Inspection on 22/06/07 for Clover Cottage

This inspection was carried out on 22nd June 2007.

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

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

Other inspections for this house

Clover Cottage 06/05/08

Clover Cottage 06/07/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Clover Cottage 44 Wincanton Road Noak Hill Romford Essex RM3 9DH Lead Inspector Jackie Date Unannounced Inspection 10:00 22 June – 17th July 2007 nd 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 Clover Cottage DS0000066722.V340110.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. Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clover Cottage Address 44 Wincanton Road Noak Hill Romford Essex RM3 9DH 01708 342 038 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) Mrs Santosh Magon Vacant Post Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2006 Brief Description of the Service: Clover Cottage is a care home providing care to 14 older people who do not require nursing care. The home consists of two storeys and is located in a residential area of Noak Hill within the London Borough of Havering. There are ten single bedrooms and two shared bedrooms, four of which have an en suite. All other bedrooms have a hand basin, TV point and a call system. There is a passenger lift and also a stair lift. The communal areas are situated on the ground floor and this is open plan with a small room divider making two lounge areas and a dining area. From this open plan area is a conservatory that is also used as a dining area. There is car parking and a garden to the front of the building, and a well maintained rear garden with disabled access from the conservatory. The home is situated close to local facilities in Noak Hill and is accessible by buses and by car from the M25, A127 and the A12. The charge per week for each resident is between £400 & £430. The manager provided this information on 17th July 2007. Information about the service provided is contained in the service users guide Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the course of two days. The first day of the inspection was unannounced and started at 10.00 am. It took place over six and a half hours. During this visit the inspector attended a staff meeting. A second arranged visit took place two weeks later. The delay between the two visits was due to the fact that the manager was unwell. The purpose of the second visit was to talk to more staff and residents to get their views on the service and their experience of living in the home. On the second day a specialist pharmacist inspection was carried out and the report from this visit is included in the section relating to medication. Care staff were asked about the care that residents receive, and were also observed carrying out their duties. All of the shared areas and some of the bedrooms were seen. Staff, care and other records were checked. Feedback questionnaires were sent to residents, relatives and staff. Responses were received from 4 residents/relatives and also from 5 staff. The contractmonitoring officer for the local authority was also contacted for feedback. During the second day the inspector also had the opportunity to meet and talk to the proprietor. Relatives were spoken to during the course of the visits. Residents were also asked about the care that they received and what it was like living at Clover Cottage. This was a key inspection and all of the key inspection standards were tested. At the time of the inspection the new manager had been in post for about three months. The manager had found that a lot of the paperwork that should have been available in the home was not. This paperwork had been available at the time of the last inspection. The proprietor confirmed that paperwork had “gone missing” prior to the new manager starting work at the home. The manager was in the process of putting all the necessary paperwork and guidance in place. Prior to the inspection, a meeting was held with the proprietors and the new manager, to discuss a number of concerns about the service. The Commission was satisfied that the proprietors and the manager were aware of the action that they needed to take to ensure that the people who use the service at Clover Cottage are receiving a safe and stimulating lifestyle. The inspector would like to thank the residents and staff for their input during the inspection, and the co-operation of the service providers and manager. What the service does well: Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 6 The home was very clean and there were no offensive odours. Bedrooms are personalised according to the wishes of each resident. Residents that were able to comment said that they were happy living at the home. They also said that the proprietor visited regularly and was very kind and caring. One relative said, “I have no complaints, they do everything to meet the needs of my mum”. Another relative said, “I think that the staff do an excellent job in all areas. I feel that I have peace of mind knowing that my mother is well looked after.” What has improved since the last inspection? What they could do better: Staffing levels must be reviewed to ensure that a safe service is provided that meets residents’ needs. Health and safety checks must be carried out regularly to ensure that a safe environment is maintained for residents. The recruitment procedure must be more robust to ensure that it safeguards residents as much as possible. Residents must have facilities to enable them to keep cash and any other valuables safe and secure. A structured induction programme and ongoing training need to be in place to ensure that staff have the necessary skills to meet residents’ needs and to provide a service in line with good practice. Please contact the provider for advice of actions taken in response to this Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 7 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. Clover Cottage DS0000066722.V340110.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 Clover Cottage DS0000066722.V340110.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): 3 & 5. Standard 6 does not apply to this home. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Information is obtained to enable the staff team to decide whether or not the home can meet the prospective resident’s needs. Prospective residents and their relatives can spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so. The home does not offer intermediate care. EVIDENCE: Referrals are usually received from Social Services department and they provide initial assessment information. This may be from information that they have gathered or from assessments made by hospital staff. The manager then carries out assessments before an individual moves into the home. At this time the prospective residents and/or their relatives are provided with Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 10 information about the home and encouraged to visit. During the course of the inspection the relatives of a prospective resident came to look around the home and to talk to the manager. The assessments cover all of the required areas and include health, mobility, nutrition, continence and religious and cultural needs. Examples of this were seen in residents’ files. From this assessment information an initial basic care plan is drawn up to enable staff to provide appropriate care for an individual when they move into the home. Individual records are kept for each resident and a number of files were examined. These included the file of the newest resident, which included preadmission assessments that had been carried out by the manager. There was also assessment information from a hospital and a background history. The home does not provide intermediate care. Clover Cottage DS0000066722.V340110.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, 10 & 11. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Care plans do not provide staff with sufficient information to ensure that care needs are being appropriately met on a daily basis. Staffing levels are not always sufficient to ensure that residents receive personal care that meets their individual needs and preferences in a timely fashion. Residents are supported to get the healthcare that they require. At the end of their life residents are supported kindly and sensitively. Although the number of requirements and recommendation indicate there is considerable work is to be done to bring the home up to standard with medication, the care and knowledge demonstrated by staff indicated an adequate standard of medicines handling was being practised. Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 12 EVIDENCE: All of the residents have plans, which cover the necessary areas and these give information about each person’s needs and preferences. The manager has only been in post for a few months and has been introducing new care plans. The care plans seen had been reviewed recently as had risk assessments. However care plans seen did not give detailed information about individual needs and did not clarify how these could be safely met. Also there was not always a care plan or risk assessment about all of the person’s needs. For example one resident is physically very dependent. There is no moving and handling risk assessment or details of how to assist her. The care plan says “two staff to mobilise”. From discussions at the staff meeting it was evident that some transfer aids have been purchased but not all staff use these and there is not a clear or consistent method of supporting this person. Some staff said that this resident could weight bear but others said that she did not, particularly if she was tired or during the night. Another resident has, over the time that she has lived at the home, become very confused but there is not any information or risk assessments in relation to this. This is a small home, with only 14 residents, and therefore staff do get to know all of the residents but it is still necessary for care plans to be in place to cover all of each person’s needs and how these should be met. Appropriate risk assessments must also be in place and specific to each person. It was of particular concern that moving and handling assessment and guidance are not in place and also that staff have not received the necessary training to support residents in this area. This potentially places residents at risk and must be addressed. The previous inspection required that care plans are amended to reflect any changes in the identified needs and the care required and this therefore has not been met. Please see the section of staffing for more information and requirements relating to staff training and staffing levels. All of the residents are registered with a local doctor and specialist help is received when needed. Records are kept of medical appointments and these show that residents have checks from the optician, dentist and when needed the chiropodist. The district nurse also visits when required. Recently a complaint was made to the Commission about a 94 year old resident being sent to hospital without an escort. The lady had become very distressed and the hospital phoned the home to ask for someone to support the person. The contracts monitoring officer of the local authority looked into this complaint and is now satisfied with the action that has been taken. The home has agreed that a member of staff will always accompany residents to appointments if the family are unable to, or do not wish to, do this. The relative that made the complaint also said that he was satisfied with the action Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 13 taken and the reassurances given. Residents are supported to get the healthcare that they need and to be as healthy as possible. Staff were observed to be polite and respectful to the residents and residents said, “the girls are nice”. Relatives said, “the staff do an excellent job, residents are well looked after.” Staff were observed to knock on doors before entering residents’ rooms or bathrooms and residents spoken to confirmed that staff respected their privacy and dignity. There were two recent complaints recorded with regard to the care given to residents. One was from a resident who said that she had been left on a commode and had to wait a long time for a response. The other was from another resident who said that staff had kept telling her to wait when she wanted to go to the toilet and as a result of this she had been incontinent. The manager had looked into both of these complaints but had been unable to ascertain exactly when the incidents had occurred or which staff were involved. Most of the residents spoken to said that staff responded when they called for assistance at night but one resident had said that she had buzzed twice and not got a response. These issues were all discussed with the manager and she has addressed them in general terms with the staff. However there are concerns about staffing levels and this in turn could mean that staff are not always available to respond as quickly as required. Details of residents’ wishes in the event of their death are recorded in care plans. This information is usually about whether a person wishes to be cremated or buried and gives the name of a funeral director. The importance of developing these further was discussed with the manager, during the inspection. At the end of their life residents are supported kindly and sensitively. Standard 9: (inspected by a CSCI pharmacist inspector) Although on the previous visit to the home by a pharmacist inspector in July 2006 there were documented policies & procedures for medicines, they were no longer available and therefore require developing to provide guidance to staff on safe usage. The medicines administration record (MAR) charts did not always include details of medicines received or carried-forward from the previous chart. The absence of this record prevents the audit of medicines usage records and the quantity remaining to indicate whether medicines are being given as prescribed. The hydroxocobalamin injection given by the district nurse at 3-monthly intervals was not entered on the resident’s medicines administration record (MAR) chart. To provide the complete medication profile, the MAR chart is to include medicines administered by health-professionals from outside the home, Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 14 in addition to all other items prescribed or taken by the service users, including any medicines not administered during the 4-week duration of the MAR chart. Where dosage is not recorded on the chart there should be an entry to indicate a record is kept elsewhere, e.g. medicines administered by a district nurse. For accountability, the entries on medicine charts made by the home’s staff require endorsement with the date of entry and signature or signed initials. Medicines kept in residents’ rooms were either kept openly or in unlocked storage allowing access by other people who may harm themselves by misuse. When doses of medicines prescribed for regular dosing were not given staff recorded a code letter on the medicines chart to indicate the reason. Most codes were defined on the medicines chart, however, when the reason did not include a defined code then the letter “O” was used. When using this undefined code the reason for the omission was not being recorded to give feedback on the treatment. When the directions for giving a medicine allow a choice of dosage, for example 1 or 2 tablets, the number given was not being recorded. Without this record it is not possible to check if medicines have been given correctly. Medicines requiring fridge storage were not having the storage temperatures adequately monitored to ensure they were kept within the correct temperature range to maintain their therapeutic action. A maximum/minimum thermometer is required to provide detail of the temperature range. Medicines, such as eye drops and oral liquids that have a reduced shelf life once in use had no entry made on the container of when first opened as an indicator of the period after which they may not be used. Medicines were stored in a locked medicines trolley but the trolley was not immobilised when not in use, as required by law. The tables at the end of this report refer to these and other issues arising from the inspection. Requirements 4 to 11 and recommendation 1 have been made as a result of the pharmacist inspector’s findings. Clover Cottage DS0000066722.V340110.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): 12, 13, 14 &15 People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Although activities are still limited this is improving and residents are satisfied about this. As far as possible, residents are helped to exercise choice and control over their lives. Visitors are made welcome at the home and are invited to social events. Therefore residents are able to maintain contact with their friends and families. Residents receive good quality meals that meet their preferences and needs. EVIDENCE: The inspector was able to talk with several residents during the inspection, and all said that they were very happy at the home. From discussions with the new manager, staff and residents it was apparent that they have discussed activities both in the home and in the community and that they are trying to Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 16 develop these. An entertainer comes to the home monthly for a sing-along. Some games and craft items have been purchased and on the first day of the inspection some residents played bingo in the afternoon and said that they enjoyed this and liked to win the prize. The new manager has held a residents’ meeting and asked residents what they would like to do. She is hoping to arrange some outings and trips out. At the end of July the home are hosting a garden party to which friends and family have been invited. In view of the fact that the new manager is working with the staff team to develop activities no requirement has been made at this inspection and the progress will be monitored through the inspection process. However staffing levels, particularly in the afternoons do have an impact on activities and further information about this can be found in the section on staffing. A hairdresser visits the home weekly and residents look forward to this as they like having their hair set and view this as a social occasion. From viewing the menus, discussions with the cook, the residents, the manager and observations, it was evident that the quality of the food has continued to improve. Fresh vegetables and fruit are provided on a daily basis, with some frozen vegetables being kept as back-up. There were ample supplies of food in fridges, freezers and the store cupboards. Residents said “if there is something that you don’t like you can always ask for something different, and this is never a problem.” Meals were well presented and the dining tables nicely laid. Residents were offered cold drinks with their meal and tea or coffee afterwards. Drinks are available throughout the day. Residents said that since the new manager has been in post “she has sorted it out so that we get tea in the morning, we never used to.” They also said that the manager had said that if they wanted a cup of tea at night this was okay and they should just ask staff. Residents were complimentary about the owner and said that when he goes to Belgium on business he always brings them back nice cakes. One member of staff said that the food is ten times better than it used to be. A relative commented that the food is excellent. One resident is diabetic and she is supported to have an appropriate diet. Religious services are held at the home on a monthly basis and this meets the needs of the current residents. Relatives can visit at any time, as there are no restrictions placed on visiting times. Residents can spend time with their visitors in the lounge, conservatory, garden or in their own rooms. Some residents said that they had relatives that visited regularly and that they were made welcome and offered refreshments. Relatives are invited to any celebrations. Residents also confirmed that they are asked what they want or what they would like and that they can then make a choice about this. Clover Cottage DS0000066722.V340110.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 & 18. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents feel able to complain and feel that the manager will listen to their concerns. Although in general residents are protected from abuse more needs to be done to protect them from financial abuse. EVIDENCE: The home does have a complaints procedure that is used in the event of a complaint being made. There were recorded complaints from residents about the care that they had received and the manager had addressed these as far as possible. From talking to the residents it was evident that the manager often asks them if everything is okay and that they feel able to tell her about things and think “she sorts things out”. The Commission has received two complaints since the last inspection; one has been fully investigated by the registered provider and the other by the placing authority. The placing authority was satisfied with the response to the complaint and the complainant also felt that the issue had been addressed so that a similar concern should not arise again. He also said that the manager was “trying hard”. Therefore any complaints or concerns are addressed and residents and relatives are listened to. In addition one member of staff commented that the proprietor is very Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 18 approachable, easy to talk to and any issues or problems could also be discussed with him. The home has policies and procedures for the protection of residents from abuse. Staff have received training in the detection and reporting of abuse. In discussions with staff they were clear what forms abuse took and were able to inform the inspector of the action they should take if any suspected abuse was witnessed. Staff spoken to said they had never seen any abuse. A group of residents said that they had never seen anyone treated badly but would stick up for people if they did. From talking to the manager, residents and staff it was evident that all were aware of the importance of adult protection, but some staff have still not received training in this area. This was a requirement of the previous inspection. (The requirement is part of the section relating to staff training.) In view of the fact that the new manager has not been in post for very long and is in the process of identifying training needs and organising training the date for compliance has been extended to allow her time to complete this. Since the last inspection visit there have not been any allegations of adult abuse. One relative said, “I feel I have peace of mind to know that my mother is well looked after.” The home does not deal with residents’ overall finances, but some residents have small cash amounts held in safekeeping and only the manager has access to this. The section on management and administration gives more details on this. Some residents keep their own cash and unfortunately recently there have been amounts of money missing. The manager took the appropriate action when these thefts were discovered and reported each one to the police. Not all of residents have cash tins and lockable drawer facilities and for some that do these facilities do not work or there are not any keys. Therefore the facilities are not available for residents to safely keep their own money if they wish too. Residents are therefore not offered adequate safeguards against financial abuse. This was discussed with the manager and the proprietor. The proprietor said that he was planning to refurbish bedrooms and new lockable facilities would be available. However he agreed to put interim measures in place and also to ensure that residents and their relatives were made aware of the problem and of the need to secure their valuables. Clover Cottage DS0000066722.V340110.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, 20, 21, 22, 23, 24, 25 & 26. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The residents live in a clean and comfortable home that has suitable aids and adaptations for most people’s needs. The proprietor continues to work to improve the environment. EVIDENCE: The home has two storeys and is located in a residential area of Noak Hill within the London Borough of Havering. There are ten single bedrooms and two shared bedrooms, four of which have an en suite. All other bedrooms have a hand basin, TV point and a call system. There is a passenger lift and also a stair lift. The communal areas are situated on the ground floor and this is open plan with a small room divider making two lounge areas and a dining area. From this open plan area is a conservatory that is also used as a dining area. There is car parking and a garden to the front of the building, and a well maintained rear garden with disabled access from the conservatory. The home Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 20 is situated close to local facilities in Noak Hill and is accessible by buses and by car from the M25, A127 and the A12. A tour of the care home indicated that the premises are clean, hygienic and well maintained, with no offensive odours. All areas were appropriately furnished and had a homely appearance. Since the last inspection new windows have been fitted and the fire alarm and emergency lighting system has been upgraded. All bedrooms were individually decorated and lots of personal possessions were on display making the rooms look homely. The proprietor has an ongoing plan for improving the environment further and is planning to refurbish bedrooms. The garden areas were attractive with plenty of seating areas for residents, and it was apparent that these are regularly maintained. A handyman is employed and any repairs and maintenance are therefore dealt with in a timely fashion. The previous inspection raised concerns regarding the storage of Zimmer frames and wheelchairs in the lounge area throughout the day, as this was a potential hazard to both residents and staff. There is a lack of storage space and in the longer term the proprietor hopes to be able to extend the home. However at present there are some difficulties with obtaining planning permission for this. In the interim staff are now more aware of the issue and items are stored as safely as possible utilising spaces that are not used all the time such as the conservatory/dining area and the patio (in fine weather). In view of the fact that this requirement has been addressed in the short term as far as is practicable the requirement has not been repeated. However the ongoing issue of improved storage will continue to be monitored through the inspection process. There were sufficient bathrooms/shower and toilets for all residents and those toilets viewed were equipped with hand washing facilities, soap and towels. The home has purchased some moving and handling aids to assist residents and two of the residents do have specialist beds that can be raised and lowered. However there is not a hoist. From discussions at the staff meeting it was evident that there is at least one resident who is unable to weight bear and requires the use of a hoist, at times, to be safely and appropriately transferred to and from a wheelchair, chair or bed. This was discussed with the manager and the proprietor and the need for appropriate assessments to be carried out to ascertain what specialist equipment is required in the home to meet residents’ needs. This equipment must then be made available. There are laundry facilities available so that residents’ clothing, bedding etc can be washed appropriately. However there are not any sluicing facilities available to enable staff to appropriately deal with soiled laundry. Appropriate Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 21 sluicing facilities must be available so that soiled washing can be dealt with in line with good hygiene and infection control standards. Standard 26: (partly inspected by a CSCI pharmacist inspector) Neither the disinfectant required to decontaminate any blood spillage nor a documented policy/procedure providing instruction was available, putting people at risk of infection with blood-borne diseases. Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 22 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 & 30. People using the service experience poor quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents are not adequately safeguarded by the home’s recruitment policy and practices. Although most staff are experienced and have received training in caring for older people they have not been provided with adequate or appropriate training to enable them to meet all the needs of residents. However feedback received was that staff are caring and hard working. Staffing levels are not satisfactory and there are not sufficient staff on duty to adequately meet the individual assessed needs of the residents. EVIDENCE: The usual staffing compliment is 2 staff during the daytime shift. One of these staff is normally a senior carer. On the day of the inspection there were two care staff on duty, 1 cook and 1 ancillary staff member who was responsible for cleaning the home, plus the manager who was not rostered on the care rota. The care staff on the morning shift must also ensure that laundry tasks are completed. During the afternoon shift there are generally only two care staff on duty who, as well as caring for 14 residents, have to do any other Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 23 tasks that might be required. For example laundry tasks, clean toilets if necessary, and prepare the teatime meal and any other drinks/snacks required by residents. On the afternoon of the visit the two care staff on duty had to go and change some beds. Although residents were informed, they were then left unsupervised whilst staff did this task. This situation is the same as at the time of the last inspection. Feedback from some staff was that staffing levels were not sufficient and this was also discussed at the staff meeting with staff indicating that they felt additional staffing was needed at busy times. Staff also discussed the fact that one of the residents required the support of two carers and if staff were assisting this person there was not anyone available to support or supervise other residents. Previous sections in the report have referred to areas where staffing levels have an impact on the care provided to residents. For example the complaints made by residents about staff not responding to meet their needs. Also with two staff on duty the aim of taking residents out into the community for a walk if they wish is not feasible. The last inspection report stated that the staffing arrangements were “not acceptable since this is taking staff time away from care hours and the quality of life for residents at Clover Cottage could be better if additional staff were employed for certain times during the day. Also it is not acceptable that care staff who may be preparing tea, or doing laundry, may be called to assist a resident to the toilet as this could pose major issues around infection control. Staffing levels during the day must be reviewed as a matter of urgency and the registered persons must ensure that levels of both care and ancillary staff are adequate and appropriate at all times. When reviewing the staffing levels during the change over of all shifts the registered persons must make sure that there is a period of formal handover to ensure that the needs, and changing needs, of residents is conveyed to staff coming on duty.” The area of staffing has been addressed in previous reports but no changes have been effected. At the time of the last inspection the previous inspector was able to discuss this matter with the then new owner and was confident that this issue would be addressed to the benefit of both residents and staff, and without the Commission having to take enforcement action. However this has not been the case. Unmet requirements impact on the welfare and well being of residents and ongoing failure to meet legal requirements will result in the Commission considering enforcement action. From discussions at the staff meeting it was apparent that staff are required to arrive at the home prior to the start time of their shift so that there can be a handover. The manager raised the issue that some staff were arriving late for this. Staff queried the issue, as they are not paid for this time. Staff were told that this was a requirement made by the Commission and that they must do this. At this point the inspector clarified that whilst there must be a handover period this should be part of staff working hours and facilitated on the rota. Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 24 Due to the fact that there are not any sleeping in facilities for staff the night time staffing arrangements are now that there are two waking night staff as opposed to one waking and one sleeping in. A selection of staff files were examined and this included the files of newer employees. Files seen contained a copy of the application form, new staff questionnaire, references, confirmation of identity, CRB (Criminal Records Bureau) check and other required details. However, staff have started work at the home prior to their CRB and POVA (Protection of Vulnerable Adults) first checks being carried out. Therefore the recruitment process is not robust and does not offer full safeguards to residents. From discussions with the manager and staff and from checking staff records it was evident that most staff have experience of caring for older people and have received training with previous employers. In addition some of the part time staff are student nurses and have received some relevant training as part of their nursing course. The manager is reviewing staff training needs and is accessing training that is being provided by the local authority. Some staff have obtained NVQ qualifications and again the manager is organising for staff to be enrolled for either NVQ level 2 or NVQ level 3. However as previously stated staff have not all had moving and handling or POVA (Protection of Vulnerable Adults) training. Additionally there is not a structured induction programme for new staff in line with the standards agreed with Skills for Care. The previous inspection required that the registered persons must ensure that all staff receive regular, adequate and appropriate training. This requirement has not been met. In view of the fact that the manager has only been in post for a short time and has started to address these issues the timescale for compliance has been extended on this occasion. Observations at the time of the inspections was that staff were patient and kind to residents and working very hard to meet their needs. Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 25 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 & 38. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The home is managed by a qualified and experienced manager but there is still a lot of work to be done to ensure that the service meets minimum requirements and that residents are safeguarded by the practices in the home. EVIDENCE: At the time of the inspection the manager had only been in post for about three months. The manager has a lot of experience of managing services for older people and has previously been a registered manager at another service. The manager has undertaken a variety of training and has obtained the RMA (Registered Managers Award). Feedback from residents was that the manager Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 26 consults them about a variety of things and also that she has made changes for the better. For example the food has improved and they now have a cup of tea before breakfast. A relative said, “the manager is trying hard”. A member of staff said that the situation at the home had been difficult as there have been three different managers in the past year. This person also said that changes had been difficult but staff were getting into a new routine and now knew what was required of them and standards expected. The Commission has received notification of incidents affecting residents under Regulation 37 of the Care Home Regulations as required by the previous inspection. The previous inspection also raised some concerns with regard to the manager’s office in that it was a very small office area with some records having to be stored in a cupboard under the stairs. The previous inspector felt that this environment was not particularly conducive to private meetings with residents, relatives or visiting professionals. As previously stated the proprietor had hoped to build an extension to the home but this has not yet been possible. He has however purchased a portacabin that is placed in the garden. The manager now uses this space as her office and the original office is now used by staff for administrative purposes and for residents’ records. The quality of the service is monitored by the manager and by the proprietor. The new manager has sent out questionnaires to obtain feedback about the service but these have not yet been collated. Residents confirmed that both the manager and the proprietor ask for their opinions and check if everything is okay. Staff also said that the proprietor visits regularly and telephones to check that everything is okay. Therefore the quality of the service provided is being monitored. However a lot of issues have been highlighted as a result of this inspection that have not been picked up as part of the proprietor’s monitoring visits and the proprietor is advised to review how the visits are undertaken so that the service is more robustly monitored and any area that do not meet minimum requirements are identified and action taken to address these. Staff spoken to confirmed that supervision has started since the new manager has been in post and also that staff meetings had been arranged. Therefore staff are now being given the opportunity to individually and collectively to discuss work practice, concerns and the care of residents. At the staff meeting attended by the inspector staff raised issues and concerns and these were discussed appropriately. The homes insurance policy is current. The home does not deal with residents’ overall finances, but for some residents has small cash amounts in safekeeping. Residents’ money held in safekeeping is used on their behalf for purchases or services mainly from the chiropodist Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 27 and hairdresser. The cash held for residents is all kept together in one tin and therefore the inspector was unable to check that each individual’s cash held was correct. Entries were recorded and receipts were kept to evidence any expenditure. However this system is not in line with good practice and each person’s cash should be kept separately with an individual record. The cash amounts and expenditure should then be checked by the manager and also by the person carrying out the monthly monitoring visits. This will offer better safeguards to both residents and to the manager who at present is the only person that accesses the cash held. The earlier section on concerns and complaints gives further information about thefts of residents’ monies and the required action. The equipment and services in the home are serviced and checked as required. For example the lift was checked and serviced in November 2006, the portable appliances in August 2006. Improvements have been made to the fire system as required by the fire service. However the checks that need to be carried out by the home are either not being done or are not being carried out regularly. Hot water temperatures are not being checked to ensure that they do not exceed maximum safe temperatures, fire alarms are not being tested weekly to ensure that they are functioning properly, fridge and freezer temperatures have not been tested since May, and food temperatures had also not been recorded since May. All of this was discussed with the manager to ensure that she is aware of the necessary checks that must be carried out to ensure that a safe environment is provided for the residents. The pharmacist inspector recommended that the home document a wound care policy to be kept readily available providing guidance for carers on the action required according to the severity of an injury. Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 28 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 2 Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 29 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 Timescale for action Care plans must cover all of each 31/08/07 persons needs and how these should be met. Staff will then have the information they require to meet people’s needs The registered manager must 31/08/07 ensure that following the monthly reviews, the care plans are amended to reflect any changes in the identified needs and the care required (Previous date for compliance 15/08/06 not met). Appropriate risk assessments 31/08/07 must also be in place and specific to each person. Staff will then have the information they require to meet individual’s needs safely. It is required to record all the 04/07/07 medicines prescribed for each service user (SU) on their medicine administration record (MAR) chart. This is to provide the complete medication profile of the SU. Medicines kept in service users’ 04/07/07 rooms are required to be in DS0000066722.V340110.R01.S.doc Version 5.2 Page 30 Requirement 2 OP7 15 3 OP7 13 4 OP9 13(2) 5 OP9 13(2) Clover Cottage 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 11 OP9 13(2) 12 OP18 13 13 OP22 23(2)(n) 14 OP26 23(2)(k) locked storage to prevent access by other residents. The residents’ medicines administration record (MAR) charts require full details of their medicines in order to provide a check that medicines are given as prescribed. Policies and procedures are required to be documented to provide direction and safe usage of medicines in the home. As part of assessing a medicine’s therapeutic effect it is required to document the reason for dosage omission on the medicines administration record (MAR) chart when entering the undefined omission code “O”. It is required to provide adequate temperature monitoring when medicines need storing in the fridge. This is necessary to maintain the medicine’s therapeutic action. Medicines with a reduced shelflife when in use require the date of first-use entered on the container to indicate when expired. The medicines trolley requires tethering to the wall when not in use to comply with medicines storage legislation. Appropriate facilities must be available for residents to safely keep their cash and other valuables and to safeguard them from financial abuse. Appropriate assessments must be carried out to ascertain what specialist equipment is required in the home to meet residents’ needs. This equipment must then be made available. Appropriate sluicing facilities must be available so that soiled washing can be dealt with in line DS0000066722.V340110.R01.S.doc 04/07/07 04/10/07 04/07/07 12/07/07 04/07/07 11/07/07 15/08/07 30/09/07 30/09/07 Clover Cottage Version 5.2 Page 31 15 OP26 13(3) 16 OP27 18(1)(a) 17 OP29 19 18 OP30 18(1)(c)(i ) 19 OP35 13 with good hygiene and infection control standards. To avoid the risk of crosscontamination of blood-borne infections e.g. Hepatitis, HIV, it is required to provide granules containing sodium dichloroisocyanurate (Presept or equivalent), as described in the Department of Health policy, and to have the granules available in the home to deal effectively with any blood spillage The manager must review the staffing arrangements for all shifts to ensure that at all times care staff are engaged in care work and not to undertake ancillary staff tasks to the detriment of residents. (Previous dates for compliance 27/11/05 & 31/07/06 not met.) The registered provider must ensure that there is a robust recruitment procedure in operation to safeguard residents. The registered persons must ensure that all staff receive regular, adequate and appropriate training. Moving/handling training updated annually and POVA training to be ongoing. (Previous date for compliance 31/08/06 not met.) Each resident’s cash should be kept separately with an individual record. The cash amounts and expenditure should then be checked by the manager and also by the person carrying out the monthly monitoring visits. This will offer better safeguards to both residents and to the manager. DS0000066722.V340110.R01.S.doc 04/07/07 31/08/07 31/07/07 31/10/07 31/08/07 Clover Cottage Version 5.2 Page 32 20 OP38 13(4) All of the necessary health and safety checks must be carried out regularly to ensure that a safe environment is maintained for residents. 15/08/07 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 OP38 Good Practice Recommendations It is recommended that the home documents a wound care policy to be kept readily available providing guidance for carers on the action required according to the severity of an injury. Clover Cottage DS0000066722.V340110.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Clover Cottage DS0000066722.V340110.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. 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