Inspection on 07/10/08 for Catherine Miller House

This inspection was carried out on 7th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Catherine Miller House 17/09/07

Catherine Miller House 10/10/06

Catherine Miller House 21/02/06

Catherine Miller House 31/10/05

Catherine Miller House 28/02/05

Catherine Miller House 14/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Catherine Miller House 13-17 Old Leigh Road Leigh On Sea Essex SS9 1LB Lead Inspector Ann Davey Unannounced Inspection 7th October 2008 08:30 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 Catherine Miller House DS0000015490.V372294.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. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Catherine Miller House Address 13-17 Old Leigh Road Leigh On Sea Essex SS9 1LB 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) 01702 713113 F/P 01702 713113 cmhouse@talktalk.net Mr Andrew Howard Stern Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th September 2007 Brief Description of the Service: BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Catherine Miller House provides personal care and accommodation for up to thirty older people. The registration category also permits the home to provide care to those service users who have dementia. The home was originally three properties that have been converted into one. This has created a home, which has several different levels with two separate living areas. Catherine Miller House has twenty-six single bedrooms and two shared bedrooms, all with en-suite facilities. Catherine Miller House is situated in a residential area of Leigh on sea, close to local shops. There are good bus and train links into the area. The home has a large well-maintained garden to the rear of the property. There are limited parking facilities to the front of the property. There is current Statement of Purpose and a Service User’s Guide available. A copy of the last inspection report was displayed in the entrance hallway. The weekly charges range from £499.00 - £560.00. The exact fee depends on the type of accommodation available i.e. single or double bedroom. There are additional charges for hairdressing, chiropodist, newspapers, toiletries and transport. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced site visit that took place over one day. The visit started at 8.30am and finished at 2.30pm. The manager assisted us throughout the inspection. The owner was on holiday. The last key inspection took place on 17th September 2007. The home’s previous Annual Quality Assurance Assessment (AQAA) had been completed and returned to us prior to us in 2007. This document provided the home with the opportunity of recording what they did well, what they could do better, what had improved in the previous twelve months and their future plans for improving the service. A new AQQA had been requested from the home. We should receive it by 20th October 2008. We sent surveys to the manager asking that they be distributed and returned to us so that we could have an understanding of how residents, staff, relatives and health care professionals felt about the care provision within the home. We received seven completed surveys from residents, one completed survey from a member of staff and nine completed surveys from relatives. This was a very good response. Comments from some of these surveys have been included within the report. The day in the home was very pleasant and all staff were co-operative and helpful. A tour of some areas of the home took place. Throughout the inspection, care practices were observed and a random selection of records viewed. We spoke with residents and staff. A notice was displayed advising any visitors to the home that an inspection was taking place. There were visitors in the home, but nobody asked to see us. All matters relating to the outcome of the inspection were discussed with the manager who took notes so that development work could be started immediately where necessary. We will send an Improvement Plan to the provider when this report is published. This will ask the provider to tell us how they are going to put things right in the home. What the service does well: Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 6 Residents living in the home had a wide range of care needs. Some residents were physically and mentally frail whist other residents were more independent. The home was able to demonstrate that they generally manage the diversity of need well and whenever possible, they had utilised specific areas of the home for the different care needs. This means that residents are able to be with other residents who may share the same interests. Consequently, the home had been able manage staffing numbers effectively. For example, there were more staff on duty during the day in the area that accommodated the more frail residents, than in the area where residents were able to be more independent. As noted within this report, consideration should be given to providing more input for residents who are admitted with care needs associated with dementia. This would further enhance the care provided by the home. Staff on duty were attentive and friendly toward residents. We saw care practices that were good, some have been described within the report. Breakfast and lunch was well presented and the food looked appetising. Staff were working well together as a team. What has improved since the last inspection? What they could do better: In the past year, three different managers had managed the home on a dayto-day basis. It would be a positive step for both residents’ and staff to experience a stable day-to-day management style. Arrangements must be made for all statutory and regulatory records to be kept in the home and available for us to inspect. For example, we were not able to see staff recruitment records, the business plan and quality assurance reports. We were not able to access some safety and maintenance certificates or the Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 7 fire risk assessment. These must be available so that we can assess compliance and to be assured that residents are safe. The home is registered to provide care for residents with dementia. There was little in place to meet the needs of these residents. There was very little signage or orientation aids around the home and some areas of the home would not be safe for these residents to be in unsupervised because of identified risks. These risks have been detailed within the report. There was no structured activity programme in place to meet the needs of those with dementia. The manager informed us that currently there were no residents that had been admitted to the home with dementia care needs. Therefore, we have not made reference to the above within the statutory requirement section at the end of this report. We noted that some records were incomplete, incorrectly stored or lacked sufficient information. For example, daily records were left in an open area and there were some errors in the medication administration records and there were a number of safety hazards noted. All these matters have been detailed within this report. The manager reported that they would be addressed so that residents’ privacy of information is protected and their wellbeing and safety is promoted. We noted that a potential safeguarding vulnerable adults incident had occurred in August that hadn’t been reported to the local authority. 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. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 8 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 Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 9 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 and 3 (standard 6 was not inspected as intermediate care is not provided) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care needs are fully assessed before admission to make sure they can be met. EVIDENCE: The home’s Statement of Purpose and Service User’s Guide was updated in August 2008. Copies of both documents are available upon request. This means that prospective residents are able to read and understand what the home can provide and offer. The pre-admission documentation of the two most recently admitted residents were viewed. Both had a clear and detailed pre-admission assessment document in place. It was clear that the residents and their families had been involved in the pre-admission and admission process. Residents are encouraged to visit the home as part of the pre-admission process if possible. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 10 We saw that residents had been provided with a contract/statement of their terms and conditions of residence. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are identified and met. EVIDENCE: Four care plans and associated documentation such as risk assessments and daily records were looked at. Within the documentation, there was evidence to support that residents (and/or family) had been consulted about their personal wishes, preferences and the way they wished to be cared. Care plans, personal risk assessments, daily reports and health care records were in place. We noted that one risk assessment regarding a bedrail which was in use was not available, daily records containing residents’ personal and confidential information had been left in a communal area, reference had not been made on one care plan informing staff that a community nurse visits to provide nursing care. Following discussion with the manager, these shortfalls were all addressed before the end of the inspection. The home was registered to provide care for residents with dementia care needs. The manager reported Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 12 that only a few of the current residents had these specific care requirements. The manager must ensure that care plans in respect of residents with dementia care needs are clear and provide good and sufficient information enabling staff to meet their care needs appropriately. For example their social activity needs. We could see that individual care needs had been reviewed and reassessed on a regular basis. Residents’ personal safety risk assessments were generally in place, although the manager acknowledged that these records needed to be reviewed to ensure they are current. We looked at some entries in the accident register. The register was well maintained. The manager must ensure that the information and detail within resident’s daily records/care plans/accident records all cross-reference. It was difficult for us to assess the effectiveness of this. We noted an entry in the home’s occurrence book regarding an incident between two residents that resulted in an injury. This has been referred to in the complaints and protection section of this report. We spoke to various members of staff about care practices in the home. Those spoken with had a good understanding of individual resident’s needs. We noted that the rapport between residents and staff was warm, natural and supportive. We observed two members of staff transferring a frail resident from a wheelchair into an armchair using a lifting hoist. Throughout the manoeuvre, the resident was continually reassured by the two members of staff, the resident remained safe and their dignity was preserved. The members of staff told us that they had received training on how to operate the hoist. This was evident by the way it was carried out. We also observed another incident where a resident had become disorientated and stressful. A member of staff guided the resident away from the immediate area and sat with them until they were reassured and calm. The member of staff then occupied the resident in a meaningful way by asking them about their choice of clothing for the day. We received the following comment from a relative within their survey ‘they look after all the needs of X in a very friendly and caring manner’. Another survey reported ‘the care staff are very helpful and have a good rapport with X’. During the inspection, residents told us that their care needs had been met, staff were kind and ‘they all do what they can to see that I’m alright’. We received no negative comments. The manager reported that the home had a good working relationship with all social and healthcare professionals. We saw entries within the care planning documentation system demonstrating that appropriate assistance had been provided when required. On the day of the visit, a resident had become unwell and we saw how an appointment to see the GP was quickly made. Staff were Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 13 attentive to the resident and arrangements were put in place to monitor their wellbeing and health. We looked at the medication administration, storage and recording system on ‘side one’ of the home and sampled various aspects for compliance. Each resident had a MAR (medication administration record) sheet in place. During the previous eight days prior to our visit, we noted at least five gaps where medication had been administered but had not been recorded as being given. The manager was able to identify the member of staff concerned and arrangements were in hand to address these errors. Routine day-to-day medicines were neatly stored in a secured metal trolley. We saw no overstocking of medicines. The home had PRN (a medicine to be administered as/when necessary) procedures in place. Some residents required oxygen and had oxygen cylinders in their bedrooms. We saw health and safety notices about this displayed in appropriate areas. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from good diet provision and a developing social activity programme. EVIDENCE: The manager told us that all residents had contact with their families, friends and/or named contacts. During the visit, there were at least three visitors. We did not get the opportunity to speak with any of them individually, but we did receive nine completed surveys from relatives. There were several small areas in the home where residents can see their visitors in private if they wish. The manager told us that representatives from the local catholic church visit the home on a regular basis. The manager reported that arrangements could be made to enable any resident to attend church on a Sunday if they wished. From our conversation with residents and from the comments in their surveys, all indicated that within reason, they are able to exercise choice and control over their personal lives within the home. During the visit, we observed staff asking residents about a choice of where to sit, had they had enough to eat at Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 15 breakfast and lunch, what they would like to wear and if they would like to go back to their respective bedroom for a rest. The home had a limited activities programme in place but had plans to develop it further. Current activities included a sing-a-long, quiz events, garden parties, trips to the park and board games. The manager acknowledged that the current provision of activities is limiting especially for residents with dementia care needs. The manager reported that they had submitted an application to the Essex Quality Development Grant to build an activities centre in the home’s grounds. We were informed that arrangements had been made for an identified member of staff to attend a training session on activities/social/occupational events. Comments within residents surveys about activities ranged from ‘we should have some activities to engage in even though (we) are limited’….’there are activities, but X never participates’….’the activities have stopped on a Tuesday but I never went to them anyway’. The daily menu was displayed. The format and presentation of this was not user friendly as the type/font was far too small for residents to read with ease. The manager acknowledged that residents with poor eyesight would have difficulty in reading it. Residents told us that they are provided with a choice of food at mealtimes. We saw records to support this. When we arrived, breakfast was being organised. Some residents were having breakfast in their bedrooms, whilst others were in one of the two dining areas. Residents were being assisted to eat in a sensitive manner. The lunch served looked appetising. Tables were attractively laid and residents were offered a cup of tea after their desserts. We saw uncovered hot food being transported on a tray by a member of staff from the kitchen to residents on ‘side two’ of the home. This meant that there was a risk of food getting cold or being contaminated. Comments within relatives surveys’ about food ranged from ‘if I dislike the food, staff always replace it with something else’….’new cook started, better improvement, always hot’…..’I had salmon which was really lovely, on the whole food is very good’. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. This judgement has been made using Residents are cared for in an environment where they are comfortable to raise concerns and know these would be dealt with appropriately, however may be at some risk because adult protection procedures had not been followed. EVIDENCE: The complaints procedure was clearly displayed in the hallway. The home had an established complaints recording system in place. The manager reported that there had been no complaints since the last inspection. We asked several residents if they would feel comfortable about raising any concern with either the manager or a member of staff. All those spoken with indicated that they would feel comfortable and felt confident that matters would be taken seriously. The manager told us that good and effective communication with residents and relatives was important and any issues of concern that have arisen had been quickly dealt with preventing a formal complaint. Staff have been provided with opportunity for training to ensure that resident are been protected and the measures that would need to be taken should poor practice be suspected. We asked three members of staff about their understanding of the procedure they would follow. All three understood the term ‘protecting vulnerable adults’ and explained to us the correct procedure should they suspect poor practice. They also understood the home’s whistle blowing policy and procedures. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 17 A safeguarding vulnerable adults from harm incident was being dealt with by Southend Borough Council (safeguarding team). The incident was in connection with an alleged poor care practice. When we looked in the home’s occurrence book, we saw an entry made in August 2008 where a resident had been injured by another resident. The manager told us that this had not been reported to Southend Borough Council as a safeguarding adults from harm alert. The manager reported that another manager was managing the home at that time and the registered provider had not identified the matter as a potential safeguarding alert either. The manager could not locate the current joint local authority (ies) (Southend Council/Thurrock Council/Essex County Council) safeguarding adult protocols/procedures. The manager agreed to notify Southend Borough Council by the end of the day about the incident. When we spoke to care staff, they correctly understood that a suspected safeguarding incident must be reported to a senior member of staff. Staff had correctly reported the incident to senior staff on duty, but from there on, there was no evidence to support that the correct reporting procedure had been followed. This means that although care staff knew what to do in reporting the incident and it was recorded, if the matter is not then referred as appropriate in accordance with guidance, residents’ wellbeing may be a risk. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, clean home that is in need of some redecoration and may be at some risk because of safety issues. EVIDENCE: Within the previous inspection reported it was recorded that some aspects of the home were in need of redecoration. In particular, mention was made of scuffed doors. At this inspection, we saw that the paintwork around some of the stairwells, skirting boards, doorposts or doors required attention. We did not establish where this was due to ongoing wear and tear, but the manager told us that the provider was undertaking a programme of decoration throughout the whole home and these areas would be attended to as part of the programme. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 19 Residents’ bedrooms were personalised and homely. The lounge and dining areas were comfortable. The kitchen was clean and tidy. Bathrooms and toilet areas were functional. The garden area was well maintained and attractive. The manager’s office was tidy and orderly. Corridors, stairwells and communal areas were free from hazards. There were no unpleasant odours in the home. The home is registered to provide care for residents with care needs associated with dementia. Apart from pictorial signage on toilet doors, there was no other signage or orientation aids for residents with dementia care needs. The manager acknowledged that the provider must address this so that all residents within who have dementia care needs can move around the home in safety and comfort. The home must provide the means to ensure that the independence of all residents is promoted. All information notices were in a text format that may not be suitable to meet the needs of residents. For example, the menu and the activity programme. As we toured the home we noted a number of potential safety hazards. For example, latex gloves had been left in bathrooms and communal areas, clean plastic bags used for disposing soiled incontinence aids had been left on the side in one bathroom, the door to the laundry which contains electrical equipment and chemical cleaning products was wide open, the cupboard containing a hot water tank and electrical wiring was open, another cupboard containing a similar tank in one of the bathrooms was left open. The doors to the laundry and the cupboard that housed the tank and electrical switches had been left unlocked. These areas should either be locked or a risk assessment put in place. The home provides care for residents with care needs associated with dementia and these practices form a risk to their health, safety and wellbeing. The manager told us that they would address these matters. We spoke to two residents who told us that they like to spend some of the day in their bedrooms. They told us that ‘I’ve got all I need’ and ‘I can choose if I want to go to the big room, but I prefer to stay here’. One resident told us that there was ‘always staff around and popping in to me’. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by an established core group of staff. EVIDENCE: A current and clear rota was available. The manager reported that there was a minimum of four carers plus a senior on duty during the day at all times. During the night there was a minimum of three carers (including a senior) on awake duty. The home employs housekeeping, cooking and maintenance staff. Since the last inspection the manager reported that some staff had left but a recruitment drive for new staff was well under way. We saw documentation to support this. During this time, staffing levels had been supported by the use of regular agency staff. This had created a team of consistent staff that had benefited residents. No resident raised any concern about the use of agency staff. The two agency staff we spoke with had worked in the home for a number of months and were part of the team. A staff handbook was available. We saw evidence of regular staff supervision sessions and team meetings. We saw a staff training matrix that identified completed training, planned training and training that was due but was yet to be arranged. We asked to see the records of the two most recently recruited members of staff. This was not possible because although there were two sets of keys to Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 21 the cupboard in which they were kept, neither were available. The provider who was on holiday had one set and the previous manager (who had left the employment of the home) had the other set. The situation was not acceptable as we were not able to assess whether these records complied with regulatory requirements. We spoke to a relatively new member of staff who had been recently recruited. They explained that they had completed an application form, undertaken a full Criminal Records Bureau check and had provided all the information requested by the provider. We saw evidence of their partly completed induction programme. The manager assured us that all induction is completed in line with the Skills for Care guidance but was unable to evidence this as the information was locked away and they had no access. Staff we spoke with knew about the care needs of residents. We saw supportive and friendly interaction between staff and residents. Staff were friendly and knowledgeable about their respective roles and responsibilities. Residents commented to us ‘they’re good to me’….always kind’….I’ve no complaints’. One resident referred to a named member of staff as ‘she’s my angel sent to help me’. Comments within residents’ surveys about the quality of staff ranged from ‘there are some carers more easier to talk to and listen, some carers (come) into the room, do their work and go’ to ‘staff are always kind and helpful’. One resident survey reported ‘ the two cleaners are very good’. Staff told us that they were happy working in the home, thought that they all worked together well as a team and were there to help each other out. All expressed satisfaction about the level of staff training they had received and reported that they had sufficient information in order to undertake their work. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home where the outcome of the day-to-day management has been inconsistent, which could pose some risk to their safety and wellbeing. EVIDENCE: In the past year, residents have lived in a home that has had three managers. The current manager had been in post for a week. Staff reported that this inconsistent management had not been easy as every manager had their own approach and style. We saw evidence of this in the various recording systems within the home. The current manager had worked in the home for some time and demonstrated competence, skill, understanding of regulatory functions and sound care practices on the day of the inspection. We could see that staff Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 23 worked well with the manager. The manager reported that they felt supported by the team of staff. A notice had been displayed in the hallway explaining the current day-to-day management arrangements. The manager experienced difficultly in locating some of the records we asked to see. For example, staff recruitment records could not be accessed, the fire risk assessment could not be located and the dates of visits or last letters from the Fire and Rescue Service and Environmental Health Services could not be located. There was no evidence of a Quality Assurance System or business plan in place. The COSHH (Control of Substances Hazard to Health) register was not current and we found two sets of generic environmental and safe working practice risk assessments. There was no provision within the home for the manager to have access to the Internet. This prevents them from being able to access current information and guidance about any aspect of residential care as well as being able to communicate via an email facility. The manager told us that the owner came to the home once or twice during the week to deal with some administration, maintenance tasks and overseas the day-to-day running of the home, but was not directly involved with the delivery of care. Following this inspection the owner told us that during the management changes, they spent more time in the home and therefore knew about the management issues first hand. Regulation 26 of the Care Homes Regulations is clear that where the registered person is not in day-to-day control of the care home, a report as detailed in that regulation must be completed. During the period of management changes, according to the information available, there was a designated manager in post responsible for the day-to-day management of the home. The manager told us that to their knowledge, the owner keeps some of the regulatory records we requested not in the home. This meant that when we identified an outdated policy for instance, the manager was unable to clarify if this was the only copy or if the owner had a more updated copy elsewhere. The owner was out of the country at the time of the visit, but the manager reported that they had contact telephone numbers in the event of an emergency. All records required by regulation must be made available at all times for inspection. It is not acceptable (unless there is good reason) for the manager who is responsible for the day-to-day management of the home not to have access to all records. Without access, we were unable to assess the home’s compliance with some regulatory functions. For example, staff recruitment records and a quality assurance system. Records required by regulation are to ensure that residents are safe and form the basis of good care. This means that the provider could have left the manager, staff and residents in a very vulnerable position. Within relatives’ surveys the following was recorded about the administration and management of the home ‘the admin side could be improved’ and ‘there’s been such a lot of change at the top, it gets confusing about who’s in charge Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 24 sometimes’….’the new manager is easy to talk to’. One resident reported ‘things keep changing here’. We saw a notice advising that a residents’ and relatives’ meeting was planned for the end of October. The home was looking after some residents’ personal monies. The system for these financial transactions had a good audit trail. We tried to sample a random selection of service/maintenance documents. This proved to be difficult as the manager experienced difficulty in locating some current documentation. Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 25 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 3 2 2 Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP18 Regulation 13 (6) Requirement All staff must follow the correct procedures if an adult protection matter is suspected. This is to ensure that residents are kept safe and protected. 2 OP19 13 (4) All areas of the home so far as possible must be kept free from avoidable hazards and danger to residents. All areas that house electrical equipment, chemical cleaning substances must be kept secure. This also includes the correct storage of latex gloves. Arrangements must be in place to protect residents from harm and danger. 3 OP29 OP31 OP32 17 Arrangements must be made to ensure that all records required by regulation are available upon request. This is to ensure that written documentation is in place to demonstrate and evidence that Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 27 Timescale for action 30/11/08 30/11/08 30/11/08 the home is managed in line with regulatory requirements and residents are kept safe. These records include staff recruitment records, health and safety records, service and maintenance records and fire risk assessments. 4 OP33 24 Arrangements must be made to 30/03/09 demonstrate through documentation to demonstrate that residents and other stakeholders are consulted about how the service delivery matches the Statement of Purpose and individuals’ expectations. Record systems must be in place to demonstrate that all matters relating to the health, welfare and safety of staff and residents are considered, assessed and addressed, put in place and be readily available to all interested parties. This relates to all matters as referred to under National Minimum Standard 38. 30/11/08 5 OP38 12,13 & 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Catherine Miller House DS0000015490.V372294.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!