Inspection on 17/09/08 for Collins House

This inspection was carried out on 17th 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

Collins House 19/01/09

Collins House 09/10/07

Collins House 09/11/06

Collins House 28/09/05

Collins House 19/04/05

Collins House 04/10/04

Collins House 23/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Collins House Springhouse Road Corringham Essex SS17 7LE Lead Inspector Michelle Love Unannounced Inspection 17th 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 Collins House DS0000036411.V372257.R02.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. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Collins House Address Springhouse Road Corringham Essex SS17 7LE 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) 01375 671162 01375 361065 jmckiernan@thurrock.gov.uk Thurrock Council Mrs Judith Anne McKiernan Care Home 45 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (45) of places Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Number of service users to whom personal care is to be provided must not exceed 45. Personal care to be provided to no more than 45 older people over the age of 65. Personal care to be provided to no more than 24 service users with dementia over the age of 65. 9th October 2007 Date of last inspection Brief Description of the Service: Collins House cares for 45 older people, 24 of whom might additionally have been diagnosed with dementia. The home is situated in a residential area close to local amenities and Corringham shopping centre. The home is on two floors and there is a passenger lift to enable access to both levels. There are 41 single and 2 double bedrooms, a large dining room and a number of lounges. There is a secure courtyard garden. The home has a Statement of Purpose and Service User Guide. These documents, together with the last inspection report are available to residents/visitors in the main hallway of the home. The current weekly fees are £584.92. There are additional charges for chiropody, hairdresser, newspapers/magazines, personal toiletries and taxi fares. Collins House DS0000036411.V372257.R02.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 an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 11.10 hours, with all but one key standard inspected. Additionally, the manager’s progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment. This is a self-assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for relatives, staff and healthcare professionals were forwarded to the home for distribution and for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report, however only 3 relatives surveys and 1 healthcare professional survey was returned and no staff surveys were completed. The Residential Care Co-ordinators (RCC) and other members of the staff team assisted the inspector on the day of the inspection. Feedback on the inspection findings, were given as a summary at the end of the day with one RCC. The opportunity for discussion and/or clarification was given. As a result of concerns relating to inadequate care planning and risk assessing, a Serious Concern letter was sent to the registered provider. What the service does well: Visitors to the care home are made to feel welcome. Many positive comments were made by residents’ representatives with regards to the care provided to their member of family by care staff. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 6 The quality of food provided at the care home for residents is good and the cook/kitchen staff, pride themselves on `home cooking`. Resident’s comments in relation to food provided, is detailed within the main text of the report. Many members of staff have been employed at Collins House for some considerable time, providing stability to people living in the care home. What has improved since the last inspection? What they could do better: Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that residents are protected. Further training and personal development is required for staff to ensure that they have the skills and competence to meet resident’s needs. Particular attention must be provided for those conditions associated with the needs of older people. Additionally staffing levels at the home must be maintained at all times, so as to ensure that people living in the home are kept safe and have their safety and wellbeing needs met. Further development is required in relation to care planning and risk assessing processes, so as to ensure that individual plans of care are comprehensive, up to date, reflective of people’s current care needs and ensure that the care provided to residents, meets their specific requirements. Care plans are not currently being used as a working document and there is a lack of understanding by the management team of the home in relation to person centred care. People living at the care home and/or their relatives need to be more actively involved within the care planning process. The social care needs for people at the home and specifically for those people who have dementia/complex needs must be improved. The person in charge needs to review the daily routines of the home to make sure that peoples’ individual choices are taken into account and the home is run for the residents and not to suit the staff. The staff team lack direction and appropriate supervision, the person in charge needs to review the management systems in the home to make sure the ethos of the home supports the rights of the people living there. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 7 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. Collins House DS0000036411.V372257.R02.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 Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents cannot expect to be properly assessed prior to admission, and therefore are not assured that their needs can be met at this home. EVIDENCE: The inspector was advised by the Residential Care Co-ordinator (RCC), at the time of the site visit, that there is a Statement of Purpose and Service Users Guide for Collins House, detailing the range of services and facilities provided at the care home. A copy of both documents was requested by the inspector, however on closer examination following the inspection, information provided was noted to relate to another service previously owned by Thurrock Council. A further copy of both documents was requested. There is a formal pre admission assessment format and procedure in place, so as to ensure that the management team are able to meet the prospective Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 10 resident’s needs. In addition to the formal assessment procedure, supplementary information is sought from the individual resident’s placing authority and/or hospital. Two care files for the newest people (respite) admitted to the home were examined. Records showed that one person had previously received respite at Collins House 9 months earlier and the manager had completed a pre admission assessment, at that stage, however there was no evidence to show that a reassessment had been undertaken for the latest period of respite so as to ensure that the service could continue to meet the person’s care needs or to confirm that their needs remained the same. The RCC could not confirm whether or not a pre admission assessment had been newly completed by the manager. The RCC confirmed that information provided within the home’s pre admission assessment and the assessment undertaken by the local authority is incorporated into the care plan for the prospective resident. A pre admission assessment was in place for the other person newly admitted. Information recorded was observed to be in a tick chart format and lacked specific detail. For example information recorded included statements such as “moderate confusion”, “severely anxious”, “mildly deluded” and “moderate depression”. No further explanation was recorded detailing the person’s specific care needs. Additionally it was noted that information recorded within the pre admission assessment is not always in line with information recorded by the placing authority e.g. the pre admission assessment completed by the manager recorded that there was no history of falls, however the placing authority assessment recorded that the prospective resident was “prone to falls” and at risk. The Annual Quality Assurance Assessment (AQAA) under the heading of `what we do well` states, “assessing residents needs”. This did not concur with the inspector’s findings. There was no evidence to show that the pre-admission assessments seen had been compiled with the resident and/or their representative. Additionally there was no evidence to show that the prospective resident and/or their representative were offered the opportunity to visit Collins House prior to admission. One relative spoken with during the inspection confirmed that prior to their member of family being admitted to the care home, a pre admission assessment had been completed by the manager. They told us that they had not been given a copy of the home’s Statement of Purpose and Service Users Guide and were not involved in the devising of the initial care plan. However, they were satisfied with the care and support provided to their member of family so far and felt the transition for their member of family from their own home to the care home had gone smoothly. The home does not provide intermediate care. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not always cared for in the way they would wish to be and cannot be sure that their health and wellbeing will be looked after. EVIDENCE: There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the care home. As part of this inspection 4 care files were examined (2 care files for individuals staying at the home for respite and 2 care files for individuals living in the home). Care records show that issues highlighted at the previous key inspection (9/10/07) have not been addressed by the management team of the home and remain outstanding. Care plan recording was seen to be inconsistent with some elements of recording giving a reasonable level of detail and other areas being basic and not person centred. No plan of care or risk assessments had been devised for Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 12 either of the new people admitted to Collins House (respite). We recognise that both people were admitted to the care home, the day prior to the inspection, however there was insufficient information available within each of the care files to enable staff to deliver care in line with the individual’s needs. Staff spoken with, confirmed they had not been given information about either person and were unclear as to their specific care needs and how they liked and/or preferred to be supported. At the commencement of the inspection, the RCC expressed concerns to us about the care needs of two people at Collins House. Both care files were examined and these showed significant shortfalls and deficits. For example, the RCC advised that one person had “acute dementia, very poor nutritional needs, refused their medication on occasions and exhibited challenging/inappropriate behaviours.” Although some elements of this person’s care plan were completed (personal hygiene, mobility, activities, maintaining a safe environment and transition to a care home), no plan of care or risk assessments were devised in relation to the areas of need described by the RCC. Although there was evidence within the person’s daily care records to show that the management team of the home were aware of the person’s needs around poor nutrition, healthcare professional visits only showed that the GP was contacted several months later. It was positive to note that a formal `behaviour recording chart` had been devised in July 2008 to record a person’s challenging/inappropriate behaviours, however, these were not recorded accurately. Additionally some recording was seen to be inappropriate e.g. Recording included, “nothing [name of resident] was fine”, “refused to be checked”, “refused to go to bed” and “[name of resident] kept to their room, talking to their dogs”. Where there was evidence to show that the resident had exhibited inappropriate behaviours, there was little information detailing actions/interventions undertaken by staff. The care plan for another person was examined. The RCC advised the inspector that the main care needs for this person, related to them having “acute Parkinson’s disease and continually calling out”. No care plan and/or risk assessment was devised for the above areas. A `summary of assessment` completed by the person’s placing authority recorded the GP as having referred the person to the Parkinson’s clinic, however there was no evidence to show this had been followed up by the staff team at Collins House. Of those care files examined, there was little evidence to show that these were reviewed regularly or updated to reflect changes to individual’s needs e.g. the manual handling assessment for one person was noted to be dated October 2007, however there was no evidence this had been reviewed since. There was no evidence that issues highlighted at the previous inspection pertaining to care planning had been addressed. During the inspection we met with the Community Services Manager, responsible for all day services for disabled Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 13 adults, who advised that a new Individual Care Plan for each resident is to be implemented very shortly. Although we recognise this as positive, this has taken nearly 12 months to be devised/implemented and in the meantime the existing care planning processes have remained static and to the detriment of the people living at Collins House. On evidence of staff meeting minutes from June 2008, comments recorded included, “inspection imminent, care staff to concentrate on tidying bedrooms and update care plans”, “Collins House is only adequate, need to improve on care plans” and “care plans shortly to be replaced, but for the time being to be using old ones and making them people focussed. Staff to get information from residents and relatives also use reviews to go on for information”. Additionally in April 2008, Regulation 26 reports completed by the provider also highlighted deficits in care planning. The report for April 2008 recorded, “the home moving towards introducing a new PCIP (Person Centred Individual Plan),” however the new care planning system was still waiting to be introduced some 7 months after the decision was made to action this. On inspection of the manager’s self audit for May and July 2008, these recorded that care plans “all need attention” and care plans “in progress” and “working on”. The AQAA details under the heading of `what we could do better, and how we are going to do this`, “Currently looking at care plans to make them more person centred, process already underway with regular input for managers” and under the heading of `what our service does well`, “Residents are being included in their plans of care which are drawn up (we are presently working on new ones that we hope to introduce in the Autumn)”. It is evident at this inspection that none of the above has been undertaken. As a result of the above concerns, a Serious Concern letter was sent to the registered provider. Relatives surveys returned to us were very complimentary regarding the care received for their member of family and comments included, “The carers and managers are always so cheerful, chatty and very very caring. They look after all their needs very well”, “The carers are very kind and supportive” and “I cannot fault this care home and am very happy that my [relative] is there. You would have to go a long way to find a more friendly, attentive and helpful staff team of people”. One healthcare professional survey recorded that “usually” the individual healthcare needs of people are met by the care team. The majority of medication is managed through a monitored dosage system (blister pack). Storage systems within the home were appropriate, and temperatures for the fridge used to store medicines were regularly recorded and noted to be satisfactory and within recommended guidelines. It is also recommended that the room temperature also be recorded so as to ensure that medicines are maintained at a safe level, as failure to store medicines at the correct temperatures may result in residents receiving medicines, which are not effective. During the morning and at lunchtime, the medication trolley was left open and unattended on several occasions. Additionally, a blister pack of medication was Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 14 observed to be left on top of the trolley whilst the senior member of staff administered medication to residents. This was noted by the RCC who placed the blister pack back in the trolley and locked it up. This is unacceptable and could result in other people helping themselves to the medicines available and residents having access to the medication and possibly overdosing with serious consequences. The senior administering medication was also observed to handle two people’s medication. Medication records were not up to date, with gaps in recording and information. There was no record of some medicines having been given to a resident when they were due, as the entries on the MAR (Medication Administration Record) record had been left unsigned/initialled by staff. Where the prescriber’s instructions state 1 or 2 tablets to be administered, the actual dose administered was not always recorded. The MAR record for some people showed medication was not administered, as this was not available and staff had failed to ensure a sufficient supply of medication and in some instances, medication had not been administered as the resident was “sleeping” e.g. the night log recorded, “[name of resident] no med given as was sleeping and not sure to give as just returned from hospital”. It was unclear as to why staff had insufficient information relating to the above. The MAR record evidenced for some people that the code ‘O’ (other) was recorded, however the rationale for the use of this code was not recorded on the reverse on the MAR sheet. Where handwritten MAR records were completed, these were not always double signed/witnessed to show that the information transferred was accurate and correct. Additionally on inspection of the medication trolley, packets and bottles of medication were not always signed and dated once opened. The RCC was advised to ensure that a list of those staff deemed competent to administer medication be devised and include their name, signature and initials, as there was no evidence this had been completed. It was positive to note that all staff, who administer medication have received up to date medication training, however no members of staff have undertaken competency assessments so as to ensure that their practice remains appropriate and in line with regulatory requirements and guidelines. Collins House DS0000036411.V372257.R02.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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the activities programme at the home, for those people with dementia, means that some residents do not have their social care needs met. People can be assured of receiving a varied diet and their nutritional needs will be met. EVIDENCE: An activities co-ordinator is employed at Collins House between 9.00 a.m. and 1.00 p.m. Monday to Friday each week. However, the RCC advised us that often the activities co-ordinator does not undertake their activity role until 10.00 a.m./10.30 a.m. as they assist care staff with undertaking personal care tasks with residents. This was confirmed by the activities co-ordinator and on the day of inspection, they were observed to not commence their activity role until after 10.30 a.m. Although we recognise the rationale for this, this leaves a limited period of time to undertake meaningful activities for people, either as a group or individually. There is a fortnightly activities programme in place and this is displayed within individual lounge areas. Activities available for people include, hand and feet Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 16 massages, nail care, music, bingo, sing-a-long, arts and crafts, cards, board games, quizzes, reminiscence, movement to music, group and individual discussions and outings (weather permitting). The activity co-ordinator was advised to consider devising the activity programme in larger print and/or pictorial format so as to enable people in the home to make an informed choice. The activities co-ordinator stated that she tries to undertake completion of a social history and to record individual’s personal preferences, likes and dislikes. Information relating to activities undertaken by individual residents is recorded in a separate activities folder, however there is limited information recorded to reflect how those people with dementia/complex needs are actively supported to have their social care needs met. Additional information is required detailing whether or not the activity was actually enjoyed and/or whether or not the person engaged in the activity. It was positive to note that several residents receive a daily newspaper. People spoken with confirmed that these are provided daily. On the day of inspection residents were observed to enjoy an external entertainer in the afternoon and comments from residents included, “oh it was good” and “I really enjoyed that”. Care records detailing people’s social care needs were seen to be basic and there was limited information recorded for those people who have complex needs or remain in bed for long periods during the day. The AQAA details under the heading of `how we have improved in the last 12 months`, “Activities programme has been adapted to meet the needs of more stimulated residents”. This was observed to concur with our findings, however the social care needs of those people with dementia and complex needs are just as important and should not be disregarded. Interaction between residents and staff was observed to be limited throughout the day and many staff (permanent and agency) only spoke to residents if engaging in a task e.g. undertaking personal care, asking a person if they wanted a drink etc. The menu was written on a sheet of paper in the main dining room and within another dining area. The menu was not available in larger print and/or pictorial format so as to enable people to make an informed choice. Six residents spoken with were unable to tell us the choices available for the lunchtime meal and stated that staff did not always advise them unless they were specifically asked. Meals provided to residents were attractively presented and portions of food seen to be plentiful. Where residents required assistance to eat their meal, staff were observed to provide appropriate support that was both respectful and sensitive to individual resident’s care needs. Tables were attractively laid with tablecloths, condiments, cutlery and serviettes. A choice of drinks was not readily available for people in the main dining room, as orange juice was the only drink offered, however in the other dining area, people were given a choice of 2-3 drinks (water, blackcurrant and coke). Comments relating to meals provided at Collins House were positive and included, “Oh yes, I can’t Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 17 complain, the food is very nice”, “The food portions are very ample” and “In fact the food portions are too much and I’m putting on weight”. It was positive to note that people were offered second and third helpings of food and people were asked if they had finished their meal before their plate was removed. The tea trolley during both the morning and afternoon were observed to be taken to different lounge areas and to individual’s rooms. Tea was the only available drink offered to residents, however the supper trolley contained a variety of night-time drinks. Collins House DS0000036411.V372257.R02.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an appropriate corporate complaints procedure and system for logging complaints and guidelines for staff in relation to safeguarding. People cannot be assured that staff, working in the care home have the skill and knowledge to deal with their challenging and/or inappropriate behaviours. EVIDENCE: Feedback forms and a suggestion box are located within the home’s reception area for people to complete. On inspection of the complaints folder, records showed that the home has received 2 complaints since the last inspection. There was evidence to show that both complaints related to alleged poor care practices. Records included the specific nature of complaint, investigation undertaken and action taken, however no outcome was recorded for 1 complaint and it was apparent that not all points of this complaint had been addressed. Several letters and cards of compliment were noted and included, “Thank you for your endless effort and support in taking care of my [relative]. I am very grateful for the great level of care you have given to my [relative]”, “Thank you for all the care and kindness my [relative] received from you all”, “It gave us peace of mind to know that [our relative] was so well looked after, everything they ever needed was there for them” and “As a family we were Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 19 happy to know they were well cared for and we were comforted by this. As constant visitors we were always impressed by the cleanliness of the home no matter what time of day we came. We were also made very welcome by all”. Since the last inspection there have been no safeguarding issues highlighted. Appropriate safeguarding policies and procedures were available within the home and staff spoken with, were able to demonstrate a good understanding and awareness of local safeguarding procedures. There are some people in Collins House who exhibit inappropriate/aggressive behaviours from time to time, yet staff have not received training on how to deal with the above. Collins House DS0000036411.V372257.R02.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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well maintained and comfortable environment. EVIDENCE: A partial tour of the premises was undertaken throughout the day. The RCC advised us that following the decision to retain Collins House, a refurbishment programme has been drawn up. It is recognised that some areas of the home are tired and worn and require modernising and redecorating. The AQAA details under the heading of `our plans for improvement in the next 12 months`, “we are presently drawing up a schedule to have all windows replaced, the residents alarm system, a loop system in each lounge for the heard of hearing, new beds, a wet room and redecoration of the home”. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 21 Signage within the care home needs to be improved so as to aid orientation for people residing at the home, especially for those people who have dementia and/or poor cognitive development. A random sample of residents’ bedrooms, were inspected and all were seen to be personalised and individualised with many personal items on display. Of those residents spoken with, all confirmed that they liked their personal space and found the home environment to be satisfactory. The home was observed to be odour free, clean and tidy and no health and safety issues were highlighted at this inspection. A maintenance person is employed at Collins House Monday to Friday for 37 hours per week. The training matrix evidences that the maintenance persons training relating to moving and handling, fire safety awareness, health and safety and COSHH (Control of Substances Hazardous to Health) is not up to date and requires reviewing. On the day of inspection the maintenance records could not be located and as a result of this, the Interim Service Manager for Older People was contacted to provide the information as part of the inspection process. The Interim Service Manager for Older People reviewed the homes maintenance log and this showed all maintenance at the home carried out on an ad hoc basis, with the response to maintenance tasks being very good. There was a fire risk assessment in place dated 2006, however this is to be reviewed. In addition a request has been made to Essex Fire and Rescue Service for them to visit Collins House to conduct an inspection. Since the last inspection there have been 3 fire drills and all fire equipment within the home was serviced in May 2008. Certificates relating to the services gas safety inspection, electrical installation and portable appliance testing were all serviced in 2008 and remain in date. The record, of hot water temperatures for wash hand basins/baths were observed to be conducted monthly with no issues highlighted. Collins House DS0000036411.V372257.R02.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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of staffing/staff deployment restricts the ability of the service to deliver person centred care and to ensure that people’s needs, can be met and that they are safe. Shortfalls in training means that residents are not fully safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. EVIDENCE: The RCC advised us that staffing levels at the home are 1 RCC and 7 care staff between 07.00 a.m. and 14.00 p.m., 1 RCC and 6 care staff between 14.00 a.m. and 22.00 p.m. and 3 waking night members of staff (including one person in charge) between 21.45 p.m. and 07.15 a.m. each day. The RCC advised that the manager’s hours are supernumerary to the above (Monday to Thursday 08.00 a.m. to 16.00 p.m. and Friday 08.00 a.m. to 13.00 p.m.). In addition to the above there is an activities co-ordinator employed between 09.00 a.m. and 13.00 p.m. Monday to Friday and a variety of ancillary staff (chef, housekeeper etc). On inspection of 4 weeks staff rosters these evidence that staffing levels as detailed above have not always been maintained. We have not received any Regulation 37 notifications advising us of the staffing shortfall and measures undertaken to deploy staff to the home. The rosters also detail that there is a Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 23 high usage of agency staff at Collins House, particularly at weekends. Where agency staff are utilised, the staff rosters did not include the full names of all staff deployed in the care home on any given shift. Staff spoken with during the inspection confirmed on occasions that staffing levels as detailed above are not always maintained, particularly at weekends and in the afternoons. This impacts significantly at teatime as existing staffing levels are reduced in the afternoon and in the ability to provide personal care tasks promptly resulting in some people having to wait a long time before their care needs are attended to. Throughout the day, we saw that lounge areas were often left unsupported for long periods of time and people who spend a significant time in their room either by choice or as a result of their physical condition, were not checked regularly by staff except when assisting people to either eat their meal or when providing personal care. Residents spoken with within one lounge area, stated they were aware that staff were very busy attending to other people and could not always be available to spend time with them, “gossiping and chatting”, but stated that it would be nice for staff to sit and talk with them from time to time. The deployment of staff within the home has not changed since the last inspection, despite being highlighted and confirms that the home is not being run for the benefit of the people living at Collins House. The staff files for 2 newly employed people were examined (one person transferred from another Thurrock Council service). The majority of records as required by regulation were evident, however gaps were noted in relation to no evidence of a health declaration for one person, no copy of a job description for one person and no recent photograph for one person. Evidence of staff induction was available for both people. The training matrix provided evidenced training deficits (including updates) for some members of staff in relation to core areas such as food hygiene, health and safety, fire awareness, first aid, safeguarding, manual handling and those conditions associated with the needs of older people. The RCC confirmed that to the best of their knowledge the training matrix was up to date. A random sample of individual staff training files were also inspected and these showed in relation to the above that since the last inspection some staff had also received training relating to understanding mental illness, epilepsy awareness and administration of rectal diazepam and personal care, however there remained limited evidence to show that people had received other training relating specifically to the care needs of older people. One RCC and 2 members of staff spoken with advised that training provided/offered is “hit and miss” and that they are not always fortunate to be provided with a place on a particular course as a result of the high demand for places. The AQAA, details under the heading of `what we do well`, “Induction and training of staff including agency staff”. This did not concur with our findings. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 24 The AQAA details that 24 members of staff have attained NVQ Level 2 or above. Collins House DS0000036411.V372257.R02.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, 32, 33, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not live in a well run home or have their best interests considered. EVIDENCE: At the time of the inspection the manager was on annual leave, however the home was being managed by a RCC. The Statement of Purpose records that the manager has worked in residential care for many years and has previous experience of managing a residential care home. Records detail that the manager has attained an NVQ Level 3 in Care, City and Guilds 325/3 Advanced Management in Care, D32/33 NVQ Assessors Award and completed the D34 Internal Verifiers Award. The previous inspection report also details that the manager has achieved the Registered Manager’s Award (NVQ Level 4 in Management). Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 26 The majority of staff spoken with were complimentary regarding the management of the home and felt that the manager was approachable, however other comments were negative as some people felt that the manager spent too much time in their office and were unaware of difficulties faced by care staff on a day to day basis. Relatives surveys returned to us were positive about the staff team and recorded, “The staff are always cheerful and nothing is too much trouble for them. The staff always attend to individual needs and requests are conducted with cheerfulness and good humour” and “I have nothing but praise for the care my [relative] receives in Collins House. All the staff, without exception, have shown nothing but kindness and patience towards my [relative]. The home is exceptionally well run, cleanliness is of a very high standard, and the food is beautifully cooked and served up. I think all staff at Collins House deserve a big pat on the back”. All sections of the Annual Quality Assurance Assessment (AQAA) were completed and the document returned to us when requested, however information recorded was very brief and provides little information about the service. Additionally it does not give an accurate account of the current situation within the service. Aspects of the document as detailed within the main text of the report provide little or no evidence to support some of the claims made within it. It is evident from this inspection that insufficient progress has been made to address previous identified shortfalls in relation to care planning and risk assessing, medication practices and procedures, ensuring that the routines of the home are around the needs of the people living in the care home, that staff deployment/actual numbers of staff within the home is suitable for the numbers and needs of residents and that there is a robust training programme in place for staff. From inspection of a random sample of staff supervision records, evidence showed these are not being conducted in line with National Minimum Standards recommendations in some cases e.g. one employee file recorded that since the commencement of their employment (5 months) they had only received 1 formal supervision and for another employee who had been in post since February 2008, they had received 2 supervisions, however on one occasion the only subject discussed related to their NVQ. A further 5 people’s supervision records were also inspected and these showed that some people are receiving regular formal supervision whilst others are not. The AQAA, details under the heading of `what we could do better`, “more regular supervisions”. Information relating to the services quality assurance were requested. The only information available related to the manager’s monthly self-audit. The RCC was unable to find any documentation relating to the home’s quality assurance systems except for blank questionnaires. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 27 Records of staff meetings were readily available and records showed that the last full staff meeting was undertaken in August 2008. In addition to this, meetings are also held for kitchen staff, housekeepers, RCC, care staff and night care staff. Since the last inspection 3 residents meetings have been conducted. The AQAA provides a list of policies and procedures currently available within the home. Some have not been updated since 1996, and may have inaccurate and not up to date information recorded. Collins House DS0000036411.V372257.R02.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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X 2 X 2 Collins House DS0000036411.V372257.R02.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 OP3 Regulation 14 Requirement People admitted to the care home must be assessed as to their suitability/continued suitably to be admitted to Collins House. Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and be regularly updated/reviewed to reflect the most up to date information. People living at the home and/or their relatives must be involved in the completion and frequent review of their care plans to ensure that they are in full agreement with way they are to be supported to meet their care needs. Previous timescale of 31.1.08 not met. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. The health and welfare of individual residents needs to be DS0000036411.V372257.R02.S.doc Timescale for action 17/09/08 2. OP7 15 17/12/08 3. OP7 13(4) 17/12/08 4. OP8 12(1)(a) 17/09/08 Collins House Version 5.2 Page 30 5. OP9 12(1)(a) 13(2) 6. OP9 17(1)(a) Schedule 3(3)(i) 7. OP9 13(4) 8. OP12 16(2)(m) and (n) 13(6) 9. OP18 10. OP27 18(1)(a) 12. OP30 18(1)(c) promoted and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. Residents must be protected from harm by having their medication administered safely and in accordance with the prescriber’s instructions so as to ensure their health and wellbeing. When medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. The medication trolley is not left unattended and medication easily accessible to residents and others. This will ensure that unnecessary risks to residents’ health and wellbeing is averted. Ensure that those people who have a diagnosis of dementia and/or who are immobile have their social care needs met. All care staff must receive appropriate training relating to dealing with people’s aggression/challenging behaviour. This will ensure that staff, have the skills and competence to manage people’s behaviours and to provide appropriate care. Sufficient staff must be on duty at all times, and the deployment of staff must be appropriate to meet the needs of residents and to ensure their safety and wellbeing. Staff must receive appropriate DS0000036411.V372257.R02.S.doc 17/09/08 17/09/08 17/09/08 17/09/08 01/01/09 17/09/08 01/01/09 Page 31 Collins House Version 5.2 training to the work they perform. This refers specifically to those conditions associated with the needs of older people and core areas. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. Previous timescale of 31.1.08 not fully met The care home must be managed effectively so as to ensure that the home is run in the best interests of the people who live at Collins House. Staff must receive regular supervision so that they feel supported and residents know that staff are appropriately managed. 13. OP32 10 17/09/08 14. OP36 18(2) 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP9 OP12 OP14 OP15 Good Practice Recommendations Ensure that residents and/or their representatives are involved in the care planning process and their views are taken into account. It is recommended that those people who administer medication to residents, undertake regular assessments to assess their continued competency. It is recommended that the activity programme is devised in larger print and/or pictorial format so as to enable the people in the home to make an informed choice. It is recommended that the routines of the home are arranged around the choices of the people living there and not solely based around task orientated routines. It is recommended that the menu is devised in larger print and/or pictorial format so as to enable the people in the home to make an informed choice. DS0000036411.V372257.R02.S.doc Version 5.2 Page 32 Collins House 6. 7. 8. OP16 OP19 OP31 The outcome of all complaints received at the home is recorded and all elements of the original complaint are addressed. It is recommended that appropriate signage be in place around the care home so as to aid people’s orientation and ability to find their way around the care home. It is recommended that the management structure is reviewed to ensure that the care staff are receiving the support they need to best meet the needs of the people living at the home. Collins House DS0000036411.V372257.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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