Inspection on 14/02/08 for Clarence House

This inspection was carried out on 14th February 2008.

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

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

Clarence House 08/03/10

Clarence House 10/11/09

Clarence House 15/10/08

Clarence House 16/04/07

Clarence House 29/08/06

Clarence House 10/04/06

Clarence House 03/11/05

Clarence House 28/04/05

Clarence House 11/01/05

Clarence House 20/10/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Clarence House 42 Warwick New Road Leamington Spa CV32 6AA Lead Inspector Patricia Flanaghan Unannounced Inspection 14th February 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clarence House DS0000040534.V359974.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. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clarence House Address 42 Warwick New Road Leamington Spa CV32 6AA 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) 01926 832826 01926 882677 Dr Jeyaratha Sivasoruban Mr Kanagasabai Sivasoruban vacant post Care Home 21 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (16) of places Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. RECOMMENDED CONDITIONS OF REGISTRATION That the Registered Manager enrols for appropriate training to obtain a qualification in the management of a care home at NVQ Level 4 and that he obtains this qualification by 1 April 2005. That until the Registered Manager has obtained a qualification as a care home manager at NVQ Level 4 the Registered Providers will employ a person as Deputy Manager who is suitably experienced/qualified in the supervision of staff who are providing personal care to elderly people. That on any change of Deputy Manager the Registered Providers will notify the Care Standards Commission of the name and qualifications of the new Deputy Manager. Date of last inspection 9th July 2007 Brief Description of the Service: Clarence House is a large Victorian property that was converted from a hotel to a care home in 1984. The home has parking to the front and garden at the rear. There is a ramped access to the front door. The home is situated ¾ of a mile from the town centre with all major facilities readily accessible. The home provides care for 21 older people (including 5 people with dementia care needs) with a wide range of needs, e.g. physical disability, sensory loss, general frailty and other conditions often associated with old age. The accommodation is arranged on three floors, there is a shaft-lift and a chair lift to ensure accessibility. On the ground floor there are two communal lounges with a dining room situated between them. Also on the ground floor there are four single bedrooms and one double bedroom. On the first floor and mezzanine floors, there are seven single and one double bedroom. On the top floor there are a further three bedrooms, one of which is a double room with an en suite. Information provided in the home’s service user guide stated that the fees ranged from £338 to £465 per week. Additional charges are made for newspapers, hairdressing, chiropody and dry cleaning. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was the second key unannounced inspection of this year. Two inspectors carried out the inspection, which took place on Thursday 14th February 2008, commencing at 8:30am and concluding at 7:30pm. We had requested that the home completed an Annual Quality Assurance Assessment (AQAA) and return it to us, however this was not received despite the home being given a statutory notice to complete this. The completion of the AQAA is a legal requirement that the provider must complete. This is designed to help the service provider focus on the quality of the service provided and its strengths and weaknesses. Since the last key inspection in April 2007 an inspection were undertaken by our pharmacist inspector in September 2007 to examine medication procedures. We visited the home again in October 2007 to check on compliance with the requirements set at the two previous inspections. There was some evidence of improvement found during the inspection visit in October. This key inspection visit showed some improvements in a number of key areas and it was evident that the provider is making some progress in ensuring Clarence House is meeting regulations and national minimum standards of practice. There are other areas where improvements have not been made and these continue to put the people who live there at risk and do not safeguard them from harm. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. On the day of inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home, conversation with the registered provider and care staff plus visitors and some residents. Some residents were unable to communicate their views verbally to us, so direct and indirect observation was used to inform the inspection process. Four people who were staying at the home were ‘case tracked’. This involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 6 We had the opportunity to meet a number of the residents by visiting them in their rooms and spending time in communal areas. We talked to several of them about their experience of the home. People were seen in their usual surroundings and the interaction between staff and residents was observed. We received two complaints about Clarence House. Issues identified in these concerns were assessed during this inspection and the outcomes reported in the appropriate area of this report. What the service does well: What has improved since the last inspection? What they could do better: The home is not well managed and this has resulted in the failure to implement improved outcomes for the people living in the home. The written planning of care is poor and the files are not well organised. There is a lack of risk assessments to help staff recognise where risk exist and what to do to reduce these. There are limited records regarding visits from GPs, District Nurses and other professionals. This does not ensure that the people who live at this home receive all the care they need. A proper fridge that is lockable for medication to be stored is needed to ensure that medicines that need refrigeration are kept safely and at the right temperature. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 7 Risk assessments are poor and do not tell the staff the level of risk to each person who lives there. This means that there is no care plans to help staff work with the individual to reduce the risk and therefore each individual is at risk of harm. Some staff do not know how to manage behaviours that are challenging such as verbal and physical aggressive behaviours. They do not know how to recognise a change in behaviour and to prevent this escalating. This puts all those in the home at risk of abuse. There is an absence of social and therapeutic stimulation therefore service users are not engaged and do not have opportunity to pursue hobbies or to develop and participate in any new interests. Suitable activities designed to meet the individual needs of service users requiring specialist dementia care are not made available. Further staff training is required to ensure staff have the appropriate skills and knowledge to care for residents effectively and in a consistent manner. The number of shifts that staff work without a day off should be monitored to ensure that this does become excessive as this may impact on the quality of care and increase the risk of abuse. The registered provider must make sure we are advised of any accident or incident that affects the health or welfare of service users. Arrangements must be made to ensure that senior staff are aware of the procedure to follow if an allegation or suspicion of abuse is reported to them. This is to protect the people living in the home from potential harm. Arrangements must be made to make sure staff are updated in Safe Moving and Handling techniques. This is to make sure that residents and staff are protected from the risk of harm due to incorrect moving and handling techniques. An annual quality audit seeking the views and opinions of residents, their relatives and other stakeholders must be carried out and an internal audit used to address any gaps in service delivery. A copy of the findings should be distributed to stake holders and a copy displayed in the home. The Annual Quality Assurance Assessment (AQAA) must in future be completed and returned to us within the legal timescale. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Clarence House DS0000040534.V359974.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 Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 & 3 were looked at. Quality in this outcome area is adequate. Residents know before admission that the home can meet their needs as a full assessment is completed. Initial plans of care are poor and this could result in the assessed needs not being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the Service User’s Guide (SUG); each resident has one in their room, it is not clear if the resident or their representative is given one of these prior to admission. The SUG needs up dating in a number of areas as shown, smoking policy needs to be clear, staffing information such as numbers, qualifications, and the management needs to be clear. The complaints process is out of date; the address for us needs updating and the name of the inspector is also wrong. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 11 The management structure of the home and organisation is unclear in the complaints process, this is required to ensure that those who use the service would know who to contact depending on the concern they would wish to raise. The most recent report was not made available, this is important so that people thinking about using this service have an idea about how well the service is run. Also those who live there should have a copy. Four profiles of people using this service were examined to determine if the information required to ensure that the service can meet their needs is carried out. One profile seen was from a person who had entered the home five years ago. The information available was limited. The remaining three profiles showed us that a full assessment was undertaken and the needs of each person were clearly recorded. Each person also had a social service assessment and initial care plan. This is good practice and shows that individuals wishing to use this service are fully assessed before being offered a place. The care plans developed by the home for the assessed needs are not always available, and those that have been completed lack detail to ensure that all staff are familiar with the needs and challenges of each person. Good written care plans enable staff to develop the same way of working with each person, which is particularly important in dementia. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were looked at. Quality in this outcome area is poor. Residents cannot always be confident that their needs are being met and that they are safe at all times through the practice of managing challenging behaviour. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people were ‘case tracked’. This involves reading all information written about them, checking if care prescribed in the care plans matches the care given, talking to them to find out how they experience their care and checking their environment to ensure it is suitable and meets their needs. Risk assessments were available but in all cases these were not completed properly and did not show us the level of risk for the person. There were no care plans to tell us how these risks would be managed and what actions staff Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 13 should take to reduce the risk. This does not ensure that all staff respond to risks in the same way and this may put the person at risk of injury and harm. The quality of the written plans is poor. They lack detail to tell the staff what is required to meet the needs of each person. For example one person had recently sustained a broken ankle, the GP had informed the home that this person could weight bear to transfer but could not mobilise. The care plan had not been up dated and showed that this person was mobile. Staff told us the care this person required and were seen assisting them to move as required by the doctor. A mental health assessment from the mental health team diagnosed that one person had difficulty understanding and finding words. There was no care plan to state how staff should approach this person and what to do to assist them to understand. This person also had episodes of aggression, both verbal and physical, there was no written information to say if the staff had investigated this, how frequently this occurred and what may have triggered the behaviour. The manager had reported this to the GP but suitable action had not been taken. There was written records showing that everyone is weighed. This is not done regularly each month, and it was not possible to tell from the records if this was due to the person refusing or another reason. The recording of weights has not prompted staff to question the individuals’ weight. For example one person weighed 10 stone in October, 11 stone 5 pounds in November and 10 stone 8 pounds in January. There was no information to show that an increase of 1 stone and 5 pounds was questioned. The overall management of people with dementia is poor, there is a lack of understanding and planning the care of those with challenging behaviours due to hallucinations and paranoia. This has resulted in a number of aggressive incidents between some of the people living at the home. As there are no clear plans on how this should be managed and what can be done to reduce the risk of aggressive outbursts as a result the people who live there and the staff are at risk due to inconsistent approaches to incidents. One person was heard to become distressed during the early evening, and a staff member was trying to calm them down. This staff member was challenging and began to argue with the individual increasing their aggression and frustration. The staff member eventually asked the provider to deal with this, which he did. This shows that some staff are not suitably trained to deal with this type of behaviour associated with dementia, and they put the person and themselves at risk of harm. Overall care planning was poor and the level of understanding and suitable training of staff compounds the poor care that people with dementia receive. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 14 Medication management was looked at and two staff were spoken to. It was found that this was managed well and improvements made had been sustained. A full audit of medication and administration is done on a monthly basis, we were told that this was to increase to weekly to pick up error earlier and to develop an action plan to deal with these. No mistakes were found at this time. The Medication Administration Records (MARs) were completed properly and showed when medication was given. The staff on duty that assisted with checking the medicines was knowledgeable about the medications, what they are used for and discussed the proper use of covert medication and selfmedication. No one at present is self-medicating. The use of sedating medication is low and this is good practice. A staff member was observed giving out medication and this was done in a sensitive manner. She stayed with each person until they had taken their medication, and asked before preparing the medication if the person wanted painkillers or not. The MARs were completed after the medication was taken. Three records were looked at and the medications checked. These showed that the correct amount of medication had been given as prescribed by the doctor. The fridge used to store medication is inadequate. It is a small drinks fridge with no lock and kept in the lounge area. A proper medication fridge is required that is lockable and a more suitable place for storage should be found. The temperature of this fridge was too high and the staff were not checking the minimum and maximum temperature to ensure that medicines requiring refrigeration were safely stored. Staff used each person’s preferred name and recognised that each person is individual. They were careful to maintain the dignity of each person and all personal activities were carried out in private. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were looked at. Quality in this outcome area is adequate. Social, and recreational activities are limited and therefore do not meet the needs or expectations of residents. Open visiting arrangements encourage regular contact with relatives and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the day individuals were sitting for long periods in the lounge and dining area with nothing to do. Some watch the television, which was on all day, while others slept on and off. There was a lack of stimulating activity. We were told that a physical activity programme took place every Wednesday, which residents enjoyed participating in. In the afternoon a staff member played with a soft ball and some of the people for a short time, and in the morning a volunteer arrived and three people joined her to complete their albums. There was a lack of activity for those people with poor short-term memory and those who find it difficult to participate because of their disability. This was because most of the activities provided required a level of concentration and memory recall that people with Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 16 dementia often no longer have. For example, board games, cards or dominoes. Newspaper and a magazine were seen and three residents were seen looking at this. Staff spent time talking to residents on a 1-1 and small group basis. There was no evidence in the profiles of residents’ wishes to participate in activities and there was no record of any activities participated in and if it was enjoyed or not. Of those ‘case tracked’ there were four profiles with a history completed by a family member, which gave an indication of past likes and dislikes, hobbies and activities undertaken. There was no visual or written information to tell us that this had been considered when deciding on the type of activities to introduce. Arrangements for visiting were flexible enabling relatives to visit at a time that suited them and residents to maintain contact with them. Relatives spoken to at the time of inspection stated that when they visited they found staff pleasant and they were kept informed of any incidents. The dining room is situated at the front of the house and this has greatly improved the dining facilities. Lunch was observed, the meal looked appetising and most residents ate a good meal. Each resident was offered a hot and cold choice. The dining room is bright with sufficient daylight and good electric lighting. Tables are round and seat four residents comfortably. Most residents ate at the table together. The Environmental Health office had served an Improvement Notice in September 2007 on the home for poor practice in the kitchen. This related to the safety of reheated meat and refrigerator temperatures being too low. This notice has now been met. Staff did not remain in the dining room to see residents were happy with their meals and encourage them to eat. We saw two residents leave the dining room without eating their meal and staff did not ask them if they had finished. This is not good practice as those with dementia can forget what they are doing, or have done very quickly. This is a demonstration that staff may not be fully aware of the impact of dementia on daily abilities and how this impacts on the individual’s capacities to met their needs. There was an increase of agitation in the afternoon and more residents wandering around the lounge, dining area and corridors on the ground floor. There appears to be a lack of staff recognising this increase in agitation and dealing with it effectively. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were looked at. Quality in this outcome area is poor. The people who live here cannot be confident that they are safe and free from harm due to poor knowledge and training of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the entrance hall. This ensures that residents and their relatives will know the process they need to take to make a complaint known. The registered provider said there had been no complaints received by the home since the last key inspection. We were unable to look at how well complaints were managed, as there was no information available from past complaints made. We received two complaints about staff issues in the home. The issues raised are addressed under the ‘Staffing’ outcome section in this report. A visitor to the home said that they felt confident in approaching any member of staff with a complaint if they needed to but they “had never really had a complaint”. There have been a number of incidents involving violent behaviour between the people who live at this home. From observation, care plans and discussion Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 18 with staff it was obvious that there is a lack of knowledge and understanding on how to deal with challenging behaviour associated with dementia. The management had failed to report these incidents to the safeguarding committee, which is available to protect vulnerable people from abuse. This shows that the management fail to recognise that violence from one person to another whether this is staff or the people who live there is abuse. There is confusion amongst the staff in regard to accidents and incidents; they were unsure what is an accident. This could impact on what action the staff take and put individuals at risk. We asked for evidence of any training staff have attended in relation to safeguarding adults and managing challenging behaviour. To date, this information has not been received. We cannot therefore be sure that staff have the necessary knowledge to ensure residents’ needs are met and they are fully safeguarded. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26 were looked at. Quality in this outcome area is adequate. The environment is varied throughout the home in relation to safety, comfort and hygiene, which might reduce the experience of quality of life for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A welcoming atmosphere was evident in the home. Residents walked about the home freely making use of all the communal areas. A tour of the environment took place, which identified that there continues to be a number of maintenance and renewal of fabric and decoration needs in the premises. For example, although the communal areas have been ‘refreshed’ some of the carpets in bedrooms are thin and ‘wrinkled’ and walls needed painting or re-papering. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 20 Radiator covers are not in use in all areas within the home and radiators are not of a low surface temperature type. For example, the radiator in a corridor by the kitchen was very hot. As this was directly underneath the ‘grab’ rail, people could inadvertently burn themselves. The back garden is small and laid out with lawn and some shrubs. Behind a fence, which is accessible to everyone, there are a number of old cars and broken equipment from the home. Those people who live there could have an accident in this area, and this would be made worst by the rubbish. We visited nine bedrooms. The quality of the furnishings and fittings in residents’ rooms varied. We saw handles missing on drawers in two rooms and a broken wardrobe door in another room. Some of the bed linen being used was very worn and pillows were thin and ‘lumpy.’ Call systems in rooms are accessible to residents, although the arrangement of the beds in a shared room means the call bell is not available to one of the residents when they are in bed. Some residents had taken the opportunity to personalise their room with some of their own belongings, such as quilt covers, cushions, ornaments and photographs. This identified these rooms as ‘belonging’ to that person. One person’s room, which they smoke in, was visited. The door from the vanity unit around the sink had come off and was propped against the unit. The décor was old and much of the furniture was old too. There are no signs to indicate that smoking occurs in this room as required by the new smoking laws. The provider has fitted some ventilation, but the window is left open, as a result this room was cold. The home was generally untidy, the small conservatory had a lot of odd bits of furniture and it would not be easy to use this room for visitors or other activities. The laundry has one industrial washing machine and two driers to support the laundry needs of the home. Baskets were clearly labelled for dirty and clean washing and there were numbered baskets for each service user. There were no hand wash facilities with soap and paper towels in the laundry to maintain good infection control practices. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is poor. There are sufficient care staff available to meet the needs of residents but it is not clear that all staff have completed the required training to ensure residents are cared for safely. Recruitment procedures are not consistently robust to safeguard vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection visit it was evident that the numbers of staff on duty were sufficient to meet the physical personal care needs of people living in the home. Evidence in the ‘Activities and Daily Living’ section of this report demonstrates that there are not enough staff available to support people with their social, psychological or recreational needs. It was noted that there are always staff available in the lounge, but they did not deal with distressed individuals immediately, which resulted in increased distress and frustration. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 22 The registered provider confirmed that the usual staffing complement for the home is: 7:45am – 2.00pm 1:45pm – 9.00pm 8:45pm –8.00am 1 Senior Carer in charge supported by 3 Care Staff 1 Senior Carer in charge supported by 2 Care Staff 2 care Staff There is a cook and a kitchen assistant in the kitchen between 8am and 2pm every day of the week. There are 2 domestic staff employed undertaking cleaning and laundry duties in the home. The examination of three weeks of duty rota between 28th January 2008 and 17th February 2008 confirmed that the staffing complement in the table above is achieved. We received a complaint alleging that staff were “overworked and tired.” An examination of the duty rota indicated that some staff work ‘ long’ shifts. For example, the duty rota for 28th January to 3rd February stated that one staff member had worked a total of 57 hours in week. We discussed this with the registered provider who said he was aware of the necessity for staff to work within the hours set in the Working Time Directive. He said he would be monitoring staff hours in the future. Although we found staff working excessive long shifts no regulations had been breached. We were able to evidence that some staff had attended training in Dementia Awareness in December 2007, Parkinson’s Disease in October 2007 and Mental Health Awareness in November 2007. We asked for details of training undertaken by all staff since the last key inspection in April 2007. The registered provider was unable to provide up to date records, but undertook to forward the information to us in a timely manner. To date, we have not received that information. The absence of evidence of attendance at training sessions does not demonstrate that staff have the appropriate skills and up to date knowledge to be able to carry out their role to meet the diverse needs of the people living in the home. We looked at four staff personal files. Records of staff employment remain poor and did not give the detail required to show a robust employment procedure. One person’s file contained only one photocopied reference, which was not dated, was not clear about who was giving the reference and was not checked as to its validity. There was no record of an interview or discussions about gaps in work history being explored. Some records did not have a start date. We cannot, therefore, be sure that Criminal Records Bureau (CRB) checks had been undertaken before the start of employment in some cases. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 23 Records of staff induction were not meeting the requirements from the Skills for Care organisation. They were not signed and dated for each element that had been shown and discussed with the new member of staff. There were no application forms for two members of staff who had been recruited through an employment agency. There were no references on either file, only one from the recruiting agency stating that the person “proved herself a valuable asset with her previous employer in India.” A copy of the original reference was not available. Another file contained an application form listing two references, one of which was the person’s most recent employer. These references had not been taken up by the home. The registered provider was unable to explain why this had not been done. The registered provider must improve recruitment practices in the home to protect and safeguard the people living there. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were assessed. Quality in this outcome area is poor. The home is not well managed and this has resulted in the failure to implement improved outcomes for the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The management of this home is poor. There is a lack of clear lines of management and responsibility. The manager, who was in the process of registering with us, has left. The registered provider told us that he is seeking to employ a further care manager and he will consider reapplying to us to become the registered manager of the service. He told us he will have obtained his National Vocational Qualification (NVQ) Level 4 in Care and Registered Managers Award (RMA) by May 2008. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 25 We had requested that the home completed an Annual Quality Assurance Assessment (AQAA) and return it to us, however this was not received despite the home being given a statutory notice to complete this. The completion of the AQAA is a legal requirement that the provider must complete. This is designed to help the service provider focus on the quality of the service provided and its strengths and weaknesses. A further AQAA will be sent to the provider for completion later this year. There was some evidence of a formal quality assurance and monitoring process. We were shown some quality questionnaires that had been returned by residents or their families. However, although some issues had been raised, an action plan had not been implemented to demonstrate how improvements needed to the service are being actioned and timescales involved. Measuring the quality of the service provided by the home would provide information to demonstrate whether the home is meeting the needs of the people living in the home. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of three residents’ personal monies was found to be correct. Health and safety is not always well managed for example, observations showed a person being transported in a wheelchair without the foot rests being in place. This increases the risk of entrapment of a person’s feet or legs if they are unable to hold them up while the wheelchair is moved. Other areas that could compromise the health and safety of residents have been mentioned throughout this report. Examples of these are related to poor employment practices and poor maintenance of care plans. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement Care plans for all residents must be developed to show where needs need to be met and how this is to be done. All health and psychological care needs must be clearly recorded on the care plans so that staff give care in a consistent manner ensuring the best outcomes for the residents. Risk assessment must be completed for each person to demonstrate the level of risk. A suitable plan of action must be developed to ensure the best outcome for each person. This should include physical risks and challenging behaviours. Timescale 14/05/07 and 10/10/07 not met 4 OP8 12 All residents must have access to 30/04/08 professionals, such as GPs, District Nurses and others. This must be documented and care DS0000040534.V359974.R01.S.doc Version 5.2 Page 28 Timescale for action 31/05/08 2 OP7 13 31/05/08 3 OP7 13(4) 31/05/08 Clarence House plans up dated where new information is available. 5 OP8 13 All residents must be weighed and where there is an unplanned weight loss or gain advice must be sought and actions put into place to monitor this. 30/04/08 6 OP18 13 Incidents of aggression between 30/04/08 residents must be reported under Regulation 37 Notifications and the social worker of the individuals involved informed. This will assist in ensuring that appropriate actions are taken to safeguard vulnerable individuals. Arrangements must be made to ensure that senior staff are aware of the procedure to follow if an allegation or suspicion of abuse is reported to them. This is to protect the people living in the home from potential harm. Staff should receive training on Adult Protection and the Management of Challenging Behaviours and Restraint. 31/05/08 7 OP18 13 8 OP29 19 Schedule 2 Sufficient information must be secured to determine the fitness of potential employees before they start working at the care home. To include: The outcome of a Criminal Record Bureau (CRB) disclosure or checks against the Protection of Vulnerable Adult PoVA) register Two written references, including where applicable, a reference relating to the person’s last period of employment, which involved work with vulnerable DS0000040534.V359974.R01.S.doc 30/04/08 Clarence House Version 5.2 Page 29 adults of not less than three months duration A full employment history, together with a satisfactory written explanation of any gaps in employment. This is to ensure that the home’s staff recruitment practices safeguard residents. Timescale 14/05/07 and 10/10/07 not met 9 OP10 16(2) Privacy screens must be available for use in shared occupancy rooms so that the residents’ can be sure that their privacy and dignity is promoted and maintained. Timescale 14/05/07 and 10/10/07 not met 10 OP30 18 All staff must receive training appropriate to the health, personal and safety care needs of the people in their care. For example: • • Dementia care Health and Safety 31/05/08 30/04/08 This will ensure the safety of people who live in the care home, that staff are trained, and competent to meet their care needs. 11 OP30 18(1) All staff should receive training to enable them to deal effectively with challenging behaviours associated with dementia. This should also include training in activities suitable for this group of people. 31/05/08 Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 30 12 OP31 8 A suitable person must be appointed to manage the care home. This will ensure that people live in a home that is well managed and considers their best interests. Staff must be suitably trained in moving and handling people so that the staff understand what methods are to be used and residents are not placed at risk of harm or injury because of unsafe staff practices. Timescale 10/10/07 not met 31/05/08 13. OP38 13(5) 30/04/08 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 OP7 Good Practice Recommendations Where bedrooms are shared, the impact of any change in an individual’s needs should be considered for each person sharing the bedroom. Information should be made available to demonstrate how oral hygiene needs are met. It is advised that a homely remedy policy is written and endorsed by the doctor for any medicine purchased to be administered as a homely remedy. In addition a self-administration risk assessment policy should be written to support any service user wishing to self administer their own medicines. All medicines prescribed on a when required basis should have a supporting protocol to ensure they are only given Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 31 2 3 OP8 OP9 when needed and not routinely. 4 OP12 Individual profiles should be further developed and where appropriate used to inform care planning. Appropriate recreation/stimulation should be provided every day to meet the assessed needs of the residents. Staff should be given the necessary time, skills and training needed to carry out reminiscence activity, which has been shown to play a powerful part in maintaining identity in older people, as well as allowing a relationship to develop between residents and staff. Residents should be consulted about a programme of activities that takes into account individual and group needs. Details of planned activities should be displayed in the home so that residents are aware of what is planned for the day and can plan their time accordingly. Daily records should include detail of the activities residents participate in and include a record of the outcome for the resident. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. 5 OP15 Alternatives offered to the main meal should vary each day so that residents are not at risk of not having their nutritional needs met. Residents should be encouraged and supported to eat their food. In the event that the resident declines then a suitable alternative should be offered. Staff should be aware of residents dietary needs so that the home can be sure individual needs are met and resident not placed at risk. The registered persons must ensure that all staff are aware of the assistance needed by each resident at meal times. These needs must be clearly documented in their care plans. Sufficient staff must be available at mealtimes to give one to one attention where needed. 6 OP24 The carpets in the bedrooms must be maintained in a good state of repair to prevent residents from tripping and falling where this is worn or poorly fitted. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 32 7 OP26 Hand washing facilities, soap and paper towels should be available in the laundry to maintain good infection control practices. The manager is advised to consider fitting a hand wash sink in this area. Staff should not work what may be considered to be excessive hours, as this may impact on the health, safety and welfare of service users and the staff. Greater effort is needed to increase the number of qualified staff to NVQ or equivalent so that residents benefit from having their needs met by a suitably qualified workforce. The manager should make sure that references obtained for prospective staff members contain information about their character, skills and competency so that people living in the home are protected by robust recruitment procedures. It is advised that an “at a glance” training schedule is devising showing all staff training completed and planned each year. This is so that it is clear all staff have completed the required training to provide safe care and services to the residents. A suitable system for reviewing and improving the quality of care provided must be implemented to demonstrate that the home is being run in the best interests of those living in the home. This will ensure that people who use the service are receiving a quality service, which is continuously reviewed and improved. 8 OP27 9 OP28 10 OP29 11 OP30 12 OP33 13 14 OP38 OP38 All service users should have easy and safe access to a call alarm. Radiators within the home need be risk assessed in regard to these being low surface temperature or guarded to prevent burn risks to residents. Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clarence House DS0000040534.V359974.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!