Inspection on 09/09/08 for College House Residential Home

This inspection was carried out on 9th September 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

College House Residential Home 17/09/09

College House Residential Home 03/03/09

College House Residential Home 12/02/07

College House Residential Home 15/02/06

College House Residential Home 06/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOMES FOR OLDER PEOPLE College House Residential Home Berrington Road Tenbury Wells Worcestershire WR15 8EJ Lead Inspector Denise Reynolds Unannounced Inspection 9th September 2008 09:00 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 College House Residential Home DS0000064821.V371388.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. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service College House Residential Home Address Berrington Road Tenbury Wells Worcestershire WR15 8EJ 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) 01584 810270 01584 811822 Oaktree Care Ltd Manager post vacant Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13), Old age, not falling within any other category (13), Physical disability over 65 years of age (13), Sensory Impairment over 65 years of age (13) College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: old age, not falling within any other category (OP) 13; physical disability over the age of 65 years (PD(E)) 13; mental disorder over the age of 65 years (MD(E)) 13; dementia over the age of 65 years (DE(E))13;sensory impairment over 65 years old (SI(E)) 13. 12th February 2007 Date of last inspection Brief Description of the Service: College House is situated amongst mainly traditional houses and cottages in the town of Tenbury Wells. The house dates back to 1698 and has been updated and extended over the years without losing the feel of an old country town house. The house has pretty gardens and is within easy walking distance of the shops and local amenities. The Home is part of the community and many people who live there, and staff, come from the local area. The Home is small in comparison with many care homes and still looks and feels like someone’s house; this helps to give it a homely atmosphere. The owner is registered in respect of the home to provide care for up to thirteen older people who need help with personal care such as washing, dressing, bathing etc; it also has registration which allows the Home to accept people who have dementia related care needs and physical disabilities. College House provides a small amount of day care and occasional short stays when they have vacancies. The Home also provides warden type support to some people living in adjacent bungalows. When we did our inspection the Home did not have a registered manager because the person who held this post left in the spring. An acting manager had been appointed and had been working at the Home for three months. Information about the fees charged by College House should be requested from the Home. The Home had a copy of our last inspection report in the Home but this was inside the bureau in the hall not on display so people would know about it. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a full inspection of College House Care Home to look at how the Home is performing in respect of the core national minimum standards (the report says which these standards are) and the quality of the service that the people who live there experience. We call this type of inspection a key inspection. We, the Commission, made three visits to the Home for this inspection. The first of these was made without the Home expecting us. The other two were arranged because there were things we needed to follow up and discuss with the acting manager and the owner. During the three days we also did our inspection of the domiciliary care service which is run from the Home. We have done a separate report about this. The Home completed an Annual Quality Assurance Assessment (AQAA) earlier in the summer and we used information provided in this to help us plan our inspection. We also took into account information from our annual service review (ASR) in June 2008. Although we sent surveys for our ASR we sent new ones to get up to date information for this inspection. We have used information from both in our report. During this inspection we spoke privately to two people who live in the Home and we were able to see how people pass their time and how much contact they have with staff. We spoke with Joan Pressdee (who runs the small company that owns the Home), the acting manager, the deputy manager and some of the staff. In our report we refer to Joan Pressdee either by name or as ‘the owner’. We inspected parts of the premises and looked at various records such as care records and staff files. What the service does well: Staff working at the Home are friendly and welcoming. They work hard and want to do their best to give the people living in the Home the care they need. People are generally happy with the service they receive and very appreciative of the staff. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 6 The location of the building close to the centre of the town makes it easy for more able people to stay in touch with the local community. Some of the people who live there already know the staff because they come from the area; this contributes to the homely atmosphere. The house is small and domestic in scale. It is decorated and furnished so that it looks as much like someone’s home as possible. This helps to avoid an institutional feel. The gardens are pretty and well maintained so that people have a pleasant place to sit in good weather. What has improved since the last inspection? What they could do better: The concerns we identified during the inspection have led to poor outcomes for people unable to give their views due to poor physical health and dementia. Other concerns relate to safety issues which people living in the Home and their relatives may not be aware of or appreciate the risks to their health and safety. Written information about the care that people need must be improved to provide clearer and more detailed guidance to staff. This is to help make sure that care is provided correctly and consistently. The Home also needs to make sure that it has the resources, knowledge and skills to cater for the individual needs of people who live in the Home or who are planning to move there. This includes developing and extending the training staff are given and making sure that they have enough staff working. More needs to be done to make sure that risks to people’s safety are identified and the right action taken. This applies to things specific to individual people, and to safety in the building which applies to everyone living there. Consideration needs to be given to improving people’s privacy in the Home, this relates to the inadequate screens in shared bedrooms and the use of the dining room for staff handovers and staff meetings due to the lack of alternative space for this. Some aspects of the way medication is managed needs to be improved to ensure that the systems in place are reliable and safe. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 7 All staff, including senior staff and the owner (in the absence of a registered manager) need to do training about safeguarding (adult protection) to improve their understanding of abuse and neglect and so they will know what to do if they suspect this is happening. Procedures for staff recruitment need to be improved to reduce the risk of unsuitable people gaining employment in the Home. Staff training must be developed so that they have up to date knowledge in essential topics related to the safety of people living in the Home. They also need training in topics which relate to the specific care needs of people living in the Home. In particular, if the Home continues to offer a service to people who have dementia they must provide staff with relevant training. We would strongly recommend that this is sourced from training providers with acknowledged expertise in this field. The records of dealings with money received from residents, held in safekeeping and spent on their behalf are inadequate and do not provide people with the financial protection. These need to be improved to provide a clear audit trail. Catering arrangements at the Home need to be improved to make sure that the food provided is good quality and sufficient in quantity. People living at the Home should have a choice of what they eat each day and be included in planning the menus. Consideration should be given to reducing the heavy reliance on frozen and convenience foods and cheaper products. Kitchen staffing needs to be reviewed to provide more stability in the kitchen and to reduce the time care staff are removed from care duties to prepare food. Arrangements for the day to day management of the Home need to be reviewed and consideration given to increasing the number of management hours allotted to the acting manager. This will help to ensure that progress is made in addressing the concerns identified at this inspection. 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. College House Residential Home DS0000064821.V371388.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 College House Residential Home DS0000064821.V371388.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, 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who move to the Home cannot be confident that the Home will be able to meet all their needs. This is because the information gathered about a person’s care needs is insufficient and because staff are not given clear information and training about important aspects of individual people’s care. EVIDENCE: We looked at information about the care of three people who have moved to the Home recently. We saw that information was recorded about their health and care needs in a set of assessment forms. These forms use scoring systems to indicate a person’s dependency levels but provide limited space to include additional details. There was no space on the forms to explain the circumstances which had lead to the people needing to move to a care home College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 10 and no information to show that the individuals had been consulted about their views and wishes. The forms do not cover all of the topics suggested in the national minimum standards. The information recorded in the assessment has not been used to develop plans describing what staff need to do to make sure people have their care needs met. We are concerned about this because people at the Home have health care needs which staff need clear guidance about. These needs include dementia, diabetes, ileostomy, pressure areas, moving and handling, falls, challenging behaviour and nutrition. In the AQAA the owner said ‘all staff has training relevant to their role’ and that ‘Training records of staff to support the individuals needs’ provided evidence of this. The staff training information she gave us during the inspection showed that few of the staff have done training in relevant topics and that where staff have had training it is not up to date. This means that the staff group is not well equipped to cater for the assessed needs of the people who have been offered places at the Home. College House Residential Home DS0000064821.V371388.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living at the Home cannot be confident that their care needs will always be met. This is due to a range of factors including the lack of clear written guidance for staff about each person’s care needs and insufficient training for staff. EVIDENCE: People who sent surveys back to us in June commented that they ‘Just have to ask’ if they need help from staff and that staff are ‘Always very helpful’. A relative wrote that the Home ‘Supports my mother in a friendly, homely atmosphere and we find her always looked after on visiting.’ One person told us they see the doctor when they need to but another said the doctor only comes once a month, not when they need him. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 12 One person said they did not want to speak to us because we would not be able to change things even if they did. People who sent surveys to us just before the inspection did not make any comments. The responses to the questions in both sets of surveys (including questions about meeting people’s needs and the skills of staff) were equally spread between ‘always’ and ‘usually/sometimes’. Comments in thank you cards and letters shown to us at the Home included – ‘It was obvious from our visits that she was being well cared for and very content in her new surroundings.’ ‘I am really happy with mum’s care. She ………………….. has settled so well. She is always clean and tidy. Her room is always very clean. The staff are always very friendly and helpful.’ ‘She was always fussy about her appearance and you managed to maintain that till the end…. You all helped to make my mother as comfortable as possible in her last years.’ The Home recently arranged for everyone to be seen by a domiciliary eye service that visited the Home to test people’s eyes. One person told us in their survey that they had been to the hearing clinic. District nurses from the local surgery visit the Home when someone needs specialist care such as wound dressings. Several people at the Home have care needs which are due to them having dementia type illnesses. We saw from the daily records that one person has had episodes of aggression and, on one occasion left the building at night. This was not noticed until the person was returned to the Home by ambulance some hours later. The Home did not notify us about any of these incidents although the law requires them to do so. We are concerned about the ability of this service to provide adequate care for people who have dementia illnesses. This is because of the staffing levels and lack of staff training in this aspect of care. We are also concerned that the staffing arrangements may not ensure that people with more physical care needs can always receive the amount of time and attention they need. We have said more about this in the staffing section of the report. In the AQAA the owner told us that the Home has ‘Care planning reflects how each individual‘s needs are met’ and ‘Person centred care plan’. During the inspection we found that there were no care plans in place and limited information regarding each person’s care needs. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 13 We saw that information about people’s care needs is available in the form of assessment documents and daily records. These records do not include care plans which describe the care to be given in respect of the identified needs for each person. This may result in aspects of a person’s care being overlooked or not being dealt with correctly. We have given some examples of this below – We found that two people living at the Home have bedrails on their beds. There was no information in their care records about the use of bedrails to explain when, why and by whom the decision to use bedrails had been made and no record of any assessment of the risks identified as part of the decision making process. It is important that this information is gathered and recorded because of the known risks associated with the use of bedrails. There was no information to guide staff regarding the nutritional and fluid intake needs for one person who was unwell and being looked after in bed. No information was being kept to enable staff to monitor what the person was having to eat or drink. This is important because adequate hydration and nutrition are vital especially when someone is ill. After we had questioned this, the acting manager started a food and fluid chart. Turn charts for the same person referred to in an entry by the acting manager on 1st September were not available on 9th September and staff on duty had not seen any but immediately started one. During the inspection we identified aspects of some people’s care where it was not clear whether or not the correct care was being provided. For example, there was no record to show that action was taken about a person’s pressure areas from 23rd August until 1st September. A member of staff told us that the problem had been mentioned to the nurse but there was no information to show when this was or what guidance had been given by the nurse about the care to be given. The first entry in the District Nurses’ records to show that they had been consulted about this was on 2nd September. The moving and handling assessment for a person showed that staff should use a hoist for transfers in and out of bed. Staff meeting minutes from 8th August highlighted that some staff were not doing this because they had not been trained. Staff we spoke to on 9th and 10th September confirmed that the person is frequently transferred manually. We learned that in addition to the lack of staff training the hoist was not working. This was being rectified during our visit on 12th September when a representative from the hoist company was at the Home. However, the issue of staff training and the faulty hoist should have been rectified more promptly so that the person could be moved safely and in accordance with the assessment made. One person had dry toothbrushes in her room and we voiced our concerns that she may not have had her teeth cleaned. The care records give no information about the help the person needs with mouth care. The owner told us she checked this and that the person has her teeth soaked, not brushed. This does College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 14 not explain why there were two toothbrushes and a tube of toothpaste by their washbasin. Although this is a simple example it does show why staff need clear care plans so they know the right care to give each person. People living in shared rooms do not have sufficient privacy because the curtains used to screen the beds do not provide privacy when a person is using the washbasin and, in one room the curtains are too short. Medication storage is secure but provides limited space for staff to work. The trolley used to take medication around the Home needs to have the chain and bolt repaired so that it can be secured to the wall when not in use. The medication administration records seen were up to date and the process for checking prescriptions before they go to the pharmacy is in line with good practice. There was no medication policy available where the medication is stored. The copy in the Home’s policy document is not tailored specifically to the Home and does not cover all the necessary areas. There is no written guidance to staff for people who have medication prescribed to be taken ‘as required’ and no homely remedies procedure was available for us to see. There was a copy of the British National Formulary on the medication trolley but this was the 2004 version and needs to be updated. The acting manager is setting up a folder with copies of the patient information leaflets relating to each person’s medicines, this is good practice. There are no photographs of people with their medication records; it is good practice to do this as an additional identification check. We were unable to do an audit to check balances of medicines in stock because staff do not date boxes of medication when they open them and do not record balances of medications held at the point new stock is received. These steps are good practice and help to provide an audit trail of medication held on the premises. College House Residential Home DS0000064821.V371388.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not receive a choice of menu to enable them to have a say in the food they eat. The quality and quantity of food provided does not ensure that meals are nutritious and enjoyable. Visitors are made welcome so that people can keep in touch with the people who are important to them. Some activities take place but the range of these is limited and may not reflect some people’s preferences. EVIDENCE: When we did our Annual Service Review in June, some people who live at the Home told us about the things they do – ‘Take part in quizzes and like puzzles news paper’, ‘Games, knitting squares, people come in to entertain us’. Some relatives also commented briefly on daily life – ‘Very good food and care. Often, some good activities and outings planned’; ‘ Nice small homely College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 16 atmosphere, very clean, excellent food. Good use of outside support, eg: hairdressers and local visits.’ While we were at the Home we saw some letters and cards thanking staff for the care they provide. One relative who was happy with the care provided commented that they had not been aware that there are any activities at the Home. Another referred to staff taking a resident away on holiday, this had clearly been greatly appreciated – ‘I’m sure it will have lifted her spirits for a while ….. many thanks to you both and my appreciation and gratitude for this mini holiday for X will never be forgotten’. During the first day of our inspection there were three staff on duty when we arrived – two carers and a cook. The cook went off duty at 3pm. During the afternoon the staff spent some of their time doing a quiz with people in the sitting room but they had to leave this several times – to answer the phone and to help with the care of a person who was ill in bed. The amount of time that we saw staff spending individual time with people was limited. This particularly applied to the person in bed who seemed to have no contact from staff other than when being turned and at meal times. The owner told us in the AQAA that evidence of all the activities they do is provided in their photographs of events; this is a new initiative so only six pictures were available but these did show people enjoying a get together. In time, this initiative may provide a more complete picture of the range of things that happen at the Home. An activity organiser has been employed for one day a week which should bring some benefits but it is important for staff to have time and opportunity for social interaction throughout the week. The care records do not include information about the things people might like to spend their time doing based on their own interests and preferences. We met one person who is able to make her own arrangements for how she spends her time and does not need much help with this from staff; she was very happy with being able to spend her time as she likes without any rigid routines. The teatime meal on the first day of our inspection was pizza, bread and butter and salad; the quantity served fitted on to small desert sized plates. No alterative was available. We checked the contents of the fridges and found that the contents were sparse. Some items were in open packs which had not been dated; this meant there was no way to know how long the packs had been open. One example of this was a four pint container of cream with a small quantity left in it. It had a use by date of the 8th September, ie the day before the inspection. There was also a pack of crumpets, also open and undated, with a use by date of 3rd September. On the last day of the inspection we saw another pack of crumpets in the freezer with the same use by date, this may mean that the open pack in the fridge had been frozen and not opened until after the use by date. In any event, there was no evidence of good stock control and food rotation. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 17 The majority of food in stock was plain wrapped or branded by the wholesale supplier indicating it to be in the ‘value’ type price range. Many value products are good value for money and nutritionally adequate however, care needs to be taken that overall enjoyment of food for people in the Home is not compromised by over reliance on cheaper foodstuffs. For example, we saw that the spread used on bread, toast etc was labelled ‘55 vegetable fat’ and the bread is unbranded, bought in bulk and frozen. We have also had information from more than one source that there is not always enough food at the Home. The acting manager had tried without success to arrange for a person who is nutritionally at risk to be prescribed supplements by the doctor. It is possible to provide a fortified diet without special supplements and the care plan for this person needs to provide clear guidance to care staff and to kitchen staff about the diet needed by the person. If in doubt the Home should request a referral to a community dietician for advice. The Home is relying on care staff and agency cooks to prepare meals; this needs to be reviewed so that food is prepared by someone able to plan and coordinate the food provision, including any special dietary needs. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Most people know who they can speak to if they have a concern about the Home but arrangements for dealing with complaints need to be easier for people to use. People cannot be confident that serious concerns about abuse or neglect will be dealt with correctly because staff do not have the training they need. EVIDENCE: In the surveys we received most people indicated that they know who to speak to if they have a complaint to make, one relative commented - ‘she speaks very highly of the staff and says she has no complaints.’ The Home has a complaints book on the bureau in the hall. When we inspected there were no entries in it. We feel that people are unlikely to use a book open to others to read to say if they are unhappy with something, as this would not give them the privacy they would want. We saw other complaints records in the office including a copy of the complaints procedure; this was out of date regarding our contact details and the name of manager. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 19 We saw information about one complaint dealt with earlier this year. The owner had recorded the outcome of this, finding that staff had not used the correct procedures to pass information on at a handover. The response did not address an element of the complaint regarding the lack of consideration given to the feelings of the complainant’s relative. There are complaint forms in the office but these are not always available to staff because, depending on which staff are on duty, the office is often locked. The office arrangements were changed during the course of this inspection to create a ‘duty office’ which can be kept unlocked. Paperwork that staff might need – like the complaints forms – should be kept in there. The Home has information about safeguarding procedures (adult protection) in its policy book. These are ‘off the shelf’ type policies which have not been tailored to the service eg the documents refer to ‘the Home’ and ‘the Home manager’. The section relating to safeguarding is not comprehensive and does not include information about local multi agency safeguarding arrangements. In the AQAA the owner told us ‘Staff have been trained in POVA and updated in their training programme’ and ‘Staff induction and training is recorded and includes knowledge of these policies’. The training information given us by the owner at the Home showed that less than half the staff have had training on this topic. None of the staff we spoke to (including the acting manager) knew about these procedures although they told us they would report abuse or neglect if they suspected this was happening. Those that had the training received it from a freelance trainer who appears not to have covered local reporting procedures. There was information about training from Worcestershire Council safeguarding coordinator at the Home. We advised the acting manager that she, the deputy, the owner and other staff at the Home need to do this training. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are on the whole provided with homely and comfortable surroundings but some aspects of the environment need upgrading to make sure people are safe, have satisfactory accommodation and facilities that meet their needs. EVIDENCE: People are encouraged to personalise their rooms and most we saw looked lived in, comfortable and homely because of this. We saw some things around the building which need attention; some of these may affect the safety of people living in the Home. We advised the owner and acting manager that they need to do a full audit of the accommodation to identify and prioritise what needs to be done. We also College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 21 advised them to contact the Health Protection Agency for advice relating to infection control. Many of the issues we identified would not, on their own be a major concern, but when seen as a whole a picture of poor attention to the accommodation emerges. The things we observed included – • In the laundry (which is kept shut but not locked) there was a large, open tub of washing powder. All cleaning chemicals should be safely stored to minimise the risk that someone might mistakenly eat or drink them. There are areas of floor that are tripping hazards where there are bare concrete sections between different sets of tiles and carpets, e.g. by the back door and outside the ground floor toilet. Toilet cistern lids have been tied down with string. The acting manager explained that this is because a resident takes them off; we suggested finding a solution that would be less unsightly. The floor of the toilet on the first floor is carpeted, this is an infection control risk. Bins for waste in toilets and in the kitchen have hand operated lids, which is another infection control risk (the owner bought new foot pedal bins during the course of the inspection). There was tablet soap in communal toilets and bathrooms, another infection control risk. There was no liquid soap or paper towels in some communal hand washing areas (the owner began to deal with this during the inspection). We saw evidence of communal toiletries and creams being used, this is poor practice because of the risk of cross infection and because people should be able to have personal toiletries that reflect their individual preferences and care needs. We saw four dressing gowns hanging on back of a bathroom door; one of these was dirty. People’s clothing needs to be returned to their rooms after bathing and dirty clothing should be taken to be washed promptly. The door of first floor bathroom doesn’t shut into the rebate properly and therefore can’t be locked to ensure privacy. In the airing cupboard and in bedrooms we saw that many of the towels were thin and frayed. There was no warning sign on the door leading onto the rear staircase. There was no lampshade on a pendant light near airing cupboard. A torch on the handrail in first floor corridor was not working; this could present a problem if night staff needed a torch if there was a power cut. We checked the underside of two commodes; both were dirty and rusty which creates an infection control risk. A bed in a room with a sloping floor was raised in one corner by a small wooden block which fell when we pushed the bed to one side. • • • • • • • • • • • • • • • College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 22 Part of the accommodation is provided in an annexe which is reached by going outside the building. Some staff we spoke to were unsure about the arrangements for locking these doors at night. The acting manager informed us that keypads with combination locks have been purchased so the doors can be locked but opened quickly without needing to use a key. Arrangements for access to the annexe, particularly at night, need to be included in the Home’s fire risk assessment. When we began our inspection the annexe contained the office, sleeping in room and two bedrooms. Following discussions about staffing at night, the sleeping in room was converted into a staff duty room. This will improve the space available for the storage of records and create a more suitable working environment for the management of the service. The Home’s call bell system rings in the main building if someone in the annexe rings but not the other way around, i.e. if both carers are in the annexe and someone in the main house rings their call bell, the staff would not know. The call system needs to be improved so that staff can hear the call bell wherever they are in the Home. The front door is locked with an old deadlock style key. The owner needs to check that the Fire and Rescue Service are satisfied with this arrangement. Fire safety tests and checks had not been done since early July. This compromises fire safety as it could result in a fault being undetected. We saw that some doors are being kept open using wooden wedges; this creates a fire hazard because, in the event of a fire, smoke and flames could spread faster. We have written to Hereford Fire and Rescue Service to inform them that we found concerns relating to fire safety because they are the organisation responsible for regulation of fire safety. We were told in the AQAA that the Home has been awarded a 3 star (good) rating by environmental health officers for food safety in the Home. During the inspection we saw documentation about legionella testing during 2008. There is problem with privacy in the Home for discussions between staff about the care of people living there. This is because the only space available to staff for handovers and meetings is the dining room. This may be resolved now that the sleeping in room has been turned into a duty room. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff are hard working and caring which means that people feel cared for. People living at College House are not protected because recruitment procedures are not robust; this increases the chance of unsuitable people being employed. Training arrangements are inadequate and do not provide staff with opportunities to develop their knowledge and skills in important aspects of safety and care. EVIDENCE: Comments we received in surveys and when we spoke to people who live in the Home gave a picture of staff who are working hard to look after people. One person we spoke to told us ‘Girls are very good – not patronising. They always seem to appear just when I need them’ another said that said she is ‘happy - the girls do their best’. In the AQAA the owner told us ‘Our recruitment and selection meets the requirements of the legislation, equal opportunity, anti discrimination.’ This was not reflected in our findings during the inspection. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 24 We looked at the recruitment records for two people. The first of these showed that a CRB check and two references had been obtained before she started work at the Home. There were no records of the person’s interview or to show that the references had been authenticated. These additional checks and records are good practice which help create a robust recruitment system. They also enable services to show that their practice is consistent with principles of equality and diversity. The second staff record we looked at showed that no POVAfirst check or references had been received but the person had started work at the Home earlier that week. During the inspection we saw her working alone cleaning a person’s bedroom. This is not acceptable as, at this stage, the Home cannot be sure that the person is suitable to work in a care setting. When we raised this with the owner she asked the person not to return to work until the required information had been received. Information given to us by the owner during the inspection showed that staff training has not been maintained during the last two years. When we interviewed staff and checked their training records we found that most people working at the Home have not had up to date training in important care and safety related topics. This has already affected the care of at least one person who is being manually lifted in and out of bed because staff have not been trained to use the hoist. According to the training matrix given to us by the owner, only seven staff have had moving and handling training and that was done more than a year ago, so is out of date. Other core training that staff have not done or is out of date includes first aid, food hygiene, infection control, fire safety, safeguarding and medication. In addition, staff have not done training in care related topics relevant to the care needs of people who live in the Home, including dementia, although the Home is registered to provide this type of care. Three staff have recently been registered to start NVQ training and the acting manager and deputy have started their Registered Managers Award. The acting manager has done NVQ level 3 and a range of other training at the Home she worked at before moving to College House. In the past, training provided at the Home has been provided by a trainer known to the owner. When we did our Annual Service Review, one comment in a survey questioned the effectiveness of the training saying – ‘All training is done in-house, sometimes the trainer reads from a book’. There are two care staff on duty during the day and at night. Until the week of the inspection only one of the night staff was rostered to be awake at night, the other was on call in the annexe. We raised concerns that this was inadequate because there are at least two people who need care during the night. One person needs two staff to provide this care. During the inspection the owner and acting manager explained that they had already had discussions College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 25 about the need for two staff to be awake at night. This was implemented from 10th September. One person living at the Home needed attention from staff every two hours for turning etc; we saw that during the time they were with this person (in the annexe), there were no staff in the main building. As already mentioned, the call bell cannot be heard in the annexe, so anyone needing help in the main Home would have to wait for the staff to return. This is particularly concerning considering the recorded incidents of agitation and aggression relating to one person living in the Home. We have commented elsewhere in the report on some of the issues arising from staffing levels in the Home which we do not consider to be adequate to meet the needs of all of the people living at the Home. For example, in the afternoons staff have to prepare and serve tea, deal with people’s physical care needs, answer the phone and attempt to provide social and emotional support to people. Information during our consultation for the Annual Service Review and for the inspection highlights staffing levels as a concern for staff, several of whom felt that staffing levels are not adequate. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of this service needs to become more effective and better organised to ensure that people living at the Home can rely on being safe and well cared for at all times. EVIDENCE: We have received two AQAAs for the service this year. The first was sent to us when we did our ASR; it contained very little information and in recognition of this the owner chose to submit a fresh one. The second document is more comprehensive but when we did our inspection we found little evidence to College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 27 support the information it gave us and in some cases we found that the information was inaccurate. We have given some examples of this in the report. We do not consider that the AQAA gave us a reliable picture of the service; it appears to describe what the owner knows the service should be achieving rather than the actual position. There was no registered manager in post when we did the inspection. A new manager has been appointed in the middle of June; she has not yet submitted an application for registration to us. The new manager has worked in a senior role in a larger care home but this is her first post as the manager of a service. We found her to be receptive to recognising the areas where the Home needs to improve and eager to develop her knowledge and skills. Until the week of the inspection she had been rostered on duty as one of the carers on each shift and had not had any supernumerary hours. During the week of the inspection her hours were changed to include 45 minutes each morning for management tasks. We told the owner we felt that this was unlikely to be enough time for the acting manager to address all of the areas where improvements are required. The owner agreed to extend this to include one morning a week. Although the Home is small, the manager of the service needs to have adequate time available to manage the service effectively. It is likely that the lack of dedicated management hours had contributed to the range of concerns we identified during our inspection. Staff have not had sufficient or recent training in safety related topics to enable them to work safely. Some of the issues we have described in the other sections of the report highlight areas where safe working practices are not in place. We noted that the owner had not highlighted these issues in the Regulation 26 reports she had written. The owner began to deal with some of the matters we raised before the end of the inspection; but should have already identified and dealt with these things. This demonstrates a need for more effective and proactive monitoring of the service by the owner, particularly while there is no registered manager. In the AQAA the owner told us they ‘have clear recording of service user finance’ and ‘Finances are recorded and audited weekly’. The records shown to us by the owner during the inspection did not provide evidence to support these statements. We looked at the records for the management of personal money for two people who live in the Home. In one case the Home holds money in safekeeping but this is administered by the person’s social worker. In the other case the Home receives the person’s pension direct to the organisation’s bank account and then holds the personal allowance element in safe keeping at the Home. None of the records available provided a transparent record of the money received and spent on behalf of the people. This does not protect College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 28 residents due to the lack of evidence of how much money is being received and spent. This can also result in staff with access to the money being vulnerable. Some work has been done to gather the views of people who use the service and their relatives. For example, surveys have been sent and some work has been done to review the results of these. This is work that the owner and acting manager recognise as important to develop. Results of surveys for the Care Home, the organisation’s meals on wheels service and domiciliary care service are combined. People using the other services and living in the community may have a different point of view from those living in the care home, so it would be better to collate the results separately. College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 1 X X 1 College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes – these have been taken into account in the new requirements and recommendations made in this report. 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 OP3 Regulation 14(1) Requirement Timescale for action 31/10/08 2 OP7 3 OP38 You must carry out a detailed pre-admission assessment to ensure you are able to provide people moving to the Home with the care they need and so a written plan of care can be provided to give staff clear information about the person’s care needs when they arrive. 15(1) There must be a written plan for each person’s care which is detailed enough to guide staff in meeting the personal, health and social care needs of each person living in the Home. Regulation You must ensure that a full 13(4)(c) assessment is in place for any people living in the Home who have bedrails in place to identify and so far as possible, eliminate risks to their health and safety. We sent an urgent action letter to the Home about this in advance of the inspection report. 31/10/08 19/09/08 College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 31 4 OP8 Regulation You must ensure that you make 12(1)(a) proper provision at the Home to and (b) ensure that each person receives the individual care they need. We sent an urgent action letter to the Home about this in advance of the inspection report. You must ensure that people in shared rooms have adequate privacy by improving the screening arrangements around the beds and at the washbasin. The medication trolley must be secured to a load-bearing wall when not in use to ensure the security of medication stored in it. All staff, including senior staff and the responsible individual (in the absence of a registered manager) must receive training about safeguarding so that they understand and recognise abuse and neglect and will know what to do if they suspect this is happening. You must improve the call bell system so that when the bell rings in the main house staff in the annexe can hear it so they will be aware if a resident is ringing for help. You must have effective arrangements to minimise the risk of infection in the Home so that people living there are protected from avoidable infection. You must identify risks in the Home and take the action needed to remove or minimise these to keep people living in the Home safe from avoidable hazards. You must have sufficient staff on duty to meet the assessed care needs of people who live in the DS0000064821.V371388.R01.S.doc 10/10/08 5 OP10 16(2) (c) 31/10/08 6 OP9 13(2) 31/10/08 7 OP18 13(6) 30/11/08 8 OP22 23(2)(n) 30/11/08 9 OP26 13(3) 31/10/08 10 OP38 13(4) (a), (b), (c) 31/10/08 11 OP27 18(1)(a) 30/11/08 College House Residential Home Version 5.2 Page 32 12 OP29 19 and schedule 2 13 OP38 12(1)(a) 14 OP38 13(4) 15 OP30 18(1) (c) 16 OP35 17(2) – Schedule 4 (9a) Home. This must include an adequate allowance of hours for the management of the service. You must have a clear procedure to make sure all the required recruitment checks for potential staff are done before they start work at the Home to reduce the risk of unsuitable people gaining employment in the Home. You must provide moving and handling training for staff so that they are competent to move people safely. There must be at least one first aid trained person in the Home at all times, to make sure that people living there receive appropriate attention in an accident. If you intend to continue to admit people to the Home who have dementia related care needs you must provide training for staff about this aspect of care so that they can improve and develop their knowledge and skill in this area of care. Clear and accountable records must be kept in all instances where the organisation and/or staff have dealings with money received from residents, held in safekeeping and spent on their behalf. These records must be available for inspection. 31/10/08 30/11/08 30/11/08 31/01/09 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 33 1 OP9 2 OP15 Arrangements for the safe management and administration of medication would be improved by – • Having a comprehensive medication policy specific to College House • Having a robust system for stock control and audit • Having photographs of people living at the Home with their medication records • Having an up to date version of the BNF • Having clear written guidance available for staff describing the circumstances in which ‘as required’ medication should be given to an individual • Having clear written guidance for staff describing the circumstances in which homely remedies should be given to an individual; this should include confirmation from the person’s doctor regarding the use of the homely remedy Catering arrangements at the Home need to be reviewed to make sure that the food provided is good quality and sufficient in quantity. People living at the Home should have a choice of what they eat each day and be included in planning the menus. The review should also consider the kitchen staffing arrangements, including the deployment of a regular cook. You should carry out a full audit of infection control and health and safety arrangements in the Home and use this to create a prioritised action plan. You should have clear procedures to make sure that any adaptations or repairs to equipment, furniture etc are identified and dealt with without delay so that people are not left without the facilities they need. An application for registration should be submitted to the Commission by the acting care manager without delay. 3 4 OP38 OP38 5 OP31 College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI College House Residential Home DS0000064821.V371388.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!