allow service users to take reasonable risks in order to allow them to make choices and live their lives as the choose, not to try to remove all risks and restrict service users lifestyles. The Registered Individual must ensure that staff can understand and communicate effectively with service users. The Registered Manager must ensure that medication stock checking systems are effective. The Registered Manager must ensure that any additional letters used on medication administration charts are clearly defined. The Registered Manager must ensure that all medication including topical preparations is signed for at the point of administration. The Registered Individuals must ensure that staff are trained in and the home operates such systems as the Gold Standard Framework and the Liverpool Care Pathway to fully support someone according to best practice when dying. The Registered Individuals must ensure that there is an organisational policy drawn up describing the current best practice the home will operate to ensure all service users’ needs are met when they are dieing. The Registered Individuals must ensure that individual activities or programmes of development are in place for service users, which are based on their identified interests and needs DS0000007013.V320087.R01.S.doc 31/12/06 28/02/07 27/11/06 27/11/06 27/11/06 28/02/07 28/02/07 28/02/07 Version 5.2 Page 32 20. OP12 12(1)(a) 15 18(1)(a) 21. OP15 16 (2) (i) 22. OP16 24 23. OP18 13 (6) 24. OP27 18 (1) (a) 25. OP27 13 (6) & and are designed to usefully engage and stimulate them. Previous requirement: Unmet timescale 28/01/05 The Registered Manager must ensure that there is a frequent, regular reminiscence group and/or reminiscence sessions are offered by appropriately trained staff who are supplied with sufficient materials to support service users to remember their early lives. This work must also meet the specific needs of service users from different cultures and ethnicity. The Registered Individual must ensure that service users have a real choice in all their meals and that the food on offer meets the needs of the service users. The Registered Manager must ensure that service users are not prevented from making complaints by having to write their complaint down when they want to just tell staff about it and that all complaints are recorded, investigated and monitored effectively. The Registered Individuals must ensure that the appropriate agencies are informed in a timely a manner of all reportable incidents at the home. The Registered Individuals must ensure that the planned 6am11am shift is covered on the ground and first floor. If problems are encountered covering this shift given the early start time then other arrangements must be made to ensure that there are additional staff on the ground and first floors ensure service users’ needs in the morning are met. The Registered Individuals must DS0000007013.V320087.R01.S.doc 28/02/07 28/02/07 28/02/07 08/12/06 08/12/06 08/12/06 Page 33 Version 5.2 18 (1) (a) 26. OP29 17 (2) 27. OP29 13 (6) 28. OP29 13 (6) & 17 (2) 29 OP30 18 (1) (c) (i) 30. OP30 OP36 18 (1) (c) (i) & 18 (2) 31. OP31 18 (1) (c) (i) 24 (1) (2) (3) 32. OP33 ensure that procedures for covering staff shifts at the home are effective to ensure that there are always the required number of staff on duty at all times. The Registered Individual must ensure that at least two staff interview all applicants and records are kept of all interviewers notes. The Registered Individuals must ensure that the POVAFirst check is only used in emergencies and not as a means to start staff at the home as a matter of course. The Registered Individuals must ensure that potential staff include a full history on their application forms and that any significant gaps are investigated appropriately. The Registered Manager must ensure that all staff receive induction and foundation training that is in line with Skills For Care national requirements. The Registered Individuals must ensure that following an at least annual appraisal, all staff have in place an individual training and development plan. These individual plans must then be brought together into an overall annual training and development plan for the home that identifies what training is required for all staff to ensure the needs of service users and aims of the home are met. Previous requirement slightly reworded: Unmet timescale 28/01/06 The Registered Individuals must ensure that the Registered Manager begins the Registered Managers award NVQ. The registered provider must ensure that a comprehensive quality assurance system is in DS0000007013.V320087.R01.S.doc 08/12/06 08/12/06 08/12/06 08/12/06 28/02/07 28/02/07 28/02/07 Version 5.2 Page 34 33. OP33 24 34. OP36 18 (2) operation in the home. Previous requirement slightly reworded: Unmet timescale 28/03/06 The Registered Individuals must ensure that there is an annual development plan based on the views of service users, their relatives and other stakeholders that shows how the home intends to improve and develop over the forthcoming year. The Registered Manager must ensure that all staff are supervised regularly and effectively. 28/02/07 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The Registered Manager should consider ways in which the staff member assessing a potential service users’ needs can be better matched to the service user in terms of gender, ethnicity and culture in an attempt to make the service user more comfortable and more able to discuss their needs. The Registered Individuals must ensure that when the information (given by prospective staff on the application form for a job) or the references do not give enough evidence of the relevant skills or experience necessary for the job, a record is made on the staff file of how the person’s suitability for the position was established. Previous recommendation. The Registered Individuals should ensure that all Equalities Monitoring forms are held anonymously. That management ensures that training on promoting residents’ rights, delivered by expert trainers in this field, external to the organisation, is provided for all staff. Previous recommendation 2. OP29 3. 4. OP29 OP30 DS0000007013.V320087.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000007013.V320087.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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