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Inspection on 10/07/08 for Colne Place

Also see our care home review for Colne Place for more information

This inspection was carried out on 10th July 2008.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Colne House continues to provide the people who live there with a homely environment, which is clean and well maintained. The gardens are attractive and fully accessible to wheelchair users. People who use the service tell us they receive good quality food, have activities which suit their needs and are supported by care staff who are friendly and work well as a team. They also confirmed they have good access to health care services, when they need them. This was confirmed in comments received in residents and relatives `Have Your Say` surveys, which included, "staff at the home are caring and friendly to residents and their relatives, they continue to help residents when their health declines and in general to the end, the home have got it about right" and "my relatives well being has greatly improved since moving into Colne Place, mentally and physically and they are very happy there" and "the staff care for all my relatives needs". Other comments about the food included, "very good standard of food" and "food is very nice, I enjoy my meals a lot" and "I always enjoy meals they are very nice".

What has improved since the last inspection?

Five requirements and one recommendation were made at the previous inspection. Information provided in the AQAA and verified at the inspection confirmed improvements have been made to address all but one of the requirements with regards to peoples access to call bells. The home is in the process of changing over to use the Monitored Dosage System (MDS), where individual`s medication is individually blister packed by the pharmacy. Improved medication policies and procedures, staff training and introduction of the MDS has lead to improved recording and administration of medication. Medications with a maximum life, such as eye drops are now being used within the recommended use by date. Improvements have been made to the monitoring and recording of temperatures of the medication fridge and room where medication is stored and a record of the action taken when this is exceeded. Staff have received infection control training and hand washing facilities, liquid soap and paper towels and protective equipment, such as gloves and aprons are now being provided in all areas where personal care is provided. Health and safety practices have been reviewed and extra care is being taken to ensure hazardous materials are locked away when not in use. Random testing of hot water temperatures are within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when washing their hands, taking a bath or shower. A previous requirement was made to ensure people living in the home are able to call for assistance and for longer call bell leads to be made available. Although longer leads have been provided, staff still need to make sure all people have access to a call bell. This will ensure they will have access to staff at all times.

CARE HOMES FOR OLDER PEOPLE Colne Place 97 High Street Earls Colne Colchester Essex CO6 2RB Lead Inspector Deborah Kerr Unannounced Inspection 10th July 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 DS0000017797.V368239.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. DS0000017797.V368239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Colne Place Address 97 High Street Earls Colne Colchester Essex CO6 2RB 01787 222314 01787 223984 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) Handsale Limited Mrs Maria Connolly Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places DS0000017797.V368239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th September 2007 Brief Description of the Service: Colne Place is a residential care home for the elderly set in a period residence with large well-maintained grounds over looking the village church. The premises have been extended and provide accommodation and 24-hour care to 33 people, with varying levels of dependency. The accommodation is mainly in single rooms many of which have en suite facilities. All parts of the home are fully equipped to provide a safe environment for those with restricted mobility. The fees range from £444.57 - £465.00 per week. Items considered to be extra to the fees include chiropody, toiletries, hairdressing and newspapers. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. CSCI inspection reports are available from the home and our website at www.csci.org.uk DS0000017797.V368239.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. The inspection was unannounced and lasted eight and a half hours on a weekday. This was a key inspection, which focused on the core standards relating to older people and to follow up concerns raised with the Commission for Social Care Inspection (CSCI) about practice issues, which resulted in a referral being made to the local authority safeguarding team. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from twelve residents, nine relatives and nine staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the CSCI. This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home, a relative and three members of staff. The manager was available during the inspection and fully contributed to the inspection process. What the service does well: Colne House continues to provide the people who live there with a homely environment, which is clean and well maintained. The gardens are attractive and fully accessible to wheelchair users. People who use the service tell us they receive good quality food, have activities which suit their needs and are supported by care staff who are friendly and work well as a team. They also confirmed they have good access to health care services, when they need them. This was confirmed in comments received in residents and relatives ‘Have Your Say’ surveys, which included, “staff at the home are caring and friendly to residents and their relatives, they continue to help residents when their health declines and in general to the end, the home have got it about right” and “my relatives well being has greatly improved since moving into Colne Place, mentally and physically and they are very happy there” and “the staff care for all my relatives needs”. Other comments about the food included, “very good standard of food” and “food is very nice, I enjoy my meals a lot” and “I always enjoy meals they are very nice”. DS0000017797.V368239.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Consideration should be given to providing the statement of purpose in a format suitable for people with a visual and/or other sensory impairments. People living in the home have been provided with a contract setting out their terms and conditions of residence, however, these need to be amended to reflect the current fees and whether they are private or funded through social services. More could be done to ensure people living in the home are treated with respect and dignity, observation and information received prior to the inspection confirmed this does not always happen. Where people require assistance to manage their continence, support plans must be completed which include the equipment and level of support to manage this. Elimination charts must be completed sufficiently to monitor their continence and reflect where problems may occur so that these are dealt with at an early stage. This will ensure people maintain good health and well being. DS0000017797.V368239.R01.S.doc Version 5.2 Page 7 Further improvements could be made to ensure safe administration and handling of medication. To avoid mistakes with people’s identity, it is good practice that each persons MAR chart has a front page with their name and photograph. It is advised that staff receiving medication into the home should use the MAR charts to show the amount and when the medication is received. This will ensure there is no mishandling of medication and an accurate audit trail is kept. Where people require hoist and slings for transfers these should be assessed by a suitably qualified person, to ensure the equipment being used, is assessed to meet the individual’s needs. Additionally the dining room should be re assessed to ensure people who require the use of a walking aid do not have their movement restricted. Training needs to be provided and plans developed with strategies of how staff manage physical and /or verbal aggression. This will ensure staff have the skills and knowledge to manage and understand behaviours challenging to others, and which safeguard the individual and others living and working in the home. All recruitment checks must be received prior to an employee commencing work, this includes a current photograph of the individual for identification purposes and two satisfactory written references. Records indicate staff supervision is now taking place, however to meet the national minimum standard these should take place at least six times a year. A record of any incident/accidents, which is detrimental too the health or welfare of a person living in the home must be recorded. This must include the nature, date and time of the incident/accident. These must be reviewed and risk assessed to prevent similar accidents/incidents reoccurring. Investigation into the concerns raised about the home concluded that there was insufficient evidence to support the allegations. However, some elements of the concerns raised, regarding staff attitudes, working with people who present behaviours that are challenging to others and the recording of incident /accidents could be improved to ensure the safety and well being of people living in 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. DS0000017797.V368239.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 DS0000017797.V368239.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, 2, 3, 5 & 6 People who use the service experience good quality outcomes in this area. People considering moving into this home and their representatives will be provided with information about the service however this may not be sufficiently up to date to include details of current fees. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information received in residents and relatives ‘Have Your Say’ surveys confirmed people considering moving to the home are provided with information, which enables them to make an informed decision about whether Colne Place will meet their needs. The statement of purpose clearly sets out the objectives and philosophy of care, detailing the services provided, quality of the accommodation, qualifications and experience of the staff and how to make a complaint. DS0000017797.V368239.R01.S.doc Version 5.2 Page 10 At the time of the inspection there were twenty-seven people living in the home. The AQAA reflects that four people have impaired vision. Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. Discussion with people using the service and their relatives confirmed they were invited to view the home and discuss their requirements with the management team. They are also invited to spend time at Colne Place before making a decision if this is the right placement for them. Information provided in the AQAA and verified at the inspection confirmed that before people move into the home an assessment is carried out to identify their individual needs. Additionally, where people had been referred through social services, a care management assessment had been obtained. This process ensures the manager has all the information they need to ensure the service will be able to meet the individual’s specific needs. People living in the home have been provided with a copy of their contract setting out their terms and conditions of residence, which had been agreed, signed and dated by the individual, or their relative. However, these need to be amended to reflect the individual’s current fees and whether they were private resident of funded through social services. The home does not provide intermediate care. DS0000017797.V368239.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. The personal care people receive is based on their individual needs and preferences, however more could be done to monitor their health and to ensure people are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of three people living in the home were looked at as part of the inspection process, all three contained information, which provided a comprehensive overview of the individual’s health, personal and social care needs. The daily recording sheets are being completed well and incorporate what has worked well for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. Observation and discussion with staff confirmed that they are aware of the needs of the people in their care. They were able to provide a verbal account of the needs and preferences of each individual. DS0000017797.V368239.R01.S.doc Version 5.2 Page 12 These were reflected in the individuals care plan in a ‘What I prefer’ list, which provided an overview of their preferred daily routines, including times they liked to get up, go to bed and the help they needed with their personal care. Discussion with residents confirmed they received support as described in the care plan. Records of care review meetings reflect people living in the home, their relatives and social worker (where funded by the local authority) are invited to participate in an annual review and have a say in their future care needs. Comments made by residents and relatives confirmed they remain satisfied with the service they receive, these included, “my relative is well cared for and I am kept informed about their health, medical or otherwise” and “I am happy here and contented, staff look after me very well” and “I am completely satisfied with the care my relative is receiving”. People living in the home are supported to access health care services. Dates and details of appointments are clearly recorded in the care plans. Healthcare needs of the people using the service are managed by visits from local General Practitioner’s (GP) and district nurses. Residents and relatives ‘Have Your Say’ surveys confirmed, “the GP comes when needed” and “the GP is called immediately, when needed” and “good use is made of the local GP’s, they are wonderful, always willing to make calls at the home”. Discussion with staff confirmed they are aware of the need to treat people with respect and dignity, when delivering personal care. However, observation and information received prior to the inspection confirmed this does not always happen. When administering the lunchtime medication it was noted that a member of staff applied an individual’s eye drops at the dining table, although they asked the individual first, this does not promote privacy and dignity. People living in the home were appropriately dressed and well presented on the day of inspection. However, comment’s received in several relatives ‘Have Your Say’ surveys suggest people are not always wearing their own clothes, for example “my relatives clothing is always kept nice and clean, however these clothes are not always their own”. An incident report in the care plan of an individual tracked as part of the inspection and to follow up the concerns raised with us (The Commission) confirmed that they had been left on their commode for about 3.5 hours. They had been found fully clothed, still on commode at 10pm when the night staff commenced duty. Their care plan reflects they need staff assistance to manage this aspect of their personal hygiene, however there is no mention of the use of commode in the elimination and personal care plan or moving and handling assessment. Additionally, the elimination monitoring charts of the three people being tracked were not being completed sufficiently to reflect they were being supported to manage their continence. No entry had been made on the elimination chart of one individual for the whole of June and July. DS0000017797.V368239.R01.S.doc Version 5.2 Page 13 Nothing was recorded to reflect if appropriate action had been taken to ensure the individual was not suffering from constipation. A previous requirement was made for improvements to be made to ensure the safe receipt, storage, administration, recording and disposal of medication. Medication policies and procedures have been reviewed and now provide detailed guidance for staff to follow to ensure people receive their correct levels of medication. The home is in the process of changing over to use the Monitored Dosage System (MDS), where individual’s medication is individually blister packed by the pharmacy. The pharmacy has provided training to all staff responsible for administering medication on how to use the new system. During our visit we looked at Medication Administration Records (MAR) charts and medication belonging to people living in the home. Examination of the monthly MAR charts reflects introduction of the MDS has lead to improved recording and administration of medication. Where medication has not been administered, staff had made good use of the reverse of the MAR chart with an explanation why medication had not been administered. To avoid mistakes with people’s identity, it is recommended good practice that each persons MAR chart has a front page with their name and photograph. The previous requirement referred to using medication within it’s use by date. Where individual containers of medicines with a maximum life, such as eye drops had been opened, the date had been clearly recorded on the box, on the day of opening. All such containers seen in the medication trolley were within the recommended use by date. The home currently has one person prescribed a controlled drug. Medication was checked against the controlled drugs register and was found to be accurate. The home has a separate metal cupboard for storing controlled medication, which is fixed to a solid wall and meets legal requirements. Records showed that regular temperatures of the medication fridge and room where medication is stored are being kept daily and the action taken when this is exceeded. Senior staff are responsible for ordering medication. The process was discussed with the senior on duty. To keep an audit trail and ensure there is no mishandling of medication staff should use the MAR charts to show when the medication is received, the amount and the signature of the person receiving the medication. DS0000017797.V368239.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience good quality outcomes in this area. People using this service are being offered the opportunity to engage in meaningful and enjoyable activities, which meet their prefrences and interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed residents are offered the opportunity to take part in social and leisure activities that they have shown an interest in or those that they have suggested by themselves. The home has a full time activities co-ordinator who provides and organises activities in groups or on one to one basis, accessing and making use of community facilities including the local shops, pubs and flower centres. A list of entertainments is provided weekly and displayed around the home informing people of ‘what’s on’. These included, boules in the garden, making posters for the forthcoming summer fete, touch and go entertainment and visits by the hairdresser. People were seen relaxing watching television or reading papers or magazines and walking in the gardens, enjoying the nice weather. People were also observed engaged in conversation, working out the a word quiz, each day letters of the alphabet are mixed up, and spell out a resident’s name, which they have to guess. DS0000017797.V368239.R01.S.doc Version 5.2 Page 15 People’s care plans included evidence that their interests had been discussed with them and a life history recorded. Individual records were also being maintained of their involvement in activities. People spoken with confirmed they had access to activities, which reflected their interests, comments included, “there is enough activities available, however I cannot always take part in activities due to poor eyesight” and “I enjoy activities, but would like a few more” and “I enjoy all activities, especially music and crafts”. Information in the homes brochure and the AQAA states that the home assists residents to maintain links to the local community, family and friends. This was confirmed by observing and speaking with relatives and friends visiting people in the home during the inspection. Visitors are made welcome and confirmed they are able to visit at any reasonable time. A monthly communion service takes place in the smaller lounge, additionally the AQAA reflects representatives of other faiths attended the home on request. The lunchtime and evening meal were observed. Meals are served in two separate dining areas. Six people who require more support eat in the smaller dining area. Where individual’s required support to eat their meal this was done sensitively and at a pace suitable for the individual to enjoy their food. Menus seen provided a good range of meals with two choices of main meal each day, with the exception of Thursdays and Sundays where a roast dinner is provided, however the chef confirmed if someone did not want a roast an alternative would be offered. Where individuals required a soft food diet, their meals were pureed, each food item was pureed individually to ensure the individual could identify the different tastes and textures. Food seen was nicely presented and appetising, people spoken with confirmed they were enjoying their meal. Residents ‘Have Your Say ‘surveys confirmed they are receiving a good balanced diet, comments included, “very nice food, I always enjoy meals they are very nice” and “I enjoy my meals a lot” and “very good standard of food, have not had a meal I do not like, I enjoy every meal and I am always ready for the next one”, however one person did comment “there should be more choices of meals”. Time was spent with the cook, who demonstrated a good understanding of the dietary needs of the people living in the home. This includes preparing food for an individual who requires a gluten free diet. All foods are being stored in accordance with food safety standards and the required temperature checks for fridges and freezers are being monitored. DS0000017797.V368239.R01.S.doc Version 5.2 Page 16 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, 17 & 18. People who use the service experience adequate quality outcomes in this area. People who use this service have access to a complaints procedure, however staff may not have sufficient skills and knowledge to understand and deal with incidents of threatening behaviour, verbal and physical aggression. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home has a clear and effective complaints procedure and an appropriate adult safeguarding and whistle blowing policy in place. It also states concerns and complaints are dealt with as soon as they are made, with the aim to resolve issues quickly to ensure the continued smooth running of the home. The AQAA reflects the service has received one complaint since the last inspection, which was dealt with within the 28-day timescales set in the complaints procedure. The manager was unable to locate the complaints logbook during the inspection to confirm this, however we (The Commission) are aware of the complaint and the recent concerns raised about practice issues. These were both raised anonymously to us, which resulted in a referral being made to the local authority safeguarding team. The responsible individual for Handsdale Limited, who are the registered provider for Colne Place, investigated these concerns. DS0000017797.V368239.R01.S.doc Version 5.2 Page 17 They have copied the outcomes of their findings to the Commission, which concluded that there was insufficient evidence to support the allegations. However, discussion with residents and relatives did support some elements of the concerns raised, regarding staff attitudes. Where concerns related to moving and handling and rough treatment of an individual by some members of staff. Investigation into the concerns identified that the person referred to stands for some members of staff and not others, therefore to provide consistency their care plan reflects they are now being transferred using a standing hoist, assisted by two members of staff at all times. Discussion with the individual confirmed this, and added due to deterioration in their health they are finding it increasingly difficult to weight bear and walk. Generally they were complimentary about the staff, but named an individual that was often curt and rude. The manager advised they would address this issue with the member of staff. Staff attitudes were also raised in a relatives ‘Have Your Say’ survey, who commented, “day staff are very good, some of the night staff could be more understanding and tactful”. The AQAA states that residents and families are able to raise concerns with the manager and staff and know that their complaints will be dealt with. This was confirmed in residents and relatives ‘Have Your Say’ surveys, comments included, “I tell the manager if I have a comment to make and they generally deal with it” and “there are always carers at hand who I could speak to but I have no complaints” and “the manager has most definitely responded to any concerns I have raised”. Staff spoken with are aware of residents rights and how to refer a complainant to a senior member of staff. They were clear about their duty of care and what they would do if they had concerns about the welfare of a resident. The pre admission assessment for an individual identified that they could be verbally and occasionally physically aggressive. There had been two incidents recorded where the individual had been verbally aggressive and used threatening behaviour towards staff and other residents. These had been recorded as an infringement of their rights, as they were asked on both occasions to return to their room. However, there was no management plan in place, which identified known triggers to behaviours or which provided guidance to staff of agreed action they needed to take to support the individual and to safeguard people living in the home. Additionally, staff confirmed they had not received training to ensure they have the skills and knowledge to understand and manage episodes of challenging behaviour. They did confirm they had received Protection of Vulnerable Adults (POVA) training and what this meant in relation to protecting people living in the home. DS0000017797.V368239.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26. People who use the service experience good quality outcomes in this area. The home provides people who live there with a safe, well maintained and comfortable environment, however assessments of peoples individual needs and the use of equipment is required to maximise people’s independence and freedom of movement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the homes brochure and verified at the inspection confirmed that Colne House prides itself on providing residents with a country home of architectural interest, which is set in three and a half acres of beautifully maintained gardens. The interior is nicely decorated, in keeping with the style of the house and in accordance with an elderly client group. Communal rooms are well furnished with domestic style furniture, carpets and curtains. All areas of the home are accessible for people, who use a wheelchair, access to the first and second floors is via stairs and two passenger DS0000017797.V368239.R01.S.doc Version 5.2 Page 19 lifts. Ramps are also provided throughout the premises and to access the gardens. A tour of the premises confirmed information in the AQAA that there continues to be a programme of improvement to the décor and maintenance of the home. Sash windows have been mended where required, some areas of the home have been refurbished, new furniture and curtains (currently being made) have been obtained for the drawing room. New carpets have been laid in the entrance hall. One of the bathrooms on the first floor is in the process of having new flooring laid, and room number 3 in the new extension is planned for redecoration where there has been a leak through the ceiling. The décor in the small dining area requires some redecoration, the paint and paper is peeling from the walls and the flooring is badly marked. The manager confirmed there are plans to refurbish the small dining area and lay a new stair carpet. All bedrooms are single and are suitable for the needs of their occupants with good lighting and safe radiators. Seventeen of the rooms have en-suite facilities and two have en-suite baths. Additionally, there are five communal bathrooms and six toilets throughout the home. Peoples’ rooms are nicely decorated reflecting the individual personalities and interests. All rooms have locks fitted to the doors and the occupants are offered the choice of holding their own key. An issue raised as part of the allegations made about the provision of care in the home included residents having to get their own walking frames and being “shoved” out of the dining room. Although, the investigation carried out by the organisation found this not to be true, a sign had been attached to the dining room door, stating that all walking frames must be taken out of the dining room, during meal times for health and safety reasons. Observation of mealtimes showed that a high number of people mobilise with frames, staff said these cause a tripping hazard if left in the dining room, with the individual. This was discussed with the manager that removing a person’s mobility aid restricts their movement. Should they wish to leave the dining room they have to wait for a member of staff to retrieve their frame or attempt to find their frame themselves. Appropriate aids and equipment to transfer immobile people safely and comfortably and to encourage independence are available throughout the home. These include grab rails, assisted baths and toilets and a variety of hoists. Discussion with an individual who due to their health is now being hoisted to transfer, explained that they find the sling and process uncomfortable. The manager was advised where peoples ability to safely transfer alone, changes due to deterioration in their health, hoist and slings should be assessed by a suitably qualified person, for example an occupational therapist to ensure the equipment being used, is assessed to meet the individuals needs. People assessed as a high risk of occurring pressure areas, DS0000017797.V368239.R01.S.doc Version 5.2 Page 20 had been provided with pressure relieving equipment. Records seen confirmed the equipment is regularly serviced to ensure they are in good working order. Call systems are provided in individual and some communal rooms. A previous requirement was made to ensure people living in the home are able to call for assistance and for longer call bell leads to be made available. Longer leads have been provided, however staff still need to make sure all people have access to a call bell. There were none available in the dining room or smaller lounge. One in the drawing room had been draped over the back of a chair. A frail lady observed sitting in the drawing room could not have reached this, if she required assistance. The home was clean throughout with no unpleasant odours. The laundry room is situated in an outside building. The home has two washing machines, which do not have a sluice facility. A previous requirement was made for the home to provide water-soluble or soluble stitched bags for any soiled laundry, so that these could be placed directly in the washing machines and washed separately above the recommended temperature of 65 degrees. The manager confirmed these had been purchased and are being used and there are plans to upgrade and replace both washing machines to include a sluice facility. Information received in residents and relatives ‘Have Your Say’ surveys, confirmed the home is kept clean an tidy, comments included, “the home is always clean and smells nice and fresh” and “there is a high standard of cleanliness” and “the home is very clean, I have never seen it dirty”. However, one person commented, “things are left under my bed, fluff and tissues”. Additionally, some people raised issues about the return of laundered clothing to the correct person. Comments included, my clothes go missing” and “the laundry seems a little uncertain as to when and how long before retuning it” and “my relatives clothing is always kept nice and clean, however these clothes are not always their own”. The surveys were received by us (The Commission) after the inspection visit, therefore this issue was not discussed with the manager or staff on the day. This part of the service needs to reviewed to ensure people receive their own clothing within an acceptable amount of time. To minimise the risk of spreading infection, a previous requirement was made to ensure appropriate hand-washing facilities of liquid soap, paper towels, gloves and aprons are situated in people’s rooms, bathrooms and toilets where staff may be required to provide assistance with personal care. A tour of the premises confirmed these were in place. DS0000017797.V368239.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People who use the service experience good quality outcomes in this area. Staff in the home are generally well trained and in adequate numbers to support the people who live there, however training needs to be expanded (see Complaints and Protection section) and recruitment must ensure the safety of people living in the home ensuring that two satisfactory written references are obtained before appointment of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states residents receive care from experienced and loyal staff in sufficient numbers to meet their needs. The duty rota reflects twenty-four hour care is provided to the people living in the home. Discussion with staff and confirmed on the rota reflects the minimum number of staff throughout the day is four care staff supported by a senior or the manager. Three staff, two awake and one sleeping in cover the nights. A chef, one kitchen assistant, a laundry assistant and three domestic staff provide additional support throughout the day. The home also employs a maintenance person and gardener. Staff confirmed staffing levels are sufficient to meet the needs of the people living in the home. However, discussion with residents and information received in relatives and residents ‘Have Your Say’ Survey’s provided mixed views about staff availability. Comments included, “staff are always ready and willing to help me in all matters, they are available when I need them night and day” and “I sometimes have to wait for help with washing and dressing” and “I some times have to wait when I pull the buzzer”. DS0000017797.V368239.R01.S.doc Version 5.2 Page 22 Staff files and information obtained in staff ‘Have Your Say’ surveys confirmed recruitment checks had been carried out prior to appointment and staff felt they had been recruited fairly. Examination of three staff files confirmed the recruitment process is generally robust, however only one of the three files had a photograph of the person for identification purposes. Another file only had one written reference, instead of the required two. All other relevant documents required under regulation had been obtained prior to the staff commencing employment, including Criminal records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) checks. All staff had been issued with a statement of terms and conditions of employment. The AQAA states we ensure staff receive up to date training to enable them to provide care and support to people using the service. This was confirmed through discussion with staff and in information received in nine staff ‘Have Your Say’ Surveys. Staff said they enjoyed working at the home and commented “we all work as a team to meet the residents needs and try to make Colne Place a homely place to live” and “ staff are always available and willing to participate in all aspects of work within the home, we have good team work” and “we have a good homely atmosphere with good staff who have worked in the home for many years and who are very loyal”. They confirmed training is provided, which is relevant to job, helps them to understand and meet needs of residents and which kept them up to date with new ways of working. Most recent training has included safe handling and administration of medication, protection of vulnerable adults, fire safety, food hygiene, moving and handling, health and safety, Control of Substances Hazardous to Health (COSHH) and infection control. Information provided in the AQAA and training schedule for 2007/8 confirmed staff are willing to learn and take on training. The home employs a total of twenty six care staff, fourteen staff have completed NVQ Level 2 or above, with six care staff currently working towards completion. These figures reflect that when staff have completed their award, the service will have achieved the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. The majority of staff have worked at the home for along time, two staff recently recruited confirmed they had received induction training. The training schedule included dates of current employees who completed TOPPS induction training, (which preceded the Skills for Care Common Induction Standards) when they were recruited in 2005/06. The manager and staff reported that new staff are provided with workbooks to complete the Skills for Care induction standards (records were not inspected on this occasion). The manager stated that workbooks are currently being reviewed at head office. DS0000017797.V368239.R01.S.doc Version 5.2 Page 23 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, 35, 36 & 38. People who use the service experience adequate quality outcomes in this area. The home is run by a qualified manager, who monitors the service through the homes quality assurance system, however management needs to be more responsive to complaints and more proactive to ensure adequate training and supervision of staff to protect the dignity, safety and welfare of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and statement of purpose confirmed that the manager has the required qualifications and experience to manage the home. They have substantial experience in care and have been employed at Colne Place since 1988. They are supported by a person in the role of head of care. The head of care completed the AQAA, which provides clear and relevant information. DS0000017797.V368239.R01.S.doc Version 5.2 Page 24 The AQAA informed us about changes that have been made to improve the service and identifies where improvements need to be made and how these are to be implemented. People using the service, relatives and staff were positive about the manager, comments included “always able to approach manager with any problems” and “the manager is lovely”. Information provided in the AQAA states that Hansdale Limited undertakes an annual Quality Assurance Programme and the results of this are used to assess the quality of the service being provided. A Quality Audit summary is produced to reflect the views of clients and their relatives. However, the most recent audit was not yet available as it is being analysed at head office. The manager provided a copy of the audit from December 2006 and agreed to forward a copy of the report to us (The Commission). The summary for 2006 reflected that people using the service were happy and satisfied to live at Colne Place and that staff were kind and that their relatives were always made to feel welcome. People using the service are supported to manage their own finances. They are provided with lockable cabinets in their rooms to keep small items of value and personal monies. Where people are unable to manage their own finances a relativie or other representative manages this on their beahlf. The manager confirmed they hold small amounts of some residents’ personal monies, deposited by their relatives. Records of three people being tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. Staff spoken with confirmed they were kept well informed about the needs of people living in the home by the manager, senior staff and through handover meetings held between shifts. They also confirmed they had regular staff meetings. The most recent staff meeting held in June 2008 discussed the issues raised in the anonymous complaint and safeguarding referral. As previously mentioned in the report, the investigation was completed by the Responsible Individual for Hansdale Limited who concluded that there was insufficient evidence to support the allegations. However, some elements of the concerns raised, regarding staff attitudes, working with people who present behaviours that are challenging to others and the recording of incident and /or accidents could be improved to ensure the safety and well being of people living in the home. The incident report in the care plan of the individual left on their commode for about 3.5 hours had not been completed properly to reflect the actual times of the incident, neither had the report been signed and dated. Therefore it was not possible to ascertain when the report had been completed. There was no evidence that the manager had assessed the incident to ensure measures had been taken to prevent a similar incident occurring. DS0000017797.V368239.R01.S.doc Version 5.2 Page 25 A previous requirement was made to ensure that staff working at the home are appropriately supervised. Information provided in the AQAA and verified at the inspection confirmed staff supervision and appraisals have improved. Records indicated that supervision is now taking place, however these should happen at least six times a year for each member of staff. Documentation reflects that sessions include discussion of general work objectives, performance and development and identify training needs. The fire logbook confirmed that the fire alarm is tested weekly using different zones and regular fire training and drills take place, with a record of the staff in attendance and outcomes of the drill are recorded. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment is being regularly checked and serviced. A number of risks were identified at the previous inspection including a cleaner’s trolley with hazardous items left unsupervised and the laundry room, also with hazardous substances left unlocked and unsupervised and water temperatures in bathrooms in excess of 43° Centigrade. Inspection of the premises confirmed that hazardous items were being locked away and random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when washing their hands, taking a bath or shower. DS0000017797.V368239.R01.S.doc Version 5.2 Page 26 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 2 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 DS0000017797.V368239.R01.S.doc Version 5.2 Page 27 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 OP2 Regulation 5 (b) Requirement The contracts setting out their terms and conditions of residence need to be amended to reflect the individual’s current fees and whether they are a private resident of funded through social services. This will ensure people using the service or their representative will know the amount they need to pay, who to and when. Elimination monitoring charts and support plans must be completed sufficiently to reflect people using the service are being supported to manage their continence. These must reflect where problems may occur to ensure these are dealt with at an early stage. This will ensure people maintain good health and well being. Staff must be appropriately trained to ensure their conduct respects the dignity of the people using the service. This will ensure that individuals are regarded as a real people, DS0000017797.V368239.R01.S.doc Timescale for action 31/08/08 2. OP8 12 (1-3) 17/08/08 3. OP10 12 (4) (a) 31/08/08 Version 5.2 Page 28 respected and supported to maintain their independence. 4. OP18 13 (6) Where people living in the home present behaviours that can be challenging to others, training needs to be provided and plans developed with strategies of how staff manage physical and /or verbal aggression. This will ensure staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others, and which safeguard the individual and others living and working in the home. Suitable adaptations and equipment must be provided for people who are old, infirm or physically disabled, which have been assessed by a suitably qualified person. This will ensure each person using the service is provided with equipment, which will meet their individual needs. Staff must make sure that people living in the home have access to a call bell. This will ensure they will have access to staff at all times. This is a repeat requirement from 10/07/2007 No person shall be employed in the care home unless documents specified in paragraphs 1-7 of Schedule 2 have been obtained in respect of that person. This will ensure people living in the home are not at risk from staff who are unsuitable to work with vulnerable people. 31/08/08 5. OP22 23(2)(n) 31/08/08 6. OP22 23(2)(n) 17/08/08 7. OP29 19 (1)(b) Schedule 2 17/08/08 8. OP38 12 (1) (a) To ensure the safety and well 18 (1) (c ) being of people living in the DS0000017797.V368239.R01.S.doc 31/08/08 Page 29 Version 5.2 home, further staff training and supervision is required. This will ensure staff act appropriately when working with people using the service, respect and promote their dignity and have the skills and knowledge to support people who present behaviours that are challenging to others. 9. OP38 17 (1) Schedule 3 (j) A record of any incident and /or accident, which is detrimental to or affects the health or welfare of a person living in the home must be recorded, which includes the nature, date and time of the incident/accident. These must be reviewed and systems put in place to prevent similar accidents/incidents reoccurring. 17/08/08 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. Refer to Standard OP1 Good Practice Recommendations Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. To avoid mistakes with people’s identity, it is recommended good practice that each persons MAR chart has a front page with their name and photograph. To keep an audit trail and ensure there is no mishandling of medication staff should use the MAR charts to show when the medication is received, the amount and the signature of the person receiving the medication. 2. OP9 3. OP9 DS0000017797.V368239.R01.S.doc Version 5.2 Page 30 4. 5. OP33 OP38 A copy of the most recent quality audit report should be forwarded to the CSCI. Supervision sessions should be undertaken at least six times a year. DS0000017797.V368239.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 DS0000017797.V368239.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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