Inspection on 09/04/09 for Catterall House

This inspection was carried out on 9th April 2009.

CQC 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

Catterall House 17/04/08

Catterall House 17/04/07

Catterall House 30/05/06

Catterall House 19/10/05

Catterall House 20/04/05

Catterall House 12/10/04

Catterall House 20/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/06/2009.

CARE HOMES FOR OLDER PEOPLE Catterall House Garstang Bypass Road (A6) Catterall Preston Lancashire PR3 0QA Lead Inspector Vivienne Morris Unannounced Inspection 9th April 2009 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 Catterall House DS0000009690.V374721.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. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Catterall House Address Garstang Bypass Road (A6) Catterall Preston Lancashire PR3 0QA 01995 602220 01772 816967 rameshvarshagulati@hotmail.com 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) Dr Varsha Gulati Manager post vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of Service Users who can be accommodated is: 24 Date of last inspection 17th April 2008 Brief Description of the Service: Catterall House is a two-storey building with single accommodation on ground and first floor levels; there is one double bedroom for those wishing to share facilities. Most bedrooms are furnished to a satisfactory standard. The home is situated on a main road position in the rural area of Catterall on the outskirts of Preston and a short drive from Garstang. The home has adequate car parking space to the side of the house and is on a bus route and within walking distance of local shops. Catterall House caters for up to twenty-four elderly people, who require assistance with personal care and the home has been adapted to suit the needs of this category of resident. A passenger lift is installed and ramps are fitted to entrances of the building to allow easy access for those in wheelchairs and the less mobile. At the time of this visit to the service the fees for care ranged from £325 to £666 per week, with additional costs for hairdressing, chiropody, newspapers and magazines. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Two Inspectors from the Care Quality Commission conducted an unannounced site visit to this service over one day in April 2009, which formed part of the key inspection process. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Ten comment cards were received from people living at the home and three from members of staff, whose feedback is reflected throughout this report. Every year the provider completes a self-assessment, which gives information to the Commission about how the home is meeting outcomes for people living at Catterall House and how the quality of service provided is monitored. We observed the activity within the home and ‘tracked’ the care of four people living there during our site visit, not to the exclusion of others. The total key inspection process focused on the outcomes for people living at Catterall House and involved gathering information about the service from a wide range of sources over a period of time. The Care Quality Commission had received two complaints about this service since the last inspection. One was in relation to allegations of neglect and was referred under safeguarding adult procedures and is being investigated by Social Services. The other was in relation to poor decoration of the home, poor quality of furnishings and poor standard of cleanliness. These issues we looked at during this site visit to the service and our findings are documented within the environment section of this report. What the service does well: Plans of care were in place for the people whose care we ‘tracked’ and these provided staff with basic guidance about how people’s needs were to be met. A variety of external professionals were involved in the care of the people living at Catterall House so that they had access to health care services. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 6 The staff team respected people living at the home, ensuring that their privacy and dignity was consistently upheld. Staff had a good understanding of the principles of care and promoting privacy and dignity. Risk assessments had been introduced so that any possible hazards were identified to ensure that staff were aware of the element of risk. People were able to eat their meals within the privacy of their own bedrooms, if they preferred. People living at the home were supported to remain independent for as long as possible and they were encouraged to maintain contact with their family and friends so that they continued to have links with the outside community. Residents’ finances were adequately protected by the home’s policies and procedures, clear record keeping and audited practices. The routines of the home were flexible and those living there were seen to be able to spend time in the area of the home that they preferred. It was evident that people visiting the home were made to feel welcome and were comfortable whilst at Catterall House. A chapel was available at the home so that people could spend some time following their religious beliefs if they wished to do so The environment was relaxed and the routines of the home were well managed. It was evident that people living at Catterall House were happy and contented. One person living at the home said, Ive no complaints. If I did Id tell my friend. Its alright here. This person’s friend told us that she would tell the manager if there were any concerns, and has done in the past. When asked what the service does well the manager wrote on the home’s selfassessment, ‘we have a widely distributed complaints procedure so that people are fully aware of how to make a compliment, complaint or suggestion. We have a system in place for recording a complaint. We take complaints seriously and respond promptly and effectively. We welcome complaints and suggestions at catterall house and use them as tools to improve the quality of our service. Should any of our residents wish to complain about the service, they are fully aware of how to do this’. Some areas of the home were pleasantly decorated and nicely furnished and in general clean and tidy which was pleasing to see. Residents were able to bring their own possessions to the home if they wished in order to promote a homely atmosphere. The induction and training of staff was satisfactory and some training had been provided. The new manager was in the process of implementing a training matrix for staff and individual training assessments so that she has an overview of what people’s training needs are. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 7 The systems and equipment within the home had been checked and serviced at regular intervals, ensuring that they were safe for use so that residents and staff were adequately protected. When asked on the comment card if there was anything else to tell us, one person living at the home wrote, ‘everything about the home is very satisfactory’. What has improved since the last inspection? What they could do better: The pre-admission assessments could have been better to ensure that everyone was thoroughly assessed before admission, by more detailed information about people’s needs being obtained, so that the home could be confident that the staff team could provide the care and support needed. The prospective resident or their relative could be given the opportunity to be involved in the pre-admission assessment process so that they have some input into the planning of their care. People living at the home should be given the terms and conditions of residence so that they know what to expect whilst living at Catterall House. The care planning process could have been better by providing clearer guidance for staff as to how people’s assessed needs were to be accurately met and by involving all individuals in the planning of their own care. The risk assessments could have been better as these did not always identify how potential hazards could be eliminated or minimised, to ensure that people are always protected from potential harm. All hand written annotations on Medication Administration Records could have been signed, witnessed and countersigned to avoid any transcription errors and training for staff in relation to the safe management of medications could have been provided for those responsible for the administration of medications. The provision of activities could have been better and could have been based on the interests of people living at the home. There was little activity evident Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 8 on the day of our visit and people spoken with felt, in general that there was not much going on. There could have been information readily available for people telling them how they could appoint an independent advocate to act on their behalf, should they wish to do so. The management of meals could have been better so that people living at the home were provided with more selection and more nutritious choices so that their dietary needs and preferences were being better met. Complaints could have been better managed so that people had easy access to information about making a complaint if they needed to do so and the maintenance of concerns received by the home could have been better organised so that any patterns would be easily identified. Separate laundry, domestic and kitchen staff could have been on duty at weekends so that care staff did not have the responsibility of cleaning, cooking meals and attending to laundry duties, which increases the risk of cross infection and reduces the availability of care staff for those living at the home. The staffing levels could have been calculated in accordance with the assessed needs of people living at the home to ensure that there was always enough staff on duty to provide the care and support required. The recruitment practices were poor because a lot of relevant information and documents had not been obtained until staff had actually started working at the home, which did not demonstrate that people living there were always protected. There were no records available to show that people who had been employed before a Criminal Records Bureau (CRB) disclosure had been obtained were consistently supervised so that people living at the home were always safeguarded. The quality of service provided could have been monitored more closely by the home conducting more detailed and wider audits and risk assessments so that any potential hazards could be identified and any shortfalls addressed. Meetings for residents and their relatives could be introduced so that people may openly discuss any concerns or relevant information, which is of interest to people involved in the home. When asked on the comment cards what the service could do better, two members of staff wrote, ‘to provide better equipment’ and one of these people added, ‘but this is already being sorted out’. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The preadmission process was not thorough enough to ensure that the staff team were able to meet everyone’s individual needs. EVIDENCE: When asked what had improved in the last twelve months the manager of the home wrote on the self-assessment, ‘the pre assessment process has been improved and prospective residents now have the choice of coming for a few weeks or days as a trial period or just coming in for a meal if they wish’. Comment cards were received from ten people using the service. Six of these people said that they had not received a contract and that they did not get enough information about the home before they moved in. One of these people wrote, ‘I moved in for emergency respite care only and decided to stay’. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 12 The care of four people admitted to the home since our last inspection was ‘tracked’ during the course of our visit to this service. One of these people had been admitted to the home as an emergency admission two months previously and therefore an assessment of their needs had not been conducted before they arrived at Catterall House. However, there was no evidence to show that the needs of this person had been assessed following admission to the home, so that staff were aware of the care and support they required. Contracts for people living at the home were not available on the four care records seen to show that they had received terms and conditions of residence. Needs assessments had been conducted for the other three people whose care we ‘tracked’. However, these documents were presented in a ‘tick’ list format, were not always dated and only contained very basic information, which did not give staff enough details about the specific needs of each individual going to live at Catterall House. There was no evidence available to show that those living at the home or their relatives had been given the opportunity to be involved in the assessment of needs before they were admitted to the home, so that they could have some input into planning their own care. The new manager of the home had started to introduce improved documentation in relation to assessing the needs of people wishing to move in to Catterall House, so that staff would be better informed of what care and support individuals required. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The planning of people’s health and personal care needs was not thorough enough to ensure that they received the support they would like and the management of medications could have been better. The privacy and dignity of people living at the home was well respected. EVIDENCE: The care planning process was better than at our last inspection, with the introduction of new documentation. However, further improvements were still needed. Plans of care were in place for the four people whose care was ‘tracked’, although some documents were not fully completed and therefore a clear picture of people’s needs was not always available. Information was provided for staff about how the needs of those living at the home were to be met. It was pleasing to see that within the care records written information was provided for staff about any medical conditions of people living at Catterall House. However, the care planning process was not person centred and did not provide staff with specific guidance about how individual needs were to be Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 14 accurately met. Evidence was not always available to show that people living at Catterall House or their relative had been given the opportunity to plan their own care, so that they could decide what support they wished to receive. A range of risk assessments had been conducted so that any potential hazards were identified, but strategies had not always been put in place to eliminate or reduce the element of risk to ensure that people living at the home were protected. At the time of our inspection the one assisted bathroom had been unavailable for use for a period of three weeks because the hoist had been deemed unsafe for use. Records showed that those requiring this facility were being ‘strip washed’. However, this had not been documented in the records seen for the past 17 days; therefore it was not possible to determine if people’s personal care needs were being fully met. We issued an immediate requirement notice at the time of our visit for a replacement bath hoist to be ordered and installed so that the personal care needs of those requiring an assisted bath could be met. A range of external professionals were involved with the care of people living at the home to ensure that they had access to health care services. The management of medications could have been better. Hand written entries on the Medication Administration Records had not always been signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. There was no evidence available to show that any specific training had been provided for staff responsible for the administration of medications to ensure that they had the knowledge and skills to manage medications in a competent manner. We saw staff talking to people living at the home in a courteous manner, showing respect for them as individuals. Assistance was provided in a discreet manner so that the privacy and dignity of people was protected at all times. One person living at the home said, Im happy here. I like reading. The staff are good and another told us, they (the staff) cant do enough for you. As care homes go this is alright. They ask me if Im alright and can manage. I like to be independent. When asked if they received the care and support they needed, including medical attention, people who returned comment cards felt that, in general they did. One person wrote, ‘I am quite happy with the support I get’ and another commented, ‘the staff are always checking if I am in good health’. A relative wrote on behalf of a person living at the home, ‘as we are not always there we can only assume our relative receives the care and support needed’. All three staff who sent us comment cards said that, in general they were given up to date information about the needs of people they supported and Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 15 cared for. When asked what the service does well one of these members of staff wrote on the comment card, ‘it provides a high standard of personal care’. When asked what the home could do better the manager of the service wrote on the home’s self-assessment, ‘by spending more time on the pre-admission assessments and care plans the needs of residents would be more in depth and detailed which would assist the staff at Catterall house to improve the quality of care that residents receive’. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. People were encouraged to maintain contact with family and friends, but were not always supported to maintain their interests and hobbies whilst living at the home and the management of meals could have been better. EVIDENCE: Some care records contained good information about the social care needs of people living at the home. However, there was little evidence to show that they were being supported to maintain their interests whilst living at Catterall House. The provision of activities needed to be developed further in accordance with the interests of people living at the home, so that they were stimulated in order to prevent boredom. Records needed to identify those not participating in any activity so that isolation could be avoided and the home may need to access more suitable ideas, such as for people with mild dementia. One person living at the home said, “there’s not much going on. There was an entertainer a while back. They (the staff) come in the lounge and throw a ball about and we have to catch it” and another told us, “The staff got a few of us Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 17 together, and some in wheelchairs, to go for a stroll outside for some fresh air. You can go out, but you need to tell them and what time youre back. A visitor said, I think they need more activity rather than just sitting around here. When asked on the comment cards if there were activities arranged by the home that people could take part in, the responses from those living at Catterall House were varied. One person said that there were always suitable activities provided by the home and another felt that there were never suitable activities arranged. The other people who sent us comment cards said that there were usually or sometimes suitable activities provided for them. One person living at the home wrote, ‘I enjoy it when singing groups visit the home’ and a relative commented, ‘activities are arranged at the home, but my mother is not always capable of joining in’. At the time of our visit to this service we saw little evidence of any activity taking place throughout the day, except for two more able people playing dominoes with a member of staff. We saw that visitors were made welcome to the home and that people living at Catterall House could take their family and friends to their own rooms if they wished to do so. Information was available about visiting arrangements so that people were supported to maintain links with the people important to them. One visitor said that they felt comfortable visiting Catterall House and was made welcome at any time. Information about access to advocacy services was not readily available within the home so that people were aware that they could have an independent person acting on their behalf, should they wish to do so. We found that the meals were not of a good standard and that the choice of menu was poor. The manager told us that she was trying to improve choice by creating a new menu, and trying to meet people’s dietary needs and preferences. One person living at the home told us, I had porridge one day and told the new manager Id like a fried egg and she went and got me one, another commented, “the meals are alright, but I would like more fresh vegetables and home cooking and a third said, the teas arent very good. One visitor told us, they need more home cooked meals, not things like pizza or spaghetti on toast. One day they had dry cream crackers for tea, and I complained to the manager who sorted it out”. At the time of our visit the stock of food was getting low, but the manager had organised a bulk buy the following day. We saw the results of a survey conducted by the home about the provision of meals, which showed the outcome to be good and that all were satisfied with the food served, although this is not the feedback we received when discussing meals with the people currently living at the home and their visitors. People who needed assistance with their lunch were supported in a discreet manner and it was nice to see staff sitting and chatting with them whilst providing help and encouragement. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 18 When asked on the comment cards if those living at the home liked the meals their responses varied. Six people said that they always did, two indicated that they usually did and two others said that they sometimes did. One person wrote on the comment card, ‘there is always plenty to eat’ and another commented, ‘I don’t enjoy the evening meals’. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The management of complaints could have been better, although people living at the home were, in general, adequately protected. EVIDENCE: The manager told us that a copy of the complaints procedure was given to people wishing to move in to the home along with the Statement Of Purpose and Service Users’ Guide. However, the procedure for making a complaint was not displayed within the home so that everyone had access to this information should they require it. The complaints procedure did not contain up to date information should people wish to make a complaint about the home to the local authority. Information was held about past complaints which were about care, food and the environment, and the action taken to address them, but all documents were just kept together in a plastic cover, with no overview or plan of action and timescales for investigations. People spoken to know what they should do if they had any concerns about the home. All ten people who sent us comment cards and who lived at the home told us that staff listened and acted on what they said and all but one said that they would know how to make a complaint. One of these people wrote, ‘I can’t complain about any of the staff’. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 20 All three staff members who sent us comment cards said that they would know what to do if a person living at the home, their relative, advocate or friend had concerns about the home. The manager told us that she had recently attended accredited safeguarding training and information about the protection of people living at Catterall House was contained in the staff handbook, telling staff about what they should do if they were concerned about the welfare of someone living at the home. Staff were able to discuss what to be aware of and what they would do in relation to safeguarding people living at the home. However, there was no evidence that staff had been provided with anything else but in-house training and no apparent refresher courses had been given to ensure that people working at the home were kept up to date with current safeguarding procedures. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 21 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements had been made to the environment, but further work was needed to raise the standards for the people living at Catterall House. The practices within the home did not always support infection control procedures. EVIDENCE: Since our last inspection the Care Quality Commission had received an anonymous complaint about the environmental standards of the home, in that the décor was of a poor standard, the furnishings were of poor quality and the cleanliness of the home was unsatisfactory. These issues were looked at during this visit to the home. The manager of the home told us that there have been a lot of recent improvements made to the environmental standards in the way of decoration, new carpets and new windows. We confirmed this information by touring the Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 22 premises and we were pleased to see that some areas of the home were pleasantly decorated and nicely furnished so that more comfortable surroundings were provided for those living at Catterall House. However, other areas needed some attention in order to bring the whole environment up to a good standard. The following areas need to be addressed. There was a damp patch on the ceiling of the ground floor bathroom and the toilet and clinical waste bin were dirty and in need of cleaning. The laundry corridor was in need of decorating as the paper was peeling off the wall in many places, possibly due to the heat generated by the laundry department. It may be more beneficial to paint these walls rather than paper them to prevent this reoccurring. Some areas of the home felt cool, including the smoking lounge and this was confirmed by someone using this area of the home. The temperature in the conservatory was also cool, which did not provide a comfortable area for people to spend their time. The paper next to the door in the smoking lounge was peeling off the wall and needed some attention. The conservatory looked ‘tired’ and in need of decoration as the wall paper was peeling off in areas and there was blue tac left in places on the walls. As we toured the premises we noted that in quite a few areas of the home the floor boards ‘creaked’, which could possibly disturb people living at the home, particularly at night time. There were no curtains hung at the window in the ground floor lounge and we were told by one person living at the home and by a staff member that there had not been any curtains at the lounge window for quite some time. A damp patch was evident on the lounge wall behind the television which needed attention. The carpet in bedroom 15 was in poor condition and in need of replacement. The curtains in this room were hanging off the curtain rail. These areas need addressing so that the accommodation for the person living in this room will be improved. Some of the bedroom furniture was in poor condition and in need of renovating or replacing in order to provide more pleasant accommodation fir those living at the home. There was a damp area on the wall in bedroom 16 and the wallpaper was peeling off. We were told that this bedroom was vacant at the moment. We would expect this problem to be rectified before the room is occupied. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 23 The bathroom on the first floor, adjacent to the passenger lift was being used for storage. Therefore, this facility was not available for people to use, if they wanted to do so. The plastic wall cabinet above the wash basin in this bathroom was in poor condition and in need of replacement. The general maintenance of the home needed improvement, including attention to detail, in order to raise the standards of the environment for the people living at Catterall House. Clinical waste was being disposed of in the correct manner and relevant policies and procedures were in place in relation to the control of infection, so that staff were aware of measures to take in order to reduce the risk of cross infection. However one person living at the home told us, you take your dirty clothes off and throw them on the floor and in the night someone comes and takes them and washes them and brings them back. The laundry department was fit for purpose to ensure that those living at the home received a satisfactory laundry service. We were told that at the weekends care staff on duty were responsible for completing domestic duties, laundry duties and for cooking meals, which increased the possibility of cross infection. When asked if there was anything else that people would like to tell us one person living at the home wrote on the comment card, ‘I find things missing from my locker in my room, such as my shirt’. In general, the home was clean and pleasant smelling. When asked if the home was fresh and clean six people who sent us comment cards and who lived at the home said that it always was, three said it usually was and one told us that it sometimes was. One person wrote, ‘I’m very happy with my bedroom and the lounge area, but the smoke room is not clean’. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 24 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were not enough appropriately trained staff to ensure that everyone’s needs were consistently met by a collectively well trained work force and the recruitment practices did not protect people living at the home. EVIDENCE: The staff rota was examined, which showed who was on duty at any time of the day or night and what grade each member of staff was. However, the staffing levels were not being calculated in accordance with the assessed needs of those living at the home to ensure that people’s needs were always being met. Those who sent us comment cards and who lived at the home told us that staff were available when they were needed. One of these people wrote, ‘I’ve never had to wait to be seen by the staff’. When asked if there were enough staff to meet the individual needs of all the people who use the service one staff member who submitted a comment card responded by saying there usually were and the other two felt that there sometimes were. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 25 We were told that at weekends the care staff had the additional responsibilities of cooking meals, completing laundry and cleaning duties, which could compromise the delivery of care for the people living at the home. At the time of our visit to this service there were 11 care assistants working at the home, four of who had achieved a recognised qualification in care, showing that some staff employed were appropriately qualified. However, this number does not yet reach the recommended level of 50 of qualified staff having obtained such an award. The personnel records of four members of staff were examined so that we could see if the recruitment practices were thorough enough to protect those living at the home. We found the recruitment practices to be poor on this occasion. Three of the four Criminal Record Bureau (CRB) disclosures had been received by the home after employment had commenced and no records were available to show that these staff had been consistently supervised until their CRB’s had been obtained. For one of these staff members there was no evidence available to show that the Protection Of Vulnerable Adults (POVA) register had been checked and for another this information had been received following the commencement of employment. One member of staff had not completed an application form and several written references were received after people started working at the home. Only one written reference was available on one staff members file and three verbal references simply recorded as, ‘good’, ‘good’ and ‘good’, had been obtained for another member of staff, which is not satisfactory. People must never be recruited prior to receipt of a POVA first check and must only be appointed before a CRB in exceptional circumstances, in which case evidence must be available to show that they are supervised at all times whilst working at the home. We were told that one person whose file we examined and for whom the home had not obtained a CRB was supervised at all times. However, there were no supervision records available to support this information. We issued an immediate requirement notice for poor recruitment practices as this concern had been highlighted at the previous three inspections to this service. All three staff who sent us comments felt that, in general they had the right support, experience and knowledge to meet the different needs of people who use the service. They also felt that they were being given training which was relevant to their role and which helped them understand and meet the individual needs of people living at Catterall House. Two of these people said that their induction covered mostly everything they needed to know to do the Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 26 job when they started and one felt that it partly did. Two people who worked at the home and sent us comments told us that their training kept them up to date with new ways of working, but one person felt that this was not the case. There was no matrix available at the home to show what training staff had undertaken so that individual needs could be easily identified. The new manager told us that she had started to develop a training matrix and that she was also in the process of completing training needs assessments for all staff so that she can look at what training is still needed. Staff induction records were seen for the four staff members whose files we examined and copies of some training certificates were on staff files to show what training they had completed. Records showed that some training had been provided for staff but that this area needed further development so that a wider range of training was available for staff, including specific training in relation to the needs of those living at Catterall House, such as dementia care training. When asked what the service does well one member of staff wrote on the comment card, ‘we work well as a team and we communicate well with each other’. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 27 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of service provided was not thoroughly monitored and the Health and Safety of people living at the home was not always protected. However, people’s finances were safeguarded by the practices adopted by the home. EVIDENCE: The current manager of Catterall House had been in post for a short period of time and therefore was not yet registered with the Care Quality Commission. The manager had completed the Registered Manager’s Award and was motivated to improve standards for people living at Catterall House. She had recognised areas for improvement and was in the process of introducing systems to address any shortfalls. All staff spoken to said that they felt well Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 28 supported by the new manager and they were able to discuss the care needs of individuals living at the home well. A variety of surveys had been conducted so that people involved with the home could give their views about the quality of service provided. However, the questionnaires returned to the home had not been dated for us to determine when they had been completed. We were told that surveys were conducted very often, but there was no structured process for obtaining the views of people living at the home, their relatives, staff and stakeholders in the community. The results of feedback obtained had not been published so that any interested parties could see what life was like at Catterall House. The manager of the home had introduced staff meetings with minutes taken so that any relevant information could be passed on to those working at the home and so that any issues raised could be discussed. The manager told us that she was planning to introduce meetings for people living at the home and their relatives, so that they could be kept up to date with anything relevant to them and so that they could discuss any concerns or issues they wished to raise. Environmental assessments and audits had not been conducted. Therefore, the home had not identified any potential hazards within a risk management framework and the quality of service provided was not being closely monitored, so that any strengths and areas for development could be recognised and strategies put in place to build on strengths and address any shortfalls. The provider of the service had undertaken regular unannounced visits during which an inspection of the service was conducted, following which a report was written so that any issues identified could be addressed. The records of money retained on behalf of people living at the home were well kept. They were clear and documented evidence was available to show any income or expenditure, with relevant receipts retained. However, the form used to record transactions was signed by one staff member only, which did not safeguard staff or those living at the home. A random selection of service certificates were examined, which showed that systems and equipment within the home had been appropriately checked to ensure that they were safe for use. A new hoist had recently been purchased to ensure that the correct equipment was used to transfer people from one place to another. Training for staff was up to date in relation to moving and handling so that the correct handling techniques were being used. However, there was no evidence available to show that staff had received training in relation to Health and Safety to ensure that they were aware of measures to take so that those living at the home were always protected. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 29 On touring the premises we noticed that several bottles of toiletries were on display in the bathrooms, giving easy access to those living at the home. Accident records were completed accurately and these were retained in line with data protection guidelines. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 30 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 31 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 OP3 Regulation 14(1)(a) (b)(c) Timescale for action The person wishing to move in to 31/05/09 the home or their relative must have been given the opportunity to be involved in the preadmission assessment process, so that they can help to plan their own care. Previous timescale of 31/05/08 not met. 2. OP7 15(1), 15(2)(b) (c) People living at the home must be given the opportunity to be involved in the care planning process so that they can tell the staff what care and support they wish to receive. Previous timescale of 31/05/08 not met. 3. OP8 12(1)(a) A new bath hoist must be ordered within seven days and installed as soon as possible. Immediate requirement notice issued. Timescale for action is date by which hoist must be ordered. Appropriate external training DS0000009690.V374721.R01.S.doc Requirement 31/05/09 16/04/09 4. OP9 13(2)(4) 30/06/09 Page 32 Catterall House Version 5.2 (c) must be provided for those responsible for the administration of medications to ensure that they have the right skills and knowledge to give out drugs to people living at the home. The areas of the home which need attention, as identified within the text of this report, must be addressed in order to provide a better environment for those living at the home. 30/11/09 5. OP19 23(2)(b) (d) 6. OP29 19(1)Sche Staff recruitment practices must dule 2 be robust in order to protect the people living at the home. Criminal Record Bureau disclosures and two written references must be obtained in respect of each person employed, before they start working at the home, in accordance with Schedule 2 of the Care Homes Regulations. Immediate requirement issued. Previous timescale of 1/06/07, 21/01/08 and 31/05/08 not met. 09/04/09 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 Where it has not been possible to assess someone’s needs before they are admitted to the home then this process should be completed within five days following admission to the home. DS0000009690.V374721.R01.S.doc Version 5.2 Page 33 Catterall House 2. 3. 4. OP3 OP3 OP7 5. 6. 7. OP8 OP9 OP12 8. 9. 10. OP14 OP15 OP16 11. OP18 12. OP26 OP27 13. OP27 Each person moving in to the home should be given the terms and conditions of residence so that they know what to expect whilst living there. The pre-admission assessment process should be more thorough so that staff are given clear guidance about the needs of people moving in to the home. Clearer, more specific guidance should be provided for staff so that they are aware of how to meet individual needs of people living at the home and all documentation should be completed so that up to date information is available. Strategies should always be implemented so that any identified risks in relation to personal and health care needs could be eliminated or minimised. Any hand written entries on the Medication Administration Records should be signed, witnessed and countersigned in order to avoid any transcription errors. The provision of activities should be improved and these should be based on the interests and social needs of those living at Catterall House. It is recommended that some activities be provided suitable for those with mild dementia and records should identify those not participating in any activity so that isolation can be avoided. Information should be readily available for people so that they are aware of how to access an independent person to act on their behalf should they so wish. The management of meals should be reviewed and improved so that better choices are provided and more nutritious food is available for those living at the home. The complaints procedure should be prominently displayed within the home and it should contain contact details for the local authority people may make a complaint to if they so wished. The management of complaints received should be improved so that a clear audit trail is evident, thereby allowing the manager to see an overview of complaints received by the home and action taken. People working at the home should be provided with formal training in relation to the Protection Of Vulnerable Adults and refresher courses should be given so that staff are kept up to date with current safeguarding procedures. Separate laundry, domestic and kitchen staff should be employed to work at weekends, so that care staff do not have to take on these responsibilities, as this increases the risk of cross infection and reduces the number of care staff available for those living at the home. Staffing numbers should be calculated in accordance with the dependency levels of those living at the home to DS0000009690.V374721.R01.S.doc Version 5.2 Page 34 Catterall House 14. OP28 15. 16. OP29 OP30 17. OP33 18. OP33 19. OP35 20, OP38 ensure that enough staff are on duty to meet everyone’s assessed needs. The home should continue to work towards achieving 50 of care staff having obtained a recognised qualification in care to ensure that enough staff are appropriately trained to provide the care required. All staff applying to work at the home should complete an application form so that relevant information is obtained and kept on file. A training matrix should be implemented and a review of all staff training needs should be conducted so that the training programme can be brought up to date and so that staff are provided with a broader range of training, including that specific to the needs of people living at the home, such as dementia care. Copies of training certificates should be retained on staff files for proof of training completed. The home should extend the system for monitoring the quality of service provided by conducting regular environmental risk assessments and audits on every aspect of life at Catterall House, to ensure that any potential hazards are identified and a good standard of service is provided for all those using it. It is recommended that meetings be held periodically for residents and their relatives, so that open discussions can take place about any concerns or any relevant information, which may be of interest to people. The form used to record the financial transactions of those living at the home should have a column for a witness signature. The person themselves should sign along with a staff member, or if the person is unable then two staff members should witness any transactions taking place. Toiletries should belong to each individual and should not be used for other people and these should be locked in a cabinet to reduce the possibility of harm due to ingestion, particularly when some people living at the home have a diagnosis of dementia. Catterall House DS0000009690.V374721.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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