Inspection on 07/06/06 for Cecil Court

This inspection was carried out on 7th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cecil Court 23/05/07

Cecil Court 22/11/06

Cecil Court 29/11/05

Cecil Court 15/06/05

Cecil Court 16/12/04

Cecil Court 01/07/04

Cecil Court 19/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cecil Court 2-4 Priory Road Kew Richmond Surrey TW9 3DG Lead Inspector Sandy Patrick Unannounced Inspection 7th June 2006 10:30 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 Cecil Court DS0000017354.V299563.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. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cecil Court Address 2-4 Priory Road Kew Richmond Surrey TW9 3DG 020 8940 5242 020 8332 1044 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) Central & Cecil Housing Trust Miriam Kajencki Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability over 65 years of age of places (45) Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: Cecil Court is a residential care home providing accommodation and personal care for up to forty-five service users. The home is managed by Central & Cecil Housing Trust. The Trust is a non-profit making organisation providing accommodation and support to vulnerable adults throughout London and the Home Counties. The house is situated in pleasant grounds in Kew, close to local shops, public transport links and local facilities. The home is also close to Kew Gardens and the River Thames. Accommodation is provided on three floors, all accessed by a passenger lift. The home is divided into four units, accommodating between 6 - 19 people. Each unit is equipped with its own facilities and communal space. All bedrooms have en suite facilities. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The fee range is £550 - £600 per week. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place over three days 7th, 8th and 13th June 2006. The Inspection Team consisted of two Regulation Inspectors and a Pharmacy Inspector. The report of the Pharmacy Inspector is contained within Section 2 of this report. The Inspectors met with residents and staff on duty. The Manager was not working at the home on the days of the inspection. The Inspectors were made welcome by all and had opportunities to speak with residents, staff and visitors. The Lead Inspector also met with the Registered Person, the organisation’s Business Manager, following the inspection to discuss some of the issues raised. A new Manager was appointed in January 2006 and has been registered with the Commission for Social Care Inspection. The CSCI sent out surveys asking residents, their relatives, staff and professionals involved with the home to comment on their experiences of the service. Twelve residents, ten visitors, twelve staff and eight health care professionals returned surveys. This response is very good and the information from the surveys has been used as part of the evidence for this inspection report. Eleven of the residents who completed surveys said that they were happy with the information they received at the time of moving to the home, one was not happy with this. They had mixed opinions on the food and activities. The majority of residents felt that staff listened to them and gave them the support they needed but some residents said that staff were not always available. Some of the comments from residents’ surveys were; ‘The atmosphere is pleasant and the staff do their best to keep us happy’; ‘My daughter is pleased that I am here because she knows that if anything goes wrong she will be informed’; ‘I am very happy here on the whole. Sometimes I don’t feel entirely confident that the staff have a high enough level of training’, ‘there are too many agency staff who are unfamiliar and need a little more training’, ‘I do not like the way the sitting room is arranged with seating in rows’ and ‘the home has cut back staffing and one has to wait for long periods to get things done’. The residents who spoke with the Inspectors during the visit said that they liked the regular staff and that they were kind and caring. Most residents who spoke to the Inspectors liked the food and opinions on activities were mixed. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 6 One person said that they thought the activities were too childish. Lots of the residents spoke about how much they liked the home’s pet cats. A number of residents said that there were now less staff available and this meant that they did not always get the care they needed. One resident said, ‘The service has gone down hill’ and another resident said, ‘I used to be happy here but I am not anymore’. All the visitors who completed surveys said that they were made welcome at the home. They said that staff were generally kind and caring and that they were kept well informed about their relatives. Some of the comments from relatives surveys were; ‘The carers are friendly and courteous at all times’; ‘The various helpers are kind and know how to keep my mother happy’; ‘The atmosphere is good and staff go out of their way to keep residents happy despite pressure of time’; ‘Staff are always very welcoming and approachable’; ‘I think Cecil Court is a brilliant home with excellent staff and an open and friendly atmosphere’; ‘The location offers easy access to many excellent local facilities’; ‘If the food were a little more to my relative’s liking the home would be perfect’; ‘All the staff are extremely friendly’; ‘The home has given my relative self esteem and independence’; ‘The home has made such a difference to my relative’s life…it’s the loving care and understanding that I value most’; ‘I believe the carers do an excellent job under difficult circumstances’; ‘The cost of the home has risen considerably above the government inflation rate’; ‘Since January 2006 the paperwork carers have to complete seems to have increased considerably’ and ‘I do not have any criticisms of the home and my relative is happy there, but I think it is very expensive’. Nine of the twelve staff who completed surveys said that they were unhappy with the support they had from the Manager. Some of them said that staff morale was low and that they did not feel listened to and were not consulted. Two of the staff were happy with the new Manager’s support. Ten of the staff surveys commented that staffing levels sometimes created problems. All the staff described recruitment procedures which were appropriate and said that they attended regular meetings. The majority of staff said that they had the training they needed although some staff identified particular areas of training they wished to undertake. Although one staff member said that they had only been offered very limited training. The Inspectors met with many of the staff on duty during their visits to the home. The majority, but not all, staff raised concerns about the way they were managed. Some of the issues they raised were very serious. Lots of the staff said that they felt unhappy and stressed. One staff member said that they were ‘too frightened to say anything’. Other staff said that they had tried to speak up but had not been supported or listened to. One staff member said that they ‘were made to feel worthless’ and another member of staff said that it was ‘like treading on egg shells’. One member of staff said, ‘this used to be a nice place but now it is a nasty place to work’. Although not all staff were unhappy, the majority of staff who spoke with Inspectors were. Some of the Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 7 staff looked stressed and physically affected by this. The atmosphere in the staff team was different than at previous visits and there was a general low morale. A small number of residents also made comments to indicate that they had noticed low morale and said that they felt affected by this. These residents were keen to point out that they felt the staff were still kind and caring, but they were also unhappy and stressed. One member of staff, who was not on duty during the inspection visit, telephoned the Lead Inspector to give their views that staff were unhappy. The eight health care professionals who completed surveys said that the staff generally worked in partnership with them and communicated well. One person felt communication could be improved. Comments from health care professionals included; ‘Care of residents is excellent’; ‘The staff are always courteous and professional’; ‘The staff are friendly, helpful and responsive’. One person said that they felt the staff continuity and lack of changes had helped the staff to have a good understanding of individual needs. The information from surveys and these discussions has formed part of the evidence for this inspection report and reference is made to the views of residents, their relatives, staff and other professionals throughout the report. Some of the concerns raised were discussed with the Registered Person, the organisation’s Business Manager, following the inspection. She has agreed to look at the concerns and how these can be addressed. What the service does well: Many of the staff have worked at the home for a long time and know the needs of individual residents well. The home is situated close to a range of local services and facilities. environment is generally well maintained and there is a well kept garden. The Residents are supported to maintain independence where they can and some of the residents organise their own time and activities. The residents said that the staff are kind, caring and responsive to their needs. Care plans are regularly reviewed. Bedrooms are personalised and residents said that they liked their rooms. The environment is generally well maintained. What has improved since the last inspection? Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 8 There have been some improvements to the way in which medication is managed. Residents care plans are now stored in individual files. The majority of staff have had updated manual handling training. Three units have been equipped with new kitchens. The staff reported that these are easier to work in and are more accessible to residents. What they could do better: 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. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 The quality in this outcome group is good, this judgement is based on evidence from the inspection visit. Residents receive information about the home which helps them make a decision about whether they want to move there. Their needs are assessed and they are able to visit the home before they make their decision. In general the needs of the residents are met, however the majority of staff do not have the knowledge and information to meet the needs of some of the residents who live at the home and this places residents at risk. EVIDENCE: There are an appropriate Statement of Purpose and Service User Guide for the home which are provided to prospective residents. Residents completing surveys about the home said that they received enough information to help them make a choice about moving to the home. Copies of the Statement of Purpose and the most recent inspection report were available throughout the home. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 11 Residents and their relatives who spoke with Inspectors and those who completed surveys said that they were able to visit the home before they made a choice about whether to move there. One resident spoke about their visit to the home saying that they felt they had been treated with kindness and that is why they wanted to move to the home. All residents are admitted on a six week trial stay and at the end of this period a review of their needs is held. At this the resident, their representatives and the home can decide whether their needs can continue to be met at the home. Copies of review meeting records were seen. The Manager and senior staff make pre admission assessments on potential residents. Copies of some assessments were seen. The views of residents are included within these. The Registered Person told the Inspector that the home was looking at admitting residents with different and more complex needs. Some admissions of people with higher needs and different health care needs had taken place. In one case there was no care plan or information for staff on how to meet a specific health care need of a resident. Staff on duty said that they had not been given any guidance on how to meet this need. One of the Inspector spent time on one unit where a resident was very confused. The staff appeared to find aspects of working with this person difficult. They told the Inspector that they had not had training in dementia. The Manager must make sure staff have information, training and support to meet the needs of all residents. Contracts of care, including a statement of terms and conditions are given to all residents. Copies of these were seen to be held on file. Residents who completed surveys all said that they had received their contracts. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 The quality in this outcome group is adequate. evidence from the inspection visit. This judgement is based Individual care plans are in place but some of these are basic and some do not contain important information about specific needs. The system of care planning does not support a person centred approach. Not all residents are able to take a shower or bath as often as they like. The overall quality of the medication standard is adequate. Minor omissions in record keeping and inappropriate administration of medication. These did not put the health or welfare of residents at immediate risk. EVIDENCE: Care plans are in place for all residents. These have been arranged into individual files which is an improvement since the last inspection. A new system of computerised care plans is being piloted at the home. Some of the care plans have been updated on to this system. Paper records of these care plans are held on the units. The design of the new care plans is repetitive Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 13 in places. The care plans seen lacked detail and some information. Some aspects of the care plans are designed for residents with nursing needs. Staff have not had the training on how to complete these. If the organisation wants to use these then the staff must have the training to understand these and use them appropriately. Where risks have been identified from specific assessments, (such as water low assessments) there was not always a care plan in place. The format for the computerised care plan does not make information accessible and clear for residents. The staff who were transferring the information to the computer system said that it was taking a long time and that they had not been given time off their normal duties to do this. The Manager should make sure the staff have sufficient time allocated for this. There were no computers on the units at the time of the inspection. However, the Registered Person said that Central and Cecil plan to install computers on all units so that staff working on these are close to the residents. This should be prioritised. A lot of the information on the care plans was task orientated and contained general statements. More detail and a more person centred approach is necessary. Information on individual social needs and personal histories was limited and must be improved. There was limited information on how to meet certain health care conditions and this puts residents at risk. Daily observation notes on residents and nighttime observations are written in various different places. Some of these are not included within the care plans. All information on residents must be included within their individual records. Some of the staff said that they did not have time to give residents baths as often as they liked. One resident told the Inspectors that they had not had a shower for some time and that they wanted to take a shower daily. The home has arrangements for the safe storage, recording, administration and disposal of medication. The recording, auditing, administration and supply of medication have improved since the previous inspection by a Pharmacist Inspector. Medication is given correctly and residents can manage their own medication. All staff giving medication are trained. Record keeping and appropriate administration of medication need to be improved. All records relating to receipt, storage, administration and disposal of current medication were examined. The manager, and three staff members were interviewed. A sample of the current medication in stock was compared to the Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 14 current records and medication not supplied in the monitored dosage system was counted and compared to the records. This was to check that medication was being given as directed. Residents self-medicating had risk assessments and appropriate monitoring in place. All the medication in stock agreed with the list of medications on the administration records. Each resident has a medication profile detailing discontinuations and alterations to medication as well as any allergies. These corresponded with the current medication administration records and the staff communication record. New procedures have been developed to detail the recording of medication prescribed when needed. Most medication is given from a monitored dosage container. Staff are able to check if medication has been given or not. A weekly audit of the records and stocks of medication is done by each unit. The current audit record for the ground floor could not be found on the day of visit. The amount of medication given was not recorded for three items. The total of medication in stock indicated that the correct amount had been given. All other current administration records had been completed. Staff were all aware of the procedure for checking and handling medication and have received, or are booked in for, training from a pharmacist. The communication book showed that staff identified issues with medication and that appropriate action was taken. When medication is not supplied in the MDS there is a clear audit trail to check whether medication has been given correctly. The amount of medication currently in stock agreed with the records. This indicated that medication had been given to the resident as prescribed unless otherwise recorded. Medication was not administered from the original dispensed container for one resident. The medication had been taken out of the original container when the resident was self-medicating. The medication being given was the current dose and there is therefore no impact on the health or welfare of the resident. A new supply of medication is due and the original containers will then be used. All medication was stored securely and in the correct conditions. The controlled drug cupboard does not comply with the Misuse of Drug (Safe custody) Regulations. This has no impact on the health or welfare of residents. The staff spoke about some of the residents who had become ill and had made it clear that they wished to die at Cecil Court. The staff and external health care professionals had worked hard to make this possible and to give appropriate care so that the residents could remain comfortably at the home. One health care professional wrote about the care of one of these residents Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 15 saying, ‘it is great credit of Cecil Court that they were willing to provide more intensive support at this time’. The practice at Cecil Court was that flowers from the residents and staff were sent to the funerals of any resident who died. The staff said that this practice had recently ceased and that they found this disappointing. The organisation should reconsider their decision to stop sending flowers, as this is an important mark of respect for the residents. Cecil Court DS0000017354.V299563.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome group is good, although further improvements are needed with activities. This judgement is based on evidence from residents, visitors and staff and from the inspection visit. There is a programme of organised activities, although this is limited and needs improvements to make sure the needs of all residents are being met. Social needs of residents who cannot organise their own leisure time are not always being addressed. Visitors are made welcome and are able to contribute to the care of relatives if they wish. The menu is varied and offers choice. Opinions on the quality and choice of food are very mixed. EVIDENCE: There is a programme of organised activities at the home, including film afternoons, art and craft, exercise, bingo and external entertainers. One activity officer visits the home on Wednesdays and ruins a club, where residents can socialised and participate in gentle exercises and craftwork. Residents participating in this told the Inspector that they enjoyed this event. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 17 Some of the residents said that they did not like the organised activities and some said that they organised their own social lives. The home is situated close to local facilities and amenities and some residents spoke about how they travelled independently to these. Risk assessments were in place where residents travelled out of the house independently and it is positive that people are encouraged to remain as independent as they can. Many of the residents spoke fondly of the home’s pet cats and clearly enjoyed sharing their home with them. The home has a pleasant and well kept garden which residents said that they enjoyed. One of the Team Leaders spoke about a planned trip to the seaside over the summer for residents who wanted to participate in this. Apart from the organised activities of one event each day there was limited opportunities for residents who could not organise their own activities. The information on some people’s interests and social needs was limited and tended to rely on how much information families had chosen to give. The staff should be more proactive in seeking information on personal interests and social histories. Although there is a well equipped activity room, there is limited resources available on the units and the Registered Person should consider equipping each unit with resources that would interest residents and be available for them to use at any time, such as craft equipment, games, puzzles and books. The staff on duty said that they had little time to spend socialising with residents. Observations during the inspection were that staff attended to tasks and were supportive to meet personal needs, but that the staff did not spend time sitting with residents chatting or supporting them to meet leisure needs. One staff member said that they had been told not to do this by the Manager. Other staff said that they did not have time to meet social needs. The staff said that they did not have the time to take residents out of the home and were discouraged from spending time doing this. This in effect means that residents who are not independent are unable to go out. The social needs are an essential part of the resident’s well being and time must be allocated for this in addition to the limited number of organised activities. Some of the comments residents had about activities were, ‘they are too childish’, ‘activities are arranged but not always well enough’, ‘I tend to get left out because I cannot read the notices and I need encouragement to attend’ and ‘we need more outings’. The Manager should look at how the needs of different residents can be met through the organised programme of activities. If some residents are finding them inappropriate then they need to be offered more suitable opportunities. Three residents said that they could not attend activities because they were partially sighted or deaf. The needs of all residents must be met and residents must not be discriminated against because of disability. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 18 The majority of residents who met with the Inspectors and who completed surveys said that they considered themselves to be of white British origin. They said that they felt their cultural and religious needs were met. There are regular church services and residents are offered Holy Communion. Residents can request specialist diets if they wish and cultural and religious needs are recorded on care plans. During the inspection a member of the local Catholic Church visited the home to give Holy Communion to one resident. He performed this in a lounge where other residents were present. He told the staff member to turn the television off, which they did. The other residents objected to this but the staff member still turned the television down and the visitor continued to give communion in the lounge. This was highly inappropriate and the staff on duty should have told the visitor that they must take the resident to a private area for this. Visitors are made welcome at the home. Relatives are able to continue to be involved in giving care if they wish and this is supported. Residents said that they were able to spend time with visitors. Residents are supported to make their own decisions and to contribute their ideas on the service through individual reviews, meetings and quality monitoring. There is a menu offering choice at each mealtimes. The menu is varied and the Chef has met with residents to ask them for their input into menu planning. However, opinions on the food were mixed. Comments from residents included, ‘sometimes meals are not hot enough. More variety of vegetables would be nice’, ‘I understand that the food has to be bland to suit everyone and therefore I sometimes find it boring’, ‘the meals are generally good but can vary from very good to poor. The evening meal is poor but I think the chef finds it difficult to please everyone’, ‘my relative has great difficulty with the food and has lost over a stone in weight after moving to Cecil Court. I feel the catering staff could be more helpful and offer more choice’, ‘poor quality food no flavour not cooked well’, ‘lunch was very good’, ‘the food is usually good’, ‘I can choose an alternative if I don’t like the meal’, ‘the fish was very tasty’, ‘desert was too creamy’ and ‘they give me what I like’. The Chef and Manager should continue to consult with residents about how to improve the menu and food. If residents are losing weight or not eating then a care plan must be put in place to look at how their needs can be met. Menus were on display throughout the home and residents and staff supporting residents at mealtimes were kind and helpful. Residents were offered choices of drinks and were able to have second helpings if they wished. Throughout the day staff were seen offering residents hot and cold drinks. Cecil Court DS0000017354.V299563.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome group is good, although improvements are needed in the way that complaints are recorded and additional staff training in protection of vulnerable adults is required. This judgement is based on information from the inspection visit. EVIDENCE: There is an appropriate complaints procedure and residents completing surveys said that they knew who to contact if they were unhappy about any aspect of their care. Copies of the complaints procedure were displayed around the home. There is a record of complaints made and the subsequent investigation. The records for a number of complaints gave conflicting information indicating that the complainant was told the complaint was not upheld but that the event would not reoccur. Some of the complaints indicated serious concerns about the conduct of staff although there was limited information on how this was followed up with staff. Records of complaints must be clear and must indicate where any follow up action has taken place. The Deputy Manager was able to explain about some of the complaints, the investigation and the action taken following complaints. The Inspectors saw evidence that action had been taken to minimise the risk of some events reoccurring following a complaint. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 20 Some of the complaints were serious and one was an allegation that money had gone missing. The CSCI had not been notified about this event and should have been. One anonymous complaint was made to the CSCI. The Registered Person was asked to investigate this. They undertook an appropriate investigation and took action to address the concerns raised. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults Procedure and Central and Cecil Have their own procedure on abuse. Not all staff have had training in this area and this must be arranged for all staff. Cecil Court DS0000017354.V299563.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The quality in this outcome group is good. evidence from the inspection visit. This judgement is based on The environment is generally safe, well maintained and comfortable. Residents have unrestricted access to communal areas and are generally happy with the environment, although some feel cleaning could be improved. Improvements have been made to some communal areas. EVIDENCE: The building is situated in pleasant and well-kept grounds, with level access areas and raised beds. The home is generally well decorated and maintained. Pictures, plants and ornaments were seen throughout communal areas. The home is divided into four interconnecting units each with a lounge, kitchen and laundry facilities. All rooms are for single occupancy and have en suite facilities. Residents are able to bring their own furniture and possessions to personalise bedrooms. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 22 Badly worn and stained carpets which were identified at the last inspection have not yet been replaced, although the Deputy Manager said that these were due to be. Building work to improve some of the communal areas has taken place and all units have been equipped with new kitchens. The home was generally clean and cleaning staff were seen attending to duties throughout the inspection. Some residents felt that high dusting was not attended to. Comments from residents about the environment included, ‘I like my nice room’, ‘my room is good’, ‘I have everything I need in my room’, ‘floors are vacuumed and bathrooms cleaned but very little dusting is done behind chairs and ceilings need a little more attention’, ‘the garden looks lovely and is very tidy’, ‘pleasant environment with good bathing facilities’ and ‘residents’ rooms are nice and we are able to bring our own furnishings if we wish’. One professional said that there was no dedicated treatment room and this would be useful for consultations. The Inspector saw staff giving residents a cup of tea in one lounge. There was not enough tables for residents to place their tea on and some residents had their tea left on the floor. The staff left the tea for one resident on a chair next to them. These practices present a risk and the Registered Person must make sure enough tables are available for residents to place their drinks whilst seated in the lounges. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome group is adequate. This judgement has been based on information received during the inspection visit. Staffing levels at the home have been reduced and staff allocation to units has changed meaning that some needs are not being met and that some staff are finding it difficult to complete all their duties. Staff files are incomplete and indicate that thorough checks on the suitability of some staff have not been made. Staff need further training to meet the needs of residents. EVIDENCE: The home employs a team of senior staff who oversee the management of each unit and the house in the absence of the Manager. Staff at the home said that the amount of staff allocated to each unit had been reduced and that they found it hard to undertake all their duties. The Inspector saw examples of situations where more staffing was needed. These included residents being left for long periods in communal areas without staff present, in one lounge the Inspector had to go and get an member of staff (who was busy elsewhere) twice to attend to the needs of a resident who was trying to walk to the bathroom alone and could not manage. Staff in one unit said that two residents needed support of two staff to get up in the morning but only one staff member was allocated to that unit. Staff in another unit said that five residents required two members of staff to get them up and only two members Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 24 of staff worked on this unit for sixteen residents. Staff on this unit said that they could not give residents baths unless an additional member of staff was allocated to cover the unit and this was arranged at the convenience of the rota and not when the residents wished to take a bath. Throughout the home on both days staff spent their time attending to tasks and did not have time to help residents to meet their leisure needs. The staff told the Inspector that there was limited opportunities for residents to be supported to go out of the home due to staffing levels. The Registered Person spoke about the home looking at admitting residents with higher and more varied needs. Some residents spoke about needs not being met because of staff not being available. One person said, ‘ there is sometimes a delay in getting staff when need them’ another resident said, ‘the house has cut back on staff and one has to wait for long periods to get things done’. Nearly all the staff who spoke to the Inspector raised concerns about staffing levels changing and many of them said that they felt stressed, overworked and that staff morale was low partly because of this. The staffing levels at the home must be reviewed and sufficient staffing must be in place to meet the needs of new residents, to meet social and leisure needs and to make sure residents are safe. Staffing levels and rotas must not be based on financial constraints and must reflect the needs of the service. The home employs one volunteer who gives additional support. The Deputy Manager said that the volunteers were ‘worth their weight in gold’. Some staff said that their shifts were changed at short notice and without consultation. The Manager must make sure staff are given sufficient warning about changes to their working pattern. The senior staff said that they had been asked to take on additional management responsibilities and also had to input data into the new computerised care planning system. They said that they were not given additional time for these tasks and were included on the rota when they needed to spend time managing staff and attending to other management responsibilities. Some of the senior staff come to work on their days off and work unpaid to complete their duties. One of the senior staff was doing this on one of the days of the inspection. The Manager must make sure the senior staff are allocated sufficient time away from direct care for management tasks. Staff on duty said that sometimes there was no one to cover them for them to take breaks. On one day of the inspection one member of staff working a long day, who started at 7:30am could not take a break until 3:00pm because no other staff were free to cover their unit. This is unacceptable and puts Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 25 residents at risk. There must be sufficient staffing available so that the staff can take reasonable and timely breaks. Nearly all residents who spoke to the Inspectors or completed surveys spoke positively about staff saying that they found them kind and caring. The staff ion duty demonstrated a good knowledge of the residents who they cared for. Staff recruitment files were examined and some of these were found to be incomplete. One file had no identification, another file contained only one reference from a co-worker, one file did not contain evidence of a criminal records check or reference checks. Files for newly employed members of staff could not be located, although the Inspector recognises that these may have been stored elsewhere and the Manager was not at the home to confirm this. The Registered Person must make sure files are in place for all staff and evidence a thorough recruitment procedure. Regular staff meetings and individual supervision are held and are evidenced in staff files. The staff who spoke to the Inspector were concerned that procedures did not allow for an in-depth handover when they started a shift at work. They said that they were not always given information on residents in other units which they may have to cover at some point during their shift. The Manager must make sure the staff have the information they need to meet the needs of all residents who they are working with. Training records indicated that the staff had recently had updated manual handling training but that they needed training in other areas including protection of vulnerable adults. Training must also be provided in palliative care, dementia, infection control and person centred planning in order to meet the needs of residents at the home. There was no record of training for bank and temporary staff and the Manager should make sure training records to evidence staff skills and knowledge are requested and held at the home. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 The quality in this outcome group is poor and improvements must be made in the way the home is managed and staff are supported to work towards continuous improvement. Health and safety and quality monitoring at the home are appropriate. However, the Registered Person does not always keep the CSCI informed of significant events or quality monitoring outcomes. EVIDENCE: The Manager was employed in January 2006 and was registered with the Commission for Social Care Inspection. The majority of staff at the home and some residents and visitors felt that the management approach was not open or supportive. Some residents said that they hardly ever saw the Manager and did not feel they had made Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 27 improvements to the home. One relative said, ‘I would like the management to be more visible and attentive’. The majority of staff said that they felt morale was low and this was partly due to the management approach. Some staff said that they were not listened to, their opinion was not valued and they had not been consulted about or supported with changes. The Inspector recognises that new Managers may implement changes to the home and the Registered Person said that she felt some changes were necessary to improve the service. However, it is clear that many staff feel devalued by the way in which changes are introduced. Some of the staff have worked at the home for many years and have valuable knowledge and experience. The staff on duty throughout the inspection demonstrated a good knowledge of individual residents’ needs. The Manager must make sure she values this knowledge and experience and consults with staff about changes. The management approach should be open, positive and inclusive and the residents and staff should feel that their opinion is important. The Manager should make sure changes are clearly explained so that the staff can understand why they are important. Some of the staff said that they had raised concerns with senior managers and these had not been addressed. Some staff said that they felt blamed for speaking out. The Registered Person should make sure all the concerns of staff are listened to and appropriate response is made. The staff should feel able to whistle blow or report practices they feel unhappy about without the fear of recrimination. The concerns of staff about the management approach at the home were discussed with the Registered Person who agreed to look at these concerns. It is essential that the Registered Person, Manager and staff take responsibility for working together to help the continuous development of the service. Failure to support staff in this area is beginning to have a detrimental effect on the service. The CSCI had not been notified of a number of accidents, incidents, and allegation of missing money and deaths and should have been. The Registered Person conducts unannounced monthly visits to look at quality outcomes in specific areas, such as food, activities, personal care and fire safety. These visits are a useful monitoring exercise and the reports give suggested actions and recommendations. The organisation should be sending copies of these reports to the CSCI. However, the last report received was from February 2006. The organisation must make sure copies of each monthly visit are forwarded. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 28 Residents make private arrangements for the management of their finances. Small amounts of cash are held by the home so that service users can make small purchases and pay for additional services, such as hairdressing. Regular checks are made on health and safety at the home and these are recorded. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 29 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 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 3 X 3 Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 12 18 Requirement Timescale for action The Registered Person must 31/08/06 make sure the staff have the information, support and training needed to meet the needs of all residents. The Registered make sure: Person must 31/08/06 2. OP7 12 15 1. Care plans are clear and can be easily understood. 2. Care planning becomes more person centred and less task orientated. 3. Staff have the knowledge and skills to assessments and that any identified risk is addressed within a care plan. 4. Health care conditions are appropriately recorded and care plans in place to meet any health care needs. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 31 3. OP9 13 The Registered make sure: Person must 01/07/06 1. The administration of all medication is recorded accurately. 2. All medication is administered from the original labelled container. 4. OP10 12 The Registered Person must 31/07/06 make sure residents are able to take a bath or shower as often as they like and staffing allows for residents to have regular baths at a time of their choosing. The Registered make sure: 1. Person must 31/10/06 5. OP12 12 16 Sufficient staff time is allocated to meet residents’ social needs. Staff are proactive in developing information on individual social needs and personal histories, so that appropriate social activities can be organised based on the actual needs of residents. Units must be equipped with leisure resources which residents can access at any time. Activities must be organised to meet the needs of all residents and they must not be discriminated against Version 5.2 Page 32 2. 3. 4. Cecil Court DS0000017354.V299563.R01.S.doc because of disability. 6. OP10 OP12 12 16 The Registered Person must 15/07/06 make sure visitors offer Holy Communion in private not communal places and that staff make sure any visitor using communal areas does not interrupt or disturb other residents. The Registered Person must 31/07/06 makes sure that records of complaints must be clear and must indicate where any follow up action has taken place. The Registered Person must 31/07/06 notify the CSCI of any significant event in accordance with this Regulation. Previous timescale 31/07/05 & 31/12/05 9. OP18 OP30 13 18 The Registered Person must 31/10/06 make sure all staff have been trained in the protection of vulnerable adults and have a good understanding of this and their responsibilities under the whistle blowing procedure. The Registered Person must 31/08/06 make sure that there are sufficient tables available for residents to take drinks in the lounges. The Registered Person must 31/08/06 review staffing levels at the home making sure the needs of DS0000017354.V299563.R01.S.doc Version 5.2 Page 33 7. OP16 22 8. OP16OP31 22 37 10. OP20 23 11. OP27 12 13 16 Cecil Court 18 19 12. OP27 18 19 residents can be safely met. The Registered Person must 31/08/06 make sure staff are given sufficient notice and are consulted when changes to their shifts are made. The Registered Person must make sure senior staff have enough time to complete their allocated duties. The Registered Person must makes sure there is sufficient staffing available so that the staff can take reasonable and timely breaks. . 13. OP29 13 18 19 The Registered Person must 31/07/06 make sure thorough pre employment checks are made on all staff. Records of these checks must be held at the home. Previous timescale 31/01/06 14. OP30 18 The Registered Person must 31/10/06 make sure staff are appropriately trained in person centred planning, dementia, infection control and palliative care. Training information must held for temporary staff. be 15. OP32 12 18 The Registered Person must 31/07/06 makes sure the management approach is positive, open and inclusive. Changes must be clearly explained and the DS0000017354.V299563.R01.S.doc Version 5.2 Page 34 Cecil Court residents and staff must be consulted about changes which effect them. The Registered Person should work closely with the home to make sure staff morale is raised and that the current climate does not have a detrimental effect on the care of residents. 16. OP32 12 18 The Registered Person must 31/07/06 make sure all the concerns of staff are listened to and appropriate response is made. The staff should feel able to whistle blow or report practices they feel unhappy about without the fear of recrimination. The Registered Person must 31/07/06 makes sure that reports of monthly visits to the home are forwarded to the Commission for Social Care Inspection. 17. OP33 26 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 OP9 Good Practice Recommendations It is recommended that controlled drugs are stored in a cupboard that complies with the appropriate legislation. The Registered Person should reconsider the decision not to send flowers to the funerals of residents who have died. 2. OP11 Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 35 3. OP19 The Registered Person should consider the replacement of stained carpets and worn flooring. Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cecil Court DS0000017354.V299563.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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