Inspection on 24/01/06 for Cerne Abbas Care Home

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cerne Abbas Care Home 26/06/08

Cerne Abbas Care Home 26/03/08

Cerne Abbas Care Home 14/06/07

Cerne Abbas Care Home 11/05/06

Cerne Abbas Care Home 25/08/05

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

CARE HOME ADULTS 18-65 Cerne Abbas Care Home Cerne Abbas Dorchester Dorset DT2 7AL Lead Inspector Joanne Pasker Announced Inspection 24 -26 January 2006 09:30 th th DS0000065834.V279940.R01.S.doc Version 5.1 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 DS0000065834.V279940.R01.S.doc Version 5.1 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 Adults 18-65. 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. DS0000065834.V279940.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cerne Abbas Care Home Address Cerne Abbas Dorchester Dorset DT2 7AL 01300 341008 01300 341111 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) Ashbourne (Eton) Limited Care Home 71 Category(ies) of Dementia - over 65 years of age (53) registration, with number of places DS0000065834.V279940.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The Cloisters unit can accommodate a maximum of 18 younger adults with acquired brain injury, or Huntington’s Disease. To provide care for four named persons (as known to the Commission for Social Care Inspection) with mental disorder, over 65 years of age. Service users over the age of 65 years in the category DE(E) may only be accommodated in the Older Person’s Unit. One named person (as known to the Commission for Social Care Inspection) under the age of 65 years may be accommodated to receive care. 25th August 2005 Date of last inspection Brief Description of the Service: Cerne Abbas Care Home is situated on the outskirts of the village of Cerne Abbas, in West Dorset and is within walking distance of the village amenities such as a post office, church, pubs and tearooms. Car parking for visitors is provided at the rear of the home. The home is registered to provide specialist nursing care for 53 older people with dementia and 18 younger adults who have acquired brain injury or Huntingtons disease. This report relates to the younger adults unit. The home provides nursing and care staff on a 24-hour basis and catering, domestic and maintenance staff are on duty throughout the waking day. In addition to the nursing, personal care and accommodation provided, the scale of charges for the home includes the provision of social activities, catering for all meals and laundry and housekeeping services. The part of the home delivering care to the younger adults is Cloisters Unit, situated on the first floor. One working lift provides access to the unit. An electronic number keypad is used on the door leading to Cloisters. The unit has a lounge, smoking room and dining area. The home has been recently acquired by Southern Cross Healthcare Ltd., who operate a number of care services throughout the United Kingdom. At the time of inspection the home was still trading under the Ashbourne (Eton) Ltd., banner. The home has been without a registered manager since August 2005. A further condition of registration has been imposed and no service users have been admitted to the home since 10 October 2005. DS0000065834.V279940.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over a two and a half day period and took two inspectors from the Commission for Social Care Inspection and two monitoring officers from the Primary Care Trust and Local Authority contracts monitoring team, approximately nineteen hours each. The purpose of the inspection was to review the requirements and recommendations made in the report in August 2005 and those made from a number of additional monitoring visits made on: 22 September 2005 23 September 2005 27 September 2005 28 September 2005 29 September 2005 6 October 2005 10 October 2005 13 October 2005 20 October 2005 23 October 2005 25 October 2005 3 November 2005 14 November 2005 30 November 2005 21 December 2005 9 January 2006. During this inspection, all areas of the premises were inspected. A total of 6 residents and 5 members of staff were spoken with and asked their views on the home. Some documentation was reviewed, including duty rotas, staff personnel files, care files, policies and procedures. An unannounced inspection took place on the 9 January 2006 to review the receipt, recording, storage, handling, administration and disposal of medicines. The findings and outcomes of that inspection have been included in this one. DS0000065834.V279940.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: As a result of this inspection a total of 21 requirements and 10 recommendations have been made. Although the home produced a service user guide during the inspection it was not generally available to residents, their families and staff, thus depriving them of information on what they could expect from this service. There is little evidence of residents being given meaningful choices and decisions with regard to the running of Cloisters. There continues to be a lack of meaningful activities for residents at Cerne Abbas Care Centre. Care staff are reliant on the two activities organisers to provide activities but staff on the units need to continue with this when activities staff are not there. A more ‘person centred’ approach needs to be followed to ensure residents’ individual needs and preferences can be achieved. Although care documentation had improved in format and layout it still did not reflect all aspects of the residents’ health and welfare and how needs were going to be met. Residents’ emotional and psychological needs in particular were not fully assessed and therefore possible needs met. Residents and/or DS0000065834.V279940.R01.S.doc Version 5.1 Page 7 their chosen representatives are not always invited to participate in the planning and review of care plans that affect them. More attention needs to be given, in ensuring that service users rights are met and staff must document more clearly how this is achieved. Work needs to continue to ensure that medication is handled safely at all times and residents are protected. The company medication policy had not been implemented to ensure that staff are aware of procedures for the control of medication. The complaints procedure was available for all to see but there was no evidence the home was following it. Residents and relatives could not be sure that their views would be listened to or acted upon. Since the August inspection 18 referrals have been made to Social Care and Health with regard to adult protection, 3 of these were made during this inspection. The home is failing to protect residents from significant harm or abuse and failing to report adverse incidents to the Commission as required by regulation. The home still needs further maintenance and refurbishment to make it a more pleasant environment in which to live. Some windows do not close properly and minor fixtures and fittings need replacing in some areas. There is still no heating in a number of en-suite bathrooms, rendering them unsuitable for use during the cold winter months. The policy on infection control also needs to be followed by the home and ensure that all clinical waste is disposed of safely and correctly. All clinical areas must be kept clean and hygienic with adequate supplies to ensure infection control guidelines are followed. The recruitment process followed at Cerne Abbas Care Home must be improved so that residents can be assured suitable staff are providing their care. All staff must have satisfactory Criminal Record Bureau and POVA (protection of vulnerable adults) First checks before they commence employment. Shortfalls in training mean that residents cannot be sure suitably qualified staff will meet their needs. There is little evidence that staff are trained to care adequately for people with Huntington’s disease or those with acquired brain injury and there appears to be no control and restraint training given. Staff must be supervised on a regular basis and registered nurses must adhere to the NMC Code of Professional Conduct and must recognise their own limitations as well as ensuring that the principles of Clinical Governance are met. DS0000065834.V279940.R01.S.doc Version 5.1 Page 8 An annual development plan and quality monitoring system needs to be put in place and information made available to residents/relatives so that they can be assured the home is run in their best interests. Staff must also follow health and safety guidelines to ensure their own safety and the safety of the residents. All staff must receive accredited training in moving and handling, fire safety and infection control and their practice must improve as a result. 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. DS0000065834.V279940.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000065834.V279940.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Not able to assess Standard 2 at this inspection as no admissions have been made since the last inspection in August 2005. The home’s new Statement of Purpose and Service User Guide provide detailed information about the care and services provided at Cerne Abbas Care Home, but this is not generally available to residents and their families. EVIDENCE: A new service user guide and statement of purpose was produced for the second day of inspection and was left in the reception area for anyone to see. As yet it had not been made available to staff, residents and relatives on the individual units. Staff spoken to confirmed that they were unaware of these documents and had not seen them. DS0000065834.V279940.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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 There are limited opportunities for residents to make decisions about their lives and therefore their needs and rights are not being fully met by the home. Residents are not consulted or enabled to participate in events that affect the day-to-day running of the home. Therefore they have no opportunity to contribute to decisions made regarding the home. EVIDENCE: A sample of 5 residents’ files were viewed as part of the inspection. There was poor evidence of residents being given choice in many aspects of their lives. Some residents spoken to confirmed that they have choice over daily activities e.g. “I watch telly in my room if I want to”, “I get up late…I like to”. It was observed that staff seen interacting with residents appeared well aware of their likes and dislikes. However these individual choices and how they were communicated are not well recorded. No resident manages their own finances. DS0000065834.V279940.R01.S.doc Version 5.1 Page 12 Cloisters does not provide any opportunities for residents to air their views and participate in decisions made about the running of the unit. There is no residents’ forum or involvement from independent advocates to help residents express their opinions. When discussed with staff, they felt that residents’ needs were so complex, with such communication difficulties, that it would be extremely difficult to implement this. Some more able residents did express their views during their individual review meetings. Residents spoken to expressed a mixed view on wanting to be more involved. The unit should give more consideration to developing service user participation and access specialist support to devise appropriate ways of involvement. This is an outstanding recommendation from the previous report. DS0000065834.V279940.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 16 & 17 The social and recreational and educational needs of the service users are not wholly satisfied, which results in some residents being bored and under stimulated. Residents do not participate in any local activities therefore they are not integrated into the local community. Appropriate relationships and links with others are maintained, ensuring residents have contact with friends and family. Individuals and staff’s daily routines do not always promote and protect service users’ rights, which they are entitled to. Generally the meals in this home have improved and offer more choice and variety during the day. DS0000065834.V279940.R01.S.doc Version 5.1 Page 14 EVIDENCE: The care files reviewed, showed that many of the residents’ social care plans have improved but the records of activities undertaken were held by the activities organisers and were not part of the service users’ individual care files. Therefore they were not available to care staff, who are responsible for continuing activities in the absence of the activity coordinators. There is still a lack of meaningful activities and this is unlikely to improve until there is some understanding of ‘person centred’ care, matched to individual’s needs and abilities. The activities programme included: • • • • DVD’s Nail care and hand massage Quiz’s Multi sensory therapy During the course of the inspection a general quiz was observed in the lounge but it was not suited to the abilities and individual needs of residents. The programme for the weekend included, for both mornings, “multi sensory therapy on all units by staff”. It was not clear what this entailed but staff did confirm that all activities took place on an “as and when” basis. There is not a multi sensory room on Cloisters but it is a resource that would greatly enhance the lives of the residents there. When spoken to, the nurse in charge confirmed that the benefits of this have been discussed with the home’s management and agreed in principle, although it is uncertain whether there are plans to provide one. There are no links with the local community and although one service user had expressed a wish to visit the local pub, which was agreed during their review on the 9 December 2005, this had not yet happened. The review stated that the goal for Resident A “to have been to the pub x 2”, was to be achieved by the next review a year later, on the 8 December 2006. A minibus had recently been made available for the home’s use but none of the staff had received the appropriate health and safety training necessary to operate the bus safely, therefore this amenity could not be utilised. No resident was engaged in any educational activities and this remains a recommendation from the last report. Staff and some residents spoken to, confirmed that visitors are welcome although few have regular involvement in daily routines and activities. Residents are able to see their visitors in the privacy of their own room or the communal areas. DS0000065834.V279940.R01.S.doc Version 5.1 Page 15 Some residents were able to lock their own doors and the agreement for this was documented in their file, along with an appropriate risk assessment. Staff were observed to exhibit a caring, committed attitude to the residents and their interaction was always cheerful and supportive. However, staff were seen on occasions to not knock on resident’s doors before entering and some overseas staff were heard talking in their own language in front of residents. Some service users were left sitting in chairs in their room or communal areas, for long periods of time, either in front of a television or by a window. When asked whether this was the resident’s choice of activity, staff stated that “X likes to do this” but there was little evidence of how this information was obtained. Given the level of some resident’s communication difficulties, the lack of specific staff training in this area and absence of any involvement from independent advocates, it is impossible to say that service users rights are fully recognised. During the course of the inspection no communication aids or tools were seen to be used and staff spoken to confirmed they did not have training or use any specific communication aids with the residents. Food appears to have improved since the last report. Residents on Cloisters are offered the choice of a full cooked breakfast in the morning and also have a different evening meal to the rest of the home. This is to ensure that they receive a higher calorie diet to adequately meet their physical needs. Staff confirmed that sandwiches and biscuits were available after 5pm and 2 residents spoken to, confirmed that they had plenty to eat and the food was “good”. Comment will be made about the cleanliness of the kitchen under standard 26 in the section of this report entitled Environment. DS0000065834.V279940.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Care documentation shows evidence of individual needs ensuring residents are supported in a way that they prefer and require. Physical needs are well documented although emotional and psychological health needs are not addressed in depth. Therefore the home does not ensure that service users’ healthcare needs are fully met. The company medication policy has not been implemented to ensure that staff are aware of the procedures for the control of medication. Some aspects of the handling and recording of medicines had improved but monitoring of audit trails, refrigerated storage and expiry dates’ still needs improvement to protect residents. EVIDENCE: There has been a change in the documentation format now used in residents’ files, since the last inspection. This is an improvement and information is easily accessible and clear to follow. However there was no evidence that residents or their chosen representatives were included in drawing up or reviewing their care plans. DS0000065834.V279940.R01.S.doc Version 5.1 Page 17 5 residents’ files were viewed as part of the inspection process and all were found to clearly record individuals preferences regarding personal support. However it was unclear again, how this information had been gathered and whether residents themselves or their representatives had contributed towards this. Detailed actions and interventions were recorded on care plans such as: • • • “Resident X is unable to communicate….for carers’ to be aware of X’s non-verbal communication and facial expressions” Resident Y “prefers personal care to be done later in the day” Resident Y “will choose own clothes but will not wear socks with their slippers” Staff were also observed asking a resident if they wanted to wear make up that day and assisted in styling their hair as required. Physical healthcare needs are met with evidence that several residents’ have involvement with other healthcare professionals, including physiotherapy, occupational therapy, dentist, dietician and speech and language therapy. The nurse in charge confirmed that the home does have 3 monthly case conferences with a consultant specialising in head injuries and Huntington’s disease. An advisor for Huntington’s disease also usually comes in monthly but had not attended the home for several months now. However there is little reference to emotional and psychological needs in individual files and care plans seen and the home needs to address this. With the specialist service that they provide, it is essential that residents with Huntington’s disease or acquired brain injury are regularly and properly assessed with regard to their mental state and this clearly documented. The scales used to weigh residents have not been calibrated since purchase eighteen months ago, therefore staff could not be sure they were accurate. There is a very comprehensive corporate medicines policy but this had not been implemented in the home since ownership changed in April 2005. The section on disposal of medicines needs revising to comply with current legislation. The operational manager said that a copy of the current policy would be circulated to all units and all staff and that all policies were going to be reviewed in March. No residents were self-medicating at the time of this visit. Medicines were stored in locked trolleys or cupboards. The upstairs clinic room needed cleaning and there was no soap in the dispenser. Boxes of enteral feed are now stored off the floor. Medicine refrigerators were locked but appropriate thermometers have not been obtained for monitoring the maximum and minimum temperatures. Controlled Drugs (CDs) were stored correctly. DS0000065834.V279940.R01.S.doc Version 5.1 Page 18 The home has not yet implemented correct procedures for disposal of medicines as advised in October 2005 but the inspector was told that containers for this were expected the next day. The home uses handwritten MAR charts and entries were checked for accuracy and countersigned. Records were kept of medicines received, administered and disposed of. The home has recently introduced recording the dates of starting new containers and about 50 of the medicines checked could be audited. 8 of 11 audits checked, agreed with the records but there were small discrepancies in 3 others that could not be explained. DS0000065834.V279940.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The complaints process in this home is very poor with little evidence that residents’/relatives’ views are listened to or acted upon. The home is failing to protect service users from significant harm or abuse. EVIDENCE: The home has a written policy for dealing with complaints and for responding to suspicion or evidence of abuse or neglect. The complaints policy in the service user guide gives inaccurate details of how social services may be contacted. The complaints log was reviewed and showed that no complaints had been made to the home since the August 2005 inspection. However this is inaccurate as care files, financial files and personnel files showed that complaints had been made. Any one wishing to make a complaint cannot therefore be sure they will be listened to or the appropriate action will be taken and records kept to demonstrate action/lessons learned and how/if the matters were resolved. During this inspection the PCT monitoring nurse made 3 referrals to Social Care and Health with regard to the protection of vulnerable adults. There have been a total of 18 referrals made since the August inspection and this number includes the older persons units. 3 of these referrals have been investigated and upheld, the remaining 15 are still under investigation. Recruitment documentation showed that the home had failed to obtain a Criminal Record and POVA first check prior to commencing employment for 21 DS0000065834.V279940.R01.S.doc Version 5.1 Page 20 members of permanent staff, therefore residents could not be sure that appropriate staff had been employed or that they were in safe hands at all times. Whilst on Cloisters unit an aggressive incident between 2 male residents was witnessed. The male carer who was in the vicinity immediately walked away from the incident, apparently to get a female member of staff. The residents continued to hit and punch one another until the PCT monitoring nurse and myself separated them to prevent further injury. Resident A who is wheelchair bound, sustained a skin tear on his forearm and staff had to be found by ourselves, to dress the wound. When questioned on their handling of the situation, staff stated that Resident B responded better to females when upset or aggressive and this was also written in his care plan. On viewing both residents’ files, there was evidence of at least 6 aggressive incidents occurring between the 2 residents in the last month, yet no specific risk assessments or planned interventions were documented. The ‘challenging behaviour record’ in Resident A’s file was also blank yet this form gave clear indications of when and how it should be used. When discussed with the nurse in charge of the unit that day, she stated that the form had not been completed as incidents occurred so frequently between the 2 residents, that it did not seem prudent to spend time filling it in every time. Registered nurses must adhere to the Nursing and Midwifery Council’s (NMC) Code of Professional Conduct in incidents such as this and have a clear duty of care to residents and procedure to follow. The home has also failed to always inform the Commission of all adverse incidents that occur, as required by regulations. DS0000065834.V279940.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 The communal areas are currently undergoing refurbishment and provide a homely appearance but several residents’ bedroom sash windows do not properly close, therefore they do not ensure a comfortable and safe environment. All residents’ have an en suite facility but none have heating, therefore these are not comfortable for use in the colder winter months. Cloisters unit appeared clean and hygienic. EVIDENCE: There has been a considerable improvement in environment on Cloisters following previous requirements made. The unit is clean and free from unpleasant odours and the smoking room has been repaired and refurbished, making it a more pleasant environment. However, the door to the smoking room is not always kept closed when in use, to ensure a pleasant environment for non-smokers is maintained. The majority of broken radiator covers have also been repaired, the dining room carpet has been replaced and decorating is continuing on one of the main corridors. DS0000065834.V279940.R01.S.doc Version 5.1 Page 22 However, there are still a number of refurbishment and maintenance issues which need attention so that Cerne Abbas Care Home becomes a more comfortable, safe place to live, including: The lack of heating in en-suite bathrooms Some bedrooms without call bells and some faulty call bells Broken toilet roll holders Sash windows, which do not close properly Cracked pane of glass in a resident’s bedroom Missing light covers in some en suites Holes in walls and ceilings sited next to electrical points. Outside areas were tidier and the car park at the rear of the property had been levelled and was accessible although 10 used gloves were seen discarded in the car park. This is a serious breach of infection control, placing others at potential risk. The courtyards were tidier but still appeared quite stark. The Commission for Social Care Inspection has also received a copy of the Environmental Health Officer’s recent inspection report. 17 requirements have been made, 1 with regard to documentation held and the remaining 16 related to poor cleanliness and general upkeep of the kitchen. The chef admits that it is difficult to find time to attend to the cleaning regime as they are currently understaffed and some equipment frequently breaks down. The laundry was viewed and was in good order, with all equipment now in working order following a previous recommendation. DS0000065834.V279940.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 The deployment and number of staff is insufficient to meet the needs of the residents. Shortfalls in training result in care staff not being fully competent to do their jobs properly and therefore residents could not be assured they were in safe hands at all times. Major shortfalls in the recruitment procedure do not protect residents from risk. EVIDENCE: At the time of inspection the staffing levels met the minimum requirements suggested by the Commission for Social Care Inspection. However at times the needs of the residents dictated there should be more staff on duty so that needs could be met fully. On the first day of inspection, a resident was left lying out in a specialist chair in the dining area with their legs resting on a dining chair at times. The involuntary movements they were experiencing caused the chair to tip several times and left the resident sliding down the seat towards the floor. Two members of the inspection team had to go and find staff on more than one occasion to ensure the safety of the resident was maintained. There were also DS0000065834.V279940.R01.S.doc Version 5.1 Page 24 insufficient staff located in the area to prevent/intervene during the aggressive incident previously documented in this report. The home employs a total of twenty-eight healthcare assistants, eight of whom hold NVQ level 2 or 3 award in care. This still falls short of the 50 recommended to ensure that residents are in safe hands at all times. Six personnel files and all the Criminal Record Bureau (CRB) checks were reviewed. Twenty-one permanent members of staff were without Criminal Record or POVA first checks. The Registered Provider was aware of the previous shortfalls in training where staff had not received the appropriate induction and foundation training. Therefore a regional trainer had been visiting the home on a regular basis to provide this. Training records were seen and records showed the percentage of compliance by staff were: • • • • • Moving and handling 75 Health and Safety 70 Food Hygiene 70 Resident welfare 50 Fire Safety 55 It was evident from looking at the duty rota that some staff left in charge of units had no CRB Disclosures and POVA First checks or fire safety training. Most of the staff had not received effective training in Huntington’s disease or acquired brain injury. Care staff spoken with confirmed they were not given any formal supervision. Previously the management team at the home had identified that certain members of staff needed close supervision and review of their competence to do their work effectively. There was no evidence that this action had been undertaken. There was a record that some registered nurses had attended one group supervision session. This does not meet the NMC’s guidance on Clinical supervision. DS0000065834.V279940.R01.S.doc Version 5.1 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 The home does not have sound quality assurance systems in place and is unable to demonstrate that resident and stakeholder consultation has regularly taken place. Service users’ and their representatives cannot therefore be confident that their views are listened to. The health, safety and welfare of residents and staff are not consistently promoted and protected. In consequence, risks to residents have been increased. EVIDENCE: On the third day of the inspection the manager demonstrated good knowledge of what quality assurance systems should be in place within the home, but was unable to provide much current evidence of this. No annual development plan for the home was found and there was no documentation seen to demonstrate that feedback is actively sought from service users and stakeholders. DS0000065834.V279940.R01.S.doc Version 5.1 Page 26 Later the manager stated that a comments book for visitors would be placed in the home’s reception area. Several internal self-audits were seen which had been carried out during the year 2005. These mainly assessed nursing care documentation, with 1 medication audit and 1 health and safety audit also. The validity of the evidence gathered in these is questionable as several had uncompleted action plans and timescales (despite the audit indicating that action was necessary) and it was unclear or illegible who had completed the audits and what their role and experience was. The nurse in charge had confirmed that relatives are given home questionnaires but there was no evidence to support this. A recent meeting had taken place with the home’s operations director, operations manager and project manager and 5 relatives on 11th January 2006. Minutes of the meeting were provided to the inspector, this being the first one held. As already documented in the environment section of this report, a tour of the unit revealed that several sash windows were broken or needed repair and there were holes seen in a wall and ceiling, sited directly next to electrical fittings. This increases the risk of injury to residents, staff and visitors and the latter is a potential fire risk. As mentioned previously training records showed that some staff have not received fire safety, health and safety and moving and handling training. A record of accidents to residents and staff was held appropriately although as previously stated, several incidents of aggression between a resident and other residents or staff had not been fully recorded. The home has failed to notify the Commission of recent incidents when residents were placed at risk of harm or injury by the behaviour of other residents. The Commission has therefore been unaware of these incidents and in consequence unable to provide staff with necessary guidance and information designed to minimise and properly manage the risks. Also there was no clear evidence of full investigation into accidents/incidents and any action that was taken following them. The home also needs to provide adequate control and restraint training for staff from a trainer, qualified to provide this training. All servicing certificates seen on the day of inspection were up to date and included emergency lighting, electrical testing, fire detection and alarm system and lift checks. There was no current gas safety certificate available as the manager informed us that this was held at the home’s head office. The fire doors seen were in working order. DS0000065834.V279940.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 1 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x 1 1 x x LIFESTYLES Standard No Score 11 x 12 1 13 1 14 1 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x x x 1 x x 1 x DS0000065834.V279940.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA14 Regulation 16(2)(n) Requirement Timescale for action 31/03/06 2 YA19 12(1) 3 YA20 13(2) 4 YA20 13(2) A programme of activities must be developed to ensure that all residents have the opportunity to engage in meaningful activities should they wish to do so. The previous timescale of 25/11/05 was not met. The emotional needs of the 07/03/06 residents must be assessed and where needed, specific advice/treatment sought and documented in a care plan. The previous timescale of 25/11/05 was not met. The home must have a clear 31/03/06 audit trail for medicines e.g. dating packs when they are started or entering a carry forward balance on the MAR chart and a system for regular monitoring of the audit trail must be introduced. The previous timescale of 26/10/05 was not met. Maximum and minimum 31/03/06 thermometers must be obtained so that nurses can monitor and record the temperatures (normal range 2-8[C]) of the fridges used to store medicines daily when in DS0000065834.V279940.R01.S.doc Version 5.1 Page 29 5 YA20 13(2) 6 7 YA20 YA22 13(2) 22(3) 8 YA23 13(6) 9 YA23 37 10 11 12 YA24 YA30 YA30 13(4) 13 & 23 13(3) 13 YA32 18(1) 14 YA33 18(1) 15 YA34 19 & Schedule 2 use. The previous timescale of 26/10/05 was not met. The manager must make arrangements for disposing of medicines in accordance with current legislation. The previous timescale of 26/10/05 was not met. The manager must ensure that staff are aware of the current medication policy. The home must follow its procedure for dealing with complaints and ensure that all complaints are fully investigated. The registered person must make arrangements, by training staff or by other measures, to prevent residents being harmed or being placed at risk of harm or abuse. The home must report to the Commission any event in the care home adversely affecting the well-being of any service user. The home must be well maintained and repairs made in a timely fashion. Clinical rooms must be kept clean and have soap available for hand washing. Staff must adhere to the home’s infection control policy and dispose of clinical gloves and aprons appropriately. All care staff must receive training in Huntingdon’s disease, acquired brain injury care and control and restraint. The registered person must ensure that where residents’ needs increase, sufficient staff are on duty to meet those needs. New staff must only be confirmed in post after a satisfactory CRB and POVA first DS0000065834.V279940.R01.S.doc 28/02/06 28/02/06 31/03/06 31/03/06 14/02/06 31/03/06 14/02/06 31/03/06 31/03/06 31/03/06 15/02/06 Version 5.1 Page 30 16 YA34 19 & Schedule 2 17 YA35 18(1) 18 19 20 YA36 YA39 YA42 18(2) 24(1) 13(5) 21 YA42 13(4) check has been carried out. The previous timescale of 18/01/06 was not met. The staff already employed at the home who do not have satisfactory CRB and POVA first checks or references must only work under supervision. The previous timescale of 18/01/06 was not met. The registered person must ensure that care staff receive the common induction training or the induction and foundation training to Sector Skills Council specification. Previous timescales of 01/11/05 and 31/12/05 were not met. Care staff must receive formal supervision at least six times a year. An effective quality monitoring system must be implemented. All staff must receive accredited manual handling training. The previous timescale of 31/12/05 was not met. All staff must receive fire safety training at regular intervals as recommended by Dorset Fire and Rescue Service. 15/02/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 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 2 Refer to Standard YA1 YA8 Good Practice Recommendations The service user guide should be made available to all residents and their relatives. The home should consider setting up a supported forum on Cloisters unit for service users to air their views and participate in decisions taken regarding the running of the unit. DS0000065834.V279940.R01.S.doc Version 5.1 Page 31 3 4 5 6 7 8 YA12 YA14 YA19 YA24 YA24 YA20 9 10 YA32 YA39 This recommendation has been made in both of the two previous reports. All residents should have access to further education and training. This recommendation was also made in the last report. The home should consider facilitating a sensory room to meet the specific needs of residents on Cloisters. The home should calibrate the residents’ weigh scales to ensure they are accurate. The second passenger lift should be repaired which would improve access for residents to all parts of the home. Suitable methods of heating should be in place in en-suite bathrooms. Staff should record the date of opening medicines with a limited life so that they are not used beyond the in use shelf life. There should be a system for checking expiry dates and removing out of date products from stock. A minimum ratio of 50 of care staff should have the NVQ level 2 award in care or equivalent To aid effective quality assurance, the registered person should seek feedback from the residents. This recommendation was also made in the last report. DS0000065834.V279940.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000065834.V279940.R01.S.doc Version 5.1 Page 33 - 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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