Inspection on 04/01/08 for Clifton Meadows

This inspection was carried out on 4th January 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

Clifton Meadows 20/08/08

Clifton Meadows 16/04/07

Clifton Meadows 09/03/06

Clifton Meadows 02/08/05

Clifton Meadows 17/03/05

Clifton Meadows 03/09/04

Clifton Meadows 26/01/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Clifton Meadows Badsley Moor Lane Rotherham South Yorkshire S65 2BA Lead Inspector Ramchand Samachetty Key Unannounced Inspection 09:30 4th January 2008 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 DS0000003101.V355686.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. DS0000003101.V355686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clifton Meadows Address Badsley Moor Lane Rotherham South Yorkshire S65 2BA 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) 01709 838639 01709 838913 jan.scott@anchor.org.uk keri.sherwood@anchor.org.uk Anchor Trust Janice Linda Scott Care Home 65 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (40) of places DS0000003101.V355686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th April 2007 Brief Description of the Service: Clifton Meadows is registered to care for 65 older people, 40 of whom being in the category of old age and 25 older people with dementia. It is owned and managed by Anchor trust, which is a national voluntary organisation providing a range of services for older people. The Home is situated in the residential area of Clifton, within easy reach of Rotherham town centre and other leisure facilities, including Clifton Park and Herringthorpe playing fields. The Home consists of 2 two-storey buildings, adjacent to each other. It also shares its premises with some units of sheltered accommodation, which are provided by its parent organisation, Anchor Trust. One of the buildings (Wentworth Lounge) has been specifically redesigned to provide a service for people with dementia. All residents bedrooms are single and have en-suite facilities. Bedrooms and some communal facilities are grouped in smaller units to facilitate group living. Each building is equipped with a kitchen, a laundry, dining areas, lounges and a range of hygiene facilities. Meals are prepared in only one of the buildings and it is transported to the other building in a heated trolley. There is a passenger lift in each building to facilitate access between the floors. There are some garden areas and car parking spaces around the Home. The home has produced a statement of purpose and a service user guide. The current scale of charges, at 7th. January 2008, range from £353.00 to £455.00 per week. Further information can be obtained from the home. DS0000003101.V355686.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 that the people who use this service experience poor quality outcomes. This key unannounced inspection was carried out on 4 and 7 January 2008, starting at 09.30 hours on the first day and finished at 18.00 hours. On the second day, the inspection started at 10.00 hours and finished at 16.30 hours. There were 62 people in residence at the time of this inspection, 22 of whom lived in the unit for people with dementia. The manager was not present on both days of this inspection. A deputy manager was present for a short time and two senior care staff were in charge, one in each of the two units. The Area Manager, Ms Carole Townend attended the home during part of this inspection. The inspection included a tour of the premises, examination of care documents and other records, which included medication, complaints and staff files. We spoke to twelve people living at the home, eight relatives and four volunteers, who were also members of ‘Friends of Clifton Meadows’. We spoke to seven members of staff besides the Home Support Manager. The care of three people who use the service was examined and some aspects of care were observed. Feedback on our findings was given to the senior members of staff and also to the Home Support Manager. We would like to thank all the people living at the home and their visitors, in particular the ‘Friends of Clifton Meadows’ and staff who helped with this inspection. What the service does well: There is a good and committed staff team, which is working hard to provide as good a standard of care as they can. People who use the service praised the care staff, who they described as ‘hard-working and friendly’. The accommodation and facilities, on the whole, continue to be of good standard. People living at the home said that they found it to be comfortable. People at the home were proud of their association with the local community and with their own ‘Friends of Clifton Meadows’ group, which undertakes fundraising activities in order to provide a range of recreational and social activities and other forms of assistance. DS0000003101.V355686.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although the statement of purpose and service user guide had been reviewed after our last inspection, these documents need further improvement. They should give more information about the service that is provided for people with dementia and other information as contained in the relevant guidance and regulations. The manager and her staff need to make sure that the new care planning system is used appropriately. Care plans must be developed, implemented and regularly reviewed. Proper records must be made of the care provided to people who live at the home. The management and audit of medicines need to be improved in order to safeguard the health and wellbeing of people who use the service. It is important for staff who administer medicines, by any agreed methods, to be trained and competent to do so. Management and staff need to review and improve the provision of social and recreational activities with regards to the needs and capabilities of people who use the service, in particular those who experience dementia. Although the meals service is generally good, people must be given opportunities to make effective choices for their meals. It is also vital that people who need help with eating their meals are appropriately assisted to do so. The complaints procedure needs to be reviewed to make sure that the timescale for dealing and concluding with complaints is clearly stated. There is also a continuing need to improve the management of complaints. The manager and staff must consider how to manage the storage of goods and equipment so that private and communal facilities are freed from unnecessary clutter and avoid potential health and safety hazards. Furthermore, they must make sure that the home is kept clean and free from malodours at all times. DS0000003101.V355686.R01.S.doc Version 5.2 Page 7 The registered provider must take action to ensure that there is sufficient care staff working at the home at all times, in order to fully meet the needs of people who use the service, in particular those who experience dementia. Consideration must be given to the lay out of the buildings and to non-care duties that are expected of the care team. At this inspection, we served the service provider with an immediate requirement to increase the number of care staff who work in the unit for people with dementia, in order to safeguard their health and wellbeing. There is a need to improve the recruitment and selection procedures used at the home in order to make sure that all pre-employment checks are appropriately sought and obtained before staff are employed to work. The manager needs to review the training needs of all care staff and take action to address any shortfalls, some of which are highlighted in this report. The manager must also make sure that a plan for the provision of staff support and supervision is developed and implemented. We recommend that the management roles at the home be reviewed in order to bring more clarity on managerial responsibilities and accountability. Records with regards to the management of the home, such as accounts and staff training need to be appropriately kept and made available as required. There is also a need to make sure that maintenance of all equipment is carried out as recommended. The registered persons must ensure that appropriate quality monitoring methods and quality assurance system are available and are effectively used in order to improve the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000003101.V355686.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000003101.V355686.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Insufficient information was provided about the home and its specialist services and this could affect the choice that people make about their placement. Assessments of needs were carried out before people were admitted to the home in order to make sure that their care needs could be met. EVIDENCE: The statement of purpose and service user guide was available at the home, but they were not clearly displayed and were not easily accessible to those who wanted to refer to them. The statement of purpose was a corporate one issued by Anchor Trust. There was an additional brochure giving information about the home. Both documents still had gaps in the information they provide and DS0000003101.V355686.R01.S.doc Version 5.2 Page 10 were not in line with the care homes regulation. The service user guide did not give information about its arrangements for the delivery of care for people who experience dementia. It also did not contain a copy of the most recent inspection report. Some people who use the service and their relatives told us that they chose the home on the recommendation of friends and acquaintances and they felt they had enough information to do so. The care files of two people who had recently been admitted to the home were checked. They showed that their needs were assessed before their admission. The assessments were undertaken by both the local care management team and also by the home staff, in order to make sure the needs of people could be met. The home does not provide an intermediate care service. DS0000003101.V355686.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience poor quality outcomes in this area. We have made this judgement using available evidence, including a visit to the service. The personal and social care needs of people who experience dementia were not appropriately addressed and this had led to inadequate care being provided to them. The management of medicines was not satisfactory and this could adversely affect the health and welfare of people using the service. EVIDENCE: People who use the service and their relatives stated that they were currently satisfied with the care being provided at the home. However, they were starting to be concerned about staff’s ability to meet the care needs of people in a consistent manner because there was not enough staff at the home. They praised the care staff and described them as ‘good and friendly’. DS0000003101.V355686.R01.S.doc Version 5.2 Page 12 People using the service and who were able to express their views commented that personal care was provided to them in their own bedrooms or in bathrooms. This helped to maintain their privacy and dignity. However we noted that a few people who experience dementia were in poor attire for most part of the day. We also found that care and communication charts were left in peoples’ bedrooms and could be accessed by anyone who went in. This practice did not promote the privacy and dignity of the people concerned and it also did not uphold confidentiality. The care plans of three people using the service were checked. Two of the people concerned suffered from dementia. Although their full assessments included some of the care needs arising from their dementia, their care plans lacked relevant information on how these needs would be catered for. The assessment of one person included the need for regular social stimulation but there was no indication in his care plan on how staff would meet this need. We noted that in one instance a person who had been in the home for a few years had not had a recent review of her changing needs. There was therefore little guidance to care staff in their tasks of providing care to that person. We noted that the existing care plan documentation was poorly used and this led to a lack of relevant information on which to develop and implement a care plan. There was inadequate recording of care provided. In some instances there were no records of care provided at night. The reviews of care plans were ‘ticked’ as being done but it was not clear what information was used in undertaking such reviews and whether people who use the service and their representatives had been involved at all. Although the home had use of a policy on the management of medicines, it was not properly followed. Medicines received at the home were not appropriately recorded and therefore they could not be accounted for. In some instances the medicines administration records were not signed for medicines, which were either given or omitted. It was noted that items of medicines for topical administration were often kept in the bedroom of people who needed them, although they were not administering their own medicines. In one instance, instruction on when a topical cream should be applied was not adhered to. Members of the care staff were drawing up the amount of prescribed insulin to be administered by intramuscular injection to a person who suffers from diabetes and there was no evidence of staff being trained and competent to do so. It was also noted that an item of ‘controlled drug’, had DS0000003101.V355686.R01.S.doc Version 5.2 Page 13 been kept at the home for a long period after its use had been discontinued and it had not been returned to the chemist for disposal. The ‘Annual Quality Assurance Assessment’, which was submitted by the manager prior to this inspection, indicated that senior staff undertook a regular audit of medicine management. However, we found no evidence of these audits or their outcomes and therefore there was a failure to evaluate and improve practice in this field. DS0000003101.V355686.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There were not sufficient and appropriate social and recreational activities for people who experience dementia. People who use the service felt they were not being listened to and that they had fewer opportunities to exercise choice. EVIDENCE: The home is organised in two separate units. One unit provides accommodation and care for older people (Solway) and the other, a smaller unit, (Wentworth) for older people who experience dementia. On the first day of this inspection, which was a Friday, we noted that a coffee morning was being held in the Solway unit. It had been organised with the help of volunteers, who were members of the ‘Friends of Clifton Meadows’. A number DS0000003101.V355686.R01.S.doc Version 5.2 Page 15 of people, who live at the home, had attended with their relatives. We noted very little staff participation in that event. A number of relatives told us that they were thankful to the huge efforts that the ‘Friends of Clifton Meadows’ were making to ensure that people who live at the home could enjoy good social and recreational activities. They added that most activities that were organised by this group, helped to raise funds for the welfare of people who live at the home. One relative said ‘ thanks to the friends’ group, my mum always get a Christmas and a birthday present; not many homes can do that’. We noted that volunteers were also attending to set up for a variety show the next day. In discussion, people who live at the home commented positively on the activities of the ‘Gardening Club’. The friends group had recently obtained a grant to erect raised garden beds so that more people could take part in gardening. Some people told us that they had taken part in games like bingo and had enjoyed sessions held by visiting artists. Two people said that staff had taken them to shop in the local area. Some people said that they did not have the opportunity to go outside the home. One person commented that although there was a well- known park near the home, she had never had the opportunity of spending time there. People, who were more able to express themselves, commented that, on the whole, they were satisfied with the social and recreational activities that they were available to them. We noted that a part time activities co-ordinator was on duty at the unit for people who experience dementia. However, on several occasions, we found that she was helping with providing care to people in that unit. In discussion, she explained the efforts she was making to cater for the social care needs of people who experience dementia. There was no evidence that their social care needs were adequately assessed and addressed in their care plans. In one instance, the assessment of a person, with dementia and who had communication difficulties indicated the need for specific staff interaction, if he is not to loose his remaining ability, but his care plan only stated that he was to be referred to the activities coordinator. There was a record of some of the activities that had been organised for people with dementia, but this was kept separate from the care planning and care recording systems. It was therefore unclear how individual needs, preferences and capabilities were being catered for and evaluated. There was a weekly activities calendar but it did not reflect the preferences and capabilities of people who live at the home. DS0000003101.V355686.R01.S.doc Version 5.2 Page 16 On the second day of our inspection, which was a Monday, there was a planned ‘coffee morning’ in the unit for people with dementia. Again, this event was organised and run by ‘Friends of Clifton Meadows’. We noted that in proportion, fewer relatives were present. There was very little staff involvement in this activity, although we noted that thirteen of the 22 people in the unit were attending the coffee morning. Staff explained that they were attending to the needs of other people. A number of relatives also told us that they did not think there was sufficient staff working at most times. People who could express themselves stated that they were satisfied with the meals provided at the home. They were less happy about the opportunities they were given to choose their meals. They had been told that they could only choose their meals on the day rather than the day before. Notes of three residents’ meetings showed that people living at the home had not been satisfied with the reason given for the change and they felt they had not been listened to. The cook explained that people at the home could still choose their meals from the publicised menu. However, some people told us that they were not always able to choose their meals from the menus. We observed breakfast being served to some people on the Wentworth site. We noted that there was only one care worker in an upstairs dining room, where there were about eight people and three others in their own rooms. One person was served toast with marmalade. He was unable to eat the toast, as it was overdone and hard. He also had difficulty reaching the table from his wheelchair. As the care worker was attending to other peoples’ needs, there was no one else to help him. A few other people, who appeared to have difficulty taking their breakfast, were also observed being left without appropriate assistance. At lunchtime, we also observed people who appeared to need assistance with their meals being left unaided. We noted that the senior carer on duty at the Wentworth site was serving meals at the same time that she was administering medicines. Staff told us that they were not able to provide the assistance that is needed because there were not enough carers on duty. Concerns about the lack of care staff had also been clearly expressed to us by some people who live at the home and their relatives as an ongoing issue. DS0000003101.V355686.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): 16 and 18. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Complaints were not satisfactorily managed and this could affect the potential to improve the service. EVIDENCE: There was a complaints procedure in place and it gave information on how to make a complaint and who would deal with it. The procedure was included in the statement of purpose and a copy was displayed in the home. However, the complaints procedure did not give clear timescale within which a complaint would be investigated, in all three stages, and concluded. The home had received three complaints in the last twelve months. The records regarding these complaints were checked. There was little information about the nature of the complaints and about the investigations that had been carried out. People who use the service and their relatives told us that they were aware of the complaints procedure and would use it if necessary. They commented that they usually talked to staff if they had any concerns and these would be dealt with in a prompt manner. DS0000003101.V355686.R01.S.doc Version 5.2 Page 18 There was also an adult safeguarding policy in place to promote the safety and welfare of people living at the home. Staff were aware of this policy and most of them had received training on issues regarding the safeguarding of vulnerable adult. There had been no concerns about the safety and welfare of people using the service in the last twelve months. DS0000003101.V355686.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): 19 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There was inappropriate storage of equipment and goods in private areas that were used by people who live at the home and this could lead to health and safety hazards. EVIDENCE: The home provides its services from two adjacent buildings. A tour of both premises was carried out. One of the buildings provided accommodation for people with dementia. Its external doors were provided with security keypads to ensure the security and safety of the people who live in it. We spoke to a few of people who live at the home and their relatives. They said that they DS0000003101.V355686.R01.S.doc Version 5.2 Page 20 were generally happy with the standard of accommodation provided at the home. The premises were in good decorative condition. Corridor walls and doors were painted in different colours to assist people with dementia find their way more easily. A new relaxation and sensory room has been set up for use by people living in this unit. We noted that one bathroom for communal use, had been taken out of service in order to store some equipment and other materials. We viewed a few bedrooms with the permission of their occupants. Some people had brought in their own items of furniture and other personal memorabilia and were able to personalise their bedrooms. These bedrooms were found to be in good state of repair and adequately decorated. We noted that some parts of the bedrooms were dusty. The en-suite toilets and shower rooms were cluttered with equipment, continence products, personal items of clothing and toiletries. This clutter made the use of the en-suite facility unsafe for people. A small number of bedrooms had persistent malodour and some of the communal areas were found to be unclean. These parts of the home were therefore unpleasant. The other building, (Solway) provided accommodation for older people and this was organised in four ‘wings’. Each wing had a dining room with kitchenette facilities. We checked a few bedrooms with the permission of their occupants. They were found clean and well decorated. Again, we found that continence products and equipment had been inappropriately stored in the en-suite facilities. One person commented that she could hardly move in her en-suite toilet because of ‘things stored in it’. People who live in the ‘Solway’ building commented that in general, the facilities were good and that that the home was comfortable and pleasant. They were pleased with the efforts made by the ‘Friends’ Group’ to develop the garden and to make accessible to everyone at the home. Both buildings were accessible to wheelchair users. The surrounding grounds were adequately maintained for the time of the year. DS0000003101.V355686.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): 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The number of care staff deployed on duty was not wholly insufficient to meet the complex needs of people who use the service, in particular those who experience dementia. There were shortfalls in staff training and supervision and these could affect the health and welfare of people who use the service. EVIDENCE: The home was registered to care for up to 65 older people in the two buildings. The Solway unit was designed to accommodate up to 40 older people and the Wentworth unit up to 25 older people with dementia. At the time of this inspection, there were 22 people in occupancy at ‘Wentworth’ and 40 people in Solway. There were only two care staff and a senior carer on afternoon shift at the Wentworth unit. There were four care staff and a senior carer at the Solway unit. Each unit also had its kitchen and domestic staff. At Wentworth, we noted that a part time ‘activities coordinator’ was also on duty in the morning and that she was spending much of her time helping with care and domestic duties. DS0000003101.V355686.R01.S.doc Version 5.2 Page 22 At the Wentworth unit, we noted that people were not receiving care and assistance in a timely manner because there was not sufficient staff on duty. A number of people, including staff and relatives told us that the unit was consistently short staffed. We looked at the duty rota and they showed that the same low staffing level had been deployed for some time and indeed had been planned to continue. This staffing level was not based on the dependency of people living in the unit and was therefore wholly insufficient to meet the complex needs of people who experienced dementia. We made an immediate requirement for an additional member of care staff to be deployed on duty in order to safeguard people living in the unit and this was complied with forthwith. There were four care staff and a senior carer on duty at the Solway unit. One carer was deployed to work on each wing during the day. Staff told us that in instances where a person needed two carers to move and handle them, they had to summon and wait for a carer from another wing to come and help. They also commented that they were expected to undertake some non-care duties like tidying up parts of the home and laundry tasks. In discussion, senior staff on duty told us that they were kept busy dealing with telephone enquiries and with administering medicines. Some carers also told us that in the afternoon, they usually helped with the laundry, cleaning and tidying, as there was no domestic service in the late afternoon. People who live at the Solway unit and some of their relatives told us that they had continued to raise the issue of staff shortages at the ‘Residents’ Meetings’ but they had been told that the service was operating according to government’ s guidelines and that it was sufficiently staffed. In discussion, staff told us that a system of internal staff rotation was operating at the home. We were unable to check whether all the care staff, who were required to work in the unit for people with dementia, had received the necessary training to do so, as no training records were available. However, one care worker who was working on that unit stated that she had not received any training on ‘dementia care’. In the ‘Annual Quality assurance assessment’ provided by the service to CSCI, the manager stated that only 12 out of the 28 carers employed at the home had achieved their ‘National Vocational Qualification’ in care to-date. We noted that a number of care staff had worked at the home for some time and were therefore familiar with their tasks. Two care workers had been recruited since the last inspection. They had been recruited in accordance with the organisation’s policy and procedures. They had provided the appropriate DS0000003101.V355686.R01.S.doc Version 5.2 Page 23 disclosures from the Criminal Records Bureau (CRB). One of the new carer had not provided a reference from her last employer before starting work at the home and therefore her work performance could not be properly checked. There were some volunteers helping at the home and it was not possible to check whether they had all provided the necessary disclosures before doing so. We noted a lack of diversity in the staff team and particularly on the issue of gender. There was only one male care staff out of 28 permanent care staff. Some care staff told us that they had received training on various care issues, including dementia care. However, a small number of them stated that they had not received training in important areas like adult safeguarding and dementia care. Although some members of staff said they had received previous briefings on the matters regarding ‘values, rights and responsibilities’ no training had been provided on ‘Equality and Diversity’. No further information about staff training was available to us. A number of staff told us that they had not received regular supervision and were therefore left without appropriate guidance and support with regards to care practices. DS0000003101.V355686.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): 31, 33, 35, 36 and 38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Management responsibilities within the service were not clearly stated and this led to a lack of accountability and poor management. Record keeping was poor and this could affect the interest of people who use the service. Quality monitoring and quality assurance methods were not adequately and effectively used to evaluate and improve the service. EVIDENCE: The registered manager has overall responsibility for both the Solway and Wentworth units and was assisted by a deputy manager in each unit. DS0000003101.V355686.R01.S.doc Version 5.2 Page 25 However, the deputy manager post in Wentworth, the unit for people with dementia was vacant at the time of this inspection. It was noted that the deputy managers were also acting up as senior care workers for part of their weekly hours of work. A full time administrator was also employed at the home to support the management team. Furthermore management at the home had use of corporate services like human resources and financial system. In discussion with senior staff, it was not clear how the responsibilities for managing the home were allocated and how performance was monitored. We noted that a number of management tasks were inadequately undertaken and these led to shortfalls in a number of areas. There was poor record keeping about staff training and supervision and complaints. No accounts were available with regards to the ‘ Residents Amenities Fund’ and therefore we could not check how it was being used for the benefit of people who live at the home. Arrangements were in place to support people living at the home with the management of their money, which was left for safekeeping by relatives. The money was deposited in a no-interest account to which four senior members of staff were signatories. Separate accounts were kept for each person, together with receipts to evidence any financial transactions. Accounts checked were in balance. We noted that people could access their spending money whenever they required it. Although the home had use of a corporate quality assurance system, there was no evidence that it was being used to monitor and improve service provision. There were no quality audit monitoring or related outcomes for areas like care planning, medicines administration, health and safety checks and accident analysis. We raised the need to improve the implementation of the quality assurance methods at our last inspection and subsequently this has not been followed up. We were given a copy of a report of the registered provider’s visit undertaken in November 2007. The report had highlighted issues relating to the day-today management of the home. We noted that action following from the report had yet to take place. Information regarding the maintenance of equipment and the utilities in use at the home was provided in the home’s ‘Annual Quality Assurance Assessment’. We noted that the emergency call system had not been serviced as DS0000003101.V355686.R01.S.doc Version 5.2 Page 26 recommended. Some people who lived at the home also told us that they could not always reach for their call bells because staff had not left them within their reach or because the extension cord was not long enough. We highlighted this issue at our last inspection and we were assured that it would be addressed. We noted that the home had received an anonymous complaint in September 2007, about the lack of hoisting equipment at the home. Staff stated that a new mobile hoist had been purchased but that it had not yet been delivered. DS0000003101.V355686.R01.S.doc Version 5.2 Page 27 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 2 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 1 X 2 DS0000003101.V355686.R01.S.doc Version 5.2 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 OP10 Regulation 12 Requirement Timescale for action The dignity and privacy of people using the service must be 14/03/08 protected and promoted at all times, in order to uphold their rights. Care plans must be appropriately developed, implemented and 14/03/08 reviewed. Care provided must be appropriately recorded so that it can be effectively evaluated. (Previous timescale 25/06/07 not fully met.) The recording and storage of medicines received at the home must be improved. Medicines administered must be appropriately signed for. These actions are necessary in order to safeguard the health and well being of people who use the service. Staff who administer intramuscular injection of insulin, must receive the appropriate training and must be competent to do so. There must be a signed DS0000003101.V355686.R01.S.doc 2. OP7 15 3. OP9 12 14/03/08 4. OP9 12 14/03/08 Version 5.2 Page 29 and dated record by the trainer, for the training given and for the competency acknowledged. 5. OP12 16 The social care needs of people with dementia must be appropriately assessed and action to be taken to meet such needs must be part of the individual’s care plan. Social and recreational activities that are organised must reflect the preferences and capabilities of people using the service. (Previous timescale of 25/06/07 not met) People who use the service must be given opportunities to make effective choices for their meals at all times. Staff must also make sure that people who need help with eating their meals are appropriately assisted to do so. These actions are necessary to ensure that the dietary needs and preferences of people using the service are met. The management of complaints must be improved to include all the relevant information about their investigations and outcomes. The complaints procedure must also indicate clearly the timescale in which a complaint would be investigated and concluded. The items stored in the bathroom on the unit for people with dementia must be removed and relocated elsewhere so that it can be restored to its intended use. The storage of boxes of continence products and other items, including equipment in en-suite facilities must be discontinued in order to avoid potential health and safety DS0000003101.V355686.R01.S.doc 14/03/08 6. OP15 16 14/03/08 7. OP16 22 14/03/08 8. OP19 23 14/03/08 Version 5.2 Page 30 9. 10. OP26 OP27 16 18 hazards to people who use them. All parts of the home must be kept clean, hygienic and free 14/03/08 from malodours. The care staffing level at both 22/02/08 units must be improved to fully meet the needs of people living at the home, in order to safeguard and promote their health and well being. The care staffing level must be appropriately based on the dependency needs of people using the service and on the lay out of the buildings and the noncare duties expected of care staff. (Previous timescale of 25/06/07 not met) Two written references, including one from a last employer, must be sought and obtained, as applicable, for all new staff. All care staff who, work with people with dementia must be appropriately trained to do so. The manager must review the training needs of all care staff working at both units and plan any required training within an agreed timescale, in order to safeguard and promote the health and well-being of people using the service. Effective internal audits and a quality monitoring and quality assurance system, which include the views of people using the service, must be consistently implemented and their outcomes made available. (Previous timescale of 25/06/07 not met) Regular supervision must be provided to all grades of care staff working at the home. (Previous timescale of DS0000003101.V355686.R01.S.doc 11 OP29 19 14/03/08 12. OP30 18 14/03/08 13. OP33 24 14/03/08 14. OP36 18 14/03/08 Version 5.2 Page 31 15. OP35 12 16. OP38 13 25/06/07 not met) All information about accounts in which money is received or paid out, on behalf of people who live at the home, including the ‘Residents Amenity Fund’, must be made available for inspection as required. The emergency call system must be appropriately serviced to ensure its proper working condition. Emergency call bells must be made available to people who live at the home, at all times, as required. Part of a previous requirement. (Timescale of 25/06/07 not met). 14/03/08 14/03/08 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. 2. Refer to Standard OP1 OP31 Good Practice Recommendations The statement of purpose and service user guide should be improved to include all the necessary information. The duties and responsibilities of the registered manager and of the deputy managers should be reviewed to ensure their clarity and accountability and to lead to improved management in the service. Training should be provided to staff on issues relating to ‘Equality and Diversity’. 3. OP30 DS0000003101.V355686.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 DS0000003101.V355686.R01.S.doc Version 5.2 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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