CARE HOMES FOR OLDER PEOPLE
Collins House Springhouse Road Corringham Essex RM17 6TJ Lead Inspector
Christine Bennett Unannounced 19 April 2005 10:00am 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 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 I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Collins House Address Springhouse Road, Corringham, Essex, RM17 6TJ Telephone number Fax number Email 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 Thurrock Council Mrs Alice Bell CRH 45 Category(ies) of 45 OP, 22 DE(E) Dementia over 65 registration, with number of places Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: The home may accommodate 45 older people of either sex, 22 of which might additionally have been diagnosed with dementia. Date of last inspection 4/10/04 Brief Description of the Service: Collins House cares for 45 older people 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 rooms and 2 double bedrooms, a large dining room and a number of lounges. There is a secure courtyard garden and the home has a minibus to take residents out. The home is registered to accommodate 22 people with dementia. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 7hrs 40 minutes. A tour of the premises took place and care records and staff records were inspected. Nine members of staff, six residents and two visitors were spoken to during the day. Twenty one standards were covered and ten requirements have been made. Two recommendations have also been made. What the service does well: What has improved since the last inspection?
Decoration is being gradually improved and the damage from wheelchairs on the walls in the communal areas has been repaired. The maintenance person has put protectors on the walls in the hall, which are a big improvement. The contracts for residents have now been amended to include the fees charged by the home. The night staff employed by the home have worked out a new rota for themselves and this is going to be overseen by a senior carer, who will work one night a week to make sure it is working well. The home encourages its staff to attend training courses and 14 have been doing NVQ level 2. The staff room had a notice board where staff could see the training days they might like to attend in the future.
Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,4 Contracts have been improved to include fees and additional extras. An assessment is carried out prior to admission involving residents and their relatives to ensure the home will meet individual care needs. EVIDENCE: Residents’ terms and conditions were seen to include fees payable and any additional services available, which are not included in the fees. Records are kept for each client and inspection of three records revealed a comprehensive pre assessment with details of individual needs. Staff members spoken with were familiar with residents and were able to demonstrate a good knowledge of their needs. There was evidence of on going training opportunities and also staff confirmed they had received relevant training. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Minor shortfalls in the completion of care plans and medication could mean that the needs of residents are not fully met. EVIDENCE: Individual care plans are kept but there was little evidence of regular reviews or input from residents and relatives. A resident who had recently been admitted to the home had a history of falls but there was no evidence of a risk assessment. Daily records did not reflect the quality of the care given, which residents and relatives said was good. The GP and District Nurse visit the home regularly and there was evidence of input from the dentist, optician and audiology department. Administration of medication was seen and there were discrepancies on two of the three records checked. This was discussed with the person administering the medication, who could offer no explanation. The acting manager and senior carer confirmed they will ask the GP to review one resident’s medication in order to prevent confusion in future. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 Some social activities take place, however due to continued sickness of the activities person, these are dependant on the care staff having time to provide them. The home provided sufficient quantity and quality of food to meet the individual nutritional needs of the residents. EVIDENCE: The activities person employed by the home had been on sick leave for a considerable length of time, which meant there was no formal activities programme. Care staff said that they do not have the time very often whilst on duty but often arranged an activity in their spare time. The previous week there had been a seafood supper, which had been organised by carers and paid for with the proceeds from a raffle. The acting manager confirmed that activities were not happening in the home unless the care staff could manage it and often depended on the goodwill of the staff. Residents and visitors spoke very positively about the food provided and lunch and tea seen confirmed that the meals were of good quality and looked appetising. Lunch was served in the dining area and care staff were seen to assist people sensitively with their meals. However some residents were sitting in the room for a long period before the meal was served, until the staff had been able to assist everybody to their place. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Appropriate arrangements are in place to protect residents from abuse. The complaints procedure is satisfactory. EVIDENCE: Evidence was seen of Protection of Vulnerable Adults from Abuse training for staff, and staff had a good understanding of reporting abuse. Two complaints have been received since the last inspection. Residents confirmed that they felt comfortable that any complaints would be dealt with appropriately. A visitor who had cause to complain said that she was happy with the outcome and felt that the home “ had done the best they could” to rectify the problem. There was no evidence to confirm that one complaint had been dealt with to the satisfaction of the complainant. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,22,24,26 The home is clean, comfortably furnished and improvements have been made to the décor. Improvements to bathrooms and toilets, and provision of more aids would enhance the quality of residents’ lives. EVIDENCE: In general the home is well maintained and improvements have been made to areas of the home since the last inspection. There were no offensive odours and a visitor to the home commented “you can’t fault the cleanliness”, and a resident was very complimentary, saying the maintenance person was happy to do jobs for her within her room to personalise it. Some toilets in the home do not have a hand basin and the home provides wipes, and staff said the provision of a shower would be beneficial to both residents and themselves. Staff also commented that the dependency of some residents had risen, which meant that there was a shortage of appropriate equipment i.e. hoists, suitable beds and some wheelchairs were not maintained satisfactorily. A senior carer in charge of the home confirmed this is the case. Discussion also took place regarding infection control in relation to
Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 13 the use of one laundry door only, the use of the same trolley for both clean and dirty laundry, and the disposal of pads. The home may wish to obtain further advice from Sarah Brill, Health Protection Agency on 01376302282. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Shortfalls on staff records do not provide the safeguards to offer protection to residents. The number of staff available prior to lunch and tea, or to provide an activity is not sufficient to meet residents’ needs. Staff training is provided in a planned way to give them the skills to care for residents with the exception of Parkinsons Disease. EVIDENCE: Omissions were noted on two staff records. One had no references apparent and another had no information other than training records. This was brought to the attention of the senior carer. Staff training opportunities were evidenced in the staff room and in individual files. The home provides a thorough induction programme, and seven members of staff have completed NVQ level 2 with a further seven in the process of obtaining NVQ level2. The home also has five NVQ assessors. None of the staff members seen had any training related to Parkinsons Disease, although one resident spoken to in the home suffered with this condition. Residents spoke very positively about the staff, saying they were kind and approachable and this was evidenced when speaking to staff. They had a good knowledge of individual residents and their needs, but felt they were unable to give the care needed due to the increasing dependency of some residents. One staff member commented there was no time to sit and talk to residents and the care had become regimented “like a conveyor belt”. This was evidenced when ten elderly people were seen sitting in the upstairs lounge with no member of staff present. Staff also said that lack of suitable equipment increased their workload. The upstairs floor had five residents who
Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 15 needed to be hoisted but only one hoist. This was particularly apparent in the hour before meals when people needed to be taken to the toilet and dining room. One resident was distressed in the corridor saying she could not stay in the lounge as “that poor man is waiting to go to the toilet” Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,38 The home has lacked leadership which has affected the staff morale and the consistency of care provided to residents. EVIDENCE: Unfortunately due to ill health of the registered manager, the home has suffered long periods of senior staff employed by Thurrock Council undertaking a 3 month “deputy manager” role. This has resulted in inconsistencies and lack of leadership within the home. It has now been confirmed that from 1st May, 2005 a six month contract has been given to one of these staff members who is in the process of undertaking NVQ level 4, and who Thurrock Council hope will bring renewed leadership to the home. Residents and visitors made very positive comments about the staff. However staff spoke of feeling unsupported, things not getting resolved and their views not taken on board. A regulation 26 has not been submitted to the CSCI since
Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 17 December 2004, and there was no evidence in the home’s records to suggest these visits were being done. Staff and staff records confirmed that supervision takes place 6 times per year. There were concerns regarding some aspects of the health, safety and welfare of residents, in particular razors and toiletries left in bathrooms, sanitizer in an open sluice, and the disposal of soiled pads. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 2 2 x 3 x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 2 2 x x x 3 x 2 Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 19 YES Are there any outstanding requirements from the last inspection? 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 7 Regulation 17 Requirement The registered person shall keep records of residents as detailed in Schedule 3. This refers to a new admission whose care plan was incomplete The registered person shall make arrangements for the recording of medication The registered person shall consult residents and provide facilities for recreation The registered person shall ensure any complaint is fully investigated The registered person shall make arrangements to prevent infection This refers to laundy arrangements nad the disposal of soiled pads. The registered person shall provide equipment in good working order. This applies to wheelchairs in need of repair The registered person shall ensure records are kept in relation to Schedule 2 The registered person shall ensure a manager is fit to manage a care home The registered provider shall visit the home at least once a month Timescale for action 1/7/05 2. 3. 4. 5. 9 12 16 21 13 16 22 13,16 1/7/05 1/7/05 1/7/05 1/7/05 6. 22 23 1/7/05 7. 8. 9. 27 31 32 19 9 26 1/7/05 1/6/05 1/6/05
Page 20 Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 10. 38 13 and prepare a report and supply it to the commission The registered person shall ensure that all parts of the home are free from hazards to residents. This refers to razors, toiletries and sanitisers 1/6/05, RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 30 22 Good Practice Recommendations It is recommended that awareness training is offered to staff regarding illnesses such as Parkinsons Disease. It is recommended that equipment is provided to assist both residents and staff. This includes additional hoists and a shower. Collins House I56-I06 S36411 Collins Hse 221678 190405 Stage4.doc Version 1.20 Page 21 Commission for Social Care Inspection Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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