Inspection on 07/08/08 for Cornelius House

This inspection was carried out on 7th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cornelius House 12/01/09

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Cornelius House 114 Fishbourne Road (West) Chichester West Sussex PO19 3JR Lead Inspector Val Sevier Unannounced Inspection 10:00 7 August 2008 th 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.V369129.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.V369129.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.V369129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th April 2006 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.V369129.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 is service 0 stars. This means the people that use this service experience poor quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: the Annual Quality Assurance Assessment (AQAA) completed by the home, and an unannounced visit to the home, which was carried out on the 7th August 2008, during we were able to have discussions with staff and have interaction with the people who use the service. During the visit we looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff and people using the service, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. At the time of writing the report of our visit we have received 6 surveys: 3 from staff, 1 from a GP and 2 from people who live at the home. The registered manager was on holiday on the day of the visit the administrator at the home spoke with Miss Venus and when asking where some information was kept told her that we were at the home. The deputy manager assisted us at the start of the visit but had to leave at 11:00, as she had to return to work later in the day due to staff sickness. The administrator assisted us with finding the documents we asked to see, and also informed the Responsible Individual Mr Kellas that we were at the home. We left an immediate require for action for medication at the time of the visit. Since sending the draft report we have received acknowledgement from the service that they have complied with the requirement. What the service does well: The home welcomes people who will use the service and their families or representatives, to visit the home and look at the facilities of the home. People who live at the home were mostly positive about the food that the home provided and the condition of the accommodation that they occupied. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Many areas of improvements have been identified as essential for the safety and welfare of people who live at the home. Care plans must detail the care and support needs for individuals where support has been identified. The service stated in their AQAA that their care plans needed updating however no evidence was seen on the day of the visit that this had begun. There must be photographs of the individuals who live at the home Risk assessments must be in place for all identified risks and must state what action must take place. Medication policy must be in place and adhered to. Medication records must be kept up to date and accurate at all times. All medication must be stored correctly. There must be activities offered daily that meet the needs of the people who use the service. Staff must receive training in safeguarding adults. The home must have a policy to support them in safeguarding adults. The home must ensure that there are sufficient staff, with the skills and knowledge to support all the needs of the individuals at the home. The procedure for recruiting staff must include all needed checks before employment commences. The maintaining of financial records and monies must be improved to ensure the safety of money that belongs to those that use the service. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cornelius House DS0000065835.V369129.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.V369129.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of consistency in assessing people who are interested in using the service, although staff seem to understand some needs of some individuals. The current assessment record would prove more beneficial to the assessment and care plan process for the individual if the record of the information is related to the care plan. EVIDENCE: We received the AQAA for the home, which stated that: “Every resident (permanent or respite) is individually assessed by Care Manager prior to entry to the Home. On acceptance an individual care plan is then drawn up. Wherever possible we talk to the potential resident’s GP to get their opinion on suitability of Cornelius House for the Resident we would never admit a resident where the GP does not endorse”. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 10 We sampled three assessments that had been carried out since our last visit to the home in 2006. They consisted of three pages of tick boxes, yes or no, list of options and a line for ‘observations’. Areas covered were for example past medical history, history of falls, general health choices – good/yes/no/frail/poor. One example we saw was a tick against frail for using the stairs observation ‘ can do stairs’. There were options to tick on preliminary assessment for bathing and eating, social needs and relationships. Personal safety and risk was laid out so that risk could be identified, the risk factor high or low and preventative instructions. For two individuals they were assessed, as at risk of falling for one there were no preventative instructions, for the other the advice was ‘ensure they have their walking sticks’. We noted that two of three individuals had been admitted to the care home from care homes with nursing. We noted that for one individual there was a risk assessment on their care plan which stated that carers were at risk, there was no reference on their assessment regarding their mental well being and any needs associated with that. Cornelius House DS0000065835.V369129.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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and medication records do not ensure that the personal and healthcare needs of people who use the service are met safely and effectively. Staff working practice helped to ensure that the privacy and dignity of most people who use the service is promoted. EVIDENCE: The home’s AQAA told us that: “We have excellent relationships with local GPs and continually consult with them. All residents are regularly supported in maintaining care in relation to chiropody, dentistry, hearing and sight. All staff treat the Residents with utmost respect and dignity. Where the occasional slip up comes to the attention of management this is dealt with promptly. In one case this year where we had a persistent problem, the member of staff was dismissed. All residents have their own rooms so privacy is available to them at all time Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 12 for confidential conversations with advisors etc. Where residents do not have a direct telephone line into their rooms. They have access to a private wireless phone. All residents wear their own clothes. We have excellent relationship with local Pharmacist who delivers prescriptions on a daily basis. Drugs are re-ordered and controlled in the administration office daily, ensuring the correct drugs are in stock and out of date or redundant drugs are returned to Pharmacist. Only members of staff trained to administer drugs are allowed to dispense”. Under ‘evidence to show that that we do this well’, the home’s AQAA stated that: “Care plans up to date. Drugs records up to date. Controlled Drugs book up to date”. We sampled three care plans of people who use the service that had moved to the home since our last visit. The care plans sampled were being used in conjunction with medication records. The care plans are pre typed on one sheet of paper with: name and age; general health with ‘elements’: vision, speech, hearing, mobility, orientation, continence and a gap to the side of each of these for ‘observations’, a space to record, weight, change to diet, recent medical history and care instructions. There was a box for risk assessment, with possible risks/preventative instructions. We did not see any photos of the individuals on either the care plan or the medication records. In the first care plan we sampled it stated by mobility: “fair, uses stick has Parkinsons so there is a tremor”. There was no record of this on the pre admission assessment. Under care instructions “Will need help with washing and dressing”. The risk assessment said that the individual was at risk of falling under possible risks/preventative instructions it said “make sure room is clear and that they have walking stick”. We saw a weight chart in the care plan file it was blank. The second care plan we sampled was for an individual we heard calling out for most of the time we were at the home. This individual had a fall whilst we there and we went to see how they were, as a member of staff was looking for a dressing. We saw that there were two skin flaps on the right leg, one approximately 2cm long the other about 3cm. The care staff said the person had been going to the bathroom in their room and had fallen, and that they often slipped. We spoke with the individual who asked who we were then their conversation became confused and then they became angry. We spoke with staff and some care staff will not go in to assist this individual as they become ‘aggressive and violent’ towards staff. One member of staff said that they are often left to go into assist this individual as they have experience with caring for people with dementia and difficult behaviours. The care plan for this individual was dated October 2007. The risk assessment in the care plan stated that “carers are at risk of being punched and kicked” the preventative action was “if they start playing up come out of the room making sure they are safe if possible go back later”. There was no risk Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 13 assessment about falls. There were several care plan sheets with handwritten notes on the back for example August 2007 “behaving in an abusive manner GP contacted, prescribed Haloperidol, if they play up come out of room”. We were told that the maintenance person had assisted care staff to lift the individual up off the floor, we asked if the home had a hoist we were told “yes, but person is awkward but not heavy”. It was seen that there were notes where the care plan had been reviewed monthly until June 2008. The last review said “All care given sometimes under difficult conditions”. There was no evidence that the care plan had been updated since 2nd October 2007. The last time the individual was weighed was March 2006 with a note that; “Mrs X doesn’t not want us to keep on weighing her”. The individual has regular blood tests as they are on Warfarin, we did not see anything on the care plan about this. The third plan we looked at was for another individual who had moved to Cornelius House from a home with nursing in June 2008. The previous home had given Cornelius a discharge letter with all the individuals likes, dislikes and allergies. They had also sent a copy of the care plan, which detailed when and how care was to be given. The service had not rewritten the care plan. The care plans did not have daily notes on the lives of the individuals who live at the home. We did see notes written on the back of the care plan of one individual where there were difficulties and concerns raised by the person’s family. Staff told us that they write issues, events and daily happenings if any in the diary. We were introduced to a trainer from a local college who was at the home at the time of the visit. They were carrying out an assessment of staff training files on medication administration. We were told that the home did not have a current medication policy and this was essential for the staff to be assessed and passed by the trainer. We were told that the college had given the home a draft policy to look at. We were also told that the home had not until recently had a Controlled Drugs (CD) record. We looked at the medication and found that the home did not have a policy, although the AQAA for the home states that it does. Staff spoken with on the day said they were unsure about how to give and destroy some medication for example Fentanyl patches. Staff advised us that the home had approached a local chemist regarding moving to a blister pack system for medication. The administrator hand writes the medication sheets every month. We noted that there were some spelling mistakes regarding the medicines and lotions that had been prescribed. The medication records state what is to be given and the time. Some items were written in red pen we asked why that was the staff said that this highlighted items to the care staff and if a medication was new. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 14 The administrator keeps a list of stock and staff write in a book when they have taken a bottle or packet from the cupboard where stock is kept, the administrator then orders a replacement. The administrator currently orders the medication and they have their own system, which is not recorded anywhere. The medication in use that are not managed as a controlled medicine, are kept in a trolley which when not in use was locked to the wall. It was full of boxes and bottles of medication. Excess stock is kept in cupboards in the office above the trolley. The CD cupboard is a made of plastic and is within a metal cupboard. The CD cupboard was also seen to contain, throat lozenges, and other medications that are not controlled. There were also hearing aid batteries and two bottles of medication with handwritten labels one dated 2003 with it stated Sinemet, another with Selegiline, and a sweet box with various tablets. An immediate requirement was left for the disposal of these three containers. The AQAA states that there were controlled medications in the home at the time of completion 11th June 2008. It was not clear when we looked at the CD book and the stock what medicines were in the home. It was not clear from the CD book what the opening stock was for each medication. For example one individual is prescribed Zomorph 10mg twice a day: the stock level in the CD book dropped from 128/127 to 119 on a single day with no explanation. The CD book had two signatures except for the day of the visit. There was no policy to refer to. One person is prescribed Haloperidol 2.5ml. The stock recorded also varied and included the use of a concealer fluid to change this record. We checked the stock for this medication and found two bottles of 200mls unopened and a 200ml bottle open and partially used, the CD book stated that the stock was 145mls after the last dose had been given. Two people were noted to have prescribed medication patches. When the boxes were examined there were multiple boxes open some with apparently used patches, others with their packaging open but it was not clear if these were used or unused. The individual packages were not dated for application or removal. It was not clear from the CD register how many new patches remained. There was no written guidance for staff on how to administer and dispose of the patches. It was noted there was no record of Fentanyl patches for one individual in the CD book. The medication was also seen to be referred to by two names Fentanyl in the MAR sheets and Buprenorphine in the CD book; the medicine box stated that they were Buprenorphine. The prescription for the individual is that the patches are to be changed every four days. We saw that there was no signature on the 1/8/08 or the 5/8/08 in the medication administration records. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 15 One record stated that an individual is prescribed Diazepam 2mg. We were unable to confirm the stock initially as we could not find the box, other staff also looked emptying out the cupboard; the medication was recorded as last being given at 1:50pm on 5/8/08. A member of staff on the afternoon shift looked in the cupboard and said they found the box of Diazepam behind three boxes of Buprenorphine patches, which we had removed to count. ‘As required medication’ is written in a section at the bottom of the medication record saying what the medication is for example “Movicol for constipation (please make sure they take it)”. There were no instructions on when it should be given or the amount. This applied to other as required medications for example: Paracetamol, Lactulose, Ibuprofen, Co Codamol. There was no space on the medication administration records to record when an as required medication was given. We asked where this was recorded and were advised that it was in the daily diary. We saw a member of staff record the giving of two Paracetamol in this book, however there was no reason recorded or outcome for the individual after having the medicine. One individual is prescribed Diazepam as needed “give when requested”, no maximum amount seen. The same individual is prescribed Nitrazepam 5mg, the box stated ‘1 before bedtime if needed’. The medication administration record states that the medication is to be given at night and is not written as required. Staff were observed speaking and assisting individuals 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. One survey returned said about staff that:” We have lost some of the older full time staff so that the newer part time staff do not always know what is expected of them. If they work with staff who also have not been trained in the way things are done they learn by example good or bad. Sometimes they get upset and feel that they are being criticised”. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are activities offered they are not offered daily and do not always meet the needs of the people who use the service. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. EVIDENCE: The AQAA sent by the home stated that: The quality of our meals continues to be the thing most appreciated about the Home. We are flexible in the services we provide. No one is ever made to act against their wishes. Residents can eat in their rooms or in the communal dining room. Total flexibility is given to residents over choice of breakfast and supper and there is always an alternative dish prepared at lunch times. Our cook knows the preferences of each resident. There is total freedom as coming and going of guests etc. Residents are always consulted wherever possible prior to visits. We have monthly Communion and local school and Church provide an annual carol service. We have an annual garden party for residents and guests. We run regular Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 17 activities, film club, bring & buy Sales, poetry & reminiscence sessions etc”. Under “Our evidence to show that we do it well” and “What we could do better” we saw N/A recorded. On the day of our visit there was a visiting activity person who attends the home weekly for music and movement. One individual receives has a massage and aromatherapy once a week. We spoke with staff about activities. They said that there is communion twice a month. They had someone come to the home for poetry reading “but it didn’t go down too well”. The home is having a garden party on the 19th August 2008. They have seasonal parties. Clothes companies come to the home with items for people to see. The hairdresser comes to the home weekly and the chiropodist comes six weekly. We asked if people go out we were told; “there are no social outings”. In the surveys we received from people who use the service there were comments about the food and activities: “The cook will always listen and find and alternative”. Both the responses had ticked ‘usually’ in response to ‘Do you like the meals at the home?’ To the question’ Are there activities arranged by the home that you can take part in?’ The respondents had ticked ‘always’ and ‘sometimes’. The service has commented that their annual survey had ‘not identified any activities the residents would like to participate in’ and ‘we do not believe our residents want daily activities’. The care plans seen did not show that people who used the service had been asked their life history, hobbies and interests, or what they would like to do if anything. Cornelius House DS0000065835.V369129.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): 16 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints process for people who use the service and their representatives to use, however it is not clear that people are protected through this policy or that staff have knowledge and understanding of safeguarding and protection issues. EVIDENCE: The home’s AQAA stated that: “Complaints procedure is well documented and presented in the Home. Whistle-blowing procedure in force and working well”. Under ‘Our evidence to show that we do it well’ the home had stated “No complaints”. Under ‘What we could do better’ and ‘How we have improved in the last 12 months’ the home had recorded “N/A” “Under Our plans for improvement in the next 12 months: Reissuing to all staff Policies and Procedures manual and incentivising them to re-visit relevant induction DVDs”. We saw that the home uses West Sussex safeguarding adult’s policy. We could not see in training records on staff files that staff have had training in safeguarding adults. We saw that there were several DVD’s in a cupboard for training purposes on several different subjects. We saw that the complaints procedure was on the wall outside the office, Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 19 surveys returned indicated that people who use the service know who to speak to if they are unhappy. The home had no record of complaints or concerns although we saw concerns had been raised and had been recorded on the back of one individuals care plan. It did not appear to follow the home’s complaint’s procedure. Staff surveys returned to us stated that new members of staff are just shown DVD’s and that training seems to have stopped. Cornelius House DS0000065835.V369129.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): 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. 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. People who live at the home are encouraged to furnish the room with 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 and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 21 Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The AQAA for the home stated that: ”We have a full time Facilities Manager with delegated responsibility for all “environment” matters in the Home. Each resident has direct interaction with FM to have any matters of concern resolved quickly and without fuss. Maintenance reviews of fire equipment and lifts sub-contracted to reputable suppliers. Upgraded smoke alarms. Built 2 extra rooms in excess of Care Standards requirements. Redecorated and re-carpeted 20 of rooms”. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have skills and knowledge in areas which would enable them to met the needs of individuals at the home. The current system of checks in the current recruitment process places people who use the service at risk. EVIDENCE: The AQAA for the home stated that: “Staff are on a 4 weekly rota to meet the agreed resource plan. Ongoing training in NVQ2, 3, 4 & RM. All new staff pre vetted prior to commencing work”. Under ‘What we could do better’: Night Staff continue to be a problem re retention. Training needs to be organised and recorded better. Under ‘How we have improved:’ Appointed new Deputy Manager who is responsible for training. Reissuing to all staff Policies and Procedures manual. Purchased up to date DVD training videos set. We are identifying relevant DVD’s for each member of staff and will incenitivise them to reinforce their training”. The home states in its AQAA that they do not have a staff development programme that meets the National Minimum Standards for the service. With regards to meeting people’s needs the AQAA for the home said that at the time of completing it there were: 16 people who needed assistance with washing, dressing undressing and bathing, help/supervision/prompts to eat Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 23 meals; 8 people who need assistance in going to the bathroom; and 1 person who needs the help of two or more staff during the day and night. We looked at the staff rotas; the deputy manager was on duty from 8:00 – 11:00 when she left, as she had to return at 5:00pm to cover someone who had gone sick, she said this was a frequent occurrence. We saw that there was two care staff until 2:00pm. In the afternoon there was 1 care staff working 2:00pm – 8:00pm, 1 care staff working 2:00pm – 5:00pm, 1 care staff working 5:00pm – 7:00pm. With the deputy going home although she was on call if needed, there was no identified person in charge at the home. The rota for Sunday 10/8/08 indicated that there were 3 care staff to work 8:00 – 2:00pm; 2 to work 2:00pm - 8:00pm and 1 to work 5:00pm – 7:00 pm. There was no evidence that staff have received training in mandatory areas such as food hygiene, first aid and manual handling, health and safety, safeguarding adults, communication, challenging behaviour and dementia. It was identified at the initial meeting on 15/7/08 with a new staff member that they needed moving and handling training; there was no evidence that this had been given or arranged. It had also been seen on care plans sampled that there were individuals who had needs with their mental well being and that staff were ‘at risk’. Surveys from staff stated that there staff who did not like to care for those with mental health needs and challenging behaviour and this was then left to the few staff who have had training prior to working at Cornelius House. We looked at three staff files of people who had begun work since our last visit. There was one file that had a photo of the member of staff. One staff member had a contract that stated that they started work on the 16/6/08. There was an email from their organisation that applies for CRB and POVA First checks for the home dated 24/6/08 regarding the POVA First check. The CRB was dated as returned 14/7/08. The two references were dated 27/6/08 and 26/6/08. The second file we saw the contract stated that the start date was 12/6/08. There was no evidence that the POVA First check had been received before the CRB on the 5/7/08, one reference was dated 9/6/08 another 13/6/08 and a third was requested 22/6/08. There was no application form seen for this person. The third staff member had a contract stating they had begun work on 3/4/08, there was no application form, and there was no evidence of the POVA First check having been carried out prior to employment commencing. There was a CRB number recorded there was no date of when it was received. One reference was dated 14/3/08 the second was dated 23/6/08. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 24 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, 33, 35 & 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The risk assessments, lack of information in the care plans; current medication administration and recording, individual financial management and recruitment practices place people who use the service at risk of not having their needs met. EVIDENCE: The AQAA for the home stated: “There have been no changes in senior management of the Home. The Care Manager (NVQ4 & RM) continues to run the Home as her sole operational responsibility. Our full time salaried Facilities Manager remains responsible for all building and Health and Safety Matters. Our owner – a Chartered Accountant and CEO of a local Domiciliary Care Charity continues to take an active interest whilst not undermining the Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 25 authority if the Care Manager. We have just undertaken our Annual Service User Questionnaire”. Under ‘Our evidence to show that we do it well’: the manager stated; “Our records are up to date. Compliments book are full of testimonials form satisfied Service Users Families”. Under ‘What we could do better: the manager stated; “We have appointed a new Deputy Manager (NVQ3) who has been delegated responsibilities for policies and training. This is to gain a fresh look at these items ensuring we are up to date with processes and procedures. This will also help her as she takes her NVQ4 training”. We looked at the AQAA to see what policies the home said they had. The ones it does not have are as follows: there are no policies that advise staff how to manage aggression and violence, physical intervention and restraint, safeguarding adults and the prevention of abuse. The AQAA stated that there is a policy for the management of medication. Under Regulation 26 of the Care Standards Act 2000 the registered individual must complete a monthly report on the activities that they have looked at in the home. We could not find any evidence that this had taken place, We saw a report that related to a survey requested by the responsible individual, provider had carried out in June 2008, we asked how that was done the staff at the home said that a nominated person not employed at the home had gone round and interviewed people who use the service about the home. We asked if the people who use the service had been able to comment on the service anonymously, we were told that their names had not been mentioned in the final report. The report mentioned the areas covered: standard of care; the quality of their room, the staff, food and activities. There was no evidence that any action had happened as a result of this report. We asked about personal monies the staff stated that the home has money for some people, which pays for hairdressing and chiropody. We sampled two people and found that one book for an individual had date, money in and out and a signature, there were no receipts or a mention of what the money had been spent on. The amount in the book corresponded with the money seen. There was no book for the second individual, there was a piece of paper which said ‘haircut, date and cost’ there were no receipts. We looked at the fire training and testing of fire equipment and warning systems. It stated that there was a fire drill in June 2008, 23 staff names were seen there are 32 staff working at the home. It was not clear if all staff training in fire every six months. We were told that the maintenance person carries out fire training, we also saw a DVD. The records sates that the last test for the fire break glass points was 25/7/08 previously the date was 4/7/08. Cornelius House DS0000065835.V369129.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 X X 1 Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation 14 Schedule 3(1)(a) 13(5) 18(c)(1) 15 Sch 3 (1)(b) 17(1)(a) Sch 3(2) 13 (4) (b)(c) Requirement Pre admission assessments must identify all needs and be used to establish that the home is able to meet those needs. People who use the service must have clear individual care plans describing the support that staff give to meet identified needs There must be a photograph of identifying the person using the service available dated and signed. 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. You must purchase and fit a controlled drugs cupboard that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 Complete and accurate records must be kept of all medicines received into the home and given to people who use the service including controlled DS0000065835.V369129.R01.S.doc Timescale for action 05/09/08 2 OP7 15/09/08 3 OP7 05/09/08 4 OP8 15/09/08 5 OP9 13 (2) 07/11/08 6 OP9 13 (2) 07/09/08 Cornelius House Version 5.2 Page 28 7 OP9 13 (2) 8 OP9 13 (2) 9 OP9 13 (2) 10 OP9 13 (2) 11 OP12 16 (2)(m)(n) 12 OP18 13(6) medication. Medicines must only be given from the original container labelled with a dispensing label indicating to whom the medication is to be administered and at what dosage and frequency. Clear and comprehensive policies and procedures for the receipt, recording, storage, safe handling, administration, self administration and disposal of medicines specific to the home, must be produced and made available to care staff so as to ensure that staff know what to do and work in a consistent way for the benefit of people who use the service. There must be a clear care plan giving detailed instructions to staff as to what constitutes ‘needed’ for people. This will ensure that medication is administered in a clear and consistent way for the benefit of people who use the service. Medication found in the CD cupboard unlabeled in sweet box, bottle with Selegiline written by hand and bottle with hand written name and label dated 2003 with Sinemet to be dispose of by 8/8/08. Immediate requirement 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. The home must have a policy on how the service will safeguard the people who use the service and what staff should do if they suspect that the policy is not DS0000065835.V369129.R01.S.doc 07/09/08 30/09/08 07/09/08 15/08/08 07/11/08 07/11/08 Cornelius House Version 5.2 Page 29 13 OP27 18(1) 14 OP29 19 Sch2 (7) 15 OP30 18(c) being followed. The service must demonstrate that there are sufficient care staff to support the identified needs of the people that use the service 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. 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. The service must undertake a quality assurance audit of its service at least annually and enable people who use the service 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 service and complete a report, which must be available at the home for inspection. The home must ensure that the personal monies of people who use the service are kept safely with accurate records. 07/09/08 07/09/08 07/10/08 16 OP33 24 (1)(3) 07/11/08 17 OP33 26 07/09/08 18 OP35 20(3) 07/09/08 Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 30 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 OP9 Good Practice Recommendations It is strongly recommended as good practice that there is a robust system to check that the medication administration records charts are correct before they are used, such as the member of staff writing the charts signing and dating the chart, and the second person checking the entry for accuracy. Cornelius House DS0000065835.V369129.R01.S.doc Version 5.2 Page 31 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. 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