Inspection on 12/01/09 for Corner House Nursing Home

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Corner House Nursing Home 06/02/08

Corner House Nursing Home 08/08/06

Corner House Nursing Home 13/10/05

Corner House Nursing Home 05/05/05

Corner House Nursing Home 21/09/04

Corner House Nursing Home 02/06/04

Corner House Nursing Home 20/01/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Corner House Nursing Home 116 Cheriton Road Folkestone Kent CT19 5HQ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary Cochrane     Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 43 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: Corner House Nursing Home 116 Cheriton Road Folkestone Kent CT19 5HQ 01303258892 01303258922 cornerhouse@counticare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Counticare Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 19. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical Disability (PD). Date of last inspection Brief description of the care home The Corner House is a large detached building situated in a residential area of Folkestone. The building is in keeping with the local area and is close to the town centre, the local leisure centre and parks. It is owned by a company called Counticare, which was purchased by the company CareTech during 2007. This is an experienced provider for care homes in this category. They also own and run a day 1 2 0 1 2 0 0 9 19 19 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 43 Brief description of the care home centre in Folkestone called the Martello centre, which is available for all the clients in this home to use. Accommodation is provided on 3 floors, all of which can be accessed by a passenger lift. There are 9 single bedrooms, 5 shared bedrooms and 2 with en-suite bathrooms. The home provides care and support to adults with physical and learning disabilities, who also have nursing needs. Some have associated sensory impairment. Fees are arranged with the funding authority, depending on the individually assessed needs of clients. They currently range from £856.04 to £1387.39 per week, with additional charges for hairdressing and personal items. Care Homes for Adults (18-65 years) Page 5 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The last inspection key unannounced inspection on this service was completed on 6th February 2008. This visit to the service was an unannounced Key Inspection which took place over one day. 2 inspectors went to the site visit The manager was available. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. Care Homes for Adults (18-65 years) Page 6 of 43 The visit included talking with service users and the care staff. General observations were made during the day. We observed how staff supported service users during daily activities and when offering care. The home is registered for 19 service users, but in practice the home supports a maximum of 16 people. We had a look around the home and various records were seen. We looked at and discussed service users individual support plans and their risk assessments. We also looked at staff files and training records. We saw how the service recruit their staff and the homes quality assurance systems. The commissions pharmacy inspector also visited the home on the 16th January 2009 to look at medication procedures and records. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. Since the last inspection there has been a safe guarding vulnerable (SVA) adult investigation at the home. This means that the local social services adult protection team has concerns about the home. They have offered support, advice and input from multidisciplinary agencies to try and move the home forward in the right direction. This is to make sure the people living at the home are safe and their needs are being met. At the time of writing this report the alert and investigation remained open. Following our site visit the Caretech Company have decided to take action about the way the home is managed. A new person has taken over managerial responsibility for the service. Following this inspection we issued a Code B notice. This informs the the recipient that we believe, under the Care Standards Act 2000, an offense has been committed, that we have taken evidence that demonstrates this breach and makes clear what the rights of the individual receiving the notice are. Subsequent to the site visit, the Responsible Individual and senior management have taken a strong approach to improve service management. They have told us that the registered manager has been suspended, pending an investigation. An experienced manager has been transferred to manager Corner House during the investigation period. What the care home does well: What has improved since the last inspection? What they could do better: Serious shortfalls were identified at this inspection. Before any of the other issues and shortfalls can be addressed at Corner House it needs to be ensured that the home is managed pro-actively and effectively and run in the best interest of the people who live there. The home needs to be managed by a person who has the skills, knowledge and abilities to ensure that all of the service users have their individual care needs met, in a safe and caring environment. All service users need to have an up to contract in place so they know what they are paying for. All service users need to have a care/support plan. Some people did not have care Care Homes for Adults (18-65 years) Page 8 of 43 plans and other care plans have not been reviewed or updated to reflect changing needs. These need to be individualised and person centred. The plans need to focus on what people can do for themselves and the input they need from staff when they need support and assistance. The staff need to have clear guidance and direction so service users needs can be supported and met consistently in the way that they prefer. This will promote independence and autonomy for service users while keeping them as safe as possible. The service must evidence that all health care needs are monitored and met. This will ensure service users are as healthy and fit as possible. There are no systems being used to make sure that all care and support needs of the service users have been identified and met. Staff have no guidance or direction in place to tell them how to care and support people who may have challenging behaviours. Specialist services had not been contacted to give advise and support to service users and staff. The service needs to make sure that it treats people with respect and dignity. And show that it offers people choices in how they live their lifes. The home needs to follow person centred procedures when giving medicines. Service users need to able to live a fulfilling and active life inside and out side the home. They need to be encouraged and supported by staff to do this. There needs to evidence of of independence and freedom of choice. The service needs to make sure that people can make complaint and that it will be taken seriously and acted on. The manager need to ensure people know what constitutes a complaint. The service needs to make sure that service users are protected from all types of abuse at all times. All information about service users needs to be kept confidential and safe. Staff need to have received the necessary training to be able to do their jobs effectively and safely. This will make sure that service users are receiving the care that they need as safely as possible. The service needs to provide dates on its maintenance and renewal programme to make sure that the works needed will be done in a timely manner. They need to continue improving the environment to ensure it is maintained to a good standard and suitable for the people who live there. The home needs to develop its quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the people who live a the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 9 of 43 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 43 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure they will receive all the information they need to make an informed decision about living at the home. Their places may not be protected and they can be sure all their needs will be identified. Evidence: The statement of purpose and service user guide have been reviewed and the documents contain all that is required. The guide is well presented and does contain pictures which may make it more accessible and understandable for the people the home caters for. The guide contains a section which allows the registered manager to fill in details about service users contracts, term and conditions and what is included in the fees. We saw that none of these new contracts had been completed. We did see old contracts which were dated 1996. These stated the accommodation fees and what activities the home would be providing for people. During our visit we saw little evidence that the service users are actually receiving the activities they are paying for which are listed in their contracts. Care Homes for Adults (18-65 years) Page 12 of 43 Evidence: There have been no recent admissions to the home. This is because there has been a voluntary agreement with social services that the home will not admit any new service users while the adult protection alert is open. We were therefore unable to look at any pre- admission assessments of prospective or new service users. There are polices and procedures in place and the documentation for assessments is provided by the company. Care Homes for Adults (18-65 years) Page 13 of 43 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users support and care needs are not all identified in their care plans. They cannot be sure their changing support needs will be reflected in their care plans and the plans will be followed. They cannot be sure that their independence will be promoted and they will be kept as safe as possible by the homes risk assessments. Attention must be paid to ensuring that confidentiality of information is maintained. Evidence: We looked in detail at 4 service users files. Each person had a profile in place which contained good information and gave a pen picture about the person. Some care needs were identified and there was some information about peoples lives and what they liked. We found that 2 of the files contained care plans but the other 2 only contained risk assessments. Care needs were not identified just risks. The registered manager told us she had not completed care plans for these people as the company were about to Care Homes for Adults (18-65 years) Page 14 of 43 Evidence: transfer over to different documentation. But care plans should have been in place prior to this. The care plans that we saw gave information on how to meet basic needs of the service user. But the plans did not reflect how to offer individual care and support. Service users plans did not cover all aspects of health and social care, medical needs, specialised needs, behaviour management and interventions. The care files that we looked at were disorganised disjointed and difficult to follow. Staff would have difficulty finding the information they needed to look after people in the way that suits them best. This was an area of concern as a lot of the staff working at the home have been agency staff who will not have know the service users very well. Care plans had not been updated to reflect the changing needs of the service users. This means that staff are not always up to date on how best to look after people. We identified that 3 of the people were exhibiting behaviours that may cause distress and harm but there was nothing in place to say how these people should be supported and cared for. There was nothing to tell staff how to manage the behaviours. We observed that staff offered inconsistent support when a service user was becoming distressed. Staff did not know how best to react or what action to take. We read that another person had hurt themselves on a piece of equipment. As a result of this a risk assessment had been developed but it gave no relevant information about what action the staff should take to minimise the risk in the future to keep the person safe. There are risks assessments in place but these do need to be reviewed to make sure that they are accurate and are tailored for individual identified risks. Some of them did not give a true picture of how risks are going to be effectively managed. We saw evidence that some important health care needs had not been identified and were not being appropriately monitored, so are not being met. (This will be discussed further in the personal and health care support section of the report). When we spoke to staff they told us that information is passed on verbally from one shift to the next. An agency nurse told us that when she came to the home she made a list of the service users and what needed to be done to look after them. Staff do not use the plans as a daily working document. Daily reports are written at the end of each shift but do not reflect what is written in the plans that are available. This means that the need of the service users are not always being met because the staff are not referring to plans. Staff handover to each other via a communal communication sheet. This sheet is in Care Homes for Adults (18-65 years) Page 15 of 43 Evidence: breach data of protection regulations and contains information about all the service users on one piece of paper. The information written on this sheet should be the information that is in daily reports and care plans. The daily records indicate and we saw that needs are being met in a task orientated way. The home does need to develop a more person centred approach to care. Key working needs to be further developed and promoted. We observed that some service users were offered limited choices about how they live their lives. Staff knew what people liked and disliked to do or eat, and some staff seemed to be able to interpret what some people wanted. This tends to be the people using the service whose communications styles are more easily understood by staff. Service users are limited in their choices especially with regards going out and being involved in daily activities. The home needs to be able to demonstrate that service users are supported to make decisions and choices. The manager told us then home has access to an independent advocacy services on a when needed basis. Care staff need to develop their understanding of how to offer choices effectively to the service user group. We did see that records and information are not kept confidentially. The downstairs office door was left open and information about service users is kept in there. Issues about confidentiality were identified at the last inspection and have also been identified following visits by the SVA team. It was also written in the services most recent monthly report that staff had reported breaches in confidentiality. Care Homes for Adults (18-65 years) Page 16 of 43 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are not experiencing a full and stimulating lifestyle. The routines in the home are inflexible and task orientated. Evidence: We saw that all the people living in the home were in at the beginning of the visit. Most people were either in the lounge or dining room. Some people were finishing their breakfast and some people were in the lounge. There is a large flat screen TV in the lounge which was on. During the day we looked to see how the people living in the home spend their time. We were told that some of the people go to the company day centre. No one attended on the day of the visit. Throughout the day we checked to see what everyone was doing. We saw staff talk to Care Homes for Adults (18-65 years) Page 17 of 43 Evidence: the people living in the home in passing. One person was engaged in a one to one talk time, some time during the afternoon and was watching some music TV. One person had a foot spa although during this time we did not see the staff talk to her during this activity. One person declined painting and instead sat at the table drawing with a member of staff. At other times people did not do anything. No one went out at all on the day of the visit. We looked through the records of activities and talked to the staff. A therapist visited the home during the afternoon to offer a music and movement activity for the first time. Two staff were in the lounge assisting with this session. The staff did not feel that the session had been very successful and the therapist confirmed this and said that the session is aimed at people who are more able to participate. From looking at the documentation kept at the home there was evidence to show that people did not participate in many meaningful activities. We talked to the people living in the home a little at a time. We spoke to two people using the inspector visits picturefolder. They looked at the folder briefly but did not interact using it. People were not able to verbally tell us what it is like to live in the home. We saw that people were calm some of the time, and some people did look up and smile and gesture when spoken to by us or the staff. Some people did vocalise but it was not always responded to as if they were trying to make their wishes known. We asked about communication aids. The staff said they did not use any at this time but there were some being designed in the office. The manager pointed to the communication wallets in the office. Each person has a wallet with photos in of themselves and objects that are familiar to them. None of these were in use. The manager said that people had had communication assessments by the speech and language therapist. We looked in three folders and saw guidelines for staff. These referred to getting down to peoples level and gaining eye contact, using some objects and taking time to allow the person to respond. We did not see this being put into action with the people whos folders we had looked at. The people living in the home mostly need total assistance eating and some people need a little assistance to enable them to eat independently. This was either with staff help or using adapted plates and cutlery. One person who was able to mobilise independently was given a tea tray so that she can pour her own tea after the meal. However she got upset at both mealtimes and staff were unsure of how to respond. The lunch was organised in two sittings. We saw that people are not hurried at mealtimes. Care Homes for Adults (18-65 years) Page 18 of 43 Evidence: Throughout the day the staff were busy moving people in wheelchairs to the dining room to eat and then out of the dining room to change and everyone who had done this sat and waited either in the dining room or in the lounge. The routines did not look like they could be flexible as staff moved from one task to another. One person walked repetitively from one area of the home to another. Due to the shortfalls in the above standards a code B noticed was issued to the home which informs them of their rights should we decide to take enforcement action. Care Homes for Adults (18-65 years) Page 19 of 43 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service Users cannot be sure that they will receive the personal and health care support to meet their individual needs. Evidence: We looked at 4 of the care files in detail. We found that there are shortfalls in the personal and health planning for the people who live at Corner House. 2 of the care files gave little information on how to deliver personal care to the service users. The home relies on a tick list for each service user to make sure basic care has been given. We saw that these had been completed but they do not tell staff how to deliver personal care in a way that is individual and best suits the needs of the service user. The registered manager told that they had recently had a visit from the Quality and Performance Manager of the company and it was reported she had said they were using too many tick charts. The other 2 plans that we saw used the companys care planning format and contained individual information on how to meet peoples needs. These were more person centred. We saw that people are weighed at regular intervals and receive visits from chiropody Care Homes for Adults (18-65 years) Page 20 of 43 Evidence: dentists, opticians and their General Practitioner (G.P.). We found that one person had a pressure sore when they came to the home, which was identified in a risk assessment. No care plan had been developed to tell staff what they had to do. The risk assessment had been updated to say the pressure sore had almost healed but there was nothing in the middle to say how this had been achieved. We saw that the district nurse is visiting a service user every week but there is nothing in the persons care plan to show the home is monitoring the treatment to make sure that progress is being made and to make sure visits are happening. The district nurses own notes were available. Another person had recently been prescribed anti- biotic treatment from their G.P but there was nothing in the care plan to say why they had been prescribed or how they are going to monitor the treatment and what they hoped the desired outcome would be. When we asked staff about this they told us it was for a chest infection. They then told us the anti biotics had not worked and they would have to call him again. There was nothing recorded. We saw that another service user was on fluid restrictions. There was only one reference to this in her care file which was dated in August 08. This was under Medical visits and just gave a short sentence saying the General Practitioner instructed to reduce daily fluids to 2000mls. Nothing was written in the care plan to give direction and guidance to staff on how this was going to be managed and what the outcome should be. We found that blood tests had not been carried out on one person which would have eliminated or confirmed a medical reason for behaviours. We found evidence in profiles and from observing and talking to staff that some of the people living at the home do express themselves through behaviours. There was nothing written in the plans to give guidance on what these behaviours might indicate. There was no guidance for staff on how to manage the situation in the best interest of the person. We observed staff responding inconsistently and not in the best interest of the service users on one occasion. Some people have been at the care of the home for a long time and behaviours are not new. We were told that the week before our inspection a referral to the local psychiatrist to review behaviours and medication had been considered. We also found evidence that a service user who is a diabetic had nothing written in her plan on how this was being supported and monitored by the care home. We did Care Homes for Adults (18-65 years) Page 21 of 43 Evidence: see that their blood sugars are being recorded daily in a separate book. We saw evidence that some important health support needs are not being monitored, so are not being met. We found that there are no systems in place to monitor peoples health. Staff deal with situations in a reactive way instead of peoples needs being anticipated and managed pro actively. Due to the shortfalls in the above standards a code B noticed was issued to the home which informs them of their rights should we decide to take enforcement action. This home has good facilities to store and handle medicines. There is no controlled drugs cupboard of the correct specification so controlled drugs cannot be stored according to the law. The medicine administration process was observed. Some residents, 3 out of 7 observed, were brought to the doorway of the office area where they were given their medicines. This practice is seen as task led and not a person centred procedure. Several residents are given medicines with jam to help with giving the medicine. Signed documentation is available from the doctor or the pharmacist for this activity indicating that the medicine is necessary. There is no intention to covertly give this medicine. It is simply a means of helping to give the medicines. There was documentation referring to behaviour seen when a resident is not wanting the medicine. However not all residents being given jam have this signed document. Documents were seen indicating medicines are correctly handled when service users are away from the home at medicine times. The written policy on this was not available to view and this could mean that there may not be consistency in the way medicine is handled when residents are out for the day. There was information available with the prescription sheet on medicines to use only when needed for consistency, or how to give medicine down a tube attached to the stomach. A record made by the doctor was noted indicating that he will write a letter to the consultant for a medication review for one client. This indicates that medicine reviews are requested although records show that this is a recent development and was somewhat absent in the past. There is in house training on medicines for staff to keep up dated on medicine issues. Care Homes for Adults (18-65 years) Page 22 of 43 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that the home will be able to identify what is a complaint and that their complaints will be listened to and taken seriously. They cannot be sure that they will be protected from all forms of abuse. Evidence: The home does have a complaints procedure in place and it is written in a format that some of the service users may be able to understand. At the inspection we did not see how people would be assisted and supported by staff to make a complaint if they were not happy about something. We did see that at least one person indicating that they were not happy about their treatment but there was no indication that staff would consider this to be concern or complaint made by the service user. Or that they were trying to indicate their needs. It was also written in the services most recent monthly report that staff were reluctant to report concerns. When we asked the registered manager if the service had received any complaints since the last inspection she told us that there had no been no complaints. The AQAA indicated that there were 3 complaints. We were told that these were the Safe Guarding Vulnerable adults alerts (SVA). The area manager did tell us the home had received 2 complaints from staff these had been dealt with appropriately through the companys policies and procedures. The home does have information about advocacy services and told us they would Care Homes for Adults (18-65 years) Page 23 of 43 Evidence: access them if necessary. Since the last key unannounced inspection their have been serious safeguarding concerns raised at the home. Kent Social Services and Health Team have been working with the home to make sure people are safe and they are receiving the care that they need. Care management reviews have been taking place. Multi agency SVA meetings have been held with the service to see if any progress has been made to improve the lives of the people living at the home. The safe guarding alert remains open and visits from out side agencies have been on going. This work is continuing. The home does have policy and procedures to protect the residents monies and valuables. At the inspection we found that the purse and money of one service user was missing. The manager could not trail where it was. Company procedures had not been adhered to. It was advised that the service report this to SVA and take advise on what action to take. This was done and an alert was raised. We have been informed that the missing purse and money has now turned up. Investigations will continue. Care Homes for Adults (18-65 years) Page 24 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 premises remain poorly maintained and do not provide a suitable and homely environment for people who live at the home. Evidence: At the last key unannounced inspection in February 2008 a lot of environmental shortfalls were identified. The Caretech Company sent us a development plan on how they were going to address these issues. The company are aware of the environmental issues that remain outstanding at the home. At this inspection we saw that some improvements had been made but a lot have not been addressed and are still only in the planning stage. We spoke to the estates manager who only has only been involved with Corner House since November 2008. The company updated us in June 2008 on the work that has been done. We have received no further information and work does not seem to have progressed much since then. The estates manager told us that new fire system has been put in place. Fire Action check the fire systems. They check 25 per cent of the home at each visit and make sure it is a different area at each subsequent visit so that it is fully checked during the year. All fire checks had been carried out by the home. Care Homes for Adults (18-65 years) Page 25 of 43 Evidence: We did see that the estates manager has a maintenance plan. The home is getting a new boiler. At present there are two boilers that keep cutting each other out so it is very inefficient system. Boiler replacement is planned for February 2009. The estate manager told us he is carrying out monthly audits. An urn was ordered on the morning of the visit. Apparently there had been a mix up and the estate manager thought the new one had arrived but he discovered during his audit that it actually hadnt been ordered so he did it straight away. The company have said they are going to replace the radiator covers and the plan is to have these fitted in 2 phases. We are not sure when this is going to happen. There still seems to an issue with the usage of the bathrooms. The 2 bathrooms with the ceiling hoists are working but staff told us its difficult to bath people in these as the baths are too low and it hurts their backs. The estates manager said he would investigate this. The third bathroom is small and hasnt got changing facilities so people have to undress and dress outside of the bathroom area. Staff said this is time consuming and can be uncomfortable for the service users. The upstairs bathroom is not being used as is waiting for refurbishment. Upstairs ensuite bath has internal panel lift to raise the person in bath but this is broken. The estates manager said that this had not been reported to him. He said the company could have repaired that one at the same time as the call out for the other one. Flooring is in reasonable condition but is not very homely. One bedroom flooring is in need of repair where it is lifting up at the edge. We saw that the maintenance plan did refer to repairs for walls, skirting boards, plaster damage etc. The laundry room needs to be refurbished. But we dont know when these things are going to happen. We also saw that the cooker hood overhead fan still needs to be repaired. With regards communal space, the estates manager told us that taking down the conservatory would cause problems because the floor had been raised and tiled and there were some drains underneath. They are considering increasing the communal space by having this as an external area so that people can sit out but be sheltered by the roof and have a low wall at the front. The estates manager felt that creating a small garden area was not a priority at the moment. He said that other areas of the Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: home are more important like recent upgrade of fire system, planned boiler replacement, changing conservatory, radiator covers and replacement of the urn in the kitchen. At the front of the house, the porch garden area has been tidied up., The car park has been cleared of rubbish. The conservatory and an old office are presently being used for storage. We were told that the conservatory was going to be cleared imminently. Service users rooms are no longer being used for storage. Although there is a development plan for the home, not much progress has been made with regards the general maintenance and upkeep within the home. No decoration has taken place. We have not received any further plan with actual time scales. The last information we received stated, The estates and maintenance manager is currently preparing an action plan to cover these areas and other fixtures and fittings for this service and this will be forward to you as soon as timescales have been determined with contractors for completion. At the time of the inspection we had received no further update. This will be an outstanding requirement on the report. These shortfalls were included in a Code B notice during the site visit. Failure to comply with the provision of this regulation is an offense. To make sure that service users benefit from well maintained, homely and conducive environment you need to take action, within the timescale set, on the requirement and warning letter. Susequent to our visit, the Responsible Individual has told us that the boilers were repleced and functional by 29th January 2009 and that the water urn was installed and working form 28th January 2009: that the cooker hood was repaired and was in workig order from 27th January. Additionally , radiators will be covered in two phases from February 2009 and a decorator has been contacted to commence the redecoration programme from mid February 2009. Care Homes for Adults (18-65 years) Page 27 of 43 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not enough staff on duty at all times with the necessary skills and knowledge to meet the needs of the service users. The recruitment practices at the home indicate that services users are at risk because they is no evidence to show that staff have been properly vetted. Evidence: There were 15 people living at the home when we visited. Staffing in the day time currently consists of 1 nurse and 5 support staff. There is 1 nurse and 2 support workers at night. Although the home is registered for 19 service users, it is the practice that the rooms which are permissible to be shared are only occupied by one person. Therefore in practice the home supports a maximum of 16 people. The home also employs a physiotherapy aid to work 16 hours per week. There is a full time cook and a full time cleaner. On the day of the inspection the cleaner was not available so care staff were undertaking some of her duties. The duty rota we looked at did not tell us the roles that staff are undertaking so it was difficult to see at a glance how many staff were on duty and who was doing what. There were 3 different versions of the duty rota all written in a different format which was confusing. It was clear that 5 support staff on duty was insufficient to enable the clients to have Care Homes for Adults (18-65 years) Page 28 of 43 Evidence: proper choices on a day to day basis about where they go and what they do. All service users need at least 1 to 1 support when going out and some need 2 to 1 support. This does not leave enough staff back at the home to carry out activities and proper time to communicate with people left in the home. The staff are not organised and do not work in a person centred way which would allow them to carry out more individualised care and activities. This was evidenced and supported when we looked at activity records for the service users. The registered manager told us that they nearly have a full quota of support staff working at the home and do not have to employ so many agency staff to cover shifts. This means service users a more consistent staff team who will be able to get to know them and how they like to be supported and cared for. The service is still trying to recruit more qualified staff. The AQAA told us that the home employs 16 permanent staff. 6 of these have achieved their NVQ level 2 or above. The home has not yet reached the 50 per cent of staff NVQ trained but progress has been made towards meeting this target. The company told us it has an induction programme and when we spoke to a new member of staff he told us in detail how this was implemented. There is also a planned programme for mandatory training. The home did not have an up-to date training matrix but we could see that shortfalls in training had been identified and training planned. We were concerned to find that the person who had been assisting with evening meals and the laundry and was going to take over responsibility for full cooking duties while the permanent cook was on holiday had not received any up to date food hygiene training or infection control training. The registered manager had requested that she undertake these roles without first making sure that she was able to do them safely and within the companys policies and procedures. When we identified this shortfalls alternative arrangements were made. We also found that a lot of staff who have been working at the home for a time have not received any updated specialist training in learning disabilities this included the nurses who work at the home. We know that the Caretech Company have good recruitment procedures in place, ensuring that a full employment history is obtained, 2 satisfactory written references, and a POVA First and CRB check prior to commencing employment. However in this home when we requested 3 staff files they were not available therefore there was no evidence to confirm that these staff were appropriately vetted and were safe to Care Homes for Adults (18-65 years) Page 29 of 43 Evidence: provide care to the people living in the home. The monthly visit from the company area manager had also identified this as a shortfall. We saw some evidence to show that staff were receiving some formal supervision. The service needs to make sure they have a minimum of six formal supervisions in a year. Care Homes for Adults (18-65 years) Page 30 of 43 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 service users do not live in home that is well managed and it is not run in their best interests. Health and safety checks have been completed to make sure the home is safe for the people who live there. Evidence: During the site visit and from looking at the information we have received since the last inspection, we found that the registered manager was not taking the necessary action for situations in the home that she has ultimate responsibility for. Examples of this are the inconsistent and inaccurate care planning. This was especially of concern around health care. The manager was not able to show us how she gave guidance and direction to the staff to make sure peoples needs are been consistently met in the way that best suits there needs. Staff reported to us in surveys and it was also documented on the last monthly report that some staff felt they did not receive the necessary guidance from the manager. We also observed a situation were staff gave conflicting messages to a service user but the manager did not intervene and offer support. The care plans did not offer staff any helpful written guidance as how to Care Homes for Adults (18-65 years) Page 31 of 43 Evidence: manage behaviours. The companys policies and procedures are not being followed. Throughout the report we have identified areas of concern which can be attributed to lack of proactive management skills. At the visit, we found that the lines of accountability in the home were not well known to the manager. In the majority of questions we posed about why requirements relating to care planning and delivery of care had not been met, she referred back to the failure of the staff team or lack of support from the company. We spoke directly to the registered manager about the shortfalls and she was agreeing with them but not taking responsibility to do anything about them. Because of the shortfalls in management of the home we issued a Code B notice. This informs the recipient that we believe, under the Care Standards Act 2000, an offense has been committed, that we have taken evidence that demonstrates this breach and makes clear what the rights of the individual receiving the notice are. The Area Manager visits the home every month to carry out Regulation 26 visits. Some of the shortfalls identified at this inspection had been documented in the most recent report done in December 2008. The senior management team did tell us that they had planned to take action with regards the shortfalls. Since completing our site visit at the home we have received information that the company has now suspended the manager from her duties. Another person from the senior management team will be taken over the responsibility of this role in the interim period. The Caretech Company does have quality assurance and monitoring systems. They told us they have a quality assurance audit files, which include audits in medication, finances, health action and health and safety. However at Corner House the systems have not been adhered to. We saw little evidence to demonstrate that the manager is making sure that all audits are being done. We were told Quality Assurance questionnaires have been sent to service users, care managers, relatives and staff last year. The results of these go to the Quality and Performance Manager. The results of these questionnaires need be collated. The information needs to be returned to the home so they can start taking steps to improve the service offered to the people who live at Corner House Nursing Home. The results of the survey need to be published and made available. All of the necessary Health and Safety checks have been carried out in the home. A Care Homes for Adults (18-65 years) Page 32 of 43 Evidence: fire assessment has been done. Fire checks and drills are done at the necessary intervals. Water temperatures are taken and comply with regulations. The service is aware of reporting incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely and regular audits are done. Care Homes for Adults (18-65 years) Page 33 of 43 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 14 12 (1) (3) To ensure there is suitable 30/04/2008 provision in the home for places to carry out different activities suitable for meeting the needs of this client group. e.g. a sensory room; or a separate quiet room. Action plan to be provided by the given date. 2 24 23 (1) (a) and The providers must ensure 30/04/2008 (2) (b,d) that the premises are well maintained. This means that sufficient maintenance hours must be provided for the ongoing general upkeep of the home; and a clearly documented maintenance plan must be put into place. This refers to repairs for walls, skirting boards, plaster damage etc. The laundry room needs to be refurbished. A decision must also be taken about the state and siting of the conservatory, which encroaches on the privacy and dignity of services users, and is in a state of poor maintenance. To provide CSCI with an action plan for these items by the given timescale. Care Homes for Adults (18-65 years) Page 34 of 43 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 3 24 23 (2) (b) To review flooring in bedrooms and bathrooms, with an action plan to be provided by the given timescale. This should be replaced where flooring is broken (e.g. quarry tiles in bathrooms); and consideration should be given to improved types of flooring in bedrooms, to improve the homely quality of the premises. 30/04/2008 4 28 23 (2) (e,g,h,i) The providers must ensure 30/04/2008 there is adequate communal space provided for service users inside the home. An action plan is to be provided by the given timescale. Care Homes for Adults (18-65 years) Page 35 of 43 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 All service users need a care 31/03/2009 plan. The manager needs to ensure that the care plans contain the relevant information to meet the individual needs of the service users and are used as a daily working document by the service users and staff. To make sure all the needs of the service users are identified and met. 2 10 12 To make sure that confidential information about service users is kept safe at all times. To protect service users privacy and dignity. 31/01/2009 3 12 16 The people living at the 28/02/2009 home are encouraged and supported to do meaningful activities as arranged in their individual programmes. Page 36 of 43 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Activity programmes need to be tailored for their individual needs and preferences. To make sure that each of the people who use the service are offered the opportunity to engage in a range of activities that are likely to engage their interests and suit their preferences and abilities. To help people live a fulfilling and meaningful life. 4 13 16 To make sure that people become part of and participate in the local community To make sure people have the support they need to be part of their local community 5 16 12 The daily routines need to promote independence and freedom of choice as far as possible To encourage and support people to make decisions about their lives 6 18 12 To provide flexible and personal and nursing support to maximise privacy dignity and independence To make sure all the 31/01/2009 31/01/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 37 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action personal and nursing needs of the people have been identified and met in a way that suits them best 7 19 13 The registered person 31/01/2009 ensures that all the health care needs of service users are assessed and recognised and that procedures are in place to address them The registered person ensures that all the health care needs of service users are assessed and recognised and that procedures are in place to address them 8 20 13 To have a written policy on 09/01/2802 procedure to follow when a resident is out at medication times To ensure continuity of treatment and have consistency in the manner medicines are handled 9 20 13 To have documents for all 28/02/2009 residents for any procedures that are different from the norm such as giving medicines with food To provide evidence that all interested parties have been consulted and to show that it is right thing to do Care Homes for Adults (18-65 years) Page 38 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 10 20 13 To obtain a correct specification controlled drugs cupboard To comply with the law 30/04/2009 11 20 13 To follow person centred procedures when giving medicines To preserve the dignity of the residents 31/01/2009 12 23 13 The manager needs to make 31/01/2009 sure that all the people living at the home are protected from all forms of abuse To make sure people living at the home are as safe as possible 13 32 18 To review the dependency 28/02/2009 needs of service users against the numbers of support staff on day duty; increasing the numbers of support staff to ensure that all assessed needs of service users can be properly met To make sure there is enough staff on at all times to support and care for the service users in the way that suits them best. 14 32 12 All staff working a the home need to have received the specialist training to make 28/02/2009 Care Homes for Adults (18-65 years) Page 39 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action sure they can support and care for people in a way that best suits their needs. To make sure staff have the skills and experience necessary for the tasks they are expected to do, including. Knowledge of the disabilities and specific conditions, communication and behaviours. Preferences and frustrations. 15 34 18 Staff need to have received the necessary training to undertake their roles safely and efficiently To make sure service users are cared for staff with the necessary knowledge and skills. 16 34 19 To adhere to the companys recruitment policies and procedures by making sure the required staff information is stored safely at the home. To make sure that the service users are protected and kept as safe as possible. 17 37 12 To have systems in place 31/01/2009 that ensure that the Home is carried on and managed in a manner by an appropriately 31/01/2009 28/02/2009 Care Homes for Adults (18-65 years) Page 40 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action experienced person who has the skills and abilities to ensure that all of the service users have their individual care and health needs met, in a safe and caring environment To make sure you monitor, record and take appropriate action, in relation to the day-to-day management of the changing needs of the service users and the impact this has on their health and welfare.To make sure the home is managed effectively and safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 5 All services users need to have an update contract in place. And the service needs to make they are receiving the care and support they are paying for. The service needs to evidence how people are supported and encouraged to make decisions about their daily lifes and events that affect them. All areas of risk need to be identified for each individual service user. The service needs to make sure that service users are kept as safe as possible. Risk assessments should enable service users not restrict them. People at the home need to be able to participate in leisure activities that they enjoy. To ensure the medicines fridge is lockable Page 41 of 43 2 7 3 9 4 5 14 20 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 22 The service need to review how they respond to the people living at the home to make sure they are heard if they are indicating they are not happy about something. The duty rota needs to contain the full name and role of the member of staff working at the home. Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. This will identify the strengths and weaknesses of the service. To make improvements for the people who live there. 7 8 31 39 Care Homes for Adults (18-65 years) Page 42 of 43 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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