Inspection on 30/11/08 for Culverley

This inspection was carried out on 30th November 2008.

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

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

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Culverley 155 Culverley Road Catford London SE6 2JZ Lead Inspector Michael Williams Unannounced Inspection 30th November 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Culverley DS0000071914.V372890.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. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Culverley Address 155 Culverley Road Catford London SE6 2JZ 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) 020 8265 6275 Sadanand Bunjun Chitradevi Bunjun Sadanand Bunjun Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: - Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: -8 30th October 2008 2. Date of last inspection Brief Description of the Service: Culverley Residential Care Home changed ownership in June 2008 and is now owned by Mr S and Mrs C Bunjun, Mr Bunjun is also registered as the manager. It is registered to provide personal care for up to 8 older people (it is not registered for any other categories such as nursing, dementia or mental health care). This care home is a large domestic style family house with bedrooms on ground and first floor, most are single rooms. There is a combined lounge and dining area towards the rear of the property. It has a kitchen and toilet towards the middle of the ground floor. There is a washing machine and dryer under the lean-to at the side of the property. Upstairs there is a very small bathroom, with an adapted hip-bath. There are several bedrooms on the first floor. The house is not well adapted for residents with mobility problems but it does have a stair left. We are advised that fees in November 2008 were from £450 per week. We also note that since the last key inspection this service has changed ownership and is regarded as a ‘new’ service for the purposes of inspection and star ratings. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This key, unannounced inspection takes into account information gathered during the course of visits by the Commission to this service on 18th September, 29th and 30th October, 4th and 30th November. We also review information provided by the owners and by other agencies such as the social services. During our site visits we have met with the new owners, Mr & Mrs Bunjun several times and we have met with their staff team, which at that time comprised mainly their family members. We also met the residents and where possible met with their visitors. A number of questionnaires have been distributed and we have taken account of any replies we received. What the service does well: What has improved since the last inspection? What they could do better: In summary the management of this home needs to improve if it is to provide a better quality of care and service for residents. Issues that need improvement arise in each of the seven sections of this report. This is a small family business and it has recently been re-registered with new owners and so it is regarded by the Commission as a new registration. The owners have yet to establish their ethos and atmosphere and from what the residents have said the residents are still getting used to Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 6 the many changes including the owners, the care staff and routines. We acknowledge that the owners, who were present for different parts of our visits, were helpful and cooperative during our visits and said they are new to the business of actually running a care home but they were willing to work with the Commission and other agencies to learn and develop their skills. The Commission is concerned that the owners must demonstrate their capacity to run this small care home well and to do so without the support and guidance that both the local Social Services and the Commission have found necessary to provide. Shortcomings in each section include for example, inaccurate information that is given at the time of admission; poor care planning was in place and poor health and social care support was being provided. The environment has various hazards and the home is not to modern standards because it is an exempted ‘existing’ care home. Staffing is inadequate including staff numbers for each shift, staff support and supervision and staff training. Management of the home is not of a high enough standard to ensure the safety and well being of residents. For those reasons this care home is assessed as providing a poor level of service. 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. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 7 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 Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 8 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): NMS 1, 2 and 3: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents cannot be assured that their needs can be properly assessed nor can they be assured that the decision to admit will reflect the conditions of registration. The home was not providing up to date information in its statement of purpose and service user guide so as to ensure residents are appropriately admitted. EVIDENCE: Section one of the Standards deals with the admission of residents and we find that residents are not within the registration category for this particular service. One resident was admitted to the home in on 6th June 2008, during the transition period and within a week of the new owners registration. Insurance cover for example is dated 4th June and Certificate of Registration 11th and Mr & Mrs Bunjun tell us that they were in the home from 9th June. The pre-assessment notes show that the resident has considerable mental health problems including persistent delusional disorder and recurrent depression. Whilst the new owners are not directly responsible for admitting this resident, they provided no evidence to show they had reviewed the appropriateness of the placement during the resident’s trial period. For another Resident the preCulverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 9 admission information and assessment reports indicate that she has dementia, with marked short term memory loss. Here the new owners should have initiated a review of her care needs and re-evaluated whether or not those needs could be met in their newly acquired service. Mr Bunjun confirmed that the conditions for registration were discussed with him in some detail at the time of his registration and he was aware that he must not accommodate residents with a condition outside his registration. Mr Bunjun stated, as he did to explain many issues, that he inherited the problem from the previous owners. We acknowledge that the new owners were presented with these issues when they decided to buy this care home as a going concern but they now need to arrange reviews for residents to deal with any ‘out of category’ issues. Residents are not given a contract or agreement that provides information about fees; we saw for example that room 6 there is an unsigned version of the contract. The contracts or agreements were archived when they should be readily accessible to residents. There was no indication that the staff team was able to meet the cultural needs of the (mainly European) residents since there was some disparity between the backgrounds of staff and that of residents as outlined in the homes own AQAA [Annual Quality Assurance Assessment] form. The Statement of Purpose and Service User Guide are both out of date and so is the information about how to complain, it contains details of the previous owners and an old address for the Commission. Failure to provide the required information in the form of a Statement of Purpose, Service User Guide and Contract and the admission of residents outside the registration category indicates a failure to comply with the regulations that apply to this section of the report and continuous non compliance may lead to enforcement action being taken. This section is assessed as poor. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 10 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): NMS 7 to 10: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Privacy and dignity are not being fully respected; health care support is not always being enabled; medication practices are not always safe so residents cannot be assured their health and social care needs can be me in this home. EVIDENCE: We found the care planning to be wholly inadequate, indeed some of the care plans were no more than pre-drafted documents which only by chance might have some reference to the individual in whose case file they were found. One such example was a pre-drafted plan, unsigned and undated, about a confusional state. Mr Bunjun conceded that he had been supplied with samples that he used without refinement. Mr Bunjun has started replacing these early copied versions with his own hand written ones but again the plans are generalised and lack detail about the individual being supported. Phrases such as “resident’s wishes to be respected” suggest a willingness to support a resident’s preferences but gives no indication they have been identified or listed in any detail that would guide care staff. It perhaps indicates a lack of clarity on the part of the new owners (about the homes registration) that Mr and Mrs Bunjun have been using documentation more suited to a home providing nursing care. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 11 The use of forms with headings such as Nursing action and signature of Nurse could readily mislead residents, care managers and others into supposing this home provided nurses and nursing care when it does not. See for example the incident regarding MO below. Where Mr Bunjun has drawn up his own care plans the information is still somewhat generalised, for example a care plan about end of life refers to “Religious and cultural wishes of family to be respected”; this gives no indication what beliefs and expectations are to be respected. We were advised by the Safeguarding coordinator for Lewisham, that Mr & Mrs Bunjun needed prompting to update care plans where there had been obvious and significant changes in a resident’s needs following a fall. She also advised us that neither the funding care management team, nor the Commission, had been advised about this serious injury the resident sustained by falling. We checked the standard form Mr Bunjun told us he was proposing to use, to make the belated notification to the Commission, and we saw that he had ticked an entry, in respect of the fall, Medical treatment given in a medical setting but person not sent to hospital; this tends to mislead since Culverley is not a medical setting. We were very concerned to find, in respect of the resident who had fallen, that the homes records show that she was in pain and had a swollen arm/wrist but had not been referred to hospital until some 3 days later when a visiting doctor advised “admission to hospital A&E”. Our concerns were compounded by the fact the resident had the fall on Saturday 18th October; the daily notes for this day have been altered to read, X had a shower today, while bringing her downstairs, she fell down, shes been checked, no bruising found, but the right arm is a bit swollen pain killer tablets given to her and bandage apply. Shes being monitored. This appeared to the inspectors to be negligent and so we referred this information to the safeguarding coordinator for Lewisham. There is no reference to Doctor, Nurse or ambulance assistance being requested until a General Practitioner visits her on Tuesday 21st October when a further entry is made in the diary notes about that visit and doctors advice that she be sent immediately to hospital to check for fractures. Mr Bunjun conceded that in consultation with his wife he checked the residents ‘observations’ pulse, bloodpressure and temperature and they decided resident did not need to be sent to hospital; a clinical judgement that should not have made since this is not a nursing home. In respect of privacy and dignity, we were told by a resident that Mr Bunjun allowed a workman to enter a resident’s bedroom whilst she was still in bed and without seeking permission of the resident to enter and measure a radiator. If the matter was urgent it would have been better to have asked a female member of staff known to the resident to undertake this task. Mr Bunjun refutes this and tells us that permission was sought. We identified numerous problems in respect of the administration of medicines. Including stock control, recording, disposal of medication, out of date stock, failure to record medicines in the home and late signing of medication charts. The Commissions Pharmacy Inspector visited on 4th November 2008 and found medication procedures and practices poor. The Pharmacy Inspector also Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 12 found staffing inadequate since there were only two very new members of staff on duty and one of whom had given out the medication earlier that day. Failure to prepare care plans that reflect accurately residents’ needs; failure to make suitable arrangements for the recording, handling, safe administration and disposal of medicines and the failure to ensure injured residents receive treatment from health professionals indicates a failure to comply with the regulations that apply to this section of the report and continuous non compliance may lead to enforcement action being taken. This section is assessed as poor. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 13 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): NMS 12 to 15: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not being supported to have social and recreational life that suites them. EVIDENCE: Section three of the Standards is about social care and daily life and in contrast to the inappropriate nursing tasks we found in care plans in the preceding section, there was little evidence of social care planning and indeed residents have spoken of reduced social opportunities since the new owners took over the running of Culverley. This was confirmed by Care Managers who told us they have interviewed residents and they are saying there seems to be less social opportunities in Culverley than before the new owners took over. During our visit on 30th November one resident told us she had not lived there very long and did not like being there, she said she felt cooped-up and staff would not take her out for walks, ‘I’m only allowed to walk in the garden’ she said. Mr Bunjun said she had gone for walks to the park. But this resident was quite clear she would like to go out more. She also said she had no money since her son was not visiting, possibly prohibited from visiting. Mr Bunjun told us that he had told residents that as manager he would not look after their money but following discussion with the inspectors agreed to review his position on this. A second resident also said, on 30th November, she did not want to live in this home but was less clear about why and seemed reluctant to comment but Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 14 seemed very grateful inspectors were checking the home and kept thanking us while we were there. It was perhaps inevitable that if the care plans were somewhat clinical in composition then the daily records of residents’ daily life in the home would reflect this bias and so they do. The daily notes frequently record that residents had a good day, given help with activities for daily living, or slept well. For the resident who fell and injured herself the daily notes for 10/10/08 are amended from had a good day to a reference about a fall; perhaps suggesting that even these meagre notes are drafted routinely and prematurely or inaccurately. The food records we saw in October were inadequate in that they merely record in a book a summary of the main meal of the day; there is no advance menu published for residents to make a choice between dishes; we are told this happens daily and informally. Nor could we judge from the records whether or not the meals supplied have been satisfactory, wholesome and nutritious as required by Regulation. We note that the kitchen is not very large and the freezer is in the lean-to near the boiler and washing machine so this does not appear to be in a very hygienic setting. We also noted on one occasion that the door to the kitchen was held open by a trolley and this is potential fire hazard and possibly a safety hazard if one or more of the residents are as confused as the owners tell us. The fire hazards associated with the kitchen remained on 30th November when we noted the other door, leading out of the building, still had a key operated lock. During our most recent visit on 30th we were shown frozen slices of beef and a piece of frozen chicken, not de-frosted as at mid morning. Mr Bunjun said his wife would come to the home with more food and at 12:10 she did so. Residents said the roast meal was very good and a visitor said it was the best meal she had seen served in the home during her visits there - and suspected it was because inspectors were present. All care homes are expected to provide, in adequate quantities, suitable, wholesome and nutritious meals which are varied and properly prepared. Detailed records are to be kept so that anyone entitled to check can assess whether or not residents have received a suitable diet. The owners might consider getting expert advice from a dietician to assist in the compilation of a suitable series of menus. They might also consider making use of the Government’s guidance, “Safer Food: Better Business”. For activities for the residents the owners might consider guidance from NAPA, “Activity Provision” by the National Association for Providers of Activities for Older People. Age Concern also provide advice. Failure to make suitable arrangements to enable residents to engage in local, social community activities and a failure to arrange a programme of activities with facilities for recreation and the failure to make suitable arrangements for residents to deposit money for safe keeping indicates a failure to comply with the regulations that apply to this section of the report and continuous non compliance may lead to enforcement action being taken. This section is assessed as poor. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 15 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): NMS 16, 17 and 18: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that the home will deal with complains efficiently nor can they be assured they will be protected at all times. EVIDENCE: Section four is about complaints and protection and here we find that from the outset the home was not fully prepared for dealing with untoward incidents. The new owners were reminded at registration they needed to acquire a copy of the local authority’s Safeguarding procedures. Having worked in various care settings before taking on Culverley this is something that they should have been aware of and dealt with before being prompted. It was still not in place by 30th November when the manager said he did not know where to get the document. The home’s own policy does not reflect the need to report untoward incidents without delay to the safeguarding team. In the short time that Mr & Mrs Bunjun have owned and managed this care home there have been several complaints made directly to the Commission – as well as to other parties including the owners themselves. The complaints though limited in number were wide ranging and included both environmental issues and quality of care and services provided and some of these issues are being investigated by care managers. The Commission has also made an unusually large number of visits to monitor services. It is most regrettable that numerous safety and welfare issues have arisen and require urgent improvement within the first six months of Mr & Mrs Bunjun’s incumbency. On 11th August we received complaints about the quality of care and services provided. Then on 14th August staff complained also about care, hygiene and equipment. During the course of a random inspection on 18th September we issued Immediate Requirements in respect of unsafe door locks Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 16 and referred a matter of restraint to the Lewisham Safeguarding team since the restraint appeared unlawful. Following that visit we also issued a Statutory Notice to the effect that the registered person shall ensure that no service user is subject to physical restraint unless the appropriate regulatory safeguards have been met. We were also concerned to see that in some of the resident’s case file there was a document indicating that a member of the family is given “full access” to the resident’s care record. There was no indication that each resident had consented to this disclosure of so much personal information, nor any indication of lawful justification under the new Mental Capacity Act. It may also breach Data Protection legislation. During the course of two further random visits on 29th and 30th October we made another referral to the safeguarding team, this time in respect of possible neglect by delaying to get suitable medical treatment for the injured resident, O. instead of calling for a doctor or ambulance the resident was given pain killers and her arm wrapped in a bandage. Mr Bunjun said he took ‘observations’ and decided nothing was seriously wrong, A clinical judgement not to be made in non-nursing care homes without reference to a Nurse or Doctor. On 30th October we issued further Immediate Requirements in respect of fire safety, in particular fire door protection. On 30th November we visited again, and once more we received complaints about the poor quality of services; we also received a complaint about an injury (a small bruise) a resident sustained and had not been reported to the family. Once the family noted the bruise the manager still did not report it to the care manager as an injury of ‘unknown origin’ nor were the Commission or the safeguarding team advised of this minor injury. After prompting by the Commission the manager agreed to inform all relevant parties. The failure to provide residents and others with accurate information about how they may complain; failing to protect residents’ personal information and a failure to report untoward incidents to the relevant authorities indicates a failure to comply with the regulations that apply to this section of the report and continuous non compliance may lead to enforcement action being taken. This section is assessed as poor. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 17 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): NMS 19, 25 and 26: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. This care home is not safe or suitable for the current client group. EVIDENCE: Section five covers the premises. This care home was sold as a going concern and so is seen by the Commission as an ‘existing’ care home and not subject to the more rigorous standards that apply to new developments. Nevertheless a number of serious shortcomings were identified during our recent visits, including fire safety matters such doors being wedged open or safety issues such as door locks. By the time we visited on 30th November bedrooms locks had been changed and only two doors were still wedged open. One was wedged with an ornament and another by carpet friction; Mr Bunjun disputed this until we showed him the evidence of the actual doors that were open. Keys are still in final exits to lounge and kitchen. We also note that a resident, with considerable mobility problems, fell in what is an environment that appears quite unsuitable for people with mobility problems and with a staff team that are not equipped to deal with residents mobility problems. We were also advised of other incidents including resident who fell whilst trying to manoeuvre out of the toilet with her walking frame. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 18 We also saw for ourselves the same lady having the greatest difficulty traversing the small step in the hall and she was attempting to do so in the absence of staff assistance. On 30th November residents complained to us that they were cold in the lounge and we checked that the temperature was low at 15.20C mid-morning. We asked staff to move a resident to a warmer spot and so she was moved to a warmer area of the lounge and given a blanket. The Bathroom is in a poor state, it has an uncovered radiator, a shower head that could fall into the toilet, screws sticking out of the wall near where residents sit upon the toilet. It is a very small room in which to manoeuvre. It has an unusual walk-in hip-bath and since this home does not cater for residents with mobility problems it seems oddly out of place here. We are told the this bath, which relies upon an access door closing tightly to prevent water leaking out, is not always available because the seal sometimes does not work effectively. There is no standard bath for more able-bodied residents. We saw that this home does not provide a private meeting place for residents’ visitors, this applies particularly to residents who share a bedroom but ‘suitable facilities for residents to meet visitors in private and which is separate from their bedrooms’ should be available to all residents. We required the replacement of unsuitable bedroom door locks and this has now been achieved. One visitor did say of the new locks that her mother would not be able to open the door if the door were locked by anyone from outside but this is because of a lack strength and cognition rather than an unsuitable lock. Radiators are now being protected by wooden covers as required but this work was not complete when we visited in November. The final exits (which serve as fire exits) still have keys in them and this is contrary to the Government’s advice for door mechanisms in Residential Care Homes. Failure to provide a safe and comfortable environment for residents indicates a failure to comply with the regulations that apply to this section of the report and continuous non compliance may lead to enforcement action being taken. This section is assessed as poor. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 19 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): NMS 27 to 30: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. We cannot assure residents that there is a stable, well qualified and experienced staff team able to meet their needs. EVIDENCE: Section six is about staffing and the majority of staff are from the Bunjun family including Mr and Mrs Bunjun and two of their adult children. The total staff team is currently was just 7 people in all to cover all the day and night shifts as sown by the duty roster for period 20th October to 2nd November. The staff team, the majority of whom (four in number) are members of the Bunjun family, and some are working excessively long hours day after day and the local Commissioning authority has already instructed Mr & Mrs Bunjun to remedy this. The Commission’s Pharmacist inspector found, when she visited on 4th November, that the owners had left two staff in charge one of whom had worked in the home just a month and the person in charge started working in the home just the day before. Neither was properly trained to administer medication she observed and clearly neither should have been left as the person in charge until such time that they had demonstrated to the owners that they were knowledgeable about the residents, the policies and procedures and familiar with the premises and assessed by the owners to be competent to be in charge. We judge it irresponsible not to take such steps to ensure the welfare and safety of residents. The inappropriate action taken by the ‘senior’ member of staff on the 18th October (when she failed to get medical attention for resident in pain) tends to support the Commission’s position that the owners are not ensuring staff are competent to be left in charge. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 20 When we checked staff records on 30th November we found all staff records shown to us had a CRB police check in place. But not all had evidence of induction and few had evidence of supervision. Mr Bunjun also confirmed to us that there has been no training, but we did note that induction training packs had been filled in as if completed by new staff. Mr Bunjun is recruiting new staff and, following instruction again from the local Commissioning authority, is now aware of the need to follow safe recruitment practices when doing so, in particular to ensure that no staff work in the home until suitable CRB [police, Criminal Record Bureau] and ‘POVA’ [Protection of Vulnerable Adults list] checks are in place. He has also been reminded of equality and diversity issues and to be mindful of the composition of the residents group, (their gender, racial group and cultural aspirations) when appointing new staff since none of the current staff team reflect the make up the current resident group – who are mainly, though not exclusively, white European. Mr Bunjun reminds us that he feels compelled by equality legislation to select staff from a diverse local workforce who may not share the same background as the residents. We also note that the owners are not employing any ancillary staff, cook, cleaner, laundress, administrator and so care staff are undertaking these duties as well being responsible for the care and supervision of residents. Since residents having been falling over and they are asking for more social activity, including going out, it is evident the owners need to review staff levels and their duties each day. Carers who have ancillary duties should be shown on the duty roster as supernumerary to care staff duties. Failure to ensure that suitably qualified and competent staff are working in the care home and failure to provide suitable induction, training and supervision indicates a failure to comply with the regulations that apply to this section of the report.. This section is assessed as poor. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 21 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): NMS 31, 33, 35, 36, 37 and 38: People using this service experience poor quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. This is not a well managed service being run in the best interests of residents with their safety and comfort as paramount. EVIDENCE: Management is dealt with in section six and Mr & Mrs Bunjun conceded, when we spoke to them, that although they have worked in a variety of care settings they do not have enough experience of actually managing a care home with all its complexities – their experiences lay mainly in direct nursing and social care and not in running the many aspects of a care home. Mr Bunjun advises us that he was deputy in another care home but only covered at weekends and the Bunjuns concede that this has not given them the necessary experience to manage Culverley unassisted. This is reflected in the shortcomings Mr & Mrs Bunjun will need to address if this home is to provide acceptable standards of care for its residents. Mr Bunjun has been emphatic in telling us that he “has learned lessons” arising from requirements issued by the Commission and by other agencies. He also emphasises his willingness to work with the Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 22 Commission to improve standards in his home. However, the Commission is concerned that it is necessary for him to ‘learn’ as he goes along by making mistakes that have to be corrected by regulation. Record keeping provides a clear example of poor management; the owners have a book to record visitors, as required by regulation, but when we visited on 29th October we saw a workman leaving the premises and we noted that there was no record of his visit in the visitors’ book. Mr Bunjun conceded that he should have been asked to sign in, for the protection of residents, so that there was a record of all visitors to the home. Whilst he has since given a commitment to this and other improvements the new owners should from the outset have had a better understanding of regulatory requirements and what records they would be required to maintain. The record of food is equally inadequate with no historic records in any detail to allow us to follow up complaints that ‘food is sometimes of poor quality’. Medication records were also poor as described by the Pharmacy Inspector. Staff and resident records also not well maintained. Health and safety is a management responsibility and we found numerous shortcomings during our several visits, including the two residents who fell; fire safety; radiator safety; door locks; and so forth. Mr Bunjun as owner/manager and Mrs Bunjun as owner/carer have yet to demonstrate that they can monitor and audit there own services so as to ensure the safety and well being residents. They have been advised to seek expert help to address this. Staffing is also very deficient as described in the previous section. We are asking the owners to provide the Commission with details of their accounts and business plan to monitor the viability of this service. The ethos of the home, its ‘atmosphere’ is already somewhat suspect since there are notices in the hall declaring when residents are be taken to their room each evening; resident say they are not free to go out for a walk, although this is disputed; there is some evidence residents were being locked in their bedrooms – or at the very least, staff were not told to check residents were not locked in inadvertently since Mr & Mrs Bunjun claim other residents may have locked the doors. It also gives a poor impression, and does not reflect a ‘resident-centred’ approach, when the owners refuse to assist residents to hold cash in the home. This facility should be available in at least two ways, either by providing the residents with a safe place to keep cash in their own rooms or by holding cash on their behalf. At present both options have been refused but Mr Bunjun agreed to review is position on this point. The owners have not reporting incidents as required but they are responding in a positive way when instructed to do so; the fall leading to a fracture and the minor bruise to the forehead serve as two examples that required prompting before a notification was issued by the owners. Fire safety still remains a problem despite the Commission serving a Immediate Requirements in October about doors being wedged open. On 30th November two doors were still not safe, one bedroom door was still being held open with an ornament and the other not closing automatically. In both instances this breaches the two-door protection needed to prevent the spread of smoke and fire. Keys are still in use at final exits doors. The owners are advised to read the Department of Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 23 Communities and Local Government for guidance on “Fire Safety in Residential Care Premises’. Failure to run the home competently, safely and in the best interests of the residents indicates a failure to comply with the regulations that apply to this section of the report and continuous non compliance may lead to enforcement action being taken. This section is assessed as poor. Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 24 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 1 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 2 18 1 1 X X X X X 1 3 STAFFING Standard No Score 27 1 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 1 1 1 1 Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 RegulRequirement ation 23(4)(4A) Fire safety: All fires door must be kept shut unless held open by a suitable magnetic door holder. This is so that residents are protected from the spread of smoke and fire. This is outstanding from 31/10/08 and enforcement action may be taken. 16(2)m,n Social Care: The registered persons must make arrangements to enable residents to engage in social and community activities and provide recreation for residents. This is so that residents have a choice about how to spend the day and not be restricted by the institutional practices of the home. This requirement is restated since the deadline for compliance has not passed. 6(a)(b) Timescale for action 30/03/09 2 OP12 30/03/09 3 OP1 4 OP1 6(a)(b) Statement of Purpose: This document 30/03/09 must be revised to bring it up to date. This is so that it will provide residents with the information listed in Schedule 1. Service User Guide: This document 30/03/09 must be revised to bring it up to date. This is so that it will provide residents with the information listed in Standard 1. DS0000071914.V372890.R01.S.doc Version 5.2 Page 26 Culverley 5 OP2 5A(2)(a), (b) 6 OP3 7 OP7 OP3 8 OP8 9 OP9 10 OP10 Information about Fees: Residents must be provided with information about fees, and any extra payments, payable no later than the day of admission. This is so that each resident will know what fees are payable and by whom. 14(1)(2) Admissions: Residents must not be admitted without an assessment by a person trained to do so. This is to ensure residents are only admitted within the home’s registration categories and any conditions so as to ensure their needs can be met. 15(1) and Care Plans: Each resident must have (2) a plan of care that covers as a minimum the items listed in Standard 3 and relates specifically and in detail to the individual for whom the plan is prepared. This is so that the residents’ needs are clearly identified and addressed by the home. 13(1)(b) Health Care: Arrangements must be made for residents to receive where necessary treatment, advice and other services from any health care professional. This is so that residents receive medical or nursing treatment, according to their health care needs, from suitably qualified professionals and not care home staff. 13(2) Medication: Suitable arrangements must be made for the safe administration of medication including record keeping and staff training. This is so that medicines are managed and administered by a person competent to do so in a safe manner. 12(4)(a) Privacy and Dignity: The privacy and dignity of residents must be respected by not using private space to store communal goods; and by entering private bedrooms only with permission of the resident. This is to respect the residents’ right to privacy and dignity in their bedrooms. 30/03/09 30/03/09 30/03/09 30/03/09 30/03/09 30/03/09 Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 27 11 OP12 OP13 16(2)m,n 11 OP12 OP13 16(2)m,n 12 OP14 15(1); 24(5); and 22 13 OP15 16(2)(i) 14 OP15 17 Schedule 4:13 15 OP16 22 16 OP17 12(4)a Daily Living: Arrangements must be made to enable residents to engage in local, social and community activities and to maintain contact with family and friends. Daily Living: Arrange must be made for a programme of activities and provide facilities for recreation. This is so that residents can have a meaningful lifestyle in the home. Autonomy and choice: Arrangements must be made to ensure that residents have autonomy and choice. This is so that residents will have some degree of autonomy and choice in respect of matters such as meals, activities, medication, money and social contacts. Meals: The home must provide meals that area in adequate quantities, wholesome and nutritious and which are varied and properly prepared. This is so residents have a suitable diet that meets their needs and preferences. Meals: A record of food provided must be maintained in sufficient detail for the Commission to determine whether or not residents have received a satisfactory diet. This is so the Commission can check residents receive a suitable diet. Complaints: A clear, simple, up to date complaints procedure, including 28 day timescale, must be provided. This is so that people will know how and to whom they may complain about this service. Data protection: The civil rights of all residents must be protected in particular their right to have information about the them held securely, privately and used only for the purpose for which it was supplied to the home. This is so that information about a resident is not shared inappropriately and contrary to the Data Protection Act. DS0000071914.V372890.R01.S.doc 30/03/09 30/03/09 30/03/09 30/03/09 30/03/09 30/03/09 30/03/09 Culverley Version 5.2 Page 28 17 OP17 12(3) Support and Restraint: Provision must 30/03/09 be made for complying with the Mental Capacity Act. This is so that the capacity of residents can be assessed by a competent person according to each decision to be made on their behalf. Protection from abuse: Arrangements 30/03/09 must be made for all staff including the owners, manager and care staff to receive training, including written evidence of the training, in the local authority’s procedures for the protection of adults. This is so that all staff including the owners know how to report any suspicion of abuse. Protection from abuse: The ‘abuse’ 30/03/09 policy of the home must be amended so as to reflect the local authority guidance in particular that abuse is reported to the correct authority and not investigated internally. Safety of Premises: The premises 30/03/09 must be kept free of hazards so far as is reasonably practicable to do so; in particular all hot surfaces such as radiators must be protected. This is to protect residents from scalding. Safety of Premises: All fire doors must 30/03/09 be maintained and operate within governmental guidance. This is so that residents are protected from the hazards of fire. Food: Standards must be maintained 30/03/09 in the kitchen that meet governmental Guidance such as Safer Food : Better Business; this includes adequate menus, record keeping and hygiene standards anywhere that food is stored or prepared. This is to ensure catering in the home meet modern standards for food hygiene and safety. DS0000071914.V372890.R01.S.doc Version 5.2 Page 29 18 OP18 13(6) 19 OP18 OP38 13(6) 20 OP19 OP38 13(4)a, b, and c 21 OP19 OP38 13(4)a, b, and c 22 OP19 OP38 13(4)a, b, and c. 16(2)g, j Culverley 22 OP19 OP38 13(4)a, b, and c. 16(2) g, j Food: The local environmental service 30/03/09 is to be consulted in respect of the storage of food in the lean-to at the side of the premises; in particular about whether or not food hygiene standards are compromised by locating the freezer near a washing machine and a boiler. This is to ensure residents are not put at risk by poor food hygiene in the home. Premises: All parts of the home must be maintained in good order and be reasonably decorated. In particular in the bathroom where projecting screws and broken tiles must be dealt with. This is so that residents are not put at risk by poor maintenance in the home. Heating and Lighting: Provision must be made to provide residents with suitable heating and lighting. This is so that residents can live in a well-lit, warm and comfortable environment. Staff Competence: Staff must not be left in charge of the premises nor undertake any duties, such as administering medication or other clinical duties, for which they have not be properly trained and assessed as competent to undertake. So as to ensure the safety and well being of residents. Staff induction and training: Until such times as staff are competent to work unsupervised and during the period of their induction a member of staff who is suitably qualified and experienced is to be appointed to supervise the new worker. This is so that residents are not cared for by staff lacking the skills to do so. Staffing levels: Staff levels must be reviewed and a sample four week duty roster submitted to the Commission that demonstrates how residents’ needs will be met and how ancillary duties will be allocated. This DS0000071914.V372890.R01.S.doc 23 OP19 OP38 13(4)a, b, and c 30/03/09 24 OP25 OP38 23(2)p 30/03/09 25 OP27 18(1)a, 18(1)ci 30/03/09 26 OP30 18 30/03/09 27 OP27 18(1)a 30/03/09 Culverley Version 5.2 Page 30 28 OP31 29 OP35 30 OP36 31 OP37 32 OP33 is so that the owners can demonstrate they have enough competent staff to undertake their duties. 9(2)b and Manager: The manager must 8(1)biii demonstrate that he has the qualifications, and the skills and experience for managing Culverley care home otherwise he shall appoint a suitable manager to be in day to day charge of the home. 16(2)L Residents’ Money: Provision must be and 17, made for residents to either manage Sch.4:9 their own money by providing suitable facilities in their bedrooms or by making suitable provision for managing money on their behalf. 18(2)a Staff Supervision: Staff must receive supervision in accordance with the relevant standard, 6 times a year. This is so that residents can be assured that staff are receiving proper supervision and appraisal of their work. 17 Record keeping: Records must be maintained, in particular the statutory records listed in Schedules 1 to 4. They must be up to date, accurate and in sufficient detail to be evaluated by inspectors. This is so that the home can demonstrate that it is being properly managed. 25 Accounts: The Commission is to be provided with the owner’s annual accounts and business plan so as to demonstrate the viability of this care home. 30/03/09 30/03/09 30/03/09 30/03/09 30/03/09 Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Culverley DS0000071914.V372890.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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