Inspection on 19/01/09 for Collins House

This inspection was carried out on 19th January 2009.

CSCI found this care home to be providing an Adequate 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 17/09/08

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Collins House Springhouse Road Corringham Essex SS17 7LE Lead Inspector Jane Greaves Unannounced Inspection 19th February 2009 07:50 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.V374271.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. Collins House DS0000036411.V374271.R01.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.V374271.R01.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. 17th September 2008 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.V374271.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key site visit that took place over 9 ½ hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. In July 2008 the manager had completed and sent into the Commission for Social Care Inspection the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Views expressed by residents and visitors to the home during the site visit have been incorporated into this report. The registered manager was absent from the service at the time; an acting manager had been in post since October 2008 and was present throughout this inspection visit. Feedback on findings was provided to the acting manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the acting manager, the staff team and visitors for the help and co-operation throughout this inspection process. What the service does well: The management and staff team have responded positively to the requirements made in the pervious inspection report and have made many improvements to the running of the home that benefit the people living there. The staff team demonstrated good knowledge of how each person preferred to be cared for and supported. Relatives told us they were generally happy with the service and care provided at Collins House. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Despite considerable work done in this area further refresher training and development is necessary for the staff team to ensure they have the skills and competence to meet people’s needs and keep them safe. The care planning and risk assessment processes have been reviewed and updated since the previous inspection visit. Staff need to improve their understanding of person centred care and use the updated care plans as working documents to ensure that people living at the home receive care and support appropriate to their individual requirements. The social care needs for people living at Collins House and specifically for those people who have dementia and complex needs must be improved. Where health issues, such as weight loss, have been recognised the staff team need to be consistently proactive in seeking professional advice and guidance so that people can be assured their health needs are looked after. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 7 Daily records need to be consistently completed so they accurately reflect the care and support provided for people living at the home. 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.V374271.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 Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People moving into Collins House can be assured their health needs should be met through a comprehensive assessment. EVIDENCE: The Statement of Purpose and Service User Guide relating to Collins House had been reviewed and updated since the previous inspection visit and were ready to go to print. Both documents contained relevant detail to inform people about the range of services and facilities provided at the care home. At the previous inspection visit we found that the system for assessing peoples’ individual needs prior to them being admitted to the home did not ensure all their needs would be identified and met. This had been revised and developed however no people had been admitted to Collins House since the previous visit so it was not possible to assess the process in practice at this visit. No people had been admitted for respite care Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 10 since the previous visit. We were provided with a copy of the pre-admission assessment form to take away with us and assess. The assessment documentation encompassed such areas as current and past medical history, peoples’ medication regime, what assistance people require to get ready for the day and to go to bed, what their usual sleep pattern is, what assistance people need with personal hygiene and foot care. People’s wishes and choices were identified regarding frequency of bathing/showering and dietary needs. Risk assessments were considered in relation to such areas as falls, safe moving and handling and maintaining a safe environment for people. There was a prompt on the pre admission assessment form to discuss individuals’ personal history such as relationships, fond memories, hobbies, interests, past working life and pets etc. All people living at Collins House were placed by the Local Authority and consequently had the standard Social Services assessment documentation too. The manager reported that the new person centred care plans would be developed using information gathered from the Local Authority assessment, the home’s pre admission assessment, discussion with the resident and family and any health care input available such as GP, district nurse etc. The action plan submitted to us in November 2008 as a result of the previous inspection of this service stated that ‘Residents and/or representatives will be involved from the pre admission assessment and will be encouraged to participate in creating and updating care plans’. The home does not provide intermediate care. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be sure their health and well being are being looked after due to inconsistent record keeping. EVIDENCE: It was acknowledged that the acting manager and her team had made big inroads into the work necessary to bring peoples’ care plans up to date in a person centred format. The plans we looked at during this visit provided clear detail about each person’s personal care and support needs and actions to be taken by staff members to meet these needs. The acting manager acknowledged that the care plans still needed some further development to put ‘meat on the bones’ and also more work was needed to change the culture within the established staff team so that they automatically worked in a person centred way as opposed to the task orientated manner that existed previously. We looked at care plans for three people living at Collins House during this visit. The care plans were clear and easy to navigate, in a typed format. Where any changes were made or a review took place a new typed sheet Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 12 replaced the old one in the care file. The old sheet was then archived elsewhere. This meant that anyone looking at the care plan for the purpose of review or tracking someone’s care and support would not have an audit trail to refer to. Daily recording was inconsistent, examples seen included ‘personal care given’ and ‘all care given’. Some examples of good informative recording told us how the person had been feeling during the shift, what they had done with their day, who had visited them, what their demeanour was etc. The manager reported that she was aware of these shortfalls in the quality of recording and that it had been included in the supervision agenda for all staff. Each care plan we looked at contained some risk assessments; these were generally about pressure sores. There was little real knowledge demonstrated by the staff team about what constituted a risk and what actions they needed to take to reduce or minimise the element of risk. The management team acknowledged that more work was necessary in this area. The plans we looked at contained evidence that care plan reviews were taking place monthly. There was a computerised system in place to flag up when peoples’ care plans were due for review ensuring that peoples’ changing needs were constantly monitored. It was a changing culture within the home and relatives were not yet in a routine of attending the reviews and signing for them however the management team reported that this was work in progress and moving in the right direction. The care plans we looked at all contained either the residents or representatives’ signature indicating that they agreed with the plan of care. We asked four relatives if they had been invited to join in care plan reviews. One person told us “It was mentioned to me long time ago”, but no one we spoke with had actually been involved in a review. Weight charts told us that one person’s weight had reduced by 11 lbs in 4 months and 9 lbs immediately prior to that. Staff told us that this would normally be looked at, as part of the monthly review however there was no evidence available to confirm this had been considered as part of the review. We looked at nutrition records to assess if the person was receiving adequate nutrition however the recording was very basic with little room for detail. There was evidence to show what choices people had made rather than what quantity had been eaten. There was the comment ‘ate well’ repeated in one column indicating that all people in the home had eaten well. A copy of the registered providers’ report for 16th January 2009 was provided for scrutiny. We noted that under the section titled care plans that the person undertaking the visit had identified that one resident had unexplained weight loss and that there was no action plan in place. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 13 Medical records and detail of healthcare appointments and the outcomes of these were maintained separately in a loose-leaf folder in the medical room. Staff told us that the rationale for this was to make the care plans less unwieldy and more manageable ensuring they were used as ‘working documents’. Staff told us that this was not always useful. An example given was in the event of an emergency instead of the care plan having all information that may be needed by paramedics or doctors the medical room had to be accessed to find the relevant page in the folder. Medication was stored in a clinical room when not being administered. When we arrived at the home at 07:50hrs the medication round was in progress in the dining room, and staff were administering each person’s medication as they came down for breakfast. At 10:30, whilst undertaking a tour of the home we saw medications being administered for people who had chosen to remain in their rooms. Staff and management both told us they felt that medication administration was taking too long. This could mean that some people may be receiving their medication later than required or that the lunch time medication round could be due to start as soon as the breakfast one had been completed leaving insufficient time in between doses. The GP has recently been involved in gradually reviewing everyone’s medication to assess if any can be removed or reduced. There were no gaps in recording on the Medication Administration Records (MARs). Where people had refused their medication or not taken it for any reason this was marked with a code on the front of the MARs sheet and detailed on the reverse. The medication trolley was locked when left unattended. The temperature of the medication room and the medication fridges were monitored daily and records confirmed the temperatures were maintained within safe ranges. The temperature of the medication room was monitored in the early morning, staff advised they realised this was not the warmest part of the day and were changing this to a lunchtime observation. Records were maintained of homely medications such as paracetamol and Senna. Controlled Drugs were stored appropriately and we checked and agreed stocks held with the register. Medications were supplied to the home in a Monitored Dosage system, staff training was provided by a local pharmacy and staff files that we looked at included evidence of regular assessments of their individual competency to safely administer medication. Where issues were identified through this process there was documentary evidence to confirm what actions had been taken to support the person to gain competency. Regular weekly audits of medication by the deputy manager have ensured that the administration and storage within the home has improved considerably since the previous visit protecting the health, safety and welfare of the residents. During the course of the inspection one staff member was overheard saying “Just time to do the toileting”. The manager reported that she felt this poor non-person centred practice had been eradicated from the culture within Collins House and demonstrated disappointment that this had occurred. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 14 Subsequent to this visit we spoke with a healthcare professional involved with the home, they told us “There have definitely some areas of improvement noted. Always drinks available in lounges and residents’ rooms”, “Asking for advice and input more often” and “Seem to be interacting with residents more. When we go into the home the staff seem to be sitting and chatting to people on a one to one basis more often”. Families spoken with during and subsequent to the inspection visit told us: “Healthcare support is not too bad” “They don’t leave the medicine trolley around so much any more” “I am very happy with the care my relative gets” “I can’t see how anything can be improved because it was very good in the first place”. “If they have any concerns they let me know” “I have no direct concerns about the care my relative receives” Collins House DS0000036411.V374271.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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people do not have their social needs met due to the shortfalls in the activities provision for those people living with dementia. EVIDENCE: We noted that dedicated activity hours were planned to be from 0900hrs to 1300hrs Monday to Friday. Staff and management acknowledged that there were instances where activity hours were reduced and actually started at 10:30am as the co-ordinator helped to attend to peoples’ personal care needs before starting the activities provision. This means that between 12 ½ and 20 hours of activity provision per week were available to 31 people currently living at the home and 45 people when all rooms are occupied. This is not sufficient to provide each person, many of whom have very complex needs, with the stimulation and social and spiritual interaction needed. The activity co-ordinator had not had specific training to provide leisure and stimulating activities for people living with dementia. The management team acknowledged that activity records were not consistently completed to provide a true picture of the interaction with residents. It was acknowledged that this was an area needing more work Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 16 especially with leisure and stimulation for those people living with dementia and being immobile or bedridden. We were provided with a copy of the activity schedule to take away with us and assess subsequent to the visit. This was written in large bold type and pictorial format. Examples of scheduled activities provided included hand and foot massages, card/board games and sing-along, music with movement, memory games, reminiscence sessions involving books, photos and objects, music stimulation, crosswords, word association, name that tune, bingo and cinema. The management team reported that there were a number of instances where 1:1 interaction and dialogue took place between care staff and residents, other than when delivering personal care and support however this was not always recognised as being a leisure activity and consequently was not always recorded. Families spoken with during and subsequent to this visit told us “No games, they are left to their own devices”, “They don’t actually stimulate people” and “My relative gets bored a lot”. All communal televisions had been replaced with large plasma screens so that they were easier for people to watch. Laminated menus were displayed on the wall of the main large dining room at the home. These were not available in the smaller dining areas available in Primrose or Sunflower Lounge. The manager’s action plan developed in response to the previous inspection report told us that residents had chosen the font style and size on the menus. The menus also included photographs of the choices on offer for those people with impaired vision or cognitive ability. We were given a copy of the four-week menu to take away with us and assess. We observed Breakfast on the day of this visit. People had the option of a full fried breakfast, boiled eggs, toast, cereals etc. There was a choice of main meal each day with the exception of Sunday when a Roast Dinner was provided. The daily dessert alternative offered was ice cream. Tea consisted of assorted sandwiches, cake, fruit and yoghurt daily with the addition of choices such as cheese and biscuits. Sausage rolls, pork pies, savoury egg. There was no option of a warm alternative at teatime. Residents we spoke with were complimentary about the food provided at the home. Comments included “We’re well looked after, good food, that’s the main thing”, “It’s got better I think”, “We’re happy” and “The food’s lovely”. Families told us: “There is no choice given to people about supper, those people not able to speak up for them selves get Jam Sandwiches every day whether they like it or not”. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can confident that their complaints and concerns will be dealt with appropriately. EVIDENCE: There had been one complaint received by the home since the previous inspection visit. There was evidence available to confirm this had been dealt with appropriately within the timescales indicated in the Policy and Procedure for dealing with complaints. One further issue was under investigation at the time of this visit. The manager was able to demonstrate that appropriate actions had been taken to date; a final outcome had not yet been reached. The manager told us of an adult safeguarding incident that had occurred whilst she had been away on leave. The staff team had taken all appropriate actions involving the local safeguarding team. The incident had not yet been reported to the commission, a copy of the regulation 37 report was given to us during the visit. Thurrock County Council vulnerable adult safeguarding guidance was available in the seniors’ office accessible to all staff members. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 18 Minutes of a recent staff meeting included reference to whistle blowing, staff were asked if they had received the policy and covering letter. All staff present confirmed this. The minutes evidenced that it was discussed how difficult it is for a member of staff to raise concerns about a colleague and that all staff must be supported in this situation. The minutes stated ‘under no circumstance will victimisation be tolerated’. The manager asked that all staff be vigilant and report any poor practice and that Collins House must be a safe and comfortable environment for the Residents that reside there. Since the previous inspection visit the care staff team have attended training to enable them to react appropriately to aggressive and challenging behaviours. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a home where the environment is gradually improving. EVIDENCE: We undertook a physical tour of the home including some personal bedrooms and all communal areas, toilets and bathrooms. The decoration and furniture throughout the home were tired and in need of refurbishment. The manager’s AQAA of July 2008 stated “We are presently drawing up a schedule to have all windows replaced, The residents’ alarm system, A loop system in each lounge for the hard of hearing, New beds, a wet room and redecoration of the home”. At the time of this visit all the windows in the home had been replaced with UPVC double glazed units, the alarm system had been ordered, 20 new profiling beds had been purchased and one ground floor bathroom had been altered to create a spacious wet room. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 20 The perimeter fencing had been replaced since the previous visit making the grounds secure for people living at the home to access safely. The manager reported plans for outside seating, raised planters, a herb garden, some decking and a fountain. There were issues with storage around the home. Many wheelchairs were stored in various locations, including ends of corridors, an alcove off the main hallway and in communal rooms. The small dining room next to Primrose lounge contained 8 wheelchairs, 2 table fans, 1 floor standing fan, an empty activity box, a radio, a television, an empty bottle for the water cooler and a hot trolley. The manager reported there were two new dining tables and some chairs on order for this room and the curtains were due to be replaced. There was a notice board with many pictures of the residents at Christmas time. The toilets and bathroom facilities were generally clean and fresh but very institutional in appearance. For example, there were racks secured to the toilet walls containing up to 6 boxes of disposable gloves and a roller of disposable aprons. It is accepted that this equipment is necessary however, a more discrete method of storage would promote the dignity of the people living at the home and make the facilities more pleasant to use. One bathroom contained an assisted bath. There were also three room dividers and two hoists stored in the bathroom, one of which was overdue a service. People living at Collins House benefit from the home having a dedicated hairdressing salon. The manager told us that a hairdresser visited the home weekly and peoples’ own hairdressers were able to use the facilities any time they wished. We saw four people using the facility during our tour of the home, they were chatting happily, interacting with each other, the staff and the hairdresser. The home had a through the floor passenger lift that was scheduled to be updated in March 2009. A stair lift will be installed for people to use for the short time the main lift will be out of service. The manager reported that the stair lift would remain as a permanent feature to enable those people able to use it independently to have more freedom to move about the home. The main dining room was a cafeteria-style room. The manager reported plans for installation of French Doors onto a new decking area and developing the existing space into a lounge/diner area. The previous report identified the need for appropriate signage to be in place around the home to aid peoples’ orientation. Efforts had been made towards this end by seeking external advice. Themed pictures and arrows had been put on the walls to direct people to the different lounge areas, such as Primrose, Lilly, Bluebell and Sunflower. These signs were not large and the pattern on the wallpaper meant that they did not stand out clearly to help people find their way around the home. The management team were aware of Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 21 this and the refurbishment plans for the home include colour coding the communal areas to coincide with the floral names, reducing the amount of heavy pattern on the walls and incorporate pictures of the relevant flowers to assist people in finding their way about the home. Minutes from a residents’ meeting held in February 2009 provided evidence that residents were involved in decision making about the décor of the home they live in. The minutes referred to the fact that the manager ‘said she would obtain some colour charts and some fabric samples so residents can choose paint and curtains’. Residents and their relatives we spoke with did not share many opinions about the environment at Collins House, one person said, “It’s very clean, spotlessly clean”. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s care needs are met but lack of staff training means that they may not always be safe. EVIDENCE: The staffing levels at the home had reduced since the previous inspection visit in line with the reduced numbers of residents living at the home, 31 at the time of this visit. A review of peoples’ dependency levels had been undertaken to ensure that enough care staff hours were allocated to meet peoples’ needs. Staffing levels at the home were 1 Residential Care Co-ordinator (RCC) and 6 care staff between 07.00 am and 14.00 pm, 1 RCC and 5 care staff between 14.00 am and 22.00 pm and 3 waking night members of staff (including one person in charge) for night duty. The manager’s hours were supernumerary to the above. In addition there was an activities co-ordinator employed between 0900hrs and 1300hrs Mon to Fri and a variety of ancillary staff (chef, housekeeper etc). Copies of staff rotas confirmed the numbers of staff on duty. Staff told us they felt the numbers were satisfactory. Records showed us that there was still a regular use of agency staff at the home. The manager was able to demonstrate that regular agency staff members attended the home in order to maintain consistency of care for the people living there. There was a separate rota for agency staff ensuring there was a clear record of who was on duty at any given time. The regular agency staff members took Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 23 part in staff meetings, were subject to direct supervision by the staff at Collins House and participated in Collins House in-house training sessions. A staff-training matrix was provided to show the training that staff members had attended. Staff spoken with said they had received a great deal of training in the 5 months since the previous inspection visit. The manager said she was aware there was an element of ‘training exhaustion’ and was concentrating on key areas to ensure people did not become too weary of training courses in a short time. Staff also said they appreciated being provided with better skills to help meet the needs of the people at the home. The acting manager told us that staff practice was monitored closely through supervision in order to assess the effectiveness of the training. Where staff indicated they needed more training in an area this was provided. For example some staff had said they were not fully comfortable with the concept of ‘person centred’ care planning. This has been acknowledged and further training had been arranged for those people. There were individual training profiles also. The manager told us that these were used in each person’s supervision to identify what areas of peoples’ practice needed refreshing. The training matrix indicated some shortfall in the provision of moving and handling training for the care staff team and duty managers. The matrix indicated that the policy was for attendance of annual refresher training in this area. Records showed that approximately 75 of care staff and duty managers were up to date with refresher training; the remainder were overdue refresher training. Records indicated 19 of the 46 staff members had not attended training in fire safety. The home’s policy is for 2 yearly refresher training. There were also gaps in the training provision and refresher training for infection control, health and safety and food hygiene. However, it was positive to note that since the previous inspection of this service in September 2008 there had been training delivered for staff in all these basic core areas, this needs to be continued throughout the staff team. 6 of the 7 night care staff, 18 of the 19 care assistants and 6 of the 7 duty managers had achieved a minimum of NVQ level 2 in care. No new people had started to work at the home since the previous inspection visit so it was not possible to assess current recruitment practices. During discussion with the manager she was able to confirm that she is aware of the correct documentation required for the safe recruitment of care staff. We looked at recruitment documents for 3 staff members; this showed us that all the relevant checks had been made to ensure the safety and well being of the people living at Collins House. Residents told us “The workers are all very pleasant” Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 24 Families had mixed views and told us: “most of the time they are short staffed”. “It is worse in the summer, if the weather is nice they go off sick”. “When the nurses have their breaks why can’t they have them separately so that more staff are left to look after people?” “The carers are exemplary and really dedicated” “Lack of staff around during handover periods. There have been instances of aggression between residents and there have been no staff on hand to deal with it”. “I know the layout of the home makes it difficult for staff to be in all places but people are left alone a great deal”. “They do look after the residents well and they work hard”. The manager praised the staff team for their dedication, hard work and commitment during the period of massive change over the past 6 months. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a home where their best interests are increasingly considered. EVIDENCE: There has been an acting manager in post since end of September 2008. The manager has approximately 19 years experience in care and has completed her NVQ4 Registered Manager’s Award. She has brought an inclusive and supportive management style into the home and the overall management structure in the home has been reviewed and amended. Staff said they felt very supported and viewed the massive changes that have taken place at the home over the past six months very positively. The manager has moved her office from a remote corridor to a place close to the central hub of the home. She reported that she liked to be able to hear Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 26 what was going on and make her self available to support staff should the need arise. Evidence of regular staff supervision was seen on file. There was a staff supervision ‘tree’ on the office wall showing which managers were responsible for supervising which staff members. Staff confirmed that their supervision had become more structured and ‘useful’ sessions where they could discuss residents they were key working for, practice issues, personal issues, training requirements etc. We saw evidence that where issues had been identified with individual staff members there were more frequent supervision sessions to deal specifically with any concerns. People living at Collins House were able to have their pocket monies looked after at the home if they wished. Monies were maintained separately in a locked facility with records and receipts available to evidence where monies had been spent and by whom. We checked balances held for three people and agreed them with the written records. There was a monthly audit system being developed involving management checking a sample of residents’ monies against the records. The manager reported that she had started the Quality Assurance process with support from the Quality Team at Thurrock CC. Quality questionnaires were in the process of being developed for residents/relatives/staff and other external stakeholders such as healthcare professionals, social workers etc. There were regular Residential Care Co-ordinator meetings, staff meetings and residents meetings, the minutes of these will also ‘feed into’ the quality assurance process along with complaints and complements received by the service. The manager reported that a summary would then be made of all the responses received to identify areas of shortfall to be addressed and good practice to be built upon. The manager reported that a copy of the resulting action plan would be sent to us. The deputy manager was able to demonstrate that a great deal of work had been done in relation to reviewing the policies and procedures in place at Collins House. This was still ‘work in progress’, and it was reported that 90 had been updated at the time of this visit. The staff handbook contained a summary of Policies and Procedures; this had been reviewed and was given to all staff. Staff files contained a signature to confirm they had received and read their staff handbook. Portable Appliance Testing was taking place on the day of this visit and certificates were displayed on a notice board in the reception area of the home to confirm that Gas systems, Electrical systems, hoists and passenger lift were regularly tested and that public liability insurance was in place. The staff-training matrix indicated that not all staff had attended all the necessary training to be confident that safe working practices were being Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 27 followed. For example, Fire awareness, moving and handling and infection control. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X 3 X 2 Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4) Requirement Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Previous timescale of 17/12/08 not fully met 2. OP8 12(1)(a) The health and welfare of individual residents needs to be 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. Previous timescale of 17/09/08 not fully met 3. OP12 16(2)(m) and (n) Ensure that those people who have a diagnosis of dementia and/or who are immobile have their social care needs met. Previous timescale of 17/09/08 not fully met. Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 30 Timescale for action 30/04/09 30/04/09 30/04/09 4. OP30 18(1)(c) The staff team must continue to 31/05/09 receive training and refresher training appropriate 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 timescales of 31/1/08 and 01/01/09 not fully met 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 Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Collins House DS0000036411.V374271.R01.S.doc Version 5.2 Page 32 - 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. 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