Inspection on 12/01/09 for Cornelius House

This inspection was carried out on 12th January 2009.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cornelius House 07/08/08

Cornelius House 12/04/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Cornelius House 114 Fishbourne Road (West) Chichester West Sussex PO19 3JR Lead Inspector Lesley Webb Unannounced Inspection 12thJanuary 2009 10:00 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 Cornelius House DS0000065835.V373422.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. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cornelius House Address 114 Fishbourne Road (West) Chichester West Sussex PO19 3JR 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) 01243 779372 01243 783237 cornelius.house@btconnect.com Cornelius House Limited Miss Pamela Annette Venus Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2008 Brief Description of the Service: Cornelius House is a care home registered to provide accommodation for up to twenty residents over 65 years of age. The home’s registered providers are Cornelius House Ltd. With Mr John Kellas registered as the Responsible Individual representing the company. Ms Pamela Venus is the registered manager who oversees the day-to-day management of the establishment. Cornelius House is situated in a quiet residential area approximately a mile from the town centre of Chichester and approximately three miles from the seafront. The care home is a large, three-storey establishment with the main garden lying to the front of the property and contains a summerhouse, flower borders and large lawn. The side and rear gardens are well laid out with flower beds, bird tables and small seating areas. The accommodation is currently arranged for all people to have single occupancy with en-suite facilities there is a lift providing access between all the floors. There is a large communal lounge/dining room and a separate lounge for smaller groups. The current fees for the home range between £550 and £645 per week and are dependent on the size of the room. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. We also looked for evidence that the home has met Requirements made at our last key inspection of 7th August 2008. During our visit to the home we talked to the Responsible Individual, Registered Manager and 3 care staff. We also ‘case tracked’ 3 residents and looked at the care plans of a further 3 residents, examined staff records, policies and procedures and other documentation. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Since our last key inspection of 7th August 2008 two pharmacy inspections have been undertaken. We have also been supplied with an Improvement Plan by the home. Information from these is included in this report. At the time of writing this report we have received 6 residents surveys. Information from these is also included in this report. The quality rating for this service is 0 stars. This means the people that use this service experience poor quality outcomes. What the service does well: What has improved since the last inspection? Needs assessment documentation has improved but this is not being completed in full for all residents. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 6 A new care planning system has been introduced to the home but this is not being completed in full or accurately for all residents. Medication systems now offer safeguards to residents although some improvement is still needed. A safeguarding policy is now in place and that all staff have been informed about this. Staffing rotas evidence that staffing levels between the hours of 8am and 8pm have increased since our last inspection. Quality monitoring systems have been introduced that are allowing the home to measure if it is achieving its aims and objectives. The Registered Provider now undertakes monthly visits to the home and completes a report, which is available at the home for inspection. The personal monies of residents are now kept safely with accurate records maintained. What they could do better: Pre admission assessments must identify all needs and be used to establish that the home is able to meet those needs. Residents must have clear, individual care plans, describing the support that staff give to meet identified needs. Where it has been identified that a resident is at risk from falls, a risk assessment must be put in place, which describes how the home will lessen those risks. The registered person must be able to demonstrate through the homes records that residents received where necessary, treatment, advice and other services from any required health care professional. Residents’ preferences with regards to times of bathing, rising and retiring must be sought and where possible implemented. Activities must be offered that are varied, flexible and meet the expectations, preferences and capacities of residents, with care plans identifying needs and expectations. The registered person must ensure that residents are offered a choice of meals that meet their individual assessed and recorded requirements. The registered person must demonstrate that there are sufficient care staff to support the identified needs of the people that use the service. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 7 The recruitment process of staff must ensure that the checks, which include references, are in place before employment commences to protect residents. The registered person must be able to demonstrate that the home only employs foreign workers after confirming their legal status and entitlement to work in this country. The registered person must demonstrate they are able to meet all the needs of people who use the service by ensuring that staff receive training from a suitably qualified person or body. This is in addition to all mandatory training. The registered person must consult with the Fire Authority regarding the practice of wedging residents’ bedroom doors open. Any advice given must be implemented. The registered person must be able to demonstrate through risk assessment that qualified first aid staff are on duty at all times as described in the CSCI policy guidance: First Aiders 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. Cornelius House DS0000065835.V373422.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 Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Needs assessment documentation has improved but this is not being completed in full for all residents. This means staff may not have all the information needed to care for individuals. EVIDENCE: At our last key inspection of 7th August 2008 a Requirement was made that the homes pre admission assessments must identify all needs and be used to establish that the home is able to meet those needs. We received an Improvement Plan from the home that informed us the pre admission policy has been reviewed and a new form implemented. Evidence gained at this inspection finds this Requirement has not been met in full. This will be addressed separately to this report. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 10 During this visit to the home we sampled three assessments finding that a new assessment form has been implemented as per the homes Improvement Plan. The form includes sections for identifying personal care, health, social and medication needs. We found that some sections of the needs assessment form have not been completed in full. For example one persons assessment had a question mark next to where their weight should be recorded, the sections for recording their height and if they have any challenging behaviour were blank. The same persons assessment states ‘yes’ they require assistance with personal care but not what this consists of. Another person’s needs assessment form states that they require assistance with personal care but does not state what elements of personal care require assistance. The same person assessment states they have no identified need with regard to falls when they have fallen within the previous two months. Intermediate care is not provided at this home. Cornelius House DS0000065835.V373422.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 poor. This judgement has been made using available evidence including a visit to this service. A new care planning system has been introduced to the home but this is not being completed in full or accurately for all residents. This means that the personal and healthcare needs of residents are not being met consistently and safely. Medication systems now offer safeguards to residents although some improvements are still required. Residents are not always treated with respect. Their rights to privacy are upheld. EVIDENCE: At our last key inspection of 7th August 2008 3 Requirements were made with regard to care management. These being that residents must have clear individual care plans describing the support that staff give to meet identified needs, that a photograph identifying the resident is available dated and signed and that where it has been identified that a resident is at risk from falls, a risk assessment must be put in place, which describes how the service will lessen Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 12 those risks. We received an Improvement Plan from the home that informed us new care plans and a procedure have been put in place, that a camera has been purchased to ensure photographs of residents are on file and a new risk assessment has been implemented. Evidence gained at this inspection finds that the Requirements relating to care plans and risk assessments have not been met in full. This will be addressed separately to this report. We sampled 6 residents care plans, all of which had been produced on the new care planning documentation as decribed in the homes Improvement Plan. The new care planning system includes a care plan summary. For one resident with regard to communication this states ‘X can hear well’. The needs assessment for this person with regard to hearing states their hearing is ‘fair’ and that ‘needs syringing fairly regularly’. No care plan was in place for this and we could find no evidence of medical intervention with regards to syringing of ears. The same persons needs assessment also states that they wear glasses and that ‘needs an appointment’. Again we could find no evidence that this had taken place. Areas for recording cognition, memory and behaviour on the care plan summary were blank. The medical visits sheet for this resident was blank. Risk management forms part of the new care planning system that has been introduced. The format for recording this information includes sections to describe the area of risk, description, assessment (low/medium/high) and action plan. The risk assessment for one resident states they are at low risk with regard to nutrition, pressure sores, trips, falls and mobility. The same assessment states bedrails are in place. No evidence was seen on file that assessed this equipment as necessary. A moving and handling plan for this resident dated 01/12/08 states to review in 1 month. No evidence of this occurring was seen. Another residents care plan summary states they require help with washing and dressing. The care plan for personal hygiene states the resident has no problems in this area. The care plan summary also informs that the resident has no teeth. No information regarding mouth care is included in any of the care plans for this person. A personal biography sheet is included in the new care planning system. This has not been completed for this person. The risk management form on file for this person had not been completed. Information on this persons needs assessment identifies they are at risk of falls. A record was seen for the above resident where the Registered Manager instructed staff to weigh the individual. No record was in place of this being undertaken. The medical appointments record of another resident states they visited their General Practitioner 04/12/08 and as a result a medication they take was increased. The last recorded information regarding medical issues for this Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 13 resident pre 04/12/08 was 31/08/08. No information as to why the resident takes this medication is recorded in any of their care plans. A weight chart was seen on this persons file evidencing weight being monitored every two months from 02/02/08 to 03/10/08. When last weighed 03/10/08 the resident weighed 5 stone. A care plan was not seen to be in place reflecting the residents weight and how this might impact on their personal and health needs. Records completed by night staff mention the use of hot water bottles for this person. The risk management form on file for this person does not include information or assessment of this equipment. The fifth persons care planning documentation we looked at included a care plan for nutrition. Medical records for this person state that the General Practitioner ‘advises give milk shakes, rice puddings or liquidise’. This information has not been transferred in the care plan. The risk management overview sheet for this person states they are not at risk nutritionally. It also states they are not at risk of pressure sores. A record on this persons file dated 06/11/08 states ‘L heel sore use pink heel protector and ‘tubifast’ to keep in place’. This information was not seen to be reflected in any care plan on file. When looking at other residents’ records we found one resident is prescribed two medications to assist with breathing. No care plan for this medication describing how and when it is to be administered was seen to be in place. Another residents care plan summary dated 06/10/08 instructs staff to ‘follow toileting care plan in their room, toilet regularly and change pad if needed, sign when toileted, commode chair purchased’. We could find no toileting care plan on this persons file. We asked the Registered Manager if this was available. She informed us this had been removed as “not relevant now”. This statement by the Registered Manager does not match the last review dated 20/11/08. At our last key inspection six Requirements were made that related to medication. A pharmacy inspection was undertaken 20/10/08 where evidence of continued non-compliance was found. As a result a Statutory Requirement Notice (SRN) was issued. A Specialist pharmacist inspection was carried out on 9th January 2009. The reason for this inspection was to check on the compliance with the statutory requirement notice served on the home on the 23rd December 2008. We found that the notice had not been met. Our findings regarding this matter have been communicated to the registered provider separately. In addition to monitoring compliance with the notice we also saw that the home now stored Controlled Drugs in a cupboard that complies with the legal definition of a Controlled Drugs cupboard. In addition Controlled Drugs are Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 14 being stock checked regularly to ensure that the balance in the register matches that in stock. At the time of our inspection 7 people were prescribed, and were receiving, Lactulose. However there was only one bottle of Lactulose in the home. It is not acceptable to use one person’s supply for other people in the home. Each person must be given their medicines from their own prescribed, dispensed and labelled bottle. The dose of a strong analgesic prescribed for one person had been increased following a visit to the GP. The records in the home showed that the new dose had been started the next day and that it had been given for 13 days. The old dose was then given for 4 days. The new dose was then given for 3 day before the old dose was again reverted to for 4 days. The new dose was then given. This constant changing of the dose of this medicine could have left this person without adequate pain control. People must be given their medicines at the correct dose that their doctor has prescribed. A bathing timetable for residents was seen on display in the office. We discussed with the Registered Manager how times and days for bathing are decided. She stated “this is decided on what room they are allocated when moving into the room unless they say a preference”. She gave an example of one resident who had expressed a wish to have bath every night. The record on display indicates this being complied with. We suggested bathing preferences should be sought based on residents choice rather than what room they occupy when moving into the home and that this should happen for everyone regardless of if they express preference or not. When discussing the continence needs of a resident with the Registered Manager she used the term “nappy pad” when referring to continence aids. We drew her attention to this term explaining it was not appropriate for an adult. She stated “we do not say this in front of the residents, just here in the office”. We explained this was still inappropriate, as it does not promote residents rights to respect and dignity. Care staff were observed speaking and assisting residents with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. Six residents surveys were completed and returned to us prior to our inspection. Four state they ‘always’ and two ‘usually’ receive the care and support they need. Four state they ‘always’ and two ‘usually’ receive the medical support they need. Two additional comments were recorded - ‘staff are very helpful and willing’ and ‘the staff are usually very busy and while they may hear what I say they don’t follow through. This only applies to certain members of staff, most of them are very helpful’. Cornelius House DS0000065835.V373422.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Activities are offered but these are not varied and do not always meet the needs of all residents. There is little evidence that residents are helped to exercise choice and control over their lives. Dietary needs are catered for but choice is limited. EVIDENCE: At our last key inspection of 7th August 2008 a Requirement was made that Activities must be offered that are varied, flexible and meet the expectations, preferences and capacities of people who use the service, with care plans identifying needs and expectations. We received an Improvement Plan from the home that informed us it intends to look at voluntary services and to extend the activity programme. Evidence gained at this inspection finds this Requirement has not been met in full. This will be addressed separately to this report. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 16 When we arrived at the home the Responsible Individual discussed the homes Improvement Plan with regard to activities stating, “certainly stepped up but not at stage where implemented in care plans”. He informed us that a Key Carers role has recently been implemented that involves the staff sitting with residents at least once a week and discussing things they would like to do. A record of which must be maintained. He informed us this is not yet fully implemented and that training for staff has been given priority. Instructions regarding this role were seen on display in the office. Of the five care plans we sampled, one contained evidence of a Key Carer having a discussion with a resident. We viewed the homes social contact policy. This states ‘Holidays and short breaks are encouraged, as are regular outings to places of local interest and also the taking of small groups to lunch at the local pub. We also arrange a wide variety of musical entertainment, reminiscent speakers and in house games for the enjoyment of the residents. There are quizzes, word games and at Christmas and New Year, relatives and friends are invited to join our festivities. Every summer we have an annual garden party which is widely supported. For residents who prefer a quieter time there is also a range of facilities that they can enjoy. They may choose to spend time in the gardens, or read the newspapers, magazines and books provided. Residents may order any magazine or newspaper that they wish to have delivered daily’. We found evidence that some elements of the policy are being applied and others not. For example three residents were observed discussing events in newspapers, doing cross words and playing scrabble and a list was seen on display in the office detailing residents preferences with regard to newspapers. A notice board informs residents that they can attend communion if they wish and that a hairdresser visits weekly. No evidence was found that holidays, short breaks or regular outings having taken place within the last 3 months. No evidence was provided to us of a wide variety of musical entertainment and reminiscent speakers being arranged (as per the homes social policy). We discussed activities with the Registered Manager. She informed us a weekly keep fit session takes place, that a pantomime was arranged at Christmas and that shortly a member of staff is going to be allocated to organise activities. She also informed us that “residents don’t like activities, its really hard to motivate them”. This comment conflicts with information contained within some residents care planning documentation we sampled. Six residents surveys were completed and returned to us prior to our inspection. Two state ‘always’ two ‘usually’ and two ‘sometimes’ there are activities arranged by the home that they can take part in. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 17 With regards to meals three residents surveys state they ‘usually’ two ‘always’ and one ‘sometimes’ like the meals at the home. Three additional comments were recorded - ‘the chef will always find something different if asked’ ‘could be better’ and ‘the food is extremely good’. The registered Manager informed us that a four-week menu is operated at the home, that this is not displayed to residents and that it does not include a choice of options. She gave an example that the main meal on Fridays is fish and that residents can have this baked or fried. She did state that if residents do not like what is being presented staff will make an alternative. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints process for residents, which promotes peoples rights to raise concerns. Safeguarding procedures are in place, which offer protection to residents. Not all recruitment practices protect residents from harm. EVIDENCE: We saw that the complaints procedure is displayed in the home. The Registered Manager informed us no complaints have been received at the home since our last inspection. Six residents surveys were completed and returned to us prior to our inspection. Three state they ‘always’ and two ‘usually’ know who to speak to if not happy. One did not respond to this question. Five state they know how to make a complaint and one they do not. At our last key inspection of 7th August 2008 a Requirement was made that the home must have a policy on how the home will safeguard residents and what staff should do if they suspect that the policy is not being followed. We Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 19 received an Improvement Plan from the home that informed us a new policy was to be drawn up and given to staff. During our inspection the Responsible Individual informed us the safeguarding policy was now in place and that all staff have been informed about this. We viewed the policy; it appears detailed and informative. The policy states as a form of preventing abuse from occurring ‘operating personnel policies which ensure that all potential staff are rigorously checked, by the taking up of references and clearance through the protection of vulnerable adults register’. When sampling the recruitment records of four staff we found that this section of the policy is not being complied with in full (further details regarding this are contained within the staffing section of this report). A copy of West Sussex safeguarding adult’s policy and procedure was seen on display in the office. A document on display in the office indicates that six of the twenty-one care staff have watched a training DVD on abuse. The same record indicates that the Registered Manager has not. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a pleasant, clean and homely environment to live in. EVIDENCE: We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible with wheelchairs. Residents’ bedrooms that were viewed contained personal belongings such as furniture and pictures, to make it feel like home. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 21 and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Laundry facilities are sited away from areas where food is prepared and stored. Six residents completed surveys and returned them to us prior to our visit. All state the home is ‘always’ fresh and clean. An additional comment was recorded - ‘Cornelius house is a very well kept and efficient place’. Cornelius House DS0000065835.V373422.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In the main staffing levels meet residents needs. Staff are not trained to care for residents. Recruitment practices continue to place residents at risk. EVIDENCE: At our last key inspection of 7th August 2008 three Requirements were made with regard to staffing. These being that the home must demonstrate that there are sufficient care staff to support the identified needs of residents, that the recruitment process of staff must ensure that the checks, which include references and POVA FIRST, are in place before employment commences to protect people who use the service and that the home must demonstrate it is able to meet all the needs of people who use the service by ensuring that staff receive training from a suitably qualified person or body. This is in addition to all mandatory training. We received an Improvement Plan from the home that informed us they are recruiting additional staff and have implemented a new rota. It also informs that the recruitment policy has been revised and a new training provider is to be found and a training plan drawn up. Evidence gained at this inspection Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 23 finds that the Requirements relating to recruitment and training have not been met in full. This will be addressed separately to this report. At the beginning of our inspection the Responsible Individual informed us that the home is being staffed to the ratio that would be in place if full, apart from times when staff are on training or on sick leave. He also confirmed that a new recruitment policy is in place, all new staff have POVAfirst before commencing work and that he completes weekly checks to ensure appropriate recruitment processes are being followed. He stated, “I have spoken to all staff, they are very positive about working here”. We viewed the homes policy on staffing. This states ‘the rota will be set according to the following factors – The numbers of service users to be cared for. The nature and level of dependency of the service users to be cared for. The ages of the service users to be cared for. The geography and layout of the building. The skills and experience of the staff. The availability of staff (part time/full time/ sickness/leave, etc)’. We discussed staffing levels with the Registered Manager asking how she assesses what are the appropriate staffing levels to meet residents’ needs. She did not refer to the homes policy on staffing and stated that there was no system in place. We looked at the staffing rotas with these evidencing that staffing levels between the hours of 8am and 8pm have increased since our last inspection. For example those looked at detail between 3 and 4 care staff on duty in the morning and 3 care of an afternoon. In addition to this kitchen and domestic staff are allocated seven days a week. When examining the staffing rotas we noted that the Registered Managers name is included but not any hours she undertakes. She informed us this is because she is “salary”. She explained that she works four days a week, normally undertakes above 37 hours per week and is ‘on-call’ all the time apart from every other weekend (when the deputy is then on call). The staffing levels at night remain the same as at our last key inspection. One person is on duty from 8pm to 8am, with a ‘sleep-in’ person on the premises who is available to assist if needed. We discussed this with the Registered Manager, explaining that records maintained by night staff indicate several residents require assistance during the night. The Registered Manager stated, “we know we are going to have to increase this eventually”. Six residents surveys were completed and returned to us prior to our visit. All state staff listen and act on what they say. Two state staff are ‘always’ and four ‘usually’ available when they need them. We spoke to the three care staff on duty on the afternoon of our visit. When asked, they all confirmed they do not hold a National Vocational Qualification Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 24 (NVQ). Two said that they had not undertaken moving and handling training and the third that they had but that this had expired. Two of the three staff stated that their first aid training certificates have expired and they were booked to attend this training later in January. The third member of staff said that they had watched a DVD about this. We spoke to the Registered Manager about the three care staff on duty, explaining that discussions with them and examination of records indicate none hold a NVQ qualification or other mandatory training. We asked how she ensures suitable numbers of qualified staff are on duty each shift. The Registered Manager stated she has no system for monitoring this. Also we asked the Registered Manager if a qualified first aider is allocated to each shift. She informed us that three people (including herself) completed an appointed persons course 21/02/06. Again the Registered Manager stated she has no system for monitoring this and that a risk assessment has not been completed with regard to first aid and the needs of residents. We directed the Registered Individual and the Registered Manager to the CSCI website where further information regarding this can be found. We asked the Registered Manager if any training has been provided to staff in relation to needs associated to older people such as continence, falls prevention, diabetes, skin care and dementia. She stated, “Not yet, just want to get on with other training first”. She informed us that no residents have diabetes or have been diagnosed with dementia. The Responsible Individual informed us that the Mulberry training system has been purchased by the home. He explained that this consists of thirteen DVD’s for various subjects and that staff are currently in the process of watching these. We asked how the home evidences that they have watched and understand and/or gained knowledge from these, that is then put into practice. The Responsible Individual informed us that there was no formal process at present. We explained that the Mulberry system includes not only DVD’s but a multiple choice questionnaire that staff have to complete after watching a DVD, that is sent to Mulberry to verification and if satisfied they issue certificate. We asked if this part of system is in place and were informed it is not. A sheet on display on the notice board in the office titled ‘Cornelius house staff training’ details 34 staff (details 2 administration, 2 facilities, 3 catering, 4 domestic, 21 care, 1 deputy, 1 manager). It states all staff have received and read ‘fire regs’. With regard to the Mulberry training system DVD’s it states – 1 - health and safety (ticks for 12 care staff having seen, no tick to indicate manager or deputy seen) 2 - fire training (ticks for 18 care staff having seen, tick for manager and deputy having seen) Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 25 3 - infection control (ticks for 12 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 4 - medication administration (tick for 12 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 5 - induction awareness (tick for 8 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 6 - COSHH (tick for 6 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 7 - first aid awareness (tick for 8 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 8 - hand hygiene (tick for 14 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 9 - principles of care and confidentiality (tick for 8 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 10 - food hygiene (tick for 15 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 11 - moving and handling (tick for 13 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 12 - moving and handling (tick for 11 care staff having seen, tick for deputy having seen, no tick to indicate manager seen) 13 - adult abuse (tick for 6 care staff having seen, tick for deputy having seen, no tick to indicate manager seen). The form states domestic staff are not required to view COSHH or moving and handling DVDs. We discussed this with the Responsible Individual and Registered Manager explaining that domestic staff need to be aware of these due to using products and moving and handling of loads. Information displayed on the notice board in the office states first aid training has been arranged for 12/01/09 and 22/01/09, moving and handling 19/01/09, 23/03/09, 06/04/09, medication 21/01/09. It also indicates that this training is being provided by external providers. The Registered Manager confirmed first aid training was taking place on the day of our inspection. We viewed the homes policy on staff recruitment and selection. It states ‘the home complies fully with standard 29 recruitment by ensuring: Recruitment and selection procedures are based on equal opportunities. Recruitment and selection procedures focus on the protection of service users. Stringent procedures for recruiting volunteers are followed which include CRB and POVA checks. Two written references are obtained before an appointment is confirmed. Gaps in the appointee’s employment record are routinely explored. All new staff are confirmed in post following completion of a satisfactory CRB enhanced or standard disclosure, which, depending on the post and of protection of vulnerable adults register. Staff are employed in accordance with the code of conduct and practice set by the General Social Care Council and are given copies of the code. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 26 All staff receive statements of terms and conditions’. All applicants whether responding internally or externally are sent an application form and a job description. Only applications made using the proper form and received by the advertised deadline are considered’. The home employs foreign workers only after confirming their legal status and entitlement to work in this country and after making equivalent checks on their criminal records and fitness to work with vulnerable people’. We found evidence that some elements of the policy are being complied with and others not. We looked at the staff files of four people who had begun working at the home since our last visit. The Registered Manager informed us two these had worked at the home previously, then resigned and then decided they wished to return to the home. One of the staff files states they commenced working at the home 20/12/08 after resigning 31/05/08. Their personnel/training record states they are employed as care assistant. The form has sections for recording CRB information, verification that passport and marriage certificates have been viewed, that an application has been made to CRB and for recording the reference number and date. All these sections were blank. A POVAfirst was in place dated 19/12/08 and an enhanced CRB dated 23/12/08. One written reference was on file dated 23/12/08 and evidence of two verbal references both dated 22/12/08. An application form from this person’s initial employment with the home was on file but not for their current employment. A copy of a basic first aid certificate was on file issued 10/08/06. No verification of any other qualifications was on file. The Registered Manager confirmed the staff member re-started working at the home 20/12/08 without receiving any form of induction. Examination of staff rotas for that date confirm the member of staff was on shift from this date as a care assistant. We informed the Registered Manager that staff should not be allocated shifts when they have a POVAfirst but no references. The second staff file we examined states they were originally employed at the home 03/02/03 as a care assistant before resigning 03/04/08. They recommenced employment 04/10/08. As with the first file we looked at this did not contain a new application form or verification of qualifications held. One reference was on file dated 16/10/08. A training and development plan was on file that states ‘moving and handling, first aid St Johns ambulance and medication’. No dates are recorded of when achieved and the form has not been signed by the Registered Manager. We discussed this with the Registered Manager who informed us this document is in place for all staff, containing the same information. She explained that dates are not included as staff may not have undertaken this training yet, but that it is arranged. A POVA first dated 31/10/08 and an enhanced CRB dated 14/10/08 were on file. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 27 The Registered Manager informed us this member of staff re-started working at the home 10/11/08 without any form of induction. Rotas that we viewed also confirmed the date supplied by the Registered Manager. We informed the Registered Manager that staff should not undertake shifts when only one reference has been obtained. The third persons records that we examined state they commenced work at the home 11/08/08. A POVA first dated 11/07/08 and enhanced CRB dated 31/07/08 were on file. Two written references dated 25/07/08 and 07/07/08 were also on file. There was a copy of the person’s passport but not a second form of identification. An original certificate was on file for Boots medication training dated 21/10/08 but no other verification of training. An induction training record on file states the member of staff has been inducted on understanding principles of care 29/09/08, confidentiality 22/09/08, person centred care 08/09/08, risk assessment 13/08/08 and health and safety 12/08/08. During our inspection we spoke with a member of staff on duty who informed us English was not their first language and that they had been living in this country for eight and a half months. We asked the Registered Manager if a work permit is required for this person. She stated she did not know but that any paperwork needed had been provided by Chichester College. Nothing is on this persons file to indicate if this is required or not. We also noted that the application form on file consists of one A4 piece of paper that asks for title, position applying for, previous experience, previous employer (and dates from and to), and qualifications. It does not ask for a full employment history or names and details of referees. We discussed this with the Registered Manager who informed us she was aware the form needs improving. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 28 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management of this home is not meeting the needs of residents safely. Quality monitoring systems have been introduced that are allowing the home to measure if it is achieving its aims and objectives. Residents’ financial interests are safeguarded. Residents and staffs health, safety and welfare is not always promoted and protected. EVIDENCE: We spoke to the Registered Manager regarding her role, responsiblities and qualifications. She informed us she holds a certificate for the Registered Managers Award. We asked if she has undertaken any other training and she Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 29 informed us moving and handling. She stated “should be doing others, but last year so busy not had time”. She informed us that she is booked on a safeguarding course with West Sussex County Council. As already mentioned in the staffing section of this report the Registered Manager has not watched any of the Mulberry training system DVD’s. When asked what she sees as her main roles and responsiblities she stated “looking after residents, making doctors appointments, try help sort problems, looking after staff, levels”. At our last key inspection a total of eighteen Requirements were made, six of which related to medication. A pharmacy inspection was undertaken 20/10/08 where evidence of continued non-compliance was found. As a result a Statutory Requirement Notice (SRN) was issued. A second pharmacy inspection was undertaken 09/01/09 to monitor the homes compliance with the SRN. This was found to be complied with but a new issue was identified resulting in a new Requirement. Evidence gained from this inspection finds five of the remaining eleven Requirements being met and six not. As a result we issued a Code B notice in line with the Police and Criminal Evidence Act and informed the Responsible Individual and Registered Manager that the commission will consider taking further action. In addition to the unmet Requirements we identified new issues (as described in other sections of this report). At our last key inspection of 7th August 2008 three Requirements were made with regard to quality assurance and residents finances. These being that the home must undertake a quality assurance audit of its service at least annually and enable residents to comment safely and anonymously if they wish. A report must be produced and the home must demonstrate that it has acted on the information, the registered provider must undertake monthly visits to the home and complete a report, which must be available at the home for inspection and the home must ensure that the personal monies of residents are kept safely with accurate records. Evidence gained at this inspection finds all of these Requirements have been met in full. We received an Improvement Plan from the home that informed us an external review will take place twice a year and report to be completed, that reports in line with Regulation 26 of the Care Home Regulations will be completed and that the residents finances policy has been revised and process implemented. The Responsible Individual informed us that previously the home was completing quality assurance annually but not produced a report. He explained that an independent agency is now going to undertake audits. A letter was viewed from this agency confirming this arrangement. In addition to this questionnaires have been devised that are going to be distributed in order to obtain peoples views on the standards of care provided at the home. Reports in line with Regulation 26 of the Care Home Regulations 2001 were viewed for 25/12/08 24/11/08 18/10/08. These detail between 5-7 visits to Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 30 the home by the Responsible Individual each month. They also evidence discussions with residents, staff and review of the homes improvement plan. As mentioned in other sections of this report we sampled a number of the homes policies and procedures. Evidence indicates that some elements of these are being complied with and others not. We viewed the policy on day-to-day management. This states ‘the registered manager should be able to demonstrate a commitment to continuous professional development by doing periodic training to update their knowledge, skills and competence’. As mentioned above we found little evidence that the Registered Manager is updating her knowledge. We asked to view residents financial records held by the home. The Responsible Individual produced a excel print out spreadsheet that contained the details of five residents. We discussed the possible Data Protection and Confidentiality issues regarding this with the Responsible Individual. He informed us these could be produced individually if needed. The Registered Manager then produced individual finance books for residents. These detail transactions for monies spent and entering the home, with all being accurate. In addition individual receipts were in place along with records of monthly financial audits undertaken by the Responsible Individual. When viewing accident records we saw a record dated 30/09/08 that states the resident sustained an injury to the left side of head (bruise and cut). Care records state that no medical intervention was sought. We asked the Registered Manager how and who makes the decision not to seek medical intervention for head injuries. She stated that if this occurs when she is not on shift (but on call) staff ring her and the decision would be made. We explained that staff left in charge of the home should be able to make such decisions in order that residents receive medical attention at the earliest time possible (see previous comments relating to qualified first aiders in the staffing section of this report). We viewed a document titled ‘Record of maintenance of equipment’. This states the lift was tested October 2008, hoists tested 04/07/08, fire detection tested 04/11/08, fire extinguishers tested 10/11/08, emergency call equipment tested February 2008, heating system tested September 2008 and gas appliances tested September 2008. Whilst looking around the building we observed fourteen residents bedroom doors wedged open. We discussed this with the Registered Manager who informed us the home is looking at providing appropriate door devises that close in the event of fire. We asked her if the practice of wedging doors is included in homes fire risk assessment. She said that she was not sure. We looked at the fire risk assessment and could not find this included. Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 2 1 Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Pre admission assessments must identify all needs and be used to establish that the home is able to meet those needs. Not met. Further action will be taken. People who use the service must have clear individual care plans describing the support that staff give to meet identified needs. Not met. Further action will be taken. Where it has been identified that people who use the service are at risk from falls, a risk assessment must be put in place, which describes how the service will lessen those risks. Not met. Further action will be taken. The registered person must be able to demonstrate through the homes records that residents received where necessary, treatment, advice and other services from any required health care professional. All medication must be administered as directed by the DS0000065835.V373422.R01.S.doc Timescale for action 28/02/09 2. OP7 15 Sch 3 (1)(b) 28/02/09 3. OP8 13 (4) (b)(c) 28/02/09 4. OP8 13(1)(b) 12/03/09 5. OP9 13(2) 12/03/09 Cornelius House Version 5.2 Page 33 6. OP10 12(2(3) 7. OP12 16 (2)(m)(n) 8. OP15 16(2)(i) 9. OP29 19 Sch2 10. OP29 19 11. OP30 18(c) 12. OP38 23(4) prescriber to the service user it was prescribed, labelled and supplied for. Residents’ preferences with regards to times of bathing, rising and retiring must be sought and where possible implemented. Activities must be offered that are varied, flexible and meet the expectations, preferences and capacities of people who use the service, with care plans identifying needs and expectations. Not met. Further action will be taken. The registered person must ensure that residents are offered a choice of meals that meet their individual assessed and recorded requirements. The recruitment process of staff must ensure that the checks, which include references and POVA FIRST, are in place before employment commences to protect people who use the service. Not met. Further action will be taken. The registered person must be able to demonstrate that the home only employs foreign workers after confirming their legal status and entitlement to work in this country. The service must demonstrate it is able to meet all the needs of people who use the service by ensuring that staff receive training from a suitably qualified person or body. This is in addition to all mandatory training. Not met. Further action will be taken. The registered person must DS0000065835.V373422.R01.S.doc 12/03/09 28/02/09 12/03/09 28/02/09 12/03/09 28/02/09 12/03/09 Page 34 Cornelius House Version 5.2 13. OP38 13(4) consult with the Fire Authority regarding the practice of wedging residents’ bedroom doors open. Any advice given must be implemented. The registered person must be able to demonstrate through risk assessment that qualified first aid staff are on duty at all times as described in the CSCI policy guidance: First Aiders 12/03/09 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 Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Cornelius House DS0000065835.V373422.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!